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A nurse is caring for a client who has severe right wrist pain.

Exhibits

The nurse has completed the assessment of the client.

Drag words from the choices below to fill in each blank in the following sentence.

The client is at risk for developing

and .
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}

Respiratory acidosis- Due to opioid-induced respiratory depression (hypoventilation, CO₂ retention). Hypervolemia: IVF at 150ml/hr is a relatively high rate for someone with CHF. Even isotonic fluids like 0.9% sodium chloride can accumulate quickly and worsen cardiac workload.

Incorrect answers:

  • Metabolic alkalosis: typically occurs due to vomiting or excessive bicarbonate intake.
  • Osteomyelitis: Infection of the bone; not a direct risk in this scenario.


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Related Questions

Correct Answer is A

Explanation

A. "The microwave in my kitchen can warm the solution before I use it." Heating dialysis fluid in a microwave is dangerous as it can cause uneven heating and burns inside the peritoneal cavity. Dialysis solutions should be warmed using a heating pad or a specialized warmer.

B. "The fluid from my abdomen will be clear or slightly yellow." Normal peritoneal dialysis effluent should be clear. Cloudy effluent indicates infection (peritonitis).

C. "The catheter can become infected even with sterile precautions." Peritoneal dialysis catheters have a high risk of infection, even with proper care.

D. "The volume of the output solution should be greater than the input solution." More fluid should come out than goes in, as excess fluid and toxins are being removed.

Correct Answer is B

Explanation

A. Assess the fistula with a large bore needle: Large bore needles are used during dialysis sessions, not for routine assessment. Inappropriate needling can damage the fistula.

B. Auscultate the fistula site for a bruit: A functional AV fistula should have a palpable thrill (vibration) and an audible bruit (whooshing sound) when auscultated with a stethoscope. These findings confirm adequate blood flow and patency.

C. Measure the blood pressure in the affected arm: Blood pressure measurements should never be taken on the fistula arm to prevent compression and potential fistula failure.

D. Assess the rate and quality of the radial pulse on the affected arm: The radial pulse does not accurately assess AV fistula patency; the focus should be on the thrill and bruit.

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