Nokea
The nurse is placing a client with chronic kidney disease on a cardiac monitor. What is the reason for this action?
- A. Clients with chronic kidney disease are prone to hypertension
- B. Hyperkalemia may result in dysrhythmias
- C. Cardiac monitoring is necessary to evaluate the need for hemodialysis
- D. Clients with chronic kidney disease may experience false episodes of asystole
Correct Answer: B
Rationale: Hyperkalemia, common in CKD, can cause dysrhythmias, necessitating cardiac monitoring.
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The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 6 of 6
History and Physical
A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.
Laboratory Results
• Hemoglobin 14 g/dL [14-18 g/dL (140–180 g/L)]
• Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
• White Blood Cell 11,000 mm3 [5-10 mm3]
• Platelet Count 140,000 mm3 [150-400 mm3 (150–400 × 109/L)]
• Glucose 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)]
• Sodium 116 mEq/L [136–145 mEq/L (mmol/L)]
• Potassium 3.3 mEq/L [3.5–5.0 mEq/L (mmol/L)]
• Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285–295 mmol/kg)]
Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8° F (36.6° C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
0850: Verbal order was received from physician to insert indwelling urethral catheter.
0910: Urinary catheter inserted with sterile technique. 40 mL of dark yellow urine returned.
Orders
• admit to intensive care unit
• nephrology consultation
• oncology consultation
• fluid restriction - 1 liter daily
• daily weight
• strict intake and output
• 250 mL of 3% saline at 75 mL/hr
• tolvaptan 15 mg PO daily - first dose now
• neurological assessments every two hours
The nurse transfers the client to the intensive care unit for further management. Eight hours later, the nurse in the ICU reassesses the client and determines which findings indicate that the treatment is effective. Select all that apply.
- A. pulse 105
- B. serum sodium 132 mEq/L
- C. Glasgow Coma Scale (GCS) score of 15
- D. orientation to person, situation, place, and time
- E. decreased lower extremity weakness
Correct Answer: B,C,D,E
Rationale: Improved sodium (132 mEq/L), GCS of 15, orientation, and reduced weakness indicate effective SIADH treatment.
A newly hired nurse is caring for a client who is receiving prescribed total parenteral nutrition (TPN) therapy. The nurse preceptor should intervene if the newly hired nurse?
- A. wears a surgical mask while changing the client's central vascular access dressing.
- B. obtains the client's capillary blood glucose every four to six hours.
- C. spikes and primes a new bag of TPN without an inline filter.
- D. continues the infusion via an infusion pump while the client is receiving a computed tomography scan.
Correct Answer: C
Rationale: TPN requires an inline filter to prevent infusion of particulate matter or air emboli. Not using a filter (C) is unsafe and requires intervention. Wearing a mask (A), checking glucose (B), and continuing infusion during a CT scan (D) are appropriate or not inherently unsafe.
The nurse is caring for a client on a medical floor. The nurse would recognize that which diagnosis increases the client's risk of developing hyperkalemia?
- A. Cushing's syndrome
- B. Acute renal failure
- C. Cystic fibrosis
- D. Bulimia nervosa
Correct Answer: B
Rationale: Acute renal failure impairs potassium excretion, leading to hyperkalemia.
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.
The nurse is assessing a client who was just diagnosed with acute pyelonephritis. Which of the following findings should the nurse expect to observe? Select all that apply.
- A. Costovertebral angle tenderness
- B. Jugular venous distention
- C. Fever and chills
- D. Urinary retention
- E. Dysuria
Correct Answer: A,C,E
Rationale: Pyelonephritis causes costovertebral angle tenderness, fever, chills, and dysuria due to kidney inflammation and infection.