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)

Answer and Explanation

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.

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Correct Answer is B

Explanation

A. Milk is low in purines and is not associated with an increase in uric acid levels or the formation of uric acid stones. In fact, dairy products like milk can be beneficial in a diet for managing kidney stones because they are low in purines and provide calcium, which may help prevent stone formation.

B. Liver is very high in purines. High-purine foods increase the levels of uric acid in the body, which can lead to the formation of uric acid stones in the kidneys. Therefore, clients with recurrent kidney stones due to excessive purine intake should avoid liver and other organ meats.
C. Spinach is considered to have a moderate level of purines. While it is not as high in purines as organ meats, it still contains a notable amount. However, in comparison to foods like liver, it is less of a concern for individuals who need to strictly limit purine intake.
D. Chocolate contains a moderate amount of purines, but it is not as high in purines as organ meats like liver. While it’s not completely free from purines, its purine content is generally lower compared to foods such as liver.

A. Potassium will be removed from the body and excreted in the stool. B. The heart will be protected from dysrhythmias while the serum potassium is elevated. C. Potassium will temporarily shift from the blood into the cells. D. Serum potassium levels will increase further due to this medication being administered.

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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Naxlex Comprehensive Predictor Exams

A client has had recurrent kidney stones. Upon lab analysis of the client's urine, it is found that excessive purine intake is the underlying cause. Which of the following high-purine foods should the nurse instruct the client to avoid?

Correct Answer is B

Explanation

A client with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse recognizes that administering IV calcium gluconate to this client will result in which of the following effects?

Correct Answer is B

Explanation

The nurse is providing education to a male client who is newly-diagnosed with polycystic kidney disease. Which of the following statements should be included in the client teaching?

A client with polycystic kidney disease is prescribed the medication Tolvaptan. What should the nurse include when educating the client about this medication.

A nurse is assessing a client's arteriovenous fistula prior to hemodialysis, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable, and the capillary refill is slow. Which of the following actions is the nurse's priority?

A nurse is assessing a client who has chronic kidney disease (CKD) for fluid volume overload prior to scheduled hemodialysis. Which of the following methods provides a reliable measurement of the amount of fluid the client has retained since the last dialysis treatment?

During the diuretic phase of acute kidney injury, the nurse understands that the client is at risk for which of the following electrolyte imbalances?

Which of the following clients is at risk of developing acute kidney injury from a post-renal cause?