A client is admitted with acute kidney injury (AKI) and a urine amount of 2300 mL in 24 hours. The nurse should prioritize assessment of ________________.

Cardiac and respiratory status

Mental health status

Edema and pain

Electrolyte and fluid imbalance

Answer and Explanation

The Correct Answer is D

Choice A reason: While cardiac and respiratory assessments are important in the oliguric phase of AKI to monitor for fluid overload, this patient is in the diuretic phase. The primary risk here is not fluid excess (leading to heart failure or pulmonary edema) but rather the systemic consequences of rapid volume depletion.

Choice B reason: Mental health status is a component of holistic care and may be affected by uremia (causing encephalopathy). However, during the diuretic phase of AKI, physiological instability due to massive fluid loss takes clinical precedence over psychosocial assessments to ensure the patient's immediate physical safety and survival.

Choice C reason: Edema is a hallmark of the oliguric phase where the kidneys fail to excrete water. In the diuretic phase, edema typically resolves as the patient voids large volumes. Assessing pain is standard, but neither edema nor pain represents the most acute physiological threat during this specific phase of renal recovery.

Choice D reason: A urine output of 2300 mL indicates the diuretic phase of AKI, where the kidneys have regained the ability to excrete waste but cannot yet concentrate urine. This puts the patient at severe risk for hypovolemia, hypotension, and critical depletion of electrolytes like potassium and sodium, requiring intensive monitoring.

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Correct Answer is B

Explanation

Choice A reason: Immobilization of the arm for 4 to 6 days is contraindicated following the creation of an arteriovenous (AV) fistula. While the incision site must be protected, gentle exercise of the arm, such as squeezing a rubber ball, is actually encouraged to increase blood flow and promote the "maturation" or thickening of the vessel walls.

Choice B reason: An AV fistula is created by a surgical anastomosis between an artery (typically the radial or brachial artery) and a vein (typically the cephalic vein). This allows high-pressure arterial blood to flow directly into the vein, causing the vein to dilate and become tough enough to withstand repeated large-bore needle cannulations.

Choice C reason: Hemodialysis requires two needles to be inserted into the fistula for each treatment, not one. One needle (the arterial needle) withdraws blood from the body to be sent to the dialyzer for cleaning, while the second needle (the venous needle) returns the filtered blood back to the patient's circulation.

Choice D reason: An AV fistula cannot be used 5 to 7 days after surgery. It requires a significant "maturation" period, usually lasting 2 to 4 months, before it is ready for use. Using it too early can cause the vessel to collapse or infiltrate. If urgent dialysis is needed, a temporary central venous catheter is used in the interim.

A. "Eat low-fiber and low-residual foods." B. "Add vegetables such as broccoli and cauliflower to your diet." C. "Foods high in animal fat help to protect the intestinal mucosa." D. "White rice and bread are easier to digest."

Correct Answer is B

Explanation

Choice A reason: Low-fiber and low-residual foods are typically recommended for patients during acute flares of inflammatory bowel disease to rest the bowel. However, for cancer prevention, these foods are contraindicated because they increase transit time and the duration that potential carcinogens remain in contact with the intestinal lining.

Choice B reason: Cruciferous vegetables like broccoli and cauliflower are high in fiber and contains chemopreventive compounds. High fiber intake increases stool bulk and decreases transit time, which dilutes potential carcinogens and reduces their contact with the colonic mucosa, significantly lowering the long-term risk of developing colorectal adenocarcinoma.

Choice C reason: Diets high in animal fats are strongly associated with an increased risk of colorectal cancer. High fat intake increases the secretion of bile acids into the gut, which can be converted by intestinal bacteria into secondary bile acids that act as promoters of cellular mutation and malignancy.

Choice D reason: While white rice and bread are refined carbohydrates that are easy to digest, they lack the essential fiber necessary for colorectal health. A diet heavy in refined grains is associated with higher glycemic loads and increased cancer risk, whereas whole grains are preferred for their protective fibrous qualities.

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A client is admitted with acute kidney injury (AKI) and a urine amount of 2300 mL in 24 hours. The nurse should prioritize assessment of ________________.

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