# A nurse is caring for a patient with end-stage renal disease who is experiencing uremic syndrome. Which nursing intervention should be the highest priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541395  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a patient with end-stage renal disease who is experiencing uremic syndrome. Which nursing intervention should be the highest priority?

A 58-year-old patient with chronic kidney disease has developed uremic syndrome with manifestations including altered mental status, pericardial friction rub, and uremic frost on the skin.

## 보기

1. Administer prescribed phosphate binders with meals
2. Monitor fluid intake and output every 8 hours
3. Prepare the patient for immediate dialysis **✔ 정답**
4. Apply moisturizing lotion to areas with uremic frost

**정답: 3**

## 해설

Uremic syndrome with altered mental status, pericardial friction rub, and uremic frost indicates life-threatening toxicity requiring immediate dialysis to remove toxins and prevent fatal complications. Other options address supportive care but do not treat the emergency.

## 심화 해설

Priority Intervention for Uremic Syndrome

The correct answer is **3. Prepare the patient for immediate dialysis**.

Clinical Reasoning and Pathophysiology

The patient's presentation includes a pericardial friction rub, which is a critical clinical finding. This sound indicates uremic pericarditis, an inflammation of the pericardium caused by the accumulation of uremic toxins in the blood that the failing kidneys cannot excrete. Uremic pericarditis is a life-threatening complication because it can rapidly progress to a pericardial effusion and, ultimately, cardiac tamponade, a condition where fluid in the pericardial sac compresses the heart and prevents it from filling properly, leading to obstructive shock and death. The presence of an altered mental status further signals that uremic toxins are severely affecting the central nervous system, a state termed uremic encephalopathy. While uremic frost (crystallized urea on the skin) is a dermatologic manifestation of severe azotemia, it is not immediately life-threatening. In this context, the highest priority is to remove the circulating uremic toxins to reverse the pericardial inflammation and prevent hemodynamic collapse.

Evidence-Based Rationale for Immediate Dialysis

According to the provided evidence, intensive hemodialysis is the definitive, first-line treatment for uremic pericarditis and its complications. The case report by Patel et al. explicitly demonstrates that cardiac tamponade secondary to uremic pericarditis can resolve with intensive hemodialysis, and it should be considered the primary management strategy [1]. This intervention directly addresses the root cause of the pericardial friction rub and altered mental status by rapidly clearing the uremic toxins. Delaying dialysis to administer phosphate binders, monitor intake and output, or provide skin care fails to address the imminent threat of cardiovascular collapse. While phosphate binders and fluid monitoring are important components of chronic kidney disease management, they do not provide the rapid correction needed in an acute, life-threatening uremic crisis. Immediate dialysis is the only intervention that can prevent the progression from pericarditis to tamponade, making it the highest nursing priority [1].

References (research sources)

- [1]Uremic Pericarditis and Cardiac Tamponade Resolving With Intensive Hemodialysis.Research articlePatel M, Rao SJ, Chittal AR, Al-Talib K, Padmanabhan S. (2024) · DOI: 10.55729/2000-9666.1307

## 임상 시나리오

Uremic Pericarditis: Emergency DialysisRecognizing and Responding to a Life-Threatening Complication
A pericardial friction rub in a patient with end-stage renal disease is a critical sign of uremic pericarditis, which can rapidly progress to cardiac tamponade and obstructive shock. The definitive, first-line treatment is immediate, intensive hemodialysis to remove circulating uremic toxins.

Altered mental status indicates uremic encephalopathy, confirming severe systemic toxicity. While managing uremic frost or phosphate levels are nursing considerations, they are not the priority when the patient is at risk for hemodynamic collapse.

CautionDo not delay preparing for dialysis to perform other interventions. A new friction rub in a uremic patient is a medical emergency requiring immediate nephrology notification and rapid initiation of dialysis to prevent irreversible cardiac compression.

## 핵심 개념

- **Uremic Pericarditis** — Inflammation of the pericardium due to retained uremic toxins, characterized by a friction rub and risk of progressing to cardiac tamponade.
- **Uremic Frost** — A dermatologic sign of severe azotemia where crystallized urea deposits appear as a white powder on the skin.
- **Cardiac Tamponade** — A life-threatening condition where fluid accumulation in the pericardial sac compresses the heart, impairing its ability to pump blood.

## 같은 주제 문제

- [A nurse is assessing a patient with end-stage renal disease who has developed uremic syndr…](https://mymerci.kr/pages/nclex_q.php?qn_id=541390)
- [A nurse is assessing a 58-year-old patient with end-stage renal disease who has developed …](https://mymerci.kr/pages/nclex_q.php?qn_id=541391)
- [A nurse is assessing a patient with chronic kidney disease who has developed uremic syndro…](https://mymerci.kr/pages/nclex_q.php?qn_id=541392)
- [A nurse is caring for a patient with acute kidney injury who is experiencing uremic sympto…](https://mymerci.kr/pages/nclex_q.php?qn_id=541393)
- [A nurse is caring for a patient with uremic syndrome secondary to diabetic nephropathy. Wh…](https://mymerci.kr/pages/nclex_q.php?qn_id=541394)
- [A nurse is caring for a patient with end-stage renal disease who has developed uremic synd…](https://mymerci.kr/pages/nclex_q.php?qn_id=541396)
- [A nurse is caring for a patient with end-stage renal disease and uremic syndrome who is at…](https://mymerci.kr/pages/nclex_q.php?qn_id=541397)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._