A nurse is caring for a client who is undergoing initial peritoneal dialysis. Which of the following should the nurse report immediately to the provider?
Purulent dialysate outflow
Blood-tinged dialysate outflow
Report of fullness with dialysate dwelling
Report of discomfort during dialysate inflow
The Correct Answer is A
Rationale:
A. Purulent dialysate outflow is a sign of infection, specifically peritonitis, which is a serious complication of peritoneal dialysis that requires immediate medical attention.
B. Blood-tinged dialysate can occur, especially if the client is new to dialysis or has had recent abdominal surgery, but it should be monitored rather than immediately reported unless it is excessive.
C. A feeling of fullness during the dialysate dwelling phase is common and usually resolves as the body adjusts to the procedure.
D. Discomfort during dialysate inflow can occur, particularly with fast inflow rates or high dialysate volumes, but it is not immediately life-threatening.
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Correct Answer is B
Explanation
Rationale:
A. During the oliguric phase of acute kidney injury, BUN and creatinine levels typically increase due to reduced kidney function, not decrease.
B. The oliguric phase is characterized by significantly reduced urine output, often defined as less than 400 mL per 24 hours, indicating severe kidney impairment.
C. The GFR does not recover during the oliguric phase; it is significantly decreased, contributing to the accumulation of waste products in the blood.
D. Renal function is not reestablished during the oliguric phase; this occurs in later stages, such as the diuretic or recovery phase.
Correct Answer is C
Explanation
Rationale:
A. Discomfort at the puncture site is expected after a thoracentesis and typically managed with analgesics.
B. A decreased temperature is not a common complication of thoracentesis and might indicate other issues, but it is not immediately alarming.
C. An increased heart rate (tachycardia) could be a sign of a pneumothorax, hemorrhage, or other serious complications following thoracentesis. This requires immediate assessment and intervention.
D. Serosanguineous drainage is expected to some extent, but it should be monitored for changes that might indicate a complication such as infection or continued bleeding.