A nurse is planning a low-protein diet for a client who has chronic renal failure.
The client states, "Why do I have to be concerned with protein?". Which of the following responses is appropriate?
A low-protein diet will help your body retain more fluid.
Protein breakdown produces waste products that can build up in your body.
Protein impairs the body's ability to store potassium.
High protein intake can cause calcium retention.
The Correct Answer is B
Choice A rationale
Fluid retention in chronic renal failure (CRF) is primarily managed by restricting sodium and fluid intake, not by a low-protein diet. Protein intake primarily impacts nitrogenous waste production, not the homeostatic mechanisms of antidiuretic hormone and aldosterone that regulate fluid volume retention.
Choice B rationale
Protein breakdown yields nitrogenous waste products, primarily in the form of urea. In chronic renal failure, the damaged nephrons lose their capacity to efficiently filter and excrete these wastes, causing them to build up in the bloodstream, leading to symptoms of uremia and an increased BUN.
Choice C rationale
Protein does not impair potassium storage. Hyperkalemia (high potassium) is a common, life-threatening complication of chronic renal failure, often resulting from the kidney's inability to excrete potassium, especially when coupled with certain medications or high dietary intake of potassium.
Choice D rationale
High protein intake, particularly from animal sources, can contribute to calcium loss by increasing the body's acid load. The body then buffers this acid by releasing calcium from the bones, a process unrelated to calcium retention, which is often impaired in renal failure due to Vitamin D metabolism issues.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Enoxaparin sodium is a low molecular weight heparin (LMWH) that is administered subcutaneously, preferably into the anterolateral or posterolateral abdominal wall. Injection should be given at least two inches away from the umbilicus, surgical scars, and other lesions to ensure good absorption and minimize hematoma risk. This site has ample subcutaneous tissue for absorption.
Choice B rationale
Massaging the injection site following the administration of enoxaparin is contraindicated. The mechanical action of massage can increase the risk of bruising and hematoma formation at the injection site due to its anticoagulant properties, as it can disrupt local blood vessels and increase drug dispersion.
Choice C rationale
Subcutaneous injections typically utilize a shorter needle, often 5/8 inch, to deposit the medication into the subcutaneous tissue layer. A 1-inch needle is typically used for intramuscular (IM) injections, which would deliver the enoxaparin too deeply, potentially causing unnecessary discomfort and poor absorption.
Choice D rationale
Subcutaneous injections are typically administered with a 25-gauge or 27-gauge needle to minimize tissue trauma and pain. A 22-gauge needle is larger (has a wider lumen) and is typically used for thicker intramuscular injections or intravenous access, making it inappropriate for the intended subcutaneous route.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale
An elevated Hct (normal ≈ 36%-50%), elevated BUN (normal 8-20 mg/dL), and high urine specific gravity (normal 1.005-1.030) are all indicative of volume depletion or dehydration. Monitoring intake and output precisely quantifies the fluid balance, which is crucial for determining the degree of deficit and evaluating the effectiveness of rehydration therapy.
Choice B rationale
The client's confusion and weakness are potential symptoms of dehydration, as reduced intravascular volume can impair cerebral perfusion and electrolyte imbalances can disrupt nerve and muscle function. Regularly checking orientation provides an essential ongoing assessment of the client's neurological status and the effectiveness of fluid replacement.
Choice C rationale
The client's lab values and symptoms strongly suggest dehydration, which requires increased fluid intake, not restriction. Fluid restriction would exacerbate the existing hypovolemia, further worsening the elevated Hct, BUN, and specific gravity, potentially leading to renal compromise and worsening confusion.
Choice D rationale
Dehydration often leads to orthostatic hypotension due to reduced circulating blood volume. Instructing the client to sit briefly before standing allows time for baroreceptor reflexes to compensate for the positional change, preventing a sudden drop in blood pressure and minimizing the risk of a fall.
Choice E rationale
Daily weights provide a highly sensitive and objective measure of fluid status changes. A rapid change in body weight, especially in the context of dehydration and hypovolemia, directly reflects the magnitude of fluid loss or gain, making it a critical parameter for monitoring the effectiveness of interventions.
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