The nurse is assessing a patient with acute renal failure.
Which of the following would be a priority nursing intervention?
Administering a potassium-sparing diuretic.
Encouraging the patient to consume a high-sodium diet.
Monitoring urine output and fluid balance.
Administering intravenous antibiotics.
The Correct Answer is C
This is because acute renal failure is a condition where the kidneys lose their ability to filter waste and excess fluid from the blood. This can lead to fluid overload, electrolyte imbalances, and metabolic acidosis. Therefore, the nurse should monitor the patient’s urine output and fluid balance to assess the severity of the renal impairment and prevent complications.
Choice A is wrong because administering a potassium-sparing diuretic would worsen the patient’s hyperkalemia, which is a common complication of acute renal failure.
Choice B is wrong because encouraging the patient to consume a high-sodium diet would increase the patient’s fluid retention and blood pressure, which can further damage the kidneys.
Choice D is wrong because administering intravenous antibiotics is not a priority intervention for acute renal failure unless there is a specific indication of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
These are all signs and symptoms of hypokalemia, which is a condition where the blood potassium level is too low. This can affect the function of the muscles, nerves, and heart. Therefore, the nurse would expect to find these signs and symptoms in a client with dehydration and hypokalemia.
Choice C is wrong because hyperreflexia is not a sign or symptom of hypokalemia.
Hyperreflexia is a condition where the reflexes are exaggerated or overactive.
This can be caused by conditions such as spinal cord injury, stroke, or electrolyte imbalances such as hypocalcemia or hypomagnesemia.
Correct Answer is A
Explanation
This is the only solution that is isotonic and compatible with blood products. It will not cause hemolysis or clotting of the blood cells.
Choice B is wrong because lactated Ringer’s is a balanced electrolyte solution that contains calcium, which can cause clotting of the blood cells.
Choice C is wrong because 5% dextrose is a hypotonic solution that can cause hemolysis of the blood cells.
Choice D is wrong because 5% dextrose in 0.45% sodium chloride is a hypertonic solution that can cause hemolysis of the blood cells.
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