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The nurse is caring for an assigned client. Which prescription requires clarification based on the laboratory data? See the exhibit. Select all that apply. Prescribed Medications: vancomycin 1-gram IVPB daily, furosemide 40 mg PO daily, 500 mL of 0.9% sodium chloride bolus x 1 dose, diltiazem XR 120 mg PO daily, Ketorolac 15 mg IV push every eight hours PRN pain. Laboratory Results: Sodium 145 mEq/L (145 mmol/L), Potassium 3.7 mEq/L (3.7 mmol/L), Calcium 9.3 mg/dL (2.32 mmol/L), BUN 25 mg/dL (8.93 mmol/L), Creatinine 2.1 mg/dL (185.64 umol/L)
- A. vancomycin 1-gram IVPB Daily
- B. furosemide 40 mg PO Daily
- C. 500 ml of 0.9% Saline IV Bolus x 1
- D. diltiazem XR 120 mg PO Daily
- E. ketorolac 15 mg IV Q 8 hours
Correct Answer: A,E
Rationale: Vancomycin (A) and Ketorolac (E) require clarification due to the elevated creatinine (2.1 mg/dL), indicating impaired renal function, which can increase the risk of toxicity for both drugs. Furosemide (B), saline bolus (C), and diltiazem (D) are not contraindicated with the given lab results.
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The client is diagnosed with acute kidney failure. Which of the following is an appropriate psychosocial problem for the nurse to include in the care plan?
- A. Imbalanced nutrition: less than body requirements related to altered metabolic state and dietary restrictions.
- B. Anxiety related to the disease process and uncertainty of prognosis.
- C. Excess fluid volume related to compromised regulatory mechanisms secondary to acute renal failure.
- D. Risk for infection related to invasive procedures and an altered immune response secondary to renal failure.
Correct Answer: B
Rationale: Anxiety is a psychosocial issue related to the uncertainty and stress of acute kidney failure, unlike the other physiological options.
The nurse is caring for a client with a kidney injury with a serum potassium level of 6.1 mEq/L (mmol/L) [3.5-5 mEq/L, mmol/L]. Which of the following actions is a priority?
- A. Obtain a prescription for a diuretic to increase urine output
- B. Check the client's sodium level
- C. Place the client on a cardiac monitor
- D. Encourage oral fluid intake
Correct Answer: C
Rationale: Hyperkalemia (6.1 mEq/L) poses a risk for cardiac dysrhythmias, making cardiac monitoring a priority.
A client experiencing an acute exacerbation of ulcerative colitis underwent diagnostic testing and was found to have elevated serum osmolality and urine specific gravity. Which of the following is related to these findings?
- A. Renal insufficiency
- B. Diabetes insipidus
- C. Hypoaldosteronism
- D. Deficient fluid volume
Correct Answer: D
Rationale: Elevated serum osmolality and urine specific gravity indicate deficient fluid volume due to dehydration from colitis.
Which nursing assessment finding are consistent with hypocalcemia? Select all that apply.
- A. Chvostek's sign
- B. Grey-Turner's sign
- C. Homan's sign
- D. Trousseau's sign
- E. Numbness and tingling of the fingers and toes
Correct Answer: A,D,E
Rationale: Hypocalcemia causes Chvostek's sign, Trousseau's sign, and numbness/tingling due to neuromuscular irritability.
As a nurse, you are administering intravenous fluids to a client. Which of the following types of IV fluids would be classified as isotonic? Select all that apply.
- A. Normal saline
- B. 1/2 Normal saline
- C. Lactated ringers
- D. D10W
- E. 3% NaCl
Correct Answer: A,C
Rationale: Normal saline and lactated ringers are isotonic, matching plasma osmolality, unlike hypotonic (1/2 NS) or hypertonic (D10W, 3% NaCl) fluids.