Nokea
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.
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The hemodialysis client is scheduled to receive weekly injections of epoetin. Which is the most important consideration to be taken by the nurse in the administration of this medication?
- A. Schedule injection on non-dialysis day.
- B. Administer immediately after dialysis.
- C. Monitor complete blood count percent dose.
- D. Administer with low-dose aspirin to prevent clot formation.
Correct Answer: A
Rationale: After dialysis, do not administer injections for 2 to 4 hours to allow time for the metabolism and excretion of heparin (which is administered during dialysis). Serum laboratory tests are performed on a routine basis to identify normal and abnormal findings. Aspirin use is not indicated with epoetin use.
A nephrostomy tube is inserted in a client with a large ureteral calculus. Which is the most important consideration in providing nursing care for this client?
- A. Clamp the tube for no longer than 2 hours at a time.
- B. Maintain free, continuous urine drainage.
- C. Leave nephrostomy site open to the air.
- D. Use only sterile NSS to irrigate the tube.
Correct Answer: B
Rationale: Clamping or kinking of the tube will create backup of urine into the renal pelvis, resulting in hydronephrosis and can contribute to renal damage. Always make sure the urine is allowed to flow continuously and freely and do not irrigate. The nephrostomy tube is inserted through a stab wound and enters the kidney. A sterile dressing should be used to prevent pathogen entry.
A client is administered dialystate solution through an abdominal catheter. The nurse notices that the return flow rate is slow, so the nurse advises the client to move to the other side. However, even after changing the client's position, the nurse does not observe an increase in return flow. Which of the following actions should the nurse perform to help accelerate the return flow rate?
- A. Disconnect the catheter and repay.
- B. Loosen the tubing clamp.
- C. Inform the physician that catheter may need repositioning.
- D. Stop the process for 5 minutes and resume later.
Correct Answer: C
Rationale: The nurse instills dialystate solution and clamps the tubing. If the return flow rate is slow, the nurse asks the client to move from side to side. If this maneuver is unsuccessful, the physician may need to reposition the catheter. The nurse should not tamper with the catheter settings because this may worsen the client's condition or damage the apparatus. Also, stopping the process and resuming it after 5 minutes will not help increase the return flow of the dialystate.
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.
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is an appropriate response by the nurse?
- A. Squamous cell carcinomas do not present with detectable symptoms.
- B. You should have sought treatment earlier.
- C. Very few symptoms are associated with renal cancer.
- D. Painless gross hematuria is the first symptom in renal cancer.
Correct Answer: C
Rationale: Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%) whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.