The nurse is receiving the morning report on four clients on a medical-surgical unit. Based on the information provided, which clients are at greatest risk for developing end-stage renal disease (ESRD)? (Select all that apply)
A 70-year-old client with a BMI of 30 and a history of hypertension
A 64-year-old client with a history of vascular disorders
A 50-year-old client with poorly controlled diabetes mellitus
A 60-year-old client with chronic obstructive pulmonary disease
A 60-year-old client with a recent episode of dehydration due to gastroenteritis
Correct Answer : A,B,C
Choice A reason: Hypertension and obesity (BMI 30) are major risk factors for ESRD. Chronic hypertension damages renal vasculature, reducing glomerular filtration over time. Obesity exacerbates hypertension and promotes glomerulosclerosis, leading to progressive kidney damage. This combination significantly increases the risk of developing ESRD through sustained renal injury.
Choice B reason: Vascular disorders, such as atherosclerosis, impair renal blood flow, causing ischemic nephropathy. Chronic reduced perfusion damages nephrons, leading to progressive renal failure. Vascular diseases also contribute to hypertension, further stressing kidneys. This client’s history indicates a high risk for ESRD due to ongoing vascular compromise affecting renal function.
Choice C reason: Poorly controlled diabetes mellitus causes diabetic nephropathy, a leading cause of ESRD. Chronic hyperglycemia damages glomerular capillaries, leading to proteinuria and declining kidney function. Sustained high glucose levels accelerate nephron loss, making this client at high risk for ESRD due to irreversible renal damage from diabetes.
Choice D reason: Chronic obstructive pulmonary disease (COPD) primarily affects the lungs, not the kidneys. While hypoxia or medications like corticosteroids may indirectly stress kidneys, COPD is not a direct risk factor for ESRD. Renal damage requires specific insults like hypertension or diabetes, making this client less likely to develop ESRD.
Choice E reason: A recent dehydration episode from gastroenteritis can cause acute kidney injury but is reversible with treatment. It is not a chronic condition leading to ESRD unless recurrent or combined with other risk factors like diabetes or hypertension. This isolated event poses a lower risk for ESRD development.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Sitting upright with uncrossed limbs at eye level conveys openness and engagement. Uncrossed arms and legs signal non-defensiveness, while eye-level positioning fosters equality and trust. This posture aligns with therapeutic communication principles, promoting a safe, accepting environment for the client to express emotions freely.
Choice B reason: Leaning forward with arms on a table may appear intrusive or aggressive, potentially making the client feel uncomfortable. While engagement is intended, this posture can reduce personal space, disrupting the therapeutic environment and hindering the client’s sense of safety and acceptance during the conversation.
Choice C reason: Sitting upright with feet on the floor is neutral but less specific in conveying acceptance. Without mention of uncrossed arms or eye-level positioning, it may not fully signal openness. While not negative, it lacks the full therapeutic posture needed to maximize client comfort and trust.
Choice D reason: Turning to the side with folded arms suggests defensiveness or disengagement, which can make the client feel unaccepted or dismissed. This posture contradicts therapeutic communication principles, as it creates a barrier to open dialogue and may hinder the client’s willingness to share emotions.
Correct Answer is D
Explanation
Choice A reason: Left-sided flank pain may suggest kidney stones or infection but is not specific to AKI. Pain can occur in various conditions, including pyelonephritis or ureteral obstruction, and does not directly indicate reduced glomerular filtration or oliguria, which are hallmarks of AKI, making it less urgent.
Choice B reason: Blood pressure of 138/86 mm Hg and heart rate of 92 bpm are within normal ranges and not specific to AKI. While hypertension can occur in AKI due to fluid overload, these values do not strongly suggest AKI without other signs like oliguria or lab abnormalities.
Choice C reason: Cloudy urine with sediment and foul odor suggests a urinary tract infection, not necessarily AKI. Infections can coexist with AKI but are not diagnostic. AKI is characterized by reduced urine output and elevated creatinine, not primarily by urine appearance, making this finding less indicative.
Choice D reason: Urine output of 150 mL in 8 hours (450 mL/day) indicates oliguria, a key sign of AKI, where kidneys fail to filter adequately, reducing urine production. This can lead to fluid overload and toxin accumulation, necessitating urgent provider notification to evaluate and manage potential AKI complications like hyperkalemia.
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