The nurse caring for a patient in the surgical intensive care unit 2 days after a cadaveric renal transplant reviews the new data available for this patient and notes that the patient's potassium is elevated,
she has produced 50 mL of urine over the last 3 hours, and the physician has ordered hemodialysis for later in the afternoon. After reading the orders, the nurse enters the patient's room to find her tearful and the patient states, "I know this transplant will never work and now I am scheduled to have dialysis in the morning." The nurse's best response is:
A) "While there is a small chance that the kidney will start to function, keep your chin up, there is always hope."
B) "After a transplant it can take up to 2 or 3 weeks for the kidney to start to function, and dialysis is often necessary until that kidney starts to work."
C) "The drug companies are always developing better medications for transplant patients, so when you have the next transplant the success rates will be higher."
D) "I think an antidepressant medication may help you right now. Are you feeling depressed?"
Ans: B
Feedback: The nurse should inform the patient that a kidney from a cadaver donor may undergo acute tubular necrosis (ATN) and therefore may not function for 2 or 3 weeks, during which time anuria, oliguria, and polyuria may be present. Hemodialysis may be required if fluid overload and hyperkalemia occur. The nurse should listen attentively and offer factual information.
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