Nokea
The nurse evaluates the client as experiencing symptoms of disequilibrium syndrome, following an initial hemodialysis treatment. Which is the appropriate action to be taken by the nurse?
- A. No action is needed.
- B. Hold the next scheduled treatment.
- C. Slow the dialysis process during future treatment.
- D. Notify the physician and manage the symptoms.
Correct Answer: C
Rationale: Disequilibrium syndrome is a neurologic condition believed to be caused by cerebral edema associated with rapid movement of water. The symptoms are self-limiting and disappear within several hours after dialysis but can be prevented by slowing the dialysis process to allow time for gradual equilibrium of water. The nurse should document the symptoms and notify the physician with repeated incidence.
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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.
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.
Following ureteroscopy, for the removal of ureteral calculus, a stent is temporarily left in place. The client asks what purpose the stent provides. Which is the correct response from the nurse?
- A. The stent is coated with an anti-infective to promote healing.
- B. The stent will catch any debris or blood clots left behind.
- C. The stent will provide easier passing of future stones.
- D. Inflammation from the stone can block the flow of urine.
Correct Answer: D
Rationale: Calculi can traumatize the lining of the ureters, resulting in inflammation and possible obstruction of urine flow. A stent is left behind to allow free-flowing urine until inflammatory process has resolved. Stents are not used for anti-infective properties or to catch debris or clots. Stents are not permanently placed for preventative measures.
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.
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the appropriate response by the nurse?
- A. Even a perfect match does not guarantee organ success.
- B. Immunosuppressive drugs guarantee organ success.
- C. The doctor may decide to delay the use of immunosuppressant drugs.
- D. Let's wait until after the surgery to discuss your treatment plan.
Correct Answer: A
Rationale: Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.