A client with chronic renal failure is asking the nurse why her hemoglobin and hematocrit counts are low. Which of the following is the nurse's best response?

Your counts are low because of all the heparin you are receiving during dialysis

Your counts are low because your kidneys are no longer producing erythropoietin

Your counts are low because you are losing blood with each dialysis treatment

Your counts are low because you are not eating a diet rich in protein

Answer and Explanation

The Correct Answer is B

Choice A reason: Heparin prevents clotting during dialysis but doesn’t reduce hemoglobin or hematocrit directly. It’s not a primary cause of anemia in renal failure, unlike erythropoietin deficiency.

Choice B reason: Kidneys in chronic renal failure fail to produce erythropoietin, a hormone stimulating red blood cell production, leading to low hemoglobin and hematocrit, the key cause here.

Choice C reason: Minor blood loss occurs in dialysis, but it’s not the primary reason for chronic anemia. Erythropoietin deficiency from renal failure has a greater impact on counts.

Choice D reason: Poor protein intake affects overall health but isn’t the main driver of anemia in renal failure. Erythropoietin loss from kidney dysfunction is the dominant factor.

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Correct Answer is A

Explanation

Choice A reason: ESRD impairs fluid excretion, causing hypervolemia, leading to edema, crackles from pulmonary fluid, and hypertension from increased vascular volume, matching these symptoms.

Choice B reason: Hypovolemia, low fluid volume, causes hypotension and dry tissues, not swelling, crackles, or high blood pressure, which indicate excess fluid, not deficit.

Choice C reason: Hyperkalemia elevates potassium, causing arrhythmias or muscle issues, not directly linked to crackles, edema, or hypertension, which are fluid-related in ESRD.

Choice D reason: Hyponatremia, low sodium, may cause neurological symptoms, but crackles, edema, and hypertension point to fluid overload, not sodium imbalance primarily.

A. Dressing in the morning B. Writing letters C. Combing hair D. Eating meals

Correct Answer is B

Explanation

Choice A reason: Dressing involves both sides but can be adapted with the left hand; right-sided CVA impairs left-side function, less affecting dominant right-hand tasks.

Choice B reason: Writing, a fine motor skill, relies on the dominant right hand, controlled by the left brain; right-sided CVA disrupts this, making it most difficult.

Choice C reason: Combing hair uses gross motor skills, manageable with the left hand despite right-sided CVA’s left-sided weakness, less challenging than writing.

Choice D reason: Eating uses the right hand but can be adjusted with utensils or left-hand assistance; it’s less precise than writing, so less impacted.

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A client with chronic renal failure is asking the nurse why her hemoglobin and hematocrit counts are low. Which of the following is the nurse's best response?

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