The client with chronic renal failure has a glomerular filtration rate (GFR) of 40 mL/min/1.73 m², as measured by a 24-hour creatinine clearance. What is the nurse's interpretation of this finding?

Increased glomerular filtration rate, client at risk for fluid overload

Reduced glomerular filtration rate, client at risk for fluid overload

Reduced glomerular filtration rate, client at risk for dehydration

Increased glomerular filtration rate, client at risk for dehydration

Answer and Explanation

The Correct Answer is B

Choice A reason: A GFR of 40 mL/min/1.73 m² is below normal (≥90), indicating reduced, not increased, kidney function. Chronic renal failure impairs fluid excretion, leading to fluid overload, not dehydration. Increased GFR would suggest hyperfiltration, seen in early diabetes, not chronic renal failure, making this interpretation incorrect.

Choice B reason: A GFR of 40 mL/min/1.73 m² indicates reduced kidney function (Stage 3B chronic kidney disease). The kidneys’ impaired ability to excrete fluid increases the risk of fluid overload, causing edema, hypertension, or pulmonary edema. This aligns with the pathophysiology of chronic renal failure, making this the correct interpretation.

Choice C reason: A GFR of 40 mL/min/1.73 m² reflects reduced kidney function, not dehydration risk. Chronic renal failure leads to fluid retention due to decreased filtration, causing hypervolemia, not hypovolemia. Dehydration is associated with prerenal causes, not established chronic kidney disease, making this interpretation inconsistent with the clinical scenario.

Choice D reason: A GFR of 40 mL/min/1.73 m² is reduced, not increased, in chronic renal failure. Reduced GFR leads to fluid retention, not dehydration, as the kidneys cannot excrete excess fluid. Increased GFR might cause dehydration in rare hyperfiltration states, but this does not apply to chronic renal failure’s pathophysiology.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is D

Explanation

Choice A reason: Polyuria, excessive urine output, typically leads to potassium loss, causing hypokalemia, not hyperkalemia. In conditions like diabetes insipidus, increased urination reduces serum potassium as the kidneys excrete more fluid and electrolytes. Elevated potassium is more associated with reduced renal excretion, as in kidney failure, not polyuria.

Choice B reason: Creatinine levels increase in acute kidney injury due to reduced glomerular filtration, impairing the kidneys’ ability to clear creatinine, a muscle metabolism byproduct. Decreased creatinine levels are rare and may reflect low muscle mass, not kidney injury, making this statement incorrect as it contradicts the pathophysiology of renal impairment.

Choice C reason: Specific gravity is increased in hypovolemia, as the kidneys conserve water, producing concentrated urine (high specific gravity, >1.020). Decreased specific gravity occurs in conditions like diabetes insipidus, where dilute urine is produced. This statement is incorrect, as hypovolemia leads to higher, not lower, urine specific gravity.

Choice D reason: Blood urea nitrogen (BUN) increases in dehydration due to reduced renal perfusion, causing the kidneys to reabsorb urea to conserve water. This elevates serum BUN levels, often with a normal creatinine, reflecting prerenal azotemia. This statement correctly aligns with the pathophysiology of dehydration’s effect on renal laboratory values.

A. Start an IV infusion of lactated Ringer’s B. Give morphine IV C. Administer oxygen therapy D. Initiate cardiac monitoring

Correct Answer is C

Explanation

Choice A reason: Starting an IV infusion of lactated Ringer’s supports fluid status and may be needed for anticoagulation administration in pulmonary embolism. However, it does not address the immediate hypoxemia caused by the embolism’s ventilation-perfusion mismatch. Oxygen therapy is the priority to correct low oxygen levels and prevent tissue hypoxia.

Choice B reason: Morphine IV may relieve pain and anxiety in pulmonary embolism, reducing oxygen demand. However, it does not directly address hypoxemia, the primary life-threatening issue. The ABCDE approach prioritizes breathing, making oxygen therapy the first intervention to stabilize the patient before pain management is considered.

Choice C reason: Pulmonary embolism causes a ventilation-perfusion mismatch, reducing oxygen delivery to the blood, leading to hypoxemia. Administering oxygen therapy immediately increases alveolar oxygen, improving arterial PaO2 and preventing tissue hypoxia. In the ABCDE approach, breathing is prioritized, making oxygen therapy the first intervention to stabilize the client.

Choice D reason: Cardiac monitoring assesses for arrhythmias or right heart strain in pulmonary embolism, which is important for ongoing management. However, it does not correct the immediate threat of hypoxemia. Oxygen therapy addresses the critical reduction in oxygen saturation, taking precedence in the ABCDE approach over monitoring in acute management.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The client with chronic renal failure has a glomerular filtration rate (GFR) of 40 mL/min/1.73 m², as measured by a 24-hour creatinine clearance. What is the nurse's interpretation of this finding?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Question 28

Correct Answer is D

Explanation

A nurse is caring for a client who develops a pulmonary embolism. Which of the following interventions should the nurse implement first?

Correct Answer is C

Explanation

A client is unable to take a deep breath and does not want to get out of bed due to chest tube discomfort. To increase the client's compliance with ambulation and deep breathing, the nurse should:

In an emergency department, a nurse is presented with four clients. Which client should the nurse prioritize based on the ABCDE approach?

A nurse in the emergency department is caring for a client who has extensive partial and full-thickness burns of the head, neck, and chest. While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and intervention?

During change-of-shift report on a medical unit, a client admitted with aspiration pneumonia and respiratory distress has become increasingly agitated. Which action should the nurse take first?

A nurse in the emergency department is caring for a client who has a 30% burn injury to her lower extremities. Which of the following interventions should the nurse perform first?

A nurse is caring for a client with acute pancreatitis in the ICU. The client develops sudden dyspnea and oxygen saturation of 85%. Which intervention should the nurse prioritize?

The nurse receives change-of-shift report on the following four clients in a burn unit. Which client should the nurse assess first?

A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the nurse's priority when assessing the severity of the client's burns?