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A nurse is caring for a patient with renal disease and has a GFR of less than 15 mL/min. The nurse knows that the GFR level indicates the need for which intervention?
- Daily weight and fluid restrictions.
- Hemodialysis or peritoneal dialysis.
- Dietary restrictions and antihypertensive medications.
- Increase of phosphate and calcium supplements.
Explanation
Correct Answer: B) Hemodialysis or peritoneal dialysis.
A GFR of less than 15 mL/min indicates Stage 5 chronic kidney disease (CKD), also known as end-stage renal disease (ESRD). At this level, the kidneys have lost nearly all of their functional capacity and can no longer adequately filter waste, regulate electrolytes, or manage fluid balance.
Renal replacement therapy — either hemodialysis or peritoneal dialysis — becomes necessary to sustain life. Daily weight monitoring, fluid restrictions, dietary changes, and antihypertensive medications are appropriate in earlier stages of CKD, but a GFR below 15 specifically signals the need for dialysis. Phosphate levels are typically restricted, not increased, in advanced renal disease.
A 37-year-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?
- Glomerular filtration rate (GFR)
- Potassium level
- Blood urea nitrogen (BUN) level
- Urine volume
Explanation
Correct Answer: A) Glomerular filtration rate (GFR)
The GFR is the most direct and comprehensive measure of kidney function, reflecting how efficiently the kidneys are filtering waste from the blood. An improving GFR indicates recovering renal function in AKI. While potassium level, BUN, and urine volume are all important parameters to monitor in AKI, they are indirect indicators of kidney function. Potassium and BUN can be affected by non-renal factors such as diet and catabolism. Urine volume alone does not confirm functional recovery, as a patient can have non-oliguric AKI with normal urine output but still have significantly impaired filtration. GFR remains the gold standard for evaluating true improvement in kidney function.
A patient with extensive electrical burn injuries is admitted to the emergency department. Which of these prescribed interventions would the nurse implement first?
- Apply dressings to burned areas
- Assess for pain at contact points
- Place on a cardiac monitor
- Start two large bore IVs
Explanation
Correct Answer: C) Place on a cardiac monitor.
As established in electrical burn management, cardiac dysrhythmias are the most immediately life-threatening complication of electrical injuries, as current travels through the body and disrupts the heart's conduction system. Cardiac monitoring is the first priority to detect and respond to potentially fatal arrhythmias such as ventricular fibrillation. Starting large bore IVs for fluid resuscitation is the next urgent step, followed by wound assessment and pain management. Addressing the cardiac risk takes precedence over all other interventions.
Prescribed: Begin Heparin IV infusion at 1,050 units/hr. Available: Heparin 25,000 units/500 mL NS. How many mL/hr will the nurse program the IV pump? Record your answer in whole number.
Explanation
Correct Answer: 21 mL/hr
Use the formula: (Desired dose ÷ Available dose) × Volume = mL/hr
(1,050 units/hr ÷ 25,000 units) × 500 mL = 0.042 × 500 = 21 mL/hr
First, determine the concentration: 25,000 units in 500 mL = 50 units/mL. Then divide the desired rate by the concentration: 1,050 ÷ 50 = 21 mL/hr. The nurse programs the IV pump to deliver 21 mL/hr.
A patient is admitted with electrical burns. What is the nurse's immediate priority assessment?
- Pain level
- Cardiac monitoring
- Capillary refill
- Skin color
Explanation
Correct Answer: B) Cardiac monitoring
Electrical burns carry a high risk of life-threatening cardiac dysrhythmias because electrical current travels through the body and can disrupt the heart's electrical conduction system, causing arrhythmias such as ventricular fibrillation or asystole — even if the patient appears stable on the surface.
Cardiac monitoring is therefore the immediate priority assessment upon admission. Pain level, capillary refill, and skin color are all important assessments but are secondary to the life-threatening cardiac complications that make electrical injuries uniquely dangerous compared to thermal burns.
During the emergent phase of burn care, which nursing action will be most useful in determining if a patient is receiving adequate fluid resuscitation?
- Measure hourly urine output.
- Monitor daily weight.
- Check skin turgor.
- Assess mucous membranes.
Explanation
Correct Answer: A) Measure hourly urine output.
Hourly urine output is the most reliable and sensitive indicator of adequate fluid resuscitation in burn patients during the emergent phase. The goal is to maintain urine output of 0.5–1 mL/kg/hour in adults, which reflects adequate renal perfusion and overall tissue perfusion. Daily weight, skin turgor, and mucous membrane assessment provide useful but less precise and less immediate information about fluid status compared to hourly urine monitoring.
A patient who is suspected of having an epidural hematoma is admitted to the emergency department. Which action will the nurse plan to take?
- Initiate high-dose barbiturate therapy.
- Prepare patient for immediate craniotomy.
- Type and cross-match for blood transfusion.
- Administer IV furosemide.
Explanation
Correct Answer: B) Prepare patient for immediate craniotomy.
An epidural hematoma is a neurosurgical emergency. It typically results from arterial bleeding (often from the middle meningeal artery) causing rapid accumulation of blood between the skull and dura mater. The classic presentation is a lucid interval followed by rapid neurological deterioration. Immediate surgical evacuation via craniotomy is required to relieve pressure and prevent brain herniation and death. High-dose barbiturates are used for refractory intracranial hypertension, not as a primary intervention. Blood transfusion and furosemide do not address the underlying hematoma.
When caring for a patient with a head injury, a nurse must stay alert for signs and symptoms of increased intracranial pressure (ICP). Which cardiovascular findings are late indicators of increased ICP?
- Hypertension and narrowing pulse pressure.
- Elevated systolic blood pressure and bradycardia.
- Hypotension and tachycardia.
- Hypotension and bradycardia.
Explanation
Correct Answer: B) Elevated systolic blood pressure and bradycardia.
The Cushing's triad is the classic late sign of severely increased ICP, consisting of elevated systolic blood pressure (with widening pulse pressure), bradycardia, and irregular respirations. The rise in systolic BP is the body's attempt to maintain cerebral perfusion pressure against the increasing intracranial pressure, while bradycardia results from vagal stimulation. This is a grave, late finding indicating impending brainstem herniation requiring immediate intervention. Hypotension and tachycardia are signs of systemic shock, not increased ICP. Narrowing pulse pressure and hypotension are inconsistent with the Cushing's response.
The development of acute disseminated intravascular coagulation (DIC) is a critical setback for the patient. The nurse knows that which are common risk factors for the development of acute DIC? Select all that apply.
- Intestinal obstruction
- Abruptio placenta
- Any type of shock
- Severe trauma and burns
- Sepsis
Explanation
Correct Answers: B, C, D, and E
Abruptio placenta is a well-established obstetric trigger for DIC, as placental separation releases thromboplastin into the bloodstream, activating widespread clotting. Any type of shock — including septic, hemorrhagic, or cardiogenic — can trigger DIC through widespread endothelial damage and hypoperfusion. Severe trauma and burns release massive amounts of tissue factor into circulation, overwhelming the coagulation system and triggering DIC. Sepsis is one of the most common causes of DIC, as endotoxins from bacteria activate the coagulation cascade systemically.
Intestinal obstruction, while serious, is not a recognized common risk factor for DIC. It does not directly trigger the systemic coagulation activation that leads to DIC.
A nurse is caring for a postoperative patient following a total knee replacement. Which of the following medications should the nurse anticipate the provider to prescribe to prevent the formulation of a deep vein thrombosis (DVT)?
- Alteplase
- Clopidogrel
- Warfarin
- Enoxaparin
Explanation
Correct Answer: D) Enoxaparin
Enoxaparin (Lovenox), a low molecular weight heparin (LMWH), is the preferred anticoagulant for DVT prophylaxis following total knee replacement. It has a predictable dose response, does not require routine monitoring, and has a well-established safety profile in the postoperative orthopedic setting. Alteplase is a thrombolytic used to dissolve existing clots, not for prevention. Clopidogrel is an antiplatelet agent used primarily in cardiovascular conditions, not DVT prophylaxis. Warfarin, while sometimes used for DVT prevention, has a delayed onset, narrow therapeutic window, and requires frequent INR monitoring, making it less preferred over enoxaparin in the immediate postoperative period.
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