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The nurse is caring for a patient with stage 2 chronic kidney disease (CKD) who is scheduled for an intravenous pyelogram (IVP). Which of the following prescriptions for the patient should the nurse question?
- A. NPO for 6 hours before IVP procedure
- B. Normal saline 500 mL IV before procedure
- C. Ibuprofen 400 mg PO PRN for pain
- D. Dulcolax suppository 4 hours before IVP procedure
Correct Answer: C
Rationale: The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided. The suppository and NPO status are necessary to ensure adequate visualization during the IVP. IV fluids are used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal failure.
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Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider?
- A. The urine output is 900-1100 mL/hour.
- B. The blood urea nitrogen (BUN) and creatinine levels are elevated.
- C. The patient's central venous pressure (CVP) is decreased.
- D. The patient has level 8 (on a 10-point scale) incisional pain.
Correct Answer: C
Rationale: The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.
The nurse is caring for a patient with a left arm arteriovenous fistula. Which of the following actions should the nurse include in the plan of care to maintain the patency of the fistula?
- A. Check the fistula site for a bruit and thrill.
- B. Assess the rate and quality of the left radial pulse.
- C. Compare blood pressures in the left and right arms.
- D. Irrigate the fistula site with saline every 8-12 hours.
Correct Answer: A
Rationale: The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.
Which of the following information is most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?
- A. Blood urea nitrogen (BUN) level
- B. Urine output
- C. Creatinine level
- D. Calculated glomerular filtration rate (GFR)
Correct Answer: D
Rationale: GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.
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 RN observes a nursing student carrying out all of these actions while caring for a patient with stage 2 chronic kidney disease. Which of the following actions require the RN to intervene?
- A. The student administers erythropoietin subcutaneously.
- B. The student assists the patient to ambulate in the hallway.
- C. The student gives the iron supplement and phosphate binder with lunch.
- D. The student carries a tray containing low-protein foods into the patient's room.
Correct Answer: C
Rationale: Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the RN student are appropriate for a patient with renal insufficiency.