Deck 22: Nutrition and Renal Diseases

Question 1

The kidneys secrete the hormone erythropoietin, which helps to regulate blood pressure.

Answer 1

False

Question 2

Although renal patients are often encouraged to consume high-fat foods to improve their energy intakes, the foods they select should provide mostly unsaturated fats.

Answer 2

True

Question 3

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

Answer 3

False

Question 4

Individuals on predialysis have lower protein needs than those on hemodialysis.

Question 5

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

Question 6

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

A) nephron.
B) glomerulus.
C) tubule.
D) lobe.
E) loop of Henle.

Question 7

Given the choice, many patients with end-stage renal disease would prefer kidney transplants, but the demand for suitable kidneys far exceeds the supply.

Question 8

Manifestations of the nephrotic syndrome include:

A) infection.
B) uremia.
C) low blood lipids.
D) dehydration.
E) poor peripheral pulses.

Question 9

A glomerular filtration rate

Question 10

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) anemia
E) scurvy

Question 11

Nephrotic syndrome develops as a result of:

A) damage to the glomeruli.
B) damage to the tubules.
C) excessive protein intake.
D) excessive fat intake.
E) increased sodium losses.

Question 12

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

Question 13

The nephrotic syndrome is associated with accelerated atherosclerosis and a sharply increased risk of heart disease and stroke.

Question 14

One primary function of the kidneys is to:

A) produce albumin.
B) aid in the digestion of fats.
C) maintain acid-base balance.
D) convert vitamin K to its active form.
E) produce enzymes that protect the body from viral infections.

Question 15

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

Question 16

Prostate cancer is an intrarenal factor that can cause acute kidney injury.

Question 17

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

Question 18

Extracorporeal shock wave lithotripsy is a procedure that involves surgically removing a kidney stone while the patient is under general anesthesia.

Question 19

Solutes are less likely to crystallize and form kidney stones in concentrated urine.

Question 20

Adults with chronic kidney disease frequently develop wasting and PEM.

Question 21

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

A) fat
B) phosphorus
C) vitamin D
D) protein
E) potassium

Question 22

Laboratory findings associated with acute kidney injury include abnormal levels of serum electrolytes and:

A) elevated WBC count.
B) glycosuria.
C) elevated BUN.
D) positive bacterial culture.
E) elevated GFR.

Question 23

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.
E) fluid retention in the peritoneal cavity.

Question 24

Kidney disease is classified according to:

A) glomerular filtration rate.
B) the ratio of albumin to creatinine in a urine sample.
C) BUN levels.
D) the degree of proteinuria.
E) the amount of urine output in a 24-hour period.

Question 25

Low-protein diets for patients with chronic kidney disease supply less _____ than high-protein diets.

A) sodium
B) phosphorous
C) potassium
D) vitamin B₆
E) magnesium

Question 26

What condition that leads to acute kidney injury is considered a prerenal factor?

A) u rinary obstruction
B) d rug exposure
C) h eart failure
D) t rauma
E) e xposure to toxins

Question 27

In patients with acute kidney injury, oliguria leads to:

A) sodium retention and elevated levels of potassium.
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.
E) hypophosphatemia and overgrowth of bone tissue.

Question 28

Secondary complications of chronic kidney disease include:

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

Question 29

Patients with kidney disease who take calcium and vitamin D supplements are at risk of _____ because of the use of phosphate binders.

A) hypophosphatemia
B) vitamin K deficiency
C) hyperphosphatemia
D) hypercalcemia
E) iron deficiency anemia

Question 30

What food is a good source of phosphorus?

A) c hicken
B) p eanut butter
C) p eas
D) b roccoli
E) c antaloupe

Question 31

During the later stages of chronic kidney disease, the recommended protein intake is _____ grams per kilogram of body weight per day.

A) 0.2 to 0.4
B) 0.6 to 0.75
C) 0.8 to 1.0
D) 1.0 to 1.2
E) 1.2 to 1.55

Question 32

Supplemental _____ among patients with chronic kidney disease should be limited to 70 mg per day because excessive intakes can contribute to kidney stone formation in those at risk.

A) vitamin D
B) phosphorus
C) potassium
D) vitamin C
E) iron

Question 33

Furosemide (Lasix) is a drug used to:

A) treat edema .
B) lower cholesterol.
C) prevent PEM.
D) activate vitamin D.
E) stimulate appetite.

Question 34

The most common cause of chronic kidney disease is:

A) diabetes.
B) infection.
C) a genetic disorder.
D) inflammation.
E) peripheral vascular disease.

Question 35

In oliguric patients, recovery from kidney injury sometimes begins with a period of _____, in which large amounts of fluid (up to 3 liters daily) are excreted.

A) hemodialysis
B) proteinuria
C) anuria
D) diuresis
E) peritoneal dialysis

Question 36

Which clinical effect is most commonly seen with uremic syndrome associated with chronic kidney disease?

A) h ypokalemia
B) h earing loss
C) h ypothyroidism
D) h ypertension
E) m outh sores

Question 37

What dietary components are restricted in patients who have nephrotic syndrome?

A) v itamins A and D
B) f luids and sodium
C) c arbohydrate and fat
D) c alcium and phosphorus
E) s odium and protein

Question 38

Total parenteral nutrition may be necessary for a patient with acute kidney injury when:

A) the patient has severe dysphagia.
B) the patient cannot tolerate tube feedings.
C) the patient has urine output of less than 400 mL per day.
D) the patient has hyponatremia.
E) the patient will need dialysis.

Question 39

A glomerular filtration rate

A) Stage 2: Mildly decreased
B) Stage 3a: Mild to moderately decreased
C) Stage 3b: Moderate to severely decreased
D) Stage 4: Severely decreased
E) Stage 5: Kidney failure

Question 40

A patient in the later stage of chronic kidney disease has been advised to increase his intake of potassium-rich foods. What food is an example of an item that is high in potassium?

A) s trawberries
B) c abbage
C) potatoes
D) watermelon
E) c arrots

Question 41

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.
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) male gender and age.
E) unknown.

Question 42

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

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

Question 43

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

A) excludes meat and dairy but includes everything else.
B) promotes flavor with salt and other seasonings.
C) allows replacing non-dairy products for his dairy products .
D) allows unlimited amounts of sweets.
E) does not need to be a permanent change.

Question 44

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

A) oral iron supplements.
B) IV and oral iron administration.
C) IV iron administration.
D) increasing intake of iron-rich foods.
E) intramuscular iron injections.

Question 45

Which factor may predispose an individual to kidney stone formation?

A) i ncreased volume of urine output
B) i ntake of foods that contain tyrosine
C) recent gastrointestinal infection
D) c hanges in urinary acidity
E) d ecreased tissue perfusion

Question 46

Which immunosuppressant drug would most likely be administered to a patient following a kidney transplant?

A) s evelamer
B) p otassium citrate
C) c alcium acetate
D) t acrolimus
E) sodium polystyrene sulfonate

Question 47

The potassium content of vegetables can be reduced through which process?

A) s teaming
B) s autéing
C) l eaching
D) b oiling
E) s praying

Question 48

Approximately _____ percent of patients with end-stage renal disease receive a kidney transplant.

A) 5
B)
C) 15
D) 20
E) 25

Question 49

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.
Mr. Wilson's estimated energy needs are:

A) 1818 kcal per day.
B) 2182 kcal per day.
C) 2545 kcal per day.
D) 2710 kcal per day.
E) 2983 kcal per day.

Question 50

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.
What principle 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 10 pounds."
E) "Most of your fluid intake should come when you take your medications."

Question 51

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

A) lower his blood cholesterol levels.
B) prevent malnutrition and weight loss.
C) treat him for iron-deficiency anemia.
D) prevent osteoporosis.
E) eliminate excess potassium from his diet.

Question 52

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.
Mr. Bradley's comprehension of the need for a lower-phosphorus diet is reflected by which statement?

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."

Question 53

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.
Protein intake for Mr. Wilson should:

A) be restricted due to slow disease progression.
B) be increased due to PEM.
C) be limited to plant protein foods.
D) be limited to animal protein foods.
E) remain the same until he begins to lose weight.

Question 54

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

A) has little influence on disease progression.
B) will not prevent the development of complications.
C) contributes to elevated serum levels of nitrogenous wastes.
D) can help to control electrolytes and avoid a life-threatening imbalance.
E) will prevent him from developing further vision loss.

Question 55

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.
Since this is Mr. Bradley's first visit to the center, his primary care nurse spends hours speaking to him while his dialysis progresses. The nurse explains 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 56

Calcium oxalate stones are most often accompanied by what metabolic condition?

A) h ypercalciuria
B) h yperkalemia
C) h yperphosphatemia
D) h ypercholesterolemia
E) h ypernatremia

Question 57

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 or more cups of fluids per day.
E) add iron supplements to the diet.

Question 58

One potential complication of hemodialysis is:

A) blood clots.
B) insomnia.
C) edema.
D) hemochromatosis.
E) hypertension.

Question 59

Uric acid kidney stones are most commonly associated with what condition?

A) h ypercalcemia
B) d iabetes
C) g out
D) a therosclerosis
E) d iarrhea

Question 60

An example of a food that is high in oxalate is:

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

Question 62

Describe special dietary considerations for a patient who has had a kidney transplant.

Question 63

Describe the appropriate dietary treatment for different types of kidney stones, including calcium oxalate, uric acid, and cystine stones.

Question 64

What describes an advantage of peritoneal dialysis over hemodialysis?

A) It is less likely to cause blood clots.
B) Its dialyzer is typically more effective.
C) It is less likely to cause infection.
D) It requires fewer dietary restrictions.
E) It can be used for longer periods.

Question 65

Explain the differences between prerenal, intrarenal, and postrenal factors in the development of acute kidney disease.

Question 66

Describe the potential consequences that can develop with nephrotic syndrome.

Question 67

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

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

Question 68

Explain energy needs when providing nutrition care of clients with chronic kidney disease.

Question 69

Nursing Exam Review Multiple Choice 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
E) hypertension

Question 70

Nursing Exam Review Multiple Choice The nurse understands that patients on peritoneal dialysis may most likely experience what side effect?

A) weight loss
B) hypoglycemia
C) lactose intolerance
D) h ypertriglyceridemia vomiting
E) u remia

Question 71

Nursing Exam Review Multiple Choice The nurse in the dialysis unit understands that patients may experience various complications during hemodialysis. What describes a common complication during hemodialysis?

A) p rofuse sweating
B) h ypertension
C) l eg cramps
D) severe pain
E) c onfusion

Question 72

Nursing Exam Review Multiple Choice A client is admitted to the emergency room and is found to have proteinuria, 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.
E) renal colic.

Question 73

Nursing Exam Review Multiple Choice A 52-year-old male patient recently required surgery for the removal of a large calcium oxalate stone. To prevent further stone formation, the nurse instructs him to consume plenty of fluids, but advises against drinking:

A) water.
B) coffee.
C) sugar flavored soft drinks.
D) draft beer.
E) wine.