A client with chronic kidney disease (CKD) is receiving calcium acetate 667 mg PO. A decrease in which blood value indicates to the nurse that the medication is having the desired effect?

pH.

Calcium.

Potassium.

Phosphate.

Answer and Explanation

The Correct Answer is D

pH: Calcium acetate is not directly related to changes in blood pH. Therefore, monitoring pH levels would not indicate the effectiveness of the medication for CKD.

B) Calcium: Calcium levels may be affected by calcium acetate, but the primary goal of using calcium acetate in CKD is to reduce phosphate levels, not calcium levels. Therefore, monitoring calcium levels would not directly indicate the effectiveness of the medication.

C) Potassium: Calcium acetate is not typically used to affect potassium levels. Monitoring potassium levels would not indicate the effectiveness of calcium acetate for CKD.

D) Phosphate: This is the correct answer. Calcium acetate is a phosphate binder commonly used in CKD to help lower elevated phosphate levels. A decrease in phosphate levels in the blood would indicate that the medication is having the desired effect in controlling phosphate levels, which is important in managing CKD and preventing complications associated with hyperphosphatemia. Therefore, monitoring phosphate levels is essential to assess the effectiveness of calcium acetate therapy in CKD.

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Correct Answer is B

Explanation

A) CT scan that was performed six months earlier: A previous CT scan performed six months earlier does not necessarily require follow-up by the nurse. However, it would be important to review the results of the previous CT scan to compare findings and assess for any changes over time.

B) Takes metformin hydrochloride for type 2 diabetes mellitus: This is the correct answer. Metformin is excreted by the kidneys, and contrast media used in CT scans can potentially cause kidney damage, particularly in clients with pre-existing renal impairment. Therefore, clients taking metformin may be at increased risk of developing lactic acidosis if renal function is compromised. It is essential for the nurse to follow up on this information and coordinate with the healthcare provider to determine whether metformin should be temporarily discontinued before the CT scan and when it can be safely resumed.

C) Report of client’s sobriety for the last five years: The client’s sobriety status for the last five years is not directly relevant to the CT scan with contrast for evaluating pulmonary embolism. While substance use history is important for overall health assessment, it does not specifically require follow-up related to the CT scan.

D) Metal hip prosthesis was placed twenty years ago: The presence of a metal hip prosthesis placed twenty years ago may be relevant for certain imaging studies, such as magnetic resonance imaging (MRI) or metal artifact reduction sequence (MARS) MRI, but it is not directly related to the CT scan with contrast for pulmonary embolism evaluation. Therefore, it does not require immediate follow-up by the nurse in this context.

A. Remove the patch and consult with the healthcare provider about the client’s pain resolution. B. Place the patch on the client’s shoulder and leave both patches in place for 12 hours. C. Apply the new patch in a different location after removing the original patch. D. Administer an oral analgesic and evaluate its effectiveness before applying the new patch.

Correct Answer is C

Explanation

A) Remove the patch and consult with the healthcare provider about the client’s pain resolution: While it’s essential to assess the need for continued pain management, removing the patch without replacing it could lead to inadequate pain control, especially if the client still requires opioid analgesia. Additionally, fentanyl patches are typically left in place for their prescribed duration, and removing them prematurely could disrupt the pain management plan.

B) Place the patch on the client's sh’ulder and leave both patches in place for 12 hours: Applying a new patch without removing the previous one could result in a higher-than-intended dose of fentanyl, increasing the risk of opioid toxicity. Leaving both patches in place simultaneously is not recommended.

C) Apply the new patch in a different location after removing the original patch: This is the correct action. Applying the new patch in a different location helps prevent skin irritation and ensures consistent drug absorption. Rotating patch sites according to the manufacturer's in’tructions is important for optimal medication delivery.

D) Administer an oral analgesic and evaluate its effectiveness before applying the new patch: While oral analgesics may provide temporary relief, they may not be as effective as transdermal fentanyl for managing chronic pain, especially if the client has been on a stable regimen of fentanyl patches. Additionally, delaying the application of the new patch could lead to inadequate pain control.

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A client with chronic kidney disease (CKD) is receiving calcium acetate 667 mg PO. A decrease in which blood value indicates to the nurse that the medication is having the desired effect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is scheduled for a spiral computed tomography (CT) scan with contrast to evaluate for pulmonary embolism. Which information in the client’s history requires follow up by the nurse?

Correct Answer is B

Explanation

The nurse is preparing to apply the client’s scheduled fentanyl transdermal patch. The nurse notes the previously applied patch is intact on the client’s upper back and the client reports no pain. Which action should the nurse take?

Correct Answer is C

Explanation

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