5. An elderly client with kidney disease is admitted with dementia. The laboratory values are: Ca++ at 7 mg/dL, PO4 at 7 mg/dL, albumin at 2 gm, creatinine at 8 mg/dL. The laboratory findings indicate:
5. An elderly client with kidney disease is admitted with dementia. The laboratory values are: Ca++ at 7 mg/dL, PO4 at 7 mg/dL, albumin at 2 gm, creatinine at 8 mg/dL. The laboratory findings indicate:
. Elevated phosphates from kidney failure.
. High risk for seizures from low Ca++. Treatment is a priority.
. Need for dialysis to raise phosphate level.
. Need for a diet high in dairy to increase albumin.
Test-Taking Tip
Focus on the elevated phosphate level. Know the normal ranges of laboratory tests in order to recognize levels that place the client at risk.
Content Area: Geriatrics, Renal; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Physiological Adaptation/Fluid and Electrolyte Imbalances
.
Answer 1 is correct because the kidneys normally excrete phosphate, which is usually maintained at a level of 2.5 to 4.5 mg/dL in adults (up to 6 mg/dL in infants and children). A low total calcium in the presence of low albumin is expected in kidney failure. Physiologically important nonbound calcium is likely to be normal so that seizure risk is not elevated. Answer 2 is incorrect because the significance of low total serum calcium must be interpreted with consideration of the low albumin that is seen with kidney failure. Less than 50% of the plasma calcium is bound to serum protein, primarily albumin. Risk for seizures is not increased. Answer 3 is incorrect because the phosphate level is already elevated. Dialysis might be used to bring it down. Answer 4 is incorrect because a diet high in dairy products contains too much phosphate to be consumed by clients with kidney disease.