A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse?
Warm the dialysate solution in a microwave before instillation
Flush the tubing with normal saline to maintain patency of the catheter.
Obtain a sample of the effluent and send to the laboratory.
Check the peritoneal catheter for kinking and curling.
The Correct Answer is C
Rationale:
A. Warming the dialysate solution in a microwave is unsafe, as it can cause uneven heating and increase the risk of peritoneal injury. Dialysate should always be warmed using a dry heating pad or warming cabinet, not a microwave.
B. Flushing the tubing with normal saline is not appropriate for managing cloudy effluent. This could introduce infection or disrupt the sterile system. The nurse must first determine the cause of the opacity before any intervention involving the catheter.
C. Obtaining a sample of the effluent and sending it to the laboratory is the priority action. An opaque or cloudy peritoneal effluent is an early sign of peritonitis, a serious complication of peritoneal dialysis. The specimen should be sent for culture and sensitivity testing to identify the causative organism and guide antibiotic therapy.
D. Checking the catheter for kinking or curling is appropriate if there is poor drainage or inflow issues, not when the effluent appears cloudy. The presence of opacity indicates infection, not a mechanical problem with the catheter.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Iron is essential for the effectiveness of epoetin alfa, a synthetic form of erythropoietin that stimulates red blood cell production in the bone marrow. Clients with chronic kidney disease (CKD) often have low erythropoietin levels and iron deficiency, which can limit the drug’s effectiveness. Adequate iron intake supports hemoglobin synthesis and ensures that newly produced red blood cells are healthy and functional. The nurse should encourage consumption of iron-rich foods such as lean meats, eggs, legumes, and fortified cereals or the use of prescribed iron supplements.
B. Sodium should be restricted in CKD because excess sodium can cause fluid retention, hypertension, and edema, worsening cardiovascular strain and contributing to further kidney damage. Increasing sodium intake would counteract fluid balance goals in these clients.
C. Protein intake is usually limited in CKD to reduce the accumulation of nitrogenous waste products such as urea and creatinine. Although protein is essential for maintaining muscle mass, excessive intake can increase the kidney’s workload and accelerate the decline in renal function.
D. Potassium should be restricted in CKD because the kidneys cannot adequately excrete it. Elevated potassium levels (hyperkalemia) can lead to dangerous cardiac dysrhythmias or cardiac arrest. Therefore, the nurse should teach the client to avoid potassium-rich foods such as bananas, oranges, and potatoes.
Correct Answer is A
Explanation
Rationale:
A. Vancomycin, an aminoglycoside-like antibiotic, is nephrotoxic, especially when administered in high doses or for prolonged periods. It can cause acute tubular necrosis and should be used with caution in clients with chronic kidney disease (CKD). Serum trough levels must be carefully monitored to maintain therapeutic effect while preventing toxicity.
B. Omeprazole is a proton pump inhibitor (PPI) used for gastric acid suppression. While long-term use has been associated with a small risk of interstitial nephritis, it is not a common direct nephrotoxin and is generally considered safe for most CKD clients.
C. Diphenhydramine (Benadryl) is an antihistamine that may cause urinary retention or sedation, but it does not cause nephrotoxicity.
D. Ondansetron (Zofran) is an antiemetic that acts on serotonin receptors and has no nephrotoxic effects.
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