A nurse is caring for a client immediately following a hemodialysis treatment. For which of the following manifestations will the nurse administer a PRN dose of phenytoin?
Headache, restlessness
Decreased blood pressure, rapid pulse
Muscle cramps, chest heaviness
Pain and tingling at the access site
The Correct Answer is A
The correct answer is Choice A
Choice A rationale: Headache and restlessness can be signs of a seizure or neurological disturbance, which phenytoin is used to treat. Phenytoin is an anticonvulsant medication that helps control seizures by stabilizing neuronal membranes and reducing excitability.
Choice B rationale: Decreased blood pressure and rapid pulse are not indications for phenytoin administration. These symptoms may suggest hypotension or cardiovascular issues, which require different interventions such as fluid resuscitation or vasopressors.
Choice C rationale: Muscle cramps and chest heaviness are not treated with phenytoin. These symptoms could indicate electrolyte imbalances or cardiac issues, which need specific treatments like electrolyte replacement or cardiac monitoring.
Choice D rationale: Pain and tingling at the access site are not indications for phenytoin administration. These symptoms may suggest local irritation or infection at the dialysis access site, requiring appropriate wound care or antibiotics.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Acute tubular necrosis (ATN) is a condition where there is damage to the renal tubular cells, which can lead to a decrease in GFR. This is because the tubular cells are responsible for reabsorbing substances from the filtrate back into the blood. When these cells are injured, they cannot function properly, leading to a buildup of waste products and a decrease in GFR.
Choice B reason: While obstruction can lead to a decrease in GFR, it is not the primary cause in the context of acute tubular necrosis. Obstruction typically occurs in postrenal causes of acute kidney injury.
Choice C reason: In?ammatory cells do invade damaged kidneys, but this is more characteristic of conditions such as acute interstitial nephritis rather than ATN. In ATN, the primary issue is the injury to the tubular cells themselves.
Choice D reason: A reduction of blood flow to the kidneys, or prerenal azotemia, can indeed lead to a decrease in GFR. However, in the context of ATN, the primary issue is not the blood flow but the damage to the renal tubules.
Correct Answer is A
Explanation
Choice A reason: General anesthesia can cause urinary retention due to its effects on the nervous system, which may temporarily impair the normal re?exes that control urination. This is particularly relevant in the immediate postoperative period.
Choice B reason: While liver failure can have many systemic effects, it is not directly associated with an increased risk of urinary retention. Urinary retention is more commonly related to factors affecting the urinary tract or nervous system.
Choice C reason: A diet high in calcium oxalate can contribute to kidney stones, but it does not directly increase the risk of urinary retention. Urinary retention typically involves an obstruction or nerve dysfunction.
Choice D reason: Antibiotic treatment for a skin infection, even one caused by Staphylococcus aureus, would not typically result in urinary retention. Urinary retention is usually related to urinary tract obstructions, medications, or nerve issues.
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