Nursing Education Capstone (C947)

Correct Answer:

B) End-stage renal disease

Explanation:

Polycystic kidney disease (PKD) is a progressive condition in which cysts develop in the kidneys, leading to kidney dysfunction over time. The most serious complication of PKD is the progression to end-stage renal disease (ESRD), which occurs when the kidneys lose their ability to filter waste and maintain fluid balance. This often requires dialysis or a kidney transplant for survival. Other complications like diabetes insipidus, chronic urinary tract infections (UTIs), and syndrome of inappropriate antidiuretic hormone (SIADH) can occur, but ESRD is the most severe and life-threatening consequence of PKD.

Why other options are wrong:

A) Diabetes insipidus: While diabetes insipidus may occur in some patients with PKD due to kidney dysfunction, it is not the most serious complication. Diabetes insipidus leads to excessive urination and thirst, but it does not typically lead to kidney failure like ESRD does.

C) Chronic UTI: Chronic UTIs are common in individuals with PKD due to cysts in the kidneys that can obstruct urinary flow. While UTIs require attention, they are not as life-threatening as the progression to end-stage renal disease.

D) Syndrome of inappropriate antidiuretic hormone secretion: SIADH is another potential complication in PKD due to kidney dysfunction, but it is less common and less severe than the progression to ESRD. It causes fluid retention and electrolyte imbalances, but it is not the most serious complication of PKD.

Correct Answer

B. Chicken, broccoli, blueberries, and pineapple.

Explanation

For clients undergoing hemodialysis, dietary restrictions are necessary to manage electrolyte imbalances and fluid retention. Foods that are low in potassium, phosphorus, and sodium are typically recommended. The combination of chicken, broccoli, blueberries, and pineapple is a balanced choice with low potassium content, making it suitable for dialysis patients. These foods provide necessary protein and vitamins without compromising kidney function.

Why other options are wrong

A. Hot dog with mustard, ketchup, and French fries.

This option includes high-sodium foods such as hot dogs and French fries, which are not ideal for kidney patients undergoing dialysis. High sodium intake can lead to fluid retention and hypertension, which complicates kidney disease management.

C. Bananas, almonds, and sweet potatoes.

Bananas and sweet potatoes are high in potassium, which can be dangerous for dialysis patients as their kidneys cannot filter excess potassium effectively. Almonds are high in phosphorus, which can also cause complications in patients with kidney disease.

D. Sausage, eggs, cantaloupe, and orange juice.

Sausage is high in sodium, and cantaloupe and orange juice are high in potassium, both of which should be limited in a renal diet. This food choice would increase the risk of hyperkalemia and fluid retention in kidney patients.

Correct Answer:

D) Calcium and phosphorus

Explanation:

In polycystic kidney disease (PKD), kidney function is compromised, leading to the loss of essential minerals such as calcium and phosphorus. The kidneys are responsible for regulating the balance of these minerals, and with impaired function, there may be a need to increase their intake through diet or supplements. Ensuring adequate intake of calcium and phosphorus helps in maintaining bone health and correcting the imbalances caused by kidney dysfunction.

Why other options are wrong:

A) Sodium and water: Sodium should generally be restricted in PKD to prevent fluid retention and high blood pressure. Excessive water intake may also worsen kidney function in some cases, so this combination would not be advisable.

B) Sodium and potassium: Sodium restriction is recommended, not increase, in PKD. While potassium may need to be managed carefully, especially in patients with advanced kidney disease, an increase in sodium would not be appropriate for this condition.

C) Water and phosphorus: While phosphorus levels are often imbalanced in PKD, water intake should be carefully managed, especially in patients with renal dysfunction. Excessive water intake can worsen fluid retention and kidney strain.

Correct Answer

b. Hyperkalemia

Explanation

Hyperkalemia is a potentially life-threatening condition that can occur in patients on hemodialysis, especially when they miss dialysis appointments. Hemodialysis is responsible for removing excess potassium from the bloodstream, and when dialysis is missed, potassium levels can build up to dangerous levels. Elevated potassium can lead to cardiac arrhythmias, which can be fatal if not addressed promptly. Monitoring and managing potassium levels is critical in dialysis patients to prevent complications.

Why other options are wrong

a. Hypoglycemia

Hypoglycemia is not a primary concern in patients on hemodialysis, particularly if they have missed dialysis appointments. While insulin and certain medications can contribute to hypoglycemia, it is not the immediate risk in this context. Hyperkalemia is a more common and immediate concern.

c. Hyponatremia

Hyponatremia, or low sodium levels, is a concern in some medical conditions but is not typically the most pressing issue in patients who have missed dialysis. In fact, dialysis patients are more likely to experience hyperkalemia or fluid imbalances rather than hyponatremia.

d. Hypercalcemia

While hypercalcemia can occur in some renal patients, it is not the most immediate concern following missed dialysis. Hyperkalemia poses a greater immediate risk to the patient’s health, especially in relation to the cardiovascular system.

Correct Answer

C. 0.9% sodium chloride

Explanation

Only 0.9% sodium chloride (normal saline) is compatible with blood products. It helps prevent hemolysis and clotting. Other IV fluids like those containing dextrose or lactate can cause red blood cell destruction or interfere with the stability of the blood product. Normal saline is used to prime the tubing, flush before and after the transfusion, and to keep the vein open during the transfusion process.

Why other options are wrong

A. Lactated Ringers

Contains calcium, which can interact with the anticoagulant in stored blood and lead to clotting. It is not recommended to run with blood products.

B. 5% dextrose in 0.9% sodium chloride

Dextrose can cause red blood cells to hemolyze, making this an unsafe choice for blood transfusion compatibility.

D. 5% dextrose in 0.45% sodium chloride

Again, the presence of dextrose makes this fluid incompatible with blood products due to the risk of hemolysis.

Correct Answer:

C) Increased water intake

Explanation:

Polycystic kidney disease (PKD) is a genetic disorder that causes cysts to form in the kidneys, leading to kidney damage over time. The treatment plan typically includes measures to manage the symptoms, such as controlling blood pressure and avoiding excessive sodium intake. Increased water intake is generally not recommended in PKD, as it could exacerbate fluid retention and place additional strain on the kidneys. The goal is to manage kidney function and avoid overhydration or dehydration.

Why other options are wrong:

A) Genetic counseling: Genetic counseling is an important part of managing polycystic kidney disease because the condition is inherited, and counseling helps patients and their families understand the risks and the inheritance pattern.

B) Sodium restriction: Sodium restriction is a common part of the treatment for polycystic kidney disease to help manage blood pressure and reduce kidney strain. Excess sodium can worsen kidney damage by increasing fluid retention and blood pressure.

D) Antihypertensive medications: Antihypertensive medications are often part of the treatment plan for polycystic kidney disease since high blood pressure is a common complication of the disease and needs to be controlled to prevent further kidney damage.

Correct Answer

C. "This test is done to ensure adequate collateral circulation"

Explanation

The Allen's test is performed to assess whether the ulnar artery can adequately supply blood to the hand if the radial artery is used for arterial blood gas sampling. This ensures that collateral circulation exists, which is critical to prevent ischemia in case the radial artery is compromised during the procedure. A proper understanding of this purpose is reflected in the client’s statement regarding collateral circulation.

Why other options are wrong

A. "Blood is drawn from the ulnar artery"

This is incorrect because arterial blood gases are typically drawn from the radial artery, not the ulnar artery. The Allen’s test evaluates the ulnar artery’s function as a backup, not the primary site for blood draw. Misunderstanding the site of the blood draw indicates a lack of comprehension.

B. "I know I have to lie down while blood is drawn"

While positioning is important in some procedures, arterial blood gas sampling does not require the patient to lie down. This statement does not relate to the purpose of the Allen’s test, which is to check blood flow rather than patient position.

D. "Direct pressure has to be placed over the site for 15 minutes after blood is drawn"

Although pressure is applied to the site to prevent bleeding or hematoma, especially in patients on anticoagulants, this is standard care for any arterial puncture and not specific to the Allen’s test. Therefore, this response does not demonstrate an understanding of the test's actual purpose.

Correct Answer

A. Change in level of consciousness

B. Vomiting

C. Decreased pulse

D. Increased blood pressure

E. Decreased respirations

Explanation

All listed options are classic signs of increased intracranial pressure (ICP). The Cushing’s triad—which includes increased blood pressure, decreased heart rate, and irregular or decreased respirations—is a late but critical indicator of increased ICP. In addition, changes in level of consciousness are often the earliest signs, and vomiting, especially without nausea (projectile vomiting), is also commonly associated with increased ICP.

Why other options are wrong

All options listed are correct signs to monitor for patients at risk for increased ICP. There are no incorrect options in this list.

Correct Answer

B. Delay hanging the blood and notify the physician

Explanation

A fever of 100.6°F indicates that the client has a potential infection or inflammatory process. The nurse should delay the transfusion and notify the physician to assess the underlying cause of the fever. Blood transfusions should not be started when the client has a fever, as it could increase the risk of transfusion reactions or mask a reaction.

Why other options are wrong

A. Begin the transfusion as prescribed

Starting a blood transfusion while the client has a fever may increase the risk of complications, including transfusion reactions. It is important to first address the underlying cause of the fever before proceeding with the transfusion.

C. Administer an antihistamine and begin the transfusion

Administering an antihistamine does not address the underlying cause of the fever, and starting the transfusion with a fever may lead to complications. The fever should be evaluated by the physician before any further actions are taken.

D. Administer two tablets of acetaminophen (Tylenol) and begin the transfusion

Administering acetaminophen may lower the fever but does not address the root cause of the fever. It is important to delay the transfusion and notify the physician to determine whether the fever is due to an underlying condition that needs further treatment.