Dialysis works using the passive transfer of toxins by diffusion.
Diffusion is the
movement of molecules from an area of higher concentration to an area of lower
concentration. The other statements show a correct understanding about hemodialysis.
DIF: Remembering/Knowledge REF:
1411 KEY: Renal system| dialysis|
patient education MSC: Integrated
Process: Teaching/Learning
NOT: Patient Needs Category: Health Promotion&Maintenance
21. The charge NP is orienting a float NP to an assigned patient with an arteriovenous
(AV) fistula for hemodialysis in her left arm. Which action by the float NP would be
considered unsafe?
a. Palpating the access site for a bruit or thrill
b. Using the right arm for a blood pressure reading
c. Administering intravenous fluids through the AV fistula
d. Checking distal pulses in the left arm
ANSWER: C
The NP should not use the arm with the AV fistula for intravenous infusion, blood
pressure readings, or venipuncture. Compression&infection can result in the loss of the
AV fistula. The AV fistula should be monitored by auscultating or palpating the access
site. Checking the distal pulse would be an appropriate assessment.
DIF: Applying/Application REF: 1412
KEY: Renal system| patient safety| injury
prevention| dialysis MSC: Integrated Process:
Nursing Process: Implementation
NOT: Patient Needs Category: Safe&Effective Care Environment: Safety&Infection Control
22. A patient is assessed by the NP after a hemodialysis session. The NP notes bleeding
from the victim nose&around the intravenous catheter. What action by the NP is the
priority?
a. Hold pressure over the victim nose for 10 minutes.
b. Take the victim pulse, blood pressure,&temperature.
c. Assess for a bruit or thrill over the arteriovenous fistula.
d. Prepare protamine sulfate for administration.
ANSWER: D
Heparin is used with hemodialysis treatments. The bleeding alerts the NP that too much
anticoagulant is in the victim system&protamine sulfate should be administered.
Pressure, taking vital signs,&assessing for a bruit or thrill are not as important as
medication administration.
DIF: Applying/Application REF:
1412 KEY: Renal system| patient
safety| heparin
MSC: Integrated Process: Nursing Process: Implementation
NOT: Patient Needs Category: Physiological Integrity: Pharmacological&Parenteral
Therapies
23. A NP is caring for a patient who is scheduled for a dose of
cefazolin&vitamins at this time. Hemodialysis for this patient is also scheduled
in 60 minutes. Which action by the NP is best?
a. Administer cefazolin since the level of the antibiotic must be maintained.
b. Hold the vitamins but administer the cefazolin.
c. Hold the cefazolin but administer the vitamins.
d. Hold all medications since both cefazolin&vitamins are dialyzable.
ANSWER: D
Both the cefazolin&the vitamins should be held until after the hemodialysis is completed
because they would otherwise be removed by the dialysis process.
DIF: Applying/Application REF: 1415
KEY: Renal system| dialysis| medications|
antibiotics MSC: Integrated Process: Nursing
Process: Implementation
NOT: Patient Needs Category: Physiological Integrity: Pharmacological&Parenteral
Therapies
24. A patient is having a peritoneal dialysis treatment. The NP notes an opaque color to
the effluent. What is the priority action by the NP?
a. Warm the dialysate solution in a microwave before instillation.
b. Take a sample of the effluent&send to the laboratory.
c. Flush the tubing with normal saline to maintain patency of the catheter.
d. Check the peritoneal catheter for kinking&curling.
ANSWER: B
An opaque or cloudy effluent is the first sign of peritonitis. A sample of the effluent
would need to be sent to the laboratory for culture&sensitivity in order to administer the
correct antibiotic. Warming the dialysate in a microwave&flushing the tubing are not
safe actions by the NP. Checking the catheter for obstruction is a viable option but will
not treat the peritonitis.
DIF: Applying/Application REF:
1419 KEY: Renal system|
dialysis| infection
MSC: Integrated Process: Nursing Process: Implementation
NOT: Patient Needs Category: Safe&Effective Care Environment: Safety&Infection Control
25. The NP is teaching a patient how to increase the flow of dialysate into the
peritoneal cavity during dialysis. Which statement by the patient demonstrates a
correct understanding of the teaching?
a. I should leave the drainage bag above the level of my abdomen.
b. I could flush the tubing with normal saline if the flow stops.
c. I should take a stool softener every morning to avoid constipation.
d. My diet should have low fiber in it to prevent any irritation.
ANSWER: C
Inflow&outflow problems of the dialysate are best controlled by preventing
constipation. A daily stool softener is the best option for the patient. The drainage bag
should be below the level of the abdomen. Flushing the tubing will not help with the flow.
A diet high in fiber will also help with a constipation problem.
DIF: Applying/Application REF: 1420
KEY: Renal system| dialysis| patient
education MSC: Integrated Process:
Teaching/Learning
NOT: Patient Needs Category: Health Promotion&Maintenance
26. A patient with chronic kidney disease states, I feel chained to the hemodialysis
machine. What is the NPs best response to the victim statement?
a. That feeling will gradually go away as you get used to the treatment.
b. You probably need to see a psychiatrist to see if you are depressed.
c. Do you need help from social services to discuss financial aid?
d. Tell me more about your feelings regarding hemodialysis treatment.
ANSWER: D
The NP needs to explore the victim feelings in order to help the patient cope&enter a
phase of acceptance or resignation. It is common for victim to be discouraged because
of the dependency of the treatment, especially during the first year. Referrals to a
mental health provider or social services are possibilities, but only after exploring the
victim feelings first. Telling the patient his or her feelings will go away is dismissive of the
