A nurse in the med-surgical ICU is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?

Hyperkalemia.

Increased glomerular filtration rate (GFR).

Decreased creatinine level.

Hypovolemia.

Answer and Explanation

The Correct Answer is A

Choice A reason: Hyperkalemia is a common finding in the oliguric phase of acute kidney injury due to reduced excretion of potassium by the kidneys. This electrolyte imbalance can have serious cardiac effects and should be expected and monitored in these patients.

Choice B reason: An increased glomerular filtration rate (GFR) would not be expected in the oliguric phase of acute kidney injury. Typically, GFR is decreased due to reduced kidney function during this phase.

Choice C reason: Decreased creatinine levels are not expected in acute kidney injury. Creatinine levels usually increase as kidney function declines and the body cannot adequately filter waste.

Choice D reason: Hypovolemia is not typically expected in the oliguric phase of acute kidney injury, as oliguria (reduced urine output) often indicates fluid retention rather than fluid loss.

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Correct Answer is A

Explanation

Choice A reason: A headache is a common and expected side effect of nitroglycerin. Nitroglycerin causes vasodilation, which can lead to increased blood flow to the head and result in headaches. It is important to inform the client that this is a known side effect and to manage it with appropriate measures, such as taking analgesics.

Choice B reason: An allergic reaction to nitroglycerin would typically present with symptoms such as rash, itching, swelling, or difficulty breathing. A headache alone does not indicate an allergic reaction.

Choice C reason: A headache does not mean the medication should not be used again. It is a common side effect, and the benefits of nitroglycerin in relieving chest pain usually outweigh the discomfort of the headache. The nurse should educate the client on managing the headache while continuing the medication.

Choice D reason: A headache is not an indication of a worsening cardiac condition. It is a common side effect of the vasodilatory effects of nitroglycerin.

A. "You will not need any special treatment after surgery." B. "You will need to undergo chemotherapy after surgery." C. "You will need to wear an abdominal binder after surgery." D. "You will need to take daily hormone replacement medications after surgery."

Correct Answer is D

Explanation

Choice A reason: Telling the client they will not need any special treatment after surgery is inaccurate. Bilateral adrenalectomy results in the removal of both adrenal glands, which produce essential hormones.

Choice B reason: Chemotherapy is not a standard post-surgical treatment for an adrenalectomy unless there is a specific indication. This statement may cause unnecessary concern for the client.

Choice C reason: An abdominal binder is not typically required after a bilateral adrenalectomy. This information is not relevant to the client's post-surgical needs.

Choice D reason: After a bilateral adrenalectomy, the client will need daily hormone replacement medications for life, as the adrenal glands are responsible for producing essential hormones like cortisol and aldosterone

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A nurse in the med-surgical ICU is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?

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Naxlex Comprehensive Predictor Exams

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Explanation

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The nurse is caring for a client who is in the oliguric phase of an acute kidney injury. Which of the following clinical manifestations would be consistent with the condition?