Nokea
The nurse is caring for a patient with end-stage renal disease (ESRD). Which of the following findings indicate that the nurse should consult with the health care provider before giving the prescribed erythropoiesis-stimulating agent (ESA)?
- A. Creatinine 99 mcmol/L.
- B. Oxygen saturation 89%
- C. Hemoglobin level 130 g/L.
- D. Blood pressure 98/56 mm Hg
Correct Answer: C
Rationale: High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when ESA is administered to a target hemoglobin of 110 g/L with a range of 100-120 g/L. Hemoglobin levels higher than 120 g/L indicate a need for a decrease in erythropoiesis-stimulating agent dose. The other information will also be reported to the health care provider but will not affect whether the medication is administered.
You may also like to solve these questions
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.
Which of the following parameters is most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation?
- A. Heart rate
- B. Blood urea nitrogen (BUN) level
- C. Urine output
- D. Creatinine clearance
Correct Answer: C
Rationale: Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a litre an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.
Which of the following assessments should the nurse complete before administering sodium polystyrene sulphonate to a patient with hyperkalemia?
- A. Blood urea nitrogen (BUN) and creatinine
- B. Blood glucose level
- C. Patient's bowel sounds
- D. Level of consciousness (LOC)
Correct Answer: C
Rationale: Sodium polystyrene sulphonate should not be given to a patient who does not have normal bowel function because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication.
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.