A client with acute renal failure has jugular vein distention, ...

[sam.t96]

A client with acute renal failure has jugular vein distention, lower extremity edema, and elevated blood pressure. Based on this data, which nursing diagnosis is the most appropriate?
 
  A) Ineffective Renal Tissue Perfusion
  B) Excess Fluid Volume
  C) Risk for Altered Cardiac Perfusion
  D) Risk for Infection

Question 2

A client agrees to receive long-term hemodialysis to treat acute renal failure. For which surgical procedure should the nurse instruct this client?
 
  A) Insertion of a double-lumen catheter into the subclavian artery
  B) Placement of a peritoneal catheter
  C) Insertion of a subarachnoid-peritoneal shunt
  D) Placement of an arteriovenous fistula

[otokexnaru]

Answer to Question 1

Answer: B

Jugular vein distention, edema, and elevated blood pressure are indications of excessive fluid. The diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Altered Cardiac Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.

Answer to Question 2

Answer: D

For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis and not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebral spinal fluid and not for hemodialysis.