When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?

Sucralfate.

Vancomycin.

Lorazepam.

Digoxin.

Answer and Explanation

The Correct Answer is B

Choice B reason: Vancomycin is an antibiotic that can treat serious bacterial infections that are resistant to other antibiotics. However, vancomycin can also cause nephrotoxicity, or damage to the kidneys, especially when given in high doses or for prolonged periods. Nephrotoxicity can lead to AKI, which is a sudden and severe decrease in kidney function that can cause fluid and electrolyte imbalances, acid-base disorders, uremia, and death. Therefore, the nurse should closely monitor the client who is receiving vancomycin for development of AKI by checking their serum creatinine and blood urea nitrogen (BUN) levels, urine output and specific gravity, and signs and symptoms of fluid overload or dehydration.

Choice A reason: Sucralfate is an anti-ulcer drug that forms a protective coating over the stomach lining and prevents further damage from acid or pepsin. Sucralfate does not cause nephrotoxicity or AKI and has minimal systemic absorption or side effects. Therefore, the nurse does not need to closely monitor the client who is taking sucralfate for development of AKI.

Choice C reason: Lorazepam is a benzodiazepine that can treat anxiety, insomnia, seizures, or alcohol withdrawal. Lorazepam does not cause nephrotoxicity or AKI and has low renal clearance or elimination. Therefore, the nurse does not need to closely monitor the client who is taking lorazepam for development of AKI.

Choice D reason: Digoxin is a cardiac glycoside that can treat heart failure or atrial fibrillation by increasing the force and efficiency of heart contractions and slowing down the heart rate. Digoxin does not cause nephrotoxicity

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Correct Answer is C

Explanation

Choice C reason: Sodium polystyrene sulfonate is a cation-exchange resin that binds to potassium in the intestine and removes it from the body through the stool. Sodium polystyrene sulfonate is used to treat hyperkalemia, or high potassium level, which can be caused by AKI, certain medications, or other conditions. Hyperkalemia can cause cardiac arrhythmias, muscle weakness, paralysis, or death. The normal range of potassium for adults is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Therefore, a decrease in potassium from above normal to within normal indicates that sodium polystyrene sulfonate has been effective in lowering potassium level and preventing complications. The nurse should monitor the client's serum potassium level regularly and adjust the dose of sodium polystyrene sulfonate as needed.

Choice A reason: Hemoglobin level of 13.5 g/dL (135 g/L) is not a laboratory finding that indicates that the medication has been effective, but rather a normal value that reflects the amount of oxygen-carrying protein in the blood. Hemoglobin is not affected by sodium polystyrene sulfonate or potassium level. The normal range of hemoglobin for adults is 12 to 16 g/dL (120 to 160 g/L). Therefore, a hemoglobin level of 13.5 g/dL does not indicate any change or improvement in the client's condition.

Choice B reason: Serum glucose level of 120 mg/dL (6.7 mmol/L) is not a laboratory finding that indicates that the medication has been effective, but rather a slightly elevated value that reflects the amount of sugar in the blood. Glucose is not affected by sodium polystyrene sulfonate or potassium level. The normal range of glucose for adults is 74 to 106 mg/dL (4.1 to 5.9 mmol/L). Therefore, a serum glucose level of 120 mg/dL may indicate impaired glucose metabolism or diabetes mellitus, but not the effectiveness of sodium polystyrene sulfonate.

Choice D reason: Serum ammonia level of 30 mg/dL (17.62 µmol/L) is not a laboratory finding that indicates that the medication has been effective, but rather a normal value that reflects the amount of nitrogen waste in the blood. Ammonia is not affected by sodium polystyrene sulfonate or potassium level. The normal range of ammonia for adults is 10 to 80 mg/dL (6 to 47 µmol/L). Therefore, a serum ammonia level of 30 mg/dL does not indicate any change or improvement in the client's condition.

A. Give sucralfate on an empty stomach. B. Assess for secondary Candida infection. C. Administer sucralfate once a day, preferably at bedtime. D. Monitor for electrolyte imbalance.

Correct Answer is A

Explanation

Choice A reason: This is the correct action to include in the client's plan of care, as sucralfate should be given on an empty stomach, at least one hour before meals and at bedtime. Sucralfate is a mucosal protectant that forms a protective barrier over the ulcer and prevents further damage from acid and pepsin. It requires an acidic environment to work, so it should not be taken with food or antacids.

Choice B reason: This is not a relevant action to include in the client's plan of care, as sucralfate does not cause or increase the risk of secondary Candida infection. Candida infection is a fungal infection that can affect the mouth, throat, esophagus, or vagina. It is more common in clients who use antibiotics, corticosteroids, or immunosuppressants, but not sucralfate.

Choice C reason: This is not an accurate action to include in the client's plan of care, as sucralfate should be administered four times a day, not once a day. Sucralfate has a short duration of action, so it needs to be taken frequently to maintain its protective effect on the ulcer.

Choice D reason: This is not a necessary action to include in the client's plan of care, as sucralfate does not cause or affect electrolyte imbalance. Electrolyte imbalance is an abnormality in the levels of sodium, potassium, calcium, magnesium, or other minerals in the blood. It can be caused by dehydration, vomiting, diarrhea, kidney disease, or other conditions, but not sucralfate.

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When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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