A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity?
Ondansetron
Diphenhydramine
Gentamicin
Omeprazole
The Correct Answer is C
Rationale:
A. Ondansetron is an antiemetic that does not typically cause nephrotoxicity and is generally safe for use in clients with chronic kidney disease.
B. Diphenhydramine is an antihistamine that does not have nephrotoxic effects and is commonly used for allergy symptoms or as a sleep aid.
C. Gentamicin is an aminoglycoside antibiotic that is known to be nephrotoxic, especially in clients with pre-existing kidney disease. It requires careful monitoring of kidney function and dosing adjustments to prevent kidney damage.
D. Omeprazole is a proton pump inhibitor used to treat gastroesophageal reflux disease (GERD) and does not typically cause nephrotoxicity, although long-term use has been associated with an increased risk of chronic kidney disease.
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Correct Answer is B
Explanation
Rationale:
A. A low sodium diet is not appropriate for a client with SIADH and hyponatremia, as it can exacerbate the low sodium levels. Increasing sodium intake might be more appropriate depending on the clinical situation.
B. Restricting fluid intake is a standard treatment for SIADH to prevent further dilution of sodium in the blood, which is critical in managing hyponatremia.
C. Desmopressin acetate is used to treat conditions with insufficient antidiuretic hormone, such as diabetes insipidus, and is not appropriate for SIADH.
D. An IV of 0.45% sodium chloride is hypotonic and could worsen hyponatremia in SIADH. Hypertonic saline would be more appropriate if IV treatment were necessary
Correct Answer is A
Explanation
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.