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The nurse is caring for a patient who has had an insertion of an arteriovenous graft (AVG) in the right forearm and has symptoms of pain and coldness of the right fingers. Which of the following actions should the nurse take?
- A. Elevate the patient's arm above the level of the heart.
- B. Report the patient's symptoms to the health care provider.
- C. Remind the patient about the need to take a daily low-dose Aspirin tablet.
- D. Educate the patient about the normal vascular response after AVG insertion.
Correct Answer: B
Rationale: The patient's complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.
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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.
The nurse is caring for a patient with diabetes who has been admitted with pneumonia and is prescribed gentamicin 60 mg IV. Which of the following parameters should the nurse monitor to evaluate the patient for adverse effects of the medication?
- A. Urine osmolality
- B. Serum potassium and sodium
- C. Blood glucose level
- D. Blood urea nitrogen (BUN) and creatinine
Correct Answer: D
Rationale: When a patient at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin.
Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider?
- A. The urine output is 900-1100 mL/hour.
- B. The blood urea nitrogen (BUN) and creatinine levels are elevated.
- C. The patient's central venous pressure (CVP) is decreased.
- D. The patient has level 8 (on a 10-point scale) incisional pain.
Correct Answer: C
Rationale: The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.
The nurse is caring for a patient who had kidney transplantation several years ago. Which of the following findings may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?
- A. Joint pain
- B. Tachycardia
- C. Postural hypotension
- D. Increase in creatinine level
Correct Answer: A
Rationale: Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.
The nurse is caring for a patient who has had progressive chronic kidney disease (CKD) for several years and is starting hemodialysis. Which of the following information about diet should the nurse include in patient teaching?
- A. Increased calories are needed because glucose is lost during hemodialysis.
- B. Unlimited fluids are allowed since retained fluid is removed during dialysis.
- C. More protein will be allowed because of the removal of urea and creatinine by dialysis.
- D. Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.
Correct Answer: C
Rationale: Once the patient is started on dialysis and nitrogenous wastes are removed, there is less protein lost, therefore more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.