Chronic Kidney Disease (CKD)

*Possible exam question* The nurse provides dietary teaching to a client with CKD. Which food should the nurse inform the client about that contains protein of high biologic value? SATA A) Fish B) Poultry C) Milk D) Legumes E) Peanut Butter

A, B, C Fish, poultry, milk Rationale: Animal sources of protein​ are meat, poultry, fish, eggs, milk,​ cheese, and yogurt which are proteins of high biologic value.​ Plants, legumes, grains,​ nuts, seeds, and vegetables provide proteins of low biologic value

*Possible exam question* Which lab finding is suggestive of chronic kidney disease? A) Increase in creatinine clearance B) Decrease in serum sodium C) Increase in hematocrit D) Decrease in BUN

B) Decrease in serum sodium Rationale: Laboratory findings associated with chronic kidney disease include decreased creatinine clearance due to a decrease in the glomerular filtration rate; decreased serum sodium because of water retention; decreased hematocrit due to decreased red blood cell production, and increased BUN due to inability of the kidneys to eliminate nitrogenous waste products.

*Possible exam question* The nurse realizes that as CKD progresses, the kidney loses ability to eliminate metabolic wastes. Which way should the nurse expect a client with this disease to eliminate wastes other than through the kidneys? A) Via respirations B) Via the skin C) Via tears D) Via the bowel

B) Via the skin Rationale: Metabolic wastes that accumulate in the blood may be eliminated through the skin in the form of uremic frost. The​ bowel, tears, and respirations cannot eliminate metabolic waste.

The nurse is planning a seminar to instruct community members on ways to reduce the development of chronic kidney disease (CKD). Which topics should the nurse include in the seminar? 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.

B, C, D, E Rationale; Prevention of CKD 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 CKD.

The nurse discusses the risk of developing CKD with a group of nursing students. Which population group should the nurse emphasize as being most at risk for developing this disorder? A) Hispanic Americans B) Caucasian Americans C) Asian Americans D) African Americans

D) African Americans Rationale: African Americans are nearly three times as likely to develop CKD as Caucasian Americans. This is much greater than the risk for Asian Americans and Hispanic Americans to develop the disease.

The nurse is preparing to discharge a client diagnosed with chronic kidney disease (CKD). The nurse is teaching the client and family about administering calcium acetate tablets by mouth with each meal at home. Which explanation about this medication is most appropriate for the nurse to include? A) "The calcium acetate will lower your serum phosphate levels." B) "The calcium acetate helps neutralize your gastric acids." C) "The calcium acetate will help stimulate your appetite." D) "The calcium acetate will decrease your serum creatinine levels."

A) "The calcium acetate will lower your serum phosphate levels." Rationale: The client with CKD 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 CKD. This medication has no effect on appetite stimulation.

The nurse reviews the stages of CKD before caring for a client with the disorder. Which stage of CKD should the nurse identify as occurring when the kidneys are unable to excrete metabolic waste and maintain fluid and electrolyte balance adequately? A) End-stage renal disease B) Renal insufficiency C) Corneal failure D) Decreasing renal reserve

A) End-stage renal disease Rationale: Chronic renal disease​ (CKD) progresses slowly. Loss of function may not be recognized for many years.​ End-stage renal​ disease, or stage​ 5, is the stage where the kidneys are finally unable to excrete metabolic wastes and to regulate fluid and electrolyte balance adequately.

The nurse is preparing to administer a hemodialysis treatment for a client diagnosed with chronic kidney disease (CKD). Which laboratory values should the nurse anticipate prior to the client's treatment? Select all that apply. A) Increased blood urea nitrogen (BUN) B) Decreased potassium C) Decreased phosphorus D) Increased urine osmolality E) Increased creatinine

A, E Increased BUN Increased CREA Rationale: The damaged kidney is unable to excrete waste products, including creatinine, so creatinine levels 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.

A client with end-stage renal disease is experiencing uremia. Which prescription should the nurse expect to receive from the HCP? A) Physical therapy care consult B) Increased fluids C) Serum electrolytes D) Begin dialysis E) ABG monitoring

C, D, E - Monitor lytes, ABGs - Start dialysis Rationale: Uremia is a manifestation of ESRD that occurs when metabolic wastes build up in the blood. Dialysis is often the only option for treatment. ABGs and serum electrolytes are monitored to assess for complications of uremia. Fluids should be​ restricted, not increased. A dietary consult might be​ necessary, but not a physical therapy consult at this time.

The nurse is caring for a client from another country who was admitted to the hospital with a diagnosis of hypertension and chronic kidney disease. The client is receiving hemodialysis three times a week. When the nurse inquires about diet, the client reports the use of salt substitutes. Why should the nurse teach the client to avoid these products? 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 contribute to hyperkalemia.

D) They can contribute to hyperkalemia Rationale: Many salt substitutes contain high levels of potassium chloride. Potassium intake must be carefully regulated in clients with chronic kidney disease, and use of salt substitutes can 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 substitutes should be avoided. Control of hypertension is essential in the management of a client with kidney disease, but salt substitutes are not known to interact with antihypertensive medications. An AV fistula does need to be protected from injury and infection, but this is unrelated to use of salt substitutes.

A client with CKD has hypertension. Which class of medications should the nurse expect to be prescribed for the client? A) ACE inhibitor B) Beta blocker C) Vasodilator D) Calcium channel blocker

A) ACE inhibitor Rationale: ACE inhibitors are the treatment of choice for hypertension associated with chronic kidney disease. They suppress the​ renin-angiotensin-aldosterone system and slow the progress of renal disease. Calcium channel​ blockers, beta​ blockers, and vasodilators are other classes of medications that are used to treat hypertension.

Why is development of Kussmaul respirations problematic in a client with chronic kidney disease (CKD)? A) It suggests the client is experiencing metabolic acidosis. B) It suggests the client is dehydrated. C) It suggests the client is hypotensive. D) It suggests the client is experiencing proteinuria.

A) It suggests the client is experiencing metabolic acidosis. Rationale: Kussmaul respirations involve an increase in respiratory rate and depth. Clients with CKD may exhibit these respirations when they are experiencing metabolic acidosis related to impaired hydrogen ion excretion and buffer production. Clients with CKD typically experience fluid retention and hypertension rather than dehydration and hypotension. Proteinuria is common among clients with CKD and does not contribute to Kussmaul respirations.

*Possible exam question* The nurse reviews the results of diagnostic tests performed on a client with suspected chronic kidney disease (CKD). Which stage of the disease should the nurse suspect the client is experiencing when the GFR is mildly decreased? A) Stage 2 B) Stage 4 C) Stage 3 D) Stage 1

A) Stage 2 Rationale: A client with mildly decreased GFR is diagnosed with stage 2 chronic kidney disease. GFR in stage 1 is increased. GFR in stage 3 is moderately decreased. GFR in stage 4 is severely decreased.

During a home visit, the nurse is concerned that an older adult client is developing chronic kidney disease (CKD). The client has no history of cardiovascular disease. Which data in the client's assessment caused the nurse to have this concern? 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

A, C Rationale: The manifestations of chronic kidney disease (CKD) 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 CKD in the older client. An increase in hunger and thirst could be an indication of diabetes mellitus and not CKD in the older client. A client with CKD will have pale dry skin with poor turgor.

The nurse reviews the complications of CKD with a group of new graduate nurses. Which complication should the nurse include in the teaching? SATA A) Uremic encephalopathy B) Celiac disease C) Anemia D) Osteodystrophy E) Diabetes insipidus

A, C, D - Uremic encephalopathy - Anemia, - osteodystrophy Rationale: In​ CKD, the kidneys produce less​ erythropoietin, which results in anemia. The kidney loses the ability to excrete metabolic waste​ products, so they build up in the blood​ (uremia). These waste products cause changes in the central nervous system known as uremic encephalopathy. Decreased vitamin D synthesis and decreased calcium absorption leads to bone resorption and remodeling that leads to osteodystrophy. Diabetes insipidus and celiac disease are not complications of CKD.

While caring for a client diagnosed with end-stage renal disease (ESRD), the nurse tracks the client's serum albumin level. For which nursing diagnosis is this action most indicated? A) Excess Fluid Volume B) Imbalanced Nutrition: Less than Body Requirements C) Risk for Ineffective Perfusion D) Risk for Infection

B) Imbalanced Nutrition: Less than Body Requirements Rationale: 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.

A client with CKD is experiencing Kussmaul respirations. Which acid-base imbalance should the nurse suspect the client is experiencing? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis

B) Metabolic acidosis Rationale: As renal failure​ advances, the kidney loses the ability to excrete hydrogen ions. The buffering action of the kidney becomes impaired. This leads to metabolic acidosis. Kussmaul respirations​ (increasing rate and​ depth) are the​ body's attempt to compensate for the acidosis. Metabolic alkalosis occurs with an increased excretion of hydrogen ions. Respiratory acidosis occurs with retention of carbon dioxide. Respiratory alkalosis occurs with an increased loss of carbon dioxide.

The nurse is providing care to a client diagnosed with chronic renal failure. Which assessment finding should the nurse expect if uremia is present? SATA A) Bruising on upper extremities B) crystals noted on the skin surface C) Pruritus D) Moist skin E) Yellow color on the sclera

B, C Rationale: High levels of urea mixing with sweat can result in uremic​ frost, crystallized deposits of urea on the skin. The condition will cause pruritus. Bruising is a common manifestation of chronic renal​ failure, but this manifestation is caused by impaired platelet function. Clients with​ end-stage renal disease​ (ESRD) may develop a yellowish tinge to the skin because of retained pigmented​ metabolites, but a yellowed sclera is significant of other disease processes. Dry skin with poor turgor is a common dermatologic assessment in clients with ESRD.

A client with CKD has a potassium level of 6.5. Which prescription should the nurse anticipate receiving for this client? SATA A) Potassium 30 mEq/L in 100 mL IV over 2 hours B) IV regular insulin C) Sodium bicarb D) Sodium polystyrene sulfonate E) IV 50% dex solution

B, C, D, E Rationale: Sodium polystyrene sulfonate is a​ potassium-ion exchange resin that removes potassium by exchanging sodium ions for potassium in the small bowel. A combination of regular​ insulin, bicarbonate, and glucose​ (dextrose) facilitates the movement of potassium ions into the cells to decrease serum potassium levels. A serum potassium level of 6.5​ mEq/L is​ hyperkalemic, so potassium replacement is not appropriate.

A client with a history of hypertension is diagnosed with chronic kidney disease (CKD). When the client asks the nurse how this disease developed, which response by the nurse is the most appropriate? A) "Thickening of the kidney structures and gradual death of nephrons has led to this diagnosis." B) "Cysts have compressed your renal tissue and destroyed your kidneys, causing this diagnosis." C) "High blood pressure has reduced your renal blood flow, harming the kidney tissue and causing this diagnosis." D) "Immune complexes have formed in your kidney tissue, causing inflammation that has led to this diagnosis."

C) "High blood pressure has reduced your renal blood flow, harming the kidney tissue and causing this diagnosis." Rationale: Long-standing 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. In contrast, diabetic nephropathy causes chronic kidney disease (CKD) by thickening and sclerosis of the glomerular basement membrane and the glomerulus with a gradual destruction of nephrons. Polycystic kidney disease causes CKD by multiple bilateral cysts gradually compressing renal tissue, impairing renal perfusion and leading to ischemia, which damages and destroys normal kidney tissue. Finally, systemic lupus erythematosus causes CKD by the formation of immune complexes in the capillary basement membrane, which lead to inflammation and sclerosis.

*Possible exam question* The nurse is caring for a client diagnosed with chronic kidney disease (CKD) who is pale and experiencing fatigue. The nurse attributes these symptoms to anemia secondary to CKD. The client's spouse asks why the client is anemic. Which response by the nurse is the most appropriate? A) "Your spouse has a genetic tendency for the development of anemia." B) "The increased metabolic waste products in your spouse's body depress the bone marrow and cause anemia." C) "Your spouse's kidneys are producing reduced amounts of the hormone erythropoietin, and this is the cause of the anemia." D) "Your spouse is not eating enough iron-rich foods, and this has led to anemia."

C) "Your spouse's kidneys are producing reduced amounts of the hormone erythropoietin, and this is the cause of the anemia." Rationale: Anemia is common in clients with chronic kidney 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 stimulating the bone marrow to produce RBCs. Metabolic wastes do not suppress bone marrow, and diet and heredity do not factor into the production of erythropoietin.

The nurse is administering peritoneal dialysis to a client with a diagnosis of chronic kidney disease (CKD). The nurse notes the presence of a cloudy dialysate return. After notifying the healthcare provider, which action by the nurse is the most appropriate and of highest priority? A) Measure the client's abdominal girth. B) Document the cloudy dialysate. C) Culture the dialysate return. D) Increase dialysate instillation.

C) Culture the dialysate return Rationale: The client's dialysate return should be clear. The presence of cloudy drainage might indicate peritonitis, so the nurse should culture the return in order to help identify the presence and type of organism that could be causing the infection. Documenting the cloudy dialysate would be a necessary nursing action, but is not the next-priority action. Measurement of abdominal girth is performed prior to the dialysis procedure, and even though increased girth could indicate peritonitis, culturing the return is more important. The instillation part of the procedure is completed prior to the collection of the dialysate return, and the rate of the instillation has no relationship to the development of an infection.

A young adult client receiving peritoneal dialysis feels fat and unattractive. Which action should the nurse use to help the client cope with a disturbed body image? A) Recommend speaking with adolescents who also have developed chronic renal failure B) Provide written information regarding the technical aspects of the dialysis procedure C) Encourage expression of feelings related to the disease and treatment and their impact on life D) Recommend increasing physical activity to manage weight

C) Encourage expression of feelings related to the disease and treatment and their impact on life Rationale: An appropriate intervention for a client with a disturbed body image is to encourage the expression of feelings related to the disease process and the treatments. While support groups are​ encouraged, the nurse would not recommend that the client speak to an adolescent client with chronic renal failure. While offering written information regarding treatment is​ important, this intervention is not appropriate for a client with disturbed body image. Telling the client to increase physical activity to avoid gaining weight is not therapeutic.

*Possible exam question* The lab work of a client with CKD shows an elevated potassium level. Which prescription should the nurse anticipate receiving from the HCP? A) Oral Vitamin D B) IV Potassium chloride C) IV glucose D) Oral calcium carbonate

C) IV glucose Rationale: A method to lower blood potassium levels is to administer intravenous glucose and insulin. The insulin drives the glucose into body cells. The glucose takes the potassium with it into the​ cells, thereby lowering blood potassium levels. Potassium supplements would not be prescribed for a client with an elevated potassium level. Oral calcium carbonate is a​ phosphorus-binding agent and reduces the phosphate level in the blood. Vitamin D is given to increase the absorption of calcium.

The nurse is planning care for a client diagnosed with chronic kidney disease (CKD) and osteoporosis. Based on this information, which should be the nurse's priority diagnosis for this client? A) Anxiety B) Disturbed Body Image C) Risk for Injury D) Risk for Bleeding

C) Risk for Injury Rationale: The client with CKD and osteoporosis is at high risk for fractures; therefore, preventing injury should be the priority nursing diagnosis. The client is at risk for anemia, but not bleeding. The client on hemodialysis may have a disturbed body image, but in this case, the client is not undergoing hemodialysis. Anxiety is not related to osteoporosis.

The nurse is providing care to a client diagnosed with chronic renal failure. Which cardiovascular assessment finding should the nurse identify that supports this diagnosis? A) Hyperkalemia B) Anemia C) Systemic hypertension D) Decreased WBC count

C) Systemic hypertension Rationale: The cardiovascular assessment finding that supports the diagnosis of chronic renal failure is systemic hypertension. Anemia is a hematologic symptom of chronic renal failure. A decreased white blood cell count is a manifestation of chronic renal failure that affects the immune system. Hyperkalemia occurs as the result of the effects of chronic renal failure on fluids and electrolytes.

*Possible exam question* The nurse instructs a client diagnosed with chronic kidney disease (CKD) regarding the prescribed medication furosemide (Lasix). Which client statement indicates that the 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."

D) "This pill will reduce the swelling in my body and get rid of the extra potassium." Rationale: 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 CKD that is used to stabilize protein levels in the body.

The nurse plans to preserve renal perfusion in a client with chronic kidney disease​ (CKD). Which intervention should the nurse implement for this​ client? A) Monitor protein intake B) Assess the arteriovenous fistula on every shift C) Monitor WBC count D) Administer an angiotensin-converting enzyme (ACE) inhibitor as prescribed

D) Administer an angiotensin converting enzyme (ACE) inhibitor as prescribed Rationale: Administering an​ angiotensin-converting enzyme​ (ACE) inhibitor will reduce systemic hypertension and preserve renal function. Assessing the arteriovenous fistula is an important nursing intervention to preserve the patency of the fistula and reduce the risk of​ infection, not to preserve renal perfusion. The kidney with chronic disease is unable to excrete protein​ by-products, causing the multisystemic effects of uremia. Monitoring the​ client's protein intake will address these effects but does not directly preserve renal perfusion. An increase in white blood cells can indicate infection but does not directly affect renal perfusion.

*Possible exam question* A client with a diagnosis of chronic kidney disease (CKD) is experiencing manifestations of anemia. Based on this data, which treatment should the nurse anticipate for this client? A) Begin fluid restriction. B) Administer intravenous glucose and insulin. C) Begin a low-sodium diet. D) Administer epoetin injections.

D) Administer epoetin injections Rationale: Epoetin injections are used in the treatment of anemia caused by CKD. This medication supplies a hormone typically created in the kidneys that signals the bone marrow to produce more red blood cells. In CKD, production of this hormone will be reduced. Fluid restriction would be indicated for uremia caused by CKD. Intravenous glucose and insulin may be used to reduce excessive potassium that is caused by CKD. A low-sodium diet is used to help reduce fluid volume excess that is caused by CKD.

A nurse is evaluating whether the drug sodium polystyrene sulfonate (Kayexalate) is exerting the desired therapeutic effect for a client diagnosed with chronic kidney disease (CKD). Which therapeutic effect should the nurse anticipate from this medication? A) Increased serum sodium B) Increased stool excretion C) Decreased urine specific gravity D) Decreased serum potassium

D) Decreased serum potassium Rationale: The client with CKD is unable to excrete potassium. Therefore, the drug sodium polystyrene sulfonate (Kayexalate) is used 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 serum sodium level or the urine specific gravity.

The nurse is caring for an older adult client diagnosed with chronic kidney disease (CKD). The client reports no bowel movements in the past 2 days. Based on this data, which condition is the client at risk for developing? A) Metabolic acidosis B) Hypercalcemia C) Increased serum creatinine levels D) Hyperkalemia

D) Hyperkalemia Rationale: Constipation exacerbates hyperkalemia, so it is important to monitor clients with CKD who already have elevated potassium levels. Hypercalcemia 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.

*Possible exam question* The nurse creates a plan of care for a client with end-stage renal disease. To what should the nurse pay particular attention when planning this care? A) Medication regimens and their side effects B) Daily weights C) Monitoring input and output D) Meal planning when dietary modifications are required

D) Meal planning when dietary modifications are required Rationale: The nurse should involve the client in meal planning if dietary modifications are required. The nurse can provide teaching about the medication​ regimen, but the client is not usually involved in planning these regimens. Weighing the client and monitoring input and output are interventions carried out by the​ nurse, with little involvement by the client.

Which stage of chronic kidney disease is characterized by hypertension, anemia, malnutrition, altered bone metabolism, metabolic acidosis, and a severely decreased glomerular filtration rate? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

D) Stage 4 Rationale: Clients in stage 1 of chronic kidney disease (CKD) are asymptomatic and have a normal or increased glomerular filtration rate (GFR). During stage 2, the GFR mildly decreases and hypertension may develop. In stage 3, there is a moderate GFR decrease, as well as hypertension, possible anemia and fatigue, anorexia, possible malnutrition, and bone pain. Stage 4 involves a severely decreased GFR as well as hypertension, anemia, malnutrition, altered bone metabolism, edema, metabolic acidosis, hypercalcemia, possible uremia, and azotemia.

The nurse is planning care for a client with chronic kidney disease​ (CKD). Which precautions should the nurse implement for this​ client? A) Airborne B) Droplet C) Contact D) Standard

D) Standard Rationale: Because a client with chronic renal failure is at risk of​ infection, healthcare providers should use standard precautions to provide care. The other types of precautions are not appropriate for a client with chronic renal failure.

The nurse reviews findings from the assessment of a client with end-stage renal disease. Which finding should the nurse identify as the most common cardiac complication of this disease? A) Hypolipidemia B) Cardiomyopathy C) Tetralogy of Fallot D) Systemic hypertension

D) Systemic hypertension Rationale: Hypertension results from excess fluid​ volume, increased​ renin-angiotensin activity, and increased peripheral vascular resistance.​ Hyperlipidemia, not​ hypolipidemia, often occurs with ESRD. Heart​ failure, not​ cardiomyopathy, results from ESRD. Tetralogy of Fallot is a congenital heart abnormality not caused by ESRD.