A nurse is assisting with the care of a client who is receiving peritoneal dialysis.Which of the following actions should the nurse take?
Weigh the client before and after the treatment.
Use clean gloves when handling dialysate bags.
Chill the dialysate prior to infusion.
Monitor the client for diarrhea.
The Correct Answer is A
Choice A rationale
Weighing the client before and after peritoneal dialysis helps assess fluid balance and ensure that the correct amount of fluid is removed during treatment. Monitoring weight changes is critical for evaluating the effectiveness of the dialysis.
Choice B rationale
Clean gloves are not sufficient for handling dialysate bags; sterile technique is required to prevent infection. Peritoneal dialysis involves a sterile procedure to reduce the risk of peritonitis.
Choice C rationale
The dialysate should be warmed to body temperature before infusion to prevent discomfort and vasoconstriction. Chilling the dialysate can cause abdominal cramping and reduce the effectiveness of the treatment.
Choice D rationale
Monitoring for diarrhea is not a standard part of peritoneal dialysis care. Peritonitis, not diarrhea, is a common complication of peritoneal dialysis, so monitoring for signs of infection is crucial.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale
Disinfecting the wound bed with alcohol can cause tissue damage and delay healing. The appropriate action is to clean the wound with a saline solution.
Choice B rationale
Preparing sterile dressing supplies 30 minutes before the procedure can compromise sterility. Supplies should be prepared immediately before use.
Choice C rationale
Sterile gloves are worn during the dressing change procedure, not for removing the old dressing. Clean gloves are appropriate for removing the old dressing.
Choice D rationale
Offering the client pain medication before the procedure can help manage pain and discomfort during the dressing change.
Correct Answer is B
Explanation
Choice B rationale
Passing of flatus indicates that the gastrointestinal tract is functioning, which is an important sign after colostomy surgery.
Choice A rationale
A pinkish-red stoma indicates good blood supply, but does not confirm colostomy functionality alone.
Choice C rationale
Absent bowel sounds could indicate a potential postoperative ileus, which is a concern rather than a positive sign.
Choice D rationale
Tolerating a clear liquid diet indicates some gastrointestinal function but is not specific to colostomy functionality.
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