NCLEX archer renal - fluids & electrolytes Exam Latest Updates

NCLEX archer renal - fluids & electrolytes Exam Latest Updates 1. naproxen - class: NSAID 2. lisinopril - class: ACE 3. During emergency situations - this medication is indicated for ventricular and atrial dysrhythmias.: Amiodarone 4. In , sodium bicarbonate is utilized only if acidosis is suspected or confirmed.: cardiac arrest 5. Tamsulosin: urinary tract dilator 6. The nurse administers bumetanide to a client with pulmonary edema. Which assessment would indicate that the client is experiencing an adverse re- sponse? 1. distended neck veins 2. adventitious lung sounds 3. leg cramps 4. increased UO: 1. Distended neck veins may indicate fluid overload, CHF, or car- diac tamponade. Fluid overload and CHF may be indications for drug administration, but it is not a complication. 7. The nurse is caring for a client who has polycystic kidney disease (PKD). Which of the following would indicate the client is achieving treatment goals? 1. BP 128/63 2. CREATIN. 2.3 3. PROTEINURIA 2+ 4. SODIUM 132: 1. BP 128/63 Treatment goals for a patient with Polycystic Kidney Disease (PKD) include main- taining normotension, the glomerular filtration rate (GFR), and preventing sodium wasting, which is evidence of a decline in renal function. Hypertension is a cardinal finding in PKD, and if a client is achieving the treatment goals, they will maintain regulated blood pressure. An elevated creatinine indicates that kidney function is declining. This suggests a worsening of the condition. Proteinuria indicates damage to the glomerulus and worsening renal function. Hyponatremia indicates sodium loss in the urine, suggesting worsening renal func- tioning. This is evidence that the client is not meeting the treatment goals. 8. The nurse is reviewing the concept of acute kidney injury (AKI) with a student nurse. Which of the following would be correct as a cause of prerenal AKI? 1. nephrotoxicity 2. bladder cancer 3. contrast media 4. hypovolemia: 4. hypovolemia Hypovolemia is a common prerenal cause of acute kidney injury (AKI). Prerenal reasons are those factors that are external to the kidney. Hypovolemia causes a decrease in blood flow to the organs. Hypovolemia can lead to intrarenal kidney disease. Other prerenal causes of AKI include sepsis, shock, and burns. Intrarenal causes of AKI are those that cause direct damage to the kidneys, such as medications (nephrotoxicity) and contrast media injection. The most common cause of intrarenal AKI is acute tubular necrosis (ATN). 9. The nurse is going over the list of assigned clients for the shift. The nurse knows which client is most at risk for experiencing a fluid volume deficit? A. A client with cirrhosis B. A client with an ileostomy and normal amount of output C. A client with a BUN of 32 and creatinine of 2.7 D. A client with diabetes insipidus and an NG tube set to low intermittent wall suction: Choice D is correct. A client with diabetes insipidus and an NG tube set to low intermittent wall suction is at very high risk for a fluid volume deficit. They have 2 risk factors and are therefore the client at the most risk. In diabetes insipidus, the body puts out huge amounts of dilute urine, depleting the body of fluid. Having an NG tube to suction also removes fluid from the client, by way of their GI secretions, making it another risk factor for fluid volume deficit. 10. the nurse is caring for a client with hypokalemia scheduled to receive the prescribed 20 mEq of intravenous (IV) potassium. Which client assessment requires notification of the primary healthcare provider (PHCP)? A. Oliguria B. Abdominal distention C. Muscle weakness D. Weak peripheral pulses: Choice A is correct. Oliguria is a contraindication to the administration of IV potassium. Oliguria is reduced urine output and can be a sign of kidney dysfunction or acute kidney injury. Parenteral potassium is highly concentrated, and this may cause life-threatening hyperkalemia if the client does not have sufficient urinary output to waste the excess potassium. The nurse must notify the physician of the oliguria so the client does not develop hyperkalemia. 11. 6 L's of HypokaLemia: Lethargy Low shallow respirations Limp muscles Lethal dysrhythmias Leg cramps Lots of UO 12. most abundant intracellular cation: k 13. important in muscle contractions, nerve impulses and acid-base imbal- ances: potassium 14. CAUSES - HypoKalemia: DITCH Drugs (laxatives, diuretics, corticosteroids) Inadequate K intake - NPO, eating disorders, alcoholism Too much water - polydipsia, excessive IVF Cushing's syndrome - too much cortisol, NA/H2O retention, k+ secretion Heavy fluid loss - NGT suction, V/D, wound drainage, sweating Alkalosis Hyperinsulinism 15. TX - HYPOKALEMIA: CARDIAC MONITORING HOLD LASIX/K+ WASTING HOLD DIGOXIN ENCOURAGE K+ ORAL K SUPPLEMENTS (GIVE W/ FOOD) IV POTASSIUM - GIVE SLOW, ALWAYS ON PUMP NEVER IVP MONITOR IV SITE FOR EXTRAVASION (K CAUSES TISSUE DAMAGE) 16. DECREASED DTR, weakness, flaccidity, shallow respirations, DE- CREASED bowel sounds, constipation, distention, ortho HoTN, weak thready pulse, cardiac dysrhythmias: HYPOKALEMIA 17. When replacing intravenously: Ensure that the client is connected to continuous cardiac monitoring. IV - should be administered via a controlled device such as a pump. The IV site must be patent and assessed for patency before administration. Potassium should be administered at a maximum of 10 mEq/L/hr peripherally; 40 mEq/L/hr in a central line.: K 18. The nurse cares for a client diagnosed with end-stage renal disease who just returned from initial hemodialysis. Which of the following assessment findings is of the highest concern? A. Headache and nausea B. Scant blood on the AV fistula C. Potassium 3.7 mEq/L (mmol/L) [3.5 - 5.0 mEq/L, mmol/L] D. Hemoglobin 8.8 mg/dL [Male: 14-18 g/dL; Female: 12-16 g/dL, Female 115-155 g/L Male 125-170 g/L]: Choice A is correct. Headache and nausea may be manifestations associated with dialysis disequilibrium syndrome (DDS). This complication is experienced by clients undergoing their first dialysis and may range from mild to severe.