Nokea
Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider?
- A. The urine output is 900-1100 mL/hour.
- B. The blood urea nitrogen (BUN) and creatinine levels are elevated.
- C. The patient's central venous pressure (CVP) is decreased.
- D. The patient has level 8 (on a 10-point scale) incisional pain.
Correct Answer: C
Rationale: The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.
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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 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.
After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which of the following actions should the nurse take first?
- A. Document the QRS interval.
- B. Notify the patient's health care provider.
- C. Look at the patient's current blood urea nitrogen (BUN) and creatinine levels.
- D. Check the patient's most recent blood potassium level.
Correct Answer: D
Rationale: The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.
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.
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.