1. Know S/S of CKD (Chronic Kidney Disease) HYPERKALEMIA QUESTION A client with a history of chronic kidney disease is hospitalized. The nurse assesses the client for signs of related kidney insufficiency, which include: 1. Facial flushing 2. Edema and pruritus 3. Dribbling after voiding 4. Diminished force and caliber of stream The nurse is reviewing a client’s record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1. Elevated creatinine level 2. Decreased hemoglobin level 3. Decreased red blood cell count 4. Increased number of white blood cells in the urine QUESTION A client with CKD is experiencing Kussmaul respirations. Which acid-base imbalance should the nurse suspect the client is experiencing? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis ANS: B) Metabolic acidosis Rationale: As renal failure advances, the kidney loses the ability to excrete hydrogen ions. The buffering action of the kidney becomes impaired. This leads to metabolic acidosis. Kussmaul respirations (increasing rate and depth) are the body's attempt to compensate for the acidosis. Metabolic alkalosis occurs with an increased excretion of hydrogen ions. Respiratory acidosis occurs with retention of carbon dioxide. Respiratory alkalosis occurs with an increased loss of carbon dioxide.