Final Exam Version 2|NUR 2790 FINAL EXAM Version 2

1. A nurse is providing teaching to a client who has chronic kidney disease and is starting hemodialysis. Which of the following information should the nurse include in the teaching? Hemodialysis: Hemodiaylsis is needed three times per week for 3-5 sessions. It involves insertion of two needels one into an artery and the other into a vein. (page 379) -Notify the nurse of headache, nausea, or dizziness during dialysis -Do not eat during dialysis -Have protamine sulfate ready to reverse the heparin -Report hypotension, cramping, vomiting, bleeding at the access site, contamination of equipment. -Provide emotional support and offer activities (books, magazines, music, cards, or television) -Have an informed consent signed for hemodialysis -Monitor the AV fistula (you want to hear a bruit but feel the thrill) -Take medications to replace folate loss -Eat a well balanced meal high in folate (beans, green vegetables) and take supplements. -Diaylsis depletes protein so increase protein intake over prediaylsis limitations (page 380) -Avoid sleeping on top of the extremity with the access device 2. Emergency care of the client in Addisonian crisis includes which one of the following interventions? This is a life threatening event. Occurs when there is an acute drop of adrenocorticoids due to sudden discontinue of glucocorticoid medication or when induced by severe trauma, infection, or stress. (page 542) -Start a rapid infusion of 0.9% Na+ Cl. (administer hydrocortisone sodium IV bolus initially then a continuous infusion. -PPI complication is C-Diff -Causes hyperkalemia (loop or thiazide diuretics are used to manage this) -It causes hyponatremia (neurologic changes are first, put them on seizure precautions), hypoglycemia, and hyperkalemia (telemetry) -Place the patient in the recumberent position with legs elevated. -Administer a H2 antagonist (rantidine) IV for ulcer prevention -Administer vasopresssors to increase the blood pressure. -Gi issues, salt cravings, weight loss, weakness, bronze pigmentation of the skin .....................................................................................CONTINUED