Nokea
Which of the following assessments should the nurse complete before administering sodium polystyrene sulphonate to a patient with hyperkalemia?
- A. Blood urea nitrogen (BUN) and creatinine
- B. Blood glucose level
- C. Patient's bowel sounds
- D. Level of consciousness (LOC)
Correct Answer: C
Rationale: Sodium polystyrene sulphonate should not be given to a patient who does not have normal bowel function because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication.
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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.
The nurse is caring for a patient in the oliguric phase of acute renal failure who has a 24-hour fluid output of 150 mL emesis and 250 mL urine. Which of the following amounts in mL should the nurse plan a fluid replacement for the following day?
- A. 400
- B. 800
- C. 1000
- D. 1400
Correct Answer: C
Rationale: Usually fluid replacement should be based on the patient's measured output plus 600 mL/day for insensible losses.
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 taking a history for a patient who is a possible candidate for a kidney transplant. Which of the following information indicates that the patient is not an appropriate candidate for transplantation?
- A. The patient has metastatic lung cancer.
- B. The patient has poorly controlled type diabetes.
- C. The patient has a history of persistent hepatitis C infection.
- D. The patient is infected with the human immunodeficiency virus.
Correct Answer: A
Rationale: Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.
The nurse is caring for a patient with acute glomerulonephritis, acute kidney injury (AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the following parameters should the nurse assess to evaluate the effectiveness of the medication?
- A. Urine output
- B. Calcium level
- C. Cardiac rhythm
- D. Neurological status
Correct Answer: C
Rationale: The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.