A nurse is assessing a client who is receiving peritoneal dialysis for manifestations of peritonitis. Which of the following findings should the nurse identify as the first indication of peritonitis?
Abdominal pain
Cloudy effluent
Nausea
Fever
The Correct Answer is B
Rationale:
A. Abdominal pain: While abdominal pain can occur with peritonitis, it often develops after the initial changes in the dialysate effluent. Pain may also be related to catheter placement or dialysate temperature, so it is not the earliest definitive indicator.
B. Cloudy effluent: Cloudy dialysate is typically the first and most reliable sign of peritonitis in clients receiving peritoneal dialysis. It indicates the presence of white blood cells and infection in the peritoneal cavity before systemic symptoms appear.
C. Nausea: Nausea may occur later as part of the systemic inflammatory response, but it is nonspecific and can be caused by multiple factors, including the dialysis process itself or other gastrointestinal disturbances.
D. Fever: Fever is a later manifestation of peritonitis, often developing after local signs are present. It indicates systemic involvement and immune activation but is not the earliest detectable change.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Personalize the conflict: Making a conflict personal can increase tension and defensiveness among staff. Effective negotiation requires addressing issues objectively rather than targeting individuals.
B. Identify solutions prior to negotiation: Preselecting solutions may limit collaborative problem-solving. Effective negotiation involves exploring options with all parties to reach mutually acceptable outcomes.
C. Attempt to understand both sides of the issue: Understanding each party’s perspective promotes open communication, trust, and collaboration. This approach helps identify common ground and develop solutions that are acceptable to all involved.
D. Focus on how the conflict occurred: Concentrating on past events can create blame and hinder forward-focused problem-solving. Effective negotiation emphasizes current needs and potential solutions rather than dwelling on the cause.
Correct Answer is B
Explanation
Rationale:
A. “Staff will apply identification bands to my baby after her first bath.": Identification bands are applied immediately after birth to ensure proper identification and prevent abduction, not after the first bath. Waiting could increase safety risks.
B. "I will not publish a public announcement about my baby's birth.": Limiting public announcements, such as on social media, reduces the risk of unwanted attention and potential abduction. This demonstrates understanding of newborn security measures.
C. "I can remove my baby's identification band as long as she is in my room.": Identification bands must remain on the newborn at all times to maintain safety and prevent misidentification or abduction. Removing them is unsafe.
D. "I can leave my baby in my room while I walk in the hallway.": Leaving a newborn unattended, even briefly, increases the risk of abduction and is against safety protocols. Constant supervision or staff assistance is required.
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