The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is evaluating the patient’s urinalysis results. The nurse should become concerned when

Correct Answer: D

Rationale: The correct answer is D because the presence of red blood cells and albumin in the urine indicates possible kidney damage from the blunt trauma. This is concerning as it may suggest renal injury or dysfunction. A: Creatinine levels in the urine being similar to blood levels is normal as creatinine is filtered by the kidneys. B: Sodium and chloride being present in the urine is expected as they are components of urine. C: Urine uric acid levels matching serum levels is common as uric acid is excreted by the kidneys. In summary, the presence of red blood cells and albumin in the urine is abnormal and indicates potential kidney damage, making it the correct answer.

Correct Answer: D

Rationale: The correct answer is D because a patient with a history of fluid overload due to heart failure is at the greatest risk of developing acute kidney injury. Heart failure can lead to decreased kidney perfusion causing acute kidney injury. In this scenario, the patient's fluid overload exacerbates the situation, further compromising kidney function. Choice A is incorrect as aminoglycosides can cause kidney injury but the duration of 6 days is less concerning compared to chronic fluid overload from heart failure in choice D. Choice B is incorrect because controlled hypertension does not directly increase the risk of acute kidney injury. Choice C is incorrect as the patient being discharged 2 weeks earlier after aminoglycoside therapy does not necessarily indicate a higher risk compared to chronic fluid overload.

Correct Answer: C

Rationale: The correct answer is C: intrarenal. The presence of sediment, crystals, and bacteria in the urinalysis indicates an issue originating within the kidney itself. This suggests a problem like a urinary tract infection or kidney stone causing the severe flank pain. Prerenal and postrenal conditions usually involve issues outside the kidney such as dehydration or urinary tract obstruction, which are not supported by the urinalysis findings. Choice D, not renal related, is incorrect as the symptoms and urinalysis results clearly point towards a renal issue.

Correct Answer: C

Rationale: The correct answer is C: administer intravenous sodium bicarbonate. In this case, the patient has metabolic acidosis with a low pH and low bicarbonate levels. Administering sodium bicarbonate can help correct the acidosis by increasing the bicarbonate levels and improving the pH. This treatment is essential to address the underlying metabolic imbalance. Choice A is incorrect because administering morphine would not address the root cause of the acidosis and could potentially worsen the respiratory status. Choice B is incorrect as intubation and mechanical ventilation are not indicated solely based on the acid-base imbalance. Choice D is also incorrect as canceling the dialysis session would not address the metabolic acidosis and could potentially worsen the patient's condition.

Correct Answer: C

Rationale: The correct answer is C: notify the provider immediately. The absence of bruit, thrill, and palpable distal pulses in a new arteriovenous fistula suggests potential complications like thrombosis or stenosis, requiring urgent intervention. Notifying the provider promptly allows for timely assessment and appropriate management to prevent further complications. Summary: A: Reassessing the patient in an hour may delay necessary intervention for a potentially serious issue. B: Raising the arm above the level of the patient’s heart does not address the underlying problem and may not improve the situation. D: Applying warm packs to the fistula site is not the appropriate intervention for the absence of bruit and thrill and may not address the underlying cause.