Nokea
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.
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A client in chronic kidney disease becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value?
- A. Elevated urea levels
- B. Hyperkalemia
- C. Hypocalcemia
- D. Elevated white blood cells
Correct Answer: B
Rationale: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic, confused, and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.
A child is brought into the clinic with symptoms of edema and dark brown rusty urine. Which nursing assessment finding would best assist in determining the cause of this problem?
- A. Sore throat 2 weeks ago
- B. Red blood cells in the urine
- C. Elevation of blood pressure
- D. Protein elevation in the urine
Correct Answer: A
Rationale: Acute glomerulonephritis usually occurs as a result of bacterial infection such as seen with a beta-hemolytic streptococcal infection or impetigo. Red blood cells and protein found in the urine and elevated blood pressure are symptoms associated with glomerulonephritis.
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.
An investment banker with chronic kidney disease informs the nurse of the choice for continuous ambulatory peritoneal dialysis. Which is the best response by the nurse?
- A. The risk of peritonitis is greater with this type of dialysis.
- B. This type of dialysis will provide more independence.
- C. Peritoneal dialysis will require more work for you.
- D. Peritoneal dialysis does not work well for every client.
Correct Answer: B
Rationale: Once a treatment has been selected by the client, the nurse should support the client in that decision. Continuous ambulatory peritoneal dialysis will provide more independence for this client and supports the client's decision for treatment mode. The risk of peritonitis is greater, and symptoms should be discussed as a part of the management of the disorder. Peritoneal dialysis is an effective method of dialysis for many clients.
The nurse is teaching a client diagnosed with polycystic kidney disease on the management of the disorder. Which statement made by the client indicates a need for further teaching?
- A. I inherited this disorder from one of my parents.
- B. The cysts can get quite large in size.
- C. As long as I have one normal kidney, I should be fine.
- D. If renal failure develops, I may need to consider dialysis.
Correct Answer: C
Rationale: Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.