Nokea
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.
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A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago. What is the priority assessment?
- A. Assess blood pressure for hypotension
- B. Assess skin turgor for dehydration
- C. Auscultate lung sounds for crackles
- D. Monitor daily weight for fluid retention
Correct Answer: A
Rationale: By taking blood pressure, the nurse is assessing for hypotension that could compromise perfusion to the new kidney. The nurse then should notify the provider immediately. Skin turgor, lung sounds, and weight could give information about the fluid status of the client, but they are not the priority assessment.
A client in the intensive care unit is started on continuous venous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse?
- A. Blood leak detector alarm
- B. Low ultrafiltrate volume
- C. High venous pressure
- D. Low arterial pressure
Correct Answer: A
Rationale: A blood leak detector alarm indicates a potential rupture in the dialysis membrane, which is a critical issue requiring immediate action to stop the procedure and ensure patient safety. Low ultrafiltrate volume, high venous pressure, or low arterial pressure may require adjustments but are not as immediately life-threatening.
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 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.
In discharge teaching for a client post-kidney transplantation, which instructions should the nurse include? (Select all that apply)
- A. Take antibiotics prophylactically before dental procedures
- B. Reduce doses of antacids with magnesium
- C. Adjust antibiotic doses
- D. Monitor insulin needs closely
- E. Limit physical activity for 6 months
Correct Answer: B,C,D
Rationale: In discharge teaching, the nurse must emphasize that the client needs to have an antibiotic prophylactically before cleared procedures to prevent infection. There may be a need for dose reduction in medications if the kidney is not excreting them properly (antacids with magnesium, antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants).