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 A

Explanation

A. This method is the most reliable for measuring fluid retention. Weight changes are a direct indicator of fluid balance because fluid retention or loss affects body weight. By comparing the client's current weight to their post-dialysis weight, you can determine the amount of fluid they have retained.

B. Creatinine and blood urea nitrogen (BUN) levels are indicators of kidney function rather than fluid volume status. Elevated levels can indicate worsening kidney function but do not directly measure fluid retention or overload.
C. While assessing skin turgor and peripheral edema can provide some clues about fluid overload, these signs are less precise and subjective compared to weight measurements. Skin turgor changes and edema can be influenced by various factors, including skin elasticity and other conditions, making them less reliable for accurately measuring fluid volume changes since the last dialysis.
D. Crackles in lung sounds can indicate pulmonary congestion due to fluid overload, but this method is not as precise for quantifying the amount of fluid retained. Crackles suggest fluid accumulation in the lungs, which is a sign of more severe fluid overload but does not provide a specific measurement of fluid volume compared to changes in body weight.

A. Milk B. Liver C. Spinach D. Chocolate

Correct Answer is B

Explanation

A. Milk is low in purines and is not associated with an increase in uric acid levels or the formation of uric acid stones. In fact, dairy products like milk can be beneficial in a diet for managing kidney stones because they are low in purines and provide calcium, which may help prevent stone formation.

B. Liver is very high in purines. High-purine foods increase the levels of uric acid in the body, which can lead to the formation of uric acid stones in the kidneys. Therefore, clients with recurrent kidney stones due to excessive purine intake should avoid liver and other organ meats.
C. Spinach is considered to have a moderate level of purines. While it is not as high in purines as organ meats, it still contains a notable amount. However, in comparison to foods like liver, it is less of a concern for individuals who need to strictly limit purine intake.
D. Chocolate contains a moderate amount of purines, but it is not as high in purines as organ meats like liver. While it’s not completely free from purines, its purine content is generally lower compared to foods such as liver.

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is A

Explanation

A client has had recurrent kidney stones. Upon lab analysis of the client's urine, it is found that excessive purine intake is the underlying cause. Which of the following high-purine foods should the nurse instruct the client to avoid?

Correct Answer is B

Explanation

A client with rapidly progressing end-stage renal disease (ESRD) asks about the possibility of a kidney transplant. In responding to the client, the nurse understands that which of the following is a contraindication for receiving a kidney transplant?

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's arteriovenous fistula prior to hemodialysis, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable, and the capillary refill is slow. Which of the following actions is the nurse's priority?

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 who received a kidney transplant last month is in the nephrology clinic for a follow-up visit. Which education should the nurse provide to the client regarding complications which can arise after a kidney transplant?

A client with polycystic kidney disease is prescribed the medication Tolvaptan. What should the nurse include when educating the client about this medication.