When providing care for a client receiving peritoneal dialysis. While draining the dialysate the nurse notices that the efluent is cloudy. Which intervention is most important for the nurse to carry out at this moment?
Prepare the client for emergency surgery.
Send a specimen for culture and sensitivity.
Clamp the catheter and call the provider.
Irrigate the peritoneal catheter with sterile saline
The Correct Answer is B
Choice A rationale: Cloudy efluent doesn't necessarily indicate a need for emergency surgery unless accompanied by severe symptoms.
Choice B rationale: Cloudy efluent may indicate infection, so obtaining a culture and sensitivity test is crucial for appropriate treatment.
Choice C rationale: This step might be necessary if the efluent suggests infection, but sending a specimen for testing is the immediate priority.
Choice D rationale: This action isn't the first step; investigating the cause of cloudiness through testing is essential.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: this is the correct answer since the darkened spots in the uterus represent endometrial-like tissue growths within the muscular wall of the uterus (the myometrium).
Choice B rationale: This picture shows leiomyomas, also known as fibroids, which are benign tumors that develop from the smooth muscle cells of the uterus. They can vary in size, number, and location within or outside the uterus. They can cause symptoms such as heavy bleeding, pelvic pressure, pain, and infertility.
Choice C rationale: This is endometriosis which is a condition where tissue similar to the endometrium (the lining of the uterus) grows outside the uterus, such as on the ovaries, fallopian tubes, pelvic wall, or bowel. This tissue responds to hormonal changes and bleeds during the menstrual cycle, causing inflammation, pain, and sometimes infertility.
Choice D rationale: This image shows a normal uterus.
Correct Answer is C
Explanation
Choice A rationale: Clients with Graves' disease may have increased sensitivity to light due to ocular manifestations like photophobia, so keeping the room well-lit may can cause eye irritation.
Choice B rationale: Encouraging frequent ambulation and exercise may worsen the symptoms of hyperthyroidism, such as tachycardia, palpitations, and tremors.
Choice C rationale: This is because clients with Graves' disease have an increased
metabolic rate and may experience weight loss, muscle wasting, and fatigue. A high- calorie and high protein diet can help prevent these complications and provide adequate nutrition for the client.
Choice D rationale: Placing extra blankets over the client may increase the body temperature and cause heat intolerance, which is another common symptom of Graves' disease.
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