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The critical care nurse is monitoring the patients urine output and drains following renal surgery. What should the nurse promptly report to the physician?
- A. Increased pain on movement
- B. Absence of drain output
- C. Increased urine output
- D. Blood-tinged serosanguineous drain output
Correct Answer: B
Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported to the physician because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected.
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A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m^2. Based on this GFR, the nurse interprets that the patients chronic kidney disease is at what stage?
- A. Stage 1
- B. Stage 2
- C. Stage 3
- D. Stage 4
Correct Answer: C
Rationale: Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m^2. This is considered a moderate decrease in GFR.
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.
Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it?
- A. Heart failure
- B. Glomerulonephritis
- C. Ureterolithiasis
- D. Aminoglycoside toxicity
Correct Answer: A
Rationale: By causing inadequate renal perfusion, heart failure can lead to prerenal failure. Glomerulonephritis and aminoglycoside toxicity are renal causes, and ureterolithiasis is a postrenal cause.
The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD?
- A. A patient with a history of polycystic kidney disease
- B. A patient with diabetes mellitus and poorly controlled hypertension
- C. A patient who is morbidly obese with a history of vascular disorders
- D. A patient with severe chronic obstructive pulmonary disease
Correct Answer: B
Rationale: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A patient with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the patient with diabetes and hypertension is likely at highest risk for ESKD.
The nurse has identified the nursing diagnosis of risk for infection in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk?
- A. Maintain aseptic technique when administering dialysate.
- B. Wash the skin surrounding the catheter site with soap and water prior to each exchange.
- C. Add antibiotics to the dialysate as ordered.
- D. Administer prophylactic antibiotics by mouth or IV as ordered.
Correct Answer: A
Rationale: Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.