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
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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Related Questions
Correct Answer is D
Explanation
A. Yogurt:
Yogurt is not a significant source of iron. While yogurt provides various nutritional benefits, it is not considered an iron-rich food.
B. Oranges:
Oranges are a good source of vitamin C, which enhances the absorption of non-heme iron from plant-based foods. However, oranges themselves do not contain substantial amounts of iron. The combination of vitamin C-rich foods with iron-rich foods can be beneficial for iron absorption.
C. Turnips:
Turnips are a vegetable that, while nutritious, is not particularly high in iron. Additionally, the iron in plant-based foods like turnips is non-heme iron, which is less easily absorbed by the body compared to heme iron found in animal products.
D. Roast beef:
Roast beef is a good source of heme iron, which is more easily absorbed by the body. Red meat, such as roast beef, is a valuable dietary source of iron, especially for individuals with iron deficiency.
Correct Answer is C
Explanation
A. "Skeletal traction has less risk for infection than skin traction."
This statement is not accurate. Both skeletal and skin traction carry some risk of infection, but the risk factors and considerations are different for each. Skeletal traction involves pins or wires directly inserted into the bone, and while the risk of infection is present, it is not necessarily lower than that of skin traction.
B. "Clients in skin traction have more mobility than those in skeletal traction."
This statement is not accurate. Skeletal traction, involving the use of weights and pins or wires inserted into the bone, tends to provide more stable immobilization. Skin traction, which relies on external devices applied to the skin's surface, may allow for some limited mobility but is generally not as effective as skeletal traction.
C. "Skeletal traction is better than skin traction for reducing a fracture."
This is the correct statement. Skeletal traction is often more effective in providing a stable and controlled environment for reducing and immobilizing fractures.
D. "Clients in skin traction have more discomfort than those in skeletal traction."
This statement is not necessarily accurate. Discomfort can vary depending on the individual, the type of fracture, and other factors. Both skeletal and skin traction may cause some discomfort, and it's important to assess and manage the client's pain appropriately in either case.
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