Nokea
The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client?
- A. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH.
- B. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis.
- C. The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate.
- D. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.
Correct Answer: C
Rationale: In CKD, the kidneys fail to excrete acids (via ammonia) and reabsorb bicarbonate, leading to metabolic acidosis. Increased acid excretion would raise pH, RBC lifespan affects anemia, and vomiting causes alkalosis, not acidosis.
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The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first?
- A. Place the client in the Trendelenburg position.
- B. Turn off the dialysis machine immediately.
- C. Bolus the client with 500 mL of normal saline.
- D. Notify the health-care provider as soon as possible.
Correct Answer: B
Rationale: Dizziness and light-headedness during dialysis suggest hypotension, often due to rapid fluid removal. Turning off the dialysis machine stops fluid removal, stabilizing the client. Trendelenburg, saline bolus, or notifying the provider are secondary actions.
The client diagnosed with a fluid and electrolyte disturbance in the emergency department is exhibiting peaked T waves on the STAT electrocardiogram. Which interventions should the nurse implement? List in order of priority.
- A. Assess the client for leg and muscle cramps.
- B. Check the serum potassium level.
- C. Notify the health-care provider.
- D. Arrange for a transfer to the telemetry floor.
- E. Administer Kayexalate, a cation resin.
Correct Answer: B,C,E,D,A
Rationale: Peaked T waves indicate hyperkalemia. Priority: 1) Check potassium level to confirm; 2) Notify HCP for orders; 3) Administer Kayexalate to lower potassium; 4) Transfer to telemetry for monitoring; 5) Assess cramps, a less urgent symptom.
If the client makes the following statements, which information is most important to report to the physician before the client undergoes an intravenous pyelography (IVP)?
- A. The barium they give me to drink causes me to have concentration.
- B. I have a low tolerance for pain during procedures.
- C. I had a reaction when my gallbladder was X-rayed before.
- D. I get claustrophobic when I am put into that big round machine.
Correct Answer: C
Rationale: A previous reaction to a contrast dye, as implied by the gallbladder X-ray reaction, indicates a potential allergy risk, which must be reported before IVP.
Which statement by the client indicates a need for further teaching about the management of urolithiasis?
- A. I will drink at least 3 liters of water daily.
- B. I will strain all my urine to collect any stones.
- C. I will take my pain medication as prescribed.
- D. I will avoid drinking water to reduce urine output.
Correct Answer: D
Rationale: Avoiding water intake is incorrect, as increased fluid intake is essential to promote stone passage and prevent recurrence.
The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply.
- A. Check for the ordered diet and medication modifications.
- B. Instruct the client to urinate, and discard this urine when starting collection.
- C. Collect all urine during 24 hours and place in appropriate specimen container.
- D. Insert an indwelling catheter in client after having the client empty the bladder.
- E. Instruct the UAP to notify the nurse when the client urinates.
Correct Answer: A,B,C
Rationale: For a 24-hour urine collection, ensure diet/medication orders are followed, discard the first void to start the collection period, and collect all subsequent urine. Catheters are unnecessary, and UAP notification is not standard.