A client with end stage renal disease presents to the emergency department with severe fatigue, palpitations, and muscle weakness.
The electrocardiogram reveals peaked T waves and a widened QRS complex. Which treatment should the nurse anticipate?

Administer a loop diuretic.

Administer furosemide.

Initiate hemodialysis.

Increase fluid intake.

Answer and Explanation

The Correct Answer is C

Managing electrolyte imbalances in end stage renal disease requires understanding renal excretion failures. The presence of cardiac rhythm changes indicates a life threatening emergency. Immediate intervention is necessary to remove toxins and excess ions that the kidneys cannot process.

Choice A rationale

Loop diuretics are ineffective for clients with end stage renal disease because the nephrons are no longer functional. These medications cannot induce diuresis or lower serum potassium levels when the kidneys have reached the point of failure.

Choice B rationale

Similar to other loop diuretics, furosemide relies on renal blood flow and functional kidney tissue to promote fluid and electrolyte excretion. In end stage failure, this medication will not resolve the cardiac symptoms or hyperkalemia.

Choice C rationale

This is the definitive treatment for life threatening hyperkalemia in renal failure. Dialysis rapidly removes excess potassium and metabolic waste from the blood. It corrects the electrical instability in the heart caused by the high potassium levels.

Choice D rationale

Increasing fluid intake is contraindicated in end stage renal disease due to the risk of fluid volume overload. This would exacerbate the client's condition, potentially leading to pulmonary edema, hypertension, and worsening of the cardiac strain.

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Free Nursing Study Resources

Correct Answer is A

Explanation

Neurological posturing indicates severe brain injury and helps localize the level of damage. Applying knowledge of motor pathway dysfunction, specifically the corticospinal tract, is necessary to distinguish between flexion and extension patterns seen in comatose patients.

Choice A rationale

Decorticate posturing results from damage to the corticospinal tract above the red nucleus. It is characterized by adduction of the arms, internal rotation, and flexion at the elbows, wrists, and fingers, while legs are extended and internally rotated.

Choice B rationale

This description does not match a standard neurological posturing pattern. Rigidity and flexion are seen in decorticate posturing, but "back hunched over" and "supination" of arms are not typical descriptors for these specific upper motor neuron indicators.

Choice C rationale

Supination of the arms is not a component of pathological posturing. Both decorticate and decerebrate posturing typically involve some form of pronation or flexion. Dorsiflexion is also not standard, as plantar flexion is commonly seen in both.

Choice D rationale

This describes decerebrate posturing, which indicates more severe damage to the brainstem or midbrain. It is characterized by rigid extension of the arms and legs, pronation of the arms, and plantar flexion of the feet with outward rotation.

A. Teach the client's wife about the risk of aspiration and explain that loss of appetite is expected when a client nears death. B. Request that the health care provider order a dietary nutrition consult to include the client's preferred foods. C. Keep fluids and finger foods at the bedside for easy access whenever the client needs them. D. Encourage the client's wife to feed the client as much as he will take to maintain adequate nutrition.

Correct Answer is A

Explanation

This scenario involves end of life care and ethical communication regarding physiological changes during the dying process. Knowledge of palliative care principles and the natural slowing of metabolic processes is required to address the family's concerns and provide reassurance.

Choice A rationale

Explaining that anorexia is a natural part of the dying process validates the physiological reality that the body no longer requires fuel. Discussing aspiration risk helps the wife understand that forced feeding could cause harm or discomfort.

Choice B rationale

Nutritional consults and preferred foods are ineffective when a client is actively dying. The focus shifts from nutritional maintenance to comfort. Interventions aimed at increasing caloric intake do not prolong life or improve quality at this terminal stage.

Choice C rationale

While keeping foods available seems supportive, it can create pressure on the client and frustration for the family. In the final stages of life, many clients lack the physical strength or reflex capability to safely consume bedside snacks.

Choice D rationale

Encouraging the wife to feed the client as much as possible increases the risk of choking and aspiration. It places an undue burden on the caregiver and may cause the client physical distress, as their digestive system slows.

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A client with end stage renal disease presents to the emergency department with severe fatigue, palpitations, and muscle weakness. The electrocardiogram reveals peaked T waves and a widened QRS complex. Which treatment should the nurse anticipate?

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The nurse suspects that a client has decorticate posturing. Which findings support the nurse's suspicion?

Correct Answer is A

Explanation

The nurse assesses a terminally ill client who is nearing death. The client's wife expresses concern that he has no appetite and eats very little. How should the nurse best respond?

Correct Answer is A

Explanation

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A client with end stage renal disease presents to the emergency department with severe fatigue, palpitations, and muscle weakness.
The electrocardiogram reveals peaked T waves and a widened QRS complex. Which treatment should the nurse anticipate?