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:
Hemodialysis does not typically result in a significant decrease in RBC count. While there can be a minimal loss of red blood cells during the process, it is not the primary focus of the treatment. The main purpose of hemodialysis is to remove waste products and excess fluid from the blood when the kidneys are not functioning properly.
Choice B reason:
Calcium levels may vary during hemodialysis, and the treatment can be adjusted to prevent significant changes in calcium levels. Hemodialysis can remove some calcium from the blood, but it is usually not the most affected value, and calcium can be added to the dialysate solution if necessary.
Choice C reason:
Potassium is one of the primary electrolytes removed during hemodialysis. High levels of potassium, which can be life-threatening, are commonly seen in clients with renal failure. Hemodialysis effectively reduces high potassium levels, which is crucial for preventing complications such as cardiac arrhythmias.
Choice D reason:
Protein levels are not directly targeted by hemodialysis, and significant protein loss is not a usual outcome of the treatment. The dialysis membrane is designed to allow smaller molecules like urea and potassium to pass through while retaining larger molecules like proteins.
Correct Answer is A
Explanation
Choice A reason:
Difficulty with abduction of the arm at the shoulder is a common finding in clients with a rotator cuff injury. The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint and facilitate its movement. When these muscles or tendons are injured, movements such as lifting the arm away from the body (abduction) can become painful and difficult.
Choice B reason:
Alteration in the contour of the joint is not typically associated with a rotator cuff injury. This finding is more indicative of conditions that cause changes in the bone structure, such as arthritis or dislocation.
Choice C reason:
A positive Tinel's sign is used to diagnose nerve compression or nerve damage, particularly in conditions like carpal tunnel syndrome. It is not a test used to assess rotator cuff injuries.
Choice D reason:
A negative drop arm test would suggest that the client does not have a rotator cuff injury. The drop arm test is performed by having the client lift the arm to 90 degrees and then slowly lower it. If the client can control the motion and lower the arm smoothly, the test is negative. A positive drop arm test, where the client cannot control the descent of the arm, would indicate a rotator cuff injury.