Nokea
The nurse is taking a history for a patient who is a possible candidate for a kidney transplant. Which of the following information indicates that the patient is not an appropriate candidate for transplantation?
- A. The patient has metastatic lung cancer.
- B. The patient has poorly controlled type diabetes.
- C. The patient has a history of persistent hepatitis C infection.
- D. The patient is infected with the human immunodeficiency virus.
Correct Answer: A
Rationale: Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.
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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 with severe heart failure who develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet which of the following goals of treatment?
- A. Replace fluid volume
- B. Prevent hypertension.
- C. Maintain cardiac output.
- D. Dilute nephrotoxic substances.
Correct Answer: C
Rationale: The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.
The nurse is caring for a patient who has been admitted with a severe crush injury after an industrial accident. Which of the following laboratory results is most important to report to the health care provider?
- A. Serum creatinine level 190 mcmol/L.
- B. Serum potassium level 6.5 mcmol/L.
- C. White blood cell count 11.5 x 10^9/L.
- D. Blood urea nitrogen (BUN) 18 mmol/L.
Correct Answer: B
Rationale: The hyperkalemia associated with crush injuries may cause life-threatening cardiac arrhythmias leading to cardiac arrest and should be treated immediately. The nurse will also report the other laboratory values, but abnormalities in these are not immediately life-threatening.
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 a history of benign prostatic hyperplasia (BPH) with acute urinary retention and an elevated blood urea nitrogen (BUN) and creatinine. Which of the following prescribed therapies should the nurse implement first?
- A. Obtain renal ultrasound.
- B. Insert retention catheter.
- C. Infuse normal saline at 50 mL/hour.
- D. Draw blood for complete blood count.
Correct Answer: B
Rationale: The patient's elevation in BUN and creatinine is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate but should be implemented after the retention catheter.