A 53-year-old male client who has no prior medical history and takes no medications is in a primary care provider's office for a routine physical. The client states that he has not seen a doctor in "about five years." The client's blood pressure is at the appointment is 157/92 mmHg and his fasting blood glucose is 83 mg/dL. Based on recent lab results, the provider determines that the client's glomerular filtration rate (GFR) is 54 mL/min. The provider diagnoses the client with stage 3a chronic kidney disease (CKD). Based on these findings, which medication should the clinic nurse anticipate will be prescribed for this client?

Gentamicin

Daily potassium supplement

Captopril

Metformin

Answer and Explanation

The Correct Answer is C

A.   Gentamicin is an aminoglycoside antibiotic used to treat bacterial infections. It is not appropriate for managing CKD directly and is generally avoided in patients with kidney impairment due to its potential nephrotoxicity.
B.   Potassium supplements are typically not recommended unless there is a documented deficiency in potassium. In stage 3a CKD, managing potassium levels is crucial, but supplements are not usually needed unless potassium levels are low.
C.   Captopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are beneficial for patients with CKD as they help lower blood pressure and provide renal protective effects. They can reduce proteinuria (protein in urine), which is common in CKD, and may slow the progression of kidney disease.
D.   Metformin is an oral medication used to manage type 2 diabetes by improving insulin sensitivity and lowering blood glucose levels. Although it is important to monitor blood glucose in CKD patients, this
client’s fasting blood glucose is within normal range (83 mg/dL), so Metformin is not indicated unless there was evidence of diabetes or significant glucose dysregulation.

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Correct Answer is ["C","D"]

Explanation

A. Green beans are relatively low in potassium compared to other foods. While they do contain potassium, it is not in particularly high amounts. Therefore, they are generally considered safe in moderate amounts for individuals with CKD, but should still be monitored as part of a potassium- restricted diet.
B. Apples are low in potassium compared to many other fruits. They can be a good option for those needing to restrict potassium intake.
C. A typical serving of orange juice can contain a significant amount of potassium, which can contribute to elevated potassium levels in CKD patients. It should be limited or avoided to manage potassium intake effectively.
D. Avocados are high in potassium. A single avocado contains a substantial amount of potassium, making it a food that should be limited or avoided in a potassium-restricted diet for individuals with CKD.
E. Onions are relatively low in potassium and can be used in moderation by individuals with CKD. They are not typically a major concern for potassium restriction.

A. Increasing hematocrit B. Decreasing serum potassium C. Decreasing platelets D. Increasing white blood cells

Correct Answer is A

Explanation

A. Hematocrit measures the proportion of blood volume that is occupied by red blood cells. Epoetin alfa stimulates red blood cell production, so a therapeutic effect would be indicated by an increase in hematocrit levels. This is a key laboratory result to monitor when assessing the effectiveness of epoetin alfa in treating anemia in CKD patients.
B. Serum potassium levels are important to monitor in CKD patients due to the risk of hyperkalemia, but they are not directly affected by epoetin alfa. Decreasing serum potassium is not a primary indicator of the therapeutic effect of epoetin alfa.
C. Platelet count measures the number of platelets in the blood, which are crucial for blood clotting. Epoetin alfa is not designed to affect platelet counts; thus, a change in platelet count is not an indicator of the medication's therapeutic effect.
D. White blood cell count reflects the immune system's status and is not directly influenced by epoetin alfa. This medication specifically targets red blood cell production and does not impact white blood cell counts.

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Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following are high-potassium foods which the client should avoid? (Select all that apply.)

Correct Answer is ["C","D"]

Explanation

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication?

Correct Answer is A

Explanation

A female client has undergone surgery to remove a large struvite kidney stone. Based on the cause of struvite stones, which medication therapy should the nurse anticipate will be ordered to prevent recurrence of the stones?

A patient who performs dialysis at home using a catheter placed through the abdominal wall reports nausea, vomiting, diarrhea, and fluid discharge from the catheter site. The laboratory reports reveal an increased white blood cell count (WBC). Which condition does the nurse suspect in the patient?

A client has had recurrent kidney stones. Upon lab analysis of the client's urine, it is found that excessive purine intake is the underlying cause. Which of the following high-purine foods should the nurse instruct the client to avoid?

During the diuretic phase of acute kidney injury, the nurse understands that the client is at risk for which of the following electrolyte imbalances?

A nurse is assessing a client who has chronic kidney disease (CKD) for fluid volume overload prior to scheduled hemodialysis. Which of the following methods provides a reliable measurement of the amount of fluid the client has retained since the last dialysis treatment?

A client with chronic kidney disease (CKD) has a serum potassium level of 6.5 mEq/L. Which of the following medications removes excess potassium from the body?