Roth 10e NCLEX Chapter 19

MULTIPLE CHOICE 1. A client with chronic renal failure who is not receiving dialysis is suffering from uremia. What nutrient will the nurse tell this client to limit in an attempt to control the uremia? a. carbohydrate c. potassium b. magnesium d. protein ANS: D Uremia is a condition in which protein wastes that should normally have been excreted are instead circulating in the blood. The diet may limit protein to as little as 40 grams a day for predialysis clients. PTS: 1 REF: Classification of Renal Disease; Special Considerations For Clients With Renal Diseases 2. The nurse at the dialysis clinic notes when she reviews a clients labs that the labs indicated hyperkalemia. She makes a note to make sure the client is adhering to all dietary restrictions. Of the following possibilities, which might the nurse ask about? a. fiber supplements c. salt substitutes b. intake of whole grains d. sugar substitutes ANS: C Potassium may be restricted in some clients because hyperkalemia tends to occur in end-stage renal disease. Excess potassium can cause cardiac arrest. Because of this danger, renal clients should not use salt substitutes or low-sodium milk because the sodium in these products is replaced with potassium. PTS: 1 REF: Dietary Treatment of Renal Disease

3. The nurse is assessing a dialysis patient who is asking to receive continuous ambulatory peritoneal dialysis (CAPD) instead of hemodialysis. Which of the following complications of CAPD will the nurse review with the client? Select all that apply. a. hypercalcemia c. hyponatremia b. hypertension d. hypotension ANS: D Clients on CAPD have a more normal lifestyle than do clients on either hemodialysis or peritoneal dialysis. Complications associated with CAPD include peritonitis, hypotension, and weight gain. PTS: 1 REF: Dialysis

4. The nurse is calculating the protein requirement for a client who is switching from peritoneal dialysis to hemodialysis. The client is 55 tall and weighs 140 pounds. How many grams of protein does this client need per day? a. 42 to 63 c. 64 to 76 b. 51 to 62 d. 76 to 96 ANS: C A client on hemodialysis requires 1.0 to 1.2 grams of protein per kilogram of body weight. The client weighs 64 kg so the requirement is 64 to 76. PTS: 1 REF: Diet During Dialysis

MULTIPLE RESPONSES 1. The nurse is assessing an otherwise healthy client with renal disease. The client is taking several supplements that are not indicated for clients who have renal disease. Which of the following will the nurse think should be discontinued? Select all that apply. a. iron d. vitamin D b. vitamin A e. vitamin E c. vitamin C f. vitamin K ANS: B, E, F Renal clients often have an increased need for vitamins B, C, and D, and supplements are often given. Vitamin A should not be given because the blood level of vitamin A tends to be elevated in uremia. If a client is receiving antibiotics, a vitamin K supplement may be given. Otherwise, supplements of vitamins E and K are not necessary. PTS: 1 REF: Dietary Treatment of Renal Disease

2. The diet order for a client receiving hemodialysis is written as 80-3-3. When the nurse explains the diet to the client, which of the following will be included in the teaching? Select all that apply. a. 80 grams of fat are allowed per day d. phosphorus is restricted to 3 grams a day b. 80 grams of protein are allowed per day e. potassium is restricted to 80 mg per day c. potassium is restricted to 3 grams a day f. sodium is restricted to 3 grams per day ANS: B, C, F A typical renal diet could be written as 80-3-3, which means 80 grams of protein, 3 grams of sodium, and 3 grams of potassium are allowed per day. PTS: 1 REF: Diet During Dialysis

3. The nurse is educating a client who recently had a kidney transplant about the dietary changes that will be necessary. Which of the following statements could the nurse make to the client? Select all that apply. a. additional calcium may be needed d. fats may be limited b. carbohydrates may be restricted e. protein may be restricted c. extra protein may be needed f. sodium may be restricted ANS: A, B, C, D, E, F After kidney transplant, there may be a need for extra protein or for the restriction of protein. Carbohydrate and sodium may be restricted. The appropriate amounts of these nutrients will depend largely on the medications given at the time. Additional calcium and phosphorus may be necessary if there was substantial bone loss before the transplant. There may be an increased appetite after transplant, so fats and simple carbohydrates may be limited to prevent excessive weight gain. PTS: 1 REF: Diet After Kidney Transplant

4. The nurse is educating the client about diet after the client was treated for calcium oxalate renal stones. The nurse tells the client about foods that should be avoided to reduce the risk of development of future renal stones. Which of the following foods could the nurse tell the client to avoid? Select all that apply. a. cheese d. spinach b. chocolate e. strawberries c. milk f. tea

ANS: B, D, E, F About 80% of the renal stones formed contain calcium oxalate. Recent studies provide no support for the theory that a diet low in calcium can reduce the risk of calcium oxalate renal stones. In fact, higher dietary calcium intake may decrease the incidence of renal stones for most people. Stones containing oxalate are thought to be partially caused by a diet especially rich in oxalate, which is found in beets, wheat bran, chocolate, tea, rhubarb, strawberries, and spinach. PTS: 1 REF: Calcium Oxalate Stones