The patient is in a progressive care unit following arteriovenous fistula implantation in his left upper arm, and is due to have blood drawn with his next set of vital signs and assessment. When the nurse assesses the patient, the nurse should

Correct Answer: D

Rationale: The correct answer is D. Auscultating the left arm for a bruit and palpating for a thrill post arteriovenous fistula implantation is crucial to assess the patency and functionality of the fistula. A bruit indicates turbulent blood flow, while a thrill signifies the presence of a strong pulse through the fistula. These assessments help identify any complications like stenosis or thrombosis. Drawing blood or taking blood pressures from the arm with the fistula can lead to inaccurate results or damage the fistula. Starting a new IV line in the left lower arm is unnecessary and not relevant to monitoring the arteriovenous fistula.

Correct Answer: A

Rationale: The correct answer is A: Cerebral salt wasting. This is indicated by the low serum sodium level (115 mEq/L), which can occur in patients with head trauma and lead to excessive sodium loss through the kidneys. This results in hypovolemia, leading to low blood pressure and tachycardia. The elevated BUN (50 mg/dL) and creatinine (8 mg/dL) levels suggest dehydration and renal impairment due to volume depletion. The patient's poor skin turgor, dry mucous membranes, confusion, and restlessness further support the diagnosis of cerebral salt wasting. Summary: B: Diabetes insipidus is characterized by excessive urination and thirst due to insufficient production of antidiuretic hormone (ADH). This patient's symptoms are not consistent with diabetes insipidus. C: Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is characterized by excessive release of ADH, leading to water retention and

Correct Answer: D

Rationale: The correct answer is D: “Recovery is possible, but it may take several months.” This response is the best because acute kidney injury can be reversible with appropriate management, and recovery may take time. It is important to provide hope and encouragement to the patient. A: “Unfortunately, kidney injury is not reversible; it is permanent.” - This is incorrect as acute kidney injury can be reversible with timely intervention and proper treatment. B: “Kidney function usually returns within 2 weeks.” - This is incorrect because the recovery timeline varies for each individual and can take longer than 2 weeks. C: “You will know for sure if you start urinating a lot all at once.” - This is incorrect as increased urine output may not always indicate complete recovery from acute kidney injury.

Correct Answer: A

Rationale: The correct answer is A: Sodium polystyrene sulfonate. It works by exchanging sodium ions for potassium ions in the colon, leading to potassium excretion. A is the safest option without the risk of causing hypernatremia or intestinal necrosis like B. Regular insulin (C) may cause hypoglycemia and is not as effective as A in reducing potassium levels. Calcium gluconate (D) does not directly reduce potassium levels and is used for treating hyperkalemia-related cardiac toxicity.

Correct Answer: A

Rationale: The correct answer is A: Heredity. Nephrogenic diabetes insipidus can be inherited as a genetic condition. The mutation in genes responsible for regulating water balance in the kidneys can lead to this disorder. Other choices are incorrect: B: Medications like lithium can cause acquired nephrogenic diabetes insipidus, not its development. C: Meningitis is an inflammatory condition that does not directly relate to nephrogenic diabetes insipidus. D: Pituitary tumors are associated with central diabetes insipidus, not nephrogenic.

Correct Answer: A

Rationale: The correct answer is A: Decreased reflexes. In myxedema coma, a severe form of hypothyroidism, patients often present with decreased mental status, hypothermia, and bradycardia. Decreased reflexes are a common neurological manifestation due to the slowing of metabolic processes and the central nervous system depression associated with this condition. Hyperthermia (B) is not typically seen in myxedema coma, as patients usually have low body temperature. Hyperventilation (C) is also unlikely, as respiratory depression is more common. Tachycardia (D) is incorrect because bradycardia is more characteristic of myxedema coma.

Correct Answer: A

Rationale: The correct answer is A because continuous venovenous hemofiltration primarily removes fluids and solutes through convection. Convection involves the movement of solutes across a semi-permeable membrane by the force of the fluid flow. This process helps to achieve fluid balance and manage electrolyte levels in patients with renal failure. Choice B is incorrect because hemofiltration does not specifically target plasma water; it aims to remove both fluids and solutes. Choice C is incorrect as hemofiltration does not involve adding dialysate; it relies on the patient's blood passing through a filter to remove waste products. Choice D is incorrect because while hemofiltration may involve aspects of ultrafiltration and dialysis, the primary mechanism is convection for removing fluids and solutes.

Correct Answer: C

Rationale: The correct answer is C (10 to 20 mg/dL). In conditions where the serum creatinine level is elevated (7 mg/dL in this case), the BUN level is expected to also be elevated due to impaired kidney function. BUN levels are typically around 10-20 mg/dL, so this range is the most appropriate given the elevated creatinine level. Choice A (1 to 2 mg/dL) is too low and would not be expected with a creatinine level of 7 mg/dL. Choice B (7 to 14 mg/dL) is a bit low for such a high creatinine level. Choice D (20 to 30 mg/dL) is too high as it exceeds the typical range for BUN levels. Therefore, choice C is the most appropriate range based on the given information.

Correct Answer: C

Rationale: The correct answer is C: intrarenal disease, probably acute tubular necrosis. The presence of coarse, muddy brown granular casts and hematuria in the urinalysis indicates damage to the renal tubules, which is characteristic of acute tubular necrosis. This condition is a type of intrarenal disease where there is direct damage to the kidney tubules, leading to decreased urinary output and symptoms like malaise and fatigue. Prerenal and postrenal conditions do not typically present with granular casts and hematuria, making choices A and B incorrect. Urinary tract infection is also unlikely to cause the specific findings seen in this case, ruling out choice D. Therefore, choice C is the most appropriate based on the urinalysis results and clinical presentation.