A male client with chronic kidney disease (CKD) is refusing to ...

[segrsyd]

A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?
 
  a. Discuss what the treatment regimen means to him.
  b. Refer the client to a mental health nurse practitioner.
  c. Reschedule the appointments to another date and time.
  d. Discuss the option of peritoneal dialysis.

Question 2

A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern?
 
  a. Albumin level of 2.5 g/dL
  b. Phosphorus level of 5 mg/dL
  c. Sodium level of 135 mmol/L
  d. Potassium level of 5.5 mmol/L

[kthug]

Answer to Question 1

ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling hemodialysis appointments may help, and referral to a mental health practitioner and the possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of the treatment should come first.

Answer to Question 2

ANS: A
Protein restriction is necessary with chronic renal failure due to the buildup of waste products from protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the protein in the diet is not enough for the client's metabolic needs. The electrolyte values are not related to the protein-restricted diet.