A patient with acute kidney injury (AKI) has longer QRS intervals ...

[notis]

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first?
 
  a. Notify the patient's health care provider.
  b. Document the QRS interval measurement.
  c. Check the medical record for most recent potassium level.
  d. Check the chart for the patient's current creatinine level.

Question 2

A 25-year-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider?
 
  a. Serum creatinine level 2.1 mg/dL
  b. Serum potassium level 6.5 mEq/L
  c. White blood cell count 11,500/L
  d. Blood urea nitrogen (BUN) 56 mg/dL

[dpost18]

Answer to Question 1

ANS: C
The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening dysrhythmias.

Answer to Question 2

ANS: B
The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse also will report the other laboratory values, but abnormalities in these are not immediately life threatening.