Nokea
A 71-year-old patient with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make?
- A. The decision is certainly yours to make, but be sure not to make a mistake.
- B. Kidney transplants in patients your age are as successful as they are in younger patients.
- C. I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare.
- D. Have you talked this over with your family?
Correct Answer: B
Rationale: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the elderly. However, the outcome is comparable to that of younger patients. The other listed options either belittle the patient or give the patient misinformation.
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The nurse is caring for a patient status after a motor vehicle accident. The patient has developed AKI. What is the nurses role in caring for this patient? Select all that apply.
- A. Providing emotional support for the family
- B. Monitoring for complications
- C. Participating in emergency treatment of fluid and electrolyte imbalances
- D. Providing nursing care for primary disorder (trauma)
- E. Directing nutritional interventions
Correct Answer: A,B,C,D
Rationale: The nurse has an important role in caring for the patient with AKI. The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances, assesses the patients progress and response to treatment, and provides physical and emotional support. Additionally, the nurse keeps family members informed about the patients condition, helps them understand the treatments, and provides psychological support. Although the development of AKI may be the most serious problem, the nurse continues to provide nursing care indicated for the primary disorder (e.g., burns, shock, trauma, obstruction of the urinary tract). The nurse does not direct the patients nutritional status; the dietician and the physician normally collaborate on directing the patients nutritional status.
A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurses most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurses most appropriate response?
- A. Assess the patient for further signs or symptoms of rejection.
- B. Recognize this as an expected finding.
- C. Inform the primary care provider of this finding.
- D. Administer exogenous antidiuretic hormone as ordered.
Correct Answer: B
Rationale: A kidney from a living donor related to the patient usually begins to function immediately after surgery and may produce large quantities of dilute urine. This is not suggestive of rejection and treatment is not warranted. There is no obvious need to report this finding.
A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment finding?
- A. Imbalanced nutrition: More than body requirements
- B. Excess fluid volume
- C. Sedentary lifestyle
- D. Adult failure to thrive
Correct Answer: B
Rationale: If the patient with AKI gains or does not lose weight, fluid retention should be suspected. Short-term weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not associated with weight gain.
A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?
- A. Monitor the patients electrolyte values every hour before the procedure.
- B. Preprocedure hydration and administration of acetylcysteine
- C. Hemodialysis immediately prior to the CT scan
- D. Obtain a creatinine clearance by collecting a 24-hour urine specimen.
Correct Answer: B
Rationale: Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The nurse would not monitor the patients electrolytes every hour preprocedure. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.
The nurse performing the health interview of a patient with a new onset of periorbital edema has completed a genogram, noting the health history of the patients siblings, parents, and grandparents. This assessment addresses the patients risk of what kidney disorder?
- A. Nephritic syndrome
- B. Acute glomerulonephritis
- C. Nephrotic syndrome
- D. Polycystic kidney disease (PKD)
Correct Answer: D
Rationale: PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.