Nokea
A patient on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurses care of this patient?
- A. The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life.
- B. The patients disease is incurable and the nurses interventions will be supportive.
- C. The patient will eventually require surgical removal of his or her renal cysts.
- D. The patient is likely to respond favorably to lithotripsy treatment of the cysts.
Correct Answer: B
Rationale: PKD is incurable and care focuses on support and symptom control. It is not self-limiting and is not treated surgically or with lithotripsy.
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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 nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the patient for what complication during this phase?
- A. Hypokalemia
- B. Hypocalcemia
- C. Dehydration
- D. Acute flank pain
Correct Answer: C
Rationale: The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The patient must be observed closely for dehydration during this phase; if dehydration occurs, the uremic symptoms are likely to increase. Excessive losses of potassium and calcium are not typical during this phase, and diuresis does not normally result in pain.
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 is caring for acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)?
- A. The patient is complains of an inability to initiate voiding.
- B. The patients urine is cloudy with a foul odor.
- C. The patients average urine output has been 10 mL/hr for several hours.
- D. The patient complains of acute flank pain.
Correct Answer: C
Rationale: Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.
The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should the nurse evaluate?
- A. Oral intake
- B. Pain intensity
- C. Level of consciousness
- D. Radiation of pain
Correct Answer: C
Rationale: Bleeding is a major complication of kidney surgery. If undetected and untreated, this can result in hypovolemia and hemorrhagic shock. The nurses role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.