You are attempting to assess a patient's AV fistula for a thrill. How is this done?

A. They will likely need ICP monitoring is incorrect because a simple scalp laceration does not typically cause increased intracranial pressure. ICP monitoring is reserved for patients with suspected or confirmed brain injury, not isolated scalp injuries.

B. They will need continuous blood pressure and oxygen saturation monitoring is incorrect because while vital signs are routinely monitored in the ED, continuous cardiac and oxygen monitoring is not generally required for a minor scalp lacerationunless there are signs of hemodynamic instability or other injuries.

C. Holding pressure on the laceration because profuse bleeding can occur is correct. The scalp is highly vascular, and even a relatively small laceration can lead to significant blood loss. Immediate nursing care focuses on applying direct pressure, controlling bleeding, and preparing for wound closure(sutures, staples, or adhesive strips). Proper hemorrhage control is essential to prevent hypovolemia and shock.

D. You will need to make sure they have warm blankets to prevent temperature from decreasing is incorrect because hypothermia prevention is not a primary concernfor a patient with an isolated scalp laceration. While warming measures may be used in trauma patients with extensive blood loss or environmental exposure, it is not the main priorityin this scenario.

A. Dribbling of urine is incorrect because this symptom is associated with postrenal causes of acute kidney injury, such as bladder outlet obstruction or urethral stricture. Postrenal AKI occurs when urine cannot exit the urinary tract properly, leading to backpressure on the kidneys. Prerenal AKI, in contrast, is caused by reduced kidney perfusion, not obstruction.

B. Vomiting and diarrhea for 3 days is correct because prolonged fluid loss leads to hypovolemia, which reduces circulating blood volume and renal perfusion. The kidneys rely on adequate blood flow to maintain glomerular filtration rate (GFR). When perfusion is decreased, the kidneys attempt to compensate by activating the renin-angiotensin-aldosterone system, but sustained hypoperfusion can lead to prerenal AKI. This type of AKI is potentially reversible if perfusion is restored promptly, making early recognition and fluid replacement critical. Conditions that commonly cause prerenal AKI include dehydration, hemorrhage, sepsis, heart failure, or severe fluid losses like vomiting and diarrhea.

C. Difficulty starting urine stream is incorrect because this symptom indicates a postrenal obstruction, such as benign prostatic hyperplasia or urethral stricture. In postrenal AKI, urine flow is blocked after it leaves the kidneys, causing backpressure and impaired renal function. This is different from prerenal AKI, where the problem originates beforethe kidneys due to reduced blood flow.

D. History of kidney stones is incorrect because kidney stones can lead to intermittent obstruction of urine flow, resulting in postrenal AKI. While kidney stones can compromise renal function if causing obstruction, they do not directly decrease renal perfusion and therefore are not a risk factor for prerenal AKI.