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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?

A.

Purulent dialysate outflow

B.

Blood-tinged dialysate outflow

C.

Report of fullness with dialysate dwelling

D.

Report of discomfort during dialysate inflow

Answer and Explanation

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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View Related questions

Correct Answer is B

Explanation

Rationale:

A. Popping sounds, also known as crackles, are typically associated with fluid in the alveoli, often seen in conditions like pneumonia or heart failure, not pleurisy.

B. Loud, grating sounds, known as pleural friction rub, are characteristic of pleurisy. This sound is produced by the inflamed pleural surfaces rubbing together during respiration.

C. Snoring sounds, or rhonchi, are usually heard in conditions involving airway obstruction by mucus, such as bronchitis, rather than pleurisy.

D. Squeaky, musical sounds, or wheezing, are associated with airway narrowing, such as in asthma or chronic obstructive pulmonary disease (COPD), and are not typically heard in pleurisy.

Correct Answer is C

Explanation

Rationale:

A. Hypernatremia, an elevated sodium level, does not cause Trousseau's or Chvostek's signs.

B. Hypermagnesemia, an elevated magnesium level, is not associated with positive Trousseau's and Chvostek's signs.

C. Hypocalcemia, a low calcium level, is commonly associated with positive Trousseau's and Chvostek's signs. Trousseau's sign is a carpopedal spasm induced by inflating a blood pressure cuff, while Chvostek's sign is facial twitching in response to tapping over the facial nerve. Both are indicative of neuromuscular irritability due to low calcium levels.

D. Hypokalemia, a low potassium level, does not cause these specific signs and is associated with different clinical manifestations.

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