Nokea
The nurse is caring for a client with end-stage renal disease who receives prescribed sevelamer. Which of the following findings would indicate a therapeutic response?
- A. Decreased serum calcium levels
- B. Increased hemoglobin and hematocrit
- C. Decreased serum potassium levels
- D. Decreased serum phosphorus levels
Correct Answer: D
Rationale: Sevelamer is a phosphate binder used to lower serum phosphorus levels in end-stage renal disease, making decreased phosphorus levels the therapeutic response. It does not directly affect calcium (A), hemoglobin/hematocrit (B), or potassium (C).
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A client was admitted to the emergency department due to low serum calcium levels. Upon further examination, the client demonstrates carpopedal spasms and reports numbness in their lips and hands. An ECG revealed a prolonged QT interval. Based on this information, the nurse should suspect which condition?
- A. Hyperthyroidism
- B. Hypothyroidism
- C. Hyperparathyroidism
- D. Hypoparathyroidism
Correct Answer: D
Rationale: Hypoparathyroidism leads to low serum calcium levels, causing symptoms like carpopedal spasms, numbness, and prolonged QT interval due to decreased parathyroid hormone.
The nurse is teaching a group of students a potential cause of metabolic alkalosis. It would indicate a correct understanding if a student stated which condition could cause this acid-base imbalance?
- A. Hyperventilation
- B. Urinary retention
- C. Opioid toxicity
- D. Excessive vomiting
Correct Answer: D
Rationale: Excessive vomiting causes loss of hydrogen ions, leading to metabolic alkalosis.
The nurse is assessing a client receiving peritoneal dialysis. Which laboratory result should immediately be reported to the primary healthcare provider (PHCP)?
- A. WBC 19,000 mm3 [5,000-10,000 mm3]
- B. Hemoglobin 9 g/dL [Male: 14-18 g/dL (140-180 g/L) Female: 12-16 g/dL (120-160 g/L)]
- C. Calcium 8.6 mg/dL [9.0-10.5 mg/dL]
- D. Serum pH 7.33 [7.35-7.45]
Correct Answer: A
Rationale: Elevated WBC (19,000 mm3) suggests infection, a serious complication in peritoneal dialysis.
The nurse is caring for a 68-year-old individual in the emergency department who had been on the bathroom floor for about 10 hours after a fall. While performing straight catheterization, the nurse notes that the urine output reaches 800 mL and continues to flow heavily. What action should the nurse take, and what is the rationale for this action?
- A. Drain the client's bladder entirely and place a small amount in a urine specimen cup. This client needs a urine sample to check for rhabdomyolysis.
- B. Continue draining the bladder fully, then place a Foley catheter to monitor for sufficient urine output.
- C. Stop draining the client's bladder because the client is at risk for developing bladder spasms.
- D. Stop draining the client's bladder to prevent the risk of urinary tract infection (UTI) and notify the primary healthcare provider (PHCP) for further instructions.
Correct Answer: A
Rationale: Prolonged immobility increases rhabdomyolysis risk, requiring a urine sample to check for myoglobin.
The nurse preceptor is orienting a newly hired nurse caring for a client with advanced polycystic kidney disease (PKD). Which of the following actions by the newly hired nurse would require follow-up by the nurse preceptor?
- A. Requesting a prescription for ketorolac to help relieve the client's pain.
- B. Instructing the client on how to use guided imagery as a comfort strategy.
- C. Applying dry heat to the client's abdomen or flank for pain relief.
- D. Provides the client with foods high in fiber and low in salt.
Correct Answer: A
Rationale: Ketorolac, an NSAID, can worsen renal function in PKD and requires follow-up.