A client in neurogenic shock secondary to a spinal cord injury continues to have a mean arterial pressure (MAP) of 50 mmHg. To assess for the onset of acute kidney injury, what laboratory findings should be reviewed?

Creatinine level, blood urea nitrogen (BUN) level, and urine specific gravity

Alkaline phosphatase level, creatinine level, and blood urea nitrogen level

Urine specific gravity, albumin level, and alkaline phosphate level

Serum albumin level, alkaline phosphate level, and blood urea nitrogen level

Answer and Explanation

The Correct Answer is A

A. creatinine level, blood urea nitrogen (BUN) level, and urine specific gravity: These values directly reflect renal perfusion and kidney function. A low MAP of 50 mmHg reduces renal blood flow, causing rising creatinine and BUN levels, while urine specific gravity helps determine whether kidneys can concentrate urine appropriately during acute kidney injury.

B. alkaline phosphatase level, creatinine level, and blood urea nitrogen level: Alkaline phosphatase is a liver and biliary enzyme and does not help assess acute kidney injury. Although creatinine and BUN are relevant, the inclusion of alkaline phosphatase makes this combination less useful for evaluating renal damage.

C. urine specific gravity, albumin level, and alkaline phosphatase level: Urine specific gravity is helpful, but albumin and alkaline phosphatase reflect nutritional or hepatic status rather than renal perfusion. These do not provide the needed information to determine acute kidney injury onset.

D. serum albumin level, alkaline phosphatase level, and blood urea nitrogen level: Albumin and alkaline phosphatase are not indicators of kidney function. BUN alone cannot determine acute kidney injury without creatinine or urine concentration data.

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Correct Answer is B

Explanation

A. Document and continue to monitor the parameters: While ongoing monitoring is important, the combination of hypotension and ICP of 15 mmHg may compromise cerebral perfusion. Immediate reporting is necessary rather than passive observation.

B. Notify the health care provider about the assessments: Hypotension in a client with a head injury can reduce cerebral perfusion pressure and worsen brain injury. ICP of 15 mmHg is at the upper limit of normal. Promptly notifying the provider ensures timely interventions to optimize perfusion and prevent secondary brain injury.

C. Decrease the client's IV infusion rate: Reducing IV fluids could exacerbate hypotension and further compromise cerebral perfusion. Volume support may be necessary to maintain adequate blood pressure in a head-injured client.

D. Check the client's pupillary response to light: Assessing pupillary response is part of neurologic monitoring, but it does not address the immediate concern of low blood pressure affecting cerebral perfusion. Action should focus on hemodynamic stability first.

A. Aspirate from the catheter using a 60 ml syringe B. Flush the catheter with 50 mL of additional dialysate C. Advance the catheter 2 to 4 cm further into the peritoneal cavity D. Reposition the client to facilitate drainage

Correct Answer is D

Explanation

A. Aspirate from the catheter using a 60 ml syringe: Aspiration can introduce infection or damage the catheter if done routinely. It is not the first-line action for slow drainage during peritoneal dialysis. Safer interventions should be attempted first.

B. Flush the catheter with 50 mL of additional dialysate: Flushing may force fluid and increase intra-abdominal pressure, potentially causing discomfort or complications. It is not recommended as an initial step to improve drainage.

C. Advance the catheter 2 to 4 cm further into the peritoneal cavity: Manipulating the catheter manually can increase the risk of trauma or infection. Catheter position is generally fixed, and adjustments should be made only under provider guidance.

D. Reposition the client to facilitate drainage: Changing the client’s position, such as turning from side to side or elevating the head of the bed, often helps the dialysate flow freely. This is a safe and effective first action to relieve slow drainage and prevent complications like fluid retention or abdominal distention.

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A client in neurogenic shock secondary to a spinal cord injury continues to have a mean arterial pressure (MAP) of 50 mmHg. To assess for the onset of acute kidney injury, what laboratory findings should be reviewed?

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Naxlex Comprehensive Predictor Exams

A client with a head injury has an arterial blood pressure of 108/54 mmHg and an intracranial pressure of 15 mmHg. Which action by the nurse is appropriate?

Correct Answer is B

Explanation

A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?

Correct Answer is D

Explanation

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