A nurse is caring for a client who underwent a radical nephrectomy for renal cell carcinoma 24 hours ago. Which nursing intervention should be the priority?

Monitoring urine output hourly and assessing for acute kidney injury is the priority because the remaining kidney must compensate for lost function, and early detection prevents life-threatening complications. Other interventions like pain management and ambulation are important but secondary to renal safety.

Core Nursing Explanation Key Concept Analysis: This question assesses postoperative priority setting for a patient after a radical nephrectomy. The core concept is the Key Point! ABCs (Airway, Breathing, Circulation) and vital organ function. After removal of one kidney, the patient's entire renal function depends on the remaining solitary kidney. The immediate postoperative priority is to ensure this kidney is functioning adequately to prevent acute kidney injury (AKI), which can rapidly become life-threatening.

Answer Rationale: Key Point! The correct answer is ① Monitor urine output hourly and assess for signs of acute kidney injury. This is the priority because:
1. Physiological Rationale: The remaining kidney undergoes compensatory hypertrophy, but immediately post-surgery, it is under stress from anesthesia, potential hypovolemia, and surgical manipulation. Normal urine output is >0.5 mL/kg/hr (approx. 30 mL/hr for a 60kg adult). A drop below this is the earliest sign of impaired renal perfusion or function.
2. Nursing Priority: Urine output is a direct, real-time indicator of renal function. Early detection of oliguria (low urine output) allows for prompt intervention (e.g., fluid resuscitation, notifying the provider) to prevent progression to AKI and potential failure of the solitary kidney.

Distractor Analysis:
• Watch out for confusion! ② Encourage early ambulation: While crucial for preventing deep vein thrombosis (DVT) and other complications, it is a secondary priority. Patient safety comes first; you must ensure the patient is hemodynamically stable (good urine output indicates adequate renal perfusion) before mobilizing.
• ③ Administer prescribed analgesics: Effective pain management is important for recovery and mobility, but it does not take precedence over monitoring for a potentially life-threatening organ dysfunction. Some analgesics (e.g., NSAIDs) can even be nephrotoxic, making renal monitoring more critical.
• ④ Provide emotional support: Addressing body image and psychosocial needs is a key part of holistic care, especially with cancer surgery, but it is addressed after physiological stability is ensured (Maslow's Hierarchy of Needs).

Related Concepts: This question integrates surgical nursing, renal physiology, and nursing process prioritization. It tests the ability to apply the principle that assessment of vital organ function (especially for a patient with reduced organ reserve) takes precedence over other important but non-emergent interventions.

Concept Summary • Radical Nephrectomy: Surgical removal of a kidney, surrounding fat, adrenal gland, and nearby lymph nodes for renal cell carcinoma.
• Solitary Kidney Physiology: The remaining kidney increases its filtration rate (glomerular filtration rate (GFR)) to compensate, but it is vulnerable to injury.
• Acute Kidney Injury (AKI): A sudden drop in kidney function. Key signs: Oliguria (

Nursing Clinical Practice Guide Clinical Scenario: You are the nurse on a surgical floor. Mr. Jones, 58, is post-op day 1 from a left radical nephrectomy for renal cell carcinoma. His vital signs are stable, but he is drowsy from patient-controlled analgesia (PCA).

Nursing Intervention Strategy:
1. Assessment: Every hour, measure and document urine output from the Foley catheter. Calculate mL/kg/hr. Assess urine color (should be yellow/amber; report bloody or cola-colored urine). Monitor vital signs, especially blood pressure (hypotension reduces renal perfusion). Review daily BUN and Creatinine lab results.
2. Planning & Implementation: If urine output drops below 30 mL/hr, first check for simple causes: Is the Foley catheter kinked or blocked? Is the IV fluid infusing? Then, increase IV fluid rate per protocol/order if the patient is not fluid overloaded. Notify the surgeon promptly if low output persists.
3. Education: Once stable, educate the patient on lifelong kidney protection: avoid NSAIDs (e.g., ibuprofen), stay well-hydrated, control blood pressure, and report any signs of urinary tract infection or flank pain.

Patient Safety and Precautions:
• Key Point! Never clamp a Foley catheter post-nephrectomy without an order. Urine output must be allowed to drain freely for accurate measurement.
• Be alert for signs of bleeding (another major post-nephrectomy complication): tachycardia, hypotension, decreasing hemoglobin, flank pain, or swelling.
• When encouraging ambulation (intervention ②), ensure the patient is assisted, has adequate pain control, and is not orthostatic.

Nursing Procedure & Medication Flow Urine Output Monitoring Procedure:
1. At the beginning of your shift, note the baseline amount in the Foley drainage bag.
2. Every hour, mark the time and measure the volume drained.
3. Document: "Time 0800-0900: Urine output 55 mL, clear yellow. Total for shift: ___ mL."
4. Report immediately: "Urine output