A client is in the oliguric phase of acute kidney injury (AKI) which was caused by massive tissue trauma. The nurse notes peaked T-waves and a widened QRS complex on the cardiac monitor. What is the first action the nurse should take?

Check the client's most recent potassium level

Administer a bolus of 1,000 mL of normal saline

Administer potassium chloride intravenously (IV)

Administer sodium polystyrene sulfonate (Kayexalate)

Answer and Explanation

The Correct Answer is A

A.   Peaked T-waves and a widened QRS complex on an ECG are often signs of hyperkalemia, which is an elevated potassium level in the blood. This can be a serious complication of acute kidney injury (AKI), especially in the oliguric phase when the kidneys are unable to effectively excrete potassium.A
B.   While fluid management is important in AKI, administering a bolus of normal saline is not the first priority in the presence of suspected hyperkalemia. The primary concern is to address the electrolyte imbalance.

C.   Administering potassium chloride would worsen hyperkalemia and should be avoided.
D.   Kayexalate is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the gastrointestinal tract. However, checking the potassium level is the first step in confirming the diagnosis and determining the appropriate treatment.

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Correct Answer is A

Explanation

A. Increased energy levels are a common and positive sign of therapeutic response to levothyroxine. Hypothyroidism often leads to fatigue and low energy. When levothyroxine is effective, it helps normalize thyroid hormone levels, which can lead to improved energy levels and a reduction in symptoms like fatigue and lethargy.
B. An increase in weight is not a desired outcome of levothyroxine therapy. In hypothyroidism, weight gain is a common symptom due to slowed metabolism. Successful levothyroxine treatment should help stabilize or reduce weight if it was previously increased due to hypothyroidism. An increase in weight could indicate that the dose of levothyroxine needs adjustment or that other factors are influencing the patient's weight.
C. A decrease in the level of thyroxine (T4) would not typically indicate a therapeutic response to levothyroxine. In fact, the goal of treatment is to normalize T4 levels, so they should be within the normal reference range. An adequate dose of levothyroxine should result in normal or near-normal T4 levels, not a decrease below the normal range.
D. A reduction in appetite is not a common or specific indicator of a therapeutic response to levothyroxine. While levothyroxine can help normalize metabolism and other symptoms of hypothyroidism, a reduction in appetite is not a typical outcome of effective therapy. Appetite changes are not usually used to gauge the effectiveness of thyroid hormone replacement.

A. "The sputum I have been coughing up is pink." B. "I feel short of breath when I lie down flat." C. "The nurse I had yesterday said she could hear fluid in my lungs." D. "Both of my legs are so swollen."

Correct Answer is D

Explanation

A. Pink, frothy sputum is typically associated with left-sided heart failure and pulmonary edema. This occurs when fluid backs up into the lungs due to left-sided heart failure. Since the question pertains to right-sided heart failure, this statement is not consistent with that condition.

B. Feeling short of breath when lying flat is known as orthopnea and is more commonly associated with left-sided heart failure. It occurs due to fluid shifting into the lungs when supine, which aggravates pulmonary congestion. This statement is not consistent with right-sided heart failure.
C. Hearing fluid in the lungs typically indicates left-sided heart failure, where fluid backs up into the pulmonary circulation, causing pulmonary edema. This symptom is associated with left-sided heart failure rather than right-sided heart failure.
D. Swelling of the legs, also known as peripheral edema, is a hallmark of right-sided heart failure. This occurs because the right side of the heart is unable to effectively pump blood out to the lungs, leading to fluid accumulation in the systemic venous circulation and resulting in swelling in the lower extremities and sometimes the abdomen

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A client is in the oliguric phase of acute kidney injury (AKI) which was caused by massive tissue trauma. The nurse notes peaked T-waves and a widened QRS complex on the cardiac monitor. What is the first action the nurse should take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?

Correct Answer is A

Explanation

The nurse is performing an admission assessment on a client who is being admitted for right- sided heart failure. Which statement made by the patient would be consistent with right-sided heart failure?

Correct Answer is D

Explanation

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