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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.
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The nurse is assessing a patient who had a kidney transplant 8 years ago and is receiving the immunosuppressants tacrolimus, cyclosporin, and prednisone. Which of the following findings is of most concern to the nurse?
- A. The blood glucose is 7.9 mmol/L.
- B. The patient's blood pressure is 150/92.
- C. There is a nontender lump in the axilla
- D. The patient has a round, moonlike face.
Correct Answer: C
Rationale: A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of persistent immunosuppressive therapy. The elevated glucose, moon face, and hypertension are possible adverse effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.
The nurse is caring for a patient who has been admitted with a severe crush injury after an industrial accident. Which of the following laboratory results is most important to report to the health care provider?
- A. Serum creatinine level 190 mcmol/L.
- B. Serum potassium level 6.5 mcmol/L.
- C. White blood cell count 11.5 x 10^9/L.
- D. Blood urea nitrogen (BUN) 18 mmol/L.
Correct Answer: B
Rationale: The hyperkalemia associated with crush injuries may cause life-threatening cardiac arrhythmias leading to cardiac arrest and should be treated immediately. The nurse will also report the other laboratory values, but abnormalities in these are not immediately life-threatening.
Which of the following actions by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?
- A. The patient slows the inflow rate when experiencing pain.
- B. The patient leaves the catheter exit site without a dressing.
- C. The patient plans 30-60 minutes for a dialysate exchange.
- D. The patient cleans the catheter while taking a bath every day.
Correct Answer: D
Rationale: Patients are taught to avoid insertion site infection and should be encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.
The nurse is caring for a patient who had kidney transplantation several years ago. Which of the following findings may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?
- A. Joint pain
- B. Tachycardia
- C. Postural hypotension
- D. Increase in creatinine level
Correct Answer: A
Rationale: Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.
The nurse is caring for a patient with acute kidney injury (AKI) who has an arterial blood pH of 7.30 Which of the following assessment findings should the nurse anticipate?
- A. Vasodilation
- B. Poor skin turgor
- C. Bounding pulses
- D. Rapid respirations
Correct Answer: D
Rationale: Patients with metabolic acidosis caused by AKI may have Kussmaul's respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.