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:
A tingling sensation is not the primary concern when planning preoperative teaching for an amputation due to a severe gangrenous infection. While some patients may experience tingling due to nerve damage or as part of phantom limb sensation, the focus of preoperative teaching should be on managing pain and understanding the recovery process.
Choice B reason:
Telling a patient that their pain will gradually become less severe may be misleading. Post-amputation, patients often experience significant pain, including phantom limb pain, which can be intense and challenging to manage. Preoperative teaching should set realistic expectations about postoperative pain and its management.
Choice C reason:
Phantom pain is a real phenomenon experienced by many amputees, where they feel pain in the amputated limb as if it were still there. It is not merely psychological but has physiological underpinnings related to the nerves and brain's interpretation of signals. Preoperative teaching should include information about phantom limb pain, its potential occurrence, and strategies for managing it.
Choice D reason:
It is unrealistic to suggest that the pain will disappear soon after the amputation. Recovery from an amputation can be a lengthy process, and pain management is a critical component. Patients need to be prepared for the possibility of ongoing pain and the need for pain management strategies postoperatively.
Correct Answer is C
Explanation
Choice A Reason:
A 10 mm wheal is not indicative of TB infection. A wheal is a raised, often itchy area of skin that usually signifies an allergic reaction, not an infection. The TST looks for induration, which is a firm swelling, as a sign of TB infection.
Choice B Reason:
A 5 mm induration is considered positive in certain high-risk groups, such as people living with HIV, recent contacts of TB patients, or those with a history of organ transplants. For individuals without these risk factors, a 5 mm induration is not considered a positive result.
Choice C Reason:
A 15 mm induration is considered a positive TST result for individuals with no known risk factors for TB. This indicates that the person's immune system has reacted to the tuberculin purified protein derivative (PPD) injected under the skin, suggesting exposure to TB bacteria.
Choice D Reason:
Erythema, or redness of the skin, is not measured when interpreting TST results. The test measures induration, which is a palpable, raised, hardened area or swelling. Therefore, a 4 mm erythema does not indicate TB infection.