The patient with CKD is receiving dialysis, and the nurse observes excoriations on the
patient's skin. What
pathophysiologic changes in CKD can
... [Show More] contribute to this finding (select all that apply)?
a. Dry skin
b. Sensory neuropathy
c. Vascular calcifications
d. Calcium-phosphate skin deposits
e. Uremic crystallization from high BUN - CORRECT ANSWER a, b, d. Pruritus is
common in patients receiving dialysis.
It causes scratching from dry skin, sensory neuropathy,
and calcium-phosphate deposition in the skin. Vascular
calcifications contribute to cardiovascular disease, not to
itching skin. Uremic frost rarely occurs without BUN levels
greater than 200 mg/dL, which should not occur in a patient
on dialysis; urea crystallizes on the skin and also causes
pruritis.
What accurately describes the care of the patient with CKD?
a. A nutrient that is commonly supplemented for the patient on dialysis because it is
dialyzable is iron.
b. The syndrome that includes all of the signs and symptoms seen in the various body
systems in CKD is azotemia.
c. The use of morphine is contraindicated in the patient with CKD because accumulation
of its metabolites may
cause seizures.
d. The use of calcium-based phosphate binders in the patient with CKD is
contraindicated when serum calcium
levels are increased. - CORRECT ANSWER d. In the patient with CKD, when serum
calcium levels
are increased, calcium-based phosphate binders are not
used. The nutrient supplemented for patients on dialysis is
folic acid. The various body system manifestations occur
with uremia, which includes azotemia. Meperidine is
contraindicated in patients with CKD related to possible
seizures.
The patient with chronic kidney disease is considering whether to use peritoneal dialysis
(PD) or hemodialysis (HD).
What are advantages of PD when compared to HD (select all that apply)?
a. Less protein loss
b. Rapid fluid removal
c. Less cardiovascular stress
d. Decreased hyperlipidemia
e. Requires fewer dietary restrictions - CORRECT ANSWER c, e. Peritoneal dialysis is
less stressful for the
cardiovascular system and requires fewer dietary
restrictions. Peritoneal dialysis actually contributes to more
protein loss and increased hyperlipidemia. The fluid and
creatinine removal are slower with peritoneal dialysis than
hemodialysis.
In which type of dialysis does the patient dialyze during sleep and leave the fluid in the
abdomen during the day?
a. Long nocturnal hemodialysis
b. Automated peritoneal dialysis (APD)
c. Continuous venovenous hemofiltration (CVVH)
d. Continuous ambulatory peritoneal dialysis (CAPD) - CORRECT ANSWER b.
Automated peritoneal dialysis (APD) is the type of
dialysis in which the patient dialyzes during sleep and
leaves the fluid in the abdomen during the day. Long
nocturnal hemodialysis occurs while the patient is
sleeping and is done up to six times per week. Continuous
venovenous hemofiltration (CVVH) is a type of continuous
renal replacement therapy used to treat AKI. Continuous
ambulatory peritoneal dialysis (CAPD) is dialysis that is
done with exchanges of 1.5 to 3 L of dialysate at least four
times daily. [Show Less]