Assessing the laboratory findings which results would the nurse most likely to expect to find in a client wit… - AIIMS Nagpur NO- 2020

AIIMS Nagpur NO- 2020

Medical & Surgical Nursing

Hard

Appeared in: AIIMS Nagpur NO- 2020

Explanation

Clients with chronic renal failure (CRF) exhibit a distinct pattern of laboratory abnormalities due to the kidneys' inability to filter waste, regulate electrolytes, and maintain acid-base balance.
Decreased Serum Calcium (Hypocalcemia): The failing kidneys cannot activate Vitamin D, which is essential for intestinal calcium absorption. This, combined with high phosphate levels (hyperphosphatemia) that bind calcium, leads to low serum calcium.
Low Blood pH (Metabolic Acidosis): Healthy kidneys excrete hydrogen ions (acid) and reabsorb bicarbonate (base). In CRF, this ability is lost, causing an accumulation of acid in the blood, which lowers the pH below the normal range of 7.35-7.45.
High Serum Potassium (Hyperkalemia): The kidneys are the primary route for potassium excretion. In CRF, reduced kidney function leads to potassium retention, causing its level to rise above the normal 5.0 mEq/L. A level of 6.5 mEq/L is a medical emergency.

Option A: The BUN and creatinine levels listed (10-30 mg/dL and 0.5-1.5 mg/dL) are within or very close to the normal range. These findings do not indicate chronic renal failure.
Option B: While the BUN is elevated and serum calcium is decreased (consistent with CRF), the potassium level (3.5 mEq/L) and blood pH (7.35) are within normal limits. Significant CRF typically presents with hyperkalemia and metabolic acidosis.
Option C: This option presents normal BUN and creatinine levels. Furthermore, it states 'increased serum calcium,' which is the opposite of what is expected in chronic renal failure (hypocalcemia).

Clinical Relevance

Nursing practice connection: Use the key finding related to Laboratory findings in Chronic Renal Failure (CRF) to guide bedside assessment, documentation, and the next nursing action.
A nurse must continuously monitor the lab values of a patient with CRF, as imbalances can be life-threatening.
Hyperkalemia (Potassium > 5.0 mEq/L) is a critical concern as it can cause fatal cardiac dysrhythmias. The nurse should monitor the patient's ECG for peaked T waves, a classic sign.
Hypocalcemia can lead to neuromuscular irritability. The nurse should assess for positive Chvostek's (facial twitching) and Trousseau's (carpal spasm) signs.

How to Approach the Question

First, identify the core condition in the question stem, which is 'chronic renal failure'.
Next, recall the primary functions of the kidneys: filtering waste products (like BUN and creatinine), regulating electrolytes (like potassium and calcium), and maintaining acid-base balance.
Predict how a 'failure' of these functions would alter lab values. For example, waste products would increase, potassium would increase (as it can't be excreted), calcium would decrease (due to lack of Vitamin D activation), and the blood would become acidic (as acid can't be excreted).
Systematically evaluate each option against this predicted profile of renal dysfunction.
Option A and C show normal waste product levels, so they are incorrect. Option B shows normal potassium and pH, making it less likely.
Select the option that presents the most complete and classic set of CRF lab abnormalities. Option D, with decreased calcium, low pH, and high potassium, is the best fit.

Concept Tested & Keywords

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