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 D

Explanation

A. Identifying triggers may be beneficial, but the client is currently in a state of severe anxiety, and immediate intervention to address the symptoms is needed.
B. Exploring past behaviors can be addressed later; the immediate focus should be on managing the acute symptoms of anxiety.

C. Attempting to distract the client can be helpful, but providing reassurance and addressing safety concerns take precedence.
D. Speaking calmly to the client and providing assurance of safety is an appropriate first step in managing severe anxiety. Once the client is more settled, other interventions can be explored.

A. Advise the UAP to stop providing care so the nurse can assess the client's condition. B. Explain to the UAP that changes in a client's condition should be reported immediately. C. Determine why the UAP did not notify the nurse of the change in the client's condition. D. Ask the UAP to position the client so the oral medications can be administered.

Correct Answer is A

Explanation

A. The priority is to immediately intervene in the care being provided by the UAP and assess the client's condition to ensure prompt intervention if necessary.

B. While educating the UAP is important, immediate assessment and intervention for the client take precedence.
C. Investigating the reason for the UAP's actions can wait until after the client's condition has been assessed and stabilized.
D. Administering oral medications can wait until after the client's condition has been assessed and stabilized.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

Correct Answer is A

Explanation

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