The nurse is planning care for a client with chronic kidney disease who is a resident at a long-term nursing facility. The client is anuric and has hemodialysis 3 times a week. Which intervention should the nurse include in the client's plan of care?

Initiate toileting schedule.

Monitor for signs of anemia.

Encourage intake of high potassium foods.

Provide perineal skin barrier cream.

Answer and Explanation

The Correct Answer is B

A.   A toileting schedule is unnecessary for an anuric client as they do not produce urine.
B.   Anemia is a common complication of chronic kidney disease due to reduced erythropoietin production, so monitoring for signs of anemia is important.
C.   High potassium foods should be avoided as impaired kidney function can lead to hyperkalemia.
D.   While perineal skin care is important, it is not as critical as monitoring for anemia in this context.

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Correct Answer is A

Explanation

A. An aPTT that is 2 times the control value indicates that the heparin is effectively anticoagulating the blood, which is a desired outcome in managing MI to prevent clot formation.
B. S3 heart sounds can indicate heart failure and are not a sign of a satisfactory response to MI treatment.
C. Wide Q waves indicate a previous infarction but do not reflect the immediate effectiveness of the treatment.
D. A positive guaiac test indicates gastrointestinal bleeding, which is a potential complication rather than a satisfactory response.

A. Administering antipyretic medication as needed B. Educating client and family on the importance of fluid restrictions C. Collaborating with dietician to prepare low protein diet D. Monitoring fluid status E. Investigating acid/base complication F. Assessing for worsening respiratory status G. Performing diagnostic testing to determine cause of fever H. Reassessing vital signs I. Identifying cardiac arrhythmias

Correct Answer is ["D","F","I"]

Explanation

A. Administering antipyretic medication as needed is important for managing the client's fever and improving comfort, but not as urgent as monitoring fluid, respiratory status, and cardiac function.
B. Client and family education on fluid management is important but can be addressed after assessing hydration status.
C. Protein restriction might be necessary for CKD management in the long term, but not the most pressing need right now.
D. Given the client's history of chronic kidney disease, monitoring fluid status is crucial to prevent fluid overload and ensure adequate kidney function. Accurate intake and output measurements, along with daily weights, are essential.
E. The bicarbonate level (18 mEq/L) is slightly low, but further investigation can come after addressing the infection.
F. The chest X-ray shows bibasilar infiltrates, and the client has a high respiratory rate.

Continuous assessment of respiratory status is important to detect any signs of respiratory distress or infection, which may require immediate intervention.
G. Performing diagnostic testing to determine cause of fever is necessary for identifying the underlying infection, but secondary to immediate stabilization efforts.
H. Reassessing vital signs is vital for ongoing assessment, but integrated into the monitoring of fluid status, respiratory status, and cardiac function.

I. The client has an elevated potassium level and an irregular heart rate, putting him at risk for cardiac arrhythmias. Continuous ECG monitoring and immediate identification of any arrhythmias are critical to prevent cardiac complications.

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The nurse is planning care for a client with chronic kidney disease who is a resident at a long-term nursing facility. The client is anuric and has hemodialysis 3 times a week. Which intervention should the nurse include in the client's plan of care?

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Explanation

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Explanation

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