A 53-year-old male client who has no prior medical history and takes no medications is in a primary care provider's office for a routine physical. The client states that he has not seen a doctor in "about five years." The client's blood pressure is at the appointment is 157/92 mmHg and his fasting blood glucose is 83 mg/dL. Based on recent lab results, the provider determines that the client's glomerular filtration rate (GFR) is 54 mL/min. The provider diagnoses the client with stage 3a chronic kidney disease (CKD). Based on these findings, which medication should the clinic nurse anticipate will be prescribed for this client?

Gentamicin

Daily potassium supplement

Captopril

Metformin

Answer and Explanation

The Correct Answer is C

A.   Gentamicin is an aminoglycoside antibiotic used to treat bacterial infections. It is not appropriate for managing CKD directly and is generally avoided in patients with kidney impairment due to its potential nephrotoxicity.
B.   Potassium supplements are typically not recommended unless there is a documented deficiency in potassium. In stage 3a CKD, managing potassium levels is crucial, but supplements are not usually needed unless potassium levels are low.
C.   Captopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are beneficial for patients with CKD as they help lower blood pressure and provide renal protective effects. They can reduce proteinuria (protein in urine), which is common in CKD, and may slow the progression of kidney disease.
D.   Metformin is an oral medication used to manage type 2 diabetes by improving insulin sensitivity and lowering blood glucose levels. Although it is important to monitor blood glucose in CKD patients, this
client’s fasting blood glucose is within normal range (83 mg/dL), so Metformin is not indicated unless there was evidence of diabetes or significant glucose dysregulation.

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Correct Answer is B

Explanation

A. Calcium gluconate is used to treat or prevent calcium deficiencies and to manage conditions related to calcium imbalances, such as hypocalcemia. It is not typically used to prevent struvite stones.
B. Antibiotics are the most appropriate choice for preventing the recurrence of struvite stones. Since struvite stones are associated with urinary tract infections caused by urease-producing bacteria, antibiotic therapy is aimed at eliminating these infections. By treating or preventing UTIs, the conditions that lead to struvite stone formation are addressed, reducing the likelihood of recurrence.
C. Tamsulosin is an alpha-blocker used to relax the muscles in the prostate and bladder neck to improve urine flow in conditions like benign prostatic hyperplasia (BPH). It is not specifically used for preventing struvite stones.
D. Phosphate binders are used to reduce phosphate levels in the blood, which is important in managing conditions such as chronic kidney disease (CKD) where phosphate levels can be elevated.

A. Peritonitis B. Pericarditis C. Pleuritis D. Intraperitoneal bleeding

Correct Answer is A

Explanation

A. This is an inflammation of the peritoneum, the lining of the abdominal cavity. It's a common complication of peritoneal dialysis (PD). Symptoms include nausea, vomiting, diarrhea, abdominal pain, and fever. Fluid discharge from the catheter site and an increased white blood cell count are also indicative of infection, supporting the diagnosis of peritonitis.
B. This is inflammation of the pericardium, the sac surrounding the heart. Symptoms typically include chest pain, shortness of breath, and irregular heartbeat.
C. This is inflammation of the pleura, the membranes surrounding the lungs. Symptoms include chest pain, shortness of breath, and dry cough.
D. This would present with severe abdominal pain, hypotension, and signs of shock. Nausea, vomiting, and diarrhea are not typical symptoms.

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Naxlex Comprehensive Predictor Exams

A female client has undergone surgery to remove a large struvite kidney stone. Based on the cause of struvite stones, which medication therapy should the nurse anticipate will be ordered to prevent recurrence of the stones?

Correct Answer is B

Explanation

A patient who performs dialysis at home using a catheter placed through the abdominal wall reports nausea, vomiting, diarrhea, and fluid discharge from the catheter site. The laboratory reports reveal an increased white blood cell count (WBC). Which condition does the nurse suspect in the patient?

Correct Answer is A

Explanation

A nurse is admitting a client who has been diagnosed with acute glomerulonephritis. Considering the most common cause of this condition, which test should the nurse anticipate will be performed?

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

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication?

A nurse is assessing a client who has chronic kidney disease (CKD) for fluid volume overload prior to scheduled hemodialysis. Which of the following methods provides a reliable measurement of the amount of fluid the client has retained since the last dialysis treatment?

A client with chronic kidney disease (CKD) has a serum potassium level of 6.5 mEq/L. Which of the following medications removes excess potassium from the body?