A nurse is caring for a client who sustained significant crush injuries and is being treated for acute renal injury. What is the pathophysiology behind the development of this renal injury?
High levels of myoglobin obstructed the tubules and caused intra-renal damage
Large amounts of IV fluids overloaded the kidneys and caused pre-renal damage
Pain medications for the injuries were nephrotoxic and caused pre-renal damage
Significant blood loss impaired renal perfusion and caused post-renal damage
The Correct Answer is A
Choice A reason: Crush injuries release myoglobin from damaged muscles, causing rhabdomyolysis. Myoglobin precipitates in renal tubules, obstructing them and leading to acute tubular necrosis, an intra-renal acute kidney injury. This toxic effect, combined with oxidative stress, impairs filtration, making this statement accurate for the pathophysiology of renal injury.
Choice B reason: Large IV fluid volumes are used to prevent renal injury in rhabdomyolysis by diluting myoglobin and maintaining perfusion. Fluid overload may cause pulmonary edema but does not typically cause pre-renal damage, which results from hypoperfusion. This statement is inaccurate, as fluids are protective, not harmful.
Choice C reason: Pain medications like NSAIDs can be nephrotoxic, causing intra-renal damage by reducing renal blood flow or causing interstitial nephritis. However, pre-renal damage results from hypoperfusion, not direct toxicity. In crush injuries, myoglobin is the primary cause, making this statement less accurate than myoglobin-related tubular damage.
Choice D reason: Significant blood loss causes pre-renal injury by reducing renal perfusion, not post-renal damage, which involves urinary obstruction. Crush injuries primarily cause intra-renal damage via myoglobin. This statement is inaccurate, as it misattributes the mechanism and type of renal injury in this context.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Hard, formed stool is typical of descending or sigmoid colostomies, where the colon reabsorbs water. A transverse colostomy, located higher in the colon, has less water absorption, producing liquid stool. This statement is inaccurate, as transverse colostomy stool is not hard or formed.
Choice B reason: A transverse colostomy, located in the mid-colon, produces mostly liquid feces with mucus due to limited water reabsorption before the stoma. The proximal colon’s contents are less formed, and mucus from inflammation (common in IBD) is present, making this statement accurate for stool consistency.
Choice C reason: Soft, semi-formed stool is more typical of descending colostomies, where water absorption occurs longer. Transverse colostomies, higher in the colon, produce more liquid output due to shorter transit time. This statement is inaccurate, as it does not reflect transverse colostomy stool consistency.
Choice D reason: Dry, pellet-like stool is characteristic of constipation or distal colon output, not a transverse colostomy. The transverse colon’s contents are liquid due to minimal water reabsorption, especially in IBD with inflammation. This statement is inaccurate, as it misrepresents the expected stool consistency.
Correct Answer is B
Explanation
Choice A reason: Acetaminophen reduces fever by acting on the hypothalamic thermoregulatory center but is ineffective for heat stroke, a hyperthermic emergency caused by environmental heat overload. It does not address core temperature elevation or systemic effects like dehydration and organ dysfunction, making it inappropriate for immediate heat stroke management.
Choice B reason: Removing the client’s clothing facilitates evaporative and convective cooling, critical in heat stroke where core body temperature exceeds 40°C. This intervention enhances heat dissipation from the skin, reducing the risk of organ damage from hyperthermia. It is a primary nursing action to lower body temperature effectively and safely.
Choice C reason: Placing a client with heat stroke in a hot bath would exacerbate hyperthermia, worsening organ damage and cardiovascular strain. Heat stroke requires rapid cooling via cold water immersion or evaporative methods, not additional heat exposure, making this intervention dangerous and contraindicated in this life-threatening condition.
Choice D reason: Encouraging oral fluids like cold water is inappropriate for a lethargic heat stroke patient, who may have impaired swallowing or consciousness, risking aspiration. Intravenous fluids are preferred to correct dehydration and electrolyte imbalances safely, as oral intake does not address the urgent need for rapid cooling and systemic stabilization.
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