A client with chronic kidney disease (CKD) complains of severe itching. Which terms should the nurse use to document this finding? (Select all that apply)
Urticaria
Atopic dermatitis
Excoriation
Pruritus
Psoriasis
Correct Answer : C,D
Choice A reason: Urticaria, commonly known as hives, refers to raised, itchy wheals on the skin often caused by an allergic reaction. While itchy, it is not the standard clinical term for the systemic, metabolic-induced itching associated with the accumulation of uremic toxins in chronic kidney disease patients.
Choice B reason: Atopic dermatitis is a chronic inflammatory skin condition, often hereditary, characterized by eczema flares. It is a primary skin disorder rather than a secondary manifestation of renal failure. Documenting uremic itching as atopic dermatitis would be medically inaccurate in a patient with chronic kidney disease.
Choice C reason: Excoriation refers to skin lesions or abrasions produced by the mechanical action of scratching. Patients with severe uremic pruritus often scratch their skin relentlessly to find relief, leading to visible linear breaks in the skin surface which must be documented by the nurse during a physical assessment.
Choice D reason: Pruritus is the correct medical term for itching. In chronic kidney disease, this is specifically referred to as uremic pruritus. It is caused by the deposition of calcium-phosphate crystals in the skin and the irritation of sensory nerve endings by high levels of serum urea and other nitrogenous wastes.
Choice E reason: Psoriasis is an autoimmune skin disease resulting in the rapid turnover of skin cells, creating silvery scales. It is not caused by renal failure. While a CKD patient could coincidentally have psoriasis, the "severe itching" reported is a direct symptom of their metabolic state, not this specific dermatological disease.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Stating that a colostomy is temporary might provide false hope if the status is uncertain, and it does not help the patient cope with their current reality. To improve body image, the patient must process their feelings about their current physical state rather than simply waiting for it to change.
Choice B reason: While education is helpful, unguided online research can expose the patient to graphic images or misinformation that may actually worsen anxiety and negative body image. The nurse should provide curated resources rather than encouraging broad, unsupervised internet searches during the initial period of psychological adjustment.
Choice C reason: Logic and "rationalizing" why the surgery was necessary (e.g., to treat cancer) often fails to address the emotional trauma of body disfigurement. A patient can be grateful to be alive while still feeling devastated by the presence of a stoma; the nurse must address the latter directly.
Choice D reason: Open dialogue allows the patient to express fears, grief, and concerns about intimacy, clothing, and social life. This therapeutic communication helps the nurse identify specific misconceptions and facilitates the patient's transition toward acceptance by validating their feelings and encouraging a realistic integration of the stoma into their self-concept.
Correct Answer is B
Explanation
Choice A reason: Immobilization of the arm for 4 to 6 days is contraindicated following the creation of an arteriovenous (AV) fistula. While the incision site must be protected, gentle exercise of the arm, such as squeezing a rubber ball, is actually encouraged to increase blood flow and promote the "maturation" or thickening of the vessel walls.
Choice B reason: An AV fistula is created by a surgical anastomosis between an artery (typically the radial or brachial artery) and a vein (typically the cephalic vein). This allows high-pressure arterial blood to flow directly into the vein, causing the vein to dilate and become tough enough to withstand repeated large-bore needle cannulations.
Choice C reason: Hemodialysis requires two needles to be inserted into the fistula for each treatment, not one. One needle (the arterial needle) withdraws blood from the body to be sent to the dialyzer for cleaning, while the second needle (the venous needle) returns the filtered blood back to the patient's circulation.
Choice D reason: An AV fistula cannot be used 5 to 7 days after surgery. It requires a significant "maturation" period, usually lasting 2 to 4 months, before it is ready for use. Using it too early can cause the vessel to collapse or infiltrate. If urgent dialysis is needed, a temporary central venous catheter is used in the interim.
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