Deck 22: Nutrition and Renal Diseases

Question 1

Individuals on peritoneal dialysis have lower protein needs than those on hemodialysis.

Answer 1

False

Question 2

Consequences of acute kidney injury include all of the following except:

A)the reduced production of urine.
B)sodium retention and elevated levels of potassium, phosphate, and magnesium in the blood.
C)the inability to metabolize nutrients.
D)the excessive secretion of parathyroid hormone.

Answer 2

C

Question 3

Supplementation of all fat-soluble vitamins is necessary in clients with chronic kidney disease.

Answer 3

False

Question 4

Nephrotic syndrome is a result of:

A)damage to the glomeruli.
B)damage to the tubules.
C)excessive protein intake.
D)excessive fat intake.

Question 5

Which of the following is not a function of the kidneys?

A)maintaining blood pressure
B)regulating electrolyte concentrations
C)maintaining acid-base balance
D)converting vitamin K to its active form

Question 6

One of the effects of nephrotic syndrome is a loss of vitamin D.This can result in _____ in children.

A)growth failure
B)poor appetite
C)rickets
D)type 1 diabetes

Question 7

The medical nutrition therapy for nephrotic syndrome helps to prevent protein-energy malnutrition and alleviate edema.

Question 8

Dialysis removes excess fluids and wastes from the blood by employing the principles of diffusion, osmosis, and ultrafiltration.

Question 9

The part of the kidney that acts like a sieve to filter wastes is the:

A)nephron.
B)glomerulus.
C)tubule.
D)lobe.

Question 10

Which of the following dietary components are restricted in nephrotic syndrome?

A)sodium and protein
B)fluids and sodium
C)carbohydrate and fat
D)calcium and phosphorus

Question 11

In kidney disease, the kidneys cannot excrete _____ in the urine.

A)ammonia
B)iron
C)potassium
D)amino acids
E)urea

Question 12

Recovery from kidney injury may begin with a period of diuresis and a patient's fluid status should be monitored closely.

Question 13

Patients with nephrotic syndrome may require supplements of:

A)vitamin D and calcium.
B)essential fatty acids.
C)essential amino acids.
D)potassium and thiamin.

Question 14

Manifestations of the nephrotic syndrome include:

A)low serum albumin.
B)uremia.
C)low blood lipids.
D)dehydration.

Question 15

A glomerular filtration rate < 29 indicates kidney failure and the need for dialysis.

Question 16

If heart failure leads to acute kidney injury, it is considered a _____ factor.

A)primary
B)prerenal
C)preventable
D)postrenal

Question 17

The nephrotic syndrome results in:

A)decreased blood pH.
B)increased blood albumin.
C)decreased LDL and VLDL.
D)increased risk for blood clots.

Question 18

Prior to the need for dialysis, most renal patients are unable to handle normal intakes of potassium.

Question 19

In patients with acute kidney injury, oliguria leads to:

A)a loss of bone calcium due to hyperphosphatemia.
B)edema due to increased urine production.
C)an increase in blood potassium levels due to excessive excretion of parathyroid hormone.
D)production of at least 800 mL of urine per day.

Question 20

Adults with chronic kidney disease frequently develop wasting and PEM.

Question 21

Which of the following needs takes priority in planning a renal diet?

A)adjustment of protein
B)adjustment of simple carbohydrate
C)adjustment of fat
D)adjustment of fiber

Question 22

Mrs.Clark weighs 59 kg and has chronic kidney disease with a GFR <50.How much protein should her daily diet include?

A)24-30 grams
B)35-47 grams
C)47-71 grams
D)59-66 grams

Question 23

The ideal diet for chronic kidney disease includes:

A)animal protein sources only.
B)plant protein sources only.
C)50% of protein from high-quality protein sources.
D)essential amino acid supplements.

Question 24

In acute kidney injury, fluid needs are determined by measuring urine output and adding _____ milliliters.

A)200
B)300
C)400
D)500

Question 25

If a client is on peritoneal dialysis, his diet should contain less _____ than other renal diets.

A)fat
B)protein
C)vitamins
D)carbohydrate

Question 26

Acidosis can worsen:

A)blood pressure.
B)malnutrition.
C)renal osteodystrophy.
D)GFR.

Question 27

The most common cause of chronic kidney disease is:

A)diabetes.
B)infectious diseases.
C)genetic disorders.
D)inflammatory diseases.

Question 28

All of the following may be restricted during the oliguric phase of acute kidney injury except:

A)fluids.
B)potassium.
C)sodium.
D)carbohydrate.

Question 29

Kidney disease is classified according to:

A)GFR.
B)the ratio of albumin to creatinine in a urine sample.
C)BUN levels.
D)the degree of proteinuria.

Question 30

The anorexia associated with chronic kidney disease has many potential causes, but _____ is/are not one of them.

A)hormonal disturbances
B)infection
C)restrictive diets
D)medications

Question 31

The various symptoms and complications that develop in the final stages of chronic kidney disease are collectively referred to as:

A)anemia.
B)PEM.
C)uremic syndrome.
D)nephrotic syndrome.

Question 32

The ideal renal diet provides enough protein to:

A)provide needed energy (kcalories).
B)keep blood ammonia levels stable.
C)decrease liver hyperactivity.
D)prevent malnutrition.

Question 33

Secondary complications of chronic kidney disease include:

A)type 1 diabetes.
B)bone disease.
C)stroke.
D)hypotension.

Question 34

The early phase of acute kidney injury characterized by the inability to produce much urine is called the _____ phase.

A)oliguric
B)recovery
C)diuretic
D)anuric

Question 35

Furosemide (Lasix) is a drug used to:

A)mobilize fluids.
B)lower cholesterol.
C)prevent PEM.
D)activate vitamin D.

Question 36

Weight gain can become a problem when peritoneal dialysis continues for an extended period of time.This is likely due to:

A)the kcalories contributed by the dialysate.
B)a less restrictive diet.
C)food cravings experienced by the patient.
D)the body's adaptation to dialysis.

Question 37

Common clinical effects of uremic syndrome include all of the following except:

A)anemia.
B)mental dysfunctions.
C)restless leg syndrome.
D)hypokalemia.

Question 38

When dialysis is initiated in a client with chronic kidney disease, protein:

A)can be consumed more liberally.
B)is restricted to a greater degree.
C)intake remains the same.
D)from nonessential amino acid sources is emphasized.

Question 39

The diet for acute kidney injury is usually restricted to about _____ per kilogram of body weight per day for noncatabolic patients not on dialysis.

A)0.2-0.5 gram protein
B)0.6-0.8 gram protein
C)0.8-1.2 grams protein
D)1.0-2.0 grams protein

Question 40

A glomerular filtration rate <15 mL/min per 1.73 m² indicates:

A)little or no loss of kidney function.
B)mild but reversible kidney damage.
C)Stage 5 chronic kidney disease.
D)that nutrition therapy but not dialysis should be prescribed.

Question 41

Following kidney transplantation, dietary restrictions:

A)are more strict.
B)are liberalized.
C)can replace immunosuppressive therapy.
D)determine whether the body rejects the kidney.

Question 42

The client with chronic kidney disease will usually need supplements of:

A)sodium, potassium, and fat-soluble vitamins.
B)vitamin B₆, folate, and calcium.
C)phosphorus, iron, and calcium.
D)potassium, phosphorus, and vitamin D.

Question 43

Side effects of immunosuppressive drug therapy following a kidney transplant may include all of the following except:

A)glucose intolerance.
B)fluid retention.
C)malabsorption of nutrients.
D)foodborne infection.

Question 44

Patients with chronic kidney disease are often encouraged to consume high-fat foods to improve their energy intake.An appropriate high-fat food choice for such a patient is:

A)fried fish.
B)peanuts.
C)cheese.
D)ice cream.

Question 45

Mr.Wilson's GFR is indicative of Stage _____ chronic kidney disease.

A)2
B)3
C)4
D)5

Question 46

Protein-restricted diets naturally curb the intake of:

A)sodium.
B)phosphorous.
C)potassium.
D)vitamin B₆.

Question 47

As compared to standard formulas, enteral formulas suitable for chronic kidney disease have all of the following characteristics except:

A)they are more calorically dense.
B)they are lower in protein.
C)they are lower in electrolytes.
D)they contain more water.

Question 48

The most appropriate food to recommend for supplementing kcalories in the renal diet is:

A)olive oil.
B)cheese.
C)whole milk.
D)a chocolate candy bar.

Question 49

The potassium content of vegetables can be reduced by a process called:

A)steaming.
B)sautéing.
C)leaching.
D)boiling.

Question 50

For clients on fluid-restricted diets who experience extreme thirst, you should suggest:

A)adding lemon juice to water to make it more refreshing.
B)drinking black coffee, as it has no kcalories.
C)eating salt-free saltines (soda crackers).
D)eating ice, as it doesn't count as a liquid.

Question 51

The most effective way to improve the iron status of patients undergoing dialysis is:

A)oral supplements.
B)IV administration.
C)IV administration in conjunction with erythropoietin therapy.
D)increasing intake of iron-rich foods.

Question 52

The best way to prevent the formation of kidney stones is to:

A)minimize calcium intake.
B)eat less meat.
C)eat fewer oxalate-containing vegetables.
D)drink 12 to 16 cups of fluids per day.
Use the following case study to answer questions 52-57.
Dennis Wilson is a 57-year-old chemical engineer who has had type 1 diabetes since he was 12 years old.He spent 34 years working in oil refineries, and he is a smoker.He is 5'11" tall and weighs 160 pounds.Over the past several years, he has experienced a gradual decline in kidney function.His GFR has declined to 27 mL/min per 1.73 m².

Question 53

Hypercalciuria can result from all of the following except:

A)excessive calcium absorption.
B)impaired calcium reabsorption.
C)elevated serum levels of parathyroid hormone.
D)impaired absorption of vitamin C.

Question 54

Which of the following foods is high in phosphorus?

A)cheese
B)corn flakes
C)peas
D)broccoli

Question 55

Calcium oxalate stones are usually accompanied by:

A)hypercalciuria.
B)hyperkalemia.
C)hyperphosphatemia.
D)hypercholesterolemia.

Question 56

A person on peritoneal dialysis can consume _____ more liberally than can a person on hemodialysis.

A)fluids
B)phosphorus
C)potassium
D)calcium

Question 57

People with chronic kidney disease frequently develop vitamin deficiencies due to all of the following except:

A)restrictive diets.
B)loss of vitamins during dialysis.
C)steatorrhea.
D)altered metabolism.

Question 58

Foods considered part of the fluid allowance in a diet for chronic kidney disease include all of the following except:

A)gelatin.
B)popsicles.
C)grapes.
D)ice milk.

Question 59

Foods high in oxalate include:

A)spinach.
B)milk.
C)carrots.
D)apples.

Question 60

Which of the following is not appropriate after a kidney transplant?

A)calcium supplements for those on corticosteroids
B)< 300 milligrams cholesterol per day
C)protein intake of at least twice the RDA
D)< 10% of total kcalories from saturated fat

Question 61

You allay Mr.Bradley's fears that his new diet will lack variety and flavor by assuring him that the diet:

A)includes all five food groups.
B)promotes flavor with herbs and low-sodium seasonings.
C)encourages unsaturated fats, such as oil-based salad dressings.
D)allows unsaturated fats, such as mayonnaise.
E)all of the above

Question 62

A client with acute kidney injury has a urine output of 500 milliliters per day.The nurse determines his daily fluid needs to be:

A)500 milliliters.
B)800 milliliters.
C)1000 milliliters.
D)1200 milliliters.

Question 63

Which form of dialysis is most appropriate for an acute kidney injury patient?

A)any that relies on diffusion
B)hemodialysis
C)peritoneal dialysis
D)continuous renal replacement therapy
Nursing Exam Review Multiple Choice

Question 64

The primary goal(s) of medical nutrition therapy for Mr.Wilson at this time should be:

A)lowering his blood cholesterol level.
B)preventing PEM and weight loss.
C)treating him for iron-deficiency anemia.
D)preventing osteoporosis.

Question 65

A patient presents with elevated BUN, creatinine, and blood pressure.He complains of fatigue, confusion, easy bruising, and pruritus.The nurse recognizes these as symptoms of:

A)uremia.
B)diuresis.
C)renal osteodystrophy.
D)gout.

Question 66

Which of the following statements is true?

A)The chemical composition of the dialysate does not affect the movement of solutes across the semipermeable membrane.
B)Bicarbonates are added to a dialysate for a person with acidosis.
C)When the concentration of a substance is higher in the dialysate than in the blood, the substance will diffuse out of the blood.
D)Dialysate contains no urea or potassium.

Question 67

Which of the following principles regarding fluid is correctly conveyed to Mr.Bradley?

A)"Gelatin, soups, fruit ices, and frozen fruit juice bars contribute to your fluid intake."
B)"Water losses from the skin and lungs are deducted from your fluid allowance."
C)"Solid foods do not contribute to your fluid intake."
D)"Your average fluid gain between dialysis treatments should ideally be 0 pounds."
E)all of the above

Question 68

Mr.Wilson's laboratory reports indicate hyperkalemia.His intake of _____ should be restricted.

A)protein
B)sodium
C)phosphorus
D)potassium

Question 69

The likely cause of Mr.Wilson's chronic kidney disease is:

A)his history of type 1 diabetes.
B)exposure to chemicals in the workplace.
C)his history of smoking.
D)unknown.
Use the following case study to answer questions 58-62.
Mr)Bradley is a 70-year-old man with a long medical history including uncontrolled diabetes mellitus since age 45 who presents to the West Smithtown Dialysis Center with new-onset end-stage kidney disease.Mr.Bradley lives in an assisted living facility where he receives full-time nursing care.As a dialysis nurse, your role is to review the nutrition guidelines with Mr.Bradley, who has diabetic retinopathy and loss of vision.He is a non-ambulatory war veteran, former smoker, and former alcohol abuser whose BMI is normal, though he has lost 3% of his body weight since being diagnosed with kidney failure one month ago.A food frequency questionnaire shows that Mr.Bradley generally meets his recommended intakes of all food groups, but his fiber intake is low, and his dairy foods consumption exceeds the recommendation by double due to his love of milk, ice cream, cheese, and other dairy products.

Question 70

A patient's lab results reveal hypoalbuminemia.The nurse realizes that this is likely to cause _____ in the patient.

A)edema
B)infection
C)rickets
D)altered blood lipids

Question 71

You explain to Mr.Bradley that the diet for end-stage renal disease:

A)strongly influences disease progression.
B)can prevent the development of complications.
C)can control serum levels of nitrogenous wastes and thus help him feel better.
D)can help to control electrolytes and avoid a life-threatening imbalance.
E)all of the above

Question 72

Since this is Mr.Bradley's first visit to the center, you, as his primary care nurse, spend hours speaking to him while his dialysis progresses.You explain that within the next week he will be seen by _____, who will counsel him about his nutrition therapy.

A)a dietitian who specializes in chronic kidney disease
B)a physician who oversees all aspects of clients' medical care
C)another client who has been following the diet for years
D)a pharmacist who will address the nutrients administered via the dialysate
E)a phlebotomy nurse who draws blood for and interprets laboratory values

Question 73

A client is admitted to the emergency room and is found to have proteinuria, a low serum albumin, edema, and elevated blood lipids.The nurse recognizes these symptoms as those associated with:

A)rejection of a kidney transplant.
B)acute kidney injury.
C)nephrotic syndrome.
D)kidney stones.

Question 74

Mr.Wilson's estimated energy needs are:

A)1818 kcal per day.
B)2182 kcal per day.
C)2545 kcal per day.
D)2909 kcal per day.

Question 75

Protein intake for Mr.Wilson should:

A)be restricted due to the lack of renal function.
B)be increased due to PEM.
C)be limited to plant protein foods.
D)be limited to animal protein foods.

Question 76

It is necessary to monitor the fluid status of renal patients.The nurse understands that all of the following are indicative of fluid status except:

A)weight.
B)blood pressure.
C)appearance of the skin.
D)pulse rate.
E)condition of the nails.

Question 77

Which of the following is the most common method used to gauge the adequacy of dialysis treatment?

A)pressure gradient
B)serum phosphorus
C)serum albumin
D)urea kinetic modeling

Question 78

A patient with a history of renal disease complains of muscle cramping, twitching, and restless leg syndrome.The nurse recognizes these as symptoms of:

A)renal osteodystrophy.
B)uremic syndrome.
C)kidney stones.
D)PEM.

Question 79

One potential complication of hemodialysis is:

A)infections.
B)insomnia.
C)edema.
D)hemochromatosis.

Question 80

Mr.Bradley's comprehension of the need for a lower-phosphorus diet is reflected by his statement that:

A)"I will need to eat fewer fatty meats."
B)"I will need to avoid legumes."
C)"I will need to limit dairy products."
D)"I can eat all the bread I want."
E)"Becoming a vegetarian would best meet my protein needs."