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An adult male who has end-stage renal disease asks the practical nurse (PN) to remove his arteriovenous (AV) fistula because he wants to discontinue dialysis. Which action should the PN take first?

A.

Encourage the client to discuss his feelings with his family.

B.

Explain what will happen if the client stops dialysis.

C.

Ask the healthcare provider to remove the fistula from his arm.

D.

Document the client's statement in his medical record.

Answer and Explanation

The Correct Answer is B

A. Encourage client to discuss feelings with family: Helpful but not the immediate priority.
B. Explain what will happen if client stops dialysis: Ensure informed decision-making about the consequences.
C. Ask provider to remove fistula: Not appropriate until client is fully informed.
D. Document the client’s statement: Should be done, but first priority is patient education.


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Related Questions

Correct Answer is C, A, D, B

Explanation

C. Move clients in immediate danger: The fundamental principle of fire safety in a clinical setting is the RACE acronym, which prioritizes Rescue (R) above all other actions. Ensuring the physical safety of the client in the room with the active flame is the immediate life-saving intervention. This action must occur before any administrative or mechanical responses. A. Activate the fire alarm: Once life-safety is addressed through rescue, the nurse must Alarm (A) to notify the facility and emergency responders. This step ensures that specialized firefighting personnel are dispatched and that the rest of the hospital is alerted to the potential hazard. It provides the necessary infrastructure for a coordinated emergency response. B. Get the fire extinguisher: Following the alarm, the nurse proceeds to Confine (C) the fire by closing doors to prevent the spread of smoke and heat. This containment strategy protects other patients and limits the oxygen supply to the fire within the affected zone. It is a critical step in preserving the environment of care. D. Shut the doors to all client rooms: The final step in the sequence is to Extinguish (E) the fire if it is small and manageable using the appropriate device. This should only be attempted after all previous life-safety and notification protocols are complete. If the fire is too large, the priority remains evacuation rather than suppression.

Correct Answer is A

Explanation

A. Have the UAP notify the client in pain that the PN will be in to check on the client after completing the procedure in progress:
Pain assessment and medication administration require licensed personnel. The PN should finish the current task and promptly address the client in pain.
B. Finish measuring the residual and assign the UAP to provide the bolus feeding so the PN can administer an analgesic:
UAPs cannot administer tube feedings unless trained and delegated appropriately, and in most settings, PEG bolus feeding is the PN’s responsibility.
C. Tell the UAP that the client's pain will subside when the client is not disturbed:
Ignoring or delaying pain relief is inappropriate and unethical.
D. Ask the UAP to finish measuring the residual volume while the PN assesses the pain level of the surgical client:
Measuring gastric residual requires clinical judgment and is a PN responsibility, not a UAP task.

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