Nokea
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.
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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 who has had progressive chronic kidney disease (CKD) for several years and is starting hemodialysis. Which of the following information about diet should the nurse include in patient teaching?
- A. Increased calories are needed because glucose is lost during hemodialysis.
- B. Unlimited fluids are allowed since retained fluid is removed during dialysis.
- C. More protein will be allowed because of the removal of urea and creatinine by dialysis.
- D. Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.
Correct Answer: C
Rationale: Once the patient is started on dialysis and nitrogenous wastes are removed, there is less protein lost, therefore more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
The nurse is caring for a patient receiving hemodialysis who has symptoms of nausea and dizziness. Which of the following actions should the nurse take first?
- A. Slow down the rate of dialysis.
- B. Obtain blood to check the blood urea nitrogen (BUN) level.
- C. Check the patient's blood pressure.
- D. Give prescribed PRN antiemetic drugs.
Correct Answer: C
Rationale: The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions may also be appropriate, based on the blood pressure obtained.
The nurse is interviewing a patient with chronic kidney disease (CKD) who brings all home medications to the clinic to be reviewed by the nurse. Which of the following medications being used by the patient indicates that patient teaching is required?
- A. Multivitamin with iron
- B. Milk of magnesia 30 mL
- C. Calcium acetate
- D. Acetaminophen 650 mg
Correct Answer: B
Rationale: Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.
The nurse is teaching a patient who is receiving hemodialysis about appropriate dietary choices. Which of the following menu choices by the patient indicates that the teaching has been effective?
- A. Scrambled eggs, English muffin, and apple juice
- B. Oatmeal with cream, half a banana, and herbal tea
- C. Split-pea soup, whole-wheat toast, and nonfat milk
- D. Cheese sandwich, tomato soup, and cranberry juice
Correct Answer: A
Rationale: Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.