A client is started on continuous venovenous hemofiltration (CWH), Which finding would require immediate action by the nurse?

Sodium level of 138 mEq/L (138 mmol/L)

Pulse rate of 88 beats/min

Blood pressure of 76/58 mm Hg

Potassium level of 5.5 mEq/L (5.5 mmol/L)

Answer and Explanation

The Correct Answer is C

Rationale:
A. A sodium level of 138 mEq/L is within the normal range (135–145 mEq/L) and does not indicate a complication.
B. A pulse rate of 88 beats/min is within the normal adult range (60–100 beats/min).
C. A blood pressure of 76/58 mm Hg indicates hypotension, which is a serious complication of continuous venovenous hemofiltration (CVVH). Hypotension can result from excessive fluid removal or rapid ultrafiltration, leading to decreased perfusion of vital organs. This finding requires immediate nursing intervention, such as stopping or slowing ultrafiltration and notifying the provider.
D. A potassium level of 5.5 mEq/L is slightly high but not immediately life-threatening compared to the risk posed by severe hypotension.

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Correct Answer is C

Explanation

Rationale:
A. The leukocyte count measures white blood cells and is not affected by epoetin alfa therapy, which specifically targets red blood cell production.
B. The platelet count measures clotting ability and is unrelated to the therapeutic goal of epoetin alfa, which stimulates erythropoiesis, not thrombopoiesis.
C. The hematocrit (Hct) is the most accurate indicator of a therapeutic response to epoetin alfa. This medication promotes red blood cell production in the bone marrow, increasing the hematocrit and hemoglobin levels, which improves oxygen-carrying capacity and reduces anemia symptoms in clients with chronic renal disease.
D. The erythrocyte sedimentation rate (ESR) is a nonspecific indicator of inflammation and does not reflect the effectiveness of epoetin alfa therapy.

A. The glomerular filtration rate decreases because there is injury to the renal tubular cells. B. The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys. C. The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down D. The glomerular filtration rate decreases because inflammatory cells invade the already damaged kidneys.

Correct Answer is A

Explanation

Rationale:
A. In acute tubular necrosis (ATN), the renal tubular epithelial cells are damaged due to ischemia or exposure to nephrotoxic agents. This cellular injury leads to sloughing and necrosis of tubular cells, which obstructs the tubules and causes backflow of filtrate into the interstitium. As a result, glomerular filtration rate (GFR) decreases because the tubules can no longer effectively reabsorb or secrete substances, and the pressure within the tubules rises, opposing filtration. This is a hallmark of intrarenal acute kidney injury.
B. A reduction in renal blood flow is characteristic of prerenal acute kidney injury, not ATN. While ischemia can initially cause ATN, once tubular damage occurs, the ongoing decline in GFR is due to cell injury, not perfusion alone.
C. An obstruction causing urine backup refers to postrenal acute kidney injury, not ATN. Postrenal causes include kidney stones or tumors, not tubular necrosis.
D. Although inflammatory cells may contribute to kidney damage in some forms of nephritis, inflammation is not the primary cause of GFR decline in acute tubular necrosis. The decrease results primarily from tubular cell death and intratubular obstruction rather than immune-mediated injury.

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A client is started on continuous venovenous hemofiltration (CWH), Which finding would require immediate action by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?

Correct Answer is C

Explanation

Correct Answer is A

Explanation

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