A client is admitted to a medical unit with the diagnosis of acute kidney failure. The nurse reviews the client's laboratory data, performs a physical assessment, and obtains the client's vital signs. What should the nurse conclude the client
is most likely experiencing?
Correct1
Hyperkalemia ...
decreased glomerular filtration leads to hyperkalemia
recurrent urinary tract infections
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HESI CRITICAL CARE EXAM QUESTIONS & ANSWERS
1
A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor
the client for which response to the medication?
1
Retention of sodium ions
2
Negative nitrogen balance
Correct3
Excessive loss of potassium ions
4
Increase in the urine specific gravity
Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle
and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the
reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism. With
edema, the specific gravity of the fluid more likely will be low.
Test-Taking Tip: Pace yourself when taking practice quizzes. Because most nursing exams
have specified time limits, you should pace yourself during the practice testing period
accordingly. It is helpful to estimate the time that can be spent on each item and still
complete the examination in the allotted time. You can obtain this figure by dividing the
testing time by the number of items on the test. For example, a 1-hour (60-minute) testing
period with 50 items averages 1.2 minutes per question. The NCLEX exam is not a timed
test. Both the number of questions and the time to complete the test varies according to
each candidate's performance. However, if the test taker uses the maximum of 5 hours to
answer the maximum of 265 questions, each question equals 1.3 minutes.
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View Topics e
Issue with this question?
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A routine urinalysis is prescribed for a client. What should the nurse do if the
specimen cannot be sent immediately to the laboratory?
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Take no special action.
Correct2
Refrigerate the specimen.
3
Store it in the dirty utility room and send it later.
4
Discard the specimen and collect another specimen later.
Refrigeration retards the growth of bacteria and may preserve the specimen for several
hours. Growth of bacteria will alter the pH and the glucose and protein levels in the urine; it
must be refrigerated to retard growth. Discarding the specimen and collecting another
specimen later represents an unnecessary waste of time, effort, and money.
Test-Taking Tip: Being emotionally prepared for an examination is key to your success.
Proper use of this text over an extended period of time ensures your understanding of the
mechanics of the examination and increases your confidence about your nursing
knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are
excited, yet anxious. This feeling is normal. A little anxiety can be good because it
increases awareness of reality; but excessive anxiety has the opposite effect, acting as a
barrier and keeping you from reaching your goal. Your attitude about yourself and your goals
will help keep you focused, adding to your strength and inner conviction to achieve
success.
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Issue with this question?
A nurse is notified that the latest potassium level for a client in acute renal failure is
6.2 mEq. What action should the nurse take?
1
Alert the cardiac arrest team
2
Call the laboratory to repeat the test
Correct3
Take vital signs and notify the primary health care provider
4
Obtain an ECG strip and obtain an antiarrhythmic medication
, Vital signs monitor the cardiopulmonary status; the health care provider must treat
this hyperkalemia to prevent cardiac dysrhythmias. The cardiac arrest team responds to a
cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time
and probably reaffirm the original results; the client needs medical attention. Obtaining an
ECG strip and having an antiarrhythmic available are correct interventions if available, but
the priority is medical attention and the health care provider should be notified
immediately.
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Issue with this question?
A client with a diagnosis of uncontrolled diabetes began receiving Lasix
(Furosemide) two days ago. The nurse reviews the morning lab results and discovers
that the client's potassium level is 2.8 mEq/L. What is the most appropriate action
for the nurse to take?
1
Hold the morning dose of the diuretic and have the lab repeat the test.
2
Continue to monitor the level to ensure that it stays within the normal limits.
Correct3
Notify the primary healthcare provider of the result, which is critically low.
4
Anticipate a prescription for an increase in the dosage of the Lasix.
The physician should be notified because a potassium level of 2.8 mEq/L is low. Normal
range for serum potassium is 3.5 to 5 mEq/L. Clients who are on diuretics require monitoring
of serum electrolytes, especially potassium and sodium, because they also are excreted with
water. The nurse should not hold the diuretic or repeat the lab test unless advised by the
physician. The client's serum potassium level is critically below the normal limit and the
physician should be notified. An increase in Lasix would cause an increased loss of
potassium.
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?
Which is the most serious complication for which the nurse must monitor a client
with kidney failure?
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