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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.
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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.
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.
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.
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.