Nokea
A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema?
- A. Maintaining oxygen saturation of 88%
- B. Minimal crackles in the lungs and lung sounds
- C. Maintaining a balanced intake and output
- D. Limited shortness of breath upon exertion
Correct Answer: C
Rationale: With an optimal fluid balance, the client will be more able to eject blood from the left ventricle without increased pressure in the left ventricle and pulmonary vessels. Maintaining a balanced intake and output is the most direct goal to prevent fluid overload and reduce the risk of pulmonary edema.
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A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?
- A. Discuss what the treatment regimen means to him
- B. Refer the client to a mental health nurse practitioner
- C. Reschedule the appointments to another date and time
- D. Discuss the option of peritoneal dialysis
Correct Answer: A
Rationale: The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all options to assess the client, the client's acceptance of the treatment should come first.
A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best?
- A. Check the client's digoxin level
- B. Administer an anti-nausea medication
- C. Ask if the client is able to eat crackers
- D. Ask if referral to a gastroenterologist is needed
Correct Answer: A
Rationale: The signs and symptoms are indications of digoxin (Lanoxin) toxicity. The nurse should check the level of this medication. Administering antiemetics, asking if the client can eat, and obtaining a referral to a specialist all address the client's symptoms but do not lead to the cause of the symptoms.
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.
A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse?
- A. Warm the dialysis solution in a microwave before instillation
- B. Take a sample of the effluent and send to the laboratory
- C. Flush the tubing with normal saline to maintain patency of the catheter
- D. Check the catheter for obstruction
Correct Answer: B
Rationale: An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent would need to be sent to the laboratory for culture and sensitivity in order to administer the correct antibiotic. Warming the dialysate in a microwave and flushing the tubing are not safe actions by the nurse.