Renal and nutrition- archer

The nurse has taught a client scheduled for a liver biopsy. Which of the following statements by the client would indicate a correct understanding of the teaching?

"I may be asked to breathe in and hold my breath before the insertion of the needle." A liver biopsy is performed with the client conscious using local anesthesia (lidocaine). During the procedure, the client is asked to take a deep breath and hold it to ensure appropriate needle placement.

The nurse has taught a client about a scheduled intravenous (IV) urography (pyelogram). Which of the following statements by the client would indicate a correct understanding of the teaching? A. "I should expect a temporary urinary catheter inserted during the procedure." B. "I will take a laxative the night before to clear my bowels." C. "I must fill my bladder with water immediately before the procedure." D. "I may experience blood in my urine for a few days after this procedure."

"I will take a laxative the night before to clear my bowels." An IV urography (pyelogram) is a diagnostic test used to gather urinary tract imaging that views the collecting ducts and renal pelvis and outlines the ureters, bladder, and urethra. The client must perform a bowel cleansing the night before to ensure adequate visualization of the urinary tract. During this procedure, the client will empty their bladder, and then an intravenous injection of contrast medium is given, and a series of x-ray films and fluoroscopy is used to observe the passage of urine from the renal pelvis to the bladder. The use of this test has decreased because of computed tomography scans of the urinary tract.

Carbohydrates, proteins, and fats provide the energy that is necessary for cellular function. A. "You should take aspirin if you have mild aches or pains." B. "You will need to consume liquids one hour after each meal." C. "It will be important to reduce the stress in your life." D. "Take your prescribed omeprazole with food."

"It will be important to reduce the stress in your life." A client with peptic ulcer disease will need to reduce the stress in their life to mitigate some of the symptoms. Ulcers are caused by excessive use of non-steroidal anti-inflammatory drugs, alcoholism, H. pylori infections, and stress. Aspirin and NSAIDs should not be taken for a client with peptic ulcer disease as they can hasten the disease process and cause bleeding. Consuming liquids one hour after meals is appropriate instruction for a client with dumping syndrome - not peptic ulcer disease. Omeprazole is a proton pump inhibitor and should be given without other medications or food.

A client is being discharged with a gastrostomy tube to allow enteral feedings to be continued at home. While educating the client and family, which inaccurate statement made by a family member indicates the need for further teaching? A. "If diarrhea occurs for 2-3 days, we will call the health care provider (HCP) or nurse." B. "We should expect a weight gain of approximately 1 lb/day now that continuous feedings will be in place." C. "When feeding, I should ensure the head of the bed is elevated, or my family member is sitting up in the chair." D. "Prepared or open formula should be used within 24 hours, and unused portions should be stored in the fridge."

"We should expect a weight gain of approximately 1 lb/day now that continuous feedings will be in place." This statement by the client's family member is inaccurate and indicates the need for further teaching. A weight gain of approximately 1 lb/day is not a realistic expectation for a client on tube feedings. If this type of weight gain were to occur, such excessive weight gain would indicate fluid retention and require immediate medical intervention. A consistent weight gain of more than 0.5 lb/day over several days should be promptly reported to the client's health care provider (HCP) so that the client may be evaluated for excess fluid volume.

The nurse is caring for a client with appendicitis. Which of the following statements are correct regarding this condition? Select all that apply.

- McBurney's point tenderness is a sign of appendicitis -Appendicitis is more common among males -The client may have an elevated white blood cell count (WBC) McBurney's point tenderness refers to right lower quadrant pain, suggesting appendicitis. Rebound tenderness is a common finding when this area is palpated. Appendicitis is more common among males than females. A low-grade fever, abdominal pain in the right lower quadrant, and an elevated white blood cell count are common findings in appendicitis.

post-op abdominal surgery

- bowel sounds may be temporarily absent due to the normal physiological response to the surgical trauma, anesthesia, and/or opiate pain medication(s) utilized during the procedure. - The return of bowel sounds can indicate that the gastrointestinal system is recovering from the surgery and functioning normally again. - The timing of the return of bowel sounds can vary depending on the type of surgery performed and the individual client's response to the procedure. - Bowel sounds should generally return within 24 to 48 hours after surgery. However, it is not uncommon for bowel sounds to be absent for a longer period, especially if the surgery involved bowel manipulation or if there was significant inflammation or infection in the area. -If there is a prolonged absence of bowel sounds or other symptoms such as abdominal distention, nausea, vomiting, or fever, it is important to notify the health care provider (HCP), as these may be signs of a complication.

Ascities

-The primary sign of ascites is an increase in abdominal girth and weight gain. -Free fluid in the abdominal cavity, known as ascites, is typically a result of portal hypertension or other hepatic or nonhepatic conditions. -Moderate amounts of fluid can increase abdominal girth and cause weight gain, and massive amounts can cause abdominal distention, pressure, and dyspnea. Signs may be absent if fluid accumulation is less than 1500 mL. -Unless the diagnosis is obvious, confirm the presence of ascites using ultrasonography or CT. -If ascites is a new diagnosis, the cause is unknown, or spontaneous bacterial peritonitis is suspected, the primary health care provider (PHCP) will often order a paracentesis and test the ascitic fluid.

The nurse is teaching a group of students on fluid and electrolytes. It would be correct for the student to identify which intravenous (IV) solution as hypertonic? Select all that apply. 3% saline Dextrose 10% in water (D10W) 5% Dextrose with 0.45% Sodium Chloride Lactated Ringers (LR) 0.45% Sodium Chloride (0.45% NaCl

3% saline Dextrose 10% in water (D10W) 5% Dextrose with 0.45% Sodium Chloride

The nurse assists a client with diverticulosis select appropriate foods on a menu. Which food choice, if made by the client, would require further teaching? Select all that apply. Bran cereal Fresh peaches White toast Scrambled eggs Cabbage soup

white toast scrambles eggs Diverticulosis requires the client to adhere to a high-fiber diet. White toast and eggs are low in fiber and would require follow-up by the nurse. Wheat bread would be a better choice.

The nurse should inform the client that a colonoscopy should begin at age

45 The majority of colon cancer cases occur in patients aged 50 or older. The United States Preventive Task Force (USPTF) recommends initiating colon cancer screening at 45. The idea of colon cancer screening with colonoscopy is to detect precancerous polyps and remove them before they can turn malignant. For those who refuse colonoscopy or cannot undergo colonoscopy, an alternative option is fecal occult blood testing (FOBT) and flexible sigmoidoscopy together. The primary prevention is counseling the client about colon cancer and recommending measures to prevent it (such as adopting a high-fiber diet). Screening for colon cancer is a form of secondary prevention.

Which of the following clients does the nurse suspect would benefit most from placement of a nasogastric tube? A. A 9-year-old client with a femur fracture. B. An 82-year-old client with congestive heart failure. C. A 65-year-old client on dialysis. D. A 52-year-old client with leukemia who is receiving chemotherapy.

52-year-old client with leukemia who is receiving chemotherapy. The nurse suspects that a 52-year-old female with leukemia receiving chemotherapy would benefit most from a nasogastric tube. Nasogastric tubes are placed to help clients meet their nutritional needs. A client with leukemia has an increased need for calories and protein, but the chemotherapy treatment she is undergoing is likely to cause anorexia and nausea. This client could benefit from a nasogastric tube to help meet her nutritional needs.

Manifestations of cholecystitis include:

• Abdominal pain in the right upper quadrant radiating to the right shoulder blade (pain is often aggravated with a high-fat meal) • Significant nausea and vomiting • Fever • + Murphy's sign • Yellowing of the eyes

liver biopsy procedure instructions

A liver biopsy requires the client to complete informed consent. ✓ Prior to a liver biopsy, coagulation studies such as aPTT, PT/INR, and platelet count should be obtained and reviewed. ✓ Food and fluid should be withheld 8-12 hours prior to this procedure. ✓ The client is positioned supine or left lateral during the procedure to expose the right side of the upper abdomen. ✓ Post-procedure, the nurse should remind the client to avoid coughing and straining. Additionally, vital signs should be monitored closely. ✓ Post-procedure, the client should be placed on the right side with a pillow under the costal margin for 2 hours. ✓ The biggest complication from this procedure is intraperitoneal hemorrhage.

The nurse is assessing a client with acute cholecystitis. Which of the following physical assessment findings would be expected?

Episodic upper abdominal pain Episodic abdominal pain originating in the right upper quadrant or epigastric area is commonly associated with cholecystitis. The pain may be induced by a meal high in fat.

The nurse is assessing a client receiving peritoneal dialysis. Which laboratory result should immediately be reported to the primary healthcare provider (PHCP)? A. WBC 19,000 mm3 [5,000-10,000 mm3] B. Hemoglobin 9 mg/dL [Male: 14-18 g/dL (140-180 g/L) Female: 12-16 g/dL (120-160 g/L)] C. Calcium 8.6 mg/dL [9.0-10.5 mg/dL] D. Serum pH 7.33 [7.35-7.45]

A. WBC 19,000 mm3 [5,000-10,000 mm3] Leucocytosis (predominantly neutrophilic) suggests infection in a client on peritoneal dialysis. The most significant complication with peritoneal dialysis is peritonitis. A client with chronic kidney disease will have anemia, hypocalcemia, and metabolic acidosis. These are all expected findings and do not need to be reported to the PHCP.

The nurse is caring for a post-abdominal surgery client four days after surgery. The nurse notes a temperature of 37°C, no complaints of pain at the incision site or elsewhere, a dry and intact wound dressing, and hypoactive bowel sounds in all four quadrants. Based on all the assessment data, what conclusion can the nurse make?

Additional gastrointestinal assessments should be performed. The nurse should use all the data gathered to analyze the situation. The client had abdominal surgery and has hypoactive bowel sounds. The nurse needs to perform further assessments (i.e., evaluation of last bowel movement, questions regarding dietary intake, abdominal distention, etc.) to determine if there are any impending gastrointestinal problems for the client and if any treatments need to be initiated.

The nurse is assessing a client who was admitted four hours ago with hypomagnesemia. Which of the following findings should the nurse recognize as a common cause of hypomagnesemia? Select all that apply.

Alcoholism Anorexia nervosa Diarrhea Alcoholism causes diuresis, which lowers serum magnesium levels. Additionally, chronic alcoholism impairs the absorption of magnesium. Anorexia nervosa is a psychiatric illness where the individual eats very few calories and causes electrolyte disturbances such as low potassium, magnesium, and sodium. All of which may be life-threatening. Diarrhea causes a depletion of all electrolytes, which would appropriately explain the low magnesium levels.

The nurse is caring for a client who has ascites and hepatic encephalopathy. Which of the following prescriptions should the nurse clarify with the primary healthcare provider (PHCP)? A. Alprazolam [37%] B. Rifaximin [25%] C. Lactulose [14%] D. Spironolactone

Alprazolam Benzodiazepines should be avoided for a client with hepatic encephalopathy. These medications can worsen the sensorium of a client, therefore putting the client at high risk for falls and injury.

Which of the following nursing diagnoses is the most appropriate for an immobilized client on complete bed rest who has a blood calcium level of 9.9 mg/dL (2.475 mmol/L) [9-10.5 mg/dL, 2.12-2.52 mmol/L] and a urinary pH of 9.9 [4.6-8]?

Impaired urinary elimination related to an alkaline urinary pH "Impaired urinary elimination related to an alkaline urinary pH" is the most appropriate nursing diagnosis for an immobilized client on complete bed rest. A urinary pH of 9.9 is abnormal, as this is outside the normal urinary pH value range of 4.6 to 8. A urinary pH of less than 4.6 is considered acidic, while urinary pH values greater than 8.0 are considered alkaline. Abnormal alkalinity, a known complication of immobility, places the client at risk for the formation of renal calculi and urinary impairments.

The nurse is assessing a client with suspected acute cholecystitis. Which of the following findings would support a diagnosis of acute cholecystitis?

Increased white blood cell count (WBC)

The health care provider (HCP) places an order to administer gentamicin intravenously to a client with acute diverticulitis. It is important the nurse knows that intravenous gentamicin is administered: A. Over one minute via IV push B. Over two minutes via IV push C. As an IV infusion over 15-20 minutes D. As an IV infusion over 30 minutes to two hours

As an IV infusion over 30 minutes to two hours Gentamicin is a weight-based medication requiring the client's pretreatment body weight to calculate the correct dosage. For this reason (and to clarify the above order), it would be reasonable for the nurse to contact the health care provider (HCP) to clarify the above order prior to administration. Regarding the administration of gentamicin, the medication may be given intramuscularly or by intravenous infusion. An additional form of gentamicin is available in eyedrop form. When administering a single dose of intravenous gentamicin, the medication is diluted in 50 to 200 mL of normal saline solution or 5% dextrose in water and intravenously infused over a period of 30 minutes to two hours.

Which nursing intervention would be a priority for a patient receiving 3% saline maintenance fluids? A. Monitor serum HCO3- B. Monitor urine sodium C. Assess blood pressure D. Collect 24-hour urine output

Assess BP 3% saline is a hypertonic solution, so the nurse should monitor for signs/symptoms of fluid volume overload and pulmonary edema (increased blood pressure, crackles in lungs, shortness of breath). This type of fluid increases extracellular osmolality and volume. High osmotic pressure causes water to shift from inside cells into the extracellular fluid. Hypertonic solutions are used to treat hypovolemia and hyponatremia.

A nurse receives a client who just returned from an endoscopy, during which the client was sedated. Before resuming the client's diet, which of the following should the nurse prioritize?

Assess for the return of the client's gag reflex Undergoing an endoscopy generally requires intravenous sedation, therefore impairing the client's gag reflex. Here, since the question asks what the nurse should prioritize before resuming the client's diet, the priority is to closely monitor the client until the effects of the sedation have resolved and the client's gag reflex has returned. Attempting to provide the client with oral intake before ensuring the return of the gag reflex may result in airway obstruction and/or aspiration. Maintain NPO status until the anesthesia has worn off and the gag reflex has returned. Provide the client with an emesis basin, and instruct the client to spit out saliva rather than swallow it. Following the return of the client's gag reflex, the client may resume their normal diet, beginning with sips of water or ice chips. If the client resumes oral intake too soon, airway obstruction and/or aspiration may occur. Aspiration can cause acute pneumonia.

The oncoming nurse learns that her new patient is suffering from Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion. Which of the following nursing actions is the most important?

Assess the patient's mental status When caring for a patient with SIADH, the nurse should carefully monitor for changes in mental status and level of consciousness. SIADH causes excess free water retention and hyponatremia, which may lead to confusion and behavioral changes. These alterations in the mental state may also lead to seizures. Patients with SIADH may also experience cardiac dysrhythmias.

The nurse is supervising a student nurse perform an abdominal assessment on a client with gastroenteritis. It would indicate effective technique if the student performs the assessment in which order?

Inspection, auscultation, percussion, palpation Inspection is always performed first. Auscultation of the abdomen must be performed before percussion and palpation to prevent the alteration of bowel sounds. When palpating the abdomen, any area(s) of tenderness should be palpated last to prevent the client from guarding their abdomen.

You are caring for a 65-year-old client who received a fecal diversion ostomy two days ago. Since then, the nursing staff has provided total care for the client and their ostomy, including irrigation and the application of the collection pouch. You have planned the education and training for this client to begin ostomy self-care; however, when you tell the client that you will be teaching them how to do this after discharge, the client states, "I do not want to even look at it. I will have my spouse care for it when I get home." Which of the following is the most appropriate nursing diagnosis which should be prioritized for this client? A. Risk for disturbed body image related to an ostomy B. Disturbed body image related to a fecal diversion ostomy C. Deficient knowledge related to the importance of self-care D. Deficient knowledge related to ostomy self-care

B. Disturbed body image related to a fecal diversion ostomy Disturbed body image related to a fecal diversion ostomy is the most appropriate and the highest priority nursing diagnosis for this client at this time. According to the NANDA International Nursing Diagnoses reference guide, disturbed body image (i.e., a negative mental picture of one's physical self) has defining characteristics, including, but not limited to, avoiding touching one's body, neglecting a nonfunctioning body part, and refusal to acknowledge a change. Here, the client has exhibited all these characteristics. Additionally, clients with stomas are identified as an "at risk population" for the disturbed body image nursing diagnosis.

The nurse is caring for a client with peritoneal dialysis. The client reports an outflow of only one-half of the dialysate solution that was dwelled. The nurse should instruct the client to do which of the following? A. Apply heat to the abdomen. B. Encourage the client to have a bowel movement. C. Strip the dialysis catheter. D. Instill more dialysate solution.

B. Encourage the client to have a bowel movement. Outflow failure is suspected when the peritoneal dialysate drainage volume is less than the inflow volume. Constipation often suppresses dialysate outflow. Constipation is a common problem in peritoneal dialysis, and it occurs due to the consumption of prescribed phosphate binders as well as due to decreased intestinal motility from chronic kidney disease itself.

The nurse is reviewing the laboratory results of a client with renal failure. Which laboratory data requires immediate follow-up? A. Blood urea nitrogen 50 mg/dL [10-20 mg/dL] B. Serum potassium 6 mEq/L (mmol/L) [3.5-5.0 mEq/L] C. Arterial blood pH 7.30 [7.35-7.45] D. Hemoglobin 10.3 g/dL (1.03 g/L) [F: 12-16 g/dL (7.4 -9.9 mmol/L) M: 14-18 g/dL (8,7-11.2 mmol/L)]

B. Serum potassium 6 mEq/L (mmol/L) [3.5-5.0 mEq/L] Choice B is correct. Renal failure can cause a significant imbalance in lab values. Although the lab results listed are abnormal, the elevated potassium level is a life-threatening finding because it may cause lethal cardiac dysrhythmias. Choice A is incorrect. Elevated renal function tests (BUN and Creatinine) are expected in an individual with acute renal failure. This is not as concerning compared to the dangerously high potassium levels. Choice C is incorrect. A pH of 7.30 is acidosis and is expected for an individual with acute renal failure. This is because of the kidney's inability to recirculate bicarbonate, which can help neutralize the acidic pH. This is not a priority compared to the critically high potassium level. Choice D is incorrect. Anemia with renal failure is expected because of the kidney's inability to secrete erythropoietin. Erythropoietin is a substance used to stimulate the production of red blood cells. The hemoglobin is low. However, it is the dangerously high potassium that is highly concerning.

A client with benign prostatic hyperplasia (BPH) is post-operative following transurethral resection of the prostate and is now on continuous bladder irrigation. Upon assessment, the nurse notes that the drainage from the urinary catheter has stopped. Which nursing intervention is most appropriate? A. Reinsert a new catheter B. Increase the infusion rate of the irrigation C. Attempt to dislodge a clot D. Contact the health care provider (HCP)

C. Attempt to dislodge a clot Following a transurethral resection of the prostate (TURP), clients often receive continuous bladder irrigation (CBI) to prevent clot retention, bladder spasms, and post-operative hemorrhage. If the continuous infusion or drainage of the sterile fluid ceases, the nurse should inspect the CBI set for the presence of a clot. If a clot is present, the most appropriate intervention would be for the nurse to attempt to dislodge any existing clot by gently aspiration the lump or irrigation through the out-port with the goal of allowing the continuous bladder irrigation to resume. Following this intervention, the nurse should document all relevant details of the intervention, including, but not limited to, a description of the clot removed.

The nurse prepares a client for a computed tomography (CT) scan of their abdomen and pelvis with intravenous (IV) contrast. The nurse should take which action prior to the client's exam?

C. Educate the client that they may experience a flushing sensation during the exam Flushing of the face is a response to the intravenous administration of contrast dye commonly seen in clients. Often, clients experience a warm sensation throughout the body once the intravenous contrast dye begins infusing. Usually, if the client does experience this warm sensation, clients will typically report the sensation occurring initially in the face and neck region. Shortly after, clients will often state they feel the warmth in their pelvic area.

Primary nutrients that are essential for optimal body function include:

Carbohydrates, proteins, and fats Carbohydrates, proteins, and fats provide the energy that is necessary for cellular function.

A client with peptic ulcer disease from chronic nonsteroidal anti-inflammatory drug (NSAID) use is prescribed misoprostol. In educating the client regarding this drug's mechanism of action, the nurse would be most accurate in informing the client that this medication:

Lines the stomach for protection Misoprostol is a synthetic prostaglandin that protects the gastric mucosa by decreasing gastric acid secretion and lining the stomach for protection by increasing mucus and bicarbonate secretion. Misoprostol reduces the risk of NSAID-induced gastric ulcers, as NSAIDs decrease prostaglandin production and predispose the client to peptic ulceration.

A client with polycystic kidney disease, the client should be educated on the following points

Measure and record your blood pressure daily. • Take your temperature if you suspect you have a fever. If a fever is present, notify your provider. • Weigh yourself every day at the same time of day and with the same amount of clothing; notify your primary health care provider if you have a sudden weight gain. • Limit your salt intake to help control your blood pressure once hyperfiltration is no longer a symptom of your disease (once chronic kidney disease [CKD] is present). • Notify your provider if your urine smells foul or has a new occurrence of blood in it. • Notify your provider if you have a headache that does not go away or if you have visual disturbances because these are symptoms of a stroke or bleeding in the brain. • Monitor bowel movements to prevent constipation.

Several substances may insult the kidneys, thus, raising the creatinine. These substances and medications include -

Metformin Aminoglycosides IV Contrast Sulfonamides NSAIDs Heavy metals

The nurse is caring for a 68-year-old individual in the emergency department who had been on the bathroom floor for about 10 hours after a fall. While performing straight catheterization, the nurse notes that the urine output reaches 800 mL and continues to flow heavily. What action should the nurse take, and what is the rationale for this action?

Stop draining the client's bladder because the client is at risk for developing bladder spasms. This option is the most cautious approach, acknowledging the potential harm associated with rapid and complete bladder drainage. Stopping the drainage aims to prevent the development of bladder spasms, which is a valid concern given the situation and the risk of over-distension.

The nurse is caring for a client with hypernatremia. Which prescribed intravenous fluid (IVF) would be appropriate? A. Dextrose 5% in water (D5W) B. 3% saline C. Lactated ringers D. 0.9% Saline

Dextrose 5% in water (D5W) This client has hypernatremia (sodium > 145 mEq/L, mmol/L) and should avoid additional sodium-containing fluids. Dextrose 5% in water replaces water losses due to hypernatremia. It would be an appropriate maintenance fluid for this client because it contains free water with no added sodium or other electrolytes and promotes renal solute excretion.

diverticulosis

Diverticulosis is when the client develops small herniations in the large bowel ✓ A common cause of this condition is a low-fiber diet, and it causes manifestations such as abdominal cramping in the left lower quadrant, bloating, flatulence, and blood in the stool ✓ The client is instructed to increase their fiber and water intake as these measures are key in promoting bowel motility ✓ If the client has difficulty adhering to a high-fiber diet, bulk-forming laxatives are recommended ✓ If the client should develop diverticulitis, the prescribed diet is NPO (nothing by mouth) status and slowly advanced to clear liquids, then low fiber, then they can resume the high-fiber diet

The nurse supervises a student nurse giving medications through a nasogastric tube (NGT) to a client receiving continuous enteral feeding. Which actions by the student require follow-up by the nurse? Gives each medication separately Verifies placement of the NGT prior to medication administration Elevates the head of the bed to 15 degrees Adds crushed medications directly to a tube feeding Crushes each tablet into a fine powder

Elevates the head of the bed to 15 degrees Adds crushed medications directly to a tube feeding These actions by the student are incorrect and require follow-up. To prevent aspiration, the client should be elevated between 30-45 degrees during and after this procedure. Crushed medications should not be added directly to the tube feeding because the tube feeding may alter the efficacy of the medication. The medication should be administered directly to the client after the tubing has been flushed with 20 to 30 mL of tap water. If giving only one dose of medication, flush the tubing with 20 to 30 mL of water after administration.

The nurse is caring for a client who has just returned from an intravenous urography procedure. Which of the following nursing interventions is most important at this time?

Encourage the client to drink at least 1 L of fluid The dye used during intravenous urography is sometimes nephrotoxic. Thus clients should be encouraged to increase fluids unless contraindicated.

The nurse has just finished assisting the physician in performing a paracentesis. What should be the priority nursing intervention following the procedure?

Monitor for signs of hypovolemia A significant complication of paracentesis is hypotension and hypovolemia secondary to fluid drainage from the peritoneum. These complications are more common with large-volume paracentesis. When significant quantities of peritoneal fluid are drained, there is a sudden change in the intraabdominal pressure and the potential for rapid fluid shifts from intravascular to interstitial space, which can result in low blood pressure and low volume. During and after the paracentesis, the nurse should monitor the client's fluid and electrolyte status. If hypovolemia is not corrected, shock can follow. The nurse should observe for pallor, tachycardia, hypotension, oliguria, and dyspnea. In order to help prevent hypovolemic shock, intravenous administration of albumin (albumin replacement) is generally considered for paracentesis involving volumes greater than 5 L.

The nurse reviews a client's laboratory results and notes that their potassium level is 5.6 mEq/L (mmol/L) [3.5-5 mEq/L, mmol/L]. Which change to the cardiac rhythm would be expected?

Narrow and peaked T-waves A potassium level over 5.0 mEq/L (mmol/L) [3.5-5 mEq/L, mmol/L] indicates hyperkalemia and is known for causing alterations to the cardiac rhythm. Tall peaked T waves with a shortened QT interval are usually the first findings. ECG changes do not always correlate with the severity of the potassium alterations. Hyperkalemia primarily affects ventricular repolarization, leading to T-wave changes, rather than P-wave alterations.

The physician has diagnosed the client with benign prostatic hyperplasia (BPH) Lisinopril Nortriptyline Clonidine Aspirin

Nortriptyline Nortriptyline is a tricyclic antidepressant used for depression and obsessive-compulsive disorders. This medication is significantly anticholinergic and would further irritate the client's BPH symptoms. The other medications are not purported to aggravate this condition.

The nurse is caring for a client who is diagnosed with acute appendicitis. After several hours of pain, the client suddenly states a relief in his pain. What is the initial action of the nurse?

Notify HCP The nurse should notify the physician immediately to assess the client and prepare for surgery since this could signify a rupture of the appendix; any delay could cause peritonitis.

The nurse is teaching a class on acid-base imbalances. It would be correct for the nurse to identify which of the following would cause respiratory acidosis? Select all that apply. Aspirin overdose Pneumothorax Opioid overdose Anxiety Renal disease

Pneumothorax Opioid Overdose Respiratory acidosis is caused by the inability to expel carbon dioxide through airway obstruction or decreased ventilation. A pneumothorax causes shallow breathing, which causes the retention of CO2 (an acid). Opioids are central nervous system depressants. When the client is exposed to toxic levels, the effect causes hypoventilation and the retention of CO2.

A nurse is conducting a dysphagia screening on a client who was recently extubated. Which assessment finding requires intervention? A. Slight cough after sipping water B. Hoarseness of voice during speech C. Complaint of throat discomfort when swallowing D. Presence of a wet, gurgling cough after drinking water

Presence of a wet, gurgling cough after drinking water A wet, gurgling cough after drinking water is a concerning finding during a dysphagia screening post-extubation. It may indicate that the client is experiencing aspiration. The nurse should stop oral intake, keep the client in a safe position, and notify the healthcare provider for further evaluation and possible interventions, such as a formal swallow study or referral to a speech therapist for swallowing rehabilitation. ✓ After identifying the presence of a wet, gurgling cough after drinking water, the nurse should closely monitor the client's respiratory status and vital signs. This includes assessing for signs of respiratory distress, such as increased respiratory rate, decreased oxygen saturation, or abnormal breath sounds. ✓ Elevating the head of the bed to a semi-Fowler's or Fowler's position can help reduce the risk of aspiration and improve respiratory function. ✓ Aspiration during the dysphagia screening requires a more comprehensive evaluation of the client's swallowing function. The nurse should work with the healthcare provider to consult speech for further evaluation.

The nurse is conducting a health screening at a local health fair. Which of the following should the nurse recognize as risk factors for peptic ulcer disease (PUD)? Select all that apply. Prolonged ibuprofen use Tobacco use Irritable bowel syndrome H. pylori Alcohol consumption

Prolonged ibuprofen use Tobacco use H. pylori Alcohol consumption These products are gastric irritants, and overexposure to these substances may cause PUD. Prolonged NSAID use (such as ibuprofen) is commonly implicated in the causation of PUD because of their ability to inhibit COX-1 in the gastrointestinal tract. H. pylori is a gram-negative bacteria that may be acquired by an individual consuming contaminated food or water. Alcohol and tobacco usage causes more gastric acid to be discharged. When used together, the risk for PUD is substantially increased.

The nurse preceptor is orienting a newly hired nurse caring for a client with advanced polycystic kidney disease (PKD). Which of the following actions by the newly hired nurse would require follow-up by the nurse preceptor?

Requesting a prescription for ketorolac to help relieve the client's pain. For a client with advanced PKD, NSAIDs should be avoided. NSAIDs cause decreased renal blood flow and would be unhelpful (if not detrimental) in PKD management. If the newly hired nurse requests a prescription of ketorolac, an NSAID, this would require follow-up because it would be inappropriate.

The nurse is caring for a client with cholecystitis who is reporting acute pain. Where should the nurse expect to find the location of this pain?

Right upper quadrant, radiating to the right shoulder Cholecystitis is known for causing pain in the right upper quadrant which can refer to the right shoulder and scapula. Referred pain is experienced away from the origin site. Visceral pain can be referred to a corresponding somatic structure and is mediated by similar segmental innervation between the originating visceral organ and the referred somatic site.

The nurse is assessing a client with pancreatitis. Which of the following type of pain would be expected?

Severe pain in the mid-epigastric area radiating to the back.

The physician orders the client to be discharged and prescribes tamsulosin

This medication may cause me to urinate more often." "I may notice an increase in my blood pressure." "My urine will change to an orange or red color."

The nurse taking care of a malnourished patient reviews their lab results and notes that the patient is currently hypokalemic. The nurse knows that given this condition, the patient should be monitored for which changes in their EKG?

U wave and a flat T wave This patient is experiencing hypokalemia, also known as a deficiency in potassium or a blood serum potassium level of less than 3.5 mmol/L. Low potassium affects the heart's ability to repolarize, which is reflected in an EKG with a flat T wave and, occasionally, the presence of a U wave.

Which orders does the nurse anticipate from the primary healthcare provider (PHCP) for a patient straining with urination, weak urinary stream, and hesitancy during urination.

Urine analysis Post-void bladder scan Digital rectal exam An order urine analysis to exclude infection and identify any abnormalities will be anticipated. Further, a post-void bladder scan will be done to determine the amount of residual urine in the client's bladder. Finally, a digital rectal exam will be performed, where the examiner will palpate the enlarged prostate.

✓ Nursing care for an abdominal paracentesis includes:

Witnessing informed consent that the primary healthcare provider obtains Assisting the client to void before the procedure Obtaining baseline vital signs Measure the abdominal girth Gather appropriate supplies (suction, tubing, paracentesis kit) Position the client per the physician's prescription. The positioning is likely upright to allow the fluid to settle in the lower abdominal quadrants. Monitor the client and the drainage Send the initial ascitic fluid to the lab for culture and sensitivity, as prescribed Reposition the client as needed to facilitate better drainage Monitor the client's vital signs throughout and after the procedure ✓ One of the major complications of paracentesis is hypovolemia. Administer an infusion of albumin as prescribed for large volumes (> 5 liters) of paracentesis. Other potential complications include persistent leakage of fluid, infection at the entry site, peritonitis, and intraperitoneal hemorrhage caused by perforation of the inferior epigastric artery.

Risk factors for cholecystitis include:

Women of all ages (risk of calculi increases with aging) • American Indian, Mexican American, or Caucasian • Obesity • Rapid weight loss or prolonged fasting; low-fat diet • Increased serum cholesterol and lipids • Women on hormone replacement therapy (HRT)

Peptic ulcer disease may be caused by

alcoholism, H. pylori infections, gastritis, NSAIDs, and corticosteroids. Complications include hemorrhage, perforation, and pyloric obstruction.

visceral pain

also known as internal pain, may cause discomfort in another part of the body that's more on the surface, like your skin or muscles. This happens because the nerves that sense pain in both the internal organ and the surface area are connected to make the pain spread.

IV contrast agents

are substances used to enhance the visibility of blood vessels, organs, and tissues during various medical imaging procedures, such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and angiograms. The most common type of IV contrast used is iodine-based contrast, but there are also gadolinium-based contrasts used for MRI imaging.

isotonic solutions

are utilized for fluid resuscitation for hemorrhaging and sepsis, severe vomiting, diarrhea, GI suctioning losses, wound drainage, mild hyponatremia, or blood transfusions (0.9% saline only) ✓ Isotonic solutions include 0.9% saline and lactated ringers (LR)

hypotonic solutions

are utilized for intracellular dehydration and hypernatremia ✓ Hypotonic solutions include: 0.45% Sodium Chloride (0.45% NaCl) 5% Dextrose in Water (D5W) - D5W may be referred to as both isotonic and hypotonic based on the context. Please note that D5W enters the body as isotonic and quickly becomes hypotonic as the liver rapidly metabolizes glucose. Thus, D5W is a hypotonic solution inside the body.

hypertonic solutions

are utilized for severe hyponatremia and cerebral edema. They should always be given via an intravenous pump ✓ Hypertonic solutions include 5% Dextrose in 0.9% Normal Saline, 3% saline, 5% Dextrose and 0.45% Sodium Chloride, and total parenteral nutrition (TPN)

Gentamicin

belongs to the class of medicines known as aminoglycoside antibiotics. It works by killing bacteria or preventing their growth.

The nurse is caring for a client immediately following an abdominal paracentesis, Immediately following this procedure, the nurse should monitor the client's

blood pressure due to risk of hypotension If the client should experience this immediate post-procedure complication, the nurse should anticipate a prescription for albumin rapid fluid removal could cause a fluid shift; therefore, the nurse should be prepared to monitor the client for post-procedure hypotension. This hypotension can be treated by infusing prescribed albumin, a colloid. This colloid will restore intravascular fluid volume, which shifted during the procedure. Infection is a concern associated with the procedure. However, it would not be an immediate post-procedure complication. The client emptied their bladder before this procedure, significantly decreasing the likelihood of bladder trauma.

Post-operative transurethral resection of the prostate (TURP) clients must be informed that

bright red urine is initially anticipated, and the redness should gradually decrease. Instruct the client to watch for changes in the color of the urine and notify the nurse if redness increases. Encourage the client to maintain adequate oral liquid intake as indicated, practice appropriate hand hygiene, keep the drainage bag below the level of the bladder, and avoid dependent loops or obstructions in the tubing.

The nurse is caring for a client receiving total parenteral nutrition (TPN), which was initiated twelve hours ago. The priority assessment for this client is which of the following?

capillary blood glucose TPN solutions contain a high concentration of dextrose, which can lead to hyperglycemia. Checking the client's blood glucose levels allows the nurse to assess the impact of TPN on the client's glycemic control. Any signs and symptoms of hyperglycemia can be promptly identified, enabling timely interventions such as adjusting the TPN infusion rate or administering insulin as ordered by the healthcare provider (PHCP). ✓ The client's blood glucose level should be monitored every four to six hours, as ordered, while the client is receiving TPN. ✓ Insulin coverage (scheduled and/or sliding scale) may also be prescribed. ✓ Regular insulin may be added to the bag of TPN (by the pharmacy) if the client's blood glucose continues to be elevated and if ordered by the PHCP. ✓ A normal blood glucose level ranges between 70-110 mg/dL (4.0-11.0 mmol/L).

The emergency department nurse is caring for a client reporting colicky abdominal pain, nausea, vomiting, and yellowing of their eyes. The nurse suspects the client has

cholecystitis Cholecystitis is a suspected diagnosis because all manifestations coincide with the client's presentation. Cholecystitis manifestations include episodic, colicky pain in the epigastric area that radiates to the back and shoulder. Pain in cholecystitis resembles indigestion or chest pain after eating fatty or fried foods. Nausea, vomiting, fever, and yellowing of the eyes are also linked with this condition.

The nurse is screening individuals at risk for gastric cancer. It would be appropriate for the nurse to identify which as a risk factor for gastric cancer? A. irritable bowel syndrome B. duodenal ulcer C. chronic gastritis D. sickle cell anemia

chronic gastritis Chronic gastritis is a risk factor for gastric cancer because it progresses from chronic gastritis to chronic atrophic gastritis, to intestinal metaplasia, to dysplasia, and eventually to adenocarcinoma. Risk factors for gastric cancer include ✓ Alcoholism ✓ Chronic gastritis ✓ Low-fiber diet ✓ H. pylori infections ✓ Obesity ✓ Smoking

While working in a post-operative unit, the nurse is assigned to take care of a 32-year-old who is post-op day one after an appendectomy. The patient has not eaten for the past three days and is asking when she will be allowed to have a meal again. Upon consulting with the interdisciplinary team, the provider decides it is time to place a diet order for your patient. Which diet does the nurse expect the provider will order?

clear-liquid diet A clear liquid diet is the most appropriate choice for this patient. Clear liquid diets consist of foods and liquids that are transparent to light and are liquid when at body temperature. This diet is best for patients who have not had oral intake for some time as well as for the first time a patient eats after complete bowel rest.

The nurse is assigned to care for a client with a sodium level of 122 mEq/L (mmol/L) [135-145 mEq/L, mmol/L]. Which assessment findings does the nurse anticipate based on this lab result?

confusion abdominal cramps nausea and vomiting This client's sodium level is critically low. When sodium falls below 125 mEq/L (mmol/L), it is considered severe hyponatremia. Sodium plays a key role in the brain, so low levels of this electrolyte can be devastating and produce symptoms ranging from confusion, lethargy, and stupor as well as seizures and cerebral edema. Abdominal cramps are another symptom of hyponatremia. Since water follows sodium, there are decreased levels of sodium in the blood and decreased fluid. This creates a fluid volume deficit, decreased urine output, muscle spasms, and abdominal cramping. Nausea and vomiting are common signs of hyponatremia.

Creatinine is different from

creatine kinase (CK), an enzyme found in muscles and other tissues. While both are involved in muscle metabolism, they serve different functions. Creatinine is a waste product, while creatine kinase is an enzyme involved in cellular energy production. Elevated levels of CK can indicate muscle damage or injury, whereas high levels of serum creatinine are associated with impaired kidney function.

Decreased urine pH levels (acidic) may be due to

diarrhea, diabetes mellitus, diabetic ketoacidosis, metabolic acidosis, starvation, high meat intake

Rhabdomyolysis

dissolution of striated muscle (caused by trauma, extreme exertion, or drug toxicity; in severe cases renal failure can result)

Three ulcers make up PUD and include

duodenal ulcers, gastric ulcers, and stress ulcers. Many ulcers are caused by H. pylori infection. Gastric ulcers usually develop in the antrum of the stomach near acid-secreting mucosa. Duodenal ulcers occur more often than other types. Most duodenal ulcers are present in the upper portion of the duodenum. Stress ulcers are acute gastric mucosal lesions occurring after an acute medical crisis or trauma. Treatment for PUD includes PPIs, H2 blockers, and antibiotics if the cause is H. pylori.

The nurse is caring for a client with urge incontinence. Which of the A. Administer prophylactic antibiotics. B. Teach the client intermittent self-catheterization. C. Have the client void on a timed schedule. D. Provide caffeinated beverages with meals.

have the client void on a timed schedule Urge incontinence is also known as overactive bladder (OAB). The essential manifestation of this incontinence is the involuntary loss of urine associated with a strong desire to urinate. Thus, it would be appropriate for a client to void on a timed schedule. Timed voiding enables an individual to gradually increase the amount of urine they may hold without an abrupt urge to go to the bathroom. The goal is also to prolong the time interval between urinating - up to a minimum of three or more hours.

The nurse is reviewing the assignment for the shift and will be caring for the following clients. Which client is at risk for hypokalemia? A client with A. hyperemesis gravidarum. B. end-stage renal failure. C. diabetic ketoacidosis. D. third-degree burns.

hyperemesis gravidarum. Hyperemesis gravidarum is a pregnancy complication characterized by severe nausea, vomiting, weight loss, and possibly dehydration. The intense vomiting is why this condition puts the patient at risk for hypokalemia. The hypokalemia associated with hyperemesis gravidarum is related to the metabolic alkalosis the client experiences due to the vomiting.

A client was admitted to the emergency department due to low serum calcium levels. Upon further examination, the client demonstrates carpopedal spasms and reports numbness in their lips and hands. An ECG revealed a prolonged QT interval. Based on this information, the nurse should suspect which condition?

hypoparathyroidism Although hypoparathyroidism symptoms often mirror hypocalcemia, the nurse should suspect hypoparathyroidism in this client based on the client's complaints and presentation. Hypoparathyroidism symptoms often manifest as numbness and tingling of the lips and hands, tetany, carpopedal spasms (Trousseau's sign), Chvostek's sign, and/or muscle/abdominal cramps. ECG analysis often reveals changes in the T waves and prolonged QT intervals. Due to low serum calcium levels, serum phosphorus levels are usually increased, as phosphorus and calcium have an inverse relationship in this situation.

Acute pancreatitis may cause

hypovolemic shock, and the client should be resuscitated with isotonic intravenous fluids once a diagnosis is made to prevent this complication. Pancreatitis may be triggered by cholelithiasis or alcoholism. This disorder commonly causes a client to experience intense epigastric pain, nausea/vomiting, and sometimes jaundice.

ulcerative colitis

is a chronic inflammatory and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea. Extraintestinal symptoms, particularly arthritis, may occur. Long-term risk of colon cancer is elevated compared to unaffected people. Diagnosis is by colonoscopy. Treatment occurs with various medications (i.e., 5-aminosalicylic acid, corticosteroids, immunomodulators, biologics, and/or antibiotics) and surgery in some clients.

Misoprostol

is a synthetic prostaglandin E1 analog that stimulates prostaglandin E1 receptors on parietal cells. -Mucus and bicarbonate secretion are also increased along with thickening of the mucosal bilayer so the mucosa can generate new cells. -Women of childbearing age should not use misoprostol. Avoid taking magnesium-containing antacids while using misoprostol.

During shift change, a nurse receives report regarding a client with ulcerative colitis, learning the client has experienced severe diarrhea over the past 24 hours. When assessing the client, the nurse should watch for signs of:

metabolic acidosis The nurse should watch for signs of metabolic acidosis, as diarrhea is one of the conditions most commonly associated with this acid-base imbalance due to bicarbonate loss occurring with diarrhea. Symptoms and signs of metabolic acidosis are primarily those of the underlying cause (i.e., here, the client's diarrhea). More severe acidemia (i.e., pH < 7.10) may cause nausea, vomiting, and malaise.

The nurse is reviewing a client's arterial blood gas (ABG) results who has a nasogastric tube (NGT) attached to continuous suction. The ABG results reveal the following: pH 7.50 [7.35-7.45], PaCO2 42 mmHg [35-45 mm Hg], HCO3- 35 mEq/L [22-28 mEq/L]. The nurse should interpret these results to indicate that the client has A. respiratory acidosis. B. respiratory alkalosis. C. metabolic acidosis. D. metabolic alkalosis.

metabolic alkalosis This ABG shows metabolic alkalosis. The first clue is that the client is receiving continuous nasogastric tube (NGT) suctioning from the stomach. When a client's stomach contents are removed through vomiting or suctioning, acidic gastric secretions are lost, and bicarbonate ions accumulate in the extracellular space.

A nurse is assigned to care for a client with liver dysfunction and ascites and is ordered to measure the client's abdominal girth daily. To ensure accuracy, the nurse should utilize which landmark?

umbilicus With ascites, free fluid accumulates primarily in the abdominal cavity. As liver dysfunction worsens, ascites typically increase, increasing abdominal girth. When measuring abdominal girth, standard practice dictates using the umbilicus as the landmark to be utilized. The technique involves encircling the abdomen with a measuring tape at the level of the umbilicus.

Elevated urine pH levels (alkaline) may be due to

urinary tract infections, vomiting, kidney failure, metabolic alkalosis, respiratory alkalosis, high consumption of fruits and veggies

The nurse has obtained a physician's order to obtain a urine specimen from a client. The nurse should instruct the client to obtain the urine sample

midstream from the bladder The preferred method of urine specimen collection for this client is known as a clean catch midstream urine sample. When clients are ambulatory and competent, this is most often a self-obtained specimen in a private bathroom. If the urine is not collected in a sterile or clean catch manner, the urine sample may be contaminated by bacteria originating from the skin or genital region and not from the urinary tract. This is often described by the clinical laboratory as mixed growth bacteria. A contaminated sample may lead to a false-positive urine culture result. The likelihood of mixed growth bacteria contamination is decreased by instructing the client to collect the specimen from the midstream portion of the client's void. ✓ In addition to the midstream collection instruction, clients must also be instructed on the proper method of cleansing the genitalia before voiding. ✓ Clients must provide a minimum urine volume for the test(s). ✓ Menstruating females are often required to undergo a straight catheterization to obtain specimen collection. ✓ Typically, the urinalysis will result rather quickly. ✓ Detailed urine culture results typically take 48 to 72 hours, so broad-spectrum antibiotics for urinary tract infections are often initially prescribed.

Serum creatinine is produced when

muscle and other proteins are broken down. Because protein breakdown is usually constant, the serum creatinine level is a good indicator of kidney function. No common pathologic condition other than kidney disease increases the serum creatinine level.

ST-segment changes, particularly elevation, are more commonly associated with conditions like

myocardial infarction myocardial infarction.

Acute cholecystitis has symptoms such as

nausea, vomiting, and right upper quadrant abdominal pain that may radiate to the shoulder blades. Clients often have an intensification of pain when the gallbladder is palpated upon inspiration (Murphy's sign).

Most cases of elevated creatinine are caused by exposure to

nephrotoxic substances. The nurse should review the client's MAR to determine if the client is taking any nephrotoxic medication.

The Patient-Generated Subjective Global Assessment is a client-reported screening tool to assess

nutritional status The Patient-Generated Subjective Global Assessment, often referred to as the PG-SGA or the PG-SGA nutritional assessment, is well recognized in clinical research as the reference method for determining the nutrition status of clients with cancer.

IV contrasts can cause an

osmotic diuretic effect, leading to increased urine output. If the client does not receive sufficient fluids, they may become dehydrated, which can have adverse effects on overall health and kidney function.

Peaked P-waves are mostly seen in conditions of high right atrial pressure or atrial dilation, such as in conditions like

pulmonary hypertension. Elevated atrial pressure can cause the P-waves to become tall and peaked on the ECG.

The nurse cares for a client who had a liver transplant 48 hours ago. It would be a priority for the nurse to notify the healthcare provider (HCP) if the client has

rising aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Acute graft rejection is a concern for a client who had a liver transplant. This complication commonly occurs from the 4th to the 10th postoperative day. While this client is only 48 hours postoperative, the rising AST/ALTs are concerning because this is a manifestation of acute graft rejection. Other manifestations of acute graft rejection include tachycardia, fever, right upper quadrant (RUQ) or flank pain, diminished bile drainage or change in bile color, or increased jaundice. ✓ Occurs from the 4th to 10th postoperative day ✓ Manifestations of this serious complication include tachycardia, fever, right upper quadrant (RUQ) or flank pain, diminished bile drainage or change in bile color, or increased jaundice ✓ Laboratory findings indicating acute graft rejection include increased levels of serum bilirubin, transaminases, and alkaline phosphatase; prolonged prothrombin time

During continuous bladder irrigation (CBI)

sterile fluid is continuously administered into the bladder via a triple-lumen urinary catheter or a "3-way catheter" and allowed to drain. Continuous bladder irrigation (CBI) is associated with a high risk of infection as it involves opening the CBI system and manipulating the catheter. Although continuous bladder irrigation (CBI) is not a true sterile procedure, sterile products help prevent the introduction of a pathogen during manipulation.

Rapid drainage of a full bladder can lead to

sudden stretching of the bladder wall. This stretching can activate nerve receptors in the bladder, triggering spasms as a response to the abrupt change.

Overactive bladder (OAB) / Urge incontinence is

the involuntary loss of urine associated with a strong desire to urinate and the inability to suppress the signal from the bladder muscle to the brain that it is time to urinate. This may be idiopathic or caused by neurologic disorders, such as stroke, benign prostatic hypertrophy, or bladder inflammation or infection. The treatment for this incontinence involves Bladder training Pelvis muscle therapy Weight reduction Avoiding bladder irritants, such as caffeine and alcohol Smoking cessation Medications: anticholinergics, tricyclic antidepressants with anticholinergic and alpha-adrenergic agonist activity, beta-adrenergic agonists, and onabotulinumtoxinA Electrical stimulation device

IV contrast agents are primarily excreted through the

the kidneys. Adequate hydration helps increase urine production, which, in turn, facilitates the elimination of the contrast material from the body. This can help reduce the risk of contrast-induced nephropathy (CIN), a potential complication characterized by kidney damage following contrast administration.

During peritoneal dialysis

the peritoneum is used as the dialyzing membrane, and the dialysate is infused through a catheter tunneled into the peritoneum. Maintaining a sterile technique is essential during peritoneal dialysis. Infection of the peritoneum (peritonitis) may occur due to contamination by touch during exchanges (by pathogenic skin bacteria) or due to an exit-site catheter infection. Peritonitis symptoms include fever, abdominal rigidity, purulent effluent, and nausea/vomiting. Cloudy outflow (into the drainage bag) is one of the earliest signs of peritonitis associated with peritoneal dialysis.

NG

✓ After the placement of an NGT, the nurse should verify the placement via an x-ray ✓ Subsequent verification should come through gastric pH analysis. A pH < 5 indicates the tube is likely in the stomach. ✓ When administering medications via NGT, the nurse should never crush extended-release or sustained-release medications. ✓ Once the medications have been administered, the nurse should flush the NGT with 20-30 mL of tepid tap water.

GI assessment

✓ Any nausea or vomiting ✓ Bowel habits and stool character ✓ Any laxative use ✓ Previous GI surgery or trauma ✓ Recent weight changes and whether it was unintentional or intentional ✓ Ask the client to identify the tender areas and palpate these areas last ✓ Pregnancy status for females ✓ Current medications

GERD

✓ PPIs are the gold standard in the treatment of GERD. ✓ Medications in this class include esomeprazole, pantoprazole, and lansoprazole. ✓ The client should be instructed to take the medication first thing in the morning without food or other medications. ✓ The long-term use of a PPI has been linked to osteoporosis and hypomagnesemia. Therefore, it is reasonable to recommend weight-bearing exercises and magnesium and calcium supplements approved by the primary healthcare provider (PHCP). ✓ PPIs should also be used with caution for those at risk for pneumonia as these have been demonstrated to be a risk factor for both community and healthcare-acquired pneumonia. The client with GERD is advised to avoid tight clothing and wear loose-fitting clothing. This type of clothing may increase pressure in the abdomen, forcing stomach contents into the esophagus.

Hypomagnesia

✓ The normal level of magnesium is 1.5-2.5 mEq/L (0.74-1.03 mmol/L) ✓ Food sources rich in magnesium include pumpkin seeds, almonds, dark leafy vegetables, soybeans, and dried figs ✓ Causes of hypomagnesemia include alcoholism, diarrhea, and diuretics ✓ Causes of hypermagnesemia include renal failure, certain antacids, excessive intake, lithium therapy, adrenal insufficiency, and hypothyroidism