Nokea
The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula?
- A. A vein and an artery in your arm will be attached surgically.
- B. The arm should be immobilized for 4 to 6 days.
- C. One needle will be inserted into the fistula for each dialysis treatment.
- D. The fistula can be used 2 days after the surgery for dialysis treatment.
Correct Answer: A
Rationale: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need time, usually 2 to 3 months, to mature before it can be used. The patient is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.
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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.
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.
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.
A patient is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the patient develops acute kidney injury. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patients hypervolemia and hyperkalemia. Which of the following therapies will the patients hemodynamic status best tolerate?
- A. Hemodialysis
- B. Peritoneal dialysis
- C. Continuous venovenous hemodialysis (CVVHD)
- D. Plasmapheresis
Correct Answer: C
Rationale: CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable patient. Peritoneal dialysis is not the best choice, as the patient may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.
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.