Which laboratory results should the nurse closely monitor in a client who has end-stage renal disease (ESRD.?

Serum potassium, calcium, and phosphorus

Erythrocytes, hemoglobin, and hematocrit

Leukocytes, neutrophils, and thyroxine

Blood pressure, heart rate, and temperature

Answer and Explanation

The Correct Answer is A

Choice B reason: Erythrocytes, hemoglobin, and hematocrit are laboratory results that are not as critical as serum potassium, calcium, and phosphorus in a client who has end-stage renal disease (ESRD.. Erythrocytes are red blood cells that carry oxygen from the lungs to the tissues. Hemoglobin is a protein in erythrocytes that binds oxygen. Hematocrit is the percentage of blood volume that is occupied by erythrocytes. ESRD can cause anemia (low erythrocyte, hemoglobin, and hematocrit levels) due to reduced production of erythropoietin, a hormone that stimulates erythrocyte formation, by the kidneys. Anemia can cause fatigue, pallor, or shortness of breath.

Choice C reason: Leukocytes, neutrophils, and thyroxine are laboratory results that are not as relevant as serum potassium, calcium, and phosphorus in a client who has end-stage renal disease (ESRD.. Leukocytes are white blood cells that fight infection and inflammation. Neutrophils are a type of leukocyte that respond to bacterial infection. Thyroxine is a hormone that regulates metabolism and growth. ESRD can cause leukopenia (low leukocyte levels) and neutropenia (low neutrophil levels) due to impaired immune function and increased susceptibility to infection. ESRD can also cause hypothyroidism (low thyroxine levels) due to reduced clearance of thyroid hormones by the kidneys. Hypothyroidism can cause weight gain, cold intolerance, or depression.

Choice D reason: Blood pressure, heart rate, and temperature are not laboratory results, but vital signs that should be monitored in a client who has end-stage renal disease (ESRD.. Blood pressure is the force of blood against the walls of the arteries. Heart rate is the number of times the heart beats per minute. Temperature is the measure of body heat. ESRD can cause hypertension (high blood pressurE. due to fluid overload and activation of the renin-angiotensin-aldosterone system, a hormonal pathway that regulates blood pressure and fluid balance. Hypertension can cause headache, chest pain, or stroke. ESRD can also cause tachycardia (high heart ratE. due to anemia, fluid overload, or electrolyte imbalance. Tachycardia can cause palpitations, dizziness, or heart failure. ESRD can also cause fever (high temperaturE. due to infection or inflammation. Fever can cause chills, sweating, or delirium.

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Correct Answer is D

Explanation

Choice A: Increasing oral fluids may help with hydration, but it will not reduce skin flushing caused by lisinopril. Lisinopril is an angiotensin-converting enzyme (ACE. inhibitor that dilates blood vessels and lowers blood pressure. Flushing occurs due to increased blood flow to the skin.

Choice B: Nitroglycerin is a vasodilator that relaxes smooth muscle in blood vessels and reduces chest pain caused by angina. It is not indicated for skin flushing caused by lisinopril. Moreover, nitroglycerin can lower blood pressure further and cause hypotension, headache, dizziness, and fainting.

Choice C: Going to an emergency department is not necessary for skin flushing caused by lisinopril. Flushing is not a sign of an allergic reaction or anaphylaxis, which would require immediate medical attention. Flushing is also not a symptom of a heart attack or stroke, which would present with other signs such as chest pain, shortness of breath, arm numbness, or slurred speech.

Choice D: Reassuring the client that facial flushing is a common side effect of lisinopril is the best action for the nurse to take. Flushing is not harmful or dangerous, and it usually subsides within a few hours. The nurse should explain the mechanism of action of lisinopril and its benefits for lowering blood pressure and preventing angina. The nurse should also advise the client to monitor his blood pressure regularly and report any signs of hypotension, such as dizziness, lightheadedness, or fainting.

A. Discuss the issue privately with the UAP. B. Note date and time of the behavior. C. Plan for scheduled break times. D. Evaluate the UAP for signs of improvement.

Correct Answer is B,A,C,D

Explanation

The correct order is:

- Note date and time of the behavior.

- Discuss the issue privately with the UAP.

- Plan for scheduled break times.

- Evaluate the UAP for signs of improvement.

Here are the reasons for this order:

- Note date and time of the behavior. This should be done first, as it can provide objective evidence of the UAP's behavior and its impact on patient care and staff workload. The unit manager should document any incidents or complaints related to the UAP's behavior in a factual manner.

- Discuss the issue privately with the UAP. This should be done second, as it can provide an opportunity for feedback and clarification. The unit manager should use a respectful and professional tone, and explain how the UAP's behavior affects patient safety and staff morale. The unit manager should also listen to any concerns or challenges that the UAP may have, and offer support or guidance as needed.

- Plan for scheduled break times. This should be done third, as it can provide a solution or prevention strategy for future occurrences. The unit manager should work with the UAP and other staff members to ensure that there are adequate breaks and coverage for patient care. The unit manager should also review any policies or procedures related to break times and staff attendance.

- Evaluate the UAP for signs of improvement. This should be done last, as it can provide a measure of effectiveness and accountability. The unit manager should monitor and document any changes in the UAP's behavior, performance, or attitude. The unit manager should also provide positive reinforcement or corrective action as appropriate.

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Which laboratory results should the nurse closely monitor in a client who has end-stage renal disease (ESRD.?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A male client reports to the on-call clinic nurse that he took two tablets of 10 mg lisinopril by mouth two hours ago and his skin now feels flushed. He reports a history of stable angina, but denies experiencing any chest pain at the moment or recently. Which action should the nurse take?

Correct Answer is D

Explanation

An unlicensed assistive personnel (UAP) leaves the unit without notifying the staff. In which order should the unit manager implement these interventions to address the UAP's behavior? (Place the actions in order from first on top to last on bottom.)

Correct Answer is B,A,C,D

Explanation

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