Nokea
The nurse is reviewing the concept of acute kidney injury (AKI) with a student nurse. Which of the following would be correct as a cause of prerenal AKI?
- A. nephrotoxicity
- B. bladder cancer
- C. contrast media
- D. hypovolemia
Correct Answer: D
Rationale: Hypovolemia causes prerenal AKI by reducing renal perfusion.
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The nurse is reviewing the assignment for the shift and will be caring for the following clients. Which client is at risk for hypokalemia? A client with
- A. hyperemesis gravidarum.
- B. end-stage renal failure.
- C. diabetic ketoacidosis.
- D. third-degree burns.
Correct Answer: A
Rationale: Hyperemesis gravidarum causes potassium loss through vomiting, increasing hypokalemia risk.
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.
The nurse is caring for a client with hyperkalemia. Which of the following treatments would the nurse recognize as appropriate options for treating this electrolyte imbalance? Select all that apply.
- A. Spironolactone
- B. Sodium polystyrene
- C. Regular insulin
- D. Hemodialysis
- E. Magnesium sulfate
Correct Answer: B,C,D
Rationale: Sodium polystyrene (B) binds potassium in the gut, regular insulin (C) shifts potassium into cells, and hemodialysis (D) removes potassium from the blood, all effective for hyperkalemia. Spironolactone (A) is a potassium-sparing diuretic and would worsen hyperkalemia. Magnesium sulfate (E) is not used for hyperkalemia.
The nurse reviews a client's laboratory data. Which laboratory data requires follow-up?
- A. Sodium
- B. Potassium
- C. Calcium
- D. BUN
- E. Creatinine
Correct Answer: B,C,D,E
Rationale: Abnormal potassium, calcium, BUN, and creatinine require follow-up due to potential renal or electrolyte imbalances.
The following scenario applies to the next 6 items.
The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 3 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.
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.
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)]
The client is demonstrating manifestations consistent with......... due to.......
- A. Cushing's syndrome
- B. diabetes insipidus
- C. syndrome of inappropriate antidiuretic hormone
- D. advanced chronic obstructive pulmonary disease.
- E. small cell lung cancer.
- F. corticosteroid usage.
Correct Answer: C,E
Rationale: SIADH, often caused by small cell lung cancer, leads to hyponatremia and neurological symptoms like disorientation.