# A nurse is caring for a patient who underwent a radical nephrectomy for renal cell carcinoma 24 hours ago. Which nursing intervention is the priority for this patient? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541501 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a patient who underwent a radical nephrectomy for renal cell carcinoma 24 hours ago. Which nursing intervention is the priority for this patient? ## 보기 1. Encourage early ambulation to prevent deep vein thrombosis 2. Monitor urine output and assess for signs of acute kidney injury **✔ 정답** 3. Administer prescribed analgesics for incisional pain management 4. Provide emotional support regarding body image changes **정답: 2** ## 해설 Monitoring urine output and assessing for acute kidney injury is the priority because the remaining kidney must compensate for the lost renal function, and early detection is crucial for patient safety. Other interventions are important but secondary to preventing life-threatening renal failure. ## 심화 해설 Understanding the Priority Post-Nephrectomy After a radical nephrectomy, the remaining kidney must immediately assume the full filtration and excretory workload. The most critical physiological threat in the first 24 to 48 hours is acute kidney injury (AKI), a sudden deterioration of kidney function diagnosed by a rise in serum creatinine or a decrease in urine output [2]. In urological surgery, AKI can result from direct surgical manipulation, vascular compromise, or obstruction, and it remains a frequent and serious complication [1][2]. Why Monitoring for AKI is the Priority The remaining kidney's ability to function is not guaranteed. Research on renal surgery consistently highlights the substantial risk of AKI regardless of the surgical approach used [4]. A prospective study on robotic renal surgery found that early detection of AKI using biomarkers is critical for predicting medium-term renal function outcomes at 12 months [4]. If AKI develops and is not identified promptly through hourly urine output monitoring, the patient can rapidly progress to fluid overload, electrolyte imbalances, and uremic complications. This makes functional assessment the physiologic priority over pain control, mobility, or psychosocial support in the immediate postoperative phase. Analyzing the Other Options While the other interventions are important, they do not take precedence over a direct assessment of the remaining organ's viability. - Option 1 (Early ambulation): Preventing deep vein thrombosis is a standard postoperative goal, but ambulation is typically initiated after hemodynamic stability and adequate pain control are established, not within the first strict monitoring window where organ function is the primary concern. - Option 3 (Administering analgesics): Pain management is essential for patient comfort and facilitating deep breathing, but administering narcotics before establishing baseline renal function can be dangerous. Impaired renal clearance can lead to the accumulation of active drug metabolites, causing respiratory depression or toxicity. - Option 4 (Emotional support): Addressing body image changes related to a surgical scar or organ loss is a psychosocial need that is addressed later in the recovery continuum, once physiological stability is secured. Clinical Application of the Evidence The management of AKI in urology centers on correcting the underlying cause, which in this context involves ensuring adequate renal perfusion and patency of the urinary drainage system [2]. The nurse’s priority assessment of urine output—often aiming for a minimum of 0.5 mL/kg/hr—provides real-time data on glomerular filtration rate. A sudden drop in output or anuria is a critical alert that requires immediate intervention to prevent irreversible damage to the solitary kidney. This monitoring directly aligns with the KDIGO criteria used in clinical trials to define and stage AKI, which rely on changes in urine output and serum creatinine [4].References (research sources) - [1]Effect of perioperative dexmedetomidine on acute kidney injury after partial nephrectomy: a single-centre, randomised, double-blind, placebo-controlled trial.RCT/clinical trialKong H, Yin QL, Li M, Xu ZZ, Zhang N, Zhao XN, Zhang ZY. (2025) · DOI: 10.1016/j.bja.2025.08.010 - [2]Acute kidney injury in urological conditions.Research articleWeerapolchai K, Lumlertgul N, Srisawat N, Ostermann M. (2026) · DOI: 10.2478/abm-2026-0002 - [4]Early Biohumoral Detection of Acute Kidney Injury After Robotic Renal Surgery and Its Impact on Medium-Term Renal Function.Research articleLa Mura R, Paladini A, Mangione P, Massa G, Pagnotta J, Ricci F, Mearini M, Giardino G, Vitale A, Mearini E, Cochetti G. (2026) · DOI: 10.3390/ijms27083515 ## 임상 시나리오 Clinical Practice Guide: Post-Radical Nephrectomy Monitoring The immediate postoperative phase after radical nephrectomy demands vigilant monitoring of the remaining kidney's function. The physiological priority is the early detection of acute kidney injury (AKI), as the solitary kidney must rapidly compensate for the loss of its counterpart. Key Assessment Priorities (First 24-48 Hours) - **Strict Intake and Output:** Monitor urine output hourly. Report output less than 0.5 mL/kg/hr immediately, as this is a primary indicator of AKI. Maintain a fluid balance chart. - **Renal Function Labs:** Monitor serial serum creatinine and BUN levels. A rapid rise in creatinine suggests impaired filtration by the remaining kidney. - **Fluid Status Assessment:** Assess for signs of fluid overload (e.g., crackles on auscultation, edema, jugular vein distension) or dehydration, as the kidney's regulatory function may be compromised. Nursing Actions - **Report Critical Findings:** Immediately notify the surgeon of oliguria, anuria, or a significant rise in creatinine to facilitate timely intervention, which may include fluid challenges or nephrology consultation. - **Maintain Catheter Patency:** Ensure the urinary catheter is draining freely. Obstruction can mimic or cause AKI. - **Integrate Other Care:** While monitoring is the priority, manage pain to facilitate deep breathing and mobility, and begin DVT prophylaxis as ordered once the patient is hemodynamically stable. ## 핵심 개념 - **Radical Nephrectomy** — Radical nephrectomy. A surgery that completely removes the kidney, including the kidney, adrenal gland, surrounding fatty tissue, and regional lymph nodes. It is primarily used for treating renal cell carcinoma. - **Renal Cell Carcinoma** — Renal cell carcinoma. It is the most common kidney cancer originating from the epithelial cells of the renal parenchyma. - **Acute Kidney Injury** — Acute kidney injury. A condition in which kidney function rapidly declines over hours to days. It is characterized by oliguria, electrolyte imbalance, and accumulation of nitrogenous waste products. - **Oliguria** — Oliguria. A condition in adults where the 24-hour urine output is less than 400mL or hourly output is less than 30mL. It is an important sign of renal dysfunction. - **Intake and Output (I&O)** — Intake and output. This is a basic nursing activity that accurately records all fluid intake, including oral and intravenous fluids, and all output, such as urine, vomitus, and drainage, to assess fluid balance. ## 같은 주제 문제 - [A nurse is assessing a 58-year-old patient with suspected renal cell carcinoma. 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