A nurse is assessing a client who has end stage kidney disease which of the following dietary

A person with stage 5 chronic kidney disease has end stage renal disease (ESRD) with a glomerular filtration rate (GFR) of 15 ml/min or less. At this advanced stage of kidney disease, the kidneys have lost nearly all their ability to do their job effectively, and eventually dialysis or a kidney transplant is needed to live.

Symptoms of stage 5 CKD

Symptoms that can occur in stage 5 CKD include:

• Loss of appetite
• Nausea or vomiting
• Headaches
• Being tired
• Being unable to concentrate
• Itching
• Making little or no urine
• Swelling, especially around the eyes and ankles
• Muscle cramps
• Tingling in hands or feet
• Changes in skin color
• Increased skin pigmentation

Because the kidneys are no longer able to remove waste and fluids from the body, toxins build up in the blood, causing an overall ill feeling. Kidneys also have other functions they are no longer able to perform such as regulating blood pressure, producing the hormone that helps make red blood cells and activating vitamin D for healthy bones.

If you are diagnosed with stage 5 CKD, you will need to see a nephrologist immediately. This is a doctor who is trained in kidney disease, kidney dialysis and transplant. The doctor will help you decide which treatment is best for you—hemodialysis, peritoneal dialysis (PD) or kidney transplant—and will recommend an access for dialysis. Your nephrologist will develop your overall care plan and manage your healthcare team.

Dialysis treatments for people with stage 5 CKD

Most people report feeling much better once they begin dialysis. As the toxins are removed from the blood medicines replace the functions the kidneys can no longer perform, they find they can enjoy a good quality of life. There are two types of dialysis treatments for people with stage 5 kidney disease.

1. Hemodialysis: This treatment that can be done in a center or in a patient’s home with assistance from a care partner. A dialysis machine removes a small amount of a patient’s blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.
2. Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free treatment and a care partner is not required to to help assist during treatment. PD can be performed at home or at work.

Kidney transplant is another treatment option

If you wish to have a kidney transplant, tell your nephrologist. Your nephrologist will explain the process of how to get on a waiting list for a cadaverous kidney or how to find a living donor.

When at stage 5 CKD, either dialysis or a kidney transplant is necessary to continue living.

Changes in the diet for people with stage 5 CKD

Once you begin dialysis, you will need to make changes in what you eat and drink. Your diet is a big part of your treatment, so you will be working with a dietitian who will coach you on how you should eat. Depending on the dialysis treatment you choose and your lab test results, your dietitian will help create a meal plan based on your individual requirements to keep you feeling your best. Your dietitian will explain what foods are restricted and which ones are recommended on the renal diet.

A healthy diet for stage 5 CKD may recommend:

• Including grains, fruits and vegetables, but limiting or avoiding whole grains and certain fruits and vegetables that are high in phosphorus or potassium
• A diet that is low in saturated fat and cholesterol and moderate in total fats, especially if cholesterol is high or if you have diabetes or heart disease
• Limiting intake of refined and processed foods high in sodium and prepare foods with less salt or high-sodium ingredients
• Aiming for a healthy weight by consuming adequate calories and including physical activity each day within your ability
• Decreasing calcium intake if necessary
• Limiting fluid intake
• Increasing protein intake to the level determined by the dietitian’s assessment of individual needs and to replace losses in the dialysis treatment
• Taking special renal vitamins high in water soluble B vitamins and limited to 100 mg of vitamin C
• Vitamin D and iron tailored to individual requirements

Find a doctor when you have stage 5 CKD

When a person learns he or she has stage 5 kidney disease, working with a nephrologist is necessary to ensure they have the right tools to treat their condition.

This is a quiz that contains NCLEX review questions for chronic kidney disease (also called end stage renal failure). As a nurse providing care to a patient with CKD, it is important to know the signs and symptoms, pathophysiology, nursing management, patient education, and treatment for this condition.

In the previous NCLEX review series, I explained about other renal disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well.

Don’t forget to watch the chronic kidney disease lecture before taking the quiz.

(NOTE: When you hit submit, it will refresh this same page. Scroll down to see your results.)

Chronic Kidney Disease (End Stage Renal Failure) NCLEX Questions

1. A 55 year old male patient is diagnosed with chronic kidney disease. The patient’s recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as?

A. Stage 1

B. Stage 3

C. Stage 4

D. Stage 5

The answer is C. This is known as Stage 4 of CKD because the GFR (glomerular filtration rate) for this stage is 15-29 mL/min (patient’s GFR is 25 mL/min). The other stage’s criteria are as follows:

Stage 1: Kidney damage with normal renal function GFR >90 ml/min but with proteinuria (3 months or more);

Stage 2: Kidney damage with mild loss of renal function GFR 60-89 ml/min with proteinuria (3 months or more);

Stage 3: Mild-to-severe loss of renal function GFR 30-59 mL/min;

Stage 4: Severe loss renal function GFR 15-29 mL/min;

Stage 5: End stage renal disease GRF less 15 mL/min

2. A patient with CKD has a low erythropoietin (EPO) level. The patient is at risk for?

A. Hypercalcemia

B. Anemia

C. Blood clots

D. Hyperkalemia

The answer is B. EPO (erythropoietin) helps create red blood cells in the bone marrow. The kidneys produce EPO and when the kidneys are damaged in CKD they can decrease in the production of EPO. Therefore, the patient is at risk for anemia.

3. A 65 year old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You’re assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient’s hypertension along with providing a protective mechanism to the kidneys?

A. Lisinopril

B. Metoprolol

C. Amlodipine

D. Verapamil

The answer is A. There are two types of drugs that can be used to treat hypertension and protect the kidneys in patients with CKD. These drugs include angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). The only drug listed here that is correct is Lisinopril. This drug is known as an ACE inhibitor. Metoprolol is a BETA BLOCKER. Amlodipine and Verapamil are calcium channel blockers.

4. Which patient below is NOT at risk for developing chronic kidney disease?

A. A 58 year old female with uncontrolled hypertension.

B. A 69 year old male with diabetes mellitus.

C. A 45 year old female with polycystic ovarian disease.

D. A 78 year old female with an intrarenal injury.

The answer is C. Options A, B, and D are all at risk for developing CKD. However, option C is not at risk for CKD.

5. A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood?

A. Calcium

B. Urea

C. Phosphate

D. Erythropoietin

The answer is B. This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this.

6. Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient’s telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality?

A. Phosphate 3.2 mg/dL

B. Calcium 9.3 mg/dL

C. Magnesium 2.2 mg/dL

D. Potassium 7.1 mEq/L

The answer is D. The patient’s potassium level is extremely elevated.  A normal potassium level is 3.5-5.1 mEq/L. This patient is experiencing hyperkalemia, which can cause tall peak T-waves. Remember in CKD (especially prior to dialysis), the patient will experience electrolyte imbalances, especially hyperkalemia.

7. You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply:

A. “This medication will help keep my calcium level normal.”

B. “I will take this medication with meals or immediately after.”

C. “It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication.”

D. “This medication will help prevent my phosphate level from increasing.”

The answers are B and D. Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient’s phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.

8. While assessing morning labs on your patient with CKD. You note the patient’s phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be?

A. Elevated

B. Low

C. Normal

D. Same as the phosphate level

The answer is B. A normal phosphate level is 2.7-4.5 mg/dL. This patient is experiencing HYPERphosphatemia. When hyperphosphatemia presents the calcium level DECREASES because phosphate and calcium bind to each. When there is too much phosphate in the blood it takes too much calcium with it and it decreases the calcium in the blood. Therefore, the nurse would expect to find the calcium level decreased.

9. A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a:

A. Low protein, low sodium, low potassium, low phosphate diet

B. High protein, low sodium, low potassium, high phosphate diet

C. Low protein, high sodium, high potassium, high phosphate diet

D. Low protein, low sodium, low potassium, high phosphate diet

The answer is A. The patient should follow this type of diet because protein breaks down into urea (remember patient will have increased urea levels), low sodium to prevent fluid excess, low potassium to prevent hyperkalemia (remember glomerulus isn’t filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia.

10. The kidneys are responsible for performing all the following functions EXCEPT?

A. Activating Vitamin D

B. Secreting Renin

C. Secreting Erythropoietin

D. Maintaining cortisol production

The answer is D. The adrenal glands are responsible for maintaining cortisol production not the kidneys.

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