A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?

Aspirate from the catheter using a 60 ml syringe

Flush the catheter with 50 mL of additional dialysate

Advance the catheter 2 to 4 cm further into the peritoneal cavity

Reposition the client to facilitate drainage

Answer and Explanation

The Correct Answer is D

A. Aspirate from the catheter using a 60 ml syringe: Aspiration can introduce infection or damage the catheter if done routinely. It is not the first-line action for slow drainage during peritoneal dialysis. Safer interventions should be attempted first.

B. Flush the catheter with 50 mL of additional dialysate: Flushing may force fluid and increase intra-abdominal pressure, potentially causing discomfort or complications. It is not recommended as an initial step to improve drainage.

C. Advance the catheter 2 to 4 cm further into the peritoneal cavity: Manipulating the catheter manually can increase the risk of trauma or infection. Catheter position is generally fixed, and adjustments should be made only under provider guidance.

D. Reposition the client to facilitate drainage: Changing the client’s position, such as turning from side to side or elevating the head of the bed, often helps the dialysate flow freely. This is a safe and effective first action to relieve slow drainage and prevent complications like fluid retention or abdominal distention.

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Correct Answer is A

Explanation

A. right-sided tension pneumothorax: Tracheal deviation away from the affected side, hypotension, tachycardia, and tachypnea are classic signs of tension pneumothorax. Since the trachea deviates to the left, the problem is on the right side. This is a life-threatening emergency requiring immediate decompression.

B. fall chest with sternal involvement: Flail chest from sternal or rib fractures causes paradoxical chest movement and respiratory distress, but tracheal deviation is not a typical finding. Hypotension may occur with associated injuries, but it does not explain the observed tracheal shift.

C. left-sided tension pneumothorax: A left-sided tension pneumothorax would push the trachea to the right, not to the left. The direction of tracheal deviation helps localize the affected side. This does not match the client’s presentation.

D. fractured ribs with splinting of the chest wall: Rib fractures can cause pain and shallow breathing, but they rarely cause tracheal deviation or severe hypotension. Splinting alone does not account for the hemodynamic instability or mediastinal shift seen in tension pneumothorax.

A. Neurogenic shock B. Cardiogenic shock C. Septic shock D. Hypovolemic shock

Correct Answer is A

Explanation

A. Neurogenic shock: Neurogenic shock results from disruption of sympathetic nervous system pathways, often due to spinal cord injury. It leads to unopposed parasympathetic activity, causing bradycardia, vasodilation, and hypotension. Unlike other shock types, the loss of vascular tone is a hallmark.

B. Cardiogenic shock: Cardiogenic shock stems from pump failure, typically after myocardial infarction, causing hypotension and poor perfusion. Tachycardia is common as a compensatory response, rather than bradycardia. Vasodilation is usually not a primary feature.

C. Septic shock: Septic shock is characterized by systemic vasodilation, hypotension, and often tachycardia due to infection and inflammatory mediator release. Bradycardia is uncommon. Warm, flushed skin may be present initially. Rapid identification and antibiotics are priorities.

D. Hypovolemic shock: Hypovolemic shock is caused by fluid or blood loss, leading to hypotension and tachycardia as compensation. Vasoconstriction occurs to maintain perfusion, not vasodilation. Bradycardia is rare unless decompensation occurs.

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A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?

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