The nurse coming on shift on the medical unit is taking a report on four clients. Which client does the nurse know is at the greatest risk for developing end-stage kidney disease (ESKD)?
A client with diabetes mellitus and poorly controlled hypertension
A client with a history of polycystic kidney disease
A client who is morbidly obese with a history of vascular disorders
A client with severe chronic obstructive pulmonary disease
The Correct Answer is A
Choice A reason: Diabetes mellitus and hypertension are the leading two causes of end-stage kidney disease in the United States. Poorly controlled hypertension causes high pressure in the renal arterioles, leading to nephrosclerosis, while diabetes causes basement membrane thickening and glomerular damage. The combination of these two chronic conditions significantly accelerates the progression of renal failure more than other isolated factors.
Choice B reason: Polycystic kidney disease (PKD) is a significant genetic cause of renal failure, but it is much rarer in the general population compared to diabetes and hypertension. While many patients with PKD will eventually require dialysis or a transplant, the sheer prevalence and systemic impact of diabetic nephropathy and hypertensive nephrosclerosis make Choice A the higher statistical risk group.
Choice C reason: Morbid obesity and vascular disorders are risk factors for renal impairment, as they contribute to metabolic syndrome and reduced renal perfusion. However, they are generally considered secondary risk factors. They often lead to the development of diabetes or hypertension, which then serve as the direct mechanisms for the development of chronic kidney disease and eventual ESKD.
Choice D reason: Severe chronic obstructive pulmonary disease (COPD) affects respiratory function and can lead to right-sided heart failure (cor pulmonale), which may reduce renal perfusion. However, it is not a primary driver of end-stage kidney disease. The pathological changes in COPD are primarily pulmonary and do not directly damage the renal parenchyma in the same way that glucose and high pressure do.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: While a high-stress job and long working hours can impact overall health and lead to sedentary behavior, they are not direct, established primary risk factors for colorectal cancer. Age is a factor for this client, but the dietary and age combination of another client presents a significantly higher risk profile.
Choice B reason: This client has two major risk factors: advanced age and a poor diet. The risk of colorectal cancer increases significantly after age 50. Furthermore, fast food is typically high in red and processed meats and animal fats while being low in fiber, which are well-documented dietary contributors to colorectal carcinogenesis.
Choice C reason: There is currently no strong scientific evidence linking high coffee consumption to an increased risk of colorectal cancer. In fact, some studies suggest that coffee may have a protective effect due to its antioxidant properties. This client’s age (37) also places them in a lower-risk category for the disease.
Choice D reason: Irritable bowel syndrome (IBS) is a functional disorder and does not increase the risk of colorectal cancer. It should not be confused with inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn’s disease, which involves chronic inflammation of the intestinal mucosa and does significantly elevate cancer risk.
Correct Answer is A
Explanation
Choice A reason: Having two first-degree relatives with colorectal cancer significantly increases an individual's lifetime risk. Clinical guidelines recommend that these high-risk individuals begin screening at an earlier age (usually age 40 or 10 years younger than the earliest diagnosis) and undergo more frequent colonoscopies to detect and remove precancerous polyps before they become malignant.
Choice B reason: Preemptive surgery (such as a total colectomy) and chemotherapy are extreme measures and are generally not indicated for someone with a family history unless they have a confirmed genetic syndrome like FAP. Prophylactic chemotherapy is not a standard medical practice for cancer prevention in the absence of a current diagnosis or high-stage disease.
Choice C reason: This statement is medically inaccurate and dangerous. Colorectal cancer risk does not "skip generations" in a predictable way. Furthermore, while some forms of colon cancer are autosomal dominant (like Lynch syndrome), having first-degree relatives with the disease always necessitates increased vigilance and screening rather than a false sense of security.
Choice D reason: While diet is a modifiable risk factor, a "low-fat and low-fiber" diet is actually associated with an increased risk of colorectal cancer. High fiber is protective. Furthermore, for someone with a strong familial predisposition, lifestyle changes alone are insufficient; they must be coupled with rigorous clinical surveillance via colonoscopy.
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