Nokea
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.
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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 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.
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 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.
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.