Nokea
The nurse is creating an education plan for a patient who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan?
- A. The importance of increased fluid intake
- B. Signs and symptoms of rejection
- C. Inspection and care of the incision
- D. Techniques for preventing metastasis
Correct Answer: C
Rationale: The nurse teaches the patient to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving, and pain management. There would be no need to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not normally recommended and the patient has minimal control on the future risk for metastasis.
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A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the patients abdomen is increasing in girth. What is the nurses most appropriate action?
- A. Advance the catheter 2 to 4 cm further into the peritoneal cavity.
- B. Reposition the patient to facilitate drainage.
- C. Aspirate from the catheter using a 60-mL syringe.
- D. Infuse 50 mL of additional dialysate.
Correct Answer: B
Rationale: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate.
The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorus-binding medication at what time?
- A. Only when needed
- B. Daily at bedtime
- C. First thing in the morning
- D. With each meal
Correct Answer: D
Rationale: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be administered with food to be effective.
The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?
- A. Hypernatremia
- B. Hypomagnesemia
- C. Hyperkalemia
- D. Hypercalcemia
Correct Answer: C
Rationale: Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.
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.
The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem?
- A. Hematuria
- B. Precipitous decrease in serum creatinine levels
- C. Hypotension unresolved by fluid administration
- D. Glucosuria
Correct Answer: A
Rationale: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.