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 A reason: This is the correct answer because serum potassium, calcium, and phosphorus are laboratory results that should be closely monitored in a client who has end-stage renal disease (ESRD). ESRD is a chronic condition that causes irreversible loss of kidney function and accumulation of waste products and fluids in the body. Potassium is an electrolyte that regulates nerve and muscle function and cardiac rhythm. ESRD can cause hyperkalemia (high potassium levels) due to reduced excretion by the kidneys. Hyperkalemia can cause cardiac arrhythmias, muscle weakness, or paralysis. Calcium and phosphorus are minerals that maintain bone health and acid-base balance. ESRD can cause hypocalcemia (low calcium levels) due to impaired vitamin D metabolism and hyperphosphatemia (high phosphorus levels) due to reduced excretion by the kidneys. Hypocalcemia can cause muscle cramps, tetany, or seizures. Hyperphosphatemia can cause soft tissue calcification, bone pain, or fractures.

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 reason: A 14-year-old client with anorexia nervosa who is refusing to eat the evening snack. This client does not require immediate attention, as refusing to eat is a common behavior for clients with anorexia nervosa. The nurse should monitor the client's nutritional intake and weight, and provide education and support.

Choice B reason: An 18-year-old client with antisocial behavior who is being yelled at by other clients. This client does not require immediate attention, as being yelled at by other clients is not a life-threatening situation. The nurse should intervene to maintain a safe and therapeutic environment, and set limits on the client's disruptive behavior.

Choice C reason: A 16-year-old client diagnosed with major depression who refuses to participate in group. This client does not require immediate attention, as refusing to participate in group is a common symptom of depression. The nurse should encourage the client to join the group, and offer individual counseling and medication as needed.

Choice D reason: A 17-year-old client diagnosed with bipolar disorder who is pacing around the lobby. This client requires immediate attention, as pacing around the lobby may indicate that the client is experiencing mania, which can lead to impulsivity, aggression, or self-harm. The nurse should assess the client's mood, behavior, and thought process, and administer medication as prescribed.

A. Secure chest tube to the stretcher for transport. B. Mark the amount of chest drainage on the container. C. Keep chest tube container below the site of insertion. D. Administer PRN pain medication prior to transport.

Correct Answer is C

Explanation

Choice A reason: Securing chest tube to the stretcher for transport is not the most important action for the nurse to take. Chest tube is a device that drains air or fluid from the pleural space or mediastinum after surgery or trauma. Securing chest tube to the stretcher can prevent accidental dislodgement or kinking of the tube during transport, but it is not as crucial as maintaining proper drainage.

Choice B reason: Marking the amount of chest drainage on the container is not the most important action for the nurse to take. Chest drainage is the fluid or air that collects in the chest tube container after being drained from the pleural space or mediastinum. Marking the amount of chest drainage on the container can help monitor fluid balance and detect excessive bleeding or leakage, but it is not as vital as ensuring proper drainage.

Choice C reason: This is the correct answer because keeping chest tube container below the site of insertion is the most important action for the nurse to take. Chest tube container is a device that collects air or fluid from the chest tube and maintains negative pressure in the pleural space or mediastinum. Keeping chest tube container below the site of insertion can prevent backflow of air or fluid into the chest cavity and maintain adequate drainage. If the chest tube container is raised above the site of insertion, it can cause tension pneumothorax, which is a life-threatening condition that occurs when air accumulates in the pleural space and compresses the lung and heart.

Choice D reason: Administering PRN pain medication prior to transport is not a timely action for the nurse to take. Pain medication is a drug that relieves pain by blocking pain signals or reducing inflammation. Administering pain medication prior to transport can improve comfort and reduce anxiety for the client, but it is not as urgent as preventing complications.

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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

The psychiatric nurse is caring for clients on an adolescent unit. Which client requires the nurse’s immediate attention?

Correct Answer is D

Explanation

A client is being urgently transported to radiology for a Computerized Tomography (CT scan) after a sudden decrease in level of consciousness. Theclient is orally intubated and has a left lateral chest tube to 20 cm suction. Which action is most important for the nurse to take?

Correct Answer is C

Explanation

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