34. Following a cardiac catheterization for recurrent angina, a 76-year-old client with a history of hypertension and type 2 diabetes, has had no urine output since the catheterization 16 hours before. Laboratory results revealed: Na+ 134 mEq/L, Cl– 96 mEq/L, K+ 6.4 mEq/L, BUN 71 mg/dL, and creatinine 4.0 mg/dL. Which factors are most likely contributing to this client's condition? Select all that apply.
. IV 0.45% NS at 125 mL/hr
. Prophylactic tobramycin (Nebcin) given during the procedure.
. Client age.
. Possible history of renal insufficiency.
. Recurrent angina.
. Risk of cardiac catheterization.
Test-Taking Tip
Select options that are contraindicated—what would make the client worse?
Content Area: Geriatric, Renal; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
. . . .
Answer 1 is incorrect because IV hydration is known to prevent renal damage from the contrast medium that was used during the catheterization. Answer 2 is correct because the client is likely to have decreased renal function because of hypertension and diabetes. Aminoglycoside antibiotics are known to be nephrotoxic. Answer 3 is correct because the glomerular filtration rate decreases with advancing age and may be a contributing factor to the elevated creatinine level. Answer 4 is correct because the client has hypertension and diabetes, which increase the risk of impaired renal function as indicated by the elevated creatinine and blood urea nitrogen (BUN) levels. Answer 5 is incorrect because angina is not contributing to the renal dysfunction. Answer 6 is correct because the contrast medium used during cardiac catheterization is nephrotoxic.