Which assessment finding of a patient with chronic kidney disease indicates to the nurse that hemodialysis is having the desired effect?

Hemodialysis is a treatment used to remove waste products and excess fluids from the blood in individuals with kidney failure or chronic kidney disease. The primary purpose of hemodialysis is to filter and clear the blood of waste products that the kidneys can no longer remove adequately. As a result, one of the key indicators that hemodialysis is having the desired effect is a decrease in serum creatinine levels. Creatinine is a waste product that builds up in the blood when the kidneys are not functioning properly. A decrease in serum creatinine indicates that the dialysis treatment is effectively removing waste products from the blood.

Weight loss is also a positive sign after hemodialysis since it indicates that excess fluid is being removed from the body. In individuals with kidney failure, the kidneys cannot adequately remove extra fluid, leading to fluid retention and weight gain. Hemodialysis helps to eliminate this excess fluid, leading to weight loss and reducing the risk of fluid overload-related complications.

The other options listed (decreased hematocrit and diuresis, increased potassium level and improved appetite, and decreased white blood cell count and diaphoresis) are not direct indicators of the effectiveness of hemodialysis in removing waste products and excess fluid from the blood.

In a patient with acute decompensated heart failure (ADHF), the priority nursing assessment is to auscultate lung sounds. ADHF is characterized by the sudden worsening of heart failure symptoms, which may include pulmonary congestion and fluid accumulation in the lungs. Assessing lung sounds helps to identify signs of pulmonary edema, which is a serious complication of ADHF.

The nurse should listen for crackles or rales, which are abnormal lung sounds caused by the presence of fluid in the alveoli. These findings suggest that the patient is experiencing fluid overload and inadequate gas exchange in the lungs. Prompt recognition of pulmonary edema allows for early intervention, such as administering diuretics or other medications, to relieve fluid overload and improve respiratory function.

While the other options (B) Facial swelling, (C) Level of anxiety, and (D) Intake and output, are important assessments in a patient with heart failure, they are not the priority in a patient with manifestations of acute decompensated heart failure. The priority is to assess for signs of respiratory

distress and pulmonary congestion, as these can quickly lead to respiratory failure and life threatening complications.