A nurse is reviewing the BUN and creatinine levels of an older adult patient with chronic kidney disease. The nurse should anticipate which of the following findings?
BUN 8 mg/dL and creatinine 0.7 mg/dL
BUN 45 mg/dL and creatinine 8 mg/dL
BUN 23 mg/dL and creatinine 1.0 mg/dL
BUN 10 mg/dL and creatinine 0.3 mg/dL
The Correct Answer is B
Choice A reason:
A BUN level of 8 mg/dL and a creatinine level of 0.7 mg/dL are within normal ranges for a healthy individual without kidney disease. In chronic kidney disease (CKD), we would expect these values to be elevated due to the kidneys' reduced ability to filter waste products from the blood.
Choice B reason:
A BUN level of 45 mg/dL and a creatinine level of 8 mg/dL are significantly higher than the normal range, which is consistent with impaired kidney function seen in CKD. These elevated levels indicate that the kidneys are not effectively filtering urea and creatinine from the blood, leading to their accumulation.
Choice C reason:
A BUN level of 23 mg/dL and a creatinine level of 1.0 mg/dL could be seen in the early stages of CKD. While the creatinine level is within the normal range, the BUN level is slightly elevated, which may suggest a decline in kidney function.
Choice D reason:
A BUN level of 10 mg/dL and a creatinine level of 0.3 mg/dL are both below the normal range. This is an unlikely finding for a patient with CKD, as kidney impairment typically leads to increased levels of these substances in the blood.
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Correct Answer is C
Explanation
Choice A reason: The use of erythropoiesis-stimulating agents (ESAs) is indicated for anemia due to chemotherapy. However, the client's hemoglobin (Hgb) level is 12.1 g/dL, which is within the normal range (normal: 12-15.5 g/dL for women). Therefore, administering an ESA is not indicated based on the Hgb level provided.
Choice B reason: A diet with increased protein can be beneficial for patients undergoing chemotherapy as it helps in tissue repair and immune system function. However, the client's albumin level is 4.5 g/dL, which falls within the normal range (normal: 3.4-5.4 g/dL), suggesting adequate protein intake. Thus, there is no indication that the client requires an increased protein diet based on the albumin level provided.
Choice C reason: The client's white blood cell (WBC) count is 1,400/mm³, which is below the normal range (normal: 4,500-11,000/mm³). This condition, known as leukopenia, significantly increases the risk of infection. Therefore, the nurse should prioritize monitoring for signs of infection and implementing infection control measures.
Choice D reason: The client's platelet count is 170,000/mm³, which is within the normal range (normal: 150,000-450,000/mm³). Although cisplatin can cause thrombocytopenia, the current platelet count does not indicate an increased risk for bleeding. Therefore, this choice is not correct based on the platelet count provided.
Correct Answer is B
Explanation
Choice A reason:
Urine specific gravity is a measure of urine concentration. The normal range is typically from 1.005 to 1.030. A specific gravity of 1.035 indicates very concentrated urine, which could be due to dehydration or other factors, but it is not specifically indicative of chronic glomerulonephritis.
Choice B reason:
Serum creatinine is a waste product from the normal breakdown of muscle tissue. Normal levels are approximately 0.6 to 1.2 mg/dL for males. A level of 7 mg/dL is significantly elevated and can indicate severe kidney dysfunction, which is consistent with chronic glomerulonephritis. This condition can lead to a decreased ability of the kidneys to filter waste, causing an accumulation of creatinine in the blood.
Choice C reason:
Creatinine clearance is a test that measures how well creatinine is removed from the blood by the kidneys. The normal range is about 95 to 120 mL/min. A clearance of 120 mL/min is within the normal range and would not typically be expected in a client with chronic glomerulonephritis, as this condition usually results in reduced kidney function.
Choice D reason:
Blood urea nitrogen (BUN) is another waste product filtered by the kidneys. Normal BUN levels are between 7 and 20 mg/dL. A BUN of 15 mg/dL is within the normal range and does not necessarily indicate kidney dysfunction from chronic glomerulonephritis.
