Fluid Volume Deficit & Excess
A client with this condition is most likely to have hypotension and dry mucous membranes.
Fluid volume deficit
Decreased circulating volume lowers BP and dries tissues.
A potassium level of 6.2 mEq/L places the client at risk for this immediate complication.
Cardiac dysrhythmias
Rationale: Elevated potassium alters cardiac conduction.
What is the primary focus of nursing care in advanced chronic renal disease?
Managing complications and slowing progression
Rationale:
CKD is irreversible, so care centers on symptom control, safety, and quality of life.
What is the primary goal of hemodialysis?
Removal of waste products and excess fluid
Rationale: Dialysis replaces kidney excretory function.
A client develops an acid–base imbalance. Which two organ systems are primarily responsible for correcting this imbalance, and how does each contribute to restoring normal pH?
The lungs and the kidneys
Rationale:
The lungs regulate acid–base balance by controlling the amount of carbon dioxide exhaled, which directly affects blood pH. The kidneys regulate acid–base balance by excreting or conserving hydrogen ions and bicarbonate.
Potassium-wasting diuretics place clients at risk for which imbalance?
Hypokalemia
Rationale: Loop and thiazide diuretics increase potassium loss.
Which nutritional deficiency may contribute to muscle cramps in electrolyte imbalances?
Calcium or magnesium deficiency
Rationale:
Both electrolytes affect neuromuscular function.
Crackles in the lungs are a hallmark finding of this fluid imbalance.
Fluid volume excess
Rationale: Pulmonary congestion indicates overload.
Which electrolyte imbalance is most common in chronic kidney disease?
Hyperkalemia
Rationale: Impaired excretion leads to potassium retention.
What type of kidney injury results from obstruction of urine outflow?
Postrenal acute kidney injury
Rationale:
Urinary tract obstruction causes back pressure and impaired filtration.
Cloudy dialysate indicates which complication?
Peritonitis
Rationale: Infection causes cloudy effluent.
Which acid–base imbalance is most likely in diabetic ketoacidosis?
Metabolic acidosis
Rationale:
Ketone accumulation lowers blood pH.
Why are magnesium-containing antacids avoided in clients with renal failure?
They can cause hypermagnesemia
Rationale:
The kidneys cannot excrete excess magnesium.
Why should clients with chronic kidney disease avoid salt substitutes?
They often contain potassium
Rationale:
Salt substitutes commonly use potassium chloride, increasing the risk for hyperkalemia.
Distended neck veins are most commonly associated with this imbalance.
Fluid volume excess
Rationale: Increased intravascular pressure causes JVD.
During a physical assessment, the nurse taps over the facial nerve just in front of the ear and observes twitching of the facial muscles on the same side. What is this clinical finding called and what does it mean?
Chvostek’s sign
Rationale:
Chvostek’s sign is a classic clinical indicator of neuromuscular irritability associated with hypocalcemia. Low calcium levels increase nerve excitability, causing facial muscle twitching when the facial nerve is stimulated.
Why are clients with chronic kidney disease at risk for anemia?
Decreased production of erythropoietin
Rationale:
Damaged kidneys cannot adequately stimulate red blood cell production.
A 5-lb weight gain between dialysis sessions reflects failure to control what?
Fluid intake
Rationale: Weight changes primarily reflect fluid.
A client has an ABG showing low pH and elevated PaCO₂. What type of imbalance is present?
Respiratory acidosis
Rationale:
CO₂ retention is causing acidity.
Why are ACE inhibitors often prescribed for clients with kidney disease?
To reduce blood pressure and slow kidney damage
Rationale:
ACE inhibitors decrease intraglomerular pressure.
A client taking loop diuretics is encouraged to eat bananas and potatoes. Which electrolyte imbalance is being prevented?
Hypokalemia
Rationale:
Loop diuretics increase potassium loss, and potassium-rich foods help replace it.
Concentrated urine with low blood pressure reflects decreased volume in this space.
Intravascular space
Which imbalance alters mental status before cardiac signs appear?
Hyponatremia/hypernatremia
Rationale: Sodium changes affect the brain first.
Which medication class should be avoided or used cautiously in CKD?
NSAIDs
Rationale:
NSAIDs reduce renal blood flow and worsen kidney damage.
Which restriction most affects dialysis clients’ quality of life?
Fluid restriction
Rationale: Strict limits impact daily living.
A client is hyperventilating, dizzy, and has tingling in the fingers. Which acid–base imbalance is most likely occurring?
Respiratory alkalosis
Rationale:
Hyperventilation causes excessive CO₂ loss, increasing blood pH and leading to neuromuscular irritability.
Why is insulin sometimes used in emergency treatment of hyperkalemia?
It shifts potassium into cells
Rationale:
This temporarily lowers serum potassium levels.
Which electrolyte imbalance may result from excessive intake of free water without electrolytes?
Hyponatremia
Rationale:
Excess water dilutes sodium levels in the blood.
Why is a client with uncontrolled congestive heart failure at high risk for hypervolemia?
Decreased cardiac output leads to fluid retention
Rationale:
Poor cardiac pumping causes reduced renal perfusion, triggering sodium and water retention.
Which neuromuscular change is expected with hypermagnesemia?
Muscle weakness
A client’s estimated glomerular filtration rate (eGFR) has steadily decreased over the past year, but their serum creatinine has remained within the normal range. What does this trend suggest about the client’s kidney function, and what is the most important nursing implication?
The client’s kidney function is gradually declining, and early kidney disease may be present despite normal creatinine levels.
Rationale:
eGFR reflects overall kidney filtration and is more sensitive to early changes in kidney function than creatinine alone. Creatinine levels can remain normal due to compensation or lower muscle mass, while eGFR decreases as nephrons are lost. For nursing care, this means the client is at increasing risk for fluid, electrolyte, and medication-related complications and requires closer monitoring and early interventions, even though creatinine appears normal.
During routine assessment of a client with a newly placed arteriovenous fistula, what finding best indicates that the fistula is patent and functioning properly?
A palpable thrill over the fistula site
Rationale:
A palpable thrill indicates blood flow through the arteriovenous fistula. Absence of a thrill suggests decreased or absent blood flow and may indicate thrombosis or access failure, which requires immediate provider notification.
Why does prolonged diarrhea lead to metabolic acidosis?
Loss of bicarbonate in stool
Rationale:
Bicarbonate is a base, and its loss lowers blood pH.
Why might Kayexalate be ordered for a client with chronic kidney disease?
Impaired kidneys cannot excrete potassium
Rationale:
Kayexalate removes potassium through the GI tract instead.
Why are processed foods restricted in clients with hypervolemia?
They are high in sodium
Rationale:
Sodium causes water retention, worsening fluid overload.
When a client is dehydrated, fluid shifts from which compartment to help maintain blood pressure?
From the intracellular space to the extracellular space
Rationale:
Water moves out of cells to support circulating volume.
Emergency treatment for severe hyperkalemia shifts potassium where?
Into the cells
Rationale: This temporarily reduces serum potassium.
Following IV contrast exposure, which assessment finding suggests worsening intrarenal kidney injury?
Decreasing urine output over several hours
Rationale:
Progressive oliguria is an early sign of tubular damage.
Why is it important for a dialysis client to receive medications after, rather than before, hemodialysis when possible?
Dialysis can remove medications from the bloodstream
Rationale:
Hemodialysis may clear certain drugs, reducing their effectiveness if given beforehand.
A client has continuous nasogastric (NG) suction for several days and begins to show muscle cramps, confusion, and shallow respirations. Which acid–base imbalance is most likely developing?
Metabolic alkalosis caused by loss of gastric acid
Gastric secretions contain hydrochloric acid. Prolonged NG suction removes large amounts of acid from the stomach, increasing blood pH and leading to metabolic alkalosis.
A client is prescribed hydrochlorothiazide for hypertension. What is the primary therapeutic effect of this medication?
Reduction of blood pressure by increasing urine output
Rationale:
Hydrochlorothiazide is a thiazide diuretic that promotes sodium and water excretion, lowering circulating volume and blood pressure.
Which nutritional change helps prevent metabolic alkalosis in a client with prolonged vomiting?
Replacing fluids and electrolytes
Rationale:
Vomiting causes loss of gastric acid and electrolytes.