Nokea
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.
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The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?
- A. Hematuria
- B. Precipitous decrease in serum creatinine levels
- C. Hypotension unresolved by fluid administration
- D. Glucosuria
Correct Answer: A
Rationale: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.
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.
The nurse is caring for a patient who has returned to the postsurgical suite after post-anesthetic recovery from a nephrectomy. The nurses most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurses best response?
- A. Assess the patient for signs of bleeding and inform the physician.
- B. Monitor the patients vital signs every 15 minutes for the next hour.
- C. Reposition the patient and reassess vital signs.
- D. Palpate the patients flanks for pain and inform the physician.
Correct Answer: A
Rationale: Bleeding may be suspected when the patient experiences fatigue and when urine output is less than 30 mL/h. The physician must be made aware of this finding promptly. Palpating the patients flanks would cause intense pain that is of no benefit to assessment.
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.
A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. What should the nurse teach the patient about hemodialysis?
- A. Hemodialysis is a treatment option that is usually required three times a week.
- B. Hemodialysis is a program that will require you to commit to daily treatment.
- C. This will require you to have surgery and a catheter will need to be inserted into your abdomen.
- D. Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again.
Correct Answer: A
Rationale: Hemodialysis is the most commonly used method of dialysis. Patients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.