Chapter 51: CKD Flashcards
A 65-year-old male with a history of diabetes and hypertension presents for routine lab work. His GFR is 50 mL/min/1.73 m², and he reports no symptoms. Based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines, which stage of chronic kidney disease is he in?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
C. Stage 3
Rationale: A GFR of 50 mL/min/1.73 m² falls within the range for Stage 3 CKD (30–59 mL/min/1.73 m²). At this stage, CKD is considered moderate, and patients may remain asymptomatic.
Which of the following is the leading cause of chronic kidney disease in the United States?
A. Hypertension
B. Glomerulonephritis
C. Diabetes
D. Cystic diseases
C. Diabetes
Rationale: Diabetes accounts for about 50% of CKD cases, making it the leading cause. Hypertension is the second most common cause, at approximately 25%.
Which of the following statements about CKD is accurate?
A. CKD is reversible if detected early.
B. CKD often remains undiagnosed until significant nephron loss has occurred.
C. Patients with CKD are frequently symptomatic in the early stages.
D. CKD has a lower prevalence than acute kidney injury (AKI).
B. CKD often remains undiagnosed until significant nephron loss has occurred.
Rationale: CKD is often underdiagnosed and untreated because it remains asymptomatic until significant nephron loss has occurred. CKD is more prevalent than AKI.
A nurse is caring for a patient with end-stage renal disease (ESRD). Which of the following treatments is necessary to sustain life?
A. Renal replacement therapy (RRT)
B. Antihypertensive therapy
C. Diabetic management
D. High-protein diet
A. Renal replacement therapy (RRT)
Rationale: Patients with ESRD (GFR <15 mL/min) require RRT (dialysis or kidney transplant) to sustain life.
Which of the following are risk factors for chronic kidney disease? (SATA)
A. Aging population
B. Increased rates of obesity
C. Hypertension
D. Urinary tract infections
E. Diabetes
A. Aging population
B. Increased rates of obesity
C. Hypertension
E. Diabetes
Rationale: Aging, obesity, hypertension, and diabetes are all established risk factors for CKD. Urinary tract infections are not a common cause of CKD.
The patient asks the nurse why CKD is often diagnosed late. The nurse should respond by stating:
A. “Symptoms usually appear during the early stages of CKD.”
B. “CKD is only diagnosed when the patient progresses to ESRD.”
C. “Blood pressure changes occur immediately when CKD develops.”
D. “CKD is difficult to detect until a significant number of nephrons are lost.”
D. “CKD is difficult to detect until a significant number of nephrons are lost.”
Rationale: CKD remains asymptomatic until considerable nephron loss occurs, leading to late diagnosis.
A patient has been diagnosed with stage 5 CKD. What is the expected GFR?
A. Less than 15 mL/min/1.73 m²
B. 30-59 mL/min/1.73 m²
C. 15-29 mL/min/1.73 m²
D. Greater than 90 mL/min/1.73 m²
A. Less than 15 mL/min/1.73 m²
Rationale: Stage 5 CKD (ESRD) is defined as a GFR of less than 15 mL/min/1.73 m².
A 74-year-old female with stage 4 CKD has a GFR of 20 mL/min/1.73 m². Which intervention should the nurse anticipate discussing with the patient?
A. Initiating renal replacement therapy
B. Continuing lifestyle modifications
C. Reassessing GFR in 6 months
D. Scheduling a kidney biopsy
A. Initiating renal replacement therapy
Rationale: A GFR of 20 mL/min/1.73 m² indicates advanced CKD nearing ESRD. RRT should be discussed and planned.
What is the primary goal of treatment for patients in the early stages of CKD?
A. Slow progression of the disease
B. Prepare the patient for dialysis
C. Reverse kidney damage
D. Maintain fluid restrictions
A. Slow progression of the disease
Rationale: Treatment in early CKD focuses on slowing disease progression by managing underlying causes, such as diabetes and hypertension.
A patient with CKD asks about the impact of aging on kidney function. Which statement by the nurse is correct?
A. “Aging does not affect kidney function unless CKD is present.”
B. “Kidney function declines with age, increasing CKD risk.”
C. “Age-related changes have no impact on CKD progression.”
D. “Older adults have a lower prevalence of CKD.”
B. “Kidney function declines with age, increasing CKD risk.”
Rationale: Aging is a risk factor for CKD due to natural declines in kidney function over time.
Which of the following are less common causes of CKD? (SATA)
A. Cystic diseases
B. Glomerulonephritis
C. Diabetes
D. Urologic diseases
E. Hypertension
A. Cystic diseases
B. Glomerulonephritis
D. Urologic diseases
Rationale: Cystic diseases, glomerulonephritis, and urologic diseases are less common causes of CKD. Diabetes and hypertension are the leading causes.
A nurse is educating a 65-year-old patient with diabetes and hypertension about reducing their risk of chronic kidney disease (CKD). Which statement by the patient indicates a need for further teaching?
A. “I should keep my blood sugar under control.”
B. “I need to avoid skipping my blood pressure medications.”
C. “I should take over-the-counter NSAIDs for joint pain as needed.”
D. “I need to have my kidney function checked regularly.”
C. “I should take over-the-counter NSAIDs for joint pain as needed.”
Rationale: NSAIDs are nephrotoxic and should be avoided in patients at risk for CKD. Controlling blood sugar and blood pressure are essential preventive measures, as diabetes and hypertension are leading causes of CKD. Regular monitoring of kidney function helps with early detection of kidney damage.
Which patient is at highest risk for CKD and should receive additional education on prevention strategies?
A. A 52-year-old with a family history of CKD and controlled hypertension
B. A 45-year-old Black individual with poorly controlled diabetes
C. A 63-year-old Native American with a history of cardiovascular disease
D. A 70-year-old with a history of nephrotoxic drug exposure
B. A 45-year-old Black individual with poorly controlled diabetes
Rationale: While all these patients have risk factors for CKD, poorly controlled diabetes in a Black individual places this patient at the highest risk. Diabetes is the leading cause of CKD, and Black individuals are at increased risk of developing CKD. The other factors are significant but less critical compared to uncontrolled diabetes.
A nurse is educating a patient with CKD on strategies to prevent further kidney damage. Which of the following should be included in the teaching? (SATA)
A. Achieve optimal glycemic control.
B. Limit the use of ACE inhibitors and ARBs.
C. Monitor blood pressure regularly.
D. Avoid nephrotoxic drugs.
E. Use over-the-counter sodium bicarbonate daily.
A. Achieve optimal glycemic control.
C. Monitor blood pressure regularly.
D. Avoid nephrotoxic drugs.
Rationale: Achieving glycemic control and monitoring blood pressure are critical in managing and preventing CKD progression. Nephrotoxic drugs should be avoided or minimized to prevent further damage. ACE inhibitors and ARBs are commonly prescribed to control blood pressure and protect kidney function, so limiting them is incorrect. Sodium bicarbonate is only administered under specific conditions, such as acidosis, and not as a routine preventive measure.
A patient with a family history of CKD asks what they can do to reduce their risk. What is the nurse’s best response?
A. “You can reduce your risk by limiting protein in your diet.”
B. “Avoid all medications that are metabolized through the kidneys.”
C. “You should focus on managing blood pressure and regular screenings.”
D. “There’s not much you can do if you are genetically predisposed.”
C. “You should focus on managing blood pressure and regular screenings.”
Rationale: While a family history increases CKD risk, managing modifiable factors like blood pressure and undergoing regular screenings (e.g., blood pressure checks, urinalysis) can help detect and manage CKD early. Limiting protein is not a universal recommendation unless specifically prescribed. Avoiding all kidney-metabolized drugs is unnecessary but avoiding nephrotoxic ones is advised. Suggesting that nothing can be done is incorrect and unhelpful.
A nurse is administering medications to a patient with CKD. Which medication should the nurse question?
A. Metformin for diabetes
B. Lisinopril for hypertension
C. Ibuprofen for pain relief
D. Sodium bicarbonate for acidosis
C. Ibuprofen for pain relief
Rationale: Ibuprofen is a nephrotoxic drug and should be avoided in patients with CKD or those at risk for kidney damage. Lisinopril is an ACE inhibitor used to manage hypertension and protect kidney function in CKD. Metformin requires monitoring due to its potential risk for lactic acidosis in advanced CKD, but it is not contraindicated in all cases. Sodium bicarbonate is often prescribed to treat metabolic acidosis in CKD.
A 58-year-old Native American patient with hypertension and cardiovascular disease is being educated on CKD prevention. Which statement indicates understanding?
A. “I need to avoid all sodium in my diet to protect my kidneys.”
B. “If I take my blood pressure medications, I don’t need regular screenings.”
C. “I will work on maintaining my blood pressure and cholesterol within target ranges.”
D. “CKD is unavoidable due to my ethnicity and age.”
C. “I will work on maintaining my blood pressure and cholesterol within target ranges.”
Rationale: Maintaining blood pressure and cholesterol within target ranges is essential to reducing CKD risk. Completely avoiding sodium is not recommended; instead, sodium intake should be reduced to appropriate levels. Regular screenings are important even if blood pressure is controlled. While ethnicity and age increase risk, CKD is not unavoidable, and modifiable factors should be addressed.
A patient with newly diagnosed stage 2 CKD asks how to prevent progression of the disease. What is the nurse’s best response?
A. “You need to completely avoid protein in your diet.”
B. “Frequent kidney biopsies will help monitor disease progression.”
C. “Taking nephrotoxic medications in small doses is safe.”
D. “It is important to keep your blood sugar and blood pressure controlled.”
D. “It is important to keep your blood sugar and blood pressure controlled.”
Rationale: Controlling blood sugar and blood pressure is crucial in preventing CKD progression. Protein intake should be moderated, not completely avoided, as protein is essential for body function. Kidney biopsies are not routine for monitoring CKD progression. Nephrotoxic medications should be avoided or used only when necessary, under close monitoring.
A patient with CKD is prescribed an ACE inhibitor. What should the nurse include in patient education about this medication?
A. “This medication helps to control blood pressure and slow kidney disease progression.”
B. “This medication will reverse your kidney damage.”
C. “You will need to avoid foods high in potassium while taking this medication.”
D. “You should stop this medication if your blood pressure drops below 140/90.”
A. “This medication helps to control blood pressure and slow kidney disease progression.”
Rationale: ACE inhibitors help control blood pressure and slow CKD progression by reducing proteinuria and protecting renal function. These medications do not reverse kidney damage. Potassium levels should be monitored, as ACE inhibitors can cause hyperkalemia, but dietary potassium restrictions depend on individual lab values. Patients should not stop taking the medication without consulting their provider, even if blood pressure is low.
A patient with a GFR of 88 mL/min/1.73 m² is diagnosed with Stage 2 CKD. What is the nurse’s priority action?
A. Start preparation for renal replacement therapy (RRT).
B. Evaluate and treat complications of CKD.
C. Estimate the progression of kidney damage.
D. Begin aggressive treatment to prevent further GFR decline.
C. Estimate the progression of kidney damage.
Rationale: In Stage 2 CKD, the GFR is mildly decreased (60–89 mL/min/1.73 m²). The primary focus is estimating disease progression and monitoring for potential decline. Aggressive treatment and RRT preparation are more appropriate for later stages, such as Stage 4 or 5.
A nurse is caring for a patient with CKD who has a GFR of 28 mL/min/1.73 m². What clinical action plan should the nurse anticipate?
A. Diagnosis and treatment with a focus on cardiovascular risk reduction
B. Estimation of CKD progression
C. Immediate initiation of dialysis
D. Aggressive management of complications and preparation for RRT
D. Aggressive management of complications and preparation for RRT
Rationale: A GFR of 28 mL/min/1.73 m² corresponds to Stage 4 CKD. At this stage, preparation for RRT (dialysis or kidney transplant) is critical, alongside managing complications. Immediate dialysis is typically reserved for Stage 5 CKD or in cases of uremia.
Which patient is classified as having Stage 3b CKD?
A. GFR of 32 mL/min/1.73 m²
B. GFR of 45 mL/min/1.73 m²
C. GFR of 60 mL/min/1.73 m²
D. GFR of 15 mL/min/1.73 m²
A. GFR of 32 mL/min/1.73 m²
Rationale: A GFR of 30–44 mL/min/1.73 m² indicates Stage 3b CKD. Stage 3a corresponds to a GFR of 45–59, Stage 4 corresponds to a GFR of 15–29, and a GFR of 15 or lower signifies Stage 5 CKD.
A patient with a GFR of 25 mL/min/1.73 m² is preparing for RRT. The nurse understands that this patient is in which stage of CKD?
A. Stage 2
B. Stage 3b
C. Stage 4
D. Stage 5
C. Stage 4
Rationale: A GFR of 15–29 mL/min/1.73 m² corresponds to Stage 4 CKD, which focuses on preparation for RRT. Stage 5 (GFR <15) involves initiating RRT when uremia is present.
A patient with Stage 3a CKD requires education on their clinical action plan. What should the nurse include in the teaching? (SATA)
A. Evaluation of complications such as anemia and electrolyte imbalances
B. Early preparation for RRT
C. Aggressive treatment of CKD-related complications
D. Focus on controlling comorbid conditions, such as diabetes and hypertension
E. Routine monitoring of kidney function
A. Evaluation of complications such as anemia and electrolyte imbalances
D. Focus on controlling comorbid conditions, such as diabetes and hypertension
E. Routine monitoring of kidney function
Rationale: In Stage 3a CKD (GFR 45–59), the focus is on evaluating and managing complications, controlling comorbid conditions to slow progression, and routine monitoring of kidney function. Preparation for RRT and aggressive treatment of complications occur in Stage 4 and Stage 3b, respectively.
A patient with CKD has a GFR of 55 mL/min/1.73 m². Which clinical intervention is most appropriate at this stage?
A. Diagnosis and cardiovascular risk reduction
B. Aggressive management of CKD-related complications
C. Preparation for RRT, such as dialysis or kidney transplant
D. Evaluation and treatment of CKD-related complications
D. Evaluation and treatment of CKD-related complications
Rationale: A GFR of 55 mL/min/1.73 m² corresponds to Stage 3a CKD. The appropriate clinical action at this stage includes evaluating and treating complications. Cardiovascular risk reduction is emphasized in Stage 1, while aggressive complication management and RRT preparation occur in later stages.
A 72-year-old patient with diabetes and hypertension presents with a GFR of 18 mL/min/1.73 m². The patient reports fatigue, nausea, and confusion. What is the nurse’s priority intervention?
A. Recommend a low-protein diet to reduce kidney workload
B. Initiate dialysis immediately due to symptoms of uremia
C. Discuss options for kidney transplantation with the healthcare team
D. Monitor symptoms and repeat GFR testing in 3 months
B. Initiate dialysis immediately due to symptoms of uremia
Rationale: A GFR of 18 mL/min/1.73 m² corresponds to Stage 4 CKD, but the presence of symptoms such as fatigue, nausea, and confusion indicates uremia, which requires immediate initiation of dialysis. Kidney transplantation and dietary changes are important but not the priority in this situation. Waiting 3 months to repeat testing could worsen the patient’s condition.
A patient with a family history of CKD is diagnosed with Stage 1 CKD. What is the nurse’s priority education?
A. “Avoid foods high in potassium and phosphorus.”
B. “Focus on cardiovascular risk reduction and monitoring kidney function.”
C. “Prepare for dialysis if symptoms worsen.”
D. “Take nephrotoxic drugs in small doses to prevent further damage.”
B. “Focus on cardiovascular risk reduction and monitoring kidney function.”
Rationale: Stage 1 CKD is characterized by kidney damage with a normal or increased GFR (≥90 mL/min/1.73 m²). The focus at this stage is on cardiovascular risk reduction, early diagnosis, and routine monitoring. Dietary restrictions are unnecessary unless complications arise, and nephrotoxic drugs should be avoided.
A nurse is reviewing the lab results of a patient with CKD. Which GFR level should prompt the nurse to prepare the patient for dialysis?
A. 70 mL/min/1.73 m²
B. 48 mL/min/1.73 m²
C. 22 mL/min/1.73 m²
D. 12 mL/min/1.73 m²
D. 12 mL/min/1.73 m²
Rationale: A GFR of <15 mL/min/1.73 m² indicates Stage 5 CKD. At this stage, dialysis or another form of RRT is initiated if uremia is present. GFR values of 70, 48, and 22 correspond to Stages 2, 3a, and 4, respectively, where RRT preparation or other interventions are the focus.
A patient with Stage 4 CKD is asking about treatment options. What is the nurse’s best response?
A. “You are not yet at risk for requiring dialysis.”
B. “We will focus on preparing you for dialysis or a kidney transplant.”
C. “Aggressive dietary changes will stop the progression to kidney failure.”
D. “CKD progression cannot be managed at this stage.”
B. “We will focus on preparing you for dialysis or a kidney transplant.”
Rationale: In Stage 4 CKD (GFR 15–29 mL/min/1.73 m²), preparation for RRT, such as dialysis or kidney transplant, is essential. While dietary changes are part of managing CKD, they cannot fully stop progression. Claiming that CKD progression cannot be managed is incorrect, as interventions can slow disease advancement.
A nurse is caring for a patient with a GFR of 12 mL/min. The patient exhibits fatigue, pruritus, and confusion. Which condition is most likely causing these symptoms?
A. Hypovolemia
B. Uremia
C. Hyperkalemia
D. Acute kidney injury
B. Uremia
Rationale: Uremia is a syndrome that occurs when kidney function declines to the point that toxins, such as urea and creatinine, accumulate in the body, typically when the GFR is 15 mL/min or less. Symptoms such as fatigue, pruritus, and confusion are characteristic of uremia. While hyperkalemia can also occur in CKD, the combination of these systemic symptoms is more indicative of uremia.
A patient with CKD presents with increased creatinine and urea levels, generalized edema, and hypertension. What is the primary cause of these manifestations?
A. Retention of water and electrolytes
B. Hormonal imbalances due to uremia
C. Rapid decline in kidney function
D. Increased metabolic demand
A. Retention of water and electrolytes
Rationale: As kidney function deteriorates, the kidneys are unable to excrete water, urea, creatinine, and electrolytes, leading to fluid overload, generalized edema, and hypertension. Hormonal imbalances may contribute to other symptoms, but retention of water and electrolytes is the primary cause of these specific manifestations.
A patient with uremia secondary to CKD may exhibit which clinical manifestations? (SATA)
A. Peripheral neuropathy
B. Pruritus
C. Increased energy levels
D. Metallic taste in the mouth
E. Confusion
A. Peripheral neuropathy
B. Pruritus
D. Metallic taste in the mouth
E. Confusion
Rationale: Uremia can cause systemic symptoms due to the accumulation of toxins in the body. Peripheral neuropathy, pruritus, a metallic taste in the mouth, and confusion are common manifestations. Increased energy levels are not associated with uremia; patients often experience fatigue instead.
A nurse is reviewing the treatment plan for a patient with CKD and uremia. Which intervention is the priority for managing uremic symptoms?
A. Restrict fluid intake to 500 mL/day
B. Administer sodium bicarbonate to correct metabolic acidosis
C. Encourage a high-protein diet to improve energy levels
D. Prepare the patient for initiation of dialysis
D. Prepare the patient for initiation of dialysis
Rationale: Uremic symptoms develop when toxins accumulate due to severely decreased kidney function, typically at a GFR of 15 mL/min or less. Initiating dialysis is the priority to remove these toxins. While sodium bicarbonate and fluid restriction may be part of the management plan, they are not sufficient to address uremia. A high-protein diet is generally avoided in advanced CKD to reduce the production of nitrogenous waste.
A patient with advanced CKD reports experiencing pruritus and a metallic taste in the mouth. The nurse understands these symptoms are caused by which pathophysiological change?
A. Retention of urea and other waste products
B. Hyperkalemia leading to neurological changes
C. Increased hormone levels due to CKD
D. Hypocalcemia and secondary hyperparathyroidism
A. Retention of urea and other waste products
Rationale: Pruritus and a metallic taste in the mouth are caused by the accumulation of urea and other waste products in the body due to reduced kidney function. These symptoms are hallmark features of uremia. Hyperkalemia and hormonal imbalances can cause other systemic effects, but they do not directly result in these symptoms.
A 65-year-old patient with a history of diabetes and hypertension presents with a GFR of 13 mL/min. The patient reports nausea, muscle twitching, and lethargy. What is the priority nursing intervention?
A. Administer an antiemetic for nausea
B. Monitor potassium levels for hyperkalemia
C. Discuss initiation of dialysis with the healthcare provider
D. Educate the patient on dietary sodium restrictions
C. Discuss initiation of dialysis with the healthcare provider
Rationale: A GFR of 13 mL/min indicates Stage 5 CKD with uremia. Symptoms such as nausea, muscle twitching, and lethargy are consistent with uremic toxicity. The priority intervention is initiating dialysis to remove accumulated toxins. Monitoring potassium levels and addressing dietary restrictions are important but secondary to managing uremia immediately.
A patient with early-stage CKD reports polyuria. What is the most likely cause of this finding?
A. Excess glucose levels associated with diabetes
B. Fluid retention from CKD progression
C. Anuria secondary to renal dysfunction
D. Decreased glomerular filtration rate (GFR)
A. Excess glucose levels associated with diabetes
Rationale: In the early stages of CKD, patients typically do not experience significant changes in urine output due to kidney disease. However, since diabetes is the leading cause of CKD, polyuria is likely related to hyperglycemia causing osmotic diuresis. Fluid retention and anuria are more commonly seen in advanced CKD.
Which of the following changes in urinary output is most indicative of advanced CKD requiring dialysis?
A. Polyuria
B. Oliguria
C. Anuria
D. Nocturia
C. Anuria
Rationale: Anuria, or the complete absence of urine output, is a hallmark of end-stage CKD and occurs after a prolonged period on dialysis. In earlier stages, patients may experience polyuria or nocturia, but anuria is a significant indicator of advanced disease progression.
A patient with CKD may experience which urinary changes as the disease progresses? (SATA)
A. Difficulty with fluid retention
B. Anuria after dialysis
C. Polyuria due to CKD progression
D. Oliguria as GFR declines
E. Proteinuria in early stages
A. Difficulty with fluid retention
B. Anuria after dialysis
D. Oliguria as GFR declines
E. Proteinuria in early stages
Rationale: As CKD progresses, patients often develop difficulty with fluid retention (leading to edema) and eventually anuria, particularly after prolonged dialysis. Oliguria (reduced urine output) is common as kidney function declines. Proteinuria often occurs in the early stages of CKD due to glomerular damage. Polyuria is more likely due to diabetes than CKD progression.
A patient with CKD reports reduced urine output and significant swelling in the legs. The nurse anticipates which intervention?
A. Increase daily fluid intake
B. Administer diuretic therapy as prescribed
C. Prepare for an immediate dialysis session
D. Restrict dietary protein intake
B. Administer diuretic therapy as prescribed
Rationale: Reduced urine output and fluid retention (manifested as swelling) in CKD are managed initially with diuretic therapy to aid in fluid elimination. Dialysis may be needed in severe cases but is not the immediate response in this scenario. Increasing fluid intake would worsen fluid overload, and protein restriction is aimed at managing uremia, not fluid retention.
A nurse is providing discharge teaching to a patient with CKD. Which statement indicates the patient understands the progression of urinary changes in CKD?
A. “I will have increased urine output as my kidney disease gets worse.”
B. “Once my kidneys fail, I will have consistent urine output due to diuretic therapy.”
C. “Urinary changes in CKD are unrelated to disease progression.”
D. “My urine output will likely decrease over time, and I may stop making urine after starting dialysis.”
D. “My urine output will likely decrease over time, and I may stop making urine after starting dialysis.”
Rationale: As CKD progresses, patients often experience decreasing urine output due to reduced kidney function, and anuria may develop after a period of dialysis. Diuretic therapy can help manage fluid retention but does not guarantee consistent urine output. Increased urine output is typically seen in conditions such as diabetes, not as CKD worsens.
Which lab value is the most accurate indicator of kidney function in a patient with CKD?
A. Blood Urea Nitrogen (BUN)
B. Serum Creatinine
C. Serum Creatinine Clearance
D. Fasting Blood Glucose
C. Serum Creatinine Clearance
Rationale: Serum creatinine clearance (calculated GFR) is the most accurate indicator of kidney function because it reflects the ability of the kidneys to filter waste products. BUN levels can be influenced by other factors such as protein intake and catabolism, and serum creatinine alone is less reliable without the GFR calculation.
A patient with CKD has significantly elevated BUN levels. Which clinical manifestations would the nurse expect?
A. Nausea, lethargy, and headaches
B. Edema, pruritus, and dyspnea
C. Polyuria, polydipsia, and weight loss
D. Hypertension, tachycardia, and hematuria
A. Nausea, lethargy, and headaches
Rationale: Elevated BUN levels contribute to symptoms such as nausea, vomiting, lethargy, fatigue, impaired cognition, and headaches. These symptoms result from the accumulation of nitrogenous waste products in the bloodstream.
Which metabolic disturbance in CKD contributes to hyperinsulinemia?
A. Increased protein catabolism
B. Decreased triglyceride synthesis
C. Cellular resistance to insulin
D. Excess insulin excretion by the kidneys
C. Cellular resistance to insulin
Rationale: Impaired glucose metabolism due to cellular insensitivity to insulin leads to hyperinsulinemia in CKD. This occurs because the kidneys, which normally help excrete insulin, are unable to function properly, causing insulin to remain in circulation longer.
A patient with CKD is at risk for which metabolic disturbances? (SATA)
A. Hyperglycemia
B. Dyslipidemia
C. Hypoinsulinemia
D. Hypertriglyceridemia
E. Decreased HDL levels
A. Hyperglycemia
B. Dyslipidemia
D. Hypertriglyceridemia
E. Decreased HDL levels
Rationale: CKD leads to hyperglycemia and hyperinsulinemia due to impaired glucose metabolism. Dyslipidemia occurs with increased VLDL and LDL levels and decreased HDL levels. Hypertriglyceridemia results from increased hepatic triglyceride production. Hypoinsulinemia is not associated with CKD.
Which intervention is most appropriate for a patient with CKD who develops dyslipidemia?
A. Administer high-dose corticosteroids
B. Provide a low-protein diet
C. Prescribe lipid-lowering agents as ordered
D. Increase dietary carbohydrate intake
C. Prescribe lipid-lowering agents as ordered
Rationale: Lipid-lowering agents are used to manage dyslipidemia, which is common in CKD due to increased VLDL and LDL levels and decreased HDL levels. Corticosteroids and increased carbohydrate intake would exacerbate the condition, while dietary protein adjustments do not directly address lipid abnormalities.
A patient with diabetes and CKD has started dialysis. What adjustment might the nurse expect in the patient’s insulin therapy?
A. Increased insulin doses
B. Decreased insulin doses
C. No change in insulin therapy
D. Temporary discontinuation of insulin therapy
B. Decreased insulin doses
Rationale: In CKD, insulin remains in the circulation longer because it is excreted by the kidneys. When dialysis is initiated, patients often require less insulin as kidney function and glucose metabolism improve, though not to normal levels.
A patient with CKD reports fatigue and difficulty concentrating. Lab results reveal elevated BUN and serum creatinine levels. What is the underlying cause of these symptoms?
A. Hyperglycemia
B. Dyslipidemia
C. Hypoalbuminemia
D. Accumulation of waste products
D. Accumulation of waste products
Rationale: Elevated BUN and creatinine levels indicate waste product accumulation due to decreased kidney function. This contributes to symptoms such as fatigue, impaired cognition, and lethargy.
Which factors contribute to elevated BUN levels in CKD? (SATA)
A. Increased protein intake
B. Fever
C. Corticosteroid use
D. Dehydration
E. Hypoglycemia
A. Increased protein intake
B. Fever
C. Corticosteroid use
D. Dehydration
Rationale: Elevated BUN levels can result from factors such as increased protein intake, fever (increased catabolism), corticosteroid use, and dehydration. Hypoglycemia does not directly affect BUN levels.
Which lipid profile would the nurse expect in a patient with CKD?
A. Increased LDL, decreased HDL, and increased triglycerides
B. Increased HDL, decreased LDL, and decreased triglycerides
C. Increased HDL, increased VLDL, and decreased triglycerides
D. Decreased LDL, decreased HDL, and increased VLDL
A. Increased LDL, decreased HDL, and increased triglycerides
Rationale: Dyslipidemia in CKD typically involves increased LDL and VLDL levels, decreased HDL levels, and elevated triglycerides due to altered lipid metabolism.
A patient with CKD reports recurrent headaches and nausea. The nurse notes a GFR of 20 mL/min and a BUN of 80 mg/dL. What is the priority intervention?
A. Prepare the patient for dialysis
B. Increase fluid intake
C. Administer antiemetics as ordered
D. Restrict dietary carbohydrates
A. Prepare the patient for dialysis
Rationale: The patient’s GFR indicates severe kidney dysfunction (Stage 4 or 5 CKD), and the high BUN level suggests significant waste product accumulation. Dialysis is the priority intervention to manage uremia and prevent further complications. Antiemetics may provide symptom relief but do not address the underlying issue.
Which metabolic disturbance explains the need for careful insulin monitoring in patients with CKD?
A. Increased renal excretion of insulin
B. Insulin resistance caused by decreased hepatic metabolism
C. Prolonged insulin activity due to decreased renal clearance
D. Increased pancreatic insulin secretion
C. Prolonged insulin activity due to decreased renal clearance
Rationale: In CKD, the kidneys cannot effectively excrete insulin, leading to prolonged insulin activity in the bloodstream. As a result, patients may require less insulin to manage blood glucose levels. This makes close monitoring essential.
A patient with CKD presents with dyslipidemia. What findings are consistent with this condition? (SATA)
A. Elevated LDL levels
B. Increased HDL levels
C. Elevated triglycerides
D. Increased VLDL levels
E. Decreased lipoprotein lipase activity
A. Elevated LDL levels
C. Elevated triglycerides
D. Increased VLDL levels
E. Decreased lipoprotein lipase activity
Rationale: Dyslipidemia in CKD is characterized by elevated LDL, triglycerides, and VLDL levels, along with decreased HDL and reduced activity of lipoprotein lipase, which impairs the breakdown of lipoproteins.
A patient with CKD reports persistent nausea and impaired concentration. Lab results reveal a BUN level of 85 mg/dL. Which recommendation should the nurse include in the plan of care?
A. Decrease protein intake to reduce nitrogenous waste
B. Increase dietary sodium to improve waste excretion
C. Restrict fluid intake to minimize fluid retention
D. Administer antiemetics to alleviate nausea
A. Decrease protein intake to reduce nitrogenous waste
Rationale: Reducing protein intake can help decrease nitrogenous waste production, thereby lowering BUN levels and alleviating symptoms like nausea and cognitive impairment. Fluid and sodium restriction are important but not directly related to BUN. Antiemetics address symptoms but do not resolve the underlying problem.
A patient with CKD is experiencing hypertriglyceridemia. The nurse explains that this is due to which mechanism?
A. Increased glucose metabolism
B. Enhanced hepatic triglyceride production
C. Increased lipoprotein lipase activity
D. Improved insulin clearance
B. Enhanced hepatic triglyceride production
Rationale: Hypertriglyceridemia in CKD results from increased hepatic triglyceride production due to hyperinsulinemia and decreased lipoprotein lipase activity, which impairs lipid breakdown.
A patient with CKD has a GFR of 25 mL/min and elevated LDL and triglyceride levels. What is the primary goal of therapy for dyslipidemia in this patient?
A. Increase HDL levels
B. Reduce dietary protein intake
C. Initiate dialysis to improve lipid metabolism
D. Lower LDL and triglyceride levels to reduce CVD risk
D. Lower LDL and triglyceride levels to reduce CVD risk
Rationale: The primary goal in managing dyslipidemia in CKD is to lower LDL and triglyceride levels to reduce the risk of cardiovascular disease (CVD), which is the leading cause of death in CKD patients. Dialysis may improve metabolism but is not the first step for lipid management.
A patient with CKD asks why they are experiencing fatigue and cognitive difficulties. The nurse explains that these symptoms are due to which factor?
A. Hyperglycemia
B. Dehydration caused by fluid restriction
C. Hypoinsulinemia
D. Retention of nitrogenous waste products
D. Retention of nitrogenous waste products
Which electrolyte imbalance is most life-threatening in CKD and requires immediate attention?
A. Hypernatremia
B. Hyperkalemia
C. Hypermagnesemia
D. Hypocalcemia
B. Hyperkalemia
Rationale: Hyperkalemia is the most critical electrolyte imbalance in CKD, as potassium levels of 7–8 mEq/L can lead to fatal dysrhythmias. This requires immediate intervention to prevent cardiac complications.
What is a primary cause of hyperkalemia in patients with CKD?
A. Decreased sodium excretion
B. Excessive dietary potassium intake
C. Impaired renal potassium excretion
D. Increased magnesium reabsorption
C. Impaired renal potassium excretion
Rationale: In CKD, the kidneys’ ability to excrete potassium is diminished, leading to hyperkalemia. Although dietary intake may contribute, impaired excretion is the primary cause.
A patient with CKD presents with edema and hypertension. Which underlying electrolyte imbalance is most likely responsible?
A. Hyperkalemia
B. Hypernatremia
C. Sodium retention
D. Hypermagnesemia
C. Sodium retention
Rationale: Sodium retention is common in CKD due to impaired sodium excretion. This leads to fluid retention, contributing to edema and hypertension.
Which are possible complications of hypermagnesemia in CKD? (SATA)
A. Increased reflexes
B. Dysrhythmias
C. Hypotension
D. Decreased mental status
E. Seizures
B. Dysrhythmias
C. Hypotension
D. Decreased mental status
Rationale: Hypermagnesemia in CKD can lead to serious complications such as dysrhythmias, hypotension, and decreased mental status. Hypermagnesemia suppresses reflexes rather than increasing them. Seizures are not a common manifestation.
What dietary recommendation is typically made for sodium intake in patients with CKD?
A. Less than 1 g/day
B. 1.5 g/day
C. 2 g/day
D. 2.5 g/day
C. 2 g/day
Rationale: Sodium intake in CKD is often restricted to 2 g/day to prevent sodium retention, which can contribute to fluid overload, edema, and hypertension.
A CKD patient’s plasma bicarbonate level is 18 mEq/L. This finding indicates:
A. Severe metabolic alkalosis
B. Normal acid-base balance
C. Mild metabolic acidosis
D. Respiratory acidosis
C. Mild metabolic acidosis
Rationale: In CKD, metabolic acidosis occurs due to the impaired excretion of acid and defective bicarbonate regeneration. A plasma bicarbonate level of 18 mEq/L indicates mild metabolic acidosis.
What compensatory mechanism helps buffer metabolic acidosis in CKD?
A. Increased renal HCO3 − reabsorption
B. Respiratory alkalosis
C. Bone demineralization
D. Increased urinary acid excretion
C. Bone demineralization
Rationale: In CKD, bone demineralization serves as a compensatory mechanism by buffering metabolic acids. This prevents plasma bicarbonate levels from falling below 16–20 mEq/L.
A patient with CKD has dilutional hyponatremia. What clinical manifestation is most likely to occur?
A. Muscle twitching
B. Peripheral edema
C. Tachycardia
D. Dry mucous membranes
B. Peripheral edema
Rationale: Dilutional hyponatremia results from sodium retention with excess water, leading to peripheral edema. Muscle twitching and tachycardia are not common findings.
Why is serum creatinine clearance a better indicator of kidney function than BUN in CKD?
A. BUN levels are affected by protein intake and catabolism
B. Serum creatinine clearance decreases more slowly
C. BUN does not correlate with kidney damage
D. Serum creatinine clearance measures tubular reabsorption
A. BUN levels are affected by protein intake and catabolism
Rationale: BUN levels can be influenced by factors such as protein intake, fever, and corticosteroid use, making serum creatinine clearance (calculated GFR) a more reliable indicator of kidney function.
Which intervention is most appropriate to prevent hypermagnesemia in CKD?
A. Administer magnesium-containing antacids
B. Increase dietary magnesium
C. Limit the use of magnesium-containing medications
D. Encourage high fluid intake
C. Limit the use of magnesium-containing medications
Rationale: To prevent hypermagnesemia in CKD, it is important to avoid magnesium-containing medications such as antacids and laxatives, as the kidneys cannot effectively excrete magnesium.
What role does metabolic acidosis play in bone health for CKD patients?
A. Decreases calcium excretion
B. Promotes bone demineralization
C. Stimulates vitamin D activation
D. Reduces phosphorus reabsorption
B. Promotes bone demineralization
Rationale: In CKD, metabolic acidosis promotes bone demineralization as a compensatory mechanism to buffer excess acids. This can contribute to weakened bones over time.
Which factors contribute to hyperkalemia in CKD patients? (SATA)
A. Breakdown of cellular protein
B. Decreased potassium intake
C. Metabolic acidosis
D. Bleeding
E. Increased potassium excretion
A. Breakdown of cellular protein
C. Metabolic acidosis
D. Bleeding
Rationale: Hyperkalemia in CKD results from impaired potassium excretion, breakdown of cellular protein, bleeding, and metabolic acidosis. Decreased potassium intake and increased excretion would not lead to hyperkalemia.
Which laboratory value reflects effective buffering of metabolic acids in CKD?
A. Potassium level of 5.0 mEq/L
B. Serum bicarbonate level of 16–20 mEq/L
C. Magnesium level of 2.0 mg/dL
D. GFR of 60 mL/min
B. Serum bicarbonate level of 16–20 mEq/L
Rationale: In CKD, plasma bicarbonate levels typically stabilize at 16–20 mEq/L as bone demineralization compensates for excess acid, reflecting the body’s buffering capacity.
What is the primary cause of anemia in patients with CKD?
A. Frequent blood samplings
B. GI bleeding
C. Decreased erythropoietin production
D. Shortened RBC lifespan
C. Decreased erythropoietin production
Rationale: Anemia in CKD primarily results from decreased erythropoietin production. Erythropoietin stimulates the bone marrow to produce RBCs, and its deficiency is a hallmark of CKD-related anemia.
Which hormone’s overproduction in CKD contributes to anemia by inhibiting erythropoiesis?
A. Insulin
B. Parathyroid hormone (PTH)
C. Aldosterone
D. Renin
B. Parathyroid hormone (PTH)
Rationale: Increased PTH levels in CKD can inhibit erythropoiesis, shorten RBC survival, and cause bone marrow fibrosis, contributing to anemia.
What type of anemia is typically seen in CKD patients?
A. Microcytic, hypochromic
B. Macrocytic, normochromic
C. Normocytic, normochromic
D. Megaloblastic
C. Normocytic, normochromic
Rationale: Anemia in CKD is normocytic and normochromic, indicating that the RBCs are normal in size and color but fewer in number due to decreased erythropoietin production.
What is the most common cause of bleeding in CKD patients with uremia?
A. Impaired platelet function
B. Low hemoglobin levels
C. Reduced coagulation factors
D. Increased fibrinogen levels
A. Impaired platelet function
Rationale: Impaired platelet function due to decreased aggregation and release of platelet factor III is the most common cause of bleeding in CKD patients with uremia.
Which factors contribute to anemia in CKD? (SATA)
A. Increased RBC hemolysis
B. GI bleeding
C. Frequent blood samplings
D. Increased RBC lifespan
E. Bone marrow fibrosis
A. Increased RBC hemolysis
B. GI bleeding
C. Frequent blood samplings
E. Bone marrow fibrosis
Rationale: Anemia in CKD is multifactorial, with contributing factors including increased RBC hemolysis, GI bleeding, frequent blood samplings, and bone marrow fibrosis due to increased PTH levels. RBC lifespan is decreased, not increased.
What supplementation is often needed for CKD patients to support RBC maturation?
A. Vitamin B12
B. Vitamin D
C. Folic acid
D. Magnesium
C. Folic acid
Rationale: Folic acid, which is water-soluble and dialyzable, is essential for RBC maturation. CKD patients often require daily folic acid supplementation (1 mg/day).
What is the most effective method of iron supplementation for patients on dialysis?
A. Oral iron supplements
B. Dietary iron intake
C. Iron injections
D. Intravenous (IV) iron therapy
D. Intravenous (IV) iron therapy
Rationale: IV iron therapy is the most effective method for restoring iron levels in dialysis patients, as oral iron supplements may not be well absorbed and can cause GI side effects.
How does regular dialysis help correct bleeding tendencies in CKD?
A. Enhances RBC production
B. Increases fibrinogen levels
C. Stimulates bone marrow function
D. Improves platelet aggregation
D. Improves platelet aggregation
Rationale: Regular dialysis corrects bleeding tendencies in CKD by improving platelet aggregation and normalizing the release of platelet factor III, addressing the underlying platelet dysfunction.
Which immune system changes in CKD patients increase their infection risk?
A. Overactive cellular immunity
B. Suppressed cellular and humoral immunity
C. Increased WBC count
D. Enhanced antibody production
B. Suppressed cellular and humoral immunity
Rationale: CKD suppresses both cellular and humoral immune responses, leading to an increased risk of infection. These changes impair the body’s ability to fight infections effectively.
What external factor contributes to the increased infection risk in patients undergoing hemodialysis?
A. Frequent blood transfusions
B. Hyperglycemia
C. Vascular access catheter insertions
D. Malnutrition
C. Vascular access catheter insertions
Rationale: Vascular access for hemodialysis, such as catheters and needle insertions, increases the risk of infection by providing entry points for pathogens.
Which laboratory finding would indicate a need for folic acid supplementation in a CKD patient?
A. Low serum calcium levels
B. Macrocytic RBCs
C. Normocytic RBCs
D. Low serum potassium
B. Macrocytic RBCs
Rationale: Macrocytic RBCs can indicate a folic acid deficiency. Folic acid is dialyzable and needs to be supplemented in CKD patients to prevent anemia related to RBC maturation defects.
What factors contribute to infection risk in CKD patients? (SATA)
A. Hyperglycemia
B. Impaired WBC function
C. Overproduction of erythropoietin
D. External trauma from vascular access
E. Excess platelet aggregation
A. Hyperglycemia
B. Impaired WBC function
C. Overproduction of erythropoietin
D. External trauma from vascular access
Rationale: CKD patients are at higher risk of infection due to hyperglycemia, impaired WBC function, and external trauma from vascular access. Overproduction of erythropoietin and excessive platelet aggregation are not contributing factors.
Which symptom would be most indicative of impaired platelet function in a CKD patient?
A. Petechiae
B. Hematuria
C. Polycythemia
D. Leukocytosis
A. Petechiae
Rationale: Petechiae, small red or purple spots caused by bleeding into the skin, are a common sign of impaired platelet function, which is a hallmark of bleeding tendencies in CKD.
What is the leading cause of death in patients with CKD?
A. Infection
B. Cardiovascular disease (CVD)
C. Hyperkalemia
D. Hypertensive encephalopathy
B. Cardiovascular disease (CVD)
Rationale: Cardiovascular disease is the leading cause of death in CKD patients due to complications like myocardial infarction, heart failure, and stroke.
Which vascular change is associated with CKD and contributes to arterial stiffness?
A. Endothelial thickening
B. Calcium deposits in the vascular medial layer
C. Collagen overproduction
D. Decreased vascular smooth muscle activity
B. Calcium deposits in the vascular medial layer
Rationale: Vascular calcification, specifically calcium deposits in the medial layer of arteries, leads to arterial stiffness in CKD patients.
Which is both a cause and a consequence of CKD?
A. Hypertension
B. Peripheral arterial disease
C. Hyperkalemia
D. Retinopathy
A. Hypertension
Rationale: Hypertension is both a cause and a consequence of CKD. It results from sodium retention, ECF volume expansion, and increased renin production.
Which mechanisms contribute to vascular calcification in CKD? (SATA)
A. Abnormal bone metabolism
B. Increased ECF sodium retention
C. Drug therapies like calcium-phosphate binders
D. Vascular smooth muscle cells changing into chondrocytes or osteoblast-like cells
E. Elevated levels of erythropoietin
A. Abnormal bone metabolism
C. Drug therapies like calcium-phosphate binders
D. Vascular smooth muscle cells changing into chondrocytes or osteoblast-like cells
Rationale: Vascular calcification in CKD results from abnormal bone metabolism, drug therapies like calcium-phosphate binders, and vascular smooth muscle cells transforming into chondrocyte- or osteoblast-like cells.
What is the primary cause of left ventricular hypertrophy (LVH) in CKD patients?
A. Hyperkalemia
B. Dyslipidemia
C. Hyperphosphatemia
D. Long-standing hypertension
D. Long-standing hypertension
Rationale: Long-standing hypertension, extracellular fluid (ECF) volume overload, and anemia are key contributors to the development of LVH in CKD patients.
What clinical sign is most indicative of uremic pericarditis in CKD patients?
A. Widened pulse pressure
B. Bounding peripheral pulses
C. Elevated central venous pressure
D. Friction rub on auscultation
D. Friction rub on auscultation
Rationale: Uremic pericarditis commonly presents with a pericardial friction rub, chest pain, and a low-grade fever.
Which cardiovascular condition in CKD patients results from hyperkalemia?
A. Dysrhythmias
B. Pericarditis
C. Stroke
D. Heart failure
A. Dysrhythmias
Rationale: Hyperkalemia increases the risk of potentially fatal dysrhythmias due to its effect on cardiac electrical conduction.
What are the potential consequences of uncontrolled hypertension in CKD patients? (SATA)
A. Retinopathy
B. Nephropathy
C. Cardiomyopathy
D. Hyperlipidemia
E. Encephalopathy
A. Retinopathy
B. Nephropathy
C. Cardiomyopathy
E. Encephalopathy
Rationale: Uncontrolled hypertension in CKD patients can lead to retinopathy, nephropathy, cardiomyopathy, and encephalopathy. Hyperlipidemia, while common, is not a direct consequence of hypertension.
What is the most important therapeutic goal in CKD management to prevent cardiovascular complications?
A. Controlling serum potassium
B. Reducing dietary phosphate intake
C. Managing blood pressure
D. Increasing serum albumin levels
C. Managing blood pressure
Rationale: Managing blood pressure is crucial in CKD management to prevent complications such as left ventricular hypertrophy, heart failure, and retinopathy.
Which CKD-related complication is most likely to progress to cardiac tamponade if untreated?
A. Dysrhythmias
B. Uremic pericarditis
C. Left ventricular hypertrophy
D. Peripheral arterial disease
B. Uremic pericarditis
Rationale: Uremic pericarditis can lead to pericardial effusion and, if untreated, progress to cardiac tamponade, a life-threatening condition.
What is the mechanism by which calcium-phosphate binders contribute to vascular calcification in CKD patients?
A. Reducing phosphate absorption from the GI tract
B. Increasing total body calcium and phosphate levels
C. Promoting renal excretion of phosphate
D. Inhibiting osteoblast activity
B. Increasing total body calcium and phosphate levels
Rationale: Calcium-phosphate binders can contribute to vascular calcification by increasing total body calcium and phosphate levels, which deposit in the vasculature.
What is the most common cardiovascular manifestation linked to sodium retention and ECF volume overload in CKD?
A. Stroke
B. Peripheral arterial disease
C. Hypertension
D. Dysrhythmias
C. Hypertension
Rationale: Sodium retention and ECF volume overload in CKD commonly lead to hypertension, which is a significant cardiovascular manifestation and a risk factor for further complications.
What type of breathing pattern may occur in patients with severe acidosis as a compensatory mechanism?
A. Bradypnea
B. Cheyne-Stokes respiration
C. Apneustic breathing
D. Kussmaul breathing
D. Kussmaul breathing
Rationale: Kussmaul breathing is a deep, labored breathing pattern that helps increase CO2 removal to compensate for severe acidosis.
Which of the following respiratory conditions is most likely to occur in CKD patients due to fluid overload?
A. Pulmonary fibrosis
B. Pneumothorax
C. Pulmonary edema
D. Chronic obstructive pulmonary disease
C. Pulmonary edema
Rationale: Pulmonary edema occurs in CKD patients due to fluid overload, which can lead to difficulty breathing and decreased oxygenation.
What condition related to the respiratory system in CKD patients is characterized by inflammation of the pleura?
A. Pneumonia
B. Uremic pleuritis
C. Pleural effusion
D. Acute respiratory distress syndrome
B. Uremic pleuritis
Rationale: Uremic pleuritis (or pleurisy) is an inflammation of the pleura that occurs in CKD patients, often contributing to respiratory discomfort and pain.
Which factor in CKD patients is most likely to contribute to dyspnea?
A. Respiratory infections
B. Hyperkalemia
C. Anemia
D. Fluid overload
D. Fluid overload
Rationale: Fluid overload, which can cause pulmonary edema and pleural effusions, is a common cause of dyspnea in CKD patients.
A 65-year-old patient with chronic kidney disease (CKD) presents with stomatitis, a metallic taste in the mouth, and anorexia. The nurse is concerned about the potential impact of these symptoms on the patient’s nutritional status. What should the nurse prioritize in the care plan for this patient?
A. Increase fluid intake to help with hydration.
B. Administer antiemetic medication to relieve nausea.
C. Provide high-protein, high-calorie foods to prevent malnutrition.
D. Encourage the patient to use mouthwash to reduce the metallic taste.
C. Provide high-protein, high-calorie foods to prevent malnutrition.
Rationale: The patient’s symptoms suggest impaired oral intake and potential malnutrition. Providing high-protein, high-calorie foods helps prevent further nutritional decline and supports the healing process. While other options address symptoms, they do not directly address the nutritional risk.
A patient with CKD presents with uremic fetor and reports feeling nauseous. The nurse understands that this could indicate progression to end-stage renal disease (ESRD). What is the most appropriate intervention for managing nausea in this patient?
A. Administer an intravenous bolus of normal saline.
B. Offer small, frequent meals that are low in protein.
C. Administer antiemetic medication as prescribed.
D. Encourage the patient to perform deep breathing exercises.
C. Administer antiemetic medication as prescribed.
Rationale: Antiemetic medication is the most appropriate intervention for managing nausea in a patient with CKD and uremic fetor. This helps reduce nausea and improve comfort. While other interventions may be helpful for overall management, antiemetic therapy directly addresses the patient’s symptom.
A 50-year-old diabetic patient with CKD develops diabetic gastroparesis and presents with weight loss, nausea, and vomiting. What would be an important consideration in planning care for this patient?
A. Increase the patient’s fiber intake to manage constipation.
B. Administer an antiemetic before meals to prevent vomiting.
C. Restrict protein intake to reduce the burden on the kidneys.
D. Encourage the patient to lie down after eating to aid digestion.
B. Administer an antiemetic before meals to prevent vomiting.
Rationale: Diabetic gastroparesis causes delayed gastric emptying, contributing to nausea and vomiting. Administering antiemetic medication before meals can help prevent these symptoms and improve the patient’s ability to eat. Other interventions are less relevant for managing the gastroparesis.
A patient with CKD is experiencing constipation due to the use of calcium-containing phosphate binders and decreased physical activity. Which intervention is most likely to help alleviate this problem?
A. Increase fluid intake to promote bowel movement.
B. Administer a stool softener as prescribed.
C. Decrease dietary intake of calcium-rich foods.
D. Encourage the patient to engage in light exercise daily.
D. Encourage the patient to engage in light exercise daily.
Rationale: Light exercise is an effective intervention for promoting bowel motility and alleviating constipation. While other options may also be useful, encouraging physical activity addresses the root cause of the constipation in this patient.
A 72-year-old male with advanced CKD reports experiencing frequent episodes of nausea, vomiting, and abdominal discomfort. He also has a history of GI bleeding due to mucosal irritation. What is the nurse’s priority action in this case?
A. Monitor vital signs, especially for signs of hypovolemia.
B. Administer a proton pump inhibitor (PPI) to reduce stomach acid.
C. Assess the patient’s platelet count and coagulation status.
D. Encourage the patient to eat smaller, more frequent meals.
C. Assess the patient’s platelet count and coagulation status.
Rationale: GI bleeding in CKD patients is commonly related to mucosal irritation and platelet dysfunction. Assessing the patient’s platelet count and coagulation status is crucial to identify any bleeding risks and prevent further complications. While other actions are also important, monitoring coagulation parameters is the priority in this case.
A 60-year-old patient with advanced chronic kidney disease (CKD) presents with complaints of feeling lethargic, irritable, and unable to concentrate. The nurse recognizes that these symptoms are likely related to the progression of CKD. What is the most appropriate initial intervention?
A. Assess the patient for potential electrolyte imbalances.
B. Administer a sedative to promote rest.
C. Begin a trial of cognitive behavioral therapy for concentration issues.
D. Increase the patient’s daily protein intake to address fatigue.
A. Assess the patient for potential electrolyte imbalances.
Rationale: Lethargy, irritability, and difficulty concentrating in CKD patients are often related to electrolyte imbalances and the buildup of nitrogenous waste products. Assessing for these imbalances is a critical first step before initiating further interventions.
A patient with CKD is showing signs of peripheral neuropathy, including paresthesias in the feet and legs. What is the most appropriate action for the nurse to take in managing this patient’s symptoms?
A. Administer pain medications as prescribed.
B. Encourage the patient to rest and limit physical activity.
C. Initiate physical therapy to improve motor function.
D. Monitor the patient’s neurological status closely and prepare for dialysis.
D. Monitor the patient’s neurological status closely and prepare for dialysis.
Rationale: Peripheral neuropathy in CKD is a result of nerve damage caused by the buildup of toxins, and dialysis is the primary treatment option to address the underlying cause. Monitoring the patient’s neurological status is essential, as it will guide the appropriate interventions, including dialysis.
A patient with CKD reports feeling a burning sensation in their feet and legs, which is a sign of peripheral neuropathy. Which additional symptom would indicate progression to motor neuropathy in this patient?
A. Loss of deep tendon reflexes
B. Sensitivity to touch and temperature
C. Increase in muscle strength
D. Decreased coordination and balance
A. Loss of deep tendon reflexes
Rationale: Loss of deep tendon reflexes is a sign of motor neuropathy, which may accompany peripheral neuropathy in CKD. This symptom indicates a progression of nerve involvement beyond sensory changes, and further management is needed.
A patient with advanced CKD has developed asterixis (hand-flapping tremor). Which intervention is most appropriate for this patient?
A. Administer an anticonvulsant to prevent seizures.
B. Increase fluid intake to reduce nitrogenous waste buildup.
C. Initiate dialysis to manage the underlying causes.
D. Apply restraints to prevent injury from the tremor.
C. Initiate dialysis to manage the underlying causes.
Rationale: Asterixis is a sign of uremic encephalopathy, which is a result of the accumulation of nitrogenous waste products in the body. Dialysis is the most appropriate intervention to address the underlying cause and reduce neurological symptoms.
A 55-year-old patient with diabetic neuropathy and CKD is experiencing worsening symptoms of uremic neuropathy, including bilateral foot drop and muscle weakness. What is the nurse’s priority concern in managing this patient’s care?
A. Prescribe a higher dose of insulin to control glucose levels.
B. Initiate physical therapy to improve muscle strength and gait.
C. Monitor for signs of respiratory depression due to muscle weakness.
D. Consider dialysis to address the underlying causes of neuropathy.
D. Consider dialysis to address the underlying causes of neuropathy.
Rationale: Uremic neuropathy is a common complication of CKD, and dialysis is the most effective treatment to address the underlying causes, such as the accumulation of waste products. Other interventions may support symptom management, but dialysis is the priority for disease management.
A patient with CKD reports nighttime leg cramps and difficulty sleeping. Which nursing intervention is most appropriate to help alleviate these symptoms?
A. Recommend stretching exercises before bed to reduce muscle cramps.
B. Suggest increasing protein intake to address muscle weakness.
C. Encourage the use of sleep medications to improve rest.
D. Advise the patient to limit fluid intake in the evening.
A. Recommend stretching exercises before bed to reduce muscle cramps.
Rationale: Stretching exercises before bed can help alleviate muscle cramps, a common symptom of CKD-related neuropathy. While other options may address some aspects of CKD, they are not directly helpful for managing leg cramps.
A 68-year-old patient with stage 5 CKD presents with altered mental status and confusion. The nurse notes that the patient has chosen not to undergo renal replacement therapy (RRT). What is the most likely cause of the patient’s altered mental status?
A. Increased nitrogenous waste products in the blood
B. Low blood glucose levels from diabetes
C. Excessive fluid retention leading to brain edema
D. Sedative medications prescribed for sleep disturbances
A. Increased nitrogenous waste products in the blood
Rationale: Altered mental status in stage 5 CKD is often caused by the accumulation of nitrogenous waste products (uremia) when renal function is severely impaired, and renal replacement therapy is not initiated.
A 70-year-old patient with CKD reports burning sensations in the feet and difficulty walking. The nurse is concerned that these symptoms may worsen. Which of the following is the most important intervention to prevent further neurological deterioration in this patient?
A. Administer pain relievers as prescribed.
B. Encourage regular exercise to maintain mobility.
C. Monitor the patient’s renal function and prepare for dialysis.
D. Recommend a diet high in antioxidants to support nerve health.
C. Monitor the patient’s renal function and prepare for dialysis.
Rationale: The progression of peripheral neuropathy in CKD is largely due to the buildup of toxins that affect nerve function. Monitoring renal function and preparing the patient for dialysis is critical to slowing or halting the progression of neurological deterioration.
A patient with CKD and peripheral neuropathy is found to have bilateral foot drop. What is the nurse’s primary concern for this patient?
A. The patient is at risk for falls due to difficulty walking.
B. The patient may experience muscle spasms and pain.
C. The patient’s foot drop may resolve with proper nutrition.
D. The patient’s condition may improve with physical therapy alone.
A. The patient is at risk for falls due to difficulty walking.
Rationale: Bilateral foot drop is a serious complication that can impair the patient’s ability to walk and maintain balance, placing them at high risk for falls and injury. Fall precautions and mobility support should be prioritized.
A patient with CKD develops restless legs syndrome (RLS) in the later stages of the disease. What is the most appropriate intervention to help manage this symptom?
A. Administer a muscle relaxant to relieve discomfort.
B. Encourage the patient to take daily warm baths before bed.
C. Begin dialysis to reduce the buildup of waste products.
D. Recommend a high-protein, low-carb diet to improve symptoms.
C. Begin dialysis to reduce the buildup of waste products.
Rationale: Restless legs syndrome in CKD is often related to the accumulation of waste products and is typically managed through dialysis, which helps to reduce these toxins. Other interventions may offer symptomatic relief but do not address the root cause of the condition.
A patient with CKD and a history of seizures is being monitored closely. The nurse notes an increasing BUN level. What is the priority action the nurse should take?
A. Administer an anticonvulsant medication to prevent seizure activity.
B. Initiate fluid restrictions to prevent worsening of kidney function.
C. Prepare for dialysis to manage the increased BUN level.
D. Increase the patient’s intake of high-calcium foods.
C. Prepare for dialysis to manage the increased BUN level.
Rationale: A rapidly increasing BUN level can lead to uremic encephalopathy, which may cause seizures and coma. Dialysis is the most effective intervention to address this issue by removing nitrogenous waste products.
A patient with advanced CKD reports irritability and difficulty concentrating. What is the most likely cause of these symptoms?
A. Hyperglycemia due to poor diabetes management
B. Electrolyte imbalances affecting muscle function
C. Side effects of medications used to manage CKD
D. Increased nitrogenous waste products affecting the CNS
D. Increased nitrogenous waste products affecting the CNS
Rationale: Increased nitrogenous waste products, such as urea, can accumulate in the blood as kidney function declines, leading to CNS depression, including irritability, difficulty concentrating, and altered mental status.
A 58-year-old patient with CKD is diagnosed with CKD-MBD. The nurse notes that the patient has low serum calcium and high serum phosphate levels. What is the most likely consequence of these imbalances in this patient?
A. Hyperkalemia and arrhythmias
B. Elevated blood pressure due to fluid retention
C. Excessive potassium excretion leading to muscle weakness
D. Increased risk for fractures due to weakened bones
D. Increased risk for fractures due to weakened bones
Rationale: Low serum calcium and high phosphate levels in CKD-MBD lead to bone demineralization and weakened bone structure, increasing the risk of fractures. These imbalances trigger parathyroid hormone (PTH) secretion, leading to further bone remodeling and weakening.
A 65-year-old patient with CKD reports experiencing muscle cramps and tingling in the hands. Blood tests show low ionized calcium levels. What is the most likely cause of these symptoms?
A. Hypocalcemia caused by CKD-MBD
B. Hyperkalemia related to kidney dysfunction
C. Dehydration due to fluid restrictions
D. High phosphate levels resulting from impaired kidney function
A. Hypocalcemia caused by CKD-MBD
Rationale: Low ionized calcium levels, which are common in CKD-MBD, can lead to symptoms such as muscle cramps and tingling in the hands. These symptoms are typically associated with hypocalcemia, which occurs as a result of impaired kidney function and reduced activation of vitamin D.
A patient with CKD and low vitamin D levels is prescribed calcium and phosphate binders. What is the primary reason for this treatment?
A. To increase serum calcium levels and decrease phosphate levels
B. To prevent bone demineralization and fractures
C. To correct metabolic acidosis and improve kidney function
D. To improve the patient’s ability to absorb dietary calcium
A. To increase serum calcium levels and decrease phosphate levels
Rationale: The primary role of calcium and phosphate binders in CKD-MBD is to decrease serum phosphate levels and prevent the further decline in serum calcium levels, helping to restore balance between calcium and phosphate.
A patient with CKD is diagnosed with osteitis fibrosa. Which of the following is the most likely cause of this condition?
A. Impaired calcium absorption from the GI tract
B. Increased calcium excretion by the kidneys
C. Increased parathyroid hormone (PTH) levels causing bone remodeling
D. Excessive vitamin D levels leading to bone mineralization
C. Increased parathyroid hormone (PTH) levels causing bone remodeling
Rationale: Osteitis fibrosa occurs when increased PTH levels cause excessive bone remodeling, leading to bone decalcification and replacement of bone tissue with fibrous tissue. This is a direct result of CKD-MBD and is a common complication of CKD.
A patient with CKD-MBD presents with a history of osteomalacia. What is the most likely cause of this condition in the patient?
A. High levels of vitamin D leading to mineralization of bones
B. Delayed bone turnover and defective mineralization of newly formed bone
C. Decreased parathyroid hormone (PTH) secretion
D. Increased phosphate excretion by the kidneys
B. Delayed bone turnover and defective mineralization of newly formed bone
Rationale: Osteomalacia is caused by slow bone turnover and defective mineralization of newly formed bone, which occurs due to low vitamin D levels and impaired calcium absorption in CKD. This leads to weakened bones and an increased risk of fractures.
A patient with CKD is at risk for vascular calcifications. What is the primary concern related to these calcifications?
A. Increased risk of bleeding and bruising
B. Disruption of cardiac conduction and potential cardiac arrest
C. Impaired bone healing and regeneration
D. Excessive fluid retention leading to hypertension
B. Disruption of cardiac conduction and potential cardiac arrest
Rationale: Vascular calcifications in CKD can disrupt cardiac conduction, increasing the risk of arrhythmias and potentially causing cardiac arrest. This is a significant complication of CKD-MBD and is a major contributor to cardiovascular disease.
A 72-year-old patient with CKD presents with a “red eye” that is painful and irritated. What is the most likely cause of this symptom?
A. Inflammation due to uremic retinopathy
B. Uremic red eye due to calcium deposits in the eye
C. Conjunctivitis from poor hygiene
D. Dry eyes from medication side effects
B. Uremic red eye due to calcium deposits in the eye
Rationale: Uremic red eye is caused by irritation from calcium deposits in the eye, a complication of CKD-MBD. This occurs due to the imbalance of calcium and phosphate in the body, which leads to vascular calcifications.
A patient with CKD has a bone biopsy performed, which confirms the diagnosis of CKD-MBD. What is the gold standard for diagnosing CKD-MBD?
A. Serum calcium and phosphate levels
B. Parathyroid hormone (PTH) levels
C. Bone biopsy
D. X-ray imaging of the bones
C. Bone biopsy
Rationale: The gold standard for diagnosing CKD-MBD is a bone biopsy, which allows for direct examination of bone tissue to confirm the presence of osteomalacia or osteitis fibrosa. Other diagnostic methods, such as blood tests and imaging, can provide supportive information but are not definitive.
A patient with CKD-MBD is being treated with vitamin D supplementation. What is the expected outcome of this treatment?
A. Increased calcium absorption from the GI tract
B. Decreased phosphate levels due to enhanced kidney excretion
C. Reduced PTH secretion and improved bone remodeling
D. Prevention of vascular calcifications
A. Increased calcium absorption from the GI tract
Rationale: Vitamin D supplementation helps increase calcium absorption from the GI tract. In CKD, where active vitamin D production is impaired, supplementation is necessary to optimize calcium levels and improve overall mineral metabolism.
A patient with CKD and hyperphosphatemia is being treated with phosphate binders. What is the primary purpose of this treatment?
A. To increase calcium absorption and reduce bone demineralization
B. To decrease vitamin D levels and prevent toxicity
C. To correct metabolic acidosis and improve kidney function
D. To reduce phosphate levels and prevent further calcium depletion
D. To reduce phosphate levels and prevent further calcium depletion
Rationale: Phosphate binders are used to reduce phosphate levels in the blood, which helps prevent further depletion of calcium and mitigates the development of complications such as vascular calcifications and bone mineralization disorders.
A patient with CKD undergoing dialysis reports intense itching, which has led to skin bleeding and infection. What is the most likely cause of this itching?
A. Dry skin and sensory neuropathy
B. Uremic frost due to high BUN levels
C. Allergic reaction to dialysis
D. Inadequate dialysis leading to toxin buildup
A. Dry skin and sensory neuropathy
Rationale: Itching in CKD patients, especially those undergoing dialysis, is often due to dry skin, calcium-phosphate deposition in the skin, and sensory neuropathy. These factors contribute to the discomfort, which can lead to skin damage from excessive scratching.
A patient with advanced CKD and a BUN level over 200 mg/dL is noted to have white crystalline deposits on the skin. What is the most likely condition?
A. Uremic frost
B. Sensory neuropathy
C. Hypercalcemia
D. Psoriasis
A. Uremic frost
Rationale: Uremic frost occurs when urea crystallizes on the skin, typically seen in patients with very high BUN levels (over 200 mg/dL). This condition is rare and is a sign of severe uremia.
A dialysis patient complains of persistent itching, which worsens at night. What is the most appropriate intervention to manage this symptom?
A. Increase the frequency of dialysis treatments
B. Recommend corticosteroid creams to reduce inflammation
C. Apply moisturizing lotions and use antihistamines as prescribed
D. Encourage increased fluid intake to hydrate the skin
C. Apply moisturizing lotions and use antihistamines as prescribed
Rationale: Itching in dialysis patients can be alleviated by moisturizing the skin and using antihistamines to control the pruritus. This addresses the common causes of itching in CKD, including dry skin and sensory neuropathy.
A patient with CKD develops intense itching and reports that the itching often leads to open wounds from scratching. What complication can result from this behavior?
A. Skin infections
B. Tissue necrosis
C. Hypercalcemia
D. Uremic frost formation
A. Skin infections
Rationale: Intense itching, especially when scratched to the point of breaking the skin, can lead to skin infections. This is a common complication in CKD patients with refractory pruritus.
A 65-year-old patient on dialysis presents with severe pruritus, and the nurse observes signs of infection on the patient’s scratching areas. What should the nurse prioritize in the care of this patient?
A. Monitor for signs of uremic frost
B. Apply topical antibiotics to scratched areas
C. Administer a topical corticosteroid cream
D. Assess for signs of peripheral neuropathy
B. Apply topical antibiotics to scratched areas
Rationale: The nurse should prioritize preventing and managing infection in areas where the patient has scratched. Applying topical antibiotics can help prevent further complications. Managing the itching is also essential but secondary to addressing the infection risk.
A woman with CKD undergoing dialysis reports amenorrhea and difficulty with fertility. Which of the following hormonal changes is most likely contributing to her condition?
A. Elevated estrogen and progesterone levels
B. Increased levels of testosterone and luteinizing hormone
C. Low follicle-stimulating hormone and high progesterone levels
D. Decreased estrogen, progesterone, and luteinizing hormone levels
D. Decreased estrogen, progesterone, and luteinizing hormone levels
Rationale: In women with CKD, low levels of estrogen, progesterone, and luteinizing hormone cause anovulation and menstrual changes, including amenorrhea. This disruption in hormonal balance is a common cause of infertility in these patients.
A male patient with CKD reports difficulty maintaining an erection. What is the most likely cause of his sexual dysfunction?
A. Peripheral neuropathy causing impotence
B. Elevated testosterone levels
C. Anemia leading to fatigue and decreased libido
D. Increased estrogen levels
A. Peripheral neuropathy causing impotence
Rationale: Peripheral neuropathy is a common cause of impotence in men with CKD. Nerve damage can affect sexual function, leading to erectile dysfunction. Anemia, while contributing to fatigue and decreased libido, is not directly linked to impotence.
A woman with CKD and a history of infertility begins dialysis and notices improvements in her menstrual cycle. What factor is most likely responsible for this improvement?
A. Decreased estrogen and progesterone levels
B. Improved peripheral neuropathy symptoms
C. Restoration of ovulation due to dialysis
D. Increased testosterone levels
C. Restoration of ovulation due to dialysis
Rationale: In women with CKD, dialysis can help restore normal menstrual cycles and ovulation by improving overall kidney function, which in turn helps normalize hormone levels. This is a common observation in patients starting dialysis.
A patient who recently underwent a kidney transplant is now pregnant. What is the most important consideration for managing this pregnancy?
A. The patient is at low risk of complications due to improved kidney function
B. Pregnancy carries significant risk for both the mother and fetus
C. Pregnancy in a transplanted patient always results in a successful outcome
D. The pregnancy is risk-free because the patient no longer requires dialysis
B. Pregnancy carries significant risk for both the mother and fetus
Rationale: Pregnancy in patients with a kidney transplant carries significant risks for both the mother and fetus, including complications related to kidney function, immunosuppressive therapy, and overall maternal health. Although some patients can carry a fetus to term, careful monitoring and management are essential.
A patient with CKD expresses feelings of sadness, fatigue, and loss of interest in daily activities. These symptoms are most likely related to:
A. Emotional lability and depression caused by the physical changes of CKD
B. Increased levels of uremic toxins that affect mood and behavior
C. Lack of access to social support and family networks
D. Overuse of medications required to manage CKD
A. Emotional lability and depression caused by the physical changes of CKD
Rationale: Personality and behavioral changes, emotional lability, and depression are common in patients with CKD, often due to the physical changes caused by the disease, such as edema, skin changes, and the presence of access devices. These factors can lead to anxiety and depressive symptoms.
A patient with CKD is experiencing significant body image changes due to edema and access devices. Which of the following interventions would be most effective in addressing the patient’s emotional distress?
A. Encouraging the patient to focus on their physical appearance
B. Providing information on available psychological support or counseling
C. Suggesting that the patient avoid discussing their condition with family members
D. Reassuring the patient that these changes will resolve with dialysis
B. Providing information on available psychological support or counseling
Rationale: Providing psychological support or counseling can help address emotional distress and body image issues. It allows the patient to express their feelings and develop coping strategies. Simply reassuring the patient or discouraging discussions may not address the underlying emotional needs.
A patient with CKD is struggling with concentration and appears disinterested in their environment. This is most likely due to:
A. Dulling of the senses from medications prescribed for CKD
B. A lack of motivation to engage in social interactions
C. The normal process of aging and not related to CKD
D. Decreased kidney function leading to slowed mental activity
D. Decreased kidney function leading to slowed mental activity
Rationale: Decreased kidney function can lead to slowed mental activity, which can make the patient appear disengaged and have difficulty concentrating. This is a common psychologic change seen in CKD patients due to the buildup of uremic toxins and the physical effects of the disease.
A 45-year-old patient with a history of diabetes has persistent proteinuria (1+ protein on dipstick testing for 3 consecutive months). Which of the following actions is the nurse most likely to recommend next?
A. Monitor the patient’s blood pressure and initiate lifestyle changes.
B. Perform a blood test for glucose and check for diabetes-related complications.
C. Evaluate for albuminuria with a urine test, as it may not be detected on routine urinalysis.
D. Begin treatment with a calcium-channel blocker to reduce kidney damage.
C. Evaluate for albuminuria with a urine test, as it may not be detected on routine urinalysis.
Rationale: Albuminuria, which is not detected on routine urinalysis, should be evaluated in patients with diabetes who have persistent proteinuria. This test is essential for assessing kidney function and identifying early kidney damage.
A patient presents with suspected CKD. Which diagnostic test would be most effective in evaluating the patient’s kidney function?
A. GFR (Glomerular Filtration Rate)
B. Serum creatinine
C. Urinalysis for RBCs
D. Kidney biopsy
A. GFR (Glomerular Filtration Rate)
Rationale: GFR is the preferred method for assessing kidney function, as serum creatinine alone is an inaccurate reflection of kidney function. GFR calculations, such as those using the MDRD equation, provide a more reliable measure of kidney function.
A patient with CKD is undergoing a renal ultrasound. The nurse explains that this test is primarily used to:
A. Detect any obstructions and assess kidney size
B. Measure kidney function and creatinine levels
C. Identify the presence of protein or glucose in the urine
D. Evaluate the results of a kidney biopsy
A. Detect any obstructions and assess kidney size
Rationale: A renal ultrasound is used to detect obstructions in the kidneys and determine their size. It is not a diagnostic tool for measuring kidney function or assessing the results of a kidney biopsy.
A patient with CKD has been experiencing persistent proteinuria. After a thorough diagnostic workup, the physician orders a kidney biopsy. The purpose of this test is to:
A. Measure the glomerular filtration rate to assess kidney function
B. Obtain tissue samples to help determine the underlying cause of CKD
C. Evaluate the size of the kidneys to determine the extent of damage
D. Detect urinary tract infections or other complications
B. Obtain tissue samples to help determine the underlying cause of CKD
Rationale: A kidney biopsy is performed to obtain tissue samples, which help establish the diagnosis and cause of CKD. It is not used to measure kidney function or detect infections.
Which of the following statements about persistent proteinuria is accurate?
A. It is often the first sign of kidney damage in CKD.
B. Proteinuria is rarely found in patients with diabetes or hypertension.
C. Proteinuria should be evaluated using only routine urinalysis.
D. Persistent proteinuria does not require further testing for CKD.
A. It is often the first sign of kidney damage in CKD.
Rationale: Persistent proteinuria is typically the first sign of kidney damage in CKD. Further testing is required to evaluate the cause of the proteinuria and assess kidney function.
A patient with diabetes is being monitored for albuminuria. The nurse knows that this test is particularly important in this population because:
A. Diabetes can result in severe protein loss that is detectable only through albuminuria testing.
B. Routine urinalysis typically detects albuminuria without further testing.
C. Albuminuria may be present even if no protein is detected on standard urinalysis.
D. Albuminuria is more common in non-diabetic patients with CKD.
C. Albuminuria may be present even if no protein is detected on standard urinalysis.
Rationale: In patients with diabetes, albuminuria may be present even when protein is not detected on routine urinalysis, making albuminuria testing essential for early detection of kidney damage.
Which of the following methods is the preferred equation for calculating GFR in CKD patients?
A. Cockcroft-Gault formula
B. Serum creatinine calculation
C. Urinalysis protein-to-creatinine ratio
D. MDRD Study equation
D. MDRD Study equation
Rationale: The MDRD Study equation is the preferred method for calculating GFR, as it provides a more accurate estimate of kidney function than other methods, such as the Cockcroft-Gault formula.
A patient with CKD has been experiencing fluid retention and electrolyte imbalances. The nurse is reviewing the patient’s diagnostic studies. Which test would provide the best insight into kidney function?
A. Serum creatinine
B. GFR using MDRD formula
C. Urine pH and specific gravity
D. Renal biopsy
B. GFR using MDRD formula
Rationale: The GFR using the MDRD formula is the most accurate method for assessing kidney function in CKD patients. It helps determine the extent of kidney damage more effectively than serum creatinine levels alone.
Which of the following diagnostic tests is specifically used to identify the presence of kidney obstructions or assess kidney size in a CKD patient?
A. Renal ultrasound
B. Kidney biopsy
C. Urinalysis for protein
D. Blood urea nitrogen (BUN) test
A. Renal ultrasound
Rationale: A renal ultrasound is used to detect kidney obstructions and assess kidney size, providing valuable information for diagnosing CKD. Other tests, such as a kidney biopsy or BUN, serve different diagnostic purposes.
A patient is diagnosed with CKD and undergoes testing for albuminuria. The nurse explains that albuminuria is not detected by routine urinalysis because:
A. Albuminuria occurs only in patients with diabetes or hypertension.
B. Albumin is too large to be filtered by the kidneys in CKD.
C. Routine urinalysis detects other forms of protein, but not albumin.
D. The kidneys are unable to filter albumin in CKD, so it is not present in urine.
C. Routine urinalysis detects other forms of protein, but not albumin.
Rationale: Routine urinalysis detects some forms of protein, but not albumin, which requires a separate test for accurate identification, especially in patients with CKD or diabetes.
Which of the following goals is most important in the interprofessional care of a patient with CKD?
A. Ensuring the patient has access to dialysis within the first year of diagnosis.
B. Preserving existing kidney function and preventing disease progression.
C. Focusing solely on the prevention of cardiovascular disease (CVD).
D. Increasing the patient’s fluid intake to promote kidney function.
B. Preserving existing kidney function and preventing disease progression.
Rationale: The primary goal in CKD therapy is to preserve existing kidney function and prevent disease progression. Although addressing CVD is important, the focus is on slowing kidney disease progression through early recognition and treatment of potential causes.
Which of the following actions should be taken early in the management of CKD to reduce the risk of complications?
A. Referral to a nephrologist as soon as CKD is diagnosed.
B. Initiation of dialysis immediately after diagnosis.
C. Prescribing high doses of vitamin D to reverse kidney damage.
D. Focusing on controlling hyperglycemia only in diabetic patients.
A. Referral to a nephrologist as soon as CKD is diagnosed.
Rationale: Early referral to a nephrologist allows for proper monitoring and management of CKD, which is crucial for slowing the progression of the disease and preventing complications.
A patient with CKD is also diagnosed with heart failure (HF). Which of the following should be the focus of their treatment plan?
A. Exclusively treating heart failure to prevent further kidney damage.
B. Focusing solely on managing fluid retention through diuretics.
C. Prioritizing dialysis to treat both heart failure and kidney failure.
D. Treating both cardiovascular disease and slowing kidney disease progression.
D. Treating both cardiovascular disease and slowing kidney disease progression.
Rationale: The treatment plan for CKD patients with HF should focus on managing both cardiovascular disease and slowing the progression of kidney disease, as these conditions often exacerbate one another.
During stages 1 through 4 of CKD, the focus of therapy is on controlling which of the following?
A. Hyperparathyroidism, CKD-MBD, anemia, and dyslipidemia.
B. The need for dialysis.
C. Exclusively lowering serum creatinine levels.
D. The administration of nephrotoxic medications.
A. Hyperparathyroidism, CKD-MBD, anemia, and dyslipidemia.
Rationale: In stages 1 through 4, the focus is on managing complications such as hyperparathyroidism, CKD-MBD, anemia, and dyslipidemia, which can slow the progression of kidney disease and improve overall health.
Which of the following strategies is recommended to prevent the progression of CKD in the early stages?
A. Focusing on renal replacement therapy (RRT) to initiate dialysis early.
B. Starting corticosteroids to reduce inflammation in the kidneys.
C. Detecting and treating reversible causes of kidney failure such as infections or dehydration.
D. Avoiding the use of nephrotoxic medications unless absolutely necessary.
C. Detecting and treating reversible causes of kidney failure such as infections or dehydration.
Rationale: Early detection and treatment of potentially reversible causes of kidney failure, such as infections, dehydration, or nephrotoxins, can help prevent the progression of CKD and preserve kidney function.
Which of the following is a potential side effect of sodium polystyrene sulfonate that the nurse should monitor for?
A. Hypertension
B. Hypercalcemia
C. Diarrhea
D. Bradycardia
C. Diarrhea
Rationale: Sodium polystyrene sulfonate has an osmotic laxative effect, which can cause diarrhea. The nurse should educate the patient about this potential side effect and monitor for any signs of excessive diarrhea.
A patient with CKD and hyperkalemia is prescribed sodium polystyrene sulfonate. Which of the following is the primary reason for this prescription?
A. To promote potassium evacuation through the bowel.
B. To decrease sodium levels in the blood.
C. To prevent hypernatremia in the patient.
D. To improve kidney filtration of potassium.
A. To promote potassium evacuation through the bowel.
Rationale: Sodium polystyrene sulfonate is a cation-exchange resin that helps lower potassium levels by promoting potassium evacuation from the bowel. It has an osmotic laxative effect, which is why diarrhea is a common side effect.
Which of the following is a key nursing consideration when administering sodium polystyrene sulfonate for hyperkalemia in CKD?
A. Monitor the patient for signs of water retention and sodium overload.
B. Instruct the patient to avoid high-potassium foods.
C. Administer the drug with food to enhance absorption.
D. Limit fluid intake to prevent hyperkalemia.
A. Monitor the patient for signs of water retention and sodium overload.
Rationale: Sodium polystyrene sulfonate exchanges sodium for potassium, which may cause sodium and water retention. The nurse should closely monitor for signs of fluid overload and hypernatremia.
A patient with CKD is being treated for hyperkalemia using sodium zirconium cyclosilicate (SZC). What is an important instruction for the nurse to give the patient?
A. “Take this medication at least 2 hours apart from other medications.”
B. “Take this medication with food to enhance potassium binding.”
C. “Expect immediate relief of symptoms from hyperkalemia.”
D. “This medication should be used in emergency situations for rapid potassium lowering.”
A. “Take this medication at least 2 hours apart from other medications.”
Rationale: Sodium zirconium cyclosilicate (SZC) should be administered at least 2 hours apart from other medications to prevent interference with their absorption. It is used for long-term management of hyperkalemia, not for emergencies.
A patient with CKD and hypertension is prescribed an ACE inhibitor. Which of the following is a key consideration for the nurse when administering this medication?
A. ACE inhibitors can increase serum potassium levels and decrease GFR.
B. ACE inhibitors should be avoided in patients with diabetes.
C. The patient should monitor for signs of hypercalcemia.
D. ACE inhibitors are first-line treatment for patients with non-diabetic proteinuria only.
A. ACE inhibitors can increase serum potassium levels and decrease GFR.
Rationale: ACE inhibitors and ARBs can increase serum potassium levels and decrease GFR. These medications must be used with caution, especially in patients with CKD, as they may exacerbate kidney function decline.
Which of the following is an important lifestyle change to recommend for a patient with CKD and hypertension?
A. Increase alcohol consumption in moderation to help with relaxation.
B. Encourage weight loss if the patient is overweight or obese.
C. Advise the patient to reduce exercise to minimize stress.
D. Recommend smoking to be stopped only during acute illness.
B. Encourage weight loss if the patient is overweight or obese.
Rationale: Weight loss is an important component of managing hypertension, especially in patients with CKD. Reducing weight can help lower blood pressure and improve overall kidney health.
A patient with CKD and diabetes is prescribed an ACE inhibitor. What is the primary benefit of this medication in the context of CKD?
A. Decreasing proteinuria and potentially delaying the progression of CKD.
B. Increasing serum calcium levels to improve bone health.
C. Enhancing glucose absorption to improve blood sugar control.
D. Reducing body weight and alleviating stress on the kidneys.
A. Decreasing proteinuria and potentially delaying the progression of CKD.
Rationale: ACE inhibitors decrease proteinuria and may help slow the progression of CKD. They are particularly beneficial for patients with diabetes or nondiabetic proteinuria.
Which of the following instructions should be included when teaching a patient to monitor their blood pressure at home while on antihypertensive medication?
A. “Measure your blood pressure in the sitting position only.”
B. “Call your healthcare provider only if your BP exceeds 160/100 mmHg.”
C. “Measure your blood pressure in the supine, sitting, and standing positions.”
D. “Take your blood pressure once a week, at the same time each day.”
C. “Measure your blood pressure in the supine, sitting, and standing positions.”
Rationale: Blood pressure should be measured in multiple positions (supine, sitting, and standing) to assess the effect of antihypertensive drugs and identify orthostatic hypotension or other changes in BP.
A patient with CKD and hypertension has been prescribed multiple antihypertensive medications. Which of the following is a common strategy to reach the target blood pressure?
A. Prescribing one medication with a high dose.
B. Recommending the use of over-the-counter antihypertensive agents.
C. Combining two or more medications from different classes.
D. Discontinuing medications once the BP reaches normal levels.
C. Combining two or more medications from different classes.
Rationale: Most patients with CKD and hypertension require two or more antihypertensive medications to achieve target blood pressure. Combining medications from different classes enhances effectiveness and reduces the risk of side effects.
A patient with CKD is prescribed an ACE inhibitor but experiences a significant increase in potassium levels. What is the nurse’s priority action?
A. Discontinue the ACE inhibitor and notify the healthcare provider.
B. Increase the dosage of the ACE inhibitor to ensure effectiveness.
C. Administer a potassium-sparing diuretic to lower potassium levels.
D. Advise the patient to increase potassium intake in their diet.
A. Discontinue the ACE inhibitor and notify the healthcare provider.
Rationale: ACE inhibitors can increase serum potassium levels, and a significant rise in potassium is a concern. The nurse should notify the healthcare provider and consider discontinuing the medication or adjusting the dosage to prevent life-threatening hyperkalemia.
Which of the following interventions is typically used in the later stages of CKD to address hypocalcemia?
A. Restrict phosphate intake to prevent calcium loss.
B. Administer calcium and vitamin D supplements if necessary.
C. Use magnesium-containing antacids to enhance calcium absorption.
D. Increase the use of phosphate binders without restricting calcium intake.
B. Administer calcium and vitamin D supplements if necessary.
Rationale: In the later stages of CKD, hypocalcemia can be treated with calcium and vitamin D supplements if serum phosphate levels are normal but hypocalcemia persists.
A patient with CKD-MBD is prescribed sevelamer carbonate (Renvela) as a phosphate binder. What is the primary reason for using this non-calcium-based binder?
A. To avoid the risk of vascular calcifications associated with calcium-based binders.
B. To increase the calcium load in the body to prevent hypocalcemia.
C. To reduce the need for vitamin D supplementation.
D. To improve phosphate absorption in the bowel.
A. To avoid the risk of vascular calcifications associated with calcium-based binders.
Rationale: Sevelamer carbonate is a non-calcium-based phosphate binder, which is used to avoid increasing the calcium load and reduce the risk of vascular calcifications, especially in patients with elevated calcium levels.
Which of the following should be monitored in patients with CKD-MBD who are prescribed phosphate binders?
A. Serum magnesium levels for signs of hypermagnesemia.
B. Phosphate and calcium levels to avoid hypercalcemia and hypocalcemia.
C. Serum albumin levels for indications of protein malnutrition.
D. Vitamin C levels to prevent oxidative stress.
B. Phosphate and calcium levels to avoid hypercalcemia and hypocalcemia.
Rationale: Patients on phosphate binders should have their phosphate and calcium levels monitored to prevent complications such as hypercalcemia or hypocalcemia, which can affect bone and vascular health.
A patient with CKD-MBD is prescribed calcimimetics such as cinacalcet (Sensipar). What is the primary purpose of this medication?
A. To directly increase calcium levels in the serum.
B. To reduce parathyroid hormone (PTH) levels by increasing the sensitivity of calcium receptors in the parathyroid glands.
C. To decrease vitamin D levels to prevent hypercalcemia.
D. To bind phosphate in the bowel and reduce phosphate absorption.
B. To reduce parathyroid hormone (PTH) levels by increasing the sensitivity of calcium receptors in the parathyroid glands.
Rationale: Cinacalcet (Sensipar) is a calcimimetic agent that increases the sensitivity of calcium receptors in the parathyroid glands, leading to decreased PTH secretion, which helps control secondary hyperparathyroidism in CKD.
Which of the following is a common side effect of phosphate binders, such as calcium acetate and calcium carbonate, that nurses should monitor for in CKD patients?
A. Diarrhea.
B. Nausea and vomiting.
C. Hypertension.
D. Constipation.
D. Constipation.
Rationale: Constipation is a common side effect of phosphate binders like calcium acetate and calcium carbonate, and patients may require stool softeners to manage this side effect.
Why should magnesium-containing antacids, such as Maalox or Mylanta, be avoided in patients with CKD?
A. They can cause hyperkalemia.
B. They increase the risk of hypocalcemia.
C. They can lead to excessive phosphate binding.
D. They depend on the kidneys for excretion, which can lead to toxicity in patients with impaired renal function.
D. They depend on the kidneys for excretion, which can lead to toxicity in patients with impaired renal function.
Rationale: Magnesium-containing antacids depend on the kidneys for excretion, and in patients with CKD, impaired renal function can lead to magnesium toxicity, which can cause serious complications.
A patient with CKD-MBD and secondary hyperparathyroidism is being treated with calcitriol (Rocaltrol). What is the purpose of this medication in CKD patients?
A. To reduce calcium absorption in the intestines.
B. To bind phosphate in the GI tract.
C. To activate vitamin D and reduce high parathyroid hormone (PTH) levels.
D. To treat anemia associated with CKD.
C. To activate vitamin D and reduce high parathyroid hormone (PTH) levels.
Rationale: Calcitriol (Rocaltrol) is the active form of vitamin D, which is used to treat secondary hyperparathyroidism in CKD patients by activating vitamin D and reducing PTH levels.
A CKD patient is found to have elevated serum calcium levels after receiving calcium and vitamin D supplements. What is the nurse’s most appropriate action?
A. Increase the dose of vitamin D to address the calcium imbalance.
B. Withhold vitamin D and replace calcium-based phosphate binders with non-calcium-based binders.
C. Continue the current treatment plan without any modifications.
D. Administer magnesium to balance the calcium levels.
B. Withhold vitamin D and replace calcium-based phosphate binders with non-calcium-based binders.
Rationale: If a patient develops hypercalcemia after calcium and vitamin D supplementation, the nurse should withhold vitamin D and replace calcium-based phosphate binders with non-calcium-based binders to prevent further complications.
What is the primary concern when using aluminum-containing preparations in CKD patients?
A. Aluminum toxicity, which is associated with osteomalacia and other bone diseases.
B. Increased risk of hypercalcemia.
C. Increased phosphate levels, leading to further complications.
D. Overuse of phosphate binders, causing hypophosphatemia.
A. Aluminum toxicity, which is associated with osteomalacia and other bone diseases.
Rationale: Aluminum-containing preparations should be used with caution in CKD patients due to the risk of aluminum toxicity, which can cause osteomalacia and other bone disorders.
A patient with CKD-MBD is undergoing a total parathyroidectomy. Which of the following statements by the patient indicates a need for further education about the procedure?
A. “If my parathyroid function becomes excessive, some cells can be removed from my forearm.”
B. “The parathyroid tissue will be transplanted into my forearm, where it will continue to produce PTH as needed.”
C. “This surgery will completely stop my body from producing parathyroid hormone.”
D. “The procedure will help control my high parathyroid hormone levels.”
C. “This surgery will completely stop my body from producing parathyroid hormone.”
Rationale: Total parathyroidectomy does not completely stop parathyroid hormone (PTH) production. The transplanted tissue in the forearm will continue to produce PTH as needed. If excessive PTH production occurs, some cells can be removed from the forearm.
Which of the following is a common side effect of cinacalcet (Sensipar) in the management of secondary hyperparathyroidism in CKD patients?
A. Hypokalemia.
B. Hypocalcemia.
C. Hypercalcemia.
D. Hyperphosphatemia.
B. Hypocalcemia.
Rationale: Cinacalcet (Sensipar) can lower calcium levels, leading to hypocalcemia as a side effect. This occurs because the drug increases the sensitivity of the calcium receptors on the parathyroid glands, which reduces PTH secretion and calcium levels.
In managing CKD-MBD, why is phosphate usually restricted to about 1 g/day when patients require renal replacement therapy (RRT)?
A. To reduce calcium retention and the risk of vascular calcification.
B. To minimize the absorption of calcium in the GI tract.
C. To decrease vitamin D requirements.
D. To prevent excessive proteinuria.
A. To reduce calcium retention and the risk of vascular calcification.
Rationale: Phosphate is restricted to about 1 g/day when patients require RRT to help manage calcium balance and reduce the risk of vascular calcification associated with high phosphate levels.
A patient with CKD-MBD is prescribed lanthanum carbonate (Fosrenol). What is a key nursing consideration when administering this medication?
A. It is best taken on an empty stomach for optimal absorption.
B. It should be taken with meals to maximize its effectiveness in binding phosphate.
C. It should be taken at least 2 hours before or after other medications.
D. It should only be given to patients with hypercalcemia.
B. It should be taken with meals to maximize its effectiveness in binding phosphate.
Rationale: Lanthanum carbonate (Fosrenol) is most effective when taken with meals because it binds phosphate in the bowel during digestion, helping to lower phosphate levels in the body.
Which of the following factors contributes to the progression of CKD-MBD in patients with ESRD?
A. Vitamin D deficiency, leading to decreased calcium absorption.
B. Excessive magnesium intake from antacids.
C. Low phosphate levels causing hypocalcemia.
D. Increased secretion of erythropoietin.
A. Vitamin D deficiency, leading to decreased calcium absorption.
Rationale: Vitamin D deficiency contributes to the progression of CKD-MBD because it leads to decreased calcium absorption from the GI tract, further exacerbating hypocalcemia and promoting secondary hyperparathyroidism.
Which of the following is a key consideration for administering IV iron supplements to a CKD patient on dialysis?
A. Iron should be given daily to prevent iron overload.
B. Oral iron supplements are preferred due to fewer side effects.
C. IV iron is preferred for patients on dialysis due to the greater need for iron and difficulty absorbing oral iron.
D. IV iron supplements should only be given if the patient has symptomatic anemia.
C. IV iron is preferred for patients on dialysis due to the greater need for iron and difficulty absorbing oral iron.
Rationale: IV iron is preferred for dialysis patients because they have an increased need for iron, and oral iron supplements are less effective due to gastrointestinal side effects and poor absorption.
A CKD patient receiving dialysis is prescribed IV iron sucrose (Venofer). What is the primary goal of this treatment?
A. To improve blood pressure regulation.
B. To reduce the need for blood transfusions.
C. To decrease phosphate levels in the blood.
D. To treat iron deficiency due to increased erythropoiesis.
D. To treat iron deficiency due to increased erythropoiesis.
Rationale: IV iron sucrose (Venofer) is used in dialysis patients to treat iron deficiency, which often occurs due to the increased demand for iron to support erythropoiesis during EPO therapy.
Which of the following is a typical side effect of oral iron supplements in CKD patients?
A. Diarrhea.
B. Constipation.
C. Hyperkalemia.
D. Nausea and vomiting.
B. Constipation.
Rationale: Constipation is a common side effect of oral iron supplements, which can reduce patient adherence to treatment. Stool softeners may be necessary to manage this side effect.
Which of the following is a reason for avoiding blood transfusions in CKD patients with anemia?
A. Blood transfusions increase the risk of iron deficiency.
B. Blood transfusions are contraindicated in patients with chronic kidney disease.
C. Blood transfusions increase the risk of developing antibodies, complicating future kidney transplants.
D. Blood transfusions worsen hypertension in CKD patients.
C. Blood transfusions increase the risk of developing antibodies, complicating future kidney transplants.
Rationale: Blood transfusions are avoided in CKD patients unless absolutely necessary because they increase the risk of developing antibodies, which can make it harder to find a compatible donor for kidney transplantation.
Why should iron supplements not be taken at the same time as phosphate binders?
A. Phosphate binders increase iron absorption in the GI tract.
B. Calcium in phosphate binders binds with iron, preventing its absorption.
C. Phosphate binders decrease calcium absorption, leading to hypocalcemia.
D. Iron supplements can cause gastrointestinal bleeding when taken with phosphate binders.
B. Calcium in phosphate binders binds with iron, preventing its absorption.
Rationale: Calcium in phosphate binders can bind with iron, preventing its absorption in the gastrointestinal tract. Therefore, iron supplements should not be taken at the same time as phosphate binders.
Which of the following lab values should be monitored regularly in a CKD patient receiving erythropoietin (EPO) therapy?
A. Hemoglobin and hematocrit levels.
B. Blood urea nitrogen (BUN) and creatinine levels.
C. Potassium and sodium levels.
D. Calcium and phosphate levels.
A. Hemoglobin and hematocrit levels.
Rationale: Hemoglobin and hematocrit levels should be monitored regularly in patients receiving EPO therapy to assess the effectiveness of treatment and ensure that hemoglobin levels do not increase too rapidly.
Which of the following is a contraindication for administering erythropoietin (EPO)?
A. Chronic kidney disease with stable hemoglobin levels.
B. Uncontrolled hypertension.
C. Anemia caused by iron deficiency.
D. Patients with diabetes and cardiovascular disease.
B. Uncontrolled hypertension.
Rationale: Erythropoietin (EPO) therapy is contraindicated in patients with uncontrolled hypertension due to the risk of increasing blood pressure and exacerbating cardiovascular problems.
What is the primary reason for administering exogenous erythropoietin (EPO) in patients with chronic kidney disease (CKD)-related anemia?
A. To decrease the number of red blood cells produced.
B. To correct the underlying iron deficiency.
C. To stimulate erythropoiesis and increase red blood cell production.
D. To reduce the risk of thromboembolic events.
C. To stimulate erythropoiesis and increase red blood cell production.
Rationale: Erythropoietin (EPO) is given to stimulate erythropoiesis and increase red blood cell production in CKD patients, addressing the anemia caused by reduced EPO production by the kidneys.
Which factor should influence the choice of dyslipidemia medication in CKD patients?
A. The patient’s age only.
B. The patient’s smoking history.
C. The patient’s blood pressure.
D. The patient’s response to the drug and healthcare provider’s recommendation.
D. The patient’s response to the drug and healthcare provider’s recommendation.
Rationale: The choice of dyslipidemia medication, such as statins or fibrates, should be based on the patient’s response to the drug and the healthcare provider’s recommendation, taking into consideration individual treatment goals and comorbidities.
Which of the following is a consideration when prescribing statins to CKD patients, especially those with diabetes?
A. Statins should only be prescribed after dialysis initiation.
B. Statins are used to increase HDL cholesterol levels in CKD patients.
C. Statins are particularly recommended in CKD patients with diabetes who are not yet on dialysis.
D. Statins should be avoided in CKD patients with diabetes.
C. Statins are particularly recommended in CKD patients with diabetes who are not yet on dialysis.
Rationale: Statins are especially recommended in CKD patients with diabetes, particularly before dialysis is initiated, as they help lower LDL cholesterol and reduce the risk of cardiovascular disease (CVD).
Which of the following is the primary action of statins (HMG-CoA reductase inhibitors) in patients with CKD?
A. Lower HDL cholesterol levels.
B. Lower LDL cholesterol levels.
C. Lower triglyceride levels.
D. Increase HDL cholesterol levels.
B. Lower LDL cholesterol levels.
Rationale: Statins, such as atorvastatin (Lipitor), are primarily used to lower LDL cholesterol levels, which helps reduce the risk of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD).
Why is it important to adjust drug doses and frequency in patients with CKD?
A. Due to the kidneys’ ability to increase drug metabolism.
B. To enhance the efficacy of drugs in CKD patients.
C. Because CKD patients require higher doses of drugs for effectiveness.
D. To prevent drug toxicity due to decreased elimination of drugs.
D. To prevent drug toxicity due to decreased elimination of drugs.
Rationale: In CKD, the kidneys’ ability to eliminate drugs is impaired, leading to drug accumulation and increased risk of toxicity. Therefore, drug doses and frequency must be adjusted based on the severity of kidney disease to prevent adverse effects.
Which of the following drugs is particularly concerning in CKD patients due to the risk of toxicity?
A. Statins.
B. Antihypertensive agents.
C. Metformin.
D. Vitamin D supplements.
C. Metformin.
Rationale: Diabetic agents such as metformin are of particular concern in CKD patients because decreased renal function may lead to drug accumulation, increasing the risk of toxicity, such as lactic acidosis.
Which of the following is a potential complication of opioid use in CKD patients?
A. Decreased pain relief due to kidney metabolism.
B. Increased risk of drug toxicity due to impaired renal elimination.
C. Improved renal function with opioid use.
D. Enhanced effectiveness of opioids due to kidney dysfunction.
B. Increased risk of drug toxicity due to impaired renal elimination.
Rationale: In CKD patients, the kidneys’ decreased ability to eliminate drugs, including opioids, can lead to drug accumulation and increased risk of toxicity, requiring careful dose adjustments.
What is a key goal of nutrition therapy in patients with CKD?
A. Restricting calorie intake to promote weight loss.
B. Encouraging high-protein diets for kidney function improvement.
C. Preventing calorie-protein malnutrition while maintaining good nutrition.
D. Eliminating all sources of sodium and phosphorus from the diet.
C. Preventing calorie-protein malnutrition while maintaining good nutrition.
Rationale: Nutrition therapy in CKD aims to prevent calorie-protein malnutrition, which can result from altered metabolism, dietary restrictions, and other complications, while maintaining overall good nutrition.
What is a common complication in CKD patients that contributes to calorie-protein malnutrition?
A. Increased appetite due to dialysis therapy.
B. Depression and anorexia caused by the disease process.
C. Excessive intake of commercial protein supplements.
D. Improved metabolism reducing the need for protein intake.
B. Depression and anorexia caused by the disease process.
Rationale: Depression, anorexia, altered metabolism, and other factors such as nausea and dietary restrictions contribute to calorie-protein malnutrition in CKD patients.
Why should patients with CKD avoid high-protein diets and supplements?
A. High-protein diets are ineffective in preventing malnutrition.
B. Protein intake has no impact on CKD progression.
C. High-protein diets lead to increased calorie intake.
D. They can overburden the already diseased kidneys.
D. They can overburden the already diseased kidneys.
Rationale: High-protein diets and supplements can place an additional burden on the already diseased kidneys, potentially worsening kidney function.
Why are diuretics commonly used in patients with CKD stages 1 to 5 not on HD?
A. To increase fluid intake and prevent dehydration.
B. To reduce fluid retention without restricting fluid intake.
C. To replace the function of dialysis in fluid removal.
D. To eliminate the need for fluid restrictions.
B. To reduce fluid retention without restricting fluid intake.
Rationale: Diuretics are used in CKD stages 1 to 5 not on HD to help reduce fluid retention, as routine fluid restriction is not typically necessary for these patients.
What is the purpose of spacing fluid intake throughout the day for CKD patients?
A. To prevent thirst and manage fluid retention effectively.
B. To ensure compliance with a high fluid intake.
C. To promote rapid elimination of fluids through the kidneys.
D. To reduce the frequency of dialysis treatments.
A. To prevent thirst and manage fluid retention effectively.
Rationale: Spacing fluid intake throughout the day helps prevent excessive thirst and supports effective management of fluid retention in CKD patients.
When is fluid restriction typically recommended for patients with CKD?
A. In CKD stages 1 to 5 regardless of urine output.
B. For patients with CKD not receiving dialysis.
C. For patients on HD as their urine output decreases.
D. Only in patients on PD due to protein loss.
C. For patients on HD as their urine output decreases.
Rationale: Fluid restriction is typically recommended for patients on hemodialysis (HD) as their urine output decreases. For CKD stages 1 to 5 not receiving dialysis, fluids are not routinely restricted.
Which foods should patients with CKD on HD avoid to manage potassium levels?
A. Processed meats and canned soups
B. Cold cuts and salad dressings
C. Bananas and oranges
D. Whole grains and lean meats
C. Bananas and oranges
Rationale: Patients on HD should avoid foods high in potassium, such as bananas, oranges, tomatoes, and potatoes, to prevent hyperkalemia.
Which group of patients is more likely to require potassium supplementation rather than restriction?
A. Patients receiving HD
B. Patients using PD
C. Patients with stage 5 CKD not on dialysis
D. Patients with hypertension but no kidney disease
B. Patients using PD
Rationale: Patients using peritoneal dialysis (PD) may lose potassium during dialysis exchanges and often require oral potassium supplementation rather than restriction.
Why should salt substitutes be avoided in potassium-restricted diets?
A. They often contain potassium chloride.
B. They contain excessive amounts of sodium.
C. They interfere with protein metabolism.
D. They increase fluid retention.
A. They often contain potassium chloride.
Rationale: Salt substitutes should be avoided in potassium-restricted diets because they often contain potassium chloride, which can contribute to hyperkalemia in CKD patients.
What is the recommended sodium restriction range for patients with CKD?
A. 1 to 2 g/day
B. 2 to 4 g/day
C. 4 to 6 g/day
D. Sodium restriction is not necessary
B. 2 to 4 g/day
Rationale: Patients with CKD are typically advised to restrict sodium intake to 2 to 4 g/day to help manage fluid retention and hypertension.
Why does phosphate elimination decrease as kidney function declines?
A. The liver compensates for phosphate metabolism.
B. Phosphate is reabsorbed in the gastrointestinal tract.
C. The kidneys lose the ability to excrete phosphate efficiently.
D. Phosphate levels decrease as protein intake increases.
C. The kidneys lose the ability to excrete phosphate efficiently.
Rationale: As kidney function declines, the kidneys lose the ability to efficiently excrete phosphate, leading to an accumulation in the blood.
What is the recommended daily phosphate intake for a patient with ESRD?
A. 500 mg/day
B. 1 g/day
C. 2 g/day
D. Phosphate intake is not restricted.
B. 1 g/day
Rationale: By the time a patient reaches ESRD, phosphate intake is typically limited to about 1 g/day to prevent hyperphosphatemia and associated complications.
Which types of food are high in phosphate and should be limited in patients with ESRD?
A. Fruits and vegetables
B. Whole grains and nuts
C. Meat and dairy products
D. Legumes and seeds
C. Meat and dairy products
Rationale: Foods high in phosphate, such as meat and dairy products (e.g., milk, cheese, yogurt, and ice cream), should be limited in patients with ESRD to manage phosphate levels.
What is the role of phosphate binders in patients with CKD?
A. They enhance phosphate absorption in the gastrointestinal tract.
B. They excrete excess phosphate through the skin.
C. They bind phosphate from the diet and reduce serum phosphate levels.
D. They prevent protein breakdown during dialysis.
C. They bind phosphate from the diet and reduce serum phosphate levels.
Rationale: Phosphate binders bind dietary phosphate in the gastrointestinal tract, preventing its absorption and helping to control serum phosphate levels in patients with CKD.
A 56-year-old patient with CKD reports using over-the-counter antacids regularly for heartburn. Which complication is most likely to occur due to this practice?
A. Hypocalcemia
B. Hyperkalemia
C. Hypermagnesemia
D. Metabolic alkalosis
C. Hypermagnesemia
Rationale: Magnesium from antacids can accumulate in patients with CKD due to reduced excretion by the kidneys, leading to hypermagnesemia.
A patient with CKD is prescribed a nephrotoxic drug. Which lab value should the nurse prioritize monitoring to assess kidney function?
A. Serum potassium
B. BUN and creatinine
C. Serum albumin
D. Hemoglobin and hematocrit
B. BUN and creatinine
Rationale: BUN and serum creatinine levels are essential indicators of kidney function and should be closely monitored when nephrotoxic drugs are prescribed.
Which patient statement indicates a need for further teaching about managing CKD?
A. “I can take ibuprofen when I have a headache.”
B. “I will check my blood pressure daily at home.”
C. “I will avoid processed foods to reduce my sodium intake.”
D. “I will watch for any changes in my urine and report them to my doctor.”
A. “I can take ibuprofen when I have a headache.”
Rationale: NSAIDs like ibuprofen can contribute to kidney damage and should be avoided in patients with CKD.
A patient with CKD asks about the possibility of a kidney transplant. What is the nurse’s best response?
A. “A transplant is not an option once dialysis has started.”
B. “Transplants are only offered to patients who are younger than 65 years old.”
C. “A transplant is the best treatment for ESRD, but donor organ availability is limited.”
D. “Dialysis and transplant are equally effective in treating CKD.”
C. “A transplant is the best treatment for ESRD, but donor organ availability is limited.”
Rationale: While a kidney transplant is the best treatment for ESRD, the critical shortage of donor organs limits this option. Dialysis is often used until a transplant becomes available.
Which patient is at the highest risk of developing CKD?
A. A 28-year-old with a history of repeated urinary tract infections
B. A 45-year-old with a family history of hypertension
C. A 60-year-old with poorly controlled diabetes
D. A 35-year-old with frequent use of OTC decongestants
C. A 60-year-old with poorly controlled diabetes
Rationale: Poorly controlled diabetes is a leading cause of CKD, making this patient the highest risk.
What is the most important aspect of health promotion for patients at risk for CKD?
A. Regular blood transfusions
B. A high-protein diet
C. Routine urinalysis and GFR monitoring
D. Early initiation of dialysis
C. Routine urinalysis and GFR monitoring
Rationale: Early detection of CKD through routine urinalysis and GFR calculation is essential for prevention and timely management.
A patient with CKD is prescribed antihypertensive therapy. What is the priority teaching point?
A. “You can stop the medication once your blood pressure normalizes.”
B. “Check your blood pressure daily and report high readings.”
C. “This medication will cure your kidney disease.”
D. “Avoid taking this medication with other prescriptions.”
B. “Check your blood pressure daily and report high readings.”
Rationale: Monitoring and reporting blood pressure changes are critical for managing CKD and preventing complications.
Which lab value would indicate worsening CKD?
A. Increased hemoglobin
B. Decreased BUN
C. Increased serum creatinine
D. Decreased potassium
C. Increased serum creatinine
Rationale: An increase in serum creatinine indicates worsening kidney function, a hallmark of CKD progression.
Which clinical problem is a priority for a patient with CKD and severe fluid retention?
A. Risk for electrolyte imbalance
B. Impaired mobility
C. Risk for infection
D. Impaired gas exchange
A. Risk for electrolyte imbalance
Rationale: Fluid retention can lead to electrolyte imbalances, requiring immediate attention to prevent complications.
A patient with CKD is referred for evaluation for a kidney transplant. What should the nurse emphasize about this process?
A. “You can only receive a transplant after starting dialysis.”
B. “A kidney transplant may eliminate the need for dialysis.”
C. “You will need frequent transfusions before your transplant.”
D. “Transplants are only available for those without diabetes.”
B. “A kidney transplant may eliminate the need for dialysis.”
Rationale: A kidney transplant may eliminate the need for dialysis, offering a better outcome for many ESRD patients.
A patient with CKD asks why they must avoid OTC NSAIDs. What is the best explanation?
A. “NSAIDs are addictive and can cause dependence.”
B. “NSAIDs reduce blood pressure, which is harmful in CKD.”
C. “NSAIDs interfere with dialysis treatments.”
D. “NSAIDs can worsen kidney damage and increase disease progression.”
D. “NSAIDs can worsen kidney damage and increase disease progression.”
Rationale: NSAIDs can impair kidney function and accelerate CKD progression, especially when used inappropriately.
What is the nurse’s priority when caring for a patient with CKD experiencing hyperkalemia?
A. Administer potassium supplements.
B. Encourage potassium-rich foods.
C. Restrict the patient’s fluid intake.
D. Monitor the patient for cardiac arrhythmias.
D. Monitor the patient for cardiac arrhythmias.
Rationale: Hyperkalemia can cause life-threatening cardiac arrhythmias, making cardiac monitoring a priority.
A patient with CKD has fluid overload and difficulty breathing. What is the initial nursing action?
A. Measure the patient’s urine output.
B. Administer prescribed diuretics.
C. Elevate the head of the bed and assess lung sounds.
D. Restrict the patient’s oral fluid intake.
C. Elevate the head of the bed and assess lung sounds.
Rationale: Elevating the head of the bed and assessing lung sounds are immediate actions to improve breathing and evaluate the severity of fluid overload.
The nurse assesses the patient with chronic kidney disease with the understanding that this condition is characterized by:
a. progressive irreversible destruction of the kidneys.
b. a rapid decrease in urine output with an elevated BUN.
c. an increasing creatinine clearance with a decrease in urine output.
d. prostration, somnolence, and confusion with coma and imminent death.
a. progressive irreversible destruction of the kidneys.
Nurses can screen patients at risk for developing chronic kidney disease. Those considered to be at increased risk include (select all that apply)
a. older Black patients.
b. patients more than 60 years old.
c. those with a history of pancreatitis.
d. those with a history of hypertension.
e. those with a history of type 2 diabetes.
a. older Black patients.
b. patients more than 60 years old.
d. those with a history of hypertension.
e. those with a history of type 2 diabetes.
Which points must the nurse consider when planning nutrition support for patients with chronic kidney disease? (select all that apply)
a. Sodium may be restricted in someone with advanced CKD.
b. Fluid is not usually restricted for patients on peritoneal dialysis.
c. Decreased fluid intake and a low-potassium diet are needed for a patient on hemodialysis.
d. Decreased fluid intake and a low-potassium diet are needed for a patient on peritoneal dialysis.
e. Decreased fluid intake and a diet in protein-rich foods are part of a diet for a patient on hemodialysis
a. Sodium may be restricted in someone with advanced CKD.
b. Fluid is not usually restricted for patients on peritoneal dialysis.
c. Decreased fluid intake and a low-potassium diet are needed for a patient on hemodialysis.
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse‘s teaching about management of CKD has been effective?
a. “I need to get most of my protein from low-fat dairy products.”
b. “I will increase my intake of fruits and vegetables to 5 per day.”
c. “I will measure my output each day to help calculate the amount I can drink.”
d. “I need erythropoietin injections to boost my immunity and prevent infection.”
c. “I will measure my output each day to help calculate the amount I can drink.”
Rationale: The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake; the total urine output plus 600-1000 ml is the daily fluid allowance. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.
Which information will the nurse monitor to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
a. Blood pressure
b. Phosphate level
c. Neurologic status
d. Creatinine clearance
b. Phosphate level
Rationale: Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.
Which laboratory result would the nurse check before administering calcium carbonate to a patient with chronic kidney disease?
a. Serum potassium
b. Serum phosphate
c. Serum creatinine
d. Serum cholesterol
b. Serum phosphate
Rationale: If serum phosphate is increased, the calcium and phosphate can cause soft tissue calcification. When calcium levels are increased or there is evidence of existing vascular or soft tissue calcifications, non–calcium-based phosphate binders are used. Total cholesterol, creatinine, and potassium values do not affect whether calcium carbonate should be administered.
A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?
a. Increased calories are needed because glucose is lost during hemodialysis.
b. More protein is allowed because urea and creatinine are removed by dialysis.
c. Dietary potassium is not restricted because the level is normalized by dialysis.
d. Unlimited fluids are allowed because retained fluid is removed during dialysis.
b. More protein is allowed because urea and creatinine are removed by dialysis.
Rationale: When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Glucose is not lost during hemodialysis. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication being taken by the patient indicates a need for patient teaching?
a. Acetaminophen
b. Calcium phosphate
c. Magnesium hydroxide
d. Multivitamin with iron
c. Magnesium hydroxide
Rationale: Magnesium is excreted by the kidneys, so patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.
What laboratory value would the nurse check before administering captopril to a patient with stage 2 chronic kidney disease?
a. Glucose
b. Potassium
c. Creatinine
d. Phosphate
b. Potassium
Rationale: Angiotensin-converting enzyme (ACE) inhibitors are often used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect administration of captopril.
A patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information would the nurse discuss with the health care provider before giving the medication?
a. Creatinine 1.6 mg/dL
b. Oxygen saturation 89%
c. Hemoglobin level 13 g/dL
d. Blood pressure 98/56 mm Hg
c. Hemoglobin level 13 g/dL
Rationale: High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) so the recommendation is to use the lowest possible dose of erythropoietin. Hemoglobin levels well in the normal range indicate a need for a decrease in epoetin alfa dose. The other information also will be reported to the health care provider but will not affect whether the medication is administered.
A licensed practical/vocational nurse (LPN/VN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention?
a. The LPN/VN assists the patient to ambulate in the hallway.
b. The LPN/VN administers the erythropoietin subcutaneously.
c. The LPN/VN administers the iron supplement and phosphate binder with lunch.
d. The LPN/VN carries a tray containing low-protein foods into the patient‘s room.
c. The LPN/VN administers the iron supplement and phosphate binder with lunch.
Rationale: Oral phosphate binders would not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder would be given with a meal and the iron given at a different time. The other actions by the LPN/VN are appropriate for a patient with renal insufficiency.
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information would the nurse report promptly to the health care provider?
a. The patient has an outflow volume of 1800 mL.
b. The patient‘s peritoneal effluent appears cloudy.
c. The patient‘s abdomen appears bloated after the inflow.
d. The patient has abdominal pain during the inflow phase.
b. The patient‘s peritoneal effluent appears cloudy.
Rationale: Cloudy-appearing peritoneal effluent is a sign of possible peritonitis and would be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.
A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, “Do you think I would go on dialysis?” Which initial response would the nurse provide?
a. “It depends on which type of dialysis you are considering.”
b. “Tell me more about what you are thinking regarding dialysis.”
c. “You are the only one who can make the decision about dialysis.”
d. “Many people your age use dialysis and have a good quality of life.”
b. “Tell me more about what you are thinking regarding dialysis.”
Rationale: The nurse would initially clarify the patient‘s concerns and questions about dialysis. The patient is the one responsible for the decision, and many people using dialysis do have good quality of life, but these responses block further assessment of the patient‘s concerns. Referring to which type of dialysis the patient might use only indirectly responds to the patient‘s question.
