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 D
Explanation
Choice A reason:
Venous thromboembolism (VTE) is a condition where blood clots form in the deep veins, usually in the legs. While VTE is a risk following trauma and immobilization, the acute onset of shortness of breath and chest pain is less typical for VTE, which more commonly presents with leg pain and swelling.
Choice B reason:
Hypovolemic shock occurs due to significant blood or fluid loss, leading to decreased blood volume and inadequate circulation. While it can result from a motor-vehicle crash, the client's symptoms of shortness of breath and chest pain are not the most indicative of hypovolemic shock, which typically presents with rapid pulse, low blood pressure, and cold, clammy skin.
Choice C reason:
Compartment syndrome is a surgical emergency where increased pressure within the muscle compartments impairs circulation and nerve function. It presents with severe pain, swelling, and sometimes paralysis of the affected limb, but it does not typically cause shortness of breath or chest pain.
Choice D reason:
Fat embolism syndrome (FES) is a serious complication that can occur after long bone fractures. Fat globules may enter the bloodstream and travel to the lungs, leading to respiratory distress, which can manifest as shortness of breath and chest pain. FES can also cause neurological symptoms and a petechial rash. Given the client's symptoms and recent trauma, FES is a likely complication and requires immediate assessment and intervention.
Correct Answer is B
Explanation
Choice A reason:
Venous insufficiency can contribute to the development of chronic wounds, particularly in the lower extremities. It is characterized by the inability of the veins to adequately return blood from the legs back to the heart, which can lead to pooling of blood and increased pressure in the veins. This can cause skin changes and ulcers, particularly around the ankles.
Choice B reason:
Malnutrition is indeed a systemic cause of chronic wounds. Adequate nutrition is essential for wound healing, as it provides the necessary proteins, vitamins, and minerals that play a crucial role in the repair process. Protein-energy malnutrition, deficiencies in vitamins C and D, zinc, and other nutrients can impair wound healing and lead to chronic wounds.
Choice C reason:
Infection is typically a local rather than a systemic cause of chronic wounds. While systemic infections can affect wound healing, local wound infections are more directly responsible for delayed healing and the chronicity of wounds. Bacteria can colonize the wound and impede the healing process, leading to a chronic wound.
Choice D reason:
Continued pressure, much like infection, is generally a local cause of chronic wounds. It is most commonly associated with the development of pressure ulcers in individuals who are bedridden or have limited mobility. The constant pressure on certain areas of the body can lead to tissue ischemia and necrosis, resulting in a chronic wound.