Nokea
A client in the intensive care unit is started on continuous venous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse?
- A. Blood leak detector alarm
- B. Low ultrafiltrate volume
- C. High venous pressure
- D. Low arterial pressure
Correct Answer: A
Rationale: A blood leak detector alarm indicates a potential rupture in the dialysis membrane, which is a critical issue requiring immediate action to stop the procedure and ensure patient safety. Low ultrafiltrate volume, high venous pressure, or low arterial pressure may require adjustments but are not as immediately life-threatening.
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A client is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Which nurse should be assigned to this client for continuity of care?
- A. A new graduate nurse
- B. A float nurse from another unit
- C. The registered nurse (RN) previously assigned to this client
- D. A licensed practical nurse (LPN)
Correct Answer: C
Rationale: Continuity of care is important to assess subtle differences in clients. Therefore, the registered nurse (RN) who was assigned to this client previously should again give care to this client. The first nurses would not be as knowledgeable about the unit and its clients. The licensed practical nurse may not have the education level of the RN to assess for pericarditis.
A client who returned from kidney transplantation 12 hours ago has low urine output, sediment, and hematuria. What should the nurse do?
- A. Report findings to the provider
- B. Monitor intake and output
- C. Assess urine characteristics
- D. Continue routine monitoring
Correct Answer: A
Rationale: The low urine output, sediment, and hematuria should be reported to the provider, as these could indicate complications such as rejection or obstruction in the newly transplanted kidney.
The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury. Which condition would the nurse expect to find in the client's recent history?
- A. Myelonephritis
- B. Myocardial infarction
- C. Kidney stones
- D. Septic shock
Correct Answer: B
Rationale: Myocardial infarction can lead to decreased cardiac output, reducing renal perfusion and causing pre-renal acute kidney injury. Myelonephritis and kidney stones are more associated with intrinsic or post-renal causes, respectively, while septic shock could also contribute but is less specific in this context.
Dialysis works using the passive transfer of toxins by diffusion. Which statement by the client indicates a need for further teaching?
- A. Dialysis removes waste through osmosis
- B. Dialysis moves toxins from high to low concentration
- C. Dialysis uses a semipermeable membrane
- D. Dialysis helps balance electrolytes
Correct Answer: A
Rationale: Dialysis works by diffusion, not osmosis. The client's statement about osmosis indicates a misunderstanding, as osmosis refers to water movement, whereas dialysis involves the movement of toxins and solutes across a semipermeable membrane from an area of higher to lower concentration.
A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse?
- A. Use the catheter for the next laboratory blood draw
- B. Monitor the central venous pressure through this line
- C. Access the line for the next intravenous medication
- D. Place a heparin or heparin/saline dwell after hemodialysis
Correct Answer: D
Rationale: The central line should have a heparin or heparin/saline dwell after hemodialysis treatment to prevent clotting. The central line catheter used for dialysis should not be used for blood sampling, monitoring central venous pressures, or giving drugs or fluids.