A nurse is caring for a client who is being treated for acute opioid toxicity. The client has a do-not-resuscitate (DNR) prescription, but the family would like to remove it. Which of the following responses should the nurse make?

Rationale:

A. Remove the cap and place it sterile-side up on a clean surface: Placing the cap with the sterile side up can contaminate the inside of the cap and potentially the solution. The cap should be placed sterile-side down or on a clean, nonsterile surface to prevent contamination of the sterile solution.

B. Hold the bottle in the center of the sterile field when pouring the solution: Placing the bottle over the sterile field risks contaminating it if any part of the bottle or solution touches the sterile area. The bottle should be held outside the sterile field and poured carefully to maintain sterility.

C. Place sterile gauze over areas of spilled solution within the sterile field: Once a sterile field is contaminated by spilled solution, it cannot be safely salvaged by placing sterile gauze over it. Any contamination requires replacement of the affected items to maintain aseptic technique.

D. Hold the irrigation solution bottle with the label facing away from the palm of the hand: This technique prevents the solution from contacting the label, which could obscure important information or lead to accidental contamination. Proper handling preserves sterility while ensuring the label remains legible for verification.

Rationale:

A. Oliguria: Clients with end-stage kidney disease (ESKD) often experience oliguria or significantly reduced urine output due to severe loss of nephron function. This contributes to fluid retention, electrolyte imbalances, and accumulation of waste products in the body.

B. Hypotension: ESKD more commonly leads to hypertension rather than hypotension because of fluid overload and activation of the renin-angiotensin-aldosterone system. Hypotension may occur only during dialysis or with certain medications but is not an expected finding in untreated ESKD.

C. Edema: Fluid retention caused by decreased glomerular filtration and impaired renal excretion leads to peripheral and sometimes generalized edema. Edema is a classic sign of ESKD and indicates compromised fluid balance.

D. Anemia: Impaired kidney function reduces erythropoietin production, leading to decreased red blood cell synthesis and resultant anemia. Clients often require erythropoiesis-stimulating agents or supplemental iron to manage this complication.

E. Bradypnea: Respiratory rate is not typically decreased in ESKD. If present, bradypnea would suggest a separate neurologic or respiratory issue rather than a direct effect of kidney failure. Clients may develop Kussmaul respirations if metabolic acidosis is severe, but bradypnea is not expected.