The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8 ° F (37.6 ° C). What is the most appropriate action by the nurse?
a. Administer fluid to increase blood pressure.
b. Check the white blood cell count.
c. Monitor the client's temperature.
d. Connect the client to an electrocardiographic (ECG) monitor.
ANS: C
During hemodialysis, the dialysate is warmed to increase diffusion and prevent hypothermia. The client's temperature could reflect the temperature of the dialysate. There is no indication to check the white blood cell count or connect the client to an ECG monitor. The other vital signs are within normal limits.
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