Page 59.Which of the following clinical manifestations would lead the nurse to suspect the renalfailure patient is developing uremia? Select all that apply.A)Weakness and fatigueB)Lethargy and confusionC)Extreme itchingD)Blood in urineE)Urine smell in the stoolAns: A, B, CFeedback:Uremia affects all body systems. The symptoms at the onset include weakness, fatigue,nausea, and apathy. These are subtle signs. More severe symptoms include extremeweakness, frequent vomiting, lethargy, and confusion.10.A hospital client with a diagnosis of chronic renal failure has orders for measurement ofher serum electrolyte levels three times per week. Which of the following statementsbest captures the relationship between renal failure and sodium regulation?A)Clients with advanced renal failure are prone to hyponatremia because ofimpaired tubular reabsorption.B)Renal clients often require a sodium-restricted diet to minimize the excretion loadon remaining nephrons.C)Clients with renal failure often maintain high sodium levels because of decreasedexcretion.D)Restrictingsodium intaNkeUhReSlpIsNtoGpTreBs.erCveOnMephron function and hastheadditional benefit of lowering blood pressure.Ans: AFeedback:The compromised ability of the tubular nephrons to reabsorb sodium predisposes renalclients to low serum sodium levels. A sodium restriction is thus not normally indicated.11.Which of the following clients' diagnostic blood work is most suggestive of chronickidney disease (CKD)?A)A client with high pH; low levels of calcium; and low levels of phosphateB)A client with low vitamin D levels; low calcitriol levels; and elevated parathyroidhormone (PTH) levelsC)A client with low bone density; low levels of calcium; and low levels ofphosphateD)A client with low potassium levels; low calcitriol levels; and increased PTH levelsAns: BFeedback:CKD is associated with low vitamin D and calcitriol levels, which induces increasedPTH production. CKD is also associated with acidosis (low pH), high levels ofphosphate, and hyperkalemia.
Page 612.Which of the following medications would the nurse anticipate being prescribed for therenal failure patient who has hyperphosphatemia?A)Vitamin D (calcitriol)B)Calcium carbonateC)Levothyroxine (Synthroid)D)Sensipar (Cinacalcet)Ans: BFeedback:Phosphate-binding antacids (aluminum salts, calcium carbonate, or calcium acetate)may be prescribed to decrease the absorption of phosphate from the GI tract.13.To maintain hematocrit levels in people with kidney failure, the nurse should beprepared toA)arrange for frequent blood transfusions in an outpatient clinic.B)administer iron dextran intravenously.C)administer a subcutaneous injection of recombinant human erythropoietin(rhEPO).
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