The nurse is collecting data on a patient admitted for symptoms of renal insufficiency. Which factor will cause the nurse to suspect prerenal injury?

Choice a reason: Laboratory results indicating a high level of an aminoglycoside can point to nephrotoxicity, which is a type of intrinsic renal injury. Aminoglycosides are antibiotics that can be toxic to the kidneys, causing damage to renal tissues. This condition is different from prerenal injury, which is related to reduced blood flow to the kidneys, not direct damage from toxins.
Choice b reason: A tumor obstruction in the right ureter is indicative of postrenal injury, which occurs due to obstruction of urine flow anywhere along the urinary tract. This kind of injury does not fall under the category of prerenal injury, which is due to factors causing reduced perfusion to the kidneys.
Choice c reason: A family history of polycystic kidney disease (PKD) suggests a genetic predisposition to intrinsic renal disease. PKD is a hereditary condition that leads to the formation of cysts in the kidneys, eventually impairing their function. This type of injury is not prerenal, as it results from structural abnormalities within the kidney itself.
Choice d reason: Impaired blood flow to the kidneys is the hallmark of prerenal injury. Prerenal injuries are caused by conditions that reduce renal perfusion, such as dehydration, heart failure, or shock. When the kidneys receive insufficient blood flow, they cannot function properly, leading to symptoms of renal insufficiency. Addressing the underlying cause to restore adequate blood flow is crucial in managing prerenal injury.

Choice a reason: Body weight is the most accurate measurement for determining fluid losses in clients undergoing hemodialysis. Weighing the client before and after dialysis allows healthcare providers to quantify the exact amount of fluid removed during the treatment. This is critical for managing fluid balance and ensuring the client does not experience excessive fluid removal, which can lead to hypotension and other complications.
Choice b reason: While monitoring blood pressure before and after hemodialysis is essential to assess the client's cardiovascular stability, it is not a direct measure of fluid loss. Blood pressure changes can be influenced by various factors such as fluid status, vascular resistance, and cardiac output, but they do not provide a precise measurement of fluid removal.
Choice c reason: Neck vein distention can indicate fluid overload or changes in intravascular volume, but it is not a precise method for quantifying fluid loss during hemodialysis. Neck vein distention is a subjective assessment and can be influenced by factors such as body position and venous pressure, making it less reliable for determining exact fluid loss.
Choice d reason: Abdominal girth measurement is typically used to assess ascites or abdominal distension, not fluid loss during hemodialysis. It is not a relevant measurement for clients undergoing hemodialysis, as it does not provide information about the volume of fluid removed during the treatment. Abdominal girth changes are more relevant for conditions such as liver disease or gastrointestinal issues.