NCLEX-RN practice › Reduction of Risk Potential
NCLEX question: dialysis disequilibrium syndrome (SATA)
Reduction of Risk Potential · Select all that apply · Clinical judgment step: Take action
Client record
Pre and post dialysis
| Parameter | Before | After |
|---|---|---|
| BUN (mg/dL) | 168 | 70 |
| Weight (kg) | 72.4 | 70.6 |
| BP (mm Hg) | 162/94 | 148/88 |
| Neuro | Alert | Headache, nausea, restless, confused |
A client completes a first hemodialysis session. The nurse obtains the assessment in the client record. Which actions are appropriate? Select all that apply.
- A. Report the symptoms to the provider as possible dialysis disequilibrium syndrome
- B. Schedule a longer, faster session tomorrow to clear more urea
- C. Tell the client the confusion is expected after dialysis and needs no follow-up
- D. Implement seizure precautions
- E. Monitor neurological status frequently
- F. Give a bolus of 1 L of dextrose 5% in water
Show the answer and rationales
Answer: A, D, E
Dialysis disequilibrium syndrome follows rapid urea removal, usually in first sessions. It causes cerebral edema symptoms. Care is to report, monitor neuro status and use seizure precautions; prevention is short, slow early sessions.
- A. Correct. A rapid fall in BUN creates an osmotic gradient that shifts water into brain cells, causing headache, nausea, restlessness and confusion.
- B. Incorrect. Disequilibrium is prevented with shorter, slower initial sessions, not longer faster ones.
- C. Incorrect. New confusion is not an expected finding and must be reported.
- D. Correct. Severe disequilibrium can progress to seizures.
- E. Correct. Neurological changes guide treatment and escalation.
- F. Incorrect. Hypotonic fluid would worsen cerebral edema.
Scoring: select all that apply items on the Next Generation NCLEX use plus/minus scoring. You gain a point for each correct option you choose and lose a point for each incorrect one, with a minimum of zero. This item is worth 3 points.
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