You are caring for a client who has suffered a severe crush injury yesterday and now has decreasing urine output. The urine is now a dark cola color. You suspect the client is developing acute kidney injury as a direct result of
acute glomerulonephritis
myoglobinuria.
embolus in a renal artery.
bilirubinemia.
The Correct Answer is B
A. acute glomerulonephritis: Acute glomerulonephritis typically presents with hematuria, proteinuria, and edema, but it is not directly related to crush injuries. It is an immune-mediated condition rather than a consequence of muscle trauma.
B. myoglobinuria: Crush injuries release myoglobin from damaged muscle into the bloodstream, which can accumulate in the kidneys and cause acute tubular necrosis. Dark, cola-colored urine is characteristic of myoglobinuria. This is a common cause of acute kidney injury following severe trauma.
C. embolus in a renal artery: A renal artery embolus can cause sudden flank pain and oliguria, but it is less likely in the context of a crush injury. It does not typically produce dark-colored urine.
D. bilirubinemia: Bilirubinemia causes jaundice and dark urine from liver dysfunction, not directly from muscle trauma. The client’s history and urine color are more consistent with myoglobinuria than liver-related causes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Encourage fluid intake as tolerated: Maintaining hydration is essential in acute hepatitis to support liver function and overall metabolic processes. Fluids help prevent dehydration from fever or nausea. This order is appropriate and supports recovery.
B. Acetaminophen 1 gm Q4 hrs for fever: Acetaminophen is hepatotoxic in high doses or in the presence of liver disease. In acute hepatitis, frequent high doses can worsen liver injury. The nurse should question this order and consult the provider for safer alternatives to manage fever.
C. Low protein diet: Restricting protein is sometimes recommended temporarily in acute hepatitis if the client develops hepatic encephalopathy. This order is generally appropriate based on clinical status.
D. Bed rest: Fatigue is common in acute hepatitis, and bed rest supports energy conservation and recovery. This order is appropriate for the client’s condition.
Correct Answer is D
Explanation
A. Creatinine clearance: Creatinine clearance measures kidney function and glomerular filtration rate but does not reflect the effectiveness of calcium carbonate therapy. Calcium carbonate is prescribed to bind phosphate, not to improve renal filtration. Monitoring creatinine is important for overall kidney status but not for medication efficacy.
B. Blood pressure: Blood pressure assessment is important in chronic kidney disease management, but it does not indicate whether calcium carbonate is effectively controlling phosphate levels. Hypertension may be affected by fluid balance and other medications, not directly by calcium carbonate.
C. Neurologic status: Neurologic assessment can detect complications of electrolyte imbalances, such as severe hyperphosphatemia or hypocalcemia, but it is not a direct measure of calcium carbonate effectiveness. Changes in neurological function are late indicators rather than immediate markers.
D. Phosphate level: Calcium carbonate binds dietary phosphate to reduce serum phosphate levels in chronic kidney disease. Monitoring phosphate levels allows the nurse to determine if the medication is achieving its therapeutic goal. A decrease in phosphate indicates effective treatment.
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