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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.
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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.
The nurse is caring for a patient who is receiving hemodialysis and has symptoms of nausea, vomiting, and sudden onset of confusion. Which of the following actions is priority?
- A. Infuse a hypotonic solution.
- B. Increase the rate of the dialysis.
- C. Administer an antiemetic medication.
- D. Stop the dialysis solution.
Correct Answer: D
Rationale: The patient's symptoms suggest disequilibrium syndrome, which is a rare complication of modern HD and develops as a result of very rapid changes in the composition of the extracellular fluid. Urea, sodium, and other solutes are removed more rapidly from the blood than from the cerebrospinal fluid and the brain. This creates a high osmotic gradient in the brain resulting in the shift of fluid into the brain, causing cerebral edema. Manifestations include nausea, vomiting, confusion, restlessness, headaches, twitching and jerking, and seizures. Treatment consists of slowing or stopping dialysis and infusing hypertonic saline solution, albumin, or mannitol to draw fluid from the brain cells back into the systemic circulation.
After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which of the following actions should the nurse take first?
- A. Document the QRS interval.
- B. Notify the patient's health care provider.
- C. Look at the patient's current blood urea nitrogen (BUN) and creatinine levels.
- D. Check the patient's most recent blood potassium level.
Correct Answer: D
Rationale: The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.
The nurse is caring for a patient with chronic kidney disease (CKD) who is prescribed calcium carbonate. Which of the following parameters should the nurse assess in order to determine the effectiveness of the treatment?
- A. Blood pressure
- B. Phosphate level
- C. Neurological status
- D. Creatinine clearance
Correct Answer: B
Rationale: Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.
The nurse is preparing to administer calcium carbonate to a patient with chronic kidney disease (CKD) Which of the following laboratory results should the nurse check prior to administration?
- A. Creatinine
- B. Potassium
- C. Total cholesterol
- D. Serum phosphate
Correct Answer: D
Rationale: If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.