CHRONIC KIDNEY DISEASE HESI CASE STUDY WITH 100% CORRECT ANSWERS 2024|GUARANTEED SUCCESS

Meet the Client Judy HarrisonJudy Harrison is a 38-year-old African American female with a long history of diabetes mellitus type 2 and hypertension. She has experienced renal insufficiency for the last two years. Her current medications include an angiotensin converting enzyme inhibitor (ACEI), a diuretic, and an oral hypoglycemic agent. She reports to the nurse at the clinic that she has lost her appetite and is very fatigued. She adds that she has to get up to go to the bathroom several times during the night and has trouble catching her breath at times. Her current weight is 114 lbs (51.7 kg). She is scheduled for diagnostic studies to evaluate for the onset of end-stage renal disease (ESRD). Etiology End-stage renal disease (ESRD) is the last stage in the progressive clinical syndrome called chronic kidney disease (CKD). Brainpower 0:02 / 0:15 1. Which explanation by the nurse is an accurate description of CKD? a. Symptoms are reversible with life long medication. b. The condition has a rapid onset with frequent remissions. c. It is a fatal disorder unless renal replacement therapy is received. d. There are frequent exacerbations since half of all nephrons are damaged. "It is a fatal disorder unless renal replacement therapy is received." CKD is fatal unless some form of renal replacement therapy (dialysis or organ transplantation) is done, whereas acute renal failure has a good prognosis for the return of kidney function if appropriate supportive care is provided during the acute period. CKD is a disorder with a complex etiology involving many interrelated factors. Diabetes mellitus is a known risk factor for renal failure. 2. What additional information in Judy's history may be related to the onset of ESRD? Select all that apply. a. Female gender. b. Hypertension. c. Hysterectomy at age 35. d. Polycystic Kidney Disease. e. African American ethnicity. "Hypertension." Hypertension is one of the primary causes of CKD. The vast majority of clients with CKD have hypertension, which may be either the cause or the result of CKD. "Polycystic Kidney Disease." PKD gene mutation will develop kidney cysts by age 30. Half of these people develop chronic kidney disease (CKD) by age 50 years. "African American ethnicity." African-American clients are more likely to develop ESKD and to have hypertensive ESKD. Diagnostic evaluation. The following diagnostic tests were performed: Hemoglobin Serum creatinine and BUN Serum calcium Arterial blood gases Serum potassium Serum phosphorus Urinary creatinine clearance 3. Which lab value is likely to be decreased in a client with chronic kidney disease? a. Serum calcium. b. Serum creatinine and BUN. c. Serum potassium. d. Serum phosphorous. "Serum calcium." Serum calcium is decreased in CKD in response to an increase in serum phosphorous. 4. Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse recognize as the cause of this abnormal lab value? a. Hematuria results in blood loss. b. Fewer red blood cells are being formed. c. Dehydration causes dilutional anemia. d. Renal waste products destroy red blood cells. "Fewer red blood cells are being formed." Hemoglobin is decreased as the kidneys become less able to produce erythropoietin necessary for the formation of red blood cells. Judy's arterial blood gas (ABG) results are: pH 7.35 PO2 96.00 mmHg PCO 2 30.00 mmHg HCO 3 18.00 mEq/L. 5. What is the correct interpretation of these ABGs? a. Respiratory acidosis (compensated). b. Respiratory alkalosis (compensated). c. Metabolic acidosis (compensated). d. Metabolic alkalosis (compensated). "Metabolic acidosis (compensated)." As excessive bicarbonate is excreted, the HCO3 level decreases, causing metabolic acidosis (decreased pH). Compensation occurs when an increased rate and depth of respirations reduce the CO2 levels, returning the pH to low normal. Clinical Manifestations Judy's diagnostic tests confirm the medical diagnosis of end-stage renal disease. In addition to Judy's report of fatigue, anorexia, dyspnea, and nocturia, the nurse's assessment findings include: +1 pedal edema, basilar crackles in both lungs, and clear, pale urine. Judy's vital signs: T 98.8° F (37.1° C), P 86, R 28, and BP 178/92. 6. Which additional assessment finding is consistent with ESRD? Select all that apply. a. Yellow-gray pallor. b. Clay-colored stool. c. Decreased attention span. d. Stridor. e. Tall tented T waves on electrocardiogram. "Yellow-gray pallor." The client with ESRD often exhibits a yellow-gray pallor as the result of anemia and uremia. In addition, the client with ESRD may exhibit other skin manifestations such as bruising and uremic frost (a very late manifestation). "Decreased attention span." Problems ranging from lethargy to seizures or coma, which may indicate uremic encephalopathy. "Tall tented T waves on electrocardiogram." Potassium excretion occurs mainly through the kidney. Any increase in potassium load during the later stages of CKD can lead to hyperkalemia (high serum potassium levels). The nurse notes that Judy's blood pressure is elevated. 7. Which explanation best describes the pathology resulting in her hypertension? a. Irritation of the pericardial lining of the heart due to uremic toxins increases blood pressure. b. An increase in the excretion of sodium and water from the kidneys causes hypertension. c. Activation of the renin-angiotensin cycle and excretion of aldosterone causes hypertension. d. The increase of uremic waste products in the blood stream increases the blood pressure. "Activation of the renin-angiotensin cycle and excretion of aldosterone causes hypertension." The renin-angiotensin cycle causes vasoconstriction of the periphery which increases the blood pressure. In addition, the excretion of aldosterone causes the retention of sodium and water, further increasing the fluid volume which increases the blood pressure. Pharmacologic Management Judy receives prescriptions for the following medications: - Calcium acetate (PhosLo) 2 gelcaps (667 mg each) PO with each meal - Ferrous sulfate (Feosol) 1 tablet PO (65 mg) daily - Epoetin alfa (Epogen) 3900 units subcutaneously 3 times per week (dosed at 75 U/kg three times a week) - Glipizide (Glucotrol) 10 mg PO daily - take 30 minutes before breakfast - Furosemide (Lasix) 40 mg PO twice daily - Captopril (Capoten) 25 mg PO twice daily - Potassium chloride (Kay Ciel) elixir 40 mEq PO three times daily. 8. Which assessment finding indicates to the nurse that the desired outcome of the calcium acetate (PhosLo) has been achieved? a. Serum glucose of 90 mg/dL. b. Serum phosphorous of 4.0 mg/dL. c. Serum hematocrit of 32%. d. Serum hemoglobin of 12 g/dL. "Serum phosphorous of 4.0 mg/dL." Calcium acetate (PhosLo) acts as a phosphate binder, reducing the high serum phosphorous levels commonly found in the client with CKD. 9. Which assessment should the nurse perform to determine if the desired outcome of the captopril (Capoten) has been achieved? a. Apical pulse. b. Blood pressure. c. Intake and output. d. Fingerstick glucose. "Blood pressure." Captopril (Capoten) is an ACE inhibitor used as an antihypertensive agent. 10. Which assessment data indicates to the nurse that the desired outcome of the epoetin alfa (Epogen) has been achieved? a. Conjunctival sac returns to a reddish-pink color. b. Consumed 100% of diet. c. No evidence of edema. d. Normo-active bowel sounds. "Conjunctival sac returns to a reddish-pink color." This assessment finding reflects an improvement in the client's anemia. Epogen stimulates the production of RBCs, resulting in an increase in hematocrit. It is used to treat the anemia common in clients with CKD. Nursing Diagnoses and Interventions Judy is admitted to an acute care facility for management of her ESRD. The nurse's plan of care includes the following nursing diagnoses: Excess Fluid Volume Potential for pulmonary edema related to fluid overload Decreased Cardiac Output Inadequate nutrition Risk for Infection Risk for Injury Fatigue Anxiety Constipation 11. Based on these diagnoses, which nursing intervention should be included in Judy's plan of care? a. Avoid any subcutaneous and intramuscular injections. b. Encourage Judy to ask questions and discuss fears about diagnosis. c. Offer frequent high-protein snacks. d. Encourage oral fluid intake. "Encourage Judy to ask questions and discuss fears about diagnosis." An open atmosphere that allows for discussion can decrease anxiety. Facilitate discussions with family members about the prognosis and the impact on lifestyle. Ethical/Legal Considerations: Medication Administration The nurse notes that the prescribed medications include potassium chloride (Kay Ciel) elixir 40 mEq PO 3 times a day. Prior to administering the medication, the nurse monitors Judy's serum potassium level, which is 6.5 mmol/L. 12. Which intervention is most important for the nurse to implement? a. Ask the pharmacist to supply a tablet rather than an elixir since Judy is on fluid restriction. b. Hold the dose of Kay Ciel and contact the HCP to report the serum potassium level. c. Administer the dose of Kay Ciel and document the serum potassium level in the medical record. d. Calculate the milliliters of medication needed and record the amount on the fluid intake record. "Hold the dose of Kay Ciel and contact the HCP to report the serum potassium level." The serum potassium level is elevated, and administering additional potassium in any form is potentially dangerous to the client. The nurse reports the serum potassium level to the HCP's office nurse, who calls back and tells the nurse that the HCP wants the dose of Kay Ciel reduced by half and changed to an oral tablet, rather than an elixir. 13. What intervention should the nurse implement? a. Administer the prescribed tablet. b. Request a faxed copy of the prescription. c. Obtain the name of the office nurse. d. Ask to speak directly with the HCP. "Ask to speak directly with the HCP." The medication prescription is unsafe and requires direct communication with the prescribing HCP. The nurse consults with HCP, who becomes angry, and tells the nurse that HCP prescriptions should never be questioned. 14. Which statement should serve as the basis for the nurse's reply? a. The professional nurse can be held accountable for the administration of any unsafe medication. b. The nurse's job description in most hospital policy manuals clearly states that adhering to the HCP's prescriptions is required. c. Only the prescribing HCP is legally liable for the administration of a prescribed, but unsafe, medication. d. State nurse practice acts indicate that the professional nurse should only administer legally prescribed medications. "The professional nurse can be held accountable for the administration of any unsafe medication." The professional nurse can be held legally liable for the administration of an unsafe medication.