A nurse is caring for a postoperative 70-kg patient who had major blood loss during surgery and now has acute kidney injury. The patient does not have signs of fluid overload. Which intervention would be most effective as a fluid challenge to promote kidney perfusion?

Administering normal saline 500-1000 mL infused over 1 hour.

Administering drugs to suppress aldosterone release.

Having the patient drink several large glasses of water.

Instilling 500-1000 mL of normal saline through a nasogastric tube.

Answer and Explanation

The Correct Answer is A

Choice A reason: Administering normal saline 500-1000 mL infused over 1 hour is an effective fluid challenge to promote kidney perfusion in patients with acute kidney injury and no signs of fluid overload. This intervention helps increase intravascular volume, improving renal blood flow and potentially enhancing urine output.

Choice B reason: Administering drugs to suppress aldosterone release is not appropriate for promoting kidney perfusion in this context. Suppressing aldosterone could potentially decrease sodium and water reabsorption, which may not be beneficial for improving renal perfusion in a patient with acute kidney injury.

Choice C reason: Having the patient drink several large glasses of water is not the most effective method for a fluid challenge. Oral intake may not provide the rapid volume expansion needed to improve kidney perfusion, especially in a patient with acute kidney injury where fluid balance and perfusion are critical.

Choice D reason: Instilling 500-1000 mL of normal saline through a nasogastric tube is not an appropriate fluid challenge for promoting kidney perfusion. This method is not typically used for volume expansion in the context of acute kidney injury, as it may not provide the rapid intravascular volume increase needed to enhance renal blood flow.

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Correct Answer is D

Explanation

Choice A reason: An epidural hematoma is a type of traumatic brain injury where blood accumulates between the dura mater and the skull. While it can cause severe symptoms, including headache, loss of consciousness, and neurological deficits, it does not typically present with ecchymosis behind the ears (Battle's sign) or bleeding from the ears. These signs are more indicative of a basilar skull fracture.

Choice B reason: An ischemic stroke occurs when a blood clot blocks or narrows an artery leading to the brain, causing reduced blood flow and oxygen to the brain tissue. Symptoms of an ischemic stroke include sudden weakness, numbness, difficulty speaking, and vision problems. However, it does not cause ecchymosis behind the ears or bleeding from the ears, which are specific signs of a basilar skull fracture.

Choice C reason: A subarachnoid hemorrhage is bleeding into the space between the brain and the tissue covering the brain (subarachnoid space). It often presents with a sudden, severe headache, nausea, vomiting, and loss of consciousness. While it is a serious condition, it does not typically cause ecchymosis behind the ears or bleeding from the ears.

Choice D reason: A basilar skull fracture is

The correct answer. This type of fracture involves the base of the skull and can cause characteristic signs such as ecchymosis behind the ears (Battle's sign) and bleeding from the ears due to the proximity of the fracture to the auditory canal and other structures. These symptoms are key indicators of a basilar skull fracture and require immediate medical attention.

A. Finger-stick glucose. B. Blood cultures x2. C. Tylenol 650 mg PO. D. Vancomycin 760 mg IV.

Correct Answer is B

Explanation

Choice A reason: Finger-stick glucose is important for monitoring blood sugar levels, especially in septic patients who may develop hyperglycemia. However, it is not the highest priority compared to obtaining blood cultures and administering antibiotics.

Choice B reason: Obtaining blood cultures x2 is the first priority in managing a patient with sepsis. Identifying the causative organism and determining antibiotic susceptibility is crucial for guiding effective treatment. Blood cultures should be obtained before administering antibiotics to ensure accurate results.

Choice C reason: Tylenol (acetaminophen) 650 mg PO may be given to reduce fever and provide comfort, but it is not the highest priority in the initial management of sepsis. Immediate diagnostic and therapeutic interventions are more critical.

Choice D reason: Vancomycin 760 mg IV is an important antibiotic for treating sepsis, especially if a resistant organism is suspected. However, it should be administered after blood cultures are obtained to avoid contaminating the cultures and ensuring accurate identification of the causative organism.

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A nurse is caring for a postoperative 70-kg patient who had major blood loss during surgery and now has acute kidney injury. The patient does not have signs of fluid overload. Which intervention would be most effective as a fluid challenge to promote kidney perfusion?

Nursing Test Bank

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