A nurse is assessing a client who is experiencing acute kidney injury. The client is found to have a significant change in mental status, is lethargic, and confused. The nurse auscultates crackles in the client's lungs. Upon reviewing labs, it is noted that the client's BUN is 140 mg/dL and the potassium is 6.7 mEq/L. Which treatment will the nurse anticipate to be ordered for a client with these findings?
Sodium polystyrene sulfonate (Kayexalate)
Bolus with 1 liter of lactated ringer's (LR)
Renal replacement therapy (RRT)
Patiromer (Veltassa)
The Correct Answer is C
A. While this medication is used to treat hyperkalemia, it is a slower acting treatment. Given the patient's critical condition with altered mental status, hyperkalemia, and elevated BUN, a more rapid intervention is needed.
B. Fluid resuscitation is important in some cases of AKI but it is not the priority in this patient. The patient is already showing signs of fluid overload (crackles in the lungs) and the primary issue is the inability of the kidneys to remove waste products and excess fluids.
C. This is the most appropriate treatment for this patient. RRT, such as hemodialysis or continuous renal replacement therapy (CRRT), can rapidly remove waste products, excess fluid, and electrolytes from the blood, correcting the imbalances and improving the patient's condition.
D. This medication is used for long-term management of hyperkalemia, but it is not effective in an acute setting like this.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Gentamicin is an aminoglycoside antibiotic used to treat bacterial infections. It is not appropriate for managing CKD directly and is generally avoided in patients with kidney impairment due to its potential nephrotoxicity.
B. Potassium supplements are typically not recommended unless there is a documented deficiency in potassium. In stage 3a CKD, managing potassium levels is crucial, but supplements are not usually needed unless potassium levels are low.
C. Captopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are beneficial for patients with CKD as they help lower blood pressure and provide renal protective effects. They can reduce proteinuria (protein in urine), which is common in CKD, and may slow the progression of kidney disease.
D. Metformin is an oral medication used to manage type 2 diabetes by improving insulin sensitivity and lowering blood glucose levels. Although it is important to monitor blood glucose in CKD patients, this
client’s fasting blood glucose is within normal range (83 mg/dL), so Metformin is not indicated unless there was evidence of diabetes or significant glucose dysregulation.
Correct Answer is B
Explanation
A. Calcium gluconate does not directly affect the elimination of potassium from the body or its excretion in the stool. It does not act on the kidneys or gastrointestinal tract to remove potassium. Its primary role is to stabilize the cardiac membrane.
B. Calcium gluconate stabilizes the cardiac membrane and reduces the risk of dysrhythmias associated with elevated serum potassium levels. Hyperkalemia can increase the risk of cardiac arrhythmias, and calcium gluconate helps to counteract these effects by protecting the heart muscle.
C. Calcium gluconate does not cause potassium to shift from the blood into the cells. The shift of potassium into cells is typically induced by other treatments such as insulin and glucose or beta- agonists. Calcium gluconate does not have this effect.
D. Calcium gluconate does not increase serum potassium levels. It primarily serves to protect the heart from the effects of high potassium levels. It does not have a direct effect on the potassium level itself but helps manage the consequences of hyperkalemia.
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