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.

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Correct Answer is D

Explanation

Choice A reason: Oxygen saturation of 88% in COPD is low but may be baseline for severe disease. It warrants oxygen therapy but is not the most urgent finding. Arterial pH of 7.28 indicates acute respiratory acidosis, a life-threatening complication requiring immediate ventilatory support to correct CO2 retention and acid-base imbalance.

Choice B reason: A respiratory rate of 26 breaths/min indicates tachypnea, common in COPD exacerbation, but is not immediately life-threatening. It reflects respiratory effort to compensate for hypoxia. Arterial pH of 7.28 suggests acute acidosis from CO2 retention, requiring urgent intervention like non-invasive ventilation, making tachypnea a lower priority.

Choice C reason: Accessory muscle use indicates increased work of breathing in COPD exacerbation, signaling distress but not immediate danger. It reflects compensatory efforts for airway obstruction. Arterial pH of 7.28 indicates severe acidosis, a life-threatening condition requiring urgent ventilatory support, making muscle use less critical in this scenario.

Choice D reason: Arterial pH of 7.28 in a COPD exacerbation indicates acute respiratory acidosis due to CO2 retention from hypoventilation. This life-threatening imbalance can lead to coma or cardiac arrest if uncorrected. Immediate intervention, such as non-invasive ventilation, is needed to restore pH and CO2 levels, making this the priority finding.

A. Low blood glucose B. High blood glucose C. Hemorrhage D. Fluid volume excess

Correct Answer is C

Explanation

Choice A reason: Low blood glucose (hypoglycemia) can cause cool, moist skin and tachycardia due to sympathetic activation, but falling blood pressure is less typical unless severe. Femur fractures are associated with significant blood loss, and the symptoms align more closely with hypovolemic shock from hemorrhage than metabolic disturbances like hypoglycemia.

Choice B reason: High blood glucose (hyperglycemia) may cause tachycardia and diaphoresis in severe cases (e.g., diabetic ketoacidosis), but cool, moist skin and falling blood pressure are not primary features. These symptoms are more indicative of hypovolemia from blood loss, as femur fractures can cause significant internal bleeding, making hyperglycemia unlikely.

Choice C reason: Hemorrhage from a femur fracture causes hypovolemic shock, characterized by cool, moist skin (due to vasoconstriction), increased heart rate (compensatory tachycardia), and falling blood pressure (due to volume loss). This is a life-threatening condition requiring urgent fluid resuscitation and hemorrhage control, aligning with the symptoms described and the injury’s severity.

Choice D reason: Fluid volume excess typically presents with edema, hypertension, and bounding pulses, not cool, moist skin or falling blood pressure. A femur fracture is unlikely to cause fluid overload acutely. The symptoms suggest hypovolemia from blood loss, not excess fluid, making this an incorrect diagnosis for the client’s presentation.

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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?

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