Nokea
A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the priority action?
- A. Calculate the mean arterial pressure (MAP)
- B. Ask for insertion of a pulmonary artery catheter
- C. Slow the normal saline infusion
- D. Monitor respiratory rate
Correct Answer: C
Rationale: The nurse should assess that the client could be developing fluid overload and respiratory distress and slow down the normal saline infusion to prevent worsening of symptoms. Calculating MAP is important but not the priority when shortness of breath is evident. A pulmonary artery catheter is invasive and not the first action. Monitoring respiratory rate is important but secondary to adjusting the infusion.
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A client is undergoing hemodialysis. The client's blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 100/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply)
- A. Adjust the rate of extracorporeal blood flow
- B. Place the client in the Trendelenburg position
- C. Administer oxygen therapy
- D. Administer a 250-mL bolus of normal saline
- E. Contact the health care provider for orders
Correct Answer: A,B,D
Rationale: Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Adjusting the extracorporeal blood flow, placing the client in the Trendelenburg position, and administering a normal saline bolus can help stabilize blood pressure.
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.
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 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 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.