A 65-year-old male patient presents with sudden onset of oliguria and signs of dehydration His blood pressure is 90/60 mmHg, heart rate is 110 bpm and he has poor skin turgor. Laboratory results show elevated blood urea nitrogen (BUN and creatinine levels. Which of the following is the most likely cause of his acute kidney injury (AKI)?
Hypovolemia leading to decreased renal perfusion
Acute tubular necrosis
Urinary tract obstruction
Chronic kidney disease
The Correct Answer is A
A. Hypovolemia leading to decreased renal perfusion. Hypovolemia from dehydration and low blood pressure reduces blood flow to the kidneys, resulting in pre-renal AKI, characterized by elevated BUN and creatinine.
B. Acute tubular necrosis. Acute tubular necrosis may cause AKI but is often due to prolonged hypoperfusion, nephrotoxic drugs, or ischemia, not the immediate presentation seen here.
C. Urinary tract obstruction. A urinary tract obstruction leads to post-renal AKI, often with symptoms like flank pain or difficulty urinating, not dehydration and low blood pressure.
D. Chronic kidney disease. Chronic kidney disease is a long-term condition and would not cause the acute symptoms or sudden onset of AKI as seen in this patient.
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Correct Answer is B
Explanation
A. Ciprofloxacin, Metronidazole, and Ranitidine: Ciprofloxacin and ranitidine are not recommended for H. pylori treatment. Ciprofloxacin is not typically used, and ranitidine is an H2 blocker, not a proton pump inhibitor.
B. Amoxicillin, Clarithromycin, and Omeprazole: This combination is a standard triple therapy for H. pylori infection. Amoxicillin and clarithromycin are antibiotics, and omeprazole (a proton pump inhibitor) reduces stomach acid to help eradicate the bacteria.
C. Metronidazole, Tetracycline, and Bismuth subsalicylate: This combination is part of quadruple therapy rather than triple therapy. Quadruple therapy is usually reserved for cases resistant to initial treatment.
D. Erythromycin, Amoxicillin, and Famotidine: Erythromycin is not part of standard triple therapy, and famotidine is an H2 blocker, not a proton pump inhibitor.
Correct Answer is D
Explanation
A. I need to monitor the puncture site for signs of infection such as redness or swelling. Monitoring the puncture site is crucial for detecting any signs of infection or complications, which the patient should be aware of.
B. I should follow a heart-healthy diet to support my recovery. A heart-healthy diet is recommended to manage cholesterol levels and prevent further coronary artery disease progression.
C. I will take my prescribed medications as directed by my doctor. Following the medication regimen is important for preventing complications and supporting recovery, especially for blood thinners or other cardiac medications.
D. I can resume my regular physical activities immediately after I get home. This statement indicates a need for further teaching, as patients should gradually resume physical activities and avoid strenuous activities immediately after PTCA to prevent complications, such as bleeding at the catheter insertion site.