A nurse is monitoring the laboratory results of a client who is in a late stage of chronic kidney disease. The nurse should expect the client to have which of the following electrolyte imbalances?

Hypernatremia

Hypercalcemia

Hypokalemia

Hypophosphatemia

Answer and Explanation

The Correct Answer is A

Rationale:

A. Hypernatremia: In late-stage chronic kidney disease (CKD), the kidneys lose their ability to concentrate or dilute urine effectively, leading to fluid imbalance and sodium retention. This can result in hypernatremia, particularly when there is inadequate fluid intake or excessive fluid loss, which the kidneys can no longer compensate for.

B. Hypercalcemia: Clients with advanced CKD typically develop hypocalcemia due to decreased activation of vitamin D and impaired calcium absorption. Additionally, phosphate retention leads to secondary hyperparathyroidism, further lowering serum calcium levels rather than elevating them.

C. Hypokalemia: Hypokalemia is not commonly associated with late-stage CKD. On the contrary, potassium tends to accumulate because the kidneys are less effective at excreting it, leading to hyperkalemia unless treated with medications or dialysis.

D. Hypophosphatemia: In CKD, phosphate excretion is impaired, resulting in hyperphosphatemia, not hypophosphatemia. Elevated phosphate levels are a hallmark finding in late-stage CKD and contribute to bone and cardiovascular complications in these clients.

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Correct Answer is C

Explanation

Rationale:

A. Position the client to maintain hip flexion: Hip flexion greater than 90 degrees increases intra-abdominal and intrathoracic pressure, which can impair venous return from the brain and raise intracranial pressure. The hips should be kept in a neutral, extended position.

B. Administer an enema if the client develops constipation: While managing constipation is important, enemas can stimulate the vagus nerve and raise ICP due to straining. Stool softeners or gentle interventions are preferred to avoid abrupt increases in intracranial pressure.

C. Provide 100% oxygen to the client prior to suctioning: Preoxygenation prevents hypoxia, which can increase cerebral blood flow and elevate ICP. Suctioning should always be preceded by hyperoxygenation to reduce this risk in patients with brain injuries.

D. Ensure that the PEEP level is set at 20 cm of H2O: High PEEP levels like 20 cm H₂O can impede cerebral venous outflow and raise ICP. PEEP should be used cautiously in clients with brain injuries and adjusted to the lowest effective setting to maintain oxygenation.

A. Slow pulse B. Upper-left abdominal pain C. Yellowing of the skin D. Diarrhea

Correct Answer is C

Explanation

Rationale:

A. Slow pulse: Bradycardia is not typically associated with liver transplant rejection. Instead, systemic signs such as fever, fatigue, and abdominal discomfort are more likely to occur during acute rejection episodes.

B. Upper-left abdominal pain: The liver is located in the upper-right quadrant of the abdomen, so pain related to liver transplant rejection is more likely to occur in that region, not the upper left.

C. Yellowing of the skin: Jaundice, or yellowing of the skin and eyes, is a key sign of liver dysfunction and may indicate transplant rejection. It results from impaired bile drainage or liver cell injury, both of which can occur during rejection.

D. Diarrhea: While diarrhea may occur due to medications or infections post-transplant, it is not a hallmark sign of liver rejection. Rejection more commonly presents with liver-specific symptoms like jaundice, right upper quadrant pain, and abnormal liver function tests.

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A nurse is monitoring the laboratory results of a client who is in a late stage of chronic kidney disease. The nurse should expect the client to have which of the following electrolyte imbalances?

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