Nokea
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.
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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 interviewing a patient with chronic kidney disease (CKD) who brings all home medications to the clinic to be reviewed by the nurse. Which of the following medications being used by the patient indicates that patient teaching is required?
- A. Multivitamin with iron
- B. Milk of magnesia 30 mL
- C. Calcium acetate
- D. Acetaminophen 650 mg
Correct Answer: B
Rationale: Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.
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 a left arm arteriovenous fistula. Which of the following actions should the nurse include in the plan of care to maintain the patency of the fistula?
- A. Check the fistula site for a bruit and thrill.
- B. Assess the rate and quality of the left radial pulse.
- C. Compare blood pressures in the left and right arms.
- D. Irrigate the fistula site with saline every 8-12 hours.
Correct Answer: A
Rationale: The presence of a thrill and bruit indicates adequate blood flow through the fistula. Pulse rate and quality are not good indicators of fistula patency. Blood pressures should never be obtained on the arm with a fistula. Irrigation of the fistula might damage the fistula, and typically only dialysis staff would access the fistula.
Which of the following information is most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?
- A. Blood urea nitrogen (BUN) level
- B. Urine output
- C. Creatinine level
- D. Calculated glomerular filtration rate (GFR)
Correct Answer: D
Rationale: GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.