Nokea
A client is administered dialystate solution through an abdominal catheter. The nurse notices that the return flow rate is slow, so the nurse advises the client to move to the other side. However, even after changing the client's position, the nurse does not observe an increase in return flow. Which of the following actions should the nurse perform to help accelerate the return flow rate?
- A. Disconnect the catheter and repay.
- B. Loosen the tubing clamp.
- C. Inform the physician that catheter may need repositioning.
- D. Stop the process for 5 minutes and resume later.
Correct Answer: C
Rationale: The nurse instills dialystate solution and clamps the tubing. If the return flow rate is slow, the nurse asks the client to move from side to side. If this maneuver is unsuccessful, the physician may need to reposition the catheter. The nurse should not tamper with the catheter settings because this may worsen the client's condition or damage the apparatus. Also, stopping the process and resuming it after 5 minutes will not help increase the return flow of the dialystate.
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The hemodialysis client is scheduled to receive weekly injections of epoetin. Which is the most important consideration to be taken by the nurse in the administration of this medication?
- A. Schedule injection on non-dialysis day.
- B. Administer immediately after dialysis.
- C. Monitor complete blood count percent dose.
- D. Administer with low-dose aspirin to prevent clot formation.
Correct Answer: A
Rationale: After dialysis, do not administer injections for 2 to 4 hours to allow time for the metabolism and excretion of heparin (which is administered during dialysis). Serum laboratory tests are performed on a routine basis to identify normal and abnormal findings. Aspirin use is not indicated with epoetin use.
Following ureteroscopy, for the removal of ureteral calculus, a stent is temporarily left in place. The client asks what purpose the stent provides. Which is the correct response from the nurse?
- A. The stent is coated with an anti-infective to promote healing.
- B. The stent will catch any debris or blood clots left behind.
- C. The stent will provide easier passing of future stones.
- D. Inflammation from the stone can block the flow of urine.
Correct Answer: D
Rationale: Calculi can traumatize the lining of the ureters, resulting in inflammation and possible obstruction of urine flow. A stent is left behind to allow free-flowing urine until inflammatory process has resolved. Stents are not used for anti-infective properties or to catch debris or clots. Stents are not permanently placed for preventative measures.
An instructor is teaching a group of students about how to perform peritoneal dialysis. Which statement would indicate to the instructor that the students need additional teaching?
- A. It is important to use strict aseptic technique.
- B. It is appropriate to warm the dialysate in a microwave.
- C. The infusion clamp should be open during infusion.
- D. The effluent should be allowed to drain by gravity.
Correct Answer: B
Rationale: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
A client is diagnosed with polycystic kidney disease. Which symptom would the nurse most likely assess?
- A. Hypertension
- B. Flank pain
- C. Fever
- D. Periorbital edema
Correct Answer: A
Rationale: Hypertension is often present in clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts. Fever would suggest an infection. Periorbital edema is noted with acute glomerulonephritis.
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the appropriate response by the nurse?
- A. Even a perfect match does not guarantee organ success.
- B. Immunosuppressive drugs guarantee organ success.
- C. The doctor may decide to delay the use of immunosuppressant drugs.
- D. Let's wait until after the surgery to discuss your treatment plan.
Correct Answer: A
Rationale: Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.