A client with chronic kidney disease receiving hemodialysis develops bleeding from the access site. What should the nurse do first?
Apply pressure to the bleeding site.
Elevate the arm above heart level.
Administer a prescribed antiplatelet medication.
Check the client's platelet count.
The Correct Answer is A
A. Correct. Applying pressure to the bleeding site is the first action to control the bleeding and prevent excessive blood loss.
B. Incorrect. Elevating the arm above heart level may not be effective in controlling bleeding from the access site and could cause unnecessary discomfort.
C. Incorrect. Administering a prescribed antiplatelet medication is not the first action to take when the client experiences bleeding from the access site, as it may further increase bleeding risk.
D. Incorrect. While checking the client's platelet count is important, it is not the first action to address active bleeding. Applying pressure to the bleeding site takes priority to control the bleeding.
QUESTIONS
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) This statement is incorrect. Cloudy dialysate drainage may indicate infection or peritonitis, and the nurse should not simply document the finding and continue monitoring without further assessment.
B) This statement is incorrect. Administering an antibiotic medication without a definitive diagnosis is not appropriate. The nurse should assess the client further to determine the cause of the cloudy drainage.
C) This statement is incorrect. Increasing the dialysis exchange frequency would not address the issue of cloudy dialysate drainage and may not be indicated without a proper assessment.
D) This statement is correct. Cloudy dialysate drainage may indicate infection or peritonitis. The nurse should check the client's vital signs and assess for signs of abdominal pain or tenderness, as this requires immediate evaluation.
Correct Answer is B
Explanation
A) This statement is incorrect. Hemodialysis does not involve the removal of the peritoneal membrane; that description is characteristic of peritoneal dialysis.
B) This statement is accurate. Hemodialysis uses a machine called a dialyzer to filter blood outside the body, removing waste products and excess fluid before returning the clean blood to the patient.
C) This statement is incorrect. Hemodialysis does not rely on a catheter inserted into the bladder; that description is characteristic of urinary catheterization.
D) This statement is incorrect. Hemodialysis does not use a pump to circulate dialysate through the intestines; that description is characteristic of peritoneal dialysis.
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