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 ["B","D","E"]

Explanation

Choice A reason: Ketoacidosis is not a typical complication of hyperglycemic hyperosmolar syndrome (HHS) treatment. HHS usually occurs without significant ketoacidosis, and the focus is on managing hyperglycemia and dehydration.

Choice B reason: Pulmonary edema is a potential complication of rapid fluid replacement therapy. The increased fluid volume can overwhelm the heart's ability to pump effectively, leading to fluid accumulation in the lungs.

Choice C reason: Atelectasis is not a common complication of HHS treatment. It is more related to lung collapse or infection rather than fluid or insulin therapy.

Choice D reason: Hypoglycemia is a potential complication of continuous insulin infusion. Close monitoring of blood glucose levels is necessary to prevent blood sugar from dropping too low during treatment.

Choice E reason: Hypokalemia is a potential complication of insulin therapy. Insulin promotes the uptake of potassium into cells, which can reduce serum potassium levels. Monitoring and managing potassium levels is important during HHS treatment.

A. Start with a rapid infusion rate to meet the patient's nutritional needs as quickly as possible. B. Initiate the infusion slowly and monitor the patient's fluid and glucose tolerance. C. Change the rate of administration every 4 hours based on serum electrolyte values. D. Increase the rate of infusion at mealtimes to mimic the circadian rhythm of the body.

Correct Answer is B

Explanation

Choice A reason: Starting with a rapid infusion rate to meet the patient's nutritional needs as quickly as possible is not recommended. Rapid infusion can cause complications such as fluid overload, hyperglycemia, and electrolyte imbalances. It is important to start TPN at a slow rate and gradually increase it as tolerated.

Choice B reason: Initiating the infusion slowly and monitoring the patient's fluid and glucose tolerance is the appropriate action. This allows the nurse to assess the patient's response to TPN, prevent complications, and make necessary adjustments to the infusion rate.

Choice C reason: Changing the rate of administration every 4 hours based on serum electrolyte values is not a standard practice. The rate should be adjusted based on the patient's overall tolerance and clinical condition, rather than frequent changes.

Choice D reason: Increasing the rate of infusion at mealtimes to mimic the circadian rhythm of the body is not appropriate for TPN. TPN is typically administered continuously over 24 hours to provide steady nutrition and prevent 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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