You suspect kidney transplant rejection when the patient shows which symptoms?
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Solution
Fever, weight gain, and diminished urine output
Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft site, peripheral edema, and diminished urine output.
You’re developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this patient is to:
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Solution
Remain afebrile and have negative cultures
The immunosuppressive activity of cyclosporine places the patient at risk for infection, and steroids can mask the signs of infection. The patient may not be able to resume normal fluid intake or return to work for an extended period of time and the patient may need cyclosporine therapy for life.
A patient who received a kidney transplant returns for a follow-up visit to the outpatient clinic and reports a lump in her breast. Transplant recipients are:
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Solution
At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral)
Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors.
Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is:
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Solution
Check the patient’s latest potassium level
The patient with ESRD may develop arrhythmias caused by hypokalemia.
Option A: Call the doctor after checking the patient’s potassium values.
Option B: Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.
What is the most important nursing diagnosis for a patient in end-stage renal disease?
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Solution
Fluid volume excess
Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.
You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi?
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Solution
Increased calcium loss from the bones
Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones form calculi, a concentration of mineral salts also known as a stone, in the renal system.
What is the best way to check for patency of the arteriovenous fistula for hemodialysis?
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Solution
Palpate the fistula throughout its length to assess for a thrill
The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow. Pinching the fistula could cause damage. Aspirating blood is a needless invasive procedure.
A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient’s diet?
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Solution
Protein
Because of damage to the nephrons, the kidney can’t excrete all the metabolic wastes of protein, so this patient’s protein intake must be restricted.
Options A, B, and D: A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient’s tissues.
Which action is most important during bladder training in a patient with a neurogenic bladder?
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Solution
Set up specific times to empty the bladder
Instruct the patient with neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day.
After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated?
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Solution
Disequilibrium syndrome
Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can diffuse from the body’s cells into the vascular system.