Nokea
The nurse is preparing to administer calcium carbonate to a patient with chronic kidney disease (CKD) Which of the following laboratory results should the nurse check prior to administration?
- A. Creatinine
- B. Potassium
- C. Total cholesterol
- D. Serum phosphate
Correct Answer: D
Rationale: If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.
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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 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.
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.
The nurse is caring for a patient with acute kidney injury (AKI) who requires hemodialysis and a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which of the following interventions should be included in the plan of care?
- A. Place the patient on bed rest.
- B. Start continuous pulse oximetry.
- C. Discontinue the urinary catheter.
- D. Restrict the patient's oral protein intake.
Correct Answer: A
Rationale: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The urinary catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.
The nurse is caring for a patient with acute kidney injury who is dehydrated with symptoms of oliguria, anemia, and hyperkalemia. Which of the following prescribed actions should the nurse take first?
- A. Insert a urinary retention catheter.
- B. Place the patient on a cardiac monitor.
- C. Administer an erythropoiesis-stimulating agent (ESA).
- D. Give sodium polystyrene sulfonate.
Correct Answer: B
Rationale: Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. ESA's will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.