RN Nursing · Acute Kidney Injury · Practice question
A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of an acute kidney injury. Which of the following findings should the nurse identify as indicating an increased risk of acute kidney injury (AKI)?
-
Blood urea nitrogen (BUN) 20mg/dL.
-
Serum Osmolality 290 mOsm/kg H2O
-
Magnesium 2.0 mEq/L
-
✓
Serum creatinine 1.8 mg/dL
Answer & explanation
Correct: Serum creatinine 1.8 mg/dL
Serum creatinine of 1.8 mg/dL is elevated above the normal range for an older adult female, which is approximately 0.5 to 1.1 mg/dL. Creatinine is a waste product filtered exclusively by the kidneys, so rising creatinine levels directly reflect declining glomerular filtration rate. After a myocardial infarction, reduced cardiac output can cause decreased renal perfusion, leading to prerenal or intrinsic acute kidney injury. A creatinine of 1.8 mg/dL in this context is a classic early indicator of AKI and warrants immediate concern. The blood urea nitrogen value of 20 mg/dL falls within the normal range of 10 to 20 mg/dL and does not independently signal AKI. Serum osmolality of 290 mOsm/kg H2O is within the normal range of 285 to 295 mOsm/kg H2O and does not indicate renal impairment. A magnesium level of 2.0 mEq/L is within the normal range of 1.5 to 2.5 mEq/L and is not a marker of AKI. Students sometimes mistake BUN elevation alone as diagnostic for AKI, but BUN can be elevated for many non-renal reasons including dehydration or high protein intake. Creatinine is the more specific and sensitive indicator of renal function, particularly when it is elevated above normal reference values for the client's age and sex.
Study note
Acute Kidney Injury (AKI): A Nursing Guide
What AKI is, the prerenal/intrarenal/postrenal categories, and the nursing priorities — including the complication that can kill fastest.
Read the study note →Practise Acute Kidney Injury questions
Work through full question sets with instant rationales, timed exams, and progress tracking.
Start practising freeRelated practice questions
- A nurse is caring for a client being treated with IV vancomycin for a severe MRSA infection. Over the past 24 hours, the client's urine output has dropped to 20 ml/hr, and their creatinine has increased from 0.9 to 2.3 mg/dL. The provider suspects acute kidney injury related to the medication. This type of renal failure is classified as:
- A nurse is caring for a client with acute kidney injury whose serum potassium level is 6.5 mEq/L. The client reports mild nausea and tingling in the hands. Telemetry shows peaked T waves. Based on these findings, the nurse should monitor the client most closely for which life-threatening complication?
- A patient is experiencing renal failure and develops a K+ level of 7.2. The nurse anticipates the administration of which of the following? (Select all that apply)
- A nurse is caring for a client in the intensive care unit. Select from the choices below to specify what condition the client is most likely experiencing ____, 2 actions the nurse should take to address that condition ____ and ____, and 2 parameters the nurse should monitor to assess the client's progress ____ and ____.