To prevent the most common serious complication of peritoneal dialysis, it is important for the nurse to:
Reposition the patient frequently and promote deep breathing.
Infuse the dialysate slowly.
Use strict aseptic technique in the dialysis procedures.
Have the patient empty the bowel before the inflow phase.
The Correct Answer is C
Choice A reason: Repositioning the patient frequently and promoting deep breathing are important interventions for various conditions, particularly for preventing atelectasis and respiratory complications. However, they are not directly related to preventing the most common serious complication of peritoneal dialysis, which is peritonitis.
Choice B reason: Infusing the dialysate slowly can help manage discomfort and ensure proper fluid exchange during peritoneal dialysis. However, it does not address the most serious complication, which is infection.
Choice C reason: Using strict aseptic technique in dialysis procedures is crucial in preventing peritonitis, the most serious and common complication of peritoneal dialysis. Peritonitis is an infection of the peritoneal cavity and can lead to severe complications if not prevented. Adhering to aseptic techniques during catheter insertion, connection, disconnection, and any other procedure involving the dialysis system is essential to reduce the risk of infection.
Choice D reason: Having the patient empty the bowel before the inflow phase can help ensure adequate space in the peritoneal cavity for the dialysate and prevent discomfort. However, this action does not directly prevent the serious complication of peritonitis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Albumin is a plasma expander and is typically used to restore blood volume in cases of shock, burns, or trauma. However, it is not specifically indicated for managing spinal shock. Albumin helps in maintaining osmotic pressure and fluid balance but does not directly address the underlying pathophysiology of spinal shock.
Choice B reason: Nitroprusside is a potent vasodilator used to manage hypertensive crises. It works by rapidly reducing blood pressure through vasodilation. In the context of spinal shock, where hypotension is a concern, administering nitroprusside would be inappropriate as it could exacerbate the hypotensive state and worsen the patient's condition.
Choice C reason: Dexamethasone, a corticosteroid, is used to reduce inflammation and edema around the spinal cord following an injury. The anti-inflammatory properties of dexamethasone help to mitigate secondary damage caused by swelling and pressure on the spinal cord tissue. It is commonly administered in cases of acute spinal cord injuries to improve neurological outcomes and manage symptoms of spinal shock.
Choice D reason: Furosemide is a diuretic used to manage fluid overload and edema. It works by increasing urine output, which can help reduce fluid retention in various conditions, such as heart failure and renal impairment. However, it is not specifically indicated for the management of spinal shock and does not address the underlying causes of spinal cord injury-related inflammation and edema.
Correct Answer is B
Explanation
Choice A reason: The rehabilitative phase of burn care focuses on restoring function, improving cosmetic appearance, and achieving the best possible quality of life for the patient. This phase typically begins after the wound has healed and continues for months to years. The care priorities mentioned, such as wound care and nutritional support, indicate that the patient is still in a more active phase of treatment rather than the long-term rehabilitative phase.
Choice B reason: The acute phase of burn care starts after the initial resuscitation and continues until the wound is closed. During this phase, the primary focus is on wound care, nutritional support, and prevention of complications like infection. The goal is to promote healing, prevent infection, and address the patient's nutritional needs to support recovery. This phase aligns with the care priorities mentioned in the question.
Choice C reason: The emergent phase, also known as the resuscitative phase, begins at the time of injury and continues for the first 24-48 hours. The primary focus during this phase is on stabilizing the patient's condition, managing airway and breathing, fluid resuscitation, and addressing immediate life-threatening issues. The care priorities in the question indicate that the patient has moved beyond the initial resuscitative efforts.
Choice D reason: The immediate resuscitative phase overlaps with the emergent phase and focuses on providing immediate life-saving measures to stabilize the patient. This includes fluid resuscitation, airway management, and treating shock. The care priorities mentioned in the question suggest that the patient is beyond the initial resuscitative efforts and is in a more ongoing phase of treatment.
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