A client with chronic renal failure is experiencing anorexia and nausea. What is the nurse's priority action?
Administer an antiemetic medication to relieve the nausea.
Encourage the client to increase protein intake.
Assess the client's serum electrolyte levels.
Monitor the client's weight and fluid intake.
The Correct Answer is D
A. Incorrect. Administering an antiemetic medication may help relieve nausea, but it is not the priority action in a client with chronic renal failure experiencing anorexia and nausea.
B. Incorrect. Encouraging the client to increase protein intake is not appropriate if they are experiencing anorexia and nausea. Protein intake may need to be adjusted based on the client's symptoms and kidney function.
C. Incorrect. While assessing serum electrolyte levels is important in chronic renal failure, it is not the priority action in this situation. The client's anorexia and nausea require immediate attention.
D. Correct. Monitoring the client's weight and fluid intake is the priority action when the client is experiencing anorexia and nausea. These symptoms may indicate fluid and electrolyte imbalances that need to be addressed promptly.
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Related Questions
Correct Answer is C
Explanation
A. Incorrect. While proper medication adherence can help prevent drug interactions, it is not the primary reason for advising clients to take medications as prescribed in chronic renal failure.
B. Incorrect. Medication adherence may or may not directly impact the cost of treatment, but the main reason for consistent use is to manage the condition effectively.
C. Correct. Adhering to medication regimens in chronic renal failure is crucial for slowing the progression of kidney damage. Medications are prescribed to control blood pressure, manage complications, and reduce the strain on the kidneys.
D. Incorrect. Medication adherence is essential, but it does not eliminate the need for dietary restrictions in chronic renal failure. Dietary modifications are also a vital part of managing the condition effectively.
Correct Answer is B
Explanation
A. Incorrect. While assessing vital signs and blood pressure is important, it is not the first action when the client reports cloudy dialysate effluent during an exchange.
B. Correct. Cloudy dialysate effluent may indicate peritonitis, an infection of the peritoneal cavity. Obtaining a sample of the effluent for testing is the first action to determine if an infection is present and requires immediate treatment.
C. Incorrect. Instructing the client to stop the exchange immediately may be necessary if there are signs of infection or other complications, but obtaining a sample of the effluent should be done first to determine the cause.
D. Incorrect. Providing the client with an analgesic is not the priority when the client reports cloudy dialysate effluent; the focus is on identifying the cause of the cloudiness.
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