The nurse is caring for four patients with chronic kidney disease. Which patient would the nurse assess first upon initial rounding?
a) Woman with a blood pressure of 158/90 mm Hg.
b) Patient with Kussmaul respirations.
c) Man with skin itching from head to toe.
d) Patient with halitosis and stomatitis.

The correct answer is: b) Patient with Kussmaul respirations.


Choice A reason: A blood pressure of 158/90 mm Hg in a patient with chronic kidney disease (CKD) is elevated and requires management to prevent complications. However, it is not as immediately life-threatening as Kussmaul respirations, which indicate severe metabolic acidosis.
Choice B reason: The patient with Kussmaul respirations should be assessed first. Kussmaul respirations are deep, labored breathing patterns typically associated with severe metabolic acidosis, such as diabetic ketoacidosis (DK

Choice A reason: Maintaining nothing by mouth (NPO) and administering intravenous fluids is the best intervention to reduce discomfort in a patient with acute pancreatitis. NPO status helps to rest the pancreas by preventing the secretion of pancreatic enzymes that can exacerbate inflammation and pain. Intravenous fluids are essential to maintain hydration and electrolyte balance while the patient is not eating or drinking.

Choice B reason: Providing small, frequent feedings with no concentrated sweets is not appropriate for a patient with acute pancreatitis. The priority is to keep the patient NPO to rest the pancreas. Introducing any food can stimulate the pancreas and worsen the condition.

Choice C reason: Administering morphine sulfate intramuscularly every 4 hours as needed can help manage pain, but the preferred route for pain medication in acute pancreatitis is intravenous, as it provides quicker relief and avoids the discomfort of intramuscular injections. Pain management is important, but it should be part of a broader plan that includes NPO status and IV fluids.

Choice D reason: Positioning the patient in a flat, supine position is not recommended for reducing discomfort in acute pancreatitis. Patients often find relief in a semi-Fowler's position (head elevated) or by leaning forward, which can help reduce abdominal pain and pressure on the inflamed pancreas.

Choice A reason: Monitoring intake and output is important in managing cirrhosis and ascites, as it helps track fluid balance and detect early signs of fluid retention. However, this action alone does not directly decrease the presence of ascites. It is more of a monitoring tool than an intervention that reduces fluid accumulation.

Choice B reason: Providing a low-sodium diet is a key intervention to decrease the presence of ascites in patients with cirrhosis. Sodium restriction helps prevent fluid retention by reducing the amount of sodium in the bloodstream, which in turn decreases the osmotic pressure that draws fluid into the abdominal cavity. This dietary modification is fundamental in the management of ascites.

Choice C reason: Increasing oral fluid intake is not an appropriate action for decreasing the presence of ascites in patients with cirrhosis. Excessive fluid intake can exacerbate fluid retention and worsen ascites. Instead, fluid intake may need to be restricted depending on the patient's condition and electrolyte balance.

Choice D reason: Weighing the patient daily is a useful tool for monitoring fluid status and detecting changes in ascites. However, similar to monitoring intake and output, this action does not directly decrease the presence of ascites. It serves as a means to track the effectiveness of other interventions, such as sodium restriction and medication.