A medical surgical nurse is concerned about professional liability when asked by a charge nurse to float to an intensive care unit. Which of the following actions should the nurse take?

Ask for an orientation to the unit at the first available break after beginning the assignment.

Refuse to accept the float assignment.

Report the assignment to the Risk Management Department.

Request a resource nurse when arriving at the other unit.

Answer and Explanation

The Correct Answer is D

Rationale:

A. Ask for an orientation to the unit at the first available break after beginning the assignment: Orientation should be provided before beginning the assignment, not delayed until a break. Starting without proper orientation may increase liability risks and compromise patient safety.

B. Refuse to accept the float assignment: Refusing to float could be seen as insubordination unless the nurse is being asked to perform beyond their scope of practice. The appropriate action is to seek support, not immediate refusal.

C. Report the assignment to the Risk Management Department: Involving Risk Management is appropriate if unsafe conditions persist or harm occurs, but this is not the nurse’s first or most immediate step when floated.

D. Request a resource nurse when arriving at the other unit: Asking for a resource nurse helps ensure patient safety and provides support for tasks outside the nurse’s usual expertise. This demonstrates accountability and helps reduce liability by ensuring guidance is available.

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Correct Answer is A

Explanation

Rationale:

A. Hypernatremia: In late-stage chronic kidney disease (CKD), the kidneys lose their ability to concentrate or dilute urine effectively, leading to fluid imbalance and sodium retention. This can result in hypernatremia, particularly when there is inadequate fluid intake or excessive fluid loss, which the kidneys can no longer compensate for.

B. Hypercalcemia: Clients with advanced CKD typically develop hypocalcemia due to decreased activation of vitamin D and impaired calcium absorption. Additionally, phosphate retention leads to secondary hyperparathyroidism, further lowering serum calcium levels rather than elevating them.

C. Hypokalemia: Hypokalemia is not commonly associated with late-stage CKD. On the contrary, potassium tends to accumulate because the kidneys are less effective at excreting it, leading to hyperkalemia unless treated with medications or dialysis.

D. Hypophosphatemia: In CKD, phosphate excretion is impaired, resulting in hyperphosphatemia, not hypophosphatemia. Elevated phosphate levels are a hallmark finding in late-stage CKD and contribute to bone and cardiovascular complications in these clients.

A. Apply a cold compress to the affected areas of the IV site. B. Aspirate the remaining medication from the catheter port with a syringe. C. Inject phentolamine into the areas that are edematous. D. Take a photograph of the IV site.

Correct Answer is B

Explanation

Rationale:

A. Apply a cold compress to the affected areas of the IV site: Cold compresses are not recommended for dopamine extravasation, as they can worsen vasoconstriction. Warm compresses or antidote administration are preferred to promote vasodilation.

B. Aspirate the remaining medication from the catheter port with a syringe: The priority after stopping the infusion is to aspirate as much of the vesicant drug as possible to limit tissue damage. This action helps prevent further injury from the extravasated dopamine.

C. Inject phentolamine into the areas that are edematous: Phentolamine is the antidote for dopamine extravasation, but it should be administered only after aspiration of the drug. Aspiration reduces the drug concentration before antidote infiltration.

D. Take a photograph of the IV site: Documentation may be useful later for quality reporting, but it is not a priority action. Immediate steps to reduce tissue damage must be taken first before photographic evidence is gathered.

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A medical surgical nurse is concerned about professional liability when asked by a charge nurse to float to an intensive care unit. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

A nurse is monitoring the laboratory results of a client who is in a late stage of chronic kidney disease. The nurse should expect the client to have which of the following electrolyte imbalances?

Correct Answer is A

Explanation

A nurse is assessing the peripheral IV site of a client who is receiving dopamine. The site is edematous and cool to the touch, and the client reports pain in that area. After disconnecting the administration set, which of the following actions should the nurse take next?

Correct Answer is B

Explanation

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