A nurse is reinforcing teaching about monitoring weight with a client who has chronic kidney disease. Which of the following instructions should the nurse include in the teaching?
Use several different scales to obtain the weight.
Weigh at the same time each day.
Calibrate weight scales every week.
Measure weight just prior to voiding.
The Correct Answer is B
Choice A rationale
Using several different scales to obtain the weight is incorrect. Consistency is key when monitoring weight, especially for clients with chronic kidney disease. Using the same scale ensures that weight measurements are accurate and comparable over time. Different scales may have slight variations, leading to inconsistent and unreliable data.
Choice B rationale
Weighing at the same time each day is correct. It is important to weigh at the same time each day, preferably in the morning after voiding and before eating, to obtain consistent and accurate measurements. This helps in monitoring fluid retention and changes in body weight, which are critical for managing chronic kidney disease.
Choice C rationale
Calibrating weight scales every week is not necessary. While it is important to ensure that the scale is accurate, weekly calibration is excessive. Regular calibration according to the manufacturer’s instructions or as needed is sufficient to maintain accuracy. Over-calibration can be time-consuming and may not significantly improve measurement accuracy.
Choice D rationale
Measuring weight just prior to voiding is incorrect. Weighing after voiding provides a more accurate measurement of body weight without the influence of bladder contents. This is especially important for clients with chronic kidney disease, as fluid balance and retention are closely monitored.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Constipation is not a common adverse effect of aspirin therapy. Aspirin primarily affects the gastrointestinal tract by causing irritation, which can lead to symptoms such as nausea, vomiting, and abdominal pain. Constipation is more commonly associated with medications that slow down bowel movements, such as opioids.
Choice B rationale
Blurred vision is not typically associated with aspirin therapy. Aspirin is a nonsteroidal anti- inflammatory drug (NSAID) that works by inhibiting the production of prostaglandins, which are involved in inflammation and pain. Blurred vision is more commonly associated with medications that affect the central nervous system or have anticholinergic effects.
Choice C rationale
Insomnia is not a common adverse effect of aspirin therapy. Aspirin does not have stimulant properties that would interfere with sleep. Insomnia is more commonly associated with medications that have stimulating effects, such as caffeine or certain antidepressants.
Choice D rationale
Bleeding is a well-known adverse effect of aspirin therapy. Aspirin inhibits platelet aggregation, which can increase the risk of bleeding. This can manifest as gastrointestinal bleeding, easy bruising, or prolonged bleeding from cuts. Patients taking aspirin should be monitored for signs of bleeding and advised to report any unusual bleeding to their healthcare provider.
Correct Answer is ["A","C","D"]
Explanation
The correct answers are Choices A, C, and D.
Choice A rationale: Obtaining the client's weight is important before and after hemodialysis to assess fluid removal and monitor the patient's fluid balance.
Choice B rationale: Verifying the glomerular filtration rate (GFR) is not necessary immediately before hemodialysis. GFR is typically assessed periodically to monitor kidney function but is not required for each dialysis session.
Choice C rationale: Checking the graft site for a palpable thrill is essential to ensure the arteriovenous (AV) fistula or graft is functioning properly. The thrill indicates that blood is flowing through the access site.
Choice D rationale: Documenting vital signs is crucial before, during, and after hemodialysis to monitor the client's hemodynamic status and detect any complications.
Choice E rationale: Administering a sedative is not a routine part of hemodialysis care. Sedatives may be prescribed for specific situations, but it is not standard practice.
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