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 B

Explanation

Choice A reason: Decreased cardiac arrhythmias are not the primary desired effect of dobutamine in heart failure patients. While dobutamine can have some effects on heart rhythm, its main action is to increase the strength of the heart's contractions.

Choice B reason: Increased myocardial contractility is the correct and desired effect of dobutamine. Dobutamine is a positive inotropic agent, meaning it increases the force of the heart's contractions. This is particularly beneficial in heart failure patients as it helps improve cardiac output and the effectiveness of the heart as a pump, thus alleviating symptoms of heart failure and improving organ perfusion.

Choice C reason: Decreased electrical conductivity in the heart is not an effect of dobutamine. In fact, dobutamine can increase the risk of arrhythmias due to its stimulating effects on the heart. The drug works by enhancing the contractility of the heart muscle rather than altering the electrical conduction system.

Choice D reason: Dilated coronary arteries are not a primary effect of dobutamine. While the drug may have some vasodilatory properties, especially at higher doses, its primary role is to enhance myocardial contractility rather than directly dilate the coronary arteries.

A. Supine B. Prone C. Lateral side D. Semi-Fowler's

Correct Answer is B

Explanation

Choice A reason: The supine position is when a patient lies flat on their back. Although it is commonly used for many procedures and treatments, it is not the best position for improving oxygenation in clients with ARDS. Lying flat on the back can cause the lungs to become compressed, reducing the efficiency of gas exchange and potentially leading to further respiratory complications.

Choice B reason: The prone position, where the patient is lying face down, is the recommended position to improve oxygenation in clients with ARDS. Prone positioning helps to recruit more alveoli, improves ventilation-perfusion matching, and reduces the shunting of blood through non-ventilated areas of the lung. Studies have shown that placing patients in the prone position can significantly improve oxygenation and decrease mortality in ARDS patients.

Choice C reason: The lateral side position, where the patient lies on their side, can be used for patients with certain conditions or during recovery from some surgical procedures. However, it does not provide the same benefits for improving oxygenation in ARDS as the prone position does. Lateral positioning might help with comfort and prevent pressure sores, but it does not enhance lung function and gas exchange in the same way.

Choice D reason: The Semi-Fowler's position, where the patient's head and torso are elevated to a 30-45 degree angle, is useful for promoting respiratory comfort and reducing the risk of aspiration. While it can help improve ventilation and is beneficial for patients with respiratory distress, it does not offer the same degree of improvement in oxygenation for ARDS patients as the prone position.

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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

Naxlex Comprehensive Predictor Exams

A client with acute heart failure is receiving dobutamine. What is the desired effect of this drug in a patient with heart failure?

Correct Answer is B

Explanation

To improve the oxygenation of a client with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation, the nurse should place the client in which position?

Correct Answer is B

Explanation

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