Nokea
The nurse is caring for a patient who has leg cramps during hemodialysis. Which of the following actions should the nurse implement first?
- A. Reposition the patient.
- B. Massage the patient's legs.
- C. Give acetaminophen.
- D. Infuse a bolus of normal saline.
Correct Answer: D
Rationale: Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.
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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 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 requires hemodialysis and a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which of the following interventions should be included in the plan of care?
- A. Place the patient on bed rest.
- B. Start continuous pulse oximetry.
- C. Discontinue the urinary catheter.
- D. Restrict the patient's oral protein intake.
Correct Answer: A
Rationale: The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake is likely to be increased when the patient is receiving dialysis. The urinary catheter is likely to remain in place because accurate measurement of output will be needed. There is no indication that the patient needs continuous pulse oximetry.
The nurse is caring for a patient with severe heart failure who develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet which of the following goals of treatment?
- A. Replace fluid volume
- B. Prevent hypertension.
- C. Maintain cardiac output.
- D. Dilute nephrotoxic substances.
Correct Answer: C
Rationale: The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.
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.