A client is in the oliguric phase of acute kidney injury (AKI) which was caused by massive tissue trauma. The nurse notes peaked T-waves and a widened QRS complex on the cardiac monitor. What is the first action the nurse should take?

Check the client's most recent potassium level

Administer a bolus of 1,000 mL of normal saline

Administer potassium chloride intravenously (IV)

Administer sodium polystyrene sulfonate (Kayexalate)

Answer and Explanation

The Correct Answer is A

A.   Peaked T-waves and a widened QRS complex on an ECG are often signs of hyperkalemia, which is an elevated potassium level in the blood. This can be a serious complication of acute kidney injury (AKI), especially in the oliguric phase when the kidneys are unable to effectively excrete potassium.A
B.   While fluid management is important in AKI, administering a bolus of normal saline is not the first priority in the presence of suspected hyperkalemia. The primary concern is to address the electrolyte imbalance.

C.   Administering potassium chloride would worsen hyperkalemia and should be avoided.
D.   Kayexalate is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the gastrointestinal tract. However, checking the potassium level is the first step in confirming the diagnosis and determining the appropriate treatment.

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Correct Answer is A

Explanation

A. Spinach is known to be high in oxalates. Oxalates are compounds that can bind with calcium in the urine, forming calcium oxalate stones, which are the most common type of kidney stones. For clients with a history of kidney stones related to high oxalate intake, it is crucial to limit or avoid high-oxalate foods such as spinach to reduce the risk of further stone formation.
B. Anchovies are not particularly high in oxalates. They are more commonly associated with other nutritional considerations, such as being a good source of omega-3 fatty acids and protein. While anchovies are not a significant source of oxalates, they are not a primary concern for those needing to manage oxalate intake.
C. Organ meats, such as liver and kidneys, are not known for high oxalate content. They are high in other nutrients and substances but do not significantly contribute to oxalate levels in the urine. Therefore, avoiding organ meats is not typically necessary for managing oxalate levels.
D. Milk is not high in oxalates. In fact, dairy products are a good source of calcium, which can help bind oxalates in the gut and reduce their absorption. For individuals managing oxalate levels, increasing calcium intake from dairy products can be beneficial. Milk and other dairy products are generally not restricted in a diet aimed at reducing oxalate intake.

A. Atrial fibrillation B. Atrial flutter C. Unstable angina D. Premature atrial contractions

Correct Answer is B

Explanation

A. Atrial fibrillation is characterized by irregularly irregular rhythms with no distinct P-waves. Instead, it has a chaotic baseline with fibrillatory waves. The ventricular response can be irregular and variable. The description provided (regular P-waves in a sawtooth formation) does not match the typical appearance of atrial fibrillation, which lacks regular P-waves and has an irregular rhythm.
B. Atrial flutter is characterized by regular, sawtooth-shaped P-waves known as "F-waves" or "flutter waves." The classic pattern is referred to as "F-waves" with a "sawtooth" appearance, often seen in the inferior leads (II, III, aVF). The atrial rate is typically between 240 to 340 beats per minute, which fits the rate of 260 beats per minute in the description. The ventricular rate can be regular or irregular, depending on the degree of AV node conduction. A

C. Unstable angina is a clinical diagnosis of chest pain due to myocardial ischemia. It is not associated with specific ECG findings related to the P-wave morphology or rate. The ECG findings described do not correspond to unstable angina, which would typically present with ST-segment changes or other signs of myocardial ischemia rather than a specific P-wave pattern.
D. Premature atrial contractions (PACs) are early beats originating from the atria that interrupt the normal rhythm. They usually present as a single early beat with a different morphology of the P-wave compared to the sinus P-waves, but do not result in a regular sawtooth pattern or a sustained rhythm at high rates like the one described.

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A client is in the oliguric phase of acute kidney injury (AKI) which was caused by massive tissue trauma. The nurse notes peaked T-waves and a widened QRS complex on the cardiac monitor. What is the first action the nurse should take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has had recurrent kidney stones. Upon lab analysis of the client's urine, it is found that excessive oxalate intake is the underlying cause. Which of the following high-oxalate foods should the nurse instruct the client to avoid?

Correct Answer is A

Explanation

Correct Answer is B

Explanation

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