Nokea
A client with chronic kidney disease (CKD) is receiving hemodialysis treatment. Which of the following nursing interventions should be implemented for this client? Select all that apply.
- A. Monitor the client's blood pressure before, during, and after hemodialysis.
- B. Administer erythropoietin (EPO) as prescribed to stimulate red blood cell production.
- C. Restrict protein intake to minimize uremic symptoms.
- D. Assess the client's access site for signs of infection or thrombosis.
- E. Administer phosphate binders as prescribed to control serum phosphate levels.
- F. Encourage the client to consume a high-potassium diet to prevent electrolyte imbalances.
Correct Answer: A,B,D,E
Rationale: Monitoring BP, administering EPO, assessing the access site, and giving phosphate binders are standard CKD hemodialysis interventions. High-potassium diets are avoided.
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The nurse is reviewing the client's laboratory data. Which current prescription should the nurse clarify with the primary healthcare provider (PHCP)?
- A. Dextrose 5% in water (D5W)
- B. dexamethasone
- C. digoxin
- D. ergocalciferol
Correct Answer: A
Rationale: D5W is hypotonic and may worsen hyponatremia, requiring clarification in a client with low sodium levels.
The nurse is reviewing the assessment data for a client with acute glomerulonephritis (AGN). Which of the following would be an expected finding?
- A. Ketonuria
- B. Hematuria
- C. Polyuria
- D. Glycosuria
Correct Answer: B
Rationale: Hematuria is a hallmark of acute glomerulonephritis due to glomerular inflammation.
A newly hired nurse is caring for a client who is receiving prescribed total parenteral nutrition (TPN) therapy. The nurse preceptor should intervene if the newly hired nurse?
- A. wears a surgical mask while changing the client's central vascular access dressing.
- B. obtains the client's capillary blood glucose every four to six hours.
- C. spikes and primes a new bag of TPN without an inline filter.
- D. continues the infusion via an infusion pump while the client is receiving a computed tomography scan.
Correct Answer: C
Rationale: TPN requires an inline filter to prevent infusion of particulate matter or air emboli. Not using a filter (C) is unsafe and requires intervention. Wearing a mask (A), checking glucose (B), and continuing infusion during a CT scan (D) are appropriate or not inherently unsafe.
The following scenario applies to the next 6 items.
The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 3 of 6
History and Physical
A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.
Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8° F (36.6° C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
Laboratory Results
• Hemoglobin 14 g/dL [14-18 g/dL (140–180 g/L)]
• Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
• White Blood Cell 11,000 mm3 [5-10 mm3]
• Platelet Count 140,000 mm3 [150-400 mm3 (150–400 × 109/L)]
• Glucose 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)]
• Sodium 116 mEq/L [136–145 mEq/L (mmol/L)]
• Potassium 3.3 mEq/L [3.5–5.0 mEq/L (mmol/L)]
• Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285–295 mmol/kg)]
The client is demonstrating manifestations consistent with......... due to.......
- A. Cushing's syndrome
- B. diabetes insipidus
- C. syndrome of inappropriate antidiuretic hormone
- D. advanced chronic obstructive pulmonary disease.
- E. small cell lung cancer.
- F. corticosteroid usage.
Correct Answer: C,E
Rationale: SIADH, often caused by small cell lung cancer, leads to hyponatremia and neurological symptoms like disorientation.
The nurse is reviewing the concept of acute kidney injury (AKI) with a student nurse. Which of the following would be correct as a cause of prerenal AKI?
- A. nephrotoxicity
- B. bladder cancer
- C. contrast media
- D. hypovolemia
Correct Answer: D
Rationale: Hypovolemia causes prerenal AKI by reducing renal perfusion.