PNC 2 PrepU - Chronic Kidney Disease - ML5

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion? A. "Actually, patients with renal failure usually can't take hydrochlorothiazide." B. "That would only work if he could come in twice a day to get it intravenously." C. "That would probably help, but we'd have to do blood work first." D. "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys."

"Actually, patients with renal failure usually can't take hydrochlorothiazide." Explanation: Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

A client asks the nurse why epoetin alfa is administered during dialysis sessions. Which response by the nurse is accurate? A. "The medication is given to eliminate the rise of creatinine, a naturally occurring electrolyte excreted by the kidneys." B. "When clients are on a renal diet, this medication produces products to stimulate increased renal output." C. "The medication will assist in your activity level when you are not in the hospital." D. "The medication is a form of erythropoietin that stimulates red blood cell production."

"The medication is a form of erythropoietin that stimulates red blood cell production." Explanation: Epoetin alfa stimulates red blood cell production essential for clients with chronic renal failure. It is not used to eliminate the rise of creatinine, to assist activity levels, or to increase renal output.

The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity? Select all that apply. A. Pale skin B. Moist skin and mucous membranes C. Increased oil gland secretion D. Brittle fingernails E. Decreased perspiration

-Pale skin -Brittle fingernails -Decreased perspiration Explanation: In CKD, anemia due to loss of erythropoietin activity causes pale skin. Perspiration and oil secretion are decreased, leading to dry skin. Fingernails become brittle.

A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply. A. High-protein diet B. Angiotensin converting enzyme (ACE) inhibitor administration C. Blood glucose control D. Smoking cessation E. Blood pressure control

-Smoking cessation -Blood pressure control -Angiotensin converting enzyme (ACE) inhibitor administration -Blood glucose control Explanation: High blood pressure creates elevated pressure in glomeruli, resulting in renal damage. Hyperglycemia fosters microalbuminuria and can add to the peripheral neuropathy of CKD. Smoking causes an increase in blood pressure and increased glomerular pressure and can cause endothelial cell dysfunction. Administration of an ACE inhibitor or angiotensin-II receptor blocker (ARB) will dilate the efferent renal arterioles, reducing pressure in the glomeruli. A low-protein diet is recommended in CKD, as protein metabolism will add to the circulating nitrogenous wastes.

A client with renal failure is placed on a potassium-restricted diet. For lunch, the client consumed 6 oz (168 g) of hamburger on a bun, one cup of cooked broccoli, a raw pear, and iced tea. Using the chart provided, calculate how many milliequivalents of potassium were in this meal. A. 37 B. 30 C. 24.4 D. 31.4

37 Explanation: According to the chart, 4 oz (112 g) of beef contains 11.2 mEq (mmol) of potassium. Add 5.6 mEq (mmol) for the additional 2 oz (56 g) for a total of 16.8 mEq (mmol) of potassium in the beef. The amount of potassium in one cup of broccoli is 14 mEq (mmol). A pear has 6.2 mEq (mmol). Thus, the total amount of potassium in this meal is 37 mEq (mmol). The iced tea and bun do not contain significant amounts of potassium and, therefore, are not listed on the chart.

A client is suspected to have chronic kidney disease (CKD). The nurse will use which glomerular filtration rate (GFR) to aid in this diagnosis? A. 70-90 mL/min/1.73 m2 for 1 month B. 60 mL/min/1.73 m2 or less for 3 months C. 70-90 mL/min/1.73 m2 for 3 months D. 60 mL/min/1.73 m2 or less for 1 month

60 mL/min/1.73 m2 or less for 3 months Explanation: A GFR of 60 ml/min/1.73 m2 or less for 3 months or longer is diagnostic for CKD.

Which clinical finding among older adults is most likely to be viewed as a normal part of age-related changes? A. 81-year-old client whose serum creatinine level has increased sharply since the last blood work B. 78-year-old client whose glomerular filtration rate (GFR) has been steadily declining over several years C. 80-year-old client whose dipstick urine reveals protein is present D. 90-year-old client whose blood urea nitrogen (BUN) is rising

78-year-old client whose glomerular filtration rate (GFR) has been steadily declining over several years Explanation: A gradual decrease in GFR is considered a normal age-related change. Sudden increase in creatinine or BUN would warrant follow up, as would the presence of protein in a client's urine.

A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD? A. Antiarrhythmic medications B. Nonsteroidal anti-inflammatory drugs (NSAIDs) C. Opioid analgesics D. Antihypertensive medications

Antihypertensive medications Explanation: Hypertension is a common result of CKD, and the mechanisms that produce hypertension in CKD include increased vascular volume, elevation of peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increased activity of the renin-angiotensin-aldosterone system. NSAIDs, opioids, and antiarrhythmics are not as frequently indicated for the treatment of CKD.

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? A. Acute glomerulonephritis B. Chronic renal failure C. Nephrotic syndrome D. Acute renal failure

Acute glomerulonephritis Explanation: Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? A. Take the client's blood pressure in the left arm. B. Keep the AV fistula site dry. C. Assess the AV fistula for a bruit and thrill. D. Keep the AV fistula wrapped in gauze.

Assess the AV fistula for a bruit and thrill. Explanation: The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? A. Increased pH with decreased hydrogen ions B. Increased serum levels of potassium, magnesium, and calcium C. Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75% D. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Explanation: The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? A. Pats skin dry after bathing B. Keeps nails trimmed short C. Uses moisturizing creams D. Brief, hot daily showers

Brief, hot daily showers Explanation: Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

The nurse is caring for a client with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which medication will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract? A. Furosemide B. Lactulose C. Calcium carbonate D. Epoetin alfa

Calcium carbonate Explanation: Early treatment of hyperphosphatemia and hypocalcemia is important to prevent or slow the development of skeletal complications. Milk products and other foods high in phosphorus content are restricted in the diet. Phosphate-binding antacids (aluminum salts, calcium carbonate, or calcium acetate) may be prescribed to decrease absorption of phosphate from the gastrointestinal tract.

Which medical term describes a manifestation of bleeding disorders in clients with chronic kidney disease (CKD)? A. Vascular ischemia B. Anemia C. Ataxia D. Coagulopathies

Coagulopathies Explanation: Coagulopathies are bleeding disorders manifested by persons with CKD and include epistaxis, menorrhagia, gastrointestinal bleeding, and bruising of skin and subcutaneous tissues. Ataxia is the loss of full control of bodily movements. Vascular ischemia is a decrease in oxygenation to the vessels. Anemia is a condition marked by a deficiency of red blood cells or of hemoglobin in the blood.

A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which treatment option is his care team most likely to reject? A. Renal transplantation B. Continuous ambulatory peritoneal dialysis C. Continuous cyclic peritoneal dialysis D. Dietary restriction plus erythropoietin

Dietary restriction plus erythropoietin Explanation: Renal transplantation and dialysis are recommended for children; of these, transplantation is the preferred treatment. Conservative measures are inappropriate in this age group because of the importance of fostering proper bone growth, especially in the first 2 years, and appropriate cognitive development, which is at risk due to issues such as uremic encephalopathy and the effect of renal failure upon the central nervous system of the developing child.

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? A. Donors with hypertension may qualify. B. Donors are selected from compatible living or deceased donors. C. The client is placed on a transplant list at the local hospital. D. Donors must be relatives.

Donors are selected from compatible living or deceased donors. Explanation: Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. Each local hospital does not have its own transplant list, instead the client will be placed on a national computerized transplant waiting list.

Which dermatologic problem most often accompanies chronic kidney disease (CKD)? A. Hirsutism and psoriasis B. Dry skin and pruritus C. Petechiae and purpura D. Alopecia and fungal rashes

Dry skin and pruritus Explanation: Dry, itchy skin is a common consequence of CKD. Petechiae, purpura, hirsutism, psoriasis, alopecia, and fungal rashes are not noted to accompany or result from CKD.

A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: A. nausea and vomiting. B. dyspnea and cyanosis. C. thrush and circumoral pallor. D. fatigue and weakness.

Fatigue and weakness. Explanation: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function. A. Glomerular filtration rate (GFR) B. Serum creatinine levels C. Urine albumin levels D. Blood urea nitrogen (BUN)

Glomerular filtration rate (GFR) Explanation: GFR is the best overall measure of kidney function. GFR is usually estimated using the serum creatinine concentration. Creatinine, a by-product of muscle metabolism, is produced at a fairly constant rate, is freely filtered in the glomerulus, and is not reabsorbed in the renal tubules. Essentially all of the creatinine filtered by the kidneys is lost in the urine; therefore, serum creatinine is an indirect measure of GFR. Proteinuria serves as a key adjunctive tool for measuring nephron injury and repair. Urine normally contains small amounts of protein. Blood tests for BUN and creatinine provide information regarding the ability to remove nitrogenous wastes from the blood.

A client with chronic kidney disease becomes confused and reports abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which lab value? A. Elevated urea levels B. Hypocalcemia C. Elevated white blood cells D. Hyperkalemia

Hyperkalemia Explanation: Hyperkalemia is the life-threatening effect of renal failure. The client can become apathetic; confused; and have abdominal cramping, dysrhythmias, nausea, muscle weakness, and numbness of the extremities. Symptoms of hypocalcemia are muscle twitching, irritability, and tetany. Elevation in urea levels can result in azotemia, which can be exhibited in fluid and electrolyte and/or acid-base imbalance. Elevation of WBCs is not indicated.

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? A. Hyperkalemia B. Elevated urea and nitrogen C. Elevated serum creatinine D. Hyperphosphatemia

Hyperphosphatemia Explanation: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching? A. Immunosuppression is common after a kidney transplant. B. As long as the medications are used properly, the transplant will not be rejected. C. The child can stop medication after 3 months of therapy. D. Induction therapy medication will prevent infection with the transplant.

Immunosuppression is common after a kidney transplant. Explanation: A kidney may be transplanted into the child with end-stage renal failure as a way of sustaining life and promoting adequate cognitive skills and growth. Because the kidney is a foreign object to the body it can be rejected. To prevent this, immunosuppressants are given. It is extremely important for these medications to be given on schedule. The levels of the drugs should be monitored to make sure the drugs stay within safe ranges. The drugs are extremely helpful in preventing rejection but they are not a 100% guarantee. There are other factors that play into the role of rejection. The transplant recipient will be taking these medications will be for the rest of his or her life. Induction therapy is related to the beginning of chemotherapy administration.

A 45-year-old client with chronic kidney disease (CKD) voices concern about her dialysis treatment. The client would like to work and spend time with her family. Which type of dialysis will best fit this client's lifestyle? A. Continuous cyclic peritoneal dialysis B. Hemodialysis C. Nocturnal intermittent peritoneal dialysis (NIPD) D. Continuous ambulatory peritoneal dialysis

Nocturnal intermittent peritoneal dialysis (NIPD) Explanation: In NIPD, the client is given 10 hours of automatic cycling each night, with the abdomen left dry during the day. This is the most beneficial for this client. Individual preference, manual ability, lifestyle, knowledge of the procedure, and physiologic response to treatment are used to determine the type of dialysis that is used. Hemodialysis is generally three times a week for 3 to 4 hours a day. CAPD involves exchanging the dialysate four to six times per day. In CCPD, the last exchange remains in the abdomen during the day.

The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication? A. Obstruction of the renal tubules with myoglobin and damaged tubular cells B. Hypokalemia and metabolic acidosis C. Development of renal stones due to stasis D. Compartment syndrome in the lower extremities

Obstruction of the renal tubules with myoglobin and damaged tubular cells Explanation: Myoglobin normally is not found in the serum or urine. It has a low molecular weight; if it escapes into the circulation, it is rapidly filtered in the glomerulus. A life-threatening condition known as rhabdomyolysis occurs when increasing myoglobinuria levels cause myoglobin to precipitate in the renal tubules, leading to obstruction and damage to surrounding tubular cells. Myoglobinuria most commonly results from muscle trauma but may result from exertion, hyperthermia, sepsis, prolonged seizures, and alcoholism or drug abuse. Rhabdomyolysis is not cured with anticoagulation administration nor does it cause kidney stones. Compartment syndrome occurs when there is insufficient blood supply to muscles and nerves due to increased pressure within one of the body's compartments. Myoglobinuria causes hyperkalemia, which may cause cardiac dysrhythmias, metabolic acidosis, hyperphosphatemia, early hypocalcemia, and late hypercalcemia.

A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease? A. Pulmonary embolism B. Pericarditis C. Myocardial infarction D. Pulmonary edema

Pericarditis Explanation: Pericarditis occurs in many people with stage 5 CKD due to the uremia and prolonged dialysis. The manifestations of uremic pericarditis resemble those of viral pericarditis with all its potential complications, including cardiac tamponade. The presenting signs include mild to severe chest pain with respiratory accentuation and a pericardial friction rub. Fever is variable in the absence of infection and is more common in dialysis than uremic pericarditis.

Retention of which electrolyte is the most life-threatening effect of renal failure? A. Potassium B. Calcium C. Phosphorous D. Sodium

Potassium Explanation: Retention of potassium is the most life-threatening effect of renal failure.

A 72-year-old client is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival? A. Reduction in T-lymphocyte function B. Acceptance of immunosuppressive therapy C. Psychological maturity D. Decreased muscle mass

Reduction in T-lymphocyte function Explanation: The general reduction in T-lymphocyte function with subsequent decrease in immune system activity that occurs with aging would foster transplant survival. The other options would not have a direct effect on rejection of the transplant. Acceptance of immunosuppressive therapy is not a specific characteristic of advanced age. Psychological maturity and decreased muscle mass have little to no effect on transplant survival.

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? A. Serum protein B. Albumin level C. Serum creatinine D. BUN

Serum creatinine Explanation: In clinical practice, GFR is usually estimated using the serum creatinine concentration. The other answers are not used to estimate the GFR.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case? A. They are the strongest form of diuretics. B. They may cause rebound edema. C. They promote excretion of potassium. D. They may cause hyperkalemia.

They may cause hyperkalemia. Explanation: Potassium-sparing diuretics accumulate in renal insufficiency and present the risk for hyperkalemia. For this reason, health care practitioners typically avoid the drug in this population. Potassium-sparing diuretics decrease potassium excretion, and, by themselves, they are weak diuretics. Rebound edema may be a concern when a diuretic is discontinued, but it is not the reason this client is a poor candidate for a potassium-sparing diuretic.

A nurse obtains an allergy history from a client based on the understanding that which class is associated with a cross-sensitivity reaction with sulfonamides? A. Carbonic anhydrase inhibitors B. Thiazide diuretics C. Potassium-sparing diuretics D. Osmotic diuretics

Thiazide diuretics Explanation: A cross-sensitivity reaction may occur with the thiazide diuretics and sulfonamides. For clients who take carbonic anhydrase inhibitors during treatment for glaucoma, contact the primary health care provider immediately if eye pain is not relieved or if it increases. When a client with epilepsy is being treated for seizures, a family member of the client should keep a record of all seizures witnessed and bring this to the primary health care provider at the time of the next visit. Contact the primary health care provider immediately if the number of seizures increases. Potassium-sparing diuretics can lead to hyperkalemia and is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal failure, older adults, and those who are severely ill, and teach the client to avoid the use of salt substitutes containing potassium. Osmotic diuretics such as mannitol or urea for treatment of increased intracranial pressure caused by cerebral edema, perform neurologic assessments (response of the pupils to light, level of consciousness, or response to a painful stimulus) in addition to vital signs at the time intervals ordered by the primary health care provider.

A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate? A. The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes. B. Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time. C. Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt. D. Treatments typically occur three times each week for 3 to 4 hours.

Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time. Explanation: In peritoneal dialysis, a sterile dialyzing solution is instilled into the peritoneum through a catheter over approximately 10 minutes. The solution remains ("dwells") in the peritoneal cavity for a determined time interval, then drains into a sterile bag. Shunts, fistulas, and artificial dialyzers are associated with hemodialysis, which is usually performed three times weekly. The frequency of peritoneal dialysis varies, but is normally performed more often than hemodialysis and can be done at home.

Which clinical finding should a nurse look for in a client with chronic renal failure? A. Uremia B. Polycythemia C. Hypotension D. Metabolic alkalosis

Uremia Explanation: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present? A. When the urine output is about 100 mL/h B. When the urine output is between 300 and 500 mL/h C. When the urine output is between 500 and 1,000 mL/h D. When the urine output is less than 30 mL/h

When the urine output is less than 30 mL/h Explanation: Oliguria is defined as urine output <0.5 mL/kg/h

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? A. Blood glucose level of 200 mg/dl B. Hematocrit (HCT) of 35% C. Potassium level of 3.5 mEq/L D. White blood cell (WBC) count of 20,000/mm3

White blood cell (WBC) count of 20,000/mm3 Explanation: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia (evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents: A. a loss of over half the client's normal kidney function. B. a need to increase water intake. C. that the kidneys are functioning normally. D. concentrated urine.

a loss of over half the client's normal kidney function. Explanation: In clinical practice, GFR is usually estimated using the serum creatinine concentration. A GFR below 60 mL/minute/1.73 m2 represents a loss of one half or more of the level of normal adult kidney function. The GFR is not diagnostic for concentrated urine or the need to drink more water.

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). The most therapeutic pharmacologic intervention would be to administer A. filgrastim. B. ferrous sulfate. C. epoetin alfa. D. enoxaparin.

epoetin alfa. Explanation: Chronic renal failure diminishes the production of erythropoietin by the kidneys and leads to a subnormal Hb level. (Normal Hb level is 13 to 18 g/dl in men and 12 to 16 g/dl in women.) An effective pharmacologic treatment for this is epoetin alfa, a recombinant erythropoietin. Because the client's anemia is caused by a deficiency of erythropoietin and not a deficiency of iron, administering ferrous sulfate would be ineffective. Neither filgrastim, a drug used to stimulate neutrophils, nor enoxaparin (low-molecular-weight heparin) will raise the client's Hb level.

A client with chronic renal failure is admitted with a heart rate of 122 beats/minute, a respiratory rate of 32 breaths/minute, a blood pressure of 190/110 mm Hg, jugular vein distention, and bibasilar crackles. Which nursing diagnosis takes highest priority for this client? A. electrolyte disturbance B. excess fluid volume C. urinary retention D. toileting self-care deficit

excess fluid volume Explanation: A client with renal failure can't eliminate sufficient fluid. This issue increases the risk of fluid overload and consequent respiratory and electrolyte problems. This client shows signs of excess fluid volume and is acutely ill. Urine retention may cause renal failure but is a less urgent concern than fluid imbalance. Electrolyte disturbance and Toileting self-care deficit may also be appropriate nursing diagnoses but they take lower priority because they aren't life-threatening.

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: A. metabolic alkalosis secondary to retention of hydrogen ions. B. a decreased serum phosphate level secondary to kidney failure. C. an increased serum calcium level secondary to kidney failure. D. water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.