Nokea
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.
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A client is experiencing acute glomerulonephritis. Which assessment finding by the nurse is most important in determining the severity of the client's condition?
- A. Presence of albumin in the urine
- B. Dark smoky colored urine
- C. Blurred vision
- D. Peripheral edema
Correct Answer: C
Rationale: Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis. Severe hypertension needs prompt treatment to prevent convulsions. Presence of albumin (protein) and RBCs in the urine, along with periorbital and peripheral edema, are common symptoms associated with glomerulonephritis.
A client with chronic kidney disease complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
- A. Elevated serum creatinine
- B. Hyperkalemia
- C. Hyperphosphatemia
- D. Elevated urea and nitrogen
Correct Answer: C
Rationale: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
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.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury?
- A. The kidneys can improve over a period of months.
- B. Once on dialysis, the need will be permanent.
- C. Kidney function will improve with transplant.
- D. Acute kidney injury tends to turn to end-stage failure.
Correct Answer: A
Rationale: The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute kidney injury can progress to chronic renal failure.
The client with chronic kidney disease complains of intense itching. Which assessment finding would indicate the need for further nursing education?
- A. Pats skin dry after bathing
- B. Uses moisturizing creams
- C. Keeps nails trimmed short
- D. Brief, hot daily showers
Correct Answer: D
Rationale: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoiding scratching and keeping nails trimmed short is indicated in the management of pruritus.