Question

A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?

Answer 1

Correct Answers:

The hematocrit (Hct)

Rationale :

🖊️ Epoetin alfa is an erythropoiesis-stimulating agent that promotes the production of red blood cells (RBCs) in the bone marrow.

🖊️ Clients with chronic kidney disease commonly develop anemia because damaged kidneys produce insufficient endogenous erythropoietin.

🖊️ Epoetin alfa acts similarly to natural erythropoietin and stimulates erythroid progenitor cells to increase RBC production.

🖊️ Increased RBC production causes the client's hemoglobin and hematocrit levels to rise.

🖊️ Monitoring the hematocrit therefore provides evidence of whether the medication is producing its intended therapeutic response.

🖊️ Successful treatment improves the blood's oxygen-carrying capacity and can reduce manifestations such as fatigue and weakness.

🖊️ Hemoglobin and hematocrit should be monitored carefully because an excessive rise can increase the risk of hypertension and thromboembolic complications.

🖊️ Therefore, an appropriate increase in hematocrit indicates a therapeutic response to epoetin alfa.

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Answer 2

Correct Answers:

Nausea and vomiting

Rationale :

🖍️ Peritonitis is a serious complication of peritoneal dialysis caused by infection and inflammation of the peritoneal membrane.

🖍️ Nausea and vomiting are common systemic and gastrointestinal manifestations of peritonitis.

🖍️ Clients can also develop abdominal pain, tenderness, fever, and abdominal distention as the infection progresses.

🖍️ A particularly important finding during peritoneal dialysis is cloudy dialysate effluent, which strongly suggests peritoneal infection.

🖍️ Contamination during catheter connections or exchanges can introduce microorganisms into the peritoneal cavity.

🖍️ Suspected peritonitis requires prompt evaluation because untreated infection can lead to sepsis and impaired peritoneal membrane function.

🖍️ The nurse should assess the dialysate drainage and obtain appropriate cultures when peritonitis is suspected.

🖍️ Therefore, nausea and vomiting are the manifestations among these options that the nurse should recognize as possible evidence of peritonitis.

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Answer 3

Correct Answers:

Hyperkalemia

Rationale :

📘 During the oliguric phase of acute kidney injury (AKI), urine output decreases significantly because the kidneys cannot adequately filter and excrete waste products.

📘 Reduced renal excretion causes potassium to accumulate in the bloodstream, resulting in hyperkalemia.

📘 Hyperkalemia is one of the most dangerous complications of AKI because it can cause life-threatening cardiac dysrhythmias.

📘 Electrocardiographic changes associated with increasing potassium can include peaked T waves, prolonged PR intervals, and widened QRS complexes.

📘 The oliguric phase can also cause fluid overload, metabolic acidosis, and accumulation of nitrogenous wastes.

📘 Laboratory findings typically demonstrate increasing serum creatinine and blood urea nitrogen (BUN) as renal filtration declines.

📘 The nurse should closely monitor serum potassium, cardiac rhythm, fluid balance, daily weight, and urine output during this phase.

📘 Therefore, hyperkalemia is an expected finding during the oliguric phase of acute kidney injury.

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Answer 4

Correct Answers:

Tomatoes
Raisins
Bananas

Rationale :

✅ Tomatoes

📗 Tomatoes and tomato products are important sources of potassium.

📗 Clients with chronic kidney disease can have difficulty excreting potassium because of reduced renal function.

📗 Potassium accumulation can result in hyperkalemia, which can interfere with normal cardiac conduction.

📗 Tomato products such as tomato sauce, paste, and juice can provide particularly concentrated amounts of potassium.

📗 Limiting high-potassium foods helps prevent excessive increases in the client's serum potassium level.

📗 Severe hyperkalemia can cause muscle weakness and potentially life-threatening cardiac dysrhythmias.

📗 The client's actual potassium restriction should be individualized according to kidney function and serum potassium levels.

📗 Therefore, tomatoes are a food the client should identify as high in potassium.

✅ Raisins

📗 Raisins are dried fruit and contain a concentrated amount of potassium.

📗 Removing water during the drying process concentrates nutrients and minerals within a relatively small serving size.

📗 Clients can therefore consume substantial potassium from raisins without eating a large volume of food.

📗 Chronic kidney disease reduces the kidneys' ability to eliminate excess potassium from the bloodstream.

📗 Potassium retention increases the risk for hyperkalemia as renal function declines.

📗 Hyperkalemia can cause dangerous changes in cardiac electrical conduction and rhythm.

📗 Dried fruits such as raisins are therefore commonly limited when a client requires a low-potassium renal diet.

📗 Therefore, raisins should be avoided or restricted according to the client's prescribed potassium allowance.

✅ Bananas

📗 Bananas are widely recognized as a high-potassium food.

📗 Normally, the kidneys maintain potassium balance by eliminating excess potassium through the urine.

📗 Chronic kidney disease can impair this process and cause potassium to accumulate in the blood.

📗 Excessive potassium intake can consequently increase the client's risk for hyperkalemia.

📗 Significant hyperkalemia can cause muscle weakness, conduction abnormalities, and cardiac dysrhythmias.

📗 Clients requiring potassium restriction are commonly instructed to limit foods such as bananas, oranges, potatoes, tomatoes, and dried fruits.

📗 Dietary potassium restrictions should still be individualized according to the client's laboratory results and stage of kidney disease.

📗 Therefore, bananas should be identified as a high-potassium food to avoid or limit.

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Answer 5

Correct Answers:

Daily weight

Rationale :

🌹 Daily weight is the most reliable routine measure of changes in fluid volume status.

🌹 Changes in body weight over a short period primarily reflect changes in body fluid, rather than changes in fat or muscle mass.

🌹 Approximately 1 kg (2.2 lb) of weight change corresponds to about 1 L of fluid gained or lost.

🌹 Clients with chronic kidney disease (CKD) have impaired ability to excrete sodium and water, increasing their risk for fluid retention.

🌹 Daily weights can identify fluid accumulation before more obvious manifestations such as severe edema or respiratory distress develop.

🌹 The client should be weighed at the same time each day, preferably in the morning after voiding and before breakfast.

🌹 Using the same scale and similar clothing improves the accuracy of comparisons between measurements.

🌹 Therefore, daily weight provides the most reliable measurement of fluid retention among the options provided.

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Answer 6

Correct Answers:

Vancomycin

Rationale :

✨ Vancomycin is an antibiotic with recognized potential to cause nephrotoxicity, particularly in clients with preexisting kidney impairment.

✨ Nephrotoxicity can result in acute kidney injury (AKI) and further deterioration of renal function.

✨ Clients with chronic kidney disease (CKD) are particularly vulnerable because their renal clearance is already reduced.

✨ Vancomycin is primarily eliminated through the kidneys, so impaired renal function can cause the medication to accumulate.

✨ The nurse should monitor serum creatinine, BUN, urine output, and estimated renal function during therapy.

✨ Vancomycin dosing and intervals often require adjustment according to the client's renal function and drug exposure monitoring.

✨ The risk of kidney injury can increase when vancomycin is administered with other nephrotoxic medications.

✨ Therefore, vancomycin should be recognized as the medication with the clearest potential for nephrotoxicity among these choices.

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Answer 7

Correct Answers:

"Reduce intake of foods high in potassium."

Rationale :

✳️ Clients with end-stage kidney disease (ESKD) have severely impaired ability to excrete potassium through the kidneys.

✳️ Potassium can consequently accumulate in the bloodstream and cause hyperkalemia.

✳️ Hyperkalemia is particularly dangerous because it can interfere with normal cardiac electrical conduction.

✳️ Severe elevations can produce muscle weakness, peaked T waves, widened QRS complexes, dysrhythmias, and cardiac arrest.

✳️ Clients with advanced kidney disease are therefore commonly instructed to limit high-potassium foods when serum potassium is elevated or restriction is prescribed.

✳️ Common high-potassium foods include bananas, oranges, tomatoes, potatoes, avocados, and dried fruits.

✳️ Dietary management before dialysis also commonly involves controlling sodium, phosphorus, fluid, and protein intake according to laboratory values and nutritional needs.

✳️ Therefore, reducing foods high in potassium is the appropriate instruction among the options provided.

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Answer 8

Correct Answers:

The client has a 5 lb weight gain since yesterday.

Rationale :

💎 A rapid 5 lb (2.3 kg) weight gain in 24 hours strongly indicates significant fluid retention.

💎 Daily weight is one of the most reliable routine measurements for detecting changes in fluid volume.

💎 Approximately 1 kg (2.2 lb) of weight gain represents about 1 L of retained fluid.

💎 A 5 lb increase therefore represents roughly 2.3 L of additional fluid, assuming the change primarily reflects fluid accumulation.

💎 Clients with end-stage kidney disease (ESKD) cannot adequately eliminate excess sodium and water because of severely impaired renal function.

💎 Fluid accumulation between hemodialysis treatments can cause hypertension, peripheral edema, jugular venous distention, and pulmonary edema.

💎 Excessive fluid accumulation can eventually impair pulmonary gas exchange and cause dyspnea, crackles, and decreased oxygen saturation.

💎 Therefore, a 5 lb increase since the previous day is the clearest indication of fluid overload among these findings.

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Answer 9

Correct Answers:

Hyperkalemia

Rationale :

⚽ Acute kidney injury (AKI) reduces the kidneys' ability to maintain normal fluid, electrolyte, and acid-base balance.

⚽ In prerenal AKI, decreased renal perfusion causes a reduction in glomerular filtration rate (GFR).

⚽ As filtration declines, the kidneys become less able to eliminate potassium effectively.

⚽ Potassium retention can consequently produce hyperkalemia, particularly as kidney dysfunction becomes more severe.

⚽ Hyperkalemia is a major concern because elevated potassium can disrupt cardiac electrical conduction.

⚽ Significant hyperkalemia can cause muscle weakness, peaked T waves, widened QRS complexes, dysrhythmias, and cardiac arrest.

⚽ The nurse should closely monitor serum potassium, renal function, urine output, and cardiac rhythm in clients with AKI.

⚽ Therefore, hyperkalemia is the expected electrolyte imbalance among the options provided.

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Answer 10

Correct Answers:

PH 7.25, HCO3-19 mEq/L, PaCO2 30 mm Hg

Rationale :

🎯 Clients with chronic kidney disease (CKD) commonly develop metabolic acidosis because impaired kidneys cannot adequately excrete hydrogen ions.

🎯 Diseased kidneys also have a reduced ability to regenerate and conserve bicarbonate (HCO₃⁻).

🎯 A pH of 7.25 indicates acidemia because the normal arterial pH range is approximately 7.35–7.45.

🎯 An HCO₃⁻ of 19 mEq/L is decreased, identifying a metabolic cause of the acidosis.

🎯 The PaCO₂ of 30 mm Hg is decreased because the lungs compensate by increasing ventilation and eliminating more carbon dioxide.

🎯 This respiratory compensation helps raise the pH toward normal but does not completely correct the underlying metabolic acidosis.

🎯 Advanced CKD can also cause retention of phosphate, sulfate, and other acids, further contributing to metabolic acidosis.

🎯 Therefore, low pH + low HCO₃⁻ + compensatory low PaCO₂ is the expected ABG pattern.

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QLexNursing

1 :
A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?

2 :
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis?

3 :
A nurse is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?

4 :
A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.)

5 :
A nurse is assessing a client who has chronic kidney disease for fluid volume increase. Which of the following provides a reliable measure of fluid retention?

6 :
A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity?

7 :
A nurse is teaching a client who has pre-dialysis end-stage kidney disease about diet. Which of the following instructions should the nurse include?

8 :
A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload?

9 :
A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI), Which of the following electrolyte imbalances should the nurse expect?

10 :
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?

QLexNursing

1 : A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?

2 : A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis?

3 : A nurse is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?

4 : A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.)

5 : A nurse is assessing a client who has chronic kidney disease for fluid volume increase. Which of the following provides a reliable measure of fluid retention?

6 : A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity?

7 : A nurse is teaching a client who has pre-dialysis end-stage kidney disease about diet. Which of the following instructions should the nurse include?

8 : A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload?

9 : A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI), Which of the following electrolyte imbalances should the nurse expect?

10 : A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?

1 :
A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?

2 :
A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis?

3 :
A nurse is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?

4 :
A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.)

5 :
A nurse is assessing a client who has chronic kidney disease for fluid volume increase. Which of the following provides a reliable measure of fluid retention?

6 :
A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity?

7 :
A nurse is teaching a client who has pre-dialysis end-stage kidney disease about diet. Which of the following instructions should the nurse include?

8 :
A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload?

9 :
A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI), Which of the following electrolyte imbalances should the nurse expect?

10 :
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?