A nurse is caring for a client who is in the oliguric phase of acute kidney injury. Which of the following actions should the nurse take?

Provide a diet high in protein.

Provide ibuprofen for retroperitoneal discomfort.

Monitor intake and output hourly

Encourage the client to consume at least 2 L of fluid daily

Answer and Explanation

The Correct Answer is C

A. Provide a diet high in protein.

During the oliguric phase of acute kidney injury (AKI), there is a risk of electrolyte imbalances, including elevated levels of blood urea nitrogen (BUN) and creatinine. Restricting protein intake is often recommended during this phase to manage azotemia and prevent the accumulation of waste products that the kidneys may struggle to excrete.

B. Provide ibuprofen for retroperitoneal discomfort.

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in AKI. They can further compromise renal function and may contribute to acute tubular necrosis. NSAIDs can also affect renal blood flow, leading to worsening kidney function.

C. Monitor intake and output hourly.

Monitoring intake and output (I&O) is a critical nursing intervention during the oliguric phase of AKI. Hourly monitoring helps assess renal function, fluid balance, and the effectiveness of interventions. It allows for early detection of changes that may require prompt intervention.

D. Encourage the client to consume at least 2 L of fluid daily.

In the oliguric phase of AKI, fluid intake is often restricted to prevent fluid overload. Encouraging excessive fluid intake may contribute to fluid retention and worsen the oliguria. Fluid management is carefully regulated based on the individual client's needs and renal function.

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Correct Answer is C

Explanation

A. Keep the prosthesis in direct contact with the residual limb.

This statement is incorrect. Prosthetic care typically involves using a liner or sock between the residual limb and the prosthesis. This helps to provide cushioning, absorb sweat, and reduce friction, contributing to comfort and preventing skin irritation.

B. Apply a moisturizing lotion or oil to the stump daily.

Moisturizing the skin on the residual limb is generally advisable to prevent dryness and irritation. However, it's crucial to ensure that the skin is completely dry before attaching the prosthesis. Moisturizing can help maintain skin health and comfort.

C. Dry the prosthesis socket completely before applying it to the limb.

This statement is correct. Ensuring that the prosthesis socket is thoroughly dry before application is crucial to prevent skin irritation and ensure a secure fit. Moisture between the skin and the prosthesis can contribute to discomfort and skin-related issues.

D. Expect some skin irritation from the prosthesis.

While it is common to experience minor skin irritation initially as the individual adjusts to the prosthesis, persistent or severe irritation should be addressed. The goal is to achieve a proper fit and minimize skin-related problems through appropriate care and adjustments.

A. Stomatitis B. Gingivitis C. Halitosis D. Pyorrhea

Correct Answer is C

Explanation

A. Stomatitis
Stomatitis refers to inflammation of the oral mucosa, which includes the lips, cheeks, gums, tongue, and palate. It can be caused by various factors, such as infections, irritants, or systemic conditions. While stomatitis may contribute to changes in oral odor, it encompasses a broader range of inflammatory conditions within the oral cavity.

B. Gingivitis
Gingivitis is inflammation of the gums (gingiva). It is often caused by plaque buildup and can lead to redness, swelling, and bleeding of the gums. While gingivitis may contribute to bad breath, it specifically involves inflammation of the gum tissue.

C. Halitosis
Halitosis refers to bad breath or a strong mouth odor. It can be caused by various factors, including poor oral hygiene, infections, dental conditions, or systemic diseases. In the context of a client with facial fractures, the nurse might observe halitosis due to challenges in maintaining oral hygiene or potential injuries.

D. Pyorrhea
Pyorrhea is an outdated term that was historically used to describe advanced stages of periodontal disease, including inflammation of the gums and supporting structures. The term is not commonly used in modern dental or medical terminology.

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A nurse is caring for a client who is in the oliguric phase of acute kidney injury. Which of the following actions should the nurse take?

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