A client diagnosed with End Stage Renal Disease (ESRD) has a potassium level of 6.8 mEq/L. Which of the following priority actions should the nurse implement?

Instruct the client to avoid high-potassium foods.

Redraw the potassium to verify results.

Check the client's blood pressure.

Obtain a serum sodium level.

Answer and Explanation

The Correct Answer is C

A. Instruct the client to avoid high-potassium foods: While important for long-term management, it is not the priority when the client is experiencing hyperkalemia, as immediate interventions are necessary to prevent complications.

B. Redraw the potassium to verify results: Redrawing the potassium may be necessary if there is concern about sample contamination or if the result is significantly different from what is expected. However, it is not the priority when the client is at risk of complications from hyperkalemia.

C. Check the client's blood pressure: This is the priority action because hyperkalemia can lead to cardiac dysrhythmias, including potentially life-threatening arrhythmias. Checking the blood pressure helps assess the client's cardiovascular status and any potential effects of hyperkalemia on cardiac function.

D. Obtain a serum sodium level: While monitoring electrolyte levels is important in ESRD, sodium levels are not the priority when the client is experiencing hyperkalemia. Monitoring potassium and managing its effects take precedence.

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Correct Answer is C

Explanation

A. Reports of joint pain: Joint pain is more indicative of musculoskeletal issues rather than chronic renal disease. While joint pain can occur in some types of kidney disease, progressive edema is a more specific symptom.

B. Increase in appetite: An increase in appetite is not typically associated with chronic renal disease. Instead, clients with kidney disease may experience a decrease in appetite due to various factors such as nausea, vomiting, and changes in taste.

C. Progressive edema: Progressive edema, especially in the lower extremities and around the eyes (periorbital edema), can be a significant indicator of declining kidney function. It results from fluid retention due to impaired kidney filtration.

D. Recent increase in thirst: While increased thirst can be a symptom of chronic renal disease, it is not as specific as progressive edema. Increased thirst may occur due to other conditions or factors such as diabetes mellitus or dehydration.

A. People mistakenly think they are experiencing seasonal allergies. B. The virus is spread by individuals who don't have symptoms. C. Hand washing is not effective against the cold virus. D. Use of over-the-counter cold products reduces immune resistance.

Correct Answer is B

Explanation

A. People mistakenly think they are experiencing seasonal allergies: While seasonal allergies may share some symptoms with the common cold, such as nasal congestion and sneezing, they are caused by allergens rather than viruses. This factor does not directly contribute to the high communicability of the common cold.

B. The virus is spread by individuals who don't have symptoms: The common cold is highly communicable because individuals infected with the virus can spread it to others even before they develop symptoms or when they have mild symptoms. This makes it challenging to prevent the spread of the virus, as infected individuals may not realize they are contagious.

C. Hand washing is not effective against the cold virus: Hand washing is an effective measure for preventing the spread of the common cold virus. Proper hand hygiene can help reduce the transmission of the virus from contaminated surfaces to the nose and mouth.

D. Use of over-the-counter cold products reduces immune resistance: Over-the-counter cold products may help relieve symptoms of the common cold but do not directly affect immune resistance. However, reliance on symptomatic relief without taking precautions to prevent the spread of the virus can contribute to its communicability.

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A client diagnosed with End Stage Renal Disease (ESRD) has a potassium level of 6.8 mEq/L. Which of the following priority actions should the nurse implement?

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