When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?

Sucralfate.

Vancomycin.

Lorazepam.

Digoxin.

Answer and Explanation

The Correct Answer is B

Choice B reason: Vancomycin is an antibiotic that can treat serious bacterial infections that are resistant to other antibiotics. However, vancomycin can also cause nephrotoxicity, or damage to the kidneys, especially when given in high doses or for prolonged periods. Nephrotoxicity can lead to AKI, which is a sudden and severe decrease in kidney function that can cause fluid and electrolyte imbalances, acid-base disorders, uremia, and death. Therefore, the nurse should closely monitor the client who is receiving vancomycin for development of AKI by checking their serum creatinine and blood urea nitrogen (BUN) levels, urine output and specific gravity, and signs and symptoms of fluid overload or dehydration.

Choice A reason: Sucralfate is an anti-ulcer drug that forms a protective coating over the stomach lining and prevents further damage from acid or pepsin. Sucralfate does not cause nephrotoxicity or AKI and has minimal systemic absorption or side effects. Therefore, the nurse does not need to closely monitor the client who is taking sucralfate for development of AKI.

Choice C reason: Lorazepam is a benzodiazepine that can treat anxiety, insomnia, seizures, or alcohol withdrawal. Lorazepam does not cause nephrotoxicity or AKI and has low renal clearance or elimination. Therefore, the nurse does not need to closely monitor the client who is taking lorazepam for development of AKI.

Choice D reason: Digoxin is a cardiac glycoside that can treat heart failure or atrial fibrillation by increasing the force and efficiency of heart contractions and slowing down the heart rate. Digoxin does not cause nephrotoxicity

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Correct Answer is C

Explanation

Choice A reason: Stopping the oral contraceptive immediately is not necessary and may increase the risk of unintended pregnancy. Erythromycin can reduce the effectiveness of oral contraceptives by interfering with their metabolism, but it does not make them completely ineffective.

Choice B reason: Taking the medications at least 12 hours apart is not sufficient to prevent the interaction between erythromycin and oral contraceptives. The interaction can occur regardless of the timing of the doses.

Choice C reason: Using an additional form of contraception is the best instruction for the client who is taking an oral contraceptive and erythromycin. This can prevent pregnancy in case the oral contraceptive fails due to the interaction with erythromycin. The additional form of contraception should be non-hormonal, such as a barrier method or a copper intrauterine device.

Choice D reason: Avoiding prolonged exposure to direct sunlight is a good advice for anyone taking erythromycin, as it can cause photosensitivity and increase the risk of sunburn. However, this is not related to the interaction with oral contraceptives and does not affect their efficacy.

A. Takes concurrent iron therapy without adverse effects. B. Reports of increased energy levels and decreased fatigue. C. Hemoglobin level increased to 12 g/dL (7.45 mmol/L). D. Food diary shows increased consumption of iron-rich foods.

Correct Answer is C

Explanation

Choice B reason: Epoetin alfa is a synthetic form of erythropoietin, a hormone that stimulates the production of red blood cells (RBCs) in the bone marrow. Epoetin alfa is used to treat anemia, or low RBC count, which can be caused by CKD, chemotherapy, HIV infection, or other conditions. Anemia can cause symptoms such as weakness, fatigue, shortness of breath, pale skin, and chest pain. Hemoglobin is the protein in RBCs that carries oxygen throughout the body. The normal range of hemoglobin for males is 14 to 18 g/dL (8.7 to 11.2 mmol/L). Therefore, an increase in hemoglobin from below normal to within normal indicates that epoetin alfa has been effective in increasing RBC production and improving oxygen delivery. The nurse should monitor the client's hemoglobin level regularly and adjust the dose of epoetin alfa as needed.

Choice A reason:While iron therapy supports the effectiveness of epoetin alfa by providing the necessary substrate for erythropoiesis, tolerating iron therapy is not an indicator of epoetin alfa's efficacy.

Choice C reason: Epoetin alfa is used to treat anemia associated with chronic kidney disease (CKD) by stimulating erythropoiesis (red blood cell production). The primary measure of its effectiveness is an increase in hemoglobin (Hgb) levels toward the target range. The hemoglobin level increasing to 12 g/dL (7.45 mmol/L) reflects a significant improvement from an anemic state and is within the target range for patients receiving epoetin alfa therapy (generally 10–12 g/dL). This is the most objective and definitive indicator of the medication's effectiveness.

Choice D reason: Taking concurrent iron therapy without adverse effects is not a finding that best indicates that the medication is effective, but rather a preventive measure that can reduce the risk of iron deficiency and improve the efficacy of epoetin alfa. Iron therapy refers to taking oral or intravenous iron supplements to increase iron levels in the blood. Iron therapy can cause side effects such as nausea, vomiting, constipation, diarrhea, dark stools, metallic taste, or allergic reactions. The nurse should instruct the client on how to take iron therapy safely and monitor for any adverse effects.

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When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

Correct Answer is C

Explanation

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Hemoglobin (Hgb) [Reference Range: Male: 14 to 18 g/dL (8.7 to 11.2 mmol/L)]

Correct Answer is C

Explanation

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When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?

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