Nokea
The nurse is caring for a patient with severe heart failure who develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet which of the following goals of treatment?
- A. Replace fluid volume
- B. Prevent hypertension.
- C. Maintain cardiac output.
- D. Dilute nephrotoxic substances.
Correct Answer: C
Rationale: The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.
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The nurse is caring for a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration. Which of the following findings is most important for the nurse to report to the health care provider?
- A. The blood urea nitrogen (BUN) level is 23.1 mmol/L.
- B. The creatinine level is 186 mcmol/L.
- C. Urine output over an 8-hour period is 2500 mL.
- D. The glomerular filtration rate is -3 mL/minute/1.73 m^2.
Correct Answer: C
Rationale: The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy.
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 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 caring for a patient who has been admitted with a severe crush injury after an industrial accident. Which of the following laboratory results is most important to report to the health care provider?
- A. Serum creatinine level 190 mcmol/L.
- B. Serum potassium level 6.5 mcmol/L.
- C. White blood cell count 11.5 x 10^9/L.
- D. Blood urea nitrogen (BUN) 18 mmol/L.
Correct Answer: B
Rationale: The hyperkalemia associated with crush injuries may cause life-threatening cardiac arrhythmias leading to cardiac arrest and should be treated immediately. The nurse will also report the other laboratory values, but abnormalities in these are not immediately life-threatening.
The nurse is teaching a patient with stage 5 chronic kidney disease (CKD) about management of CKD. Which of the following patient statements indicate that the teaching was effective?
- A. I need to try to get more protein from dairy products.
- B. I will try to increase my intake of fruits and vegetables.
- C. I will measure my urinary output each day to help calculate the amount I can drink.
- D. I need to take the erythropoietin to boost my immune system and help prevent infection.
Correct Answer: C
Rationale: The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.