A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication?
Blood pressure 98/56 mm Hg
Creatinine 1.6 mg/dL
Oxygen saturation 89%
Hemoglobin level 13 g/dL
The Correct Answer is D
A. Blood pressure 98/56 mm Hg: A slightly low blood pressure is not a contraindication to epoetin alfa administration. The major concern with this medication is hypertension, not hypotension, so this finding would not prevent giving the dose.
B. Creatinine 1.6 mg/dL: Elevated creatinine is expected in end-stage kidney disease and does not affect the decision to administer epoetin alfa. This medication is used specifically to manage anemia related to chronic kidney disease.
C. Oxygen saturation 89%: A low oxygen saturation reflects hypoxemia, but epoetin alfa does not treat oxygenation problems directly. Supplemental oxygen and pulmonary assessment would be the priority, but this finding is not a contraindication to giving the drug.
D. Hemoglobin level 13 g/dL: Epoetin alfa stimulates red blood cell production, and giving it when hemoglobin is already elevated increases the risk of serious adverse effects such as thrombosis, stroke, and hypertension. Reporting this value is essential drug administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. It shows that the access site is not safe for dialysis: The presence of a thrill and bruit does not indicate danger; instead, it signals that blood flow is adequate. An unsafe access would be suspected if no thrill or bruit is present, suggesting poor patency.
B. It suggests a blockage in the access site: A blockage would diminish or eliminate the thrill and bruit rather than create them. Detecting these signs means blood is moving effectively through the fistula without significant obstruction.
C. It confirms the maturation of the access site: A palpable thrill and an audible bruit are expected findings that confirm adequate blood flow and fistula maturation. These signs indicate that the fistula is functioning well and is ready or preparing for use in hemodialysis.
D. It indicates the presence of an infection: Infection of an AV fistula is characterized by redness, warmth, swelling, pain, or purulent drainage. A thrill and bruit are not infection signs but rather vascular flow indicators confirming patency.
Correct Answer is C
Explanation
A. Asking the patient to empty the bladder completely and then collecting the next specimen is not specific enough for a clean-catch technique. This method does not reduce contamination from the urethral meatus or surrounding genital area.
B. Using povidone iodine is not recommended for routine clean-catch urine collection because it can irritate the urethral area and does not offer additional benefit over standard cleansing with mild soap and water or antiseptic wipes.
C. Cleaning the urethral area reduces contamination, and discarding the initial urine flushes out bacteria from the urethra. Collecting midstream urine ensures that the sample accurately reflects bladder contents for culture and sensitivity testing.
D. Catheterization is an invasive procedure and is reserved for patients who cannot provide a clean-catch specimen. Routine midstream collection is preferred to reduce infection risk and discomfort while still providing an uncontaminated sample.
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