A nursing student learns about modifiable risk factors for coronary artery disease. Which factors does this include? Select all that apply.

Choice A reason: An increase in serum hematocrit indicates that epoetin has been effective. Epoetin, also known as erythropoietin, is a medication used to stimulate the production of red blood cells. In patients with chronic kidney disease, the kidneys may not produce enough natural erythropoietin, leading to anemia. By administering epoetin, the goal is to increase red blood cell production, which is reflected in higher hematocrit levels (the proportion of red blood cells in the blood).

Choice B reason: An increase in serum calcium is not related to the effectiveness of epoetin. Serum calcium levels are regulated by different mechanisms, including parathyroid hormone and vitamin D, and are not directly influenced by epoetin administration.

Choice C reason: A decrease in serum creatinine levels would indicate improved kidney function, but this is not the expected outcome of epoetin therapy. Epoetin specifically targets red blood cell production and does not have a direct impact on kidney function or creatinine levels.

Choice D reason: A decrease in blood pressure is also not an expected indicator of epoetin effectiveness. While managing blood pressure is important in chronic kidney disease, epoetin's primary role is to address anemia by stimulating red blood cell production. Blood pressure regulation involves other medications and interventions.

Choice A reason: A blood pressure of 158/90 mm Hg in a patient with chronic kidney disease (CKD) is elevated and requires management to prevent complications. However, it is not as immediately life-threatening as Kussmaul respirations, which indicate severe metabolic acidosis.

Choice B reason: The patient with Kussmaul respirations should be assessed first. Kussmaul respirations are deep, labored breathing patterns typically associated with severe metabolic acidosis, such as diabetic ketoacidosis (DKA) or severe kidney failure. This condition requires immediate intervention to correct the underlying acidosis and stabilize the patient's condition.

Choice C reason: Itching (pruritus) is a common symptom in CKD due to the accumulation of uremic toxins. While it can be very uncomfortable and requires treatment, it is not as urgent as Kussmaul respirations, which indicate a potentially life-threatening situation.

Choice D reason: Halitosis (bad breath) and stomatitis (inflammation of the mouth) can occur in CKD due to the buildup of uremic toxins and other factors. These symptoms need attention, but they do not indicate an immediate threat to the patient's life compared to Kussmaul respirations.