The nurse is developing a plan of care for a client diagnosed with acute renal failure (ARF). Which statement would be an appropriate outcome for the client?

Electrolytes are within normal limits.

Blood pressure is decreased to 120/80

Decrease of pain by 3 points on a 1-10 scale.

The client will understand how to care for the AV fistula

Answer and Explanation

The Correct Answer is A

A. Electrolytes are within normal limits: Acute Renal Failure (ARF) leads to electrolyte imbalances (↑ K+, ↑ BUN/creatinine, metabolic acidosis). A successful treatment goal is restoring normal electrolyte balance.

B. Blood pressure is decreased to 120/80. BP control is important but not the primary goal in ARF.

C. Decrease of pain by 3 points on a 1-10 scale. Pain control is important, but not the main indicator of ARF improvement.

D. The client will understand how to care for the AV fistula. This applies to chronic kidney disease clients on hemodialysis, not ARF management.

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Correct Answer is C

Explanation

A. Request a neurological consult: This is likely a metabolic issue (hypocalcemia), not a neurological disorder.

B. Have another nurse take their blood pressure: Rechecking BP does not address the underlying cause of the abnormal movement.

C. Review the client's lab values: Carpopedal spasm (Trousseau's sign) during BP measurement suggests hypocalcemia. The nurse should check serum calcium levels to confirm.

D. Call the healthcare provider for orders: The nurse should first review lab results to provide accurate data when notifying the provider.

A. Administer scheduled medications B. Explain that dialysis occurs via the peritoneum C. Weigh the client to determine a baseline for comparison D. Obtain a serum creatinine to determine kidney function

Correct Answer is C

Explanation

A. Administer scheduled medications: Some medications (e.g., antihypertensives, water-soluble vitamins, and antibiotics) should be held before dialysis to prevent removal during treatment.

B. Explain that dialysis occurs via the peritoneum: This describes peritoneal dialysis, not hemodialysis.

C. Weigh the client to determine a baseline for comparison: Pre-dialysis weight is crucial to determine fluid removal needs during dialysis. Weight differences before and after dialysis indicate fluid loss or retention.

D. Obtain a serum creatinine to determine kidney function: Serum creatinine levels are monitored regularly but are not a required step before every dialysis session.

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The nurse is developing a plan of care for a client diagnosed with acute renal failure (ARF). Which statement would be an appropriate outcome for the client?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

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