The nurse is caring for a patient with chronic kidney disease (CKD) who is at risk for renal osteodystrophy. Which intervention will the nurse implement to manage this condition?

Administer phosphate binders with meals.

Encourage the patient to increase potassium-rich foods.

Monitor calcium levels for signs of hypocalcaemia.

Increase fluid intake to 3 litters per day.

Answer and Explanation

The Correct Answer is A

Choice A reason: Administering phosphate binders with meals is an essential intervention for managing renal osteodystrophy in patients with chronic kidney disease (CKD). Renal osteodystrophy results from an imbalance of calcium and phosphate in the body due to impaired kidney function. Phosphate binders help reduce the absorption of phosphate from the diet, thereby lowering serum phosphate levels and preventing complications such as secondary hyperparathyroidism and bone disorders. This intervention helps maintain the proper balance of minerals, improving bone health and reducing the risk of fractures and other skeletal complications in CKD patients.

Choice B reason: Encouraging the patient to increase potassium-rich foods is not appropriate for managing renal osteodystrophy. Patients with CKD often need to limit their potassium intake because impaired kidney function can lead to hyperkalaemia (elevated potassium levels), which is potentially life-threatening. Instead of promoting potassium-rich foods, the focus should be on controlling phosphate and maintaining calcium levels.

Choice C reason: Monitoring calcium levels for signs of hypocalcaemia is important in CKD management, but it is not the primary intervention for renal osteodystrophy. While hypocalcaemia can occur in CKD due to disrupted vitamin D metabolism, addressing phosphate levels through the use of phosphate binders is a more targeted approach to managing renal osteodystrophy and preventing secondary hyperparathyroidism.

Choice D reason: Increasing fluid intake to 3 litters per day is generally not recommended for CKD patients, especially those with reduced urine output or fluid retention issues. Excessive fluid intake can lead to fluid overload, hypertension, and heart failure in CKD patients. The intervention should focus on phosphate control rather than fluid intake adjustments.

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Correct Answer is A

Explanation

Choice A reason: Removal of the transplanted kidney is the definitive intervention for hyperacute rejection. Hyperacute rejection occurs within minutes to hours after transplantation due to pre-formed antibodies against the donor organ. This form of rejection is irreversible and requires immediate removal of the transplanted kidney to prevent further complications and damage to the recipient's health.

Choice B reason: An increase in the dose of cyclosporine therapy is not effective in hyperacute rejection. Cyclosporine is an immunosuppressive medication used to prevent rejection, but in cases of hyperacute rejection, the rapid and severe immune response cannot be controlled by increasing the dose. The affected kidney must be removed.

Choice C reason: A new kidney transplant from a living donor is not an immediate intervention for hyperacute rejection. Before considering another transplant, it is essential to identify and address the underlying cause of hyperacute rejection and ensure that the recipient's immune system is adequately managed to prevent recurrence.

Choice D reason: Administration of methylprednisolone sodium succinate is typically used to manage acute rejection episodes but is not effective for hyperacute rejection. The rapid onset and severity of hyperacute rejection necessitate the removal of the transplanted organ rather than relying on immunosuppressive medications.

A. A post-operative patient after thyroid surgery preparing for discharge with a new medication B. A patient diagnosed with Cushing's disease after insertion of a nasogastric tube C. A patient scheduled for a chest radiograph who is anxious about their treatment D. A patient with chronic obstructive pulmonary disease who requested a breathing treatment during the previous shift

Correct Answer is D

Explanation

Choice A reason: While a post-operative patient preparing for discharge is important, they are stable enough to be considered for discharge and do not require immediate assessment.

Choice B reason: A patient with Cushing's disease after insertion of a nasogastric tube may need monitoring, but this is not as urgent as a patient with potential respiratory distress.

Choice C reason: A patient scheduled for a chest radiograph who is anxious about their treatment does not require immediate intervention compared to a patient experiencing respiratory issues.

Choice D reason: A patient with chronic obstructive pulmonary disease who requested a breathing treatment during the previous shift may be experiencing respiratory distress and requires immediate assessment and intervention to prevent further complications.

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The nurse is caring for a patient with chronic kidney disease (CKD) who is at risk for renal osteodystrophy. Which intervention will the nurse implement to manage this condition?

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