Nephrology clinic. A client with stage 4 CKD from diabetes takes sevelamer, epoetin alfa every 2 weeks, losartan and insulin glargine. Data 3 months ago Today Phosphorus (mg/dL) 7.4 5.0 Calcium (mg/dL) 8.2 8.8 Hgb (g/dL) 8.6 10.6 Potassium (mEq/L) 5.3 4.6 BP (mm Hg) 158/94 132/80 Weight change between visits +6 lb +2 lb Which client statements show the plan of care is working as intended? Select all that apply.

Outpatient dialysis center. Ninety minutes into a 4-hour hemodialysis run, a client who took metoprolol and amlodipine this morning reports leg cramps and dizziness. Data Pre-dialysis At 90 minutes Weight (kg) 81.2 (dry weight 77.5) — BP (mm Hg) 146/84 84/50 HR (/min) 78 96 Fluid removed Goal 3.7 L 1.9 L so far Which actions should the nurse take? Select all that apply.

Three months after starting ferrous sulfate 325 mg by mouth three times daily for iron deficiency anemia from slowly bleeding hemorrhoids, since repaired, a client says, “My energy is back. Can I stop the iron now?” Lab At diagnosis Week 6 Month 3 Hgb (g/dL) 8.8 11.2 13.4 MCV (fL) 71 77 85 Serum ferritin (ng/mL) 5 9 16 Which response by the nurse is best?

Urgent care, July. A landscaper who takes lisinopril and hydrochlorothiazide for hypertension has taken ibuprofen 800 mg three times daily for a week for back pain while working outdoors in the heat. The client feels dizzy and has passed little urine today. Data 3 months ago Today BP (mm Hg) 132/80 96/58 BUN (mg/dL) 16 52 Creatinine (mg/dL) 1.0 2.1 Urine specific gravity — 1.030 Urinalysis — No casts, no protein Bladder scan — 90 mL The provider classifies this as prerenal AKI. Which statement describes the cause of prerenal AKI?

Outpatient infusion suite, 0910. A client with pulmonary arterial hypertension who takes sildenafil (Revatio) 20 mg three times daily, last dose at 0800, reports chest pressure while waiting for an appointment. A covering provider gives sublingual nitroglycerin 0.4 mg at 0912. Assessment 0910 0920 0935 BP (mm Hg) 126/78 88/52 70/42 HR (/min) 90 118 132 SpO2 93% 92% 92% Breath sounds Clear both sides Clear both sides Clear both sides Trachea and neck veins Midline, flat Midline, flat Midline, flat Behavior Anxious Dizzy, flushed Pale, slow to answer Which statement explains why sildenafil and nitroglycerin should not be given together?

Transplant unit, day 9 after a deceased-donor kidney transplant. The client takes tacrolimus, mycophenolate and prednisone. Data Day 6 Day 9 Temperature 98.6°F 100.9°F Urine output (mL/24 hr) 2,400 650 Creatinine (mg/dL) 1.4 2.6 Tacrolimus trough (target 8–12 ng/mL) 9 4 Graft site Nontender Tender, swollen CMV PCR — Negative The provider diagnoses acute rejection. Which statement describes acute rejection of a kidney transplant?

Case study Saturday, 1340. A 26-year-old graduate student with asthma arrives by ambulance after wheezing began 3 hours ago at a backyard bonfire. The client has taken 12 puffs of albuterol since then and took naproxen yesterday for a sprained ankle. History includes childhood eczema. The home controller, budesonide-formoterol twice daily, ran out 2 weeks ago. Assessment, 1340 Data Vital signs T 99.0°F (37.2°C), HR 128/min, RR 30/min, BP 150/90 mm Hg, SpO2 88% on room air Respiratory Pauses to breathe after 3–4 words, sits in tripod position, inspiratory and expiratory wheezes, intercostal and sternocleidomastoid retractions Peak expiratory flow (PEF) 42% of personal best Mental status Restless and oriented Between 1355 and 1445 the client received 3 nebulized treatments of albuterol with ipratropium, prednisolone 50 mg by mouth, and oxygen by nasal cannula. Finding 1355 1445 pH 7.49 7.37 PaCO2 (mm Hg) 30 43 PaO2 (mm Hg) 56 54 PEF (% personal best) 42% 33% Behavior Restless Drowsy, slow to answer At 1445 (see the item 3 table) the SpO2 reads 86% on 4 L/min, and the provider orders IV magnesium sulfate. What should the nurse do first?

Case study Saturday, 1340. A 26-year-old graduate student with asthma arrives by ambulance after wheezing began 3 hours ago at a backyard bonfire. The client has taken 12 puffs of albuterol since then and took naproxen yesterday for a sprained ankle. History includes childhood eczema. The home controller, budesonide-formoterol twice daily, ran out 2 weeks ago. Assessment, 1340 Data Vital signs T 99.0°F (37.2°C), HR 128/min, RR 30/min, BP 150/90 mm Hg, SpO2 88% on room air Respiratory Pauses to breathe after 3–4 words, sits in tripod position, inspiratory and expiratory wheezes, intercostal and sternocleidomastoid retractions Peak expiratory flow (PEF) 42% of personal best Mental status Restless and oriented 1355. The client says both hands feel tingly. Arterial blood gas results are back. ABG, 1355 Result pH 7.49 PaCO2 (mm Hg) 30 PaO2 (mm Hg) 56 HCO3− (mEq/L) 23 Which explanation fits these data?

Medical unit. On day 6 of IV ceftriaxone for pneumonia, an 81-year-old client has had 8 watery, foul-smelling stools in 24 hours. Data Day 1 Day 6 WBC (/µL) 13,500 19,800 Creatinine (mg/dL) 1.0 1.6 C. difficile toxin — Positive Abdomen Soft, nontender Distended, tender Which actions should the nurse take? Select all that apply.

A patient suddenly feels an intense need to urinate and involuntarily voids. This is most consistent with: