A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client’s diet to maximize the therapeutic effect and minimize the risks of complications. The client’s diet should include which of the following modifications?

Increased potassium intake

Increased protein intake

Decreased phosphorus intake

Decreased calcium intake/supplementation

Answer and Explanation

The Correct Answer is C

Choice A reason: Increased potassium intake is dangerous in ESRD, as impaired kidneys cannot excrete potassium, leading to hyperkalemia. This can disrupt cardiac membrane potentials, causing arrhythmias or cardiac arrest. ESRD diets require strict potassium restriction to prevent life-threatening electrolyte imbalances, making this modification inappropriate.

Choice B reason: Increased protein intake is often recommended in ESRD patients on hemodialysis to replace protein lost during dialysis and prevent malnutrition. However, it must be balanced to avoid excess urea production, which can worsen uremia. This is not the primary focus compared to phosphorus management in this context.

Choice C reason: Decreased phosphorus intake is critical in ESRD, as kidneys cannot excrete phosphate, leading to hyperphosphatemia. This causes vascular calcification and secondary hyperparathyroidism, increasing cardiovascular risk. Dietary phosphorus restriction, often with phosphate binders, prevents these complications, making it a key dietary modification for hemodialysis patients.

Choice D reason: Decreased calcium intake is not recommended in ESRD, as patients often have hypocalcemia due to impaired vitamin D activation and phosphate retention. Calcium supplementation or adequate intake is needed to prevent bone disease and secondary hyperparathyroidism, making this modification incorrect for ESRD management.

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Correct Answer is D

Explanation

Choice A reason: Implementing interventions addresses specific needs but is not the primary goal of therapeutic communication during admission. Interventions follow after building trust, as depression and anxiety require a strong therapeutic alliance to ensure effective treatment engagement, making this a secondary priority at this stage.

Choice B reason: Teaching self-care skills is important for long-term management but not the initial communication goal. Clients with depression and anxiety need trust and emotional safety first to engage in learning, making skill-building secondary to establishing a therapeutic relationship during the admission assessment.

Choice C reason: Facilitating emotional expression is a key component of therapeutic communication but depends on a trusting relationship. Without a strong nurse-client bond, clients with depression and anxiety may resist sharing emotions, making this goal important but secondary to establishing rapport during the initial assessment.

Choice D reason: Establishing a therapeutic nurse-client relationship is the priority during admission, as it builds trust and safety, critical for clients with depression and anxiety. This foundation enables emotional expression, engagement in interventions, and skill-building, ensuring effective communication and treatment adherence, making it the primary goal in this context.

A. Be coerced to accept treatment B. Have the client’s family petition for a 302 as they recently witnessed the client’s behavior C. Continue to refuse treatment D. Be committed by their doctor involuntarily to receive needed treatment

Correct Answer is C

Explanation

Choice A reason: Coercing treatment violates the voluntary client’s autonomy. Legally, voluntary patients can refuse medication unless they pose imminent danger, requiring involuntary commitment. Manipulation or disruption does not meet legal criteria for forced treatment, as mental health laws prioritize patient rights absent clear harm risks.

Choice B reason: A 302 (involuntary commitment) requires evidence of imminent danger to self or others, not just disruptive behavior. Family petitions cannot override this legal threshold without clinical justification, and manipulation alone does not qualify, making this option incorrect for enforcing treatment in a voluntary client.

Choice C reason: As a voluntary client, the individual retains the right to refuse treatment unless deemed a danger to self or others. Mental health laws protect autonomy, and manipulation or lack of progress does not justify forced medication, making refusal a legal right in this scenario.

Choice D reason: Involuntary commitment by a doctor requires evidence of imminent danger or inability to care for oneself, not just disruptive behavior or nonadherence. Without such criteria, the client’s voluntary status protects their right to refuse, making involuntary commitment legally inappropriate in this situation.

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A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client’s diet to maximize the therapeutic effect and minimize the risks of complications. The client’s diet should include which of the following modifications?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is performing an admission assessment for a client on the behavioral health unit with depression and anxiety. Which goal of therapeutic communication will the nurse prioritize?

Correct Answer is D

Explanation

Correct Answer is C

Explanation

A nurse is reviewing an electronic medical record to determine if a client’s rights have been violated by another member of the healthcare team. Which finding will the nurse identify that would indicate a violation of the client’s rights?

Which statement by a nurse may undermine a patient’s feelings and belittle the patient’s concerns?

A nurse is assigned to administer oral medications to a client. Which action will the nurse do first if a client refuses to take prescribed oral medications?

The nurse is sitting down with a client to begin a conversation. Which position will the nurse take to convey acceptance of the client?

An adult client was put in restraints after all other attempts to reduce aggression have failed. Which is required now that restraints have been instituted by the nurse?

Which of the following is true regarding mental health and mental illness?

A nurse working on a psychiatric unit receives a telephone call from a client’s employer requesting a copy of the client’s psychological evaluation results. Based on the nurse’s knowledge of breach of confidentiality, which response would be appropriate?

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?