Chronic Kidney Disease (Pearson)
The nurse is preparing to discharge a client with chronic kidney disease. The nurse is teaching the client and family about administering calcium acetate 2 tablets by mouth with each meal at home. Which explanation by the nurse is most appropriate? A) "The calcium acetate will lower your serum phosphate levels." B) "The calcium acetate helps to neutralize your gastric acids." C) "The calcium acetate will help to stimulate your appetite." D) "The calcium acetate will decrease your serum creatinine levels."
Answer: A Explanation: A) The client with chronic kidney disease has elevated phosphate levels due to the inability of the damaged kidney to excrete this electrolyte. Calcium acetate, when given with meals, will bind serum phosphorus and therefore lower the serum level. Calcium acetate has no effect on serum creatinine. Although calcium acetate can act as an antacid and neutralize gastric acid when given between meals, this is not the reason it is given to a client with chronic kidney disease. This medication has no effect on appetite stimulation.
During a home visit, the nurse is concerned that an older client is developing renal failure. The client has no history of cardiovascular disease. What did the nurse assess in this client? Select all that apply. A) Progressive edema B) Complaints of hip joint pain C) New onset of hypertension D) Recent increase in hunger and thirst E) Warm moist skin
Answer: A, C Explanation: A) The manifestations of renal failure often are missed in aging clients because edema may be attributed to heart failure or high blood pressure to preexisting hypertension. Hip joint pain is not a manifestation of renal failure in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not renal failure in the older client. A client with renal failure will have pale dry skin with poor turgor.
The nurse is preparing to administer a hemodialysis treatment for a client with chronic kidney disease. Which laboratory values are expected for this client prior to hemodialysis occurring? Select all that apply. A) Increased blood urea nitrogen (BUN) B) Decreased potassium C) Decreased phosphorus D) Increased urine osmolality E) Increased creatinine
Answer: A, E Explanation: A) The damaged kidney is unable to excrete waste products, including creatinine, so it will be increased. The client will also have an increased blood urea nitrogen (BUN) level due to the damaged kidneys. The damaged kidney is unable to excrete solutes; therefore, the serum osmolality will be increased and the urine osmolality will be decreased. Both phosphorus and potassium increase during renal failure due to the inability of the kidney to excrete them.
While caring for a client with end-stage renal disease, the nurse tracks the client's serum albumin level. For which nursing diagnosis is the action most indicated? A) Excess Fluid Volume B) Imbalanced Nutrition: Less Than Body Requirements C) Risk for Ineffective Perfusion D) Risk for Infection
Answer: B Explanation: B) Interventions appropriate for the diagnosis of Imbalanced Nutrition: Less Than Body Requirements include monitoring laboratory values such as such as serum albumin. Assessing for edema and monitoring heart rate and blood pressure would be interventions for the diagnosis of Excess Fluid Volume. Monitoring for orthostatic blood pressure changes would be appropriate for the diagnosis of Risk for Ineffective Perfusion. Monitoring the white blood cell count would be an intervention appropriate for the diagnosis of Risk for Infection.
10) The nurse is planning a seminar to instruct community members on ways to reduce the development of chronic kidney disease. What should the nurse include in this teaching? Select all that apply. A) Avoid eating red meat. B) Control blood glucose levels in diabetes mellitus. C) Adhere to medication regimen to control hypertension. D) Participate in regular exercise. E) Avoid smoking.
Answer: B, C, D, E Explanation: B) Prevention of end-stage renal disease should focus on aggressive management of chronic disease states, especially diabetes and hypertension. In addition, clients should consume diets low in sodium, exercise regularly, keep healthcare provider appointments, avoid smoking, and limit alcohol intake. Eating red meat does not need to be avoided to prevent the development of end-stage renal disease.
The nurse is caring for a client with chronic renal disease. The client is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to chronic renal disease. A student nurse assigned to assist the nurse asks why the client is anemic. Which response by the nurse is best? A) "It is most likely that the client has a genetic tendency for the development of anemia." B) "The increased metabolic waste products in the body depress the bone marrow." C) "There is a decreased production by the kidneys of the hormone erythropoietin." D) "The client is not eating enough iron-rich foods."
Answer: C Explanation: C) Anemia is common in clients with renal disease. Among the factors causing the anemia are decreased production of erythropoietin by the kidneys and shortened red blood cell (RBC) life. Erythropoietin is involved in the stimulation of the bone marrow to produce RBCs. Metabolic wastes do not suppress the bone marrow. Diet and heredity do not factor into the production of erythropoietin.
A child who is in renal failure has hyperkalemia. The nurse is planning meals for the child while hospitalized. Which meal choice would be most appropriate for this client? A) Hamburger on a bun, banana B) Cold cuts with bun with fresh pears C) Spaghetti and meat sauce, breadsticks D) Carrots and green, leafy vegetables
Answer: C Explanation: C) Carrots; green, leafy vegetables; pears; and bananas are high in potassium. Spaghetti and meat sauce with breadsticks would be the most appropriate meal from the choices provided.
A client with hypertension, surprised to be diagnosed with chronic kidney disease, asks how this disease could have developed. What should the nurse respond to the client? A) "Thickening of the kidney structures and gradual death of nephrons." B) "Cysts compress renal tissue that destroys the kidneys." C) "A long history of hypertension reduces renal blood flow and harms the kidney tissue." D) "Immune complexes form in the kidney tissue that causes inflammation."
Answer: C Explanation: C) Longstanding hypertension leads to sclerosis and narrowing of renal arterioles and small arteries with subsequent reduction of blood flow. This leads to ischemia, glomerular destruction, and tubular atrophy. Diabetic nephropathy causes renal failure by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes renal failure by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Systemic lupus erythematosus causes renal failure by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.
The nurse is planning care for a client with chronic kidney disease and osteoporosis. The nurse reviews the client's medical record and determines the priority nursing diagnosis to be: A) Anxiety B) Disturbed Body Image C) Risk for Injury D) Risk for Bleeding
Answer: C Explanation: C) The client with chronic kidney disease with significant osteodystrophy (osteoporosis, or calcium loss from the bones) is at high risk for fractures; therefore, preventing injury is the most appropriate outcome. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, it is specified that the client has significant osteoporosis. Anxiety is not related to osteoporosis.
The nurse is caring for a 68-year-old client diagnosed with chronic kidney disease. The client reports no bowel movement in the past 2 days. This client is at an increased risk for which condition? A) Metabolic acidosis B) Hypercalcemia C) Increased serum creatinine levels D) Hyperkalemia
Answer: D Explanation: D) Constipation exacerbates hyperkalemia, and it is important to monitor CRF clients who already have impairment of potassium. Hypokalemia is not affected by constipation. Metabolic acidosis and serum creatinine levels may not directly correlate with a decrease in the glomerular filtration rate in the elderly and are not directly affected by constipation.
A client with chronic kidney disease is experiencing manifestations of anemia. Which treatment should the nurse expect to be prescribed for this client? A) Begin a fluid restriction. B) Administer intravenous glucose and insulin. C) Begin a low-sodium diet. D) Epoetin injections
Answer: D Explanation: D) Epoetin injections are used in the treatment of anemia caused by chronic kidney disease. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In chronic kidney disease, this hormone production will be reduced. A fluid restriction would be indicated for uremia caused by chronic kidney disease. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by chronic kidney disease. A low-sodium diet is used to help reduce fluid volume excess that is caused by chronic kidney disease.
The nurse instructs a client with chronic kidney disease on the prescribed medication furosemide (Lasix). Which client statement indicates that teaching has been effective? A) "I will take this medication to keep my calcium balance normal." B) "This medication will make sure I have enough red blood cells in my body." C) "I will take this pill to keep my protein level in my body stable." D) "This pill will reduce the swelling in my body and get rid of the extra potassium."
Answer: D Explanation: D) Furosemide (Lasix) is a loop diuretic that may be prescribed to reduce extracellular fluid volume and edema. Diuretic therapy also can reduce hypertension and cause potassium wasting, lowering serum potassium levels. Oral phosphorus-binding agents, such as calcium carbonate or calcium acetate, are given to lower serum phosphate levels and normalize serum calcium levels. Folic acid and iron supplements are given to combat anemia associated with chronic kidney disease. There is no medication provided to a client with chronic kidney disease that is used to stabilize protein levels in the body.
The nurse is caring for a client from another country who was admitted with hypertension and chronic kidney disease. The client is receiving hemodialysis three times a week. The nurse is assessing the client's diet and the client reports the use of salt substitutes. The nurse knows that salt substitutes should be avoided by this client because: A) They will increase the risk of AV fistula infection. B) They will cause the client to retain fluid. C) They will interact with the client's antihypertensive medications. D) They can potentiate hyperkalemia.
Answer: D Explanation: D) Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitute is to be avoided. The control of hypertension is essential in the management of a client with kidney disease, but salt substitute is not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection could be caused by constricting clothing, venipunctures, and other items.
A nursing student has been assigned to complete medication cards for the assigned client who is hospitalized with chronic kidney disease. The student is evaluating the therapeutic effect of the drug sodium polystyrene sulfonate (Kayexalate) in this client. Which is the therapeutic finding for this client? A) Increased serum sodium B) Increased stool excretion C) Decreased urine specific gravity D) Decreased serum potassium
Answer: D Explanation: D) The client with chronic kidney disease is unable to excrete potassium, and therefore the drug sodium polystyrene sulfonate (Kayexalate) is utilized in order to exchange sodium for potassium in the large intestine, resulting in decreased serum potassium levels. Although the client might have increased stools, the therapeutic effectiveness of the drug is measured by monitoring the serum potassium. This drug does not affect either the sodium level or the specific gravity.
