The nurse is admitting a client diagnosed with acute renal failure (ARF). The nursing assessment will prioritize ...
Urine output and electrolyte levels.
Understanding of how to prevent falls.
Peripheral vascular perfusion and pain.
Risk for bleeding and white blood cell count (WBC)
The Correct Answer is A
Acute renal failure is characterized by a sudden decline in kidney function, resulting in the inability of the kidneys to adequately filter waste products and maintain fluid and electrolyte balance. Monitoring urine output is essential in assessing kidney function and determining the severity of renal failure. A decrease in urine output or anuria may indicate worsening renal function and the need for immediate interventions.
Assessing electrolyte levels, such as sodium, potassium, calcium, and phosphorus, is crucial because renal failure can disrupt the balance of these electrolytes in the body. Imbalances can lead to complications such as electrolyte abnormalities, cardiac dysrhythmias, and neuromuscular disturbances. Prompt identification and management of electrolyte imbalances are essential in preventing further complications and supporting optimal patient outcomes.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Opioid tolerance occurs when the body becomes less responsive to the effects of opioids over time. This means that higher doses of the medication are needed to achieve the same level of pain relief that was previously achieved with lower doses. Opioid tolerance is a common phenomenon in long-term opioid therapy and can occur in patients who have been using opioids for an extended period.
Opioid abstinence syndrome, also known as opioid withdrawal, refers to the set of symptoms that occur when a person abruptly stops or reduces their use of opioids after developing physical dependence.
Opioid toxicity refers to the harmful effects that occur when an individual takes an excessive dose of opioids, leading to potentially life-threatening complications. It is characterized by symptoms such as respiratory depression, sedation, pinpoint pupils, and decreased level of consciousness.
Opioid addiction is a complex condition characterized by compulsive drug-seeking behavior, loss of control over opioid use, and continued use despite negative consequences.
Correct Answer is B
Explanation
A blood glucose level of 40 mg/dL indicates severe hypoglycemia, which is a medical emergency requiring immediate attention. Hypoglycemia can lead to confusion, altered mental status, seizures, and loss of consciousness if not treated promptly. Therefore, it is crucial to assess and intervene quickly to raise the patient's blood glucose level to a safe range.
While the other clients mentioned also require attention and appropriate care, the severity and immediate risk associated with severe hypoglycemia make it the priority situation. The nurse should initiate appropriate treatment for hypoglycemia, such as administering glucose or glucagon, and closely monitor the patient's response.
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