Immunosuppression following Kidney transplantation is continued:
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Solution
For life.
Your patient has complaints of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi?
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Solution
Dark, scanty urine output
Patients with renal calculi commonly have blood in the urine caused by the stone’s passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.
Polystyrene sulfonate (Kayexalate) is used in renal failure to:
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Solution
Exchange potassium for sodium
In renal failure, patients become hyperkalemic because they can’t excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium.
Which criterion is required before a patient can be considered for continuous peritoneal dialysis?
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Solution
The patient must be hemodynamically stable
Hemodynamic stability must be established before continuous peritoneal dialysis can be started.
Which statement correctly distinguishes renal failure from prerenal failure?
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Solution
With prerenal failure, an IV isotonic saline infusion increases urine output
Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase blood pressure in both conditions.
What change indicates recovery in a patient with nephritic syndrome?
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Solution
Disappearance of protein from the urine
With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more porous, leading to loss of protein in the urine. As the patient recovers, less protein is found in the urine.
You’re preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority?
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Solution
Delay catheterization and notify the doctor
Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor.
A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120ml. The drainage system has no obstructions. Which intervention has priority?
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Solution
Evaluate the patient’s circulation and vital signs
A total UO of 120ml is too low. Assess the patient’s circulation and hemodynamic stability for signs of hypovolemia. A fluid bolus may be required, but only after further nursing assessment and a doctor’s order.
Which cause of hypertension is the most common in acute renal failure?
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Solution
Hypervolemia
Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of renin. Therefore, hypervolemia causes hypertension.
Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure?
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Solution
Oliguria
Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.