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

Explanation

A. It helps to temporarily lower serum potassium levels by driving potassium into the cells. This effect is usually short-lived and is often used in emergency situations to quickly manage hyperkalemia.
B. Calcium Gluconate is used to stabilize the cardiac membrane in the setting of hyperkalemia, especially if there are ECG changes or symptoms of hyperkalemia. It does not lower the serum potassium level but helps protect the heart from the potential arrhythmias caused by elevated potassium levels.
C. Patiromer (Veltassa) is a potassium binder that helps to remove excess potassium from the body through the gastrointestinal tract. It binds potassium in the gut and facilitates its excretion in the stool.
D. Lisinopril is an ACE inhibitor used to treat hypertension and heart failure. It can actually increase potassium levels by decreasing the excretion of potassium through the kidneys.

A. "If you experience chronic rejection, you will not be eligible to go back onto the transplant list." B. "You are at an increased risk of developing benign prostatic hyperplasia after a transplant." C. "You should limit your fluid intake to 1,500 mL per day so your new kidney will not have to work as hard." D. "Immunosuppressants can make hypertension worse, so you may need to go on blood pressure medication."

Correct Answer is D

Explanation

A. This is incorrect. While chronic rejection is a serious complication, patients who experience it can often receive another transplant.
B. This is incorrect and unrelated to kidney transplant.
C. This is incorrect. Adequate hydration is essential for proper kidney function.
D. This is correct. Immunosuppressants can contribute to hypertension, a common complication after kidney transplant.

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is C

Explanation

A client who received a kidney transplant last month is in the nephrology clinic for a follow-up visit. Which education should the nurse provide to the client regarding complications which can arise after a kidney transplant?

Correct Answer is D

Explanation

Which of the following clients is at risk of developing acute kidney injury from a post-renal cause?

A client with rapidly progressing end-stage renal disease (ESRD) asks about the possibility of a kidney transplant. In responding to the client, the nurse understands that which of the following is a contraindication for receiving a kidney transplant?

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.)

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 acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse recognizes that administering IV calcium gluconate to this client will result in which of the following effects?

The nurse is providing education to a male client who is newly-diagnosed with polycystic kidney disease. Which of the following statements should be included in the client teaching?