chapter 65 quiz 3
Which laboratory test is the best indicator of kidney function?
creatinine The laboratory test that is the best indicator of kidney function is creatinine excretion. Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best laboratory marker of renal function.BUN may be affected by protein, fluid intake, rapid cell destruction, cancer treatment, steroid therapy, and hepatic damage. AST and alkaline phosphatase are measures of hepatic function.
A client with these assessment data is preparing to undergo a computed tomography (CT) scan with contrast:Physical AssessmentDiagnostic FindingsMedicationsFlank painBUN 54 mg/dL (19.3 mmol/L)CaptoprilDysuriaCreatinine 2.4 mg/dL (212 umol/L)MetforminBilateral knee painCalcium 8.5 mg/dL (2.13 mmol/L)AcetylcysteineWhich medication does the nurse plan to administer before the procedure?
Acetylcysteine (Mucomyst) Before a CT scan with contrast, the nurse needs to administer acetylcysteine to the client. This client has kidney impairment demonstrated by increased creatinine. Acetylcysteine (an antioxidant) would be used to prevent contrast-induced nephrotoxic effects.Metformin is held at least 24 hours before and for at least 48 hours after procedures using contrast. Although captopril and acetaminophen may be administered with a sip of water with permission of the provider, this is not essential before the procedure.
When caring for a client with uremia, the nurse assesses for which symptom?
Nausea and vomiting The signs and symptoms the nurse needs to assess for are nausea and vomiting. Other manifestations of uremia include anorexia, nausea, vomiting, muscle cramps, pruritus, fatigue, and lethargy.CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.
The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast:History and Physical AssessmentMedicationsDiagnostic FindingsPolycystic kidney diseaseDiabetesHysterectomyAbdomen distendedNegative edemaGlyburideMetforminSynthroidBUN 26 mg/dL (9.2 mmol/L)Creatinine 1.0 mg/dL (77 umol/L)HbA1c 6.9%Glucose 132 mg/dL (7.3 mmol/L)Which intervention is essential for the nurse to perform?
Hold the metformin 24 hours before and on the day of the procedure. The essential intervention for the nurse to perform is to withhold metformin at least 24 hours before the time of a contrast media study and for at least 48 hours after the procedure because metformin may cause lactic acidosis.The focus of this scenario is the client with polycystic kidneys. A TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HbA1c is in an appropriate range.
A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns to the unit?
Arise slowly and call for assistance when ambulating." When a client returns to the unit from a captopril retinal scan, the nurse needs to teach the client to rise slowly and call for help when ambulating. Captopril can cause severe hypotension during and after the procedure. The client would be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension.Intake and output measurement is not necessary after this procedure, unless it had been requested previously. The urine is not radioactive, because only a small amount of radioisotope is used in a renal scan. Standard Precautions need to be implemented and the nurse must wear gloves. Cardiac monitoring is not needed, although the nurse would monitor for hypotension secondary to captopril.
Which urinary assessment information for a client indicates the potential need for increased fluids
Increased blood urea nitrogen Potential for increased fluids are needed for a client with increased blood urea nitrogen. Increased blood urea nitrogen can indicate dehydration.Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.
The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first?
Position the client supine. When caring for a client after a kidney biopsy, the nurse first needs to position the client in a supine position. The client is positioned supine with a back roll for several hours after a kidney biopsy to decrease the risk for hemorrhage.BUN and creatinine would be obtained before the procedure is performed. Only local discomfort would be noted around the procedure site. Severe pain could indicate hematoma. Although pink urine may develop, the nurse would position the client to prevent bleeding first. The other actions are appropriate after this procedure, but do not need to be done immediately after the biopsy.
for which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider (HCP)?
client with an allergy to shrimp Client with a history of asthma Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L) Client who took metformin (Glucophage) 4 hours ago