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Difficulty: MediumReduction of Risk Potential

An older adult client with type 2 diabetes mellitus is scheduled to undergo a computed tomography (CT) scan of the abdomen with intravenous contrast in two hours. The practical nurse is reviewing the client's morning laboratory results, which reveal a serum creatinine level of 2.2 mg/dL2.2\ \text{mg/dL} (194 μmol/L194\ \mu\text{mol/L}) and a blood urea nitrogen (BUN) of 35 mg/dL35\ \text{mg/dL} (12.5 mmol/L12.5\ \text{mmol/L}). What is the priority action for the practical nurse?

  1. Report the abnormal renal function tests to the supervising registered nurse or provider immediately.Answer
  2. B
    Enter the laboratory values into the pre-procedure checklist and continue preparing the client.
  3. C
    Administer the client's scheduled morning dose of metformin to maintain glycemic control.
  4. D
    Assess the client's baseline blood pressure and heart rate to verify hemodynamic stability.

Answer

The priority action is to immediately report the abnormal renal function tests to the supervising registered nurse or provider.
The correct answer is to report the abnormal laboratory results. A serum creatinine of 2.2 mg/dL2.2\ \text{mg/dL} indicates significantly impaired renal function. Intravenous contrast is nephrotoxic and can cause permanent kidney damage if administered to a client with an already elevated creatinine level. The provider must be notified immediately so the procedure can be canceled, postponed, or performed without contrast.

Step-by-Step Solution

1
Identify the planned procedure and its associated risks.
The client is scheduled for a CT scan with intravenous contrast, which is known to be nephrotoxic.
Understanding the nature of the procedure is essential for identifying potential complications.
2
Analyze the provided laboratory data.
The serum creatinine (2.2 mg/dL2.2\ \text{mg/dL}) and BUN (35 mg/dL35\ \text{mg/dL}) are significantly elevated.
Elevated creatinine and BUN indicate impaired renal function or acute kidney injury.
3
Synthesize the data to determine the clinical risk.
Administering IV contrast to a client with existing renal impairment places them at high risk for contrast-induced nephropathy. Furthermore, the client takes metformin for diabetes, which increases the risk of lactic acidosis if given alongside contrast.
Connecting the client's underlying condition and laboratory values to the procedural risks guides safe nursing practice.
4
Select the appropriate nursing intervention within the practical nurse scope of practice.
The practical nurse must immediately notify the registered nurse or healthcare provider to halt the procedure and re-evaluate the plan of care.
Timely escalation of critical findings is a primary responsibility to prevent adverse client outcomes.

Key Concept

Prevention of Contrast-Induced Nephropathy
Estimated Time:1m 0s
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Topics

Reduction of Risk Potential

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