Nokea
The nurse is caring for a patient in the oliguric phase of acute renal failure who has a 24-hour fluid output of 150 mL emesis and 250 mL urine. Which of the following amounts in mL should the nurse plan a fluid replacement for the following day?
- A. 400
- B. 800
- C. 1000
- D. 1400
Correct Answer: C
Rationale: Usually fluid replacement should be based on the patient's measured output plus 600 mL/day for insensible losses.
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The nurse is caring for a patient with acute glomerulonephritis, acute kidney injury (AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the following parameters should the nurse assess to evaluate the effectiveness of the medication?
- A. Urine output
- B. Calcium level
- C. Cardiac rhythm
- D. Neurological status
Correct Answer: C
Rationale: The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.
The nurse is caring for a patient with acute kidney injury (AKI) who has an arterial blood pH of 7.30 Which of the following assessment findings should the nurse anticipate?
- A. Vasodilation
- B. Poor skin turgor
- C. Bounding pulses
- D. Rapid respirations
Correct Answer: D
Rationale: Patients with metabolic acidosis caused by AKI may have Kussmaul's respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.
The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which of the following information should be reported immediately to the health care provider?
- A. The patient has an outflow volume of 1800 mL.
- B. The patient's peritoneal effluent appears cloudy.
- C. The patient has abdominal pain during the inflow phase.
- D. The patient complains of feeling bloated after the inflow.
Correct Answer: B
Rationale: Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.
The nurse is caring for a patient who had kidney transplantation several years ago. Which of the following findings may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?
- A. Joint pain
- B. Tachycardia
- C. Postural hypotension
- D. Increase in creatinine level
Correct Answer: A
Rationale: Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.
The nurse is taking a history for a patient who is a possible candidate for a kidney transplant. Which of the following information indicates that the patient is not an appropriate candidate for transplantation?
- A. The patient has metastatic lung cancer.
- B. The patient has poorly controlled type diabetes.
- C. The patient has a history of persistent hepatitis C infection.
- D. The patient is infected with the human immunodeficiency virus.
Correct Answer: A
Rationale: Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.