A client with chronic kidney disease (CKD) missed dialysis yesterday to attend a funeral. The client's spouse calls the home health nurse and reports that the client is lethargic and hard to arouse. Which instruction is most important for the nurse to provide?

Take the client to the emergency department (ED)

Apply the client's home oxygen

Ensure that the client avoids salt intake for the rest of the day

Check for a thrill and bruit at the client's dialysis access site

Answer and Explanation

The Correct Answer is A

Choice A reason: Taking the client to the emergency department is crucial because missing a dialysis session can lead to severe complications such as fluid overload, high potassium levels, and other electrolyte imbalances. These conditions can be life-threatening and require immediate medical attention to stabilize the client.

Choice B reason: Applying home oxygen is not the most critical intervention in this scenario. While oxygen therapy might be necessary in some cases, it does not address the immediate risk of complications arising from missed dialysis.

Choice C reason: Ensuring that the client avoids salt intake for the rest of the day is important for managing fluid balance, but it is not the most urgent action needed in this situation. The client's lethargy and difficulty arousing indicate a more serious underlying issue that requires immediate medical evaluation.

Choice D reason: Checking for a thrill and bruit at the client's dialysis access site is important for assessing the patency of the access site, but it is not the most critical action in this scenario. The immediate concern is the client's lethargy and potential complications from missed dialysis, which necessitate emergency medical care.

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Correct Answer is B

Explanation

Choice A reason: Placing the chin down and tilting the head for dysphagia (difficulty swallowing) during meals is not directly related to managing mucositis. While it may help with swallowing difficulties, it does not address the inflammation and pain caused by mucositis.

Choice B reason: Normal saline mouth rinses as swish and spit after meals and bedtime is an effective intervention for managing mucositis. Rinsing with saline helps to keep the mouth clean, reduce bacterial load, and soothe inflamed tissues. It can also help to remove food particles and debris, reducing the risk of infection and promoting healing. Saline rinses are gentle and do not contain irritating ingredients, making them ideal for sensitive oral tissues affected by mucositis.

Choice C reason: Eating high caloric meals to prevent weight loss is important for overall nutrition, especially for clients undergoing cancer treatment. However, it does not specifically address the management of mucositis. High caloric meals alone will not alleviate the pain, inflammation, and ulceration associated with mucositis. Clients with mucositis often have difficulty eating due to pain, so focusing on soothing and healing the oral tissues is a priority before addressing caloric intake.

Choice D reason: Using a commercial mouthwash for xerostomia (dry mouth) is not recommended for managing mucositis. Many commercial mouthwashes contain alcohol and other harsh ingredients that can further irritate the already inflamed mucous membranes. It is better to use a gentle and soothing rinse, such as saline, to manage mucositis symptoms and promote healing of the oral tissues.

A. Substances that change a cell so that it becomes cancerous are potential sources of cancer. B. Carcinogens are substances that contain cancerous cells. C. Carcinogens are in the environment and cannot be avoided. D. Environmental factors such as sunlight and chemicals can cause cancer to spread.

Correct Answer is A

Explanation

Choice A reason: Substances that change a cell so that it becomes cancerous are potential sources of cancer. Carcinogens are agents that cause genetic mutations or damage to cells, leading to uncontrolled cell growth and the development of cancer. This definition accurately reflects the nature of carcinogens and their role in cancer development.

Choice B reason: Carcinogens are not substances that contain cancerous cells. Instead, they are substances or factors that can induce cancer by causing genetic mutations or cellular damage. The statement is incorrect because it misrepresents the nature of carcinogens.

Choice C reason: While it is true that some carcinogens are present in the environment, the statement that they cannot be avoided is not entirely accurate. Many carcinogens can be avoided or minimized through lifestyle choices, such as avoiding tobacco smoke, reducing exposure to harmful chemicals, and using protective measures against ultraviolet (UV) radiation. The statement is overly deterministic and does not account for preventive measures.

Choice D reason: Environmental factors such as sunlight and chemicals can contribute to the development of cancer, but they do not cause cancer to spread. The spread of cancer (metastasis) occurs when cancer cells break away from the original tumor and travel to other parts of the body. The statement conflates the causes of cancer with the mechanisms of cancer spread, making it inaccurate.

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A client with chronic kidney disease (CKD) missed dialysis yesterday to attend a funeral. The client's spouse calls the home health nurse and reports that the client is lethargic and hard to arouse. Which instruction is most important for the nurse to provide?

Nursing Test Bank

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