Nokea
The nurse is caring for a patient with acute kidney injury who is dehydrated with symptoms of oliguria, anemia, and hyperkalemia. Which of the following prescribed actions should the nurse take first?
- A. Insert a urinary retention catheter.
- B. Place the patient on a cardiac monitor.
- C. Administer an erythropoiesis-stimulating agent (ESA).
- D. Give sodium polystyrene sulfonate.
Correct Answer: B
Rationale: Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. ESA's will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.
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Which of the following information is most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?
- A. Blood urea nitrogen (BUN) level
- B. Urine output
- C. Creatinine level
- D. Calculated glomerular filtration rate (GFR)
Correct Answer: D
Rationale: GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.
The nurse is caring for a patient in the oliguric phase of acute renal failure who has a 24-hour fluid output of 150 mL emesis and 250 mL urine. Which of the following amounts in mL should the nurse plan a fluid replacement for the following day?
- A. 400
- B. 800
- C. 1000
- D. 1400
Correct Answer: C
Rationale: Usually fluid replacement should be based on the patient's measured output plus 600 mL/day for insensible losses.
Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider?
- A. The urine output is 900-1100 mL/hour.
- B. The blood urea nitrogen (BUN) and creatinine levels are elevated.
- C. The patient's central venous pressure (CVP) is decreased.
- D. The patient has level 8 (on a 10-point scale) incisional pain.
Correct Answer: C
Rationale: The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.
The nurse is caring for a patient with acute kidney injury (AKI) who requires hemodialysis and a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which of the following interventions should be included in the plan of care?
- A. Place the patient on bed rest.
- B. Start continuous pulse oximetry.
- C. Discontinue the urinary catheter.
- D. Restrict the patient's oral protein intake.
Correct Answer: A
Rationale: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The urinary catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.
The nurse is caring for a patient who has had an insertion of an arteriovenous graft (AVG) in the right forearm and has symptoms of pain and coldness of the right fingers. Which of the following actions should the nurse take?
- A. Elevate the patient's arm above the level of the heart.
- B. Report the patient's symptoms to the health care provider.
- C. Remind the patient about the need to take a daily low-dose Aspirin tablet.
- D. Educate the patient about the normal vascular response after AVG insertion.
Correct Answer: B
Rationale: The patient's complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.