A nurse is caring for a client who has a vented NG tube set to low intermittent suction and has vomited.

Which of the following actions should the nurse perform first?

Answer and explanation.

The correct answer is choice C, hypertension. Hypertension is a contraindication to living kidney donation because it can increase the risk of kidney disease and cardiovascular complications in the donor. Hypertension can also affect the quality and survival of the donated kidney in the recipient.

Therefore, a potential donor with uncontrolled or poorly controlled hypertension should not undergo nephrectomy.

Choice A, osteoarthritis, is not a contraindication to living kidney donation.

Osteoarthritis is a degenerative joint disease that does not affect the kidneys or the cardiovascular system.

It may cause pain and stiffness in the joints, but it can be managed with medications and physical therapy. A potential donor with osteoarthritis can donate a kidney if they have normal kidney function and no other medical problems.

Choice B, primary glaucoma, is not a contraindication to living kidney donation.

Primary glaucoma is a condition that causes increased pressure in the eye and can lead to vision loss if untreated.

It does not affect the kidneys or the cardiovascular system. A potential donor with primary glaucoma can donate a kidney if they have normal kidney function and no other medical problems.

Choice D, amputation, is not a contraindication to living kidney donation.

Amputation is the surgical removal of a limb or part of a limb due to injury, infection, or disease.

It does not affect the kidneys or the cardiovascular system. A potential donor with amputation can donate a kidney if they have normal kidney function and no other medical problems.

Normal ranges for blood pressure are less than 120/80 mmHg for systolic and diastolic pressure, respectively.

Normal ranges for kidney function are eGFR above 60 mL/min/1.73 m2 and albuminuria below 30 mg/g.

The correct answer is d. Evaluate functioning of the suction device.

Choice D rationale:

• Prompt assessment of the suction device is crucial to determine if it's functioning properly.If the suction is inadequate,it can lead to gastric contents accumulating and potentially causing vomiting.
• Assessing the suction device first allows for timely interventionif it's not working correctly,preventing further complications and discomfort for the client.

Choice A rationale:

• Replacing the NG tube might be necessary if it's dislodged or blocked, but it shouldn't be the immediate action.
• Evaluating the suction device first can help determine if the NG tube itself is the issue or if the problem lies with the suction.

Choice B rationale:

• Providing oral hygiene care is important for comfort and to prevent aspiration, but it's not the priority intervention in this situation.
• Addressing the cause of the vomiting, which could be related to suction malfunction, takes precedence.

Choice C rationale:

• Administering an antiemetic might be helpful to control nausea and vomiting, but it doesn't address the underlying cause.
• Evaluating the suction device first is essential to ensure proper gastric decompression and prevent further vomiting episodes.