Nokea
The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which of the following information should be reported immediately to the health care provider?
- A. The patient has an outflow volume of 1800 mL.
- B. The patient's peritoneal effluent appears cloudy.
- C. The patient has abdominal pain during the inflow phase.
- D. The patient complains of feeling bloated after the inflow.
Correct Answer: B
Rationale: Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.
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The nurse is caring for a patient who requires vascular access for hemodialysis and asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. Which of the following information should the nurse explain is an advantage of the fistula?
- A. Is much less likely to clot
- B. Increases patient mobility.
- C. Accommodates larger needles.
- D. Can be used sooner after surgery.
Correct Answer: A
Rationale: AV fistulas are much less likely to clot than grafts although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.
The nurse is caring for a patient with acute glomerulonephritis, acute kidney injury (AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the following parameters should the nurse assess to evaluate the effectiveness of the medication?
- A. Urine output
- B. Calcium level
- C. Cardiac rhythm
- D. Neurological status
Correct Answer: C
Rationale: The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.
The nurse is assessing a patient who had a kidney transplant 8 years ago and is receiving the immunosuppressants tacrolimus, cyclosporin, and prednisone. Which of the following findings is of most concern to the nurse?
- A. The blood glucose is 7.9 mmol/L.
- B. The patient's blood pressure is 150/92.
- C. There is a nontender lump in the axilla
- D. The patient has a round, moonlike face.
Correct Answer: C
Rationale: A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of persistent immunosuppressive therapy. The elevated glucose, moon face, and hypertension are possible adverse effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.
The nurse is caring for a patient with acute kidney injury (AKI) who has an arterial blood pH of 7.30 Which of the following assessment findings should the nurse anticipate?
- A. Vasodilation
- B. Poor skin turgor
- C. Bounding pulses
- D. Rapid respirations
Correct Answer: D
Rationale: Patients with metabolic acidosis caused by AKI may have Kussmaul's respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.
The nurse is caring for a patient with acute kidney injury who is dehydrated with symptoms of oliguria, anemia, and hyperkalemia. Which of the following prescribed actions should the nurse take first?
- A. Insert a urinary retention catheter.
- B. Place the patient on a cardiac monitor.
- C. Administer an erythropoiesis-stimulating agent (ESA).
- D. Give sodium polystyrene sulfonate.
Correct Answer: B
Rationale: Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. ESA's will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.