Chronic Kidney Disease- HESI Case Study

What is the best description of CKD?
It is a fatal disorder unless renal replacement therapy is received.
What additional information in Louellen’s history may be related to the onset of ESRD?
Hypertension.
Which lab value is likely to be decreased in a client with chronic kidney disease?
Serum calcium.
What is the underlying pathology causing this abnormal lab value?
Fewer red blood cells are being formed.
What is the correct interpretation of these ABGs?
Metabolic acidosis (compensated).
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Which additional assessment finding is consistent with ESRD?
Yellow-gray pallor.
Which explanation best describes the pathology resulting in her hypertension?
Activation of the renin-angiotensin cycle and excretion of aldosterone causes hypertension.
Which assessment finding indicated to the nurse that the desired outcome of the calcium acetate (Phoslo) has been achieved?
Serum phosphorus of 4.0 mg/dL
Which assessment should the nurse perform to determine if the desired outcome of the captopril (Capoten) has been achieved?
Blood pressure.
Which assessment data indicates to the nurse that the desired outcome of the epoetin alfa (Epogen) has been achieved?
Conjunctival sac returns to a reddish-pink color.
Based on these diagnoses, which nursing intervention should be included in Louellen’s plan of care?
Monitor and record daily weights.
The nurse’s response is based on what understanding?
Eggs are a source of high biologic value protein.
How much fluid will Louellen be allowed to drink during the next 24 hours?
720 ml of fluid
What is the best nursing intervention?
Hold the dose of Kay Ciel and contact the health care provider to report the serum potassium level.
What intervention should the nurse implement?
Ask to speak directly with the health care provider.
Which statement should serve as the basis for the nurse’s reply?
The professional nurse can be help accountable for administration of any unsafe medication.
Which factor is related to the use of hemodialysis?
High risk for air embolus.
Louellen is at increased risk for the development of which problem while receiving hemodialysis?
Hepatitis B and C.
What is the best description of an AV graft?
Synthetic tubing tunneled beneath the skin connecting an artery and a vein.
Which documentation should the nurse enter into the nurses’ notes?
Thrill present and palpated.
Which intervention should the nurse include in Louellen’s plan of care?
Perform sterile dressing changes at the dual-lumen catheter site.
Which expected outcome should be included in he nurse’s teaching plan?
Client will select fods high in iron and calcium from a menu.
What is the maximum amount of weight that Louellen should gain between each dialysis treatment?
1.5 kg of weight .
Which nursing assessment has the highest priority during the first 24-hour postoperative period?
Vital signs.
Which intervention should be included in the plan of care during the immediate postoperative period?
Monitor Louellen’s urinary output hourly using an urimeter.
How many mL of the medication should the nurse draw up?
4.8
Which nursing diagnosis has the greatest priority when caring for a client receiving immunosuppressive agents?
Risk for infection.
Which interventions are important to include in Louellen’s plan of care while she is receiving multiple immunosuppressants? (Select all that apply)
-Instruct visitors that fresh flowers should not be taken into the room.
-Have all staff and visitors wash their hands every time they enter her room.
Which action should the nurse implement first?
Administer an analgesic.
Which action can be delegated to the unlicensed assistive personnel (UAP)?
Measure the client’s urinary output.
What is the best initial response by the nurse?
Describe the location and type of pain you are having.
Which instructions should the nurse give Louellen?
Advise her to come to the clinic right away for further evaluation.
What is the best response by the nurse?
This is a very difficult time for you and your family.
What action should the nurse implement?
Encourage the expression of anger in a non-harmful manner.
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