A nurse is reviewing the medication list of a patient with end-stage renal disease (ESRD) who is receiving hemodialysis. The nurse knows that certain medications are used to prevent complications of this disease. Which of the following medications would the nurse question as part of routine therapy for preventing complications of ESRD?

Choice A reason: White crystals (uremic frost) and yellowish skin in CKD indicate severe uremia due to toxin accumulation from impaired kidney function. Applying medicated lotion addresses skin symptoms but does not treat the underlying uremia, which can lead to life-threatening complications like metabolic acidosis, hyperkalemia, or encephalopathy. This action is secondary to addressing systemic toxicity through dialysis.

Choice B reason: Elevated BUN, creatinine, and uremic frost signify advanced CKD with uremia, requiring urgent dialysis to remove toxins and excess fluids. Notifying the provider ensures timely intervention to prevent complications such as seizures, coma, or cardiac arrhythmias due to electrolyte imbalances and toxin buildup, making this the priority action for patient safety.

Choice C reason: A cardiac monitor detects arrhythmias, which may occur in CKD due to hyperkalemia or fluid overload. However, monitoring alone does not address the root cause of uremia. Without dialysis to correct metabolic imbalances, arrhythmias may persist or worsen, making this action less urgent than initiating dialysis to stabilize the patient’s condition.

Choice D reason: Assessing a fistula for bruit and thrill ensures vascular access patency for dialysis. While important, it is not the priority when uremic symptoms are present, as dialysis orders must be secured first to address the acute uremic state and prevent life-threatening complications like encephalopathy or cardiac arrest due to toxin accumulation.

Choice A reason: A calm expression does not reliably indicate low anxiety, as individuals may mask emotions due to cultural norms or coping mechanisms. Nonverbal cues are subjective and context-dependent, and physiological signs like heart rate or cortisol levels are more accurate indicators of anxiety than facial expressions alone.

Choice B reason: Eye contact is not a universal measure of attentiveness, as cultural norms vary (e.g., some cultures avoid eye contact to show respect). Individual factors like anxiety or neurodiversity can also affect eye contact, making it an unreliable indicator of engagement without considering context and patient background.

Choice C reason: Nonverbal communication, such as gestures or expressions, varies widely across cultures and individuals. For example, nodding may signify agreement in one culture but acknowledgment in another. Individual personality or mental health conditions also influence nonverbal cues, making this statement accurate as it accounts for diverse interpretations.

Choice D reason: Therapeutic touch responses vary by individual and cultural preferences, and some patients may find it intrusive or distressing. Verbal interaction is often more consistent in therapeutic settings, as it allows clearer communication of intent. Touch is not universally more effective, making this statement inaccurate.