Nokea
A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?
- A. Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.
- B. Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this patient.
- C. A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary.
- D. There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.
Correct Answer: A
Rationale: Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.
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The nurse is creating an education plan for a patient who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan?
- A. The importance of increased fluid intake
- B. Signs and symptoms of rejection
- C. Inspection and care of the incision
- D. Techniques for preventing metastasis
Correct Answer: C
Rationale: The nurse teaches the patient to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving, and pain management. There would be no need to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not normally recommended and the patient has minimal control on the future risk for metastasis.
The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?
- A. A vein and an artery in your arm will be attached surgically.
- B. The arm should be immobilized for 4 to 6 days.
- C. One needle will be inserted into the fistula for each dialysis treatment.
- D. The fistula can be used 2 days after the surgery for dialysis treatment.
Correct Answer: A
Rationale: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need time, usually 2 to 3 months, to mature before it can be used. The patient is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.
An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment. The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patient may contribute to AKI? Select all that apply.
- A. Anxiety
- B. Low BMI
- C. Age-related physiologic changes
- D. Chronic systemic disease
- E. NPO status
Correct Answer: C,D
Rationale: Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney dysfunction and renal failure. In addition, the presence of chronic, systemic diseases increases the risk of AKI. Low BMI and anxiety are not risk factors for acute renal disease. NPO status is not a risk, provided adequate parenteral hydration is administered.
The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.
- A. Percuss for pain in the right lower abdominal quadrant.
- B. Assess for the presence of peripheral edema.
- C. Auscultate the patients apical heart rate for dysrhythmias.
- D. Assess the patients BP.
- E. Assess the patients orientation and judgment.
Correct Answer: B,D
Rationale: Most patients with acute glomerular inflammation have some degree of edema and hypertension. Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations of acute glomerular inflammation.
The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient?
- A. Using a stethoscope for auscultating the fistula is contraindicated.
- B. The patient feels best immediately after the dialysis treatment.
- C. Taking a BP reading on the affected arm can damage the fistula.
- D. The patient should not feel pain during initiation of dialysis.
Correct Answer: C
Rationale: When blood flow is reduced through the access for any reason (hypotension, application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful.