Chronic Kidney Disease
A patient with a glomerular filtration rate (GFR) of 30 mL/min has a hemoglobin of 5 g/dL. The peripheral smear tests show that the red blood cells are normocytic and normochromic. The nurse suspects that which physiologic change led to this condition? Reduced excretion of potassium Increased extracellular fluid volume Defective reabsorption of bicarbonate Decreased production of erythropoietin
Decreased production of erythropoietin A patient with a GFR of 30 mL/min has stage 3 chronic kidney disease (CKD). Normocytic normochromic anemia is common in patients with CKD due to reduced production of the erythropoietin hormone by the kidneys. Erythropoietin stimulates precursor cells in the bone marrow and helps in production of red blood cells. The patient with CKD may have a high serum potassium level, which can cause fatal dysrhythmias. An increase in extracellular fluid volume may lead to hypertension in patients with CKD. Metabolic acidosis may occur in CKD patients with defective reabsorption and regeneration of bicarbonate.
The nurse reviews the plan of care for a patient in fluid volume overload due to chronic kidney disease. Furosemide and bumetanide have been ineffective. The nurse anticipates a prescription for which medication that is an osmotic diuretic? Mannitol Ethacrynate Chlorothiazide Spironolactone
Mannitol Mannitol is an osmotic diuretic that promotes diuresis by increasing the concentration of filtrates in the kidney and blocking reabsorption of the water by the renal tubules. Chlorothiazide is a thiazide diuretic that inhibits the reabsorption of sodium (Na +) and chloride (Cl -) ions from the distal convoluted tubules. Ethacrynate is a loop diuretic that inhibits sodium (Na +), potassium (K +), and chloride (Cl -) reabsorption. Spironolactone is a potassium-sparing diuretic.
Which condition does the nurse suspect in a patient with a glomerular filtration rate (GFR) of 10 mL/minute, a blood urea nitrogen (BUN) level of 23 mg/dL, a potassium level of 4 mEq/L, and a serum bicarbonate level of 20 mEq/L? Uremia Hypertension Dysrhythmias Metabolic acidosis
Uremia A patient with glomerular filtration rate (GFR) of 10 mL/minute has chronic kidney disease (CKD), causing the BUN to rise above the normal BUN level of 6 to 20 mg/dL, which may be a result of uremia. Hypertension may result from hypernatremia in the patient with CKD; there is no sodium level information given. Dysrhythmias may occur in the patient with CKD due to hyperkalemia due to decreased excretion of potassium by the kidneys; however, this patient's potassium level of 4 mEq/L is a normal finding. An inability of the kidneys to excrete ammonia and generate bicarbonates leads to metabolic acidosis, indicated by a serum bicarbonate level lower than 15 mEq/L; the patient's level is greater than 15 mEq/L.
The nurse is planning an educational course about risk factors for chronic kidney disease (CKD). Which factors does the nurse identify as nonmodifiable risk factors? Select all that apply. Hypertension Ethnic minority Age greater than 60 Exposure to nephrotoxic drugs Family history of CKD
- Age greater than 60 - Family history of CKD Ethnicity, family history of chronic kidney disease, and age greater than 60 are risk factors out of the patient's control. The patient can make lifestyle changes to reduce high BP. The patient has a choice to take drugs that are considered nephrotoxic.
The nurse recognizes that which patient is most likely to develop chronic kidney disease (CKD) and will benefit from education about preventive measures? A 50-year-old white patient with hypertension A 61-year-old Native American patient with diabetes A 40-year-old Hispanic patient with cardiovascular disease A 28-year-old black patient with a urinary tract infection (UTI)
A 61-year-old Native American patient with diabetes It is especially important that the nurse should teach CKD prevention to the 61-year-old Native American patient with diabetes. This patient is at highest risk because diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD six times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. Blacks have the highest rate of CKD because hypertension is increased significantly in this population. A UTI will not cause CKD unless it is not treated or occurs recurrently.
Which statement made by a nursing student indicates effective learning about which intervention is included in a plan of care for a patient with chronic kidney disease who is taking gluconate and calcium acetate? Administer a stool softener. Give both drugs at the same time. Obtain consent for immediate dialysis. Administer sodium polystyrene sulfonate.
Administer a stool softener. A patient with chronic kidney disease who is taking oral iron salts (such as ferrous gluconate) and phosphate binders (such calcium acetate) may develop constipation and need to take a stool softener. Dialysis does not provide relief from constipation in patients with chronic kidney disease. Oral iron supplements should not be given at the same time as calcium-containing phosphate binders because they prevent iron absorption. Sodium polystyrene sulfonate helps to treat hyperkalemia but does not provide relief from constipation.
The nurse is planning an education program related to chronic kidney disease (CKD) and identifies that which population has the highest rate of CKD? Hispanics Native Americans Whites Blacks
Blacks Blacks have the highest rate of CKD, nearly 4 times that of whites. The rate of CKD in Hispanics is 1.5 times higher than in non-Hispanic whites. Native Americans have a rate of CKD 2 times that of whites.
The nurse recognizes that which test helps to detect microalbuminuria in patients with chronic kidney disease (CKD)? Urinalysis Dipstick test Renal biopsy Renal ultrasound
Dipstick test Proteinuria is the first indication of kidney damage. Dipstick evaluation of protein helps to detect microalbuminuria, which is a type of proteinuria. Urinalysis, renal biopsy, and renal ultrasound do not detect microalbuminuria.
The nurse identifies that a patient with chronic kidney disease (CKD) is at risk for which electrolyte disturbance? Hypokalemia Hyponatremia Hypercalcemia Hyperphosphatemia
Hyperphosphatemia A patient with CKD has hyperphosphatemia due to a decrease in elimination of phosphate by the kidneys. Hyperkalemia, rather than hypokalemia, is a serious electrolyte disturbance that occurs in the patient with CKD. Hypernatremia, rather than hyponatremia, leads to hypertension and fluid retention in a patient with CKD. Hypocalcemia, not hypercalcemia, occurs in the later stages of CKD due to the inability to absorb calcium in the absence of active vitamin D.
The nurse reviews the list of drugs being taken by a patient with chronic kidney disease. The nurse questions which medication? Ibuprofen Calcium acetate Acetaminophen Calcium supplements
Ibuprofen Ibuprofen, and other nonsteroidal antiinflammatory drugs (NSAIDs), will cause further damage to the kidneys. Chronic kidney disease (CKD) patients should be taking Tylenol as prescribed for pain. CKD patients also could be consuming calcium supplements and PhosLo tablets as prescribed by the health care provider.
The nurse is teaching a patient with chronic kidney disease about restricting phosphorous in the diet. The nurse determines the teaching was effective when the patient correctly identifies which examples of foods as high in phosphorous? Select all that apply. Milk Steak Cheese Pudding White bread
Milk Steak Cheese Pudding As kidney function deteriorates, phosphate elimination by the kidneys is decreased and the patient begins to develop hyperphosphatemia. Foods that are high in phosphate include meat and dairy products (e.g., milk, ice cream, cheese, yogurt, pudding); therefore they should be avoided. In general, foods that contain more than 160 mg of phosphorous per serving are considered high in phosphorous and should be avoided. White bread is not high in phosphorous.
The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD) recalls that the medication should have a beneficial effect on which laboratory value? Sodium Potassium Magnesium Phosphorus
Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not affect sodium, potassium, or magnesium levels.
The nurse is providing care for a patient two days after kidney transplantation surgery. An appropriate roommate to cohort with the postoperative patient is the patient with which diagnosis? Hepatitis C Renal calculi Osteomyelitis Bronchial pneumonia
Renal calculi A patient who has had a kidney transplant will be undergoing immunosuppressive therapy and ideally should be in a private room. However, if a roommate is necessary, someone with renal calculi would be least likely to possess an infectious organism that could be spread to the immunocompromised transplant patient. A patient with hepatitis C, osteomyelitis, or bronchial pneumonia is not an appropriate roommate because of the risk of infection.
A patient with chronic kidney disease (CKD) is being administered 15 g sodium polystyrene sulfonate orally for hyperkalemia. Which intervention does the nurse perform? Observe the patient for iron overload. Provide magnesium-containing antacids. Report peaked T waves on the electrocardiogram (ECG). Inform the patient that constipation is an expected side effect.
Report peaked T waves on the electrocardiogram (ECG). The nurse should report changes to the health care provider in the ECG, such as peaked T waves and widened QRS complexes; dialysis may be required to remove excess potassium. Monitoring for iron overload is a consideration for blood transfusions, but not for administration of sodium polystyrene sulfonate. The nurse should warn the patient that this treatment will often cause diarrhea because the preparation contains sorbitol, a sugar alcohol that has an osmotic laxative action. Magnesium-containing antacids should not be prescribed for patients with chronic kidney disease because magnesium is excreted by the kidneys.
Which dietary intake guideline is appropriate for the nurse to recommend to a patient with pre-end-stage renal disease (ESRD)? Sodium intake of 2 to 4 g/day Protein intake of 1.2 g/kg/day Calorie intake of 25 kcal/kg/day Calcium intake of 1000 to 1500 mg/day
Calcium intake of 1000 to 1500 mg/day A patient with kidney disease must maintain good nutrition with supplements. Calcium intake of 1000 to 1500 mg/day is beneficial in the patient with pre-ESRD to prevent hypocalcemia. Sodium intake should be individualized, or 1 to 3 g/day is appropriate for patients with pre-ESRD. Sodium intake of 2 to 4 g/day is beneficial for patients with peritoneal dialysis. Protein intake should be restricted to 0.6 to 1 g/day for patients with pre-ESRD. Protein intake of 1.2 g/kg/day is preferred for patients with hemodialysis. Calorie intake of 25 kcal/kg/day will not be sufficient for patients with pre-ESRD. Calorie intake of 30 to 35 kcal/kg/day is recommended for this patient.
The nurse provides education for a group of nursing students about cardiovascular problems associated with chronic kidney disease (CKD). The nurse explains that arterial stiffness is related to which event? Excessive sodium retention Increase in nitrogenous waste products Decrease in the sodium bicarbonate level Excessive calcium deposition in the vascular smooth layer
Excessive calcium deposition in the vascular smooth layer A patient with CKD may have arterial stiffness due to calcium deposition in the vascular smooth layer of the blood vessels. Excessive sodium retention causes extracellular fluid accumulation that leads to hypertension and edema. Decrease in the sodium bicarbonate level in the body leads to metabolic acidosis. Accumulation of the nitrogenous waste products leads to neurologic complications.
Which fluid restriction would the nurse expect to incorporate into the plan of care after reviewing the hand-off report for this patient's arrival to the unit? Fluid restriction as desired by the patient Fluid restriction not necessary for this patient Fluid restriction if BP becomes elevated Fluid restriction of 600 to 1000 mL plus urine output volume
Fluid restriction of 600 to 1000 mL plus urine output volume The patient on hemodialysis would be placed on a fluid restriction of 600 to 1000 mL plus urine output volume. The patient with pre-end stage renal disease may have fluid restricted as desired or may not be necessary. The patient using peritoneal dialysis would restrict fluid if BP becomes elevated.
The nurse suspects that which electrolyte abnormality is a cause of cerebral edema in a patient with chronic kidney disease? Hyperkalemia Hyponatremia Hypermagnesemia Hypophosphatemia
Hyponatremia Damaged tubules cannot conserve sodium. Urinary sodium excretion may increase, resulting in normal or below-normal levels of serum sodium. Uncontrolled hyponatremia or water excess can lead to cerebral edema. Hyperkalemia can cause cardiac dysrhythmias. Hypermagnesemia may lead to absence of reflexes, decreased mental status, and hypotension. Hypophosphatemia can lead to bone weakness, fractures, and muscle damage.
A patient with a 25-year history of diabetes is hospitalized with uncontrolled hypertension. A diagnosis of chronic kidney disease (CKD) is suspected. The nurse identifies that which study is the most accurate indicator of the patient's kidney function? Serum creatinine Serum potassium Blood urea nitrogen (BUN) Calculated glomerular filtration rate (GFR)
Calculated glomerular filtration rate (GFR) As the GFR decreases, the BUN and serum creatinine levels increase. The BUN increase is not only from kidney disease but also protein intake, fever, corticosteroids, and catabolism. For this reason, serum creatinine clearance determinations (calculated GFR) are considered more accurate indicators of kidney function than BUN or creatinine. The calculated GFR is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for three months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample, and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.
The nurse is teaching a nursing student about the development of anemia in patients with chronic kidney disease (CKD). The student correctly identifies which pathologic alteration as the cause of anemia in a patient with CKD? Poor absorption of calcium Elevated serum creatinine levels Decreased production of erythropoietin Accumulation of circulating phosphorous
Decreased production of erythropoietin Erythropoietin is a hormone secreted by the kidney that stimulates the production of red blood cells. Decreased levels of erythropoietin results in anemia in the patient with CKD. Elevated serum creatinine levels indicate impaired renal function. Calcium is poorly absorbed due to decreased vitamin D conversion; however, this does not result in anemia. Accumulation of circulating serum phosphorous is problematic for the CKD patient, but it does not result in anemia.
Which clinical action plan is most appropriate for a patient in stage 3 of chronic kidney disease? Diagnosis and treatment Estimation of progression Renal replacement therapy Evaluation and treatment of complications
Evaluation and treatment of complications A patient in stage 3 of chronic kidney disease has a moderate decrease in the glomerular filtration rate (GFR). The most appropriate clinical action plan for this patient is evaluation and treatment of complications. Diagnosis and treatment is the clinical action plan for patients in stage 1 of chronic kidney disease. Estimation of progression is the clinical action plan for patients in stage 2 of chronic kidney disease because this stage is associated with kidney damage with mild decrease in GFR. Renal replacement therapy is the clinical action plan for patients in stage 5, which is associated with kidney failure.
A patient with chronic kidney failure is prescribed erythropoietin for treatment of anemia. The nurse would monitor the patient for indications of which adverse effect? Paralytic ileus Iron deficiency Hyperparathyroidism Systemic lupus erythematosus
Iron deficiency Erythropoietin is a hematopoietic agent that is prescribed for anemia in people with chronic kidney failure. Erythropoietin promotes erythropoiesis. An adverse effect of the medication is iron-deficiency anemia as a result of increased demand for iron to support erythropoiesis. Paralytic ileus is a side effect of sodium polystyrene sulfonate administered for the treatment of hyperkalemia. Hyperparathyroidism occurs in the patient with end-stage renal failure. Systemic lupus erythematosus leads to chronic renal failure.
The nurse provides postoperative care 18 hours after a patient received a kidney during transplant surgery. Which is an expected assessment finding for this patient during this stage of recovery? Hypokalemia Hyponatremia Large urine output Leukocytosis with cloudy urine output
Large urine output Patients frequently experience diuresis (a large volume of urine output) in the hours and days immediately following a kidney transplant. Hypokalemia, hyponatremia, and signs of infection are unexpected findings that warrant prompt intervention.
A patient has a glomerular filtration rate (GFR) of 70 mL/minute, a BP of 140/100 mm Hg, and fluid accumulation in the legs. To help prevent heart failure, the nurse provides the patient with which instruction? Limit protein intake. Restrict sodium to 2 g/day. Take vitamin D supplements. Avoid magnesium-containing laxatives.
Restrict sodium to 2 g/day. A patient with a glomerular filtration rate of 70 mL/min has stage 2 chronic kidney disease. A BP of 140/100 mm Hg, along with fluid accumulation in the legs, indicates that the patient has hypertension and edema. Patients with increased blood urea nitrogen levels should limit protein intake to prevent neurologic complications. High sodium retention may lead to heart failure, so the patient should restrict sodium intake to 2 grams per day. Patients with low vitamin D levels or hypocalcemia should take vitamin D supplements. Patients with hypermagnesemia should avoid taking magnesium-containing laxatives.
The nurse identifies that which drug should be used with caution in a patient with renal failure? Cinacalcet Paricalcitol Gemfibrozil Vancomycin
Vancomycin A patient with renal failure has a reduced ability to eliminate metabolites and drugs. Therefore drugs like vancomycin, which are mainly excreted by the kidney, need to be used with caution and monitoring for accumulation and potential drug toxicity is necessary. Cinacalcet is a calcimimetic agent that helps to control secondary hyperparathyroidism. Paricalcitol is an active vitamin D supplement that helps to control elevated levels of parathyroid hormone and is used for treating secondary hyperparathyroidism in patients with end-stage chronic kidney disease. Gemfibrozil helps to reduce triglyceride levels and increases high-density cholesterol in patients with chronic kidney disease.
The nurse instructs a patient with hyperphosphatemia to avoid which food item? Yogurt Soy sauce Canned soup Salad dressing
Yogurt Yogurt is rich is phosphate and should be avoided by patients with hyperphosphatemia. The patient with hypernatremia and hypertension should avoid soy sauce, canned soups, and salad dressings because they are high in sodium.
The patient with end-stage renal disease (ESRD) has decided to terminate dialysis treatments. Which is the best response by the nurse? "You cannot stop now; you have so much to live for." "Are you sure this is the right decision? Can I ask a psychiatrist to come speak with you?" "I respect your decision. Would you like me to ask the health care provider for a palliative care consult?" "I respect your decision but believe you need to discuss options with your health care provider. Would you like me to contact the health care provider to come speak with you?"
"I respect your decision but believe you need to discuss options with your health care provider. Would you like me to contact the health care provider to come speak with you?" The patient has the right to end treatment. This decision must be made with the health care provider. Telling the patient that he or she has too much to live for may be giving false reassurance. The nurse has no right to question the decision or call a psychiatrist at this point.
The nurse provides education for a patient with chronic kidney disease (CKD) who is experiencing constipation. The patient's BP is 145/95 mm Hg. Which statement made by the patient indicates effective learning? "I should eat three bananas after every meal." "I should monitor my BP regularly at home." "I should rest in a prone position while recording my BP." "I should take magnesium-containing laxatives if I am experiencing constipation."
"I should monitor my BP regularly at home." A patient with CKD and hypertension has to monitor BP at home regularly. Controlling BP helps to slow the incidence of atherosclerosis that further impairs kidney function. The patient with CKD has an elevated level of serum potassium and ingestion of bananas may aggravate the condition and lead to fatal dysrhythmias. The patient should be in supine position while measuring BP, not in prone position. The patient may develop hypermagnesemia from taking magnesium-containing laxatives.
The nurse provides dietary education for a patient with chronic kidney disease (CKD) who receives peritoneal dialysis (PD). Which recommendations does the nurse include? Select all that apply. Fluids: Urine output plus 500 to 600 mL Calories: 25 to 35 kcal/kg/day (includes calories from dialysate glucose absorption) Proteins: At least 1.2 g/kg of ideal body weight (IBW) Potassium: 1 to 2 g/day Phosphate: 0.6 to 1.2 g/day
- Calories: 25 to 35 kcal/kg/day (includes calories from dialysate glucose absorption) - Proteins: At least 1.2 g/kg of ideal body weight (IBW) - Phosphate: 0.6 to 1.2 g/day The recommended caloric intake for patients undergoing PD is 25 to 35 kcal/kg/day (includes calories from dialysate glucose absorption). Dietary protein guidelines for PD differ from those for hemodialysis because of protein loss through the peritoneal membrane. During PD, protein intake must be high enough to compensate for the losses so that the nitrogen balance is maintained. The recommended protein intake is at least 1.2 g/kg of ideal body weight (IBW) per day. Recommendations for phosphate intake are patient specific or about 0.6 to 1.2 g/day. Fluid intake is unrestricted if weight and BP are controlled, and there is residual renal function. Potassium intake is usually not restricted.
The nurse is caring for a patient with chronic kidney disease. Which electrolyte, if abnormal, can result in decreased mental status, absence of reflexes, and respiratory failure for this patient? Sodium Calcium Potassium Magnesium
Magnesium A patient with hypermagnesemia, or an increase in the level of magnesium in the body, may have absence of reflexes, decreased mental status, cardiac dysrhythmias, hypotension, and respiratory failure. Sodium retention contributes to edema, hypertension, and heart failure in a patient with chronic kidney disease. Patients with hypocalcemia are at an increased risk for fractures. Hyperkalemia, or abnormally high potassium levels, is a serious electrolyte disorder in a patient with chronic renal failure that can lead to fatal dysrhythmias.
A patient with chronic kidney disease (CKD) who is not yet on dialysis experiences dyslipidemia. The nurse anticipates that which medication will be prescribed? Cholestyramine Atorvastatin Clofibrate Evolocumab
Atorvastatin Dyslipidemia, a risk factor for cardiovascular disease (CVD), is a common problem in CKD. Statins (HMG-CoA reductase inhibitors), such as atorvastatin (Lipitor), are used to lower low-density lipoprotein (LDL) cholesterol levels. Statins should be used in patients with CKD, especially those with diabetes, not yet on dialysis. Cholestyramine is a bile acid-binding resin, an alternative to statins. Clofibrate is a fibrate, a statin alternative. Evolocumab is a PCSK9 inhibitor, a statin alternative.
A patient has a glomerular filtration rate (GFR) of 50 mL/minute and a serum potassium level of 8 mEq/L. The nurse monitors the patient for which complication? Hypotension Respiratory failure Metabolic acidosis Cardiac dysrhythmias
Cardiac dysrhythmias The patient's glomerular filtration rate (GFR) of 50 mL/min is indicative of stage 3 chronic kidney disease, and the patient's serum potassium level of 8 mEq/L indicates hyperkalemia, which may lead to cardiac dysrhythmias. Hypotension and respiratory failure may result from hypermagnesemia. Metabolic acidosis occurs when the patient's bicarbonate levels are lower than 20 mEq/L.
A patient with chronic kidney disease has an arteriovenous (AV) graft in the right forearm. Which is the nurse's priority in determining the patency of the graft? Determine the range of motion of the right arm and shoulder. Observe for clubbing of the fingers on the right hand of the AV graft site. Compare radial pulses by checking the right and left pulses simultaneously. Check for a bruit by listening over the right arm AV graft site with a stethoscope.
Check for a bruit by listening over the right arm AV graft site with a stethoscope. The AV graft is an artificial connection between an artery and vein to provide access for hemodialysis. Thrombosis may occur; therefore the need to determine patency is an essential assessment. Palpation of the site should indicate a thrill, which also indicates that the graft is patent. Listening over the AV graft should reveal a bruit sound, indicating patency. A bruit sounds similar to the impulse beat heard when measuring BP. The arm that has the AV graft site should not be put through range-of-motion movements or exercises. Clubbing is not a complication observed in the fingers of a patient with an AV graft. Comparing the left radial pulse with the pulse on the AV graft site is not an accurate patency assessment procedure.
The nurse recognizes that which intervention will likely be included in a treatment plan for a patient with chronic kidney disease (CKD) who is undergoing peritoneal dialysis? Restricting potassium intake Encouraging consumption of 25 to 35 kcal/kg/day Calculating fluid restrictions based on urine output Avoiding iron supplements when taking erythropoietin
Encouraging consumption of 25 to 35 kcal/kg/day A patient with CKD must maintain good nutrition and should be referred to a dietitian for nutritional education and guidance. To avoid calorie-protein malnutrition, the patient should consume 25 to 35 kcal/kg/day, which includes calories from dialysate glucose absorption. Potassium is usually not restricted for a patient undergoing peritoneal dialysis. The patient needs to take iron supplements when on erythropoietin to prevent iron deficiency. Fluid intake in the patient who is undergoing peritoneal dialysis should be unrestricted if weight and BP are in control. Therefore it is not dependent upon urine output.
The nurse provides discharge instructions for a patient with chronic kidney disease (CKD). Which action by the patient indicates effective learning? Maintains a pillbox organizer for medication management Takes nonsteroidal antiinflammatory drugs (NSAIDs) for pain Takes aluminum-based laxatives for constipation Takes magnesium-based antacids for heartburn
Maintains a pillbox organizer for medication management Because patients with CKD take many medications, a pillbox organizer or a list of the drugs and the times of administration may be helpful. The nurse should tell the patient to avoid over-the-counter (OTC) medications, such as NSAIDs and aluminum- and magnesium-based laxatives and antacids. The nurse should instruct the patient to avoid OTC NSAIDs because most of these drugs are nephrotoxic, which leads to further deterioration of kidney function.
A patient with end-stage chronic kidney disease (CKD) is scheduled for hemodialysis. Which dietary recommendation does the nurse give to the patient? Drink more fluids. Eat protein-rich foods. Take folic acid supplementation. Take phosphate supplementation.
Take folic acid supplementation. The patient with CKD who has a very low glomerular filtration rate (GFR), such as 10 mL/min, requires dialysis. Folic acid, which is required for red blood corpuscles maturation, is water soluble and depleted during dialysis. A supplement can prevent anemia. A patient with CKD has low urine output and fluid retention, so fluid intake should be restricted. Protein-rich foods should be restricted in a patient with CKD to prevent neurologic complications. A patient with CKD has a low rate of phosphate excretion and may develop hyperphosphatemia, so additional phosphate is not recommended.
The nurse recognizes that which recommendation is appropriate for a patient with chronic kidney disease (CKD)? Drink plenty of water. Eat prunes and raisins. Take phosphate binders with meals. Take calcium and iron supplements together on an empty stomach.
Take phosphate binders with meals. A patient with CKD who is prescribed phosphate binders, such as lanthanum carbonate, should take them with meals to reduce gastrointestinal side effects. The patient must avoid potassium-rich foods such as bananas, prunes, and raisins to prevent further aggravation of hyperkalemia. Patients with CKD have decreased urine output and fluid accumulation, so an appropriate fluid balance is important to prevent further complications such as edema and heart failure. The patient should take calcium supplements on an empty stomach for better absorption, but not at the same time as iron supplements.
