A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?
More protein is allowed because urea and creatinine are removed by dialysis.
Dietary potassium is not restricted because the level is normalized by dialyses
Unlimited fluids are allowed because retained fluid is removed during dialysis
increased calories are needed because glucose is lost during hemodialysis
The Correct Answer is A
A. More protein is allowed because urea and creatinine are removed by dialysis: Hemodialysis removes nitrogenous waste products, allowing patients to tolerate a higher protein intake than before dialysis. Adequate protein supports tissue repair and prevents malnutrition, which is common in CKD patients.
B. Dietary potassium is not restricted because the level is normalized by dialysis: Potassium intake still needs monitoring, as hyperkalemia can occur between dialysis sessions. Dialysis does not completely prevent dangerous fluctuations in serum potassium.
C. Unlimited fluids are allowed because retained fluid is removed during dialysis: Fluid intake must still be controlled because excessive consumption can lead to weight gain, hypertension, and edema between dialysis sessions.
D. Increased calories are needed because glucose is lost during hemodialysis: Hemodialysis may result in minimal glucose loss, but the primary dietary focus is on adequate protein intake. Caloric intake should meet overall nutritional needs but is not primarily adjusted.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. BUN 23 mg/dL and creatinine 1.0 mg/dL: These values are within or near normal range for an older adult and do not reflect the impaired renal clearance expected in chronic kidney disease. Mild elevation of BUN alone without creatinine elevation is more consistent with dehydration than CKD.
B. BUN 45 mg/dL and creatinine 8 mg/dL: Both BUN and creatinine are markedly elevated, which is expected in chronic kidney disease due to reduced glomerular filtration rate and accumulation of nitrogenous waste products. Such levels indicate significant renal impairment.
C. BUN 8 mg/dL and creatinine 0.7 mg/dL: These values fall below or within the normal range and do not suggest chronic kidney disease. They reflect adequate kidney filtration and nitrogen waste clearance rather than impaired renal function.
D. BUN 10 mg/dL and creatinine 0.3 mg/dL: These levels are lower than expected, which can be seen in conditions such as low muscle mass or malnutrition, but not in chronic kidney disease. CKD typically presents with elevated values, not reduced ones.
Correct Answer is A
Explanation
A. Fleet enema: Fleet enemas contain phosphate, which can be absorbed systemically and worsen hyperphosphatemia in patients with impaired kidney function. For a patient with elevated BUN and creatinine, indicating possible renal impairment, phosphate-based enemas increase the risk of electrolyte imbalance and should be questioned.
B. Sennandocusate (Senokot-S): This stool softener and stimulant combination works by drawing water into the bowel and softening stools. It does not contain phosphate or other nephrotoxic substances, making it generally safe for patients with renal impairment.
C. Tap-water enema: Tap-water enemas are non-phosphate-based and generally safe for patients with impaired kidney function. They help evacuate the bowel without introducing substances that could exacerbate electrolyte disturbances.
D. Bisacodyl (Dulcolax) tablets: Bisacodyl is a stimulant laxative taken orally, which acts locally on the colon. It does not contain phosphate and does not pose significant risk to patients with elevated BUN or creatinine, making it an acceptable bowel preparation.
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