A nurse is teaching a client and his partner about performing peritoneal dialysis at home.
When discussing peritonitis, which of the following manifestations should the nurse identify as the earliest indication of this complication?

Increased heart rate

Generalized abdominal pain

Cloudy effluent

Fever

Answer and Explanation

The Correct Answer is C

This is because peritonitis is an infection of the peritoneal cavity that can occur as a complication of peritoneal dialysis. Peritonitis can cause inflammation and irritation of the peritoneum, which can lead to cloudy or milky appearance of the dialysate fluid that drains out of the abdomen (also known as effluent). Cloudy effluent is often the first and most reliable sign of peritonitis in peritoneal dialysis patients. Other signs and symptoms of peritonitis may include increased heart rate, generalized abdominal pain, fever, nausea, vomiting, loss of appetite, and malaise.

The nurse should instruct the client and his partner to inspect the effluent for clarity every time they perform an exchange and to report any changes to their health care provider immediately. The nurse should also teach them how to prevent peritonitis by following strict aseptic technique when handling catheters and supplies, washing hands before and after each exchange, wearing a mask during exchanges, and storing supplies in a clean and dry place.

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Correct Answer is D

Explanation

Back pain is a common symptom of a hemolytic transfusion reaction, which occurs when the recipient's immune system attacks and destroys the donor's red blood cells. Other symptoms include fever, chills, dyspnea, chest pain, hypotension, tachycardia, hemoglobinuria, and jaundice. A hemolytic transfusion reaction is a medical emergency that requires immediate intervention.

A. Position the mouthpiece 2.5 cm (1 in) from the mouth. B. Exhale slowly through pursed lips. C. Hold breaths about 3 to 5 seconds before exhaling. D. Place hands on the upper abdomen during inhalation.

Correct Answer is C

Explanation

An incentive spirometer is a device that helps improve lung function by encouraging deep breathing and preventing atelectasis (collapse of alveoli) after surgery or prolonged bed rest. The client should position the mouthpiece firmly in their mouth, inhale deeply and slowly through the mouthpiece until the indicator reaches the desired level, hold their breath for 3 to 5 seconds, and then exhale normally through their nose or mouth.

Exhaling slowly through pursed lips or placing hands on the upper abdomen are techniques that can help with dyspnea (shortness of breath), but are not part of using an incentive spirometer. Positioning the mouthpiece 2.5 cm.

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A nurse is teaching a client and his partner about performing peritoneal dialysis at home. When discussing peritonitis, which of the following manifestations should the nurse identify as the earliest indication of this complication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is monitoring a client who is receiving 2 units packed RBCs. Which of the following manifestations indicates a hemolytic transfusion reaction?

Correct Answer is D

Explanation

A nurse is teaching a client about the use of an incentive spirometer. Which of the following instructions should the nurse include in the teaching?

Correct Answer is C

Explanation

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A nurse is teaching a client and his partner about performing peritoneal dialysis at home.
When discussing peritonitis, which of the following manifestations should the nurse identify as the earliest indication of this complication?