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The nurse is caring for a patient receiving hemodialysis who has symptoms of nausea and dizziness. Which of the following actions should the nurse take first?
- A. Slow down the rate of dialysis.
- B. Obtain blood to check the blood urea nitrogen (BUN) level.
- C. Check the patient's blood pressure.
- D. Give prescribed PRN antiemetic drugs.
Correct Answer: C
Rationale: The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions may also be appropriate, based on the blood pressure obtained.
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The nurse is teaching a patient who is receiving hemodialysis about appropriate dietary choices. Which of the following menu choices by the patient indicates that the teaching has been effective?
- A. Scrambled eggs, English muffin, and apple juice
- B. Oatmeal with cream, half a banana, and herbal tea
- C. Split-pea soup, whole-wheat toast, and nonfat milk
- D. Cheese sandwich, tomato soup, and cranberry juice
Correct Answer: A
Rationale: Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.
The nurse is caring for a patient with end-stage renal disease (ESRD). Which of the following findings indicate that the nurse should consult with the health care provider before giving the prescribed erythropoiesis-stimulating agent (ESA)?
- A. Creatinine 99 mcmol/L.
- B. Oxygen saturation 89%
- C. Hemoglobin level 130 g/L.
- D. Blood pressure 98/56 mm Hg
Correct Answer: C
Rationale: High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when ESA is administered to a target hemoglobin of 110 g/L with a range of 100-120 g/L. Hemoglobin levels higher than 120 g/L indicate a need for a decrease in erythropoiesis-stimulating agent dose. The other information will also be reported to the health care provider but will not affect whether the medication is administered.
The nurse is caring for a patient with hypertension and stage 2 chronic kidney disease (CKD) who is prescribed ramipril. Which of the following laboratory tests should the nurse assess before administration of the medication?
- A. Glucose
- B. Potassium
- C. Creatinine
- D. Phosphate
Correct Answer: B
Rationale: Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the ramipril was given or not.
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 who is receiving hemodialysis and has symptoms of nausea, vomiting, and sudden onset of confusion. Which of the following actions is priority?
- A. Infuse a hypotonic solution.
- B. Increase the rate of the dialysis.
- C. Administer an antiemetic medication.
- D. Stop the dialysis solution.
Correct Answer: D
Rationale: The patient's symptoms suggest disequilibrium syndrome, which is a rare complication of modern HD and develops as a result of very rapid changes in the composition of the extracellular fluid. Urea, sodium, and other solutes are removed more rapidly from the blood than from the cerebrospinal fluid and the brain. This creates a high osmotic gradient in the brain resulting in the shift of fluid into the brain, causing cerebral edema. Manifestations include nausea, vomiting, confusion, restlessness, headaches, twitching and jerking, and seizures. Treatment consists of slowing or stopping dialysis and infusing hypertonic saline solution, albumin, or mannitol to draw fluid from the brain cells back into the systemic circulation.