A patient with chronic kidney disease usually has a decrease in the ability to activate vitamin D, likely resulting in signs and symptoms (S&S) such as:

Hypercalcemia: increased absorption of calcium from the gut into the blood.

A positive Chvostek’s sign: hypocalcemia.

Tetany: hyperpolarization.

Hyperphosphatemia: inability to absorb phosphate from the gut into the blood.

Answer and Explanation

The Correct Answer is B

Choice A rationale
Hypercalcemia is characterized by increased calcium levels in the blood, often due to increased absorption of calcium from the gut. However, in chronic kidney disease (CKD), the kidneys’ ability to activate vitamin D is impaired, leading to decreased calcium absorption from the gut, not increased. Therefore, hypercalcemia is not a typical sign of CKD1.
Choice B rationale
A positive Chvostek’s sign is indicative of hypocalcemia, which is a common symptom in CKD. The kidneys’ reduced ability to activate vitamin D leads to decreased calcium absorption from the gut, resulting in low calcium levels in the blood. This hypocalcemia can cause neuromuscular irritability, leading to a positive Chvostek’s sign.
Choice C rationale
Tetany is a condition characterized by muscle cramps and spasms, often due to hypocalcemia. In CKD, hypocalcemia occurs due to the kidneys’ inability to activate vitamin D, leading to decreased calcium absorption from the gut. This hypocalcemia can cause hyperexcitability of nerves and muscles, resulting in tetany.
Choice D rationale
Hyperphosphatemia is characterized by high phosphate levels in the blood. In CKD, the kidneys’ ability to excrete phosphate is impaired, leading to its accumulation in the blood. However, this is not directly related to the inability to absorb phosphate from the gut but rather the kidneys’ reduced excretion capacity.

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Correct Answer is C

Explanation

Choice A rationale
A respiratory rate of 22 breaths per minute is slightly elevated but not necessarily concerning for a client with COPD. COPD patients often have higher respiratory rates due to their chronic lung condition.
Choice B rationale
A temperature of 38°C (100.4°F) indicates a fever, which could be a sign of infection. However, it is not the most concerning finding in a COPD patient.
Choice C rationale
A pulse oximetry reading of 88% is concerning because it indicates hypoxemia. COPD patients often have lower oxygen levels, but a reading below 90% is worrisome and may require supplemental oxygen or other interventions.
Choice D rationale
A blood pressure of 140/90 mmHg is elevated but not immediately concerning in the context of COPD. It is important to monitor, but it is not the most critical finding.

A. Administer sodium polystyrene sulfonate as prescribed. B. Monitor the client’s cardiac rhythm. C. Restrict dietary potassium intake. D. Prepare the client for hemodialysis.

Correct Answer is B

Explanation

Choice A rationale
Administering sodium polystyrene sulfonate helps to lower potassium levels by exchanging sodium ions for potassium ions in the intestines. However, it is not the first intervention because it takes time to work and does not address the immediate risk of cardiac arrhythmias caused by hyperkalemia.
Choice B rationale
Monitoring the client’s cardiac rhythm is the first intervention because hyperkalemia can cause life-threatening cardiac arrhythmias. Continuous cardiac monitoring allows for the early detection and treatment of these arrhythmias, which is crucial for the client’s safety.
Choice C rationale
Restricting dietary potassium intake is an important long-term management strategy for hyperkalemia, especially in clients with chronic kidney disease. However, it does not address the immediate risk of cardiac arrhythmias and is not the first intervention.
Choice D rationale
Preparing the client for hemodialysis is a definitive treatment for hyperkalemia, especially in clients with chronic kidney disease. However, it is not the first intervention because it takes time to arrange and initiate dialysis. Immediate cardiac monitoring is necessary to manage the acute risk of arrhythmias.

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A patient with chronic kidney disease usually has a decrease in the ability to activate vitamin D, likely resulting in signs and symptoms (S&S) such as:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client with a history of chronic obstructive pulmonary disease (COPD). Which of the following findings is most concerning?

Correct Answer is C

Explanation

A nurse is caring for a client with chronic kidney disease (CKD) who presents with hyperkalemia. Which of the following interventions should the nurse implement first?

Correct Answer is B

Explanation

A nurse is caring for a client with a temperature of 37.5°C (99.5°F) and a respiratory rate of 28 breaths per minute. Which condition is the client most likely experiencing?

A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with increased shortness of breath and a productive cough. The nurse notes the client’s oxygen saturation is 88% on room air. Which of the following interventions should the nurse implement first?

Which infection control measure, by the nurse, reduces the potential spread of methicillin-resistant Staphylococcus aureus (MRSA)?

Which acute event is most likely to occur in a patient who has chronic atrial fibrillation?

A nurse is caring for a client with a history of hypertension who presents with a severe headache and blurred vision. What is the most likely cause of these symptoms?

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A nurse has identified a fluid volume deficit in the patient who has suffered prolonged vomiting and diarrhea. Which assessment data is most important in identifying that the patient may be developing prerenal acute kidney injury (AKI)?