Hemodialysis & Peritoneal Dialysis (Simple Nursing)

A

A client has a temporary permcath inserted into the subclavian area for emergent hemodialysis. Which of the following is an important part of routine nursing care for this client? A. Maintain sterile technique when changing the catheter dressing. B. Keep the affected extremity immobilized for the first 24 hours. C. Flush the catheter with heparin every 8 hours and after medication administration. D. Auscultate for a bruit and palpate for a thrill every 12 hours.

B

A client is leaving the unit to go to hemodialysis. In which way should the nurse manage the client's medications? A. Give all of the client's medications since they will be gone for several hours B. Hold the client's antihypertensives because of the risk of hypotension during hemodialysis C. Do not give any of the client's medications the morning of dialysis because they will all be removed during dialysis D. Only subcutaneous and IV medications may be given prior to dialysis

A

A client who is prescribed hemodialysis has the following assessment data: serum potassium level is 8 mEq/L (8 mmol/L) and the latest electrocardiogram (ECG) indicates tall, peaked T waves. Which is the priority prescription for the nurse to implement to protect the client from experiencing dysrhythmias related to hyperkalemia? A. Calcium gluconate by intravenous piggyback (IVPB). B. Intravenous (IV) regular insulin with dextrose. C. Sodium polystyrene sulfonate by mouth. D. Furosemide 40 mg by intravenous push (IVP) now.

C

A client with kidney failure is beginning hemodialysis. Which medication should the nurse anticipate being prescribed to supplement red blood cell production? A. Insulin B. Filgrastim C. Epoetin alfa D. Eltrombopag

READ

A low-grade fever is a symptom of peritonitis; therefore, the nurse reports this finding to the HCP.

READ

Allowing the client time to verbalize feelings related to the disease and treatment is the supportive action the nurse will implement. Chronic kidney disease and the treatment will cause an impact on the client's emotional wellbeing. Lack of understanding concerning the disease and treatment can cause fear and anxiety for the client. It is beneficial for the nurse to allow the client opportunities to verbalize thoughts and feelings.

READ

Dark, cloudy effluent is an indicator of infection or fecal contamination from perforation; therefore, the nurse reports this finding to the HCP.

READ

Discussing how life is going to change with this diagnosis and treatment is the supportive action the nurse will implement. Chronic kidney disease and the treatment will cause an impact on the client's emotional wellbeing.t is beneficial for the nurse to allow the client opportunities to discuss adjusting to the life changes.

READ

Epoetin alfa is synthetic erythropoietin used in clients with severe anemia caused by many conditions including kidney failure and chemotherapy. Erythropoietin is normally produced by the healthy kidney. The hormone is released into the bloodstream to stimulate RBC production in the bone marrow. All clients with kidney failure are anemic due to lack of this hormone, therefore it is a necessary part of treatment to maintain optimal health. Without this injection the client can become anemic so the client should be informed of the need for this injection. Symptoms of anemia include shortness of breath, fatigue, and pale skin and mucous membranes.

READ

Following sterile technique when caring for a PD catheter is the priority intervention the nurse will stress to the client. The leading complication of peritoneal dialysis is peritonitis. To maintain infection control, it is important to follow meticulous sterile technique when caring for the peritoneal dialysis catheter and when hooking up or clamping off dialysate bags.

Large, Hypotension

Hemodialysis often eliminates ______ amounts of blood resulting in _____. The client may need to have boluses of fluid during the procedure to counteract this hypotension. Administration of antihypertensives can worsen this problem and lead to severe hypotension.

READ

Metoprolol is a beta-blocker that is prescribed for the treatment of hypertension. This medication is held prior to dialysis to prevent the client from experiencing hypotension; therefore, this medication should be questioned due to the scheduled dialysis.

READ

Providing the client with education concerning the disease and treatment is the supportive action the nurse will implement. Chronic kidney disease and the treatment will cause an impact on the client's emotional wellbeing. Lack of understanding concerning the disease and treatment can cause fear and anxiety for the client. It is beneficial for the nurse to provide information and education concerning the disease and treatment.

Fidelity

Refers to doing what is promised faithfulness; loyalty

Nonmaleficence

Refers to the act of doing no harm

READ

Relaxing in a hot tub each night to enhance sleep increases the risk of infection due to the peritoneal catheter in the abdomen. The client should be instructed to avoid soaking in hot tubs and bath tubs, but to instead relax in showers.

Justice

Respecting the rights of others and giving them what is rightfully theirs

Central, Infections

Sterile technique must be maintained during dressing changes on all ______ venous catheters. Central line associated blood infections are a major cause of hospital acquired infection so interventions should be aimed at preventing these _____.

READ

Tachycardia, or an increased heart rate, is a clinical manifestation that could indicate peritonitis; therefore, the nurse reports this finding to the HCP.

READ

The administration of IV calcium gluconate addresses the client's tall, peaked T waves by raising the threshold for dysrhythmia in order to temporarily stabilize the myocardial tissue; therefore, this is the priority prescription for the nurse to implement.

C

The nurse assesses a client who performs peritoneal dialysis in the home. Which client information indicates to the nurse that the client is at risk for an infection? A. Follows the daily diet/fluid allowance as prescribed B. Wears a mask throughout the dialysis procedure C. Relaxing in a hot tub each night enhances sleep D. Avoid tight clothing or belts around the catheter site

READ

The nurse can promote the child's self-esteem by encouraging the school-age client to spend time with other children with similar diagnoses and prescribed treatments. Having a friend who is similar in appearance, such as a child who requires peritoneal dialysis, promotes self-esteem by decreasing feelings of isolation.

C

The nurse is caring for a client receiving peritoneal dialysis that has just been placed on the list for a kidney transplant. The client asks the nurse about how recipients are selected. The nurse is aware which primary ethical principle is considered when matching donor organs with recipients? A. Beneficence B. Nonmaleficence C. Justice D. Fidelity

A, B, E

The nurse is caring for a client with chronic kidney diseases beginning hemodialysis. Which action will the nurse take to support this client? Select all that apply. A. Allow time to verbalize feelings related to the disease and treatment B. Provide with education concerning the disease and treatment C. Reinforce that everything is going to be okay despite the disease and treatment D. Explain that anger is not going to change the diagnosis and treatment E. Discuss how life is going to change with this diagnosis and treatment

E, D. B, C, A

The nurse preceptor reviews hand hygiene practices for a novice nurse who provides care for a pediatric client who requires peritoneal dialysis for the treatment of chronic kidney disease (CKD). Which is the order for hand hygiene with soap and water that the nurse preceptor should review with the novice nurse? Place the steps in the correct sequence. All options must be used. Answer Example: 13254 A. Dry the hands using a paper towel.. B. Scrub the hands for at least 20 seconds. C. Rinse the hands with clean, running water. D. Lather the hands by rubbing them together. E. Wet the hands and apply soap.

C

The nurse provides care for a pediatric client who requires peritoneal dialysis for the treatment of chronic kidney disease (CKD). Which action by the nurse is best to enhance the child's safety by decreasing the risk for infection? A. Implementing seizure precautions B. Restricting fluid intake as prescribed C. Using sterile technique with dressing changes D. Administering the prescribed prophylactic antibiotic therapy

B

The nurse provides care for a school-age client who is admitted for the treatment of chronic kidney disease (CKD) that requires hemodialysis. The child is crying and states, "I am scared to have surgery! What if I don't wake up?" Which response by the nurse is therapeutic? A. "I will ask your doctor for medication that will calm you." B. "Tell me more about what is scaring you about surgery." C. "Your parents will be disappointed that you aren't being brave." D. "Your surgery is common and there is no reason to be scared."

C

The nurse provides care for a school-age client who requires peritoneal dialysis for the treatment of chronic kidney disease (CKD). The child states, "I am always the different one in every group. I just want to fit in with my friends." Which action by the nurse is best to promote the child's self-esteem? A. Asking the client, "Why do you feel different?" B. Encouraging the client to discuss feelings with a therapist C. Introducing the client to another child who requires the same treatment D. Telling the client, "It is easy to hide the catheter required for this form of dialysis."

A

The nurse provides care for an adolescent client who is diagnosed with chronic kidney disease (CKD) and is prescribed hemodialysis. The client states, "I hate the way my arm looks!" Which action by the nurse is best to promote the child's body image? A. Support the client's choice for clothing. B. Tell the client, "It could be much worse." C. Educate the client on why dialysis is important. D. Ask the client, "Do you know anyone else with a fistula?"

READ

The priority action by the nurse in this situation is to contact the HCP as the client's symptoms are indicative of dialysis disequilibrium syndrome (DDS), a potentially life-threatening condition that can progress to coma and death if severe. Treatment focuses on interventions aimed at resolving cerebral edema and symptom management.

READ

The use of fashionable and comfortable clothing that may disguise anatomic abnormalities and dialysis tubing is an intervention that can promote an adolescent's body image; therefore, supporting the adolescent's clothing choices is the best action by the nurse.

READ

The vascular access site is only used for hemodialysis purposes. Infusing intravenous fluids through the vascular access can cause damage to the site/device.

READ

Think about the ABCs (airway, breathing, circulation) when answering this question. Calcium gluconate treats the life-threatening dysrhythmia, a threat to the client's circulation; once this is addressed, other interventions are implemented to treat the underlying hyperkalemia.

Beneficence

This refers to Doing good or causing good to be done; kindly action. Benefits the client

READ

Using sterile technique when performing dressing changes for a child who is prescribed peritoneal dialysis for the treatment of CKD is the best nursing action to decrease the child's risk for infection. Sterile technique decreases the likelihood of introducing microorganisms into the child's peritoneal cavity which can cause peritonitis and sepsis.

A, C, E

Which assessment finding noted by the nurse for a client receiving peritoneal dialysis requires health care provider (HCP) notification? Select all that apply. A. Dark outflow with sediment. B. Dry, itchy skin. C. A heart rate of 120 beats/minute. D. Low urine output. E. An oral temperature of 99.5

B

Which is the priority nursing action for a client who returns from hemodialysis and begins vomiting, is confused, and has a seizure? A. Administering the prescribed intravenous (IV) ondansetron to treat nausea. B. Informing the health care provider (HCP) about the change in the client's status. C. Placing the client in Trendelenburg to help relieve the headache. D. Providing the prescribed antihypertensive medications that were held prior to dialysis.

B

Which morning medication should the nurse question for a client with end-stage kidney disease who is scheduled for dialysis in one hour? A. Calcium acetate. B. Metoprolol. C. Aspart insulin. D. Vitamin E.

B

While providing care to the client that has a right forearm vascular access for dialysis, which action by the graduate nurse (GN) will require intervention by the nurse? A. Assesses the pulse and capillary refill in the right extremity B. Attempts to initiate intravenous fluid via the vascular access C. Assesses for a bruit and thrill at the vascular access site D. Avoids using the right arm to assess blood pressure

B

While providing education for implementing home peritoneal dialysis (PD) to the client and spouse, which priority intervention will the nurse stress to the client? A. Keep a record of weight daily, using the same scale B. Follow sterile technique when caring for a PD catheter C. Measure weight before and after performing peritoneal dialysis D. Adhere to the nutritional restrictions ordered