A nurse is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?
Hypomagnesemia
Hyperkalemia
Decreased creatinine level
Increased glomerular filtration rate (GFR)
The Correct Answer is B
Choice A Reason: This choice is incorrect because hypomagnesemia is not a common finding in the oliguric phase of acute kidney injury. Hypomagnesemia is a condition in which the serum magnesium level is lower than normal (less than 1.5 mEq/L). It may be caused by various factors such as malnutrition, diarrhea, diuretics, or alcohol abuse. It may cause symptoms such as muscle weakness, tremors, tetany, or cardiac arrhythmias.
Choice B Reason: This choice is correct because hyperkalemia is a common finding in the oliguric phase of acute kidney injury. Hyperkalemia is a condition in which the serum potassium level is higher than normal (more than 5 mEq/L). It may be caused by reduced renal excretion of potassium due to decreased urine output (oliguria). It may cause symptoms such as muscle weakness, paresthesia, bradycardia, or cardiac arrest.
Choice C Reason: This choice is incorrect because decreased creatinine level is not a common finding in the oliguric phase of acute kidney injury. Creatinine is a waste product of muscle metabolism that is filtered by the kidneys and excreted in urine. A normal creatinine level ranges from 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women. In acute kidney injury, creatinine level usually increases due to reduced renal function and impaired clearance of creatinine.
Choice D Reason: This choice is incorrect because increased glomerular filtration rate (GFR) is not a common finding in the oliguric phase of acute kidney injury. GFR is a measure of how well
the kidneys filter blood and remove waste products.
A normal GFR range is 90,to 120 mL/min/1.73 m2. In acute kidney injury, GFR usually decreases due to reduced blood flow,to,the kidneys or damage to the glomeruli, which are the tiny blood vessels that filter blood in the kidneys.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason: This is incorrect because a thrombotic stroke is caused by a clot that forms in a cerebral artery, usually due to atherosclerosis. It typically occurs gradually and does not cause a sudden, severe headache or seizure.
Choice B Reason: This is incorrect because an embolic stroke is caused by a clot that travels from another part of the body, such as the heart, to a cerebral artery. It usually occurs abruptly and does not cause vomiting or fever.
Choice C Reason: This is incorrect because a transient ischemic atack (TIA) is caused by a temporary interruption of blood flow to a part of the brain. It usually lasts less than an hour and does not cause permanent brain damage or loss of consciousness.
Choice D Reason: This is correct because a hemorrhagic stroke is caused by a rupture of a blood vessel in the brain, resulting in bleeding into the brain tissue or the subarachnoid space. It usually causes a sudden, severe headache, vomiting, seizure, and loss of consciousness. It can also cause elevated blood pressure, fever, and increased intracranial pressure.
Correct Answer is D
Explanation
Choice A Reason: This choice is incorrect because flatened neck veins are not a sign of cardiac tamponade. Cardiac tamponade is a condition in which fluid accumulates in the pericardial sac that surrounds the heart, causing compression and impaired filling of the heart chambers. This leads to reduced cardiac output and hypotension. One of the manifestations of cardiac tamponade is distended neck veins due to increased venous pressure and impaired venous return.
Choice B Reason: This choice is incorrect because bradycardia is not a sign of cardiac tamponade. Bradycardia is a condition in which the heart rate is slower than normal (less than 60 beats per minute). It may be caused by various factors such as vagal stimulation, medication side effects, hypothyroidism, or sinus node dysfunction. It may cause symptoms such as fatigue, dizziness, or syncope, but it does not indicate cardiac tamponade.
Choice C Reason: This choice is incorrect because sudden lethargy is not a specific sign of cardiac tamponade. Lethargy is a condition in which the person feels tired, sluggish, or drowsy. It may be caused by various factors such as sleep deprivation, depression, infection, anemia, or hypoglycemia. It may affect the person's mental and physical performance, but it does not indicate cardiac tamponade.
Choice D Reason: This choice is correct because muffled heart sounds are a sign of cardiac tamponade. Muffled heart sounds are heart sounds that are fainter or softer than normal due to reduced transmission of sound waves through fluid-filled pericardial sac. They may indicate that the heart function is compromised by cardiac tamponade and require immediate intervention such as pericardiocentesis (removal of fluid from pericardial sac).
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