Nokea
The nurse is teaching a patient who is receiving hemodialysis about appropriate dietary choices. Which of the following menu choices by the patient indicates that the teaching has been effective?
- A. Scrambled eggs, English muffin, and apple juice
- B. Oatmeal with cream, half a banana, and herbal tea
- C. Split-pea soup, whole-wheat toast, and nonfat milk
- D. Cheese sandwich, tomato soup, and cranberry juice
Correct Answer: A
Rationale: Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.
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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 diabetes who has been admitted with pneumonia and is prescribed gentamicin 60 mg IV. Which of the following parameters should the nurse monitor to evaluate the patient for adverse effects of the medication?
- A. Urine osmolality
- B. Serum potassium and sodium
- C. Blood glucose level
- D. Blood urea nitrogen (BUN) and creatinine
Correct Answer: D
Rationale: When a patient at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin.
The RN observes a nursing student carrying out all of these actions while caring for a patient with stage 2 chronic kidney disease. Which of the following actions require the RN to intervene?
- A. The student administers erythropoietin subcutaneously.
- B. The student assists the patient to ambulate in the hallway.
- C. The student gives the iron supplement and phosphate binder with lunch.
- D. The student carries a tray containing low-protein foods into the patient's room.
Correct Answer: C
Rationale: Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the RN student are appropriate for a patient with renal insufficiency.
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.
Which of the following parameters is most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation?
- A. Heart rate
- B. Blood urea nitrogen (BUN) level
- C. Urine output
- D. Creatinine clearance
Correct Answer: C
Rationale: Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a litre an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.