Which information about a patient with Goodpasture syndrome requires the most rapid action by the nurse?
a. Blood urea nitrogen level is 70 mg/dL.
b. Urine output over the last 2 hours is 30 mL.
c. Audible crackles bilaterally over the posterior chest to the midscapular level.
d. Elevated level of antiglomerular basement membrane (anti-GBM) antibodies.
ANS: C
Crackles heard to a high level indicate a need for rapid actions such as assessment of oxygen saturation, reporting the findings to the health care provider, initiating oxygen therapy, and dialysis. The other findings will also be reported, but are typical of Goodpasture syndrome and do not require immediate nursing action.
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