A client with chronic kidney disease is prescribed a low-protein diet. Which laboratory result should the nurse monitor to evaluate the effectiveness of the diet?

Correct Answer: A

Rationale: The correct answer is A: Blood urea nitrogen (BUN). BUN is a waste product that reflects protein intake and kidney function. In chronic kidney disease, high protein intake can increase BUN levels, so monitoring BUN helps assess the effectiveness of the low-protein diet. Incorrect choices: B: Serum potassium - This is more related to kidney function but not specifically affected by a low-protein diet. C: Serum calcium - Calcium levels are not directly affected by protein intake or a low-protein diet in chronic kidney disease. D: Creatinine clearance - This measures kidney function but is not directly influenced by protein intake.

Correct Answer: B

Rationale: The correct answer is B: Prothrombin time (PT) and international normalized ratio (INR). Warfarin works by inhibiting vitamin K-dependent clotting factors, affecting the PT and INR. Monitoring these levels helps assess the effectiveness of warfarin in preventing clot formation. Platelet count (A) assesses clotting ability but not the effectiveness of warfarin. Activated partial thromboplastin time (C) assesses intrinsic pathway clotting factors, not affected by warfarin. Fibrinogen level (D) assesses the final step of clot formation, not specific to warfarin effectiveness.

Correct Answer: C

Rationale: Correct Answer: C - Keep the head of the bed elevated at 30 degrees. Rationale: 1. Elevating the head of the bed at 30 degrees helps prevent aspiration by promoting proper drainage of gastric contents. 2. This position reduces the risk of reflux and pulmonary complications in clients with NG tubes. 3. It also helps maintain the proper position of the tube in the stomach, decreasing the likelihood of displacement. Summary of Other Choices: A. Flushing the NG tube with water before and after feedings is important for tube patency but does not directly prevent complications associated with the NG tube. B. Checking gastric residual volume every 6 hours is important to monitor feeding tolerance but does not directly prevent complications related to the NG tube. D. Replacing the NG tube every 24 hours is not necessary unless there are specific indications such as tube blockage or dislodgment. Regular replacement can increase the risk of complications and is not a standard practice.

Correct Answer: B

Rationale: The correct answer is B: Encourage passive range-of-motion exercises. This intervention helps improve joint mobility, reduce stiffness, and alleviate pain in clients with rheumatoid arthritis. Passive range-of-motion exercises can prevent joint contractures and maintain joint function. Applying cold packs (A) may help reduce inflammation but does not address joint stiffness. Administering a muscle relaxant (C) is not typically indicated for rheumatoid arthritis. Providing a high-calorie diet (D) is important for overall health but does not directly address joint pain and stiffness in this case.

Correct Answer: C

Rationale: The correct answer is C: Moon face and buffalo hump. In Cushing's syndrome, excessive cortisol production leads to characteristic symptoms like moon face (round, puffy face) and buffalo hump (fat accumulation at the back of the neck). This is due to redistribution of fat in the body. Hyperpigmentation (choice A) is seen in Addison's disease, not Cushing's. Hypotension (choice B) is unlikely due to the cortisol-induced sodium retention. Weight loss (choice D) is less common in Cushing's due to the metabolic changes causing weight gain.