Chapter 18: Nutrition for Diseases of the Kidneys My Nursing Test Banks

Chapter 18: Nutrition for Diseases of the Kidneys

Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition

MULTIPLE CHOICE

1. Kidney disease affects the bodys ability to maintain

a.

body temperature.

b.

body weight.

c.

bone health.

d.

bowel function.

ANS: C

Kidney disease prevents the final step of vitamin D synthesis and disrupts calcium and phosphorus metabolism; thus it adversely affects bone health. The kidneys do not play a role in regulation of body temperature, bowel function, or body weight.

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2. If a patient is losing significant amounts of protein in urine, he or she probably has

a.

acute renal failure.

b.

chronic renal failure

c.

nephrotic syndrome.

d.

renal calculi.

ANS: C

Loss of protein in the urine occurs in patients with nephritic syndrome. Acute and chronic renal failure cause, respectively, abrupt and gradual loss of renal function, but protein is not usually lost in the urine. Renal calculi, or kidney stones, do not cause loss of protein in the urine.

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3. One of the nurses important roles in care of patients with nephrotic syndrome is

a.

monitoring serum sodium level.

b.

monitoring fluid intake and output.

c.

ordering a high-protein, low-sodium diet.

d.

monitoring serum phosphorus level.

ANS: B

It is very important for nurses to monitor fluid intake and output of patients with nephrotic syndrome because needs change as kidney function changes. Protein intake is individualized to minimize stress on the kidneys and prevent malnutrition. Sodium intake is usually restricted. Ordering diets is the responsibility of the physician. The nurse may alter the physicians orders if the patients serum sodium levels are elevated, but this is not the nurses primary responsibility. Monitoring serum phosphorus levels is more important for patients with end-stage renal disease.

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4. The best way to ensure that patients with nephrotic syndrome are able to use their dietary protein to maintain lean body tissue is to

a.

provide 1.5 to 2.0 g protein per kilogram of body weight per day.

b.

encourage daily exercise.

c.

ensure adequate energy intake.

d.

provide adequate dietary potassium.

ANS: C

Adequate energy intake is important to ensure that protein can be used to maintain lean body mass rather than for energy. Protein intake is usually restricted to 0.7 to 1.0 g/kg/day to decrease the burden on the kidneys. Patients with nephrotic syndrome are usually too sick to exercise. Increasing potassium intake does not increase retention of muscle mass.

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5. An example of a source of hidden sodium is

a.

mouthwash.

b.

saltine crackers.

c.

opaque salt shakers.

d.

raw fruits and vegetables.

ANS: A

Hidden sources of sodium include mouthwash; if patients use mouthwash, they should be instructed not to swallow it. Saltine crackers are coated with visible salt. Opaque salt shakers do not hide the fact that they contain sodium. Raw fruits and vegetables have low levels of sodium.

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6. If a patient with acute renal failure gains 2 lb in 24 hours, the cause is likely to be

a.

urea retention.

b.

fluid retention.

c.

increased fat stores.

d.

increased muscle mass.

ANS: B

In patients with acute renal failure, sudden increases in weight are usually caused by fluid retention. Most such patients have very little appetite, and so they are unlikely to gain fat; they are also inactive, and so they are unlikely to increase muscle mass. Also, gains in muscle mass and fat stores tend to be slow. Urea retention does not cause an increase in weight.

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7. If a patient with third-degree burns covering 40% of the body surface area suddenly exhibits high blood pressure and edema and is not producing urine, he or she has probably developed

a.

severe malnutrition.

b.

nephrotic syndrome.

c.

chronic renal failure.

d.

acute renal failure.

ANS: D

In a stressed patient, loss of urine production accompanied by high blood pressure and edema is a sign of acute renal failure. Chronic renal failure develops more gradually, usually over several years. Nephrotic syndrome is characterized by loss of protein in the urine, but urine production does not usually stop. Severe malnutrition would cause edema but not hypertension and loss of urine production.

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8. It would be most challenging to design a diet for chronic renal failure for

a.

a patient with elevated levels of serum low-density lipoprotein (LDL) cholesterol.

b.

a patient with hypertension.

c.

someone who follows a vegan eating pattern.

d.

someone who adheres to strict kosher food laws.

ANS: C

It would be most difficult to design a diet for a patient who follows a vegan eating pattern because vegetable proteins are generally of lower quality, and the foods that contain them tend to have high phosphorus levels. Many patients with chronic renal failure also have high blood pressure and high LDL cholesterol levels; diets for renal disease generally restrict sodium intake and can be designed to be low in saturated fat. Kosher food laws can be accommodated within renal diets; meat and dairy cannot be eaten together, but dairy is restricted for patients with renal disease anyway.

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9. Protein needs of patients with acute renal failure who do not need dialysis are

a.

lower than those of patients receiving hemodialysis.

b.

the same as those of patients receiving hemodialysis.

c.

higher than those of patients receiving hemodialysis.

d.

dependent on the volume of urine produced.

ANS: A

Patients with acute renal failure who do not need dialysis have lower protein needs than patients receiving hemodialysis because the latter lose protein during treatments. Protein is not lost in the urine, and so protein needs are not affected by the volume of urine produced.

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10. In order to calculate fluid needs for a patients in the oliguric phase of acute renal failure, it is important to know the patients

a.

body weight.

b.

energy intake.

c.

serum sodium level.

d.

amount of output.

ANS: D

In the oliguric phase of acute renal failure, fluid needs are the amount of output (urine, vomitus, and diarrhea) plus 500 mL per day, and so it is important to know the patients urine output. Fluid needs for these patients are not based on body weight, energy intake, or serum sodium level.

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11. The person who is most likely to develop chronic kidney disease is a(n)

a.

obese woman with elevated levels of LDL cholesterol.

b.

man with type 2 diabetes and hypertension.

c.

man who drinks two alcoholic beverages a day and smokes cigarettes.

d.

woman with tuberculosis and acquired immunodeficiency syndrome (AIDS).

ANS: B

Chronic renal failure often results from vascular damage in patients with type 2 diabetes and hypertension. Regular alcohol intake may cause liver damage (although two drinks per day is not excessive for a man), and smoking causes lung damage and increases risk for cardiovascular disease. Elevated LDL cholesterol levels and obesity are associated with cardiovascular disease. Tuberculosis and AIDS are not associated with chronic kidney disease.

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12. Before development of end-stage renal disease, the primary focus of nutrition therapy for patients with chronic renal failure is

a.

limiting intake of sodium and fluid.

b.

limiting foods that produce toxic metabolic byproducts.

c.

providing sufficient protein to prevent secondary complications.

d.

providing adequate energy, protein, and nutrients to promote recovery.

ANS: B

Before development of end-stage renal disease, nutrition therapy for patients with chronic renal failure focuses on limiting foods that produce toxic metabolic byproducts; this reduces the burden on the kidneys. Sodium intake and fluid intake do not need to be limited at this stage. Protein intake should be limited to the amount needed by the body because breakdown of excess protein produces toxic metabolic byproducts. Chronic kidney disease is irreversible, and so provision of adequate nutrients does not promote recovery, although it is important to maintain good nutritional status.

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13. The National Renal Diet

a.

provides carefully calculated menus for patients with chronic renal failure.

b.

provides flexible meal planning tools for patients with chronic renal failure.

c.

provides lists of foods that are acceptable for patients with chronic renal failure.

d.

allows patients with chronic renal failure to select foods without the help of a registered dietitian.

ANS: B

The National Renal Diet provides flexible meal planning tools for patients with chronic renal failure. Food intake needs to be tailored to individual preferences and lifestyles, and so menus are not provided. The help of a registered dietitian is still needed to develop a personalized meal plan. There are no acceptable and unacceptable foods for patients with chronic renal failure, but the National Renal Diet helps patients choose appropriate portion sizes of foods with high levels of nutrients that must be limited.

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14. Of the following, the meal that would be best to include as part of a renal diet plan is

a.

cheese omelet with biscuits.

b.

baked chicken with rice and green beans.

c.

bean burrito with tortilla chips and salsa.

d.

peanut butter sandwich on whole wheat bread.

ANS: B

The meal that would fit best within a renal diet plan is baked chicken with rice and green beans. This provides high-quality protein without excessive sodium, potassium, or phosphorus. The omelet provides high-quality protein from eggs and cheese, but cheese has high levels of phosphorus and biscuits have higher levels of sodium than do other breads. The beans in the burrito provide lower quality protein and have high levels of phosphorus; also, the tortilla chips have high levels of sodium (unless they are unsalted). Peanut butter provides lower quality protein and has high levels of phosphorus; whole wheat bread also has high levels of phosphorus.

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15. A food that is restricted in patients who are receiving hemodialysis and taking phosphate binders is

a.

banana.

b.

potato.

c.

egg.

d.

milk.

ANS: D

Milk is restricted in patients who are receiving hemodialysis because it has high levels of phosphorus. Bananas and potatoes have high amounts of potassium, not phosphorus. Eggs do not have high levels of phosphorus and provide a good source of high-quality protein.

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16. It is most appropriate to take medications to reduce serum phosphorus levels

a.

with fluids.

b.

with meals.

c.

between meals.

d.

one hour after meals.

ANS: B

Phosphate binders, used to reduce serum phosphorus levels, should be taken with meals. This allows the medications to bind the phosphorus in the food. They are ineffective if taken with fluids only, between meals, or 1 hour after meals.

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17. Patients with chronic renal failure often need supplements that contain an active form of vitamin

a.

A.

b.

C.

c.

D.

d.

K.

ANS: C

Patients with chronic renal failure often need supplements that contain an active form of vitamin D because the kidney fails to complete the final step in activating vitamin D. Supplements of fat-soluble vitamins (including A and K) are not needed; vitamin A toxicity has sometimes developed in patients undergoing hemodialysis. Supplements of vitamin C and other water-soluble vitamins may be needed but do not need to be given in an active form.

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18. If a patient with chronic renal failure develops anemia, he or she probably needs to be given

a.

erythropoietin.

b.

vitamin B12 supplements.

c.

folate supplements.

d.

red blood cells.

ANS: A

In patients with chronic renal failure, the kidneys do not produce sufficient erythropoietin, a hormone that stimulates bone marrow to produce red blood cells. Erythropoietin is administered to prevent anemia. Vitamin B12 and folate supplements are not usually needed because the anemia is not caused by deficiency of these nutrients. Administering red blood cells would provide only temporary relief, rather than replacing the hormone that makes the body produce its own red blood cells.

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19. The nurse would be most concerned if a family member visited a patient during hemodialysis treatment and brought the patient

a.

a salad with olive oil dressing and chopped egg.

b.

a bagel with homemade jam.

c.

unsalted pretzel sticks and honey.

d.

a chocolate milkshake.

ANS: D

Patients receiving dialysis need to limit their intake of phosphorus, and both chocolate and dairy products have high levels of phosphorus. A salad with olive oil dressing has low levels of phosphorus and sodium, and the chopped egg would provide a reasonable amount of high-quality protein. A bagel and unsalted pretzel sticks have low levels of phosphorus and sodium, and jam and honey add enjoyable calories.

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20. If a patient with chronic renal failure begins peritoneal dialysis, his or her protein intake should

a.

be calculated on the basis of the degree of malnutrition.

b.

be determined by the patients blood urea nitrogen level.

c.

decrease because the patient is not losing protein in urine.

d.

increase because protein is lost into the dialysate.

ANS: D

Patients treated with peritoneal dialysis require additional protein to replace losses into the dialysate by diffusion. Protein is not lost in the urine in patients with chronic renal failure. Protein intake is based on body weight, not on degree of malnutrition or blood urea nitrogen level.

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21. If a patient wishes to continue working and be active during the day, the best kind of peritoneal dialysis would be

a.

intermittent.

b.

manual.

c.

mechanical.

d.

continuous ambulatory.

ANS: D

Continuous ambulatory peritoneal dialysis allows patients to continue their usual activities; they just need to take time to exchange dialysate four or five times within a 24-hour period. Intermittent dialysis required patients to be restricted to a chair or bed during treatments. Ability to continue normal activities does not depend on whether dialysate is exchanged manually or mechanically, although manual exchanges are likely to be more convenient.

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22. In comparison with patients treated with hemodialysis, patients treated with peritoneal dialysis have _____ dietary protein needs.

a.

slightly higher

b.

slightly lower

c.

much higher

d.

much lower

ANS: A

Patients treated with peritoneal dialysis have higher dietary protein needs that those treated with hemodialysis because a little more protein is lost into the dialysate. However, some protein is lost into the dialysate with both forms of dialysis, and so the difference is not great.

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23. In comparison with patients treated with hemodialysis, patients treated with peritoneal dialysis have

a.

similar energy needs.

b.

higher energy needs.

c.

lower energy needs.

d.

more variable energy needs, depending on activity level.

ANS: C

Patients treated with peritoneal dialysis have lower energy needs than those treated with hemodialysis because dextrose is absorbed from the peritoneal dialysate. Activity level affects energy needs of patients with either form of dialysis.

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24. For bone health, it is very important for patients with chronic renal failurewhether they are receiving hemodialysis, peritoneal dialysis, or no dialysisto restrict their intake of

a.

potassium.

b.

oxalates.

c.

fluid.

d.

phosphorus.

ANS: D

Elevated blood phosphorus levels may lead to osteodystrophy (defective bone development) in patients with chronic renal failure, regardless of treatment; it is very important for them to restrict intake of foods with high levels of phosphorus. Fluid restrictions depend on urine output and blood pressure. Potassium intake should be restricted to 2 to 3 g/day in patients receiving hemodialysis and 2 to 4 g/day in patients receiving hemodialysis; intake depends on use of diuretics in patients not receiving dialysis. Oxalates do not need to be restricted in patients with renal failure but should be restricted by patients who develop calcium oxalate renal calculi.

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25. The most significant challenge for patients with diabetes mellitus and chronic renal failure who are treated with peritoneal dialysis is that

a.

insulin is lost into the dialysate.

b.

glucose is absorbed from the dialysate.

c.

the combined food restrictions are complex.

d.

peritoneal dialysis causes taste changes and food aversions.

ANS: B

Peritoneal dialysis may cause difficulty with metabolic control for patients with diabetes mellitus because glucose is absorbed from the dialysate. Loss of insulin into the dialysate is not a problem. Combined food restrictions are somewhat complex but do not make control of blood glucose levels more difficult. All patients with renal disease experience taste changes and food aversions, but these do not necessarily affect control of diabetes.

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26. Two weeks after a patient has undergone renal transplantation, his or her energy needs

a.

are lower than normal.

b.

are higher than normal.

c.

fluctuate from day to day.

d.

depend on nutritional status before surgery.

ANS: B

For the first 6 to 8 weeks after renal transplantation, energy needs are higher than normal because of the stress from surgery and catabolism. They do not generally fluctuate from day to day and do not depend on nutritional status before surgery.

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27. In a patient who is receiving steroids after renal transplantation, it is important to monitor _____ levels.

a.

hemoglobin

b.

blood glucose

c.

blood urea nitrogen

d.

serum phosphorus

ANS: B

Steroid therapy may cause glucose intolerance, and so blood glucose levels should be monitored. Steroids do not usually cause anemia. Serum phosphorus and blood urea nitrogen levels should be normal after successful renal transplantation and are not affected by steroid use.

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28. A patient who has calcium oxalate kidney stones should

a.

limit foods with high levels of calcium.

b.

avoid calcium supplements.

c.

limit foods with high levels of oxalate.

d.

avoid lower quality vegetable proteins.

ANS: C

For patients with calcium oxalate kidney stones, it is most effective to limit foods with high levels of oxalate. Patients do not need to restrict dietary calcium; in fact, adequate calcium intake from food and supplements is encouraged. Restricting animal protein sources is recommended; restriction of vegetable proteins is not recommended.

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29. The most important advice for preventing kidney stones is to

a.

restrict dietary calcium intake.

b.

increase dietary protein intake.

c.

drink at least 10 to 12 cups of fluid daily.

d.

achieve and maintain a healthy body weight.

ANS: C

The most important advice for preventing kidney stones is to drink at least 10 to 12 cups of fluid daily. Restricting dietary calcium intake is not necessary and may actually increase stone formation. Increasing dietary protein intake may increase stone formation. Body weight does not appear to be related to formation of kidney stones.

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30. An example of a food that may increase urinary oxalate levels is

a.

a ginger cookie.

b.

a cinnamon roll.

c.

a blueberry muffin.

d.

strawberry shortcake.

ANS: D

Strawberries are among the eight foods (spinach, rhubarb, beets, nuts, chocolate, tea, wheat bran, and strawberries) that cause significant increases in urinary oxalate excretion; therefore, strawberry shortcake may increase urinary oxalate levels. Ginger cookies, cinnamon rolls, and blueberry muffins would not increase urinary oxalate levels.

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