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The nurse is reviewing the laboratory results of a client with renal failure. Which laboratory data requires immediate follow-up?
- A. Blood urea nitrogen 50 mg/dL [10-20 mg/dL]
- B. Serum potassium 6 mEq/L (mmol/L) [3.5-5.0 mEq/L]
- C. Arterial blood pH 7.30 [7.35-7.45]
- D. Hemoglobin 10.3 g/dL (1.03 g/L) [F: 12-16 g/dL (7.4 -9.9 mmol/L) M: 14-18 g/dL (8,7-11.2 mmol/L)]
Correct Answer: B
Rationale: Hyperkalemia (6 mEq/L) requires immediate follow-up due to the risk of cardiac dysrhythmias.
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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.
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.
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.
The nurse is caring for a client who has bacterial cystitis. The physician prescribes the client gentamicin. To prevent a complication associated with this medication, the nurse should monitor the client's?
- A. intake and output ratio.
- B. creatinine.
- C. visual acuity.
- D. fasting blood glucose.
Correct Answer: B
Rationale: Gentamicin, an aminoglycoside, is nephrotoxic, so monitoring creatinine is essential to detect renal impairment. Intake and output (A) are less specific, and visual acuity (C) and blood glucose (D) are not directly affected by gentamicin.