A nurse is developing a plan of care for a client who is to begin receiving peritoneal dialysis. Which of the following interventions should the nurse implement to ensure proper dialysate exchange?

Maintain the client in a left lateral position during dialysis.

Monitor vital signs every 2 hours during the procedure.

Warm the dialysate solution prior to instillation.

Place the drainage bag above the level of the client's abdomen.

Answer and Explanation

The Correct Answer is C

Choice A reason: Maintaining the client in a left lateral position is not specifically required for peritoneal dialysis. Positioning may vary based on the individual's comfort and specific medical needs.

Choice B reason: While monitoring vital signs is important during any medical procedure, it is not an intervention that directly ensures proper dialysate exchange in peritoneal dialysis.

Choice C reason: Warming the dialysate solution prior to instillation is a standard practice in peritoneal dialysis. It helps to promote patient comfort and more efficient exchange of wastes and fluids.

Choice D reason: Placing the drainage bag above the level of the client's abdomen would impede gravity drainage, which is necessary for proper dialysate exchange. The drainage bag should be placed below the level of the client's abdomen.

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Correct Answer is D

Explanation

Choice A reason: A BUN level of 8 mg/dL and a creatinine level of 0.7 mg/dL are within normal ranges for healthy individuals. In CKD, BUN and creatinine levels are typically elevated due to decreased kidney function.

Choice B reason: A BUN level of 45 mg/dL is elevated, which could be expected in CKD, but a creatinine level of 8 ng/dL is not correctly expressed. Creatinine is measured in mg/dL, and in CKD, it would be higher than normal, not lower.

Choice C reason: A BUN level of 10 mg/dL and a creatinine level of 0.3 mg/dL are both lower than what would typically be expected in a patient with CKD. CKD usually results in higher levels due to reduced kidney function.

Choice D reason: A BUN level of 23 mg/dL and a creatinine level of 1.0 mg/dL are more aligned with what might be expected in CKD. Normal BUN levels range from 7 to 20 mg/dL, and normal creatinine levels can vary based on age, sex, and body size. In CKD, both levels tend to be higher as the kidneys' ability to filter blood decreases.

A. The glomerular filtration rate decreases because there is injury to the renal tubular cells. B. The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down. C. The glomerular filtration rate decreases because in?ammatory cells invade the already damaged kidneys. D. The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys.

Correct Answer is A

Explanation

Choice A reason: Acute tubular necrosis (ATN) is a condition where there is damage to the renal tubular cells, which can lead to a decrease in GFR. This is because the tubular cells are responsible for reabsorbing substances from the filtrate back into the blood. When these cells are injured, they cannot function properly, leading to a buildup of waste products and a decrease in GFR.

Choice B reason: While obstruction can lead to a decrease in GFR, it is not the primary cause in the context of acute tubular necrosis. Obstruction typically occurs in postrenal causes of acute kidney injury.

Choice C reason: In?ammatory cells do invade damaged kidneys, but this is more characteristic of conditions such as acute interstitial nephritis rather than ATN. In ATN, the primary issue is the injury to the tubular cells themselves.

Choice D reason: A reduction of blood flow to the kidneys, or prerenal azotemia, can indeed lead to a decrease in GFR. However, in the context of ATN, the primary issue is not the blood flow but the damage to the renal tubules.

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A nurse is developing a plan of care for a client who is to begin receiving peritoneal dialysis. Which of the following interventions should the nurse implement to ensure proper dialysate exchange?

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