Nokea
A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication?
- A. Decrease in the blood flow through the kidneys
- B. Obstruction of urine flow from the kidneys
- C. Blood clot formed in the kidneys interfered with the flow
- D. Structural damage occurred in the nephrons of the kidneys
Correct Answer: A
Rationale: Acute kidney injury can be caused by poor perfusion under decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but is not indicated in this client.
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A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead the nurse to support that the client is experiencing rejection?
- A. Hypertension
- B. Weight loss
- C. Polyuria
- D. Tenderness over transplant site
Correct Answer: D
Rationale: Signs and symptoms of transplant rejection include abdominal pain, hypertension, weight gain, oliguria, edema, fever, increased serum creatinine levels, and swelling or tenderness over the transplanted kidney site.
A nephrostomy tube is inserted in a client with a large ureteral calculus. Which is the most important consideration in providing nursing care for this client?
- A. Clamp the tube for no longer than 2 hours at a time.
- B. Maintain free, continuous urine drainage.
- C. Leave nephrostomy site open to the air.
- D. Use only sterile NSS to irrigate the tube.
Correct Answer: B
Rationale: Clamping or kinking of the tube will create backup of urine into the renal pelvis, resulting in hydronephrosis and can contribute to renal damage. Always make sure the urine is allowed to flow continuously and freely and do not irrigate. The nephrostomy tube is inserted through a stab wound and enters the kidney. A sterile dressing should be used to prevent pathogen entry.
The hemodialysis client is scheduled to receive weekly injections of epoetin. Which is the most important consideration to be taken by the nurse in the administration of this medication?
- A. Schedule injection on non-dialysis day.
- B. Administer immediately after dialysis.
- C. Monitor complete blood count percent dose.
- D. Administer with low-dose aspirin to prevent clot formation.
Correct Answer: A
Rationale: After dialysis, do not administer injections for 2 to 4 hours to allow time for the metabolism and excretion of heparin (which is administered during dialysis). Serum laboratory tests are performed on a routine basis to identify normal and abnormal findings. Aspirin use is not indicated with epoetin use.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury?
- A. The kidneys can improve over a period of months.
- B. Once on dialysis, the need will be permanent.
- C. Kidney function will improve with transplant.
- D. Acute kidney injury tends to turn to end-stage failure.
Correct Answer: A
Rationale: The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute kidney injury can progress to chronic renal failure.
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is an appropriate response by the nurse?
- A. Squamous cell carcinomas do not present with detectable symptoms.
- B. You should have sought treatment earlier.
- C. Very few symptoms are associated with renal cancer.
- D. Painless gross hematuria is the first symptom in renal cancer.
Correct Answer: C
Rationale: Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%) whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.