Which laboratory results should the nurse closely monitor in a client who has end-stage renal disease (ESRD)?

Serum potassium, calcium, and phosphorus

Erythrocytes, hemoglobin, and hematocrit

Leukocytes, neutrophils, and thyroxine

Blood pressure, heart rate, and temperature

Answer and Explanation

The Correct Answer is A

Choice A reason: This is the correct answer because serum potassium, calcium, and phosphorus are laboratory results that should be closely monitored in a client who has end-stage renal disease (ESRD). ESRD is a chronic condition that causes irreversible loss of kidney function and accumulation of waste products and fluids in the body. Potassium is an electrolyte that regulates nerve and muscle function and cardiac rhythm. ESRD can cause hyperkalemia (high potassium levels) due to reduced excretion by the kidneys. Hyperkalemia can cause cardiac arrhythmias, muscle weakness, or paralysis. Calcium and phosphorus are minerals that maintain bone health and acid-base balance. ESRD can cause hypocalcemia (low calcium levels) due to impaired vitamin D metabolism and hyperphosphatemia (high phosphorus levels) due to reduced excretion by the kidneys. Hypocalcemia can cause muscle cramps, tetany, or seizures. Hyperphosphatemia can cause soft tissue calcification, bone pain, or fractures.

Choice B reason: Erythrocytes, hemoglobin, and hematocrit are laboratory results that are not as critical as serum potassium, calcium, and phosphorus in a client who has end-stage renal disease (ESRD). Erythrocytes are red blood cells that carry oxygen from the lungs to the tissues. Hemoglobin is a protein in erythrocytes that binds oxygen. Hematocrit is the percentage of blood volume that is occupied by erythrocytes. ESRD can cause anemia (low erythrocyte, hemoglobin, and hematocrit levels) due to reduced production of erythropoietin, a hormone that stimulates erythrocyte formation, by the kidneys. Anemia can cause fatigue, pallor, or shortness of breath.

Choice C reason: Leukocytes, neutrophils, and thyroxine are laboratory results that are not as relevant as serum potassium, calcium, and phosphorus in a client who has end-stage renal disease (ESRD). Leukocytes are white blood cells that fight infection and inflammation. Neutrophils are a type of leukocyte that respond to bacterial infection. Thyroxine is a hormone that regulates metabolism and growth. ESRD can cause leukopenia (low leukocyte levels) and neutropenia (low neutrophil levels) due to impaired immune function and increased susceptibility to infection. ESRD can also cause hypothyroidism (low thyroxine levels) due to reduced clearance of thyroid hormones by the kidneys. Hypothyroidism can cause weight gain, cold intolerance, or depression.

Choice D reason: Blood pressure, heart rate, and temperature are not laboratory results, but vital signs that should be monitored in a client who has end-stage renal disease (ESRD). Blood pressure is the force of blood against the walls of the arteries. Heart rate is the number of times the heart beats per minute. Temperature is the measure of body heat. ESRD can cause hypertension (high blood pressure) due to fluid overload and activation of the renin-angiotensin-aldosterone system, a hormonal pathway that regulates blood pressure and fluid balance. Hypertension can cause headache, chest pain, or stroke. ESRD can also cause tachycardia (high heart rate) due to anemia, fluid overload, or electrolyte imbalance. Tachycardia can cause palpitations, dizziness, or heart failure. ESRD can also cause fever (high temperature) due to infection or inflammation. Fever can cause chills, sweating, or delirium.

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Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A reason: Centering attention on positive upbeat music is not a specific instruction for the nurse to include, as this is a general coping strategy that may or may not be helpful for this client. This is a distractor choice.

Choice B reason: Finding outlets for more social interaction is not a relevant instruction for the nurse to include, as this may not address the underlying causes of anxiety or stress for this client. This is another distractor choice.

Choice C reason: Practicing using muscle relaxation techniques is an appropriate instruction for the nurse to include, as this can help reduce physical tension and promote calmness and relaxation for this client. Therefore, this is the correct choice.

Choice D reason: Thinking about reasons the episodes occur is not a helpful instruction for the nurse to include, as this can increase rumination and anxiety for this client. This is another distractor choice.

A. Maintain a quiet, non-stimulating environment. B. Force oral fluids and provide frequent small meals. C. Confront the client's denial of substance abuse. D. Encourage attendance and group participation.

Correct Answer is A

Explanation

Choice A reason: This is the correct answer because maintaining a quiet, non-stimulating environment is important to reduce agitation, anxiety, and hallucinations that may occur in clients with alcohol withdrawal delirium. Alcohol withdrawal delirium is a severe and potentially life-threatening condition that can cause confusion, disorientation, tremors, seizures, and autonomic instability.

Choice B reason: Forcing oral fluids and providing frequent small meals are not the most important interventions for a client with alcohol withdrawal delirium. Although hydration and nutrition are important to prevent dehydration and electrolyte imbalance, they are not the priority in this case. The client may have difficulty swallowing, vomiting, or aspiration due to altered mental status.

Choice C reason: Confronting the client's denial of substance abuse is not an appropriate intervention for a client with alcohol withdrawal delirium. The client may not be able to comprehend or respond rationally to such confrontation due to impaired cognition and perception. The nurse should avoid arguing or challenging the client's beliefs and focus on providing safety and comfort.

Choice D reason: Encouraging attendance and group participation is not a feasible intervention for a client with alcohol withdrawal delirium. The client may not be able to participate in any social or educational activities due to severe withdrawal symptoms and delusions. The nurse should limit visitors and stimuli and provide one-to-one supervision and reassurance.

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Which laboratory results should the nurse closely monitor in a client who has end-stage renal disease (ESRD)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing education to a client who experiences recurrent levels of moderate anxiety to situations and perceived stress. In addition to information about prescribed medication and administration, which instruction should the nurse include in the teaching?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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