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 B
Explanation
Choice A reason:
In primary hypothyroidism, the thyroid gland is underactive and does not produce sufficient thyroid hormones, including Free T4. Therefore, we would not expect an elevation of Free T4 in primary hypothyroidism; instead, its levels would typically be low or normal.
Choice B reason:
Thyroid-stimulating hormone (TSH) levels are elevated in primary hypothyroidism because the pituitary gland releases more TSH in an attempt to stimulate the thyroid gland to produce more thyroid hormones. This is a compensatory response to the low levels of circulating thyroid hormones, particularly thyroxine (T4).
Choice C reason:
Serum T3 levels may be low or normal in primary hypothyroidism. T3 is the active form of thyroid hormone and is usually converted from T4. If T4 levels are low, T3 levels may also be affected; however, T3 levels are not the primary diagnostic marker for hypothyroidism and do not typically show elevation in this condition.
Choice D reason:
Serum T4 levels are typically low in primary hypothyroidism because the thyroid gland is not producing enough of this hormone. An elevation of serum T4 would not be expected unless the patient is receiving treatment for hypothyroidism.
Correct Answer is C
Explanation
Choice A reason: Hypotension
Hypotension, or low blood pressure, can be a consequence of dehydration, which is a common complication of DI due to the excessive loss of water. However, hypotension is not a direct neurological effect of DI. It is more of a circulatory system response to the changes in fluid volume within the body.
Choice B reason: Poor skin turgor
Poor skin turgor is an indicator of dehydration, which can occur in DI due to the large volume of urine excreted. Skin turgor refers to the skin's ability to change shape and return to normal (elasticity), and it becomes less elastic when the body is dehydrated. While this is an important sign to monitor, it is not a neurological effect.
Choice C reason: Ataxia
Ataxia, which is a lack of muscle coordination affecting speech, eye movements, the ability to swallow, walking, picking up objects, and other voluntary movements, can be a neurological effect of DI if severe dehydration and electrolyte imbalance affect the brain. Symptoms such as confusion and muscle cramps can also be associated with ataxia, making it a relevant neurological effect to monitor in a client with DI.
Choice D reason: Dilute urine
Dilute urine is a primary symptom of DI, not a neurological effect. It is the result of the kidneys' inability to concentrate urine due to a deficiency in the anti-diuretic hormone (ADH) or the kidneys' response to ADH. Monitoring urine concentration is crucial in managing DI, but it does not represent a neurological effect.