Med Surg Renal

1. In regards to peritoneal dialysis, which of the following does not need to be reported to the physician?

Respiratory distress

Abdominal pain

Inflow that exceeds outflow

Light yellow outflow

None of the above

Amount of outflow is expected to equal or exceed amount of dialysate inflow. Color that is clear and light yellow is expecte. Monitor for complications (respiratory distress, abdominal pain, insufficient outflow, discolored outflow). Monitor for signs of infection (fever, blood, cloudy, or frothy dialysate return, drainage at access site) (ATI, Med-Surg, p. 432).

Explanation

Amount of outflow is expected to equal or exceed amount of dialysate inflow. Color that is clear and light yellow is expecte. Monitor for complications (respiratory distress, abdominal pain, insufficient outflow, discolored outflow). Monitor for signs of infection (fever, blood, cloudy, or frothy dialysate return, drainage at access site) (ATI, Med-Surg, p. 432).

2. Which of the following is not a complication of hemodialysis?

Hyperglycemia

Disequilibrium syndrome

Anemia

Hypotension

Infectious diseases

Complications include: Clotting/infection of access site (use surgical aseptic technique during cannulation, avoid compression of access site/extremity). Disequilibrium syndrome (too rapid a decrease of BUN). Hypotention (discontinue dialysis. Place client in Trendelenberg position). Anemia (administer prescribed medication therapy (EPO) to stimulate production of red blood cells). Infectious diseases (HD poses a risk for transmission of bloodborne diseases such as HIV and hepatitis B and C. Maintain sterility of equipment. Use standard precautions). HYPERGLYCEMIA is a complication of peritoneal dialysis (ATI, Med/Surg, p. 432-433).

Explanation

Complications include: Clotting/infection of access site (use surgical aseptic technique during cannulation, avoid compression of access site/extremity). Disequilibrium syndrome (too rapid a decrease of BUN). Hypotention (discontinue dialysis. Place client in Trendelenberg position). Anemia (administer prescribed medication therapy (EPO) to stimulate production of red blood cells). Infectious diseases (HD poses a risk for transmission of bloodborne diseases such as HIV and hepatitis B and C. Maintain sterility of equipment. Use standard precautions). HYPERGLYCEMIA is a complication of peritoneal dialysis (ATI, Med/Surg, p. 432-433).

3. Which of the following is not a risk factor for dialysis?

Renal sufficiency

Drug overdose

Chronic renal failure

Hyperkalemia

None of the above

Risk factors for dialysis: Renal INsufficiency, acute renal failure, chronic renal failure, drug overdose, persistent hyperkalemia, hypervolemia unresponsive to diuretics (ATI, Med-Surg, p. 430).

Explanation

Risk factors for dialysis: Renal INsufficiency, acute renal failure, chronic renal failure, drug overdose, persistent hyperkalemia, hypervolemia unresponsive to diuretics (ATI, Med-Surg, p. 430).

4. Which of the following is false?

Dialysis is used to rid the body of excess fluid and electorytes

Hemodialysis requires internal or external access device

Peritoneal dialysis involves instillation of fluid into the peritoneal cavity and the peritoneum serves as the filtration membrane

Dialysis replaces the hormonal functions of the kidney, such as the release of erythropoietin

None of the above

Dialysis does not replace the hormonal functions of the kidney (ATI, Med-Surg, p. 430).

Explanation

Dialysis does not replace the hormonal functions of the kidney (ATI, Med-Surg, p. 430).

5. Which of the following is the major complication of PD?

Infection at access site

Protein loss

Hyperglycemia

Peritonitis

None of the above

Peritonitis is the major complication of PD (ATI, Med-Surg, p. 433).

Explanation

Peritonitis is the major complication of PD (ATI, Med-Surg, p. 433).

6. Which of the following is not included in patient teaching?

Avoid carrying objects that compress the extrimity

Avoid all liftining

Perform hand exercises that promote fistula maturation

Avoid sleeping with body weight on top of the extremity with the access device

None of the above

Avoid lifting heavy objects with the access-site arm (ATI, Med-Surg, p. 431).

Explanation

Avoid lifting heavy objects with the access-site arm (ATI, Med-Surg, p. 431).

7. Which of the following is not a complication following hemodialysis?

Hypotension and Headache

Muscle cramps and Bleeding

Hypervolemia and N&V

Hepatitis and Disequilibrium syndrome

None of the above

After hemodialysis assess for complications (hypotensin, access clotting, headache, muscle cramps, bleeding, disequilibrium syndrome, hepatitis), access site for bleeding and infection. Assess for nausea, vomiting, and LOC. Assess for signs of HYPOVOLEMIA (ATI, Med-Surg, p. 431).

Explanation

After hemodialysis assess for complications (hypotensin, access clotting, headache, muscle cramps, bleeding, disequilibrium syndrome, hepatitis), access site for bleeding and infection. Assess for nausea, vomiting, and LOC. Assess for signs of HYPOVOLEMIA (ATI, Med-Surg, p. 431).

8. Which of the following is expected:

Increase in weight

Decrease in blood pressure

Decrease in BUN

Decrease in eletrolytes

None of the above

Decreases in blood pressure, weight, and laboratory values (BUN, serum creatinine, electrolytes, hematrocrit) are expected following dialysis

Explanation

Decreases in blood pressure, weight, and laboratory values (BUN, serum creatinine, electrolytes, hematrocrit) are expected following dialysis

9. The nurse observes that the PD catheter has a fibrin clot, the nurse's priority duty is to:

Strip the catheter

Discontinue the infusion and notify the primary care provider

Milk the PD catheter

All of the above

None of the above

Carefully milk PD catheter if firbin clot has formed (ATI, med-surg, p. 432).

Explanation

Carefully milk PD catheter if firbin clot has formed (ATI, med-surg, p. 432).

10. Which is true of disequilibrium syndrome?

It is a complication of peritoneal dialysis

Requires clean technique

Signs include abdominal pain and hyperglycemia

Is an aspect of peritonitis

None of the above

Disequilibrium syndrome is too rapid a decrease of BUN. Eearly recognition is essential. Signs include nausea, vomiting, change in LOC, seizures, and agitation. Can be avoided with a slow dialysis exhcnage rate, especially in older adult clients and those being newly treated with hemodialysis. Anticonvulsants/barbiturates may be needed (ATI, Med-Surg, p. 432).

Explanation

Disequilibrium syndrome is too rapid a decrease of BUN. Eearly recognition is essential. Signs include nausea, vomiting, change in LOC, seizures, and agitation. Can be avoided with a slow dialysis exhcnage rate, especially in older adult clients and those being newly treated with hemodialysis. Anticonvulsants/barbiturates may be needed (ATI, Med-Surg, p. 432).