Nokea
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.
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The nurse is preparing to administer calcium carbonate to a patient with chronic kidney disease (CKD) Which of the following laboratory results should the nurse check prior to administration?
- A. Creatinine
- B. Potassium
- C. Total cholesterol
- D. Serum phosphate
Correct Answer: D
Rationale: If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.
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 who has leg cramps during hemodialysis. Which of the following actions should the nurse implement first?
- A. Reposition the patient.
- B. Massage the patient's legs.
- C. Give acetaminophen.
- D. Infuse a bolus of normal saline.
Correct Answer: D
Rationale: Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.
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.
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.