A nurse is responsible for screening client’s history for risk factors for possible complications.
Vital signs
BP 188/93
P 80
A nurse is correlating data documented in a client's medical history. The nurse should recognize that which client data indicates risk factors for acute kidney injury? (Select all that apply.)
low serum albumin
Renal Calculi
Hypertension
Hypovolemia
ineffective wound healing
Correct Answer : B,C,D
A. Low serum albumin: While low albumin indicates poor nutrition or liver disease, it's not a direct cause of AKI.
B. Renal Calculi: Can cause obstruction in the urinary tract, leading to post-renal AKI.
C. Hypertension: Chronic high BP damages renal vasculature, increasing AKI risk.
D. Hypovolemia: Decreased perfusion leads to prerenal AKI.
E. Ineffective wound healing: Indicates poor nutrition or infection, but is not a primary AKI risk factor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Assessing psychosocial coping:
Important, but not a priority in the early acute phase, when survival is the focus.
B. Adequate fluid resuscitation:
Major burns lead to capillary leakage and hypovolemia. Fluid resuscitation prevents shock and organ failure.
C. Provide nutritional support:
Necessary but becomes more relevant in the later stages after fluid and hemodynamic stability are achieved.
D. Mitigating risk of infection:
Infection control is vital but comes after fluid volume replacement in prioritization.
Correct Answer is C
Explanation
A. A combination of benzodiazepines and topical anesthetics: This is not effective for the deep and constant pain experienced with burns.
B. The use of oral opioids: Absorption may be delayed or unpredictable in critically ill burn clients.
C. A patient-controlled analgesia (PCA) system: PCA provides rapid and individualized control of pain, which is essential in the acute phase.
D. Distraction and relaxation techniques: These are supportive, not primary, strategies for severe pain.
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