When a client is in the diuretic phase of acute kidney injury, the nurse must monitor for which serum electrolyte imbalances?

Hyperkalemia and hypernatremia

Hypokalemia and hypernatremia

Hyperkalemia and hyponatremia

Hypokalemia and hyponatremia

Answer and Explanation

The Correct Answer is D

A. Hyperkalemia and hypernatremia: During the diuretic phase, the kidneys excrete large volumes of urine, leading to loss of potassium and sodium. Hyperkalemia and hypernatremia are more characteristic of the oliguric phase of AKI.

B. Hypokalemia and hypernatremia: Although potassium is lost, sodium loss also occurs during the diuretic phase, making hypernatremia unlikely. Sodium depletion can result from excessive urinary losses.

C. Hyperkalemia and hyponatremia: Hyperkalemia is typically seen in the oliguric phase. In the diuretic phase, potassium is excreted in large amounts, making hypokalemia more common.

D. Hypokalemia and hyponatremia: The diuretic phase causes high urine output with excessive loss of electrolytes. Both potassium and sodium are depleted, putting the client at risk for hypokalemia and hyponatremia. Monitoring and replacement are essential.

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Correct Answer is C

Explanation

A. Narrowing pulse pressure, bradycardia, irregular heart rate: Narrowing pulse pressure is not characteristic of increasing ICP. ICP elevation typically causes widening pulse pressure, making this combination inconsistent with the classic signs of herniation.

B. Stiff neck, bradycardia, narrowing pulse pressure: While a stiff neck may indicate meningeal irritation, it is not a primary sign of rising ICP. Narrowing pulse pressure does not align with the hemodynamic changes seen in Cushing’s triad.

C. Bradycardia, irregular breathing, widening pulse pressure: The Cushing’s triad is the hallmark of increased ICP. It reflects the body’s response to maintain cerebral perfusion: systolic hypertension widening pulse pressure, bradycardia from baroreceptor reflex, and irregular respirations from brainstem compression.

D. Narrow pulse pressure, bradycardia, irregular respirations: Narrow pulse pressure is inconsistent with elevated ICP, which usually produces hypertension with a widened pulse pressure. The other signs may occur, but the combination does not match the classic presentation of ICP elevation.

A. Phosphate level B. Cardiac rhythm C. Urine output D. Calcium level

Correct Answer is B

Explanation

A. Phosphate level: Phosphate levels are not directly affected by calcium gluconate administration. Monitoring phosphate is important in kidney disease but does not indicate the immediate effectiveness of calcium gluconate in hyperkalemia.

B. Cardiac rhythm: Calcium gluconate stabilizes cardiac membranes in hyperkalemia but does not lower potassium levels. Monitoring the cardiac rhythm allows the nurse to evaluate whether the medication is preventing life-threatening arrhythmias. This is the primary indicator of effectiveness.

C. Urine output: Urine output reflects kidney function but does not provide immediate information about the cardiac protective effects of calcium gluconate. Changes in urine are unrelated to the acute response to this therapy.

D. Calcium level: While calcium levels may increase slightly, the goal of IV calcium gluconate is membrane stabilization, not correcting hypocalcemia. Monitoring cardiac rhythm is more critical than measuring calcium levels to assess effectiveness.

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When a client is in the diuretic phase of acute kidney injury, the nurse must monitor for which serum electrolyte imbalances?

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