A nurse is caring for a client who sustained significant crush injuries and is being treated for acute renal injury. What is the pathophysiology behind the development of this renal injury?
High levels of myoglobin obstructed the tubules and caused intra-renal damage
Large amounts of IV fluids overloaded the kidneys and caused pre-renal damage
Pain medications for the injuries were nephrotoxic and caused pre-renal damage
Significant blood loss impaired renal perfusion and caused post-renal damage
The Correct Answer is A
Choice A reason: Crush injuries release myoglobin from damaged muscles, causing rhabdomyolysis. Myoglobin precipitates in renal tubules, obstructing them and leading to acute tubular necrosis, an intra-renal acute kidney injury. This toxic effect, combined with oxidative stress, impairs filtration, making this statement accurate for the pathophysiology of renal injury.
Choice B reason: Large IV fluid volumes are used to prevent renal injury in rhabdomyolysis by diluting myoglobin and maintaining perfusion. Fluid overload may cause pulmonary edema but does not typically cause pre-renal damage, which results from hypoperfusion. This statement is inaccurate, as fluids are protective, not harmful.
Choice C reason: Pain medications like NSAIDs can be nephrotoxic, causing intra-renal damage by reducing renal blood flow or causing interstitial nephritis. However, pre-renal damage results from hypoperfusion, not direct toxicity. In crush injuries, myoglobin is the primary cause, making this statement less accurate than myoglobin-related tubular damage.
Choice D reason: Significant blood loss causes pre-renal injury by reducing renal perfusion, not post-renal damage, which involves urinary obstruction. Crush injuries primarily cause intra-renal damage via myoglobin. This statement is inaccurate, as it misattributes the mechanism and type of renal injury in this context.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Sweating, trembling, and confusion indicate hypoglycemia in type 1 diabetes, likely from excess insulin. Administering fast-acting carbohydrates (e.g., glucose tablets, juice) rapidly raises blood glucose by providing readily absorbable sugars, reversing neuroglycopenic symptoms. This is the first action to prevent seizures or coma, ensuring immediate stabilization.
Choice B reason: Administering insulin during hypoglycemia would further lower blood glucose, exacerbating symptoms and risking severe outcomes like unconsciousness. Insulin drives glucose into cells, worsening the deficit. This action is contraindicated and dangerous, as it directly opposes the need to raise blood sugar immediately.
Choice C reason: Complex carbohydrates and proteins digest slowly, providing delayed glucose release, unsuitable for acute hypoglycemia requiring rapid correction. While appropriate for long-term glucose stability, this is not the first action, as it fails to address the urgent need for fast-acting sugars to reverse symptoms.
Choice D reason: Calling the healthcare provider delays treatment of hypoglycemia, which requires immediate carbohydrate administration to prevent neurological damage. While provider consultation may follow for insulin adjustment, it is not the first action. This choice is inappropriate, as it postpones critical intervention needed for symptom resolution.
Correct Answer is A
Explanation
Choice A reason: Phenazopyridine is a urinary analgesic that relieves pain, burning, and irritation in the urinary tract by exerting a topical anesthetic effect on the uroepithelium. It is commonly used for symptomatic relief in UTIs, making this statement accurate, as it directly addresses its therapeutic role in managing urinary discomfort.
Choice B reason: Phenazopyridine is used short-term (typically 2 days) for symptom relief, not necessarily until an antibiotic course is completed. Antibiotics treat the underlying UTI, while phenazopyridine addresses symptoms. This statement is inaccurate, as their durations are independent, based on clinical need, not synchronized completion.
Choice C reason: Phenazopyridine is not contraindicated in UTIs; it is specifically indicated for symptomatic relief in these infections. It does not treat the infection but alleviates discomfort. This statement is inaccurate, as phenazopyridine is a standard adjunctive therapy in UTI management for pain relief.
Choice D reason: Phenazopyridine provides relief within hours, not almost immediately. Its onset requires absorption and distribution to the urinary tract, typically taking 1-2 hours. This statement is inaccurate, as the relief, while rapid, is not instantaneous, and patients should be informed of the expected timeframe.
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