Nokea
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client?
- A. Urine output of 35 to 40 ml/hour
- B. Pain of 3 out of 10, 1 hour after analgesic administration
- C. SpO2 at 90% with fine crackles in the lung bases
- D. Blood tinged drainage in Jackson-Pratt drainage tube
Correct Answer: C
Rationale: Altered Breathing Pattern and Ineffective Airway Clearance Risk are often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output are monitored to maintain a urine output of greater than 30 ml/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.
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An investment banker with chronic kidney disease informs the nurse of the choice for continuous ambulatory peritoneal dialysis. Which is the best response by the nurse?
- A. The risk of peritonitis is greater with this type of dialysis.
- B. This type of dialysis will provide more independence.
- C. Peritoneal dialysis will require more work for you.
- D. Peritoneal dialysis does not work well for every client.
Correct Answer: B
Rationale: Once a treatment has been selected by the client, the nurse should support the client in that decision. Continuous ambulatory peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as a part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.
A client with chronic kidney disease complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
- A. Elevated serum creatinine
- B. Hyperkalemia
- C. Hyperphosphatemia
- D. Elevated urea and nitrogen
Correct Answer: C
Rationale: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the appropriate response by the nurse?
- A. Even a perfect match does not guarantee organ success.
- B. Immunosuppressive drugs guarantee organ success.
- C. The doctor may decide to delay the use of immunosuppressant drugs.
- D. Let's wait until after the surgery to discuss your treatment plan.
Correct Answer: A
Rationale: Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury?
- A. The kidneys can improve over a period of months.
- B. Once on dialysis, the need will be permanent.
- C. Kidney function will improve with transplant.
- D. Acute kidney injury tends to turn to end-stage failure.
Correct Answer: A
Rationale: The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute kidney injury can progress to chronic renal failure.
The client with chronic kidney disease is exhibiting signs of anemia. Which is the best nursing rationale for this symptom?
- A. Azotemia
- B. Diminished erythropoietin production
- C. Impaired immunologic response
- D. Electrolyte imbalances
Correct Answer: B
Rationale: Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic kidney disease but not indicated with anemia.