Which medication taken by a patient with decreased renal function will be of most concern to the nurse?
folic acid (vitamin B5)
penicillin (Bicillin C-R)
warfarin (Coumadin
Ibuprofen (Motrin)
The Correct Answer is D
A. Folic acid (vitamin B5): Folic acid is a water-soluble vitamin that supports red blood cell production and is often supplemented in patients with renal disease due to losses during dialysis. It does not harm kidney function and is generally considered safe.
B. Penicillin (Bicillin C-R): Penicillin is excreted by the kidneys, so dosage adjustments may be required in renal impairment. However, it is not as directly nephrotoxic as some other medications and can usually be managed safely with monitoring.
C. Warfarin (Coumadin): Warfarin metabolism occurs primarily in the liver, not the kidneys. While close monitoring of INR is always required, renal impairment does not directly contraindicate its use or pose high nephrotoxic risk.
D. Ibuprofen (Motrin): NSAIDs such as ibuprofen decrease renal blood flow by inhibiting prostaglandin synthesis, which can significantly worsen kidney function. In patients with decreased renal function, they increase the risk of acute kidney injury and fluid retention.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Hematuria: The presence of blood in the urine is expected for the first few days after extracorporeal shock wave lithotripsy. It results from trauma to the urinary tract and usually resolves on its own, so it does not require urgent reporting unless it becomes severe or prolonged.
B. Oliguria: Decreased urine output is the most concerning finding because it may indicate obstruction from stone fragments or acute kidney injury. This complication can quickly compromise renal function and requires immediate evaluation by the healthcare provider.
C. Ecchymosis in left flank: Bruising around the flank is a common side effect of the shock waves used during lithotripsy. While it may be uncomfortable, it is not considered dangerous and does not require urgent intervention.
D. Left flank discomfort: Pain is expected after the procedure due to both the passage of stone fragments and localized tissue trauma. Analgesics are typically used to manage this symptom, and it is not considered a critical finding to report.
Correct Answer is B
Explanation
A. Hyperkalemia: Hyperkalemia can occur in clients with kidney failure, but peritoneal dialysis typically helps remove excess potassium. It is not the most common complication associated specifically with this therapy.
B. Peritonitis: Peritonitis is the most frequent and serious complication of peritoneal dialysis. It results from infection introduced during the dialysis exchange process, often presenting with abdominal pain, cloudy effluent, fever, and nausea, and requires prompt intervention with antibiotics.
C. Hypertension: Hypertension may be present in clients with renal disease, but peritoneal dialysis generally helps control blood pressure by removing excess fluid.
D. Weight loss: Some clients may experience weight changes due to fluid shifts or dietary modifications, but weight loss is not a typical complication of peritoneal dialysis and is less clinically significant than infection risk.
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