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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.
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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.
The nurse is caring for a patient with end-stage renal disease (ESRD). Which of the following findings indicate that the nurse should consult with the health care provider before giving the prescribed erythropoiesis-stimulating agent (ESA)?
- A. Creatinine 99 mcmol/L.
- B. Oxygen saturation 89%
- C. Hemoglobin level 130 g/L.
- D. Blood pressure 98/56 mm Hg
Correct Answer: C
Rationale: High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when ESA is administered to a target hemoglobin of 110 g/L with a range of 100-120 g/L. Hemoglobin levels higher than 120 g/L indicate a need for a decrease in erythropoiesis-stimulating agent dose. The other information will also be reported to the health care provider but will not affect whether the medication is administered.
The nurse is teaching a patient with stage 5 chronic kidney disease (CKD) about management of CKD. Which of the following patient statements indicate that the teaching was effective?
- A. I need to try to get more protein from dairy products.
- B. I will try to increase my intake of fruits and vegetables.
- C. I will measure my urinary output each day to help calculate the amount I can drink.
- D. I need to take the erythropoietin to boost my immune system and help prevent infection.
Correct Answer: C
Rationale: The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.
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 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.