NURS 111 Chronic Kidney Disease
Chronic Kidney Disease
Instructions
Meet the Client: Louellen Sanderson
Louellen Sanderson is a 58-year-old female with a long history of diabetes mellitus and
hypertension. She has experienced renal insufficiency for the last two years. Her current
medications include 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 these times. Her current weight is 114 pounds. 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).
1.
What is the best description of CKD?
A) Symptoms are reversible with life long medication.
INCORRECT
Chronic kidney disease is progressive, irreversible kidney injury. Acute renal failure may be reversible
with adequate supportive care during the acute episode.
B) Condition has a rapid onset with frequent remissions.
INCORRECT
Acute renal failure has a rapid onset, but chronic kidney disease has a gradual onset, occurring over
months or years. Neither form of renal failure has frequent periods of remission.
C) It is a fatal disorder unless renal replacement therapy is received.
CORRECT
CKD is fatal unless some form of renal replacement therapy (dialysis or organ transplant) 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.
D) There are frequent exacerbations since half of all nephrons are damaged.
INCORRECT
Half of all nephrons are often damaged in acute renal failure. In CKD, about 90% of nephrons are
typically involved.
CKD is a disorder with a complex etiology involving many interrelated factors. Diabetes mellitus is a
known risk factor for renal failure.
,NURS 111 Chronic Kidney Disease
2.
What additional information in Louellen's history may be related to the onset of ESRD?
A) Female gender.
INCORRECT
CKD does not seem to be more common in either gender.
B) Hypertension.
CORRECT
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.
C) Use of diuretics.
INCORRECT
Use of diuretics is not a cause of CKD, but obtaining a medication history is important since many
medications are nephrotoxic.
D) Hysterectomy at age 35.
INCORRECT
This is not a risk factor for CKD.
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.
CORRECT
Serum calcium is decreased in CKD in response to an increase in serum phosphorous.
B) Serum creatinine and BUN.
INCORRECT
, NURS 111 Chronic Kidney Disease
Serum creatinine and BUN are tests which evaluate the removal of nitrogenous wastes by the kidney.
Both are increased in chronic kidney disease, although BUN levels are directly impacted by protein
intake, hydration status, and other factors.
C) Serum potassium.
INCORRECT
Serum potassium levels are increased in CKD as the kidney loses the ability to remove potassium from
the body. Clients with CKD should be assessed carefully for symptoms of hyperkalemia.
D) Serum phosphorous.
INCORRECT
Serum phosphorous is increased as less phosphorous is excreted by the kidney.
The nurse notes that Louellen's Hemoglobin level is 7.8.
4.
What is the underlying pathology causing this abnormal lab value?
A) Hematuria results in blood loss.
INCORRECT
CKD does not result in hematuria.
B) Fewer red blood cells are being formed.
CORRECT
Hemoglobin is decreased as the kidneys become less able to produce erythropoietin necessary for the
formation of red blood cells.
C) Dehydration causes dilutional anemia.
INCORRECT
If dehydration occurred, it would be more likely to result in a high hemoglobin level rather than a low level.
D) Renal waste products destroy red blood cells.
INCORRECT
This does not occur.
Louellen's arterial blood gas (ABG) results are:
• pH 7.35.
• PO2 96.00 mmHg.
• PCO2 30.00 mmHg.
• HCO3 18.00 mEq/L.
5.
What is the correct interpretation of these ABGs?
Chronic Kidney Disease
Instructions
Meet the Client: Louellen Sanderson
Louellen Sanderson is a 58-year-old female with a long history of diabetes mellitus and
hypertension. She has experienced renal insufficiency for the last two years. Her current
medications include 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 these times. Her current weight is 114 pounds. 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).
1.
What is the best description of CKD?
A) Symptoms are reversible with life long medication.
INCORRECT
Chronic kidney disease is progressive, irreversible kidney injury. Acute renal failure may be reversible
with adequate supportive care during the acute episode.
B) Condition has a rapid onset with frequent remissions.
INCORRECT
Acute renal failure has a rapid onset, but chronic kidney disease has a gradual onset, occurring over
months or years. Neither form of renal failure has frequent periods of remission.
C) It is a fatal disorder unless renal replacement therapy is received.
CORRECT
CKD is fatal unless some form of renal replacement therapy (dialysis or organ transplant) 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.
D) There are frequent exacerbations since half of all nephrons are damaged.
INCORRECT
Half of all nephrons are often damaged in acute renal failure. In CKD, about 90% of nephrons are
typically involved.
CKD is a disorder with a complex etiology involving many interrelated factors. Diabetes mellitus is a
known risk factor for renal failure.
,NURS 111 Chronic Kidney Disease
2.
What additional information in Louellen's history may be related to the onset of ESRD?
A) Female gender.
INCORRECT
CKD does not seem to be more common in either gender.
B) Hypertension.
CORRECT
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.
C) Use of diuretics.
INCORRECT
Use of diuretics is not a cause of CKD, but obtaining a medication history is important since many
medications are nephrotoxic.
D) Hysterectomy at age 35.
INCORRECT
This is not a risk factor for CKD.
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.
CORRECT
Serum calcium is decreased in CKD in response to an increase in serum phosphorous.
B) Serum creatinine and BUN.
INCORRECT
, NURS 111 Chronic Kidney Disease
Serum creatinine and BUN are tests which evaluate the removal of nitrogenous wastes by the kidney.
Both are increased in chronic kidney disease, although BUN levels are directly impacted by protein
intake, hydration status, and other factors.
C) Serum potassium.
INCORRECT
Serum potassium levels are increased in CKD as the kidney loses the ability to remove potassium from
the body. Clients with CKD should be assessed carefully for symptoms of hyperkalemia.
D) Serum phosphorous.
INCORRECT
Serum phosphorous is increased as less phosphorous is excreted by the kidney.
The nurse notes that Louellen's Hemoglobin level is 7.8.
4.
What is the underlying pathology causing this abnormal lab value?
A) Hematuria results in blood loss.
INCORRECT
CKD does not result in hematuria.
B) Fewer red blood cells are being formed.
CORRECT
Hemoglobin is decreased as the kidneys become less able to produce erythropoietin necessary for the
formation of red blood cells.
C) Dehydration causes dilutional anemia.
INCORRECT
If dehydration occurred, it would be more likely to result in a high hemoglobin level rather than a low level.
D) Renal waste products destroy red blood cells.
INCORRECT
This does not occur.
Louellen's arterial blood gas (ABG) results are:
• pH 7.35.
• PO2 96.00 mmHg.
• PCO2 30.00 mmHg.
• HCO3 18.00 mEq/L.
5.
What is the correct interpretation of these ABGs?
