ADULT CCRN CERTIFICATION MODULE 6 RENAL AND GENITOURINARY 4 PRACTICE TESTS 2024, Exams of Nursing

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ADULT CCRN CERTIFICATION

MODULE 6

RENAL AND GENITOURINARY

4 PRACTICE TESTS

1. A 65-year-old man with a history of hypertension, diabetes mellitus,

and chronic kidney disease (CKD) stage 3 presents to the

emergency department with dyspnea, orthopnea, and bilateral

crackles on chest auscultation. His blood pressure is 180/

mmHg, pulse is 110 beats/min, respiratory rate is 28 breaths/min,

and oxygen saturation is 90% on room air. His serum creatinine is

2.5 mg/dL and blood urea nitrogen (BUN) is 50 mg/dL. What is the

most likely diagnosis for this patient?

• A) Acute kidney injury (AKI) due to volume overload
• B) AKI due to contrast-induced nephropathy
• C) AKI due to acute tubular necrosis
• D) CKD exacerbation due to heart failure*
• Rationale: The patient has signs and symptoms of heart failure,

which is a common cause of CKD exacerbation. Heart failure can

lead to reduced renal perfusion, increased venous pressure, and

activation of neurohormonal pathways that worsen renal function.

Volume overload, contrast-induced nephropathy, and acute tubular

necrosis are possible causes of AKI, but they do not explain the

patient's cardiac findings.

2. A 45-year-old woman with a history of systemic lupus

erythematosus (SLE) and CKD stage 4 is admitted to the intensive

care unit with fever, rash, arthralgia, and hematuria. She has been

taking prednisone and hydroxychloroquine for her SLE. Her serum

creatinine is 3.8 mg/dL and BUN is 60 mg/dL. A urine analysis

shows proteinuria, hematuria, and red blood cell casts. A renal

biopsy reveals diffuse proliferative glomerulonephritis. What is the

most appropriate treatment for this patient?

• A) High-dose corticosteroids and cyclophosphamide*
• B) Low-dose corticosteroids and azathioprine
• C) Angiotensin-converting enzyme (ACE) inhibitors and diuretics
• D) Hemodialysis and plasmapheresis
• Rationale: The patient has lupus nephritis, which is a severe form

of SLE that affects the kidneys. Lupus nephritis can cause rapid

deterioration of renal function and progression to end-stage renal

disease if not treated aggressively. The standard treatment for lupus

nephritis is high-dose corticosteroids and cyclophosphamide, which

are immunosuppressive agents that reduce inflammation and

prevent further damage to the glomeruli. Low-dose corticosteroids

and azathioprine are less effective and may be used for maintenance

therapy after induction with high-dose corticosteroids and

cyclophosphamide. ACE inhibitors and diuretics are supportive

measures that can lower blood pressure and reduce edema, but they

do not address the underlying cause of lupus nephritis.

Hemodialysis and plasmapheresis are reserved for patients with

severe renal failure or life-threatening complications such as

pulmonary hemorrhage or cerebral vasculitis.

3. A 55-year-old man with a history of hypertension, coronary artery

disease, and CKD stage 5 is on maintenance hemodialysis three

times a week. He complains of fatigue, weakness, nausea, vomiting,

and pruritus. His serum calcium is 8.0 mg/dL, phosphorus is 6.

mg/dL, parathyroid hormone (PTH) is 800 pg/mL, and vitamin D is

10 ng/mL. What is the most likely diagnosis for this patient?

• A) Secondary hyperparathyroidism*
• B) Primary hyperparathyroidism

• C) Hypoparathyroidism
• D) Pseudohypoparathyroidism
• Rationale: The patient has secondary hyperparathyroidism, which is a common

complication of CKD that results from impaired phosphate excretion, reduced

vitamin D synthesis, and decreased calcium absorption. These factors lead to

hypocalcemia, hyperphosphatemia, and low vitamin D levels, which stimulate PTH

secretion from the parathyroid glands. PTH acts to increase calcium levels by

mobilizing calcium from the bones, increasing calcium reabsorption in the kidneys,

and stimulating vitamin D activation in the kidneys. However, in CKD patients, PTH

becomes less effective due to reduced renal function and receptor resistance.

Therefore, PTH levels continue to rise, causing bone resorption, soft tissue

calcification, and metabolic acidosis. Primary hyperparathyroidism is caused by a

parathyroid adenoma or hyperplasia that secretes PTH autonomously, leading to

hypercalcemia, hypophosphatemia, and low vitamin D levels. Hypoparathyroidism is

caused by a deficiency of PTH, leading to hypocalcemia, hyperphosphatemia, and

high vitamin D levels. Pseudohypoparathyroidism is a rare genetic disorder that

causes resistance to the action of PTH, leading to hypocalcemia, hyperphosphatemia,

and high PTH levels.

Which of the following is a characteristic feature of acute kidney injury

(AKI)?

a) Gradual deterioration of kidney function

b) Sudden onset of kidney dysfunction

c) Irreversible damage to the kidneys

d) Slow progression of symptoms over months

Answer: b) Sudden onset of kidney dysfunction

Rationale: Acute kidney injury is characterized by a rapid decline in

kidney function over a short period, leading to the accumulation of

waste products and imbalances in bodily fluids.

What is the most common cause of acute kidney injury?

a) Hypertension

b) Diabetes mellitus

c) Urinary tract infection

d) Decreased blood flow to the kidneys

Answer: d) Decreased blood flow to the kidneys

Rationale: Reduced blood flow to the kidneys, known as ischemic

injury, is the most common cause of acute kidney injury, leading to

decreased filtration and impaired kidney function.

Which of the following laboratory findings is consistent with acute

kidney injury?

a) Elevated creatinine and blood urea nitrogen (BUN) levels

b) Decreased serum potassium levels

c) Low urine specific gravity

d) Normal glomerular filtration rate (GFR)

Answer: a) Elevated creatinine and blood urea nitrogen (BUN) levels

Rationale: In acute kidney injury, there is a rapid rise in serum

creatinine and blood urea nitrogen levels due to impaired kidney

function and decreased filtration.

Chronic kidney disease is defined as a gradual loss of kidney function

over a period of:

a) 3 months or more

b) 6 months or more

c) 1 year or more

d) 2 years or more

Answer: a) 3 months or more

Rationale: Chronic kidney disease is characterized by a progressive

decline in kidney function over a period of 3 months or longer,

leading to the accumulation of waste products and fluid imbalances.

Which of the following is a common cause of chronic kidney disease?

a) Acute glomerulonephritis

b) Polycystic kidney disease

c) Urinary tract infection

d) Acute tubular necrosis

Answer: b) Polycystic kidney disease

Rationale: Polycystic kidney disease is a genetic disorder

characterized by the growth of numerous cysts in the kidneys,

eventually leading to chronic kidney disease.

The most common cause of end-stage renal disease (ESRD) worldwide

is:

a) Diabetes mellitus

b) Hypertension

c) Glomerulonephritis

d) Obstructive uropathy

Answer: a) Diabetes mellitus

Rationale: Diabetes mellitus is the leading cause of end-stage renal

disease globally, contributing to the progressive loss of kidney

function and the need for renal replacement therapy.

Which of the following is a common complication of chronic kidney

disease?

a) Hypokalemia

b) Anemia

c) Hypernatremia

d) Hypocalcemia

Answer: b) Anemia

Rationale: Chronic kidney disease often leads to a decrease in the

production of erythropoietin, resulting in anemia due to reduced red

blood cell production.

The recommended dietary protein intake for patients with chronic

kidney disease is:

a) High protein diet

b) Low protein diet

c) Normal protein diet

d) No specific dietary recommendations

Answer: b) Low protein diet

Rationale: A low protein diet is recommended for patients with

chronic kidney disease to reduce the buildup of waste products and

decrease the workload on the kidneys.

Which of the following is a key component of managing acute kidney

injury?

a) Increasing fluid intake

b) Administering nephrotoxic medications

c) Monitoring urine output and renal function

d) Allowing unrestricted dietary sodium intake

Answer: c) Monitoring urine output and renal function

Rationale: Close monitoring of urine output and renal function is

essential in managing acute kidney injury to assess kidney function

and response to treatment.

The primary goal of treatment in chronic kidney disease is to:

a) Reverse kidney damage

b) Prevent the progression of kidney disease

c) Restore normal kidney function

d) Increase sodium and potassium excretion

Answer: b) Prevent the progression of kidney disease

Rationale: The main objective in treating chronic kidney disease is

to slow or halt the progression of the disease and prevent

complications associated with advanced kidney failure.

Which of the following medications is commonly used to manage

anemia in patients with chronic kidney disease?

a) Erythropoietin-stimulating agents

b) Nonsteroidal anti-inflammatory drugs (NSAIDs)

c) Loop diuretics

d) Angiotensin-converting enzyme (ACE) inhibitors

Answer: a) Erythropoietin-stimulating agents

Rationale: Erythropoietin-stimulating agents are frequently

prescribed to stimulate red blood cell production and treat anemia

associated with chronic kidney disease.

Renal replacement therapy, such as hemodialysis or peritoneal dialysis,

is indicated in:

a) Stage 1 chronic kidney disease

b) Stage 2 chronic kidney disease

c) Stage 3 chronic kidney disease

d) End-stage renal disease (ESRD)

Answer: d) End-stage renal disease (ESRD)

Rationale: Renal replacement therapy is necessary in end-stage renal

disease when the kidneys are no longer able to function effectively

and sustain life.

Which of the following is a potential complication of hemodialysis?

a) Hypotension

b) Hypernatremia

c) Hypoglycemia

d) Hyperkalemia

Answer: a) Hypotension

Rationale: Hypotension is a common complication of hemodialysis

due to rapid fluid removal during the procedure, leading to a drop in

blood pressure.

The most common type of kidney cancer in adults is:

a) Renal cell carcinoma

b) Wilms tumor

c) Transitional cell carcinoma

d) Nephroblastoma

Answer: a) Renal cell carcinoma

Rationale: Renal cell carcinoma is the most prevalent type of kidney

cancer in adults, arising from the renal tubular epithelial cells.

Which of the following is a potential risk factor for the development of

kidney stones?

a) Hydration

b) Low sodium intake

c) Hypercalcemia

d) Alkaline urine pH

Answer: c) Hypercalcemia

Rationale: Hypercalcemia, an excess of calcium in the bloodstream,

is a risk factor for the formation of kidney stones due to the

increased presence of calcium in the urine.

1. Which of the following is a risk factor commonly associated with

acute kidney injury (AKI)?

a. Hypertension

b. Poorly controlled diabetes mellitus

c. Previous episode of AKI

d. Chronic liver disease

Answer: a. Hypertension

Rationale: Hypertension is a known risk factor for AKI, as it can lead

to impaired renal blood flow and kidney damage.

2. Which of the following is a characteristic feature of chronic kidney

disease (CKD)?

a. Gradual decline in kidney function over time

b. Sudden onset and rapid deterioration of renal function

c. Reversible impairment of kidney function

d. Absence of proteinuria

Answer: a. Gradual decline in kidney function over time

Rationale: CKD is characterized by a slow and progressive decline in

kidney function, leading to irreversible damage over time.

3. The most common cause of AKI is:

a. Glomerulonephritis

b. Urinary tract obstruction

c. Hypovolemia

d. Polycystic kidney disease

Answer: b. Urinary tract obstruction

Rationale: Urinary tract obstruction, such as by kidney stones or

enlarged prostate, is the most common cause of AKI as it hampers

the normal flow of urine.

4. Which laboratory finding is indicative of chronic kidney disease?

a. Increased glomerular filtration rate (GFR)

b. Elevated blood urea nitrogen (BUN)

c. Normal levels of serum creatinine

d. Decreased urine output

Answer: b. Elevated blood urea nitrogen (BUN)

Rationale: Elevated BUN levels are commonly found in patients with

CKD due to impaired kidney function and reduced filtration ability.

5. Which condition is commonly associated with prerenal acute kidney

injury?

a. Acute tubular necrosis

b. Nephrotic syndrome

c. Cardiogenic shock

d. Polycystic kidney disease

Answer: c. Cardiogenic shock

Rationale: Prerenal AKI occurs when there is a decrease in renal blood

flow, often caused by conditions such as cardiogenic shock or

hypovolemia.

6. Which of the following symptoms is commonly observed in both

AKI and CKD?

a. Polyuria

b. Hematuria

c. Hypertension

d. Seizures

Answer: c. Hypertension

Rationale: Hypertension is a common symptom observed in both AKI

and CKD due to impaired renal function and fluid and electrolyte

imbalances.

7. The gold standard diagnostic method for assessing kidney function

is:

a. Renal ultrasound

b. Urinalysis

c. Creatinine clearance test

d. Serum electrolyte levels

Answer: c. Creatinine clearance test

Rationale: The creatinine clearance test provides an accurate measure

of kidney function by assessing the filtration capacity of the

kidneys.

8. Which of the following is a potential complication of AKI?

a. Renal recovery and restoration of normal function

b. Chronic kidney disease progression

c. Resolution without any long-term effects

d. Improvement of glomerular filtration rate (GFR)

Answer: b. Chronic kidney disease progression

Rationale: AKI can lead to the development or progression of CKD,

especially if not managed properly or if there are underlying risk

factors.

9. A patient with end-stage renal disease (ESRD) typically requires:

a. Dialysis or kidney transplantation

b. Antibiotic therapy and diuretics

c. Increased fluid intake and bed rest

d. Nutritional supplements and blood transfusions

Answer: a. Dialysis or kidney transplantation

Rationale: ESRD refers to the advanced stage of CKD where the

kidneys have permanently lost their function, making dialysis or

kidney transplantation the primary treatment options.

10. Which of the following is a common sign of chronic kidney disease

in the early stages?

a. Polyuria

b. Hematuria

c. Edema

d. Fatigue

Answer: d. Fatigue

Rationale: Fatigue is a common symptom experienced by individuals

with early-stage CKD due to the build-up of waste products in the

body and hormonal imbalances.

11. The primary goal of treatment for AKI is to:

a. Reverse the underlying cause and restore normal renal function

b. Simply manage symptoms and maintain tissue perfusion

c. Increase fluid intake and promote diuresis

d. Administer antibiotics to prevent infection

Answer: a. Reverse the underlying cause and restore normal renal

function

Rationale: The primary treatment goal for AKI is to identify and

address the underlying cause, with the aim of restoring normal renal

function.

12. In CKD patients, dietary restrictions often include limiting:

a. Protein intake

b. Calcium intake

c. Fluid intake

d. Sodium intake

Answer: a. Protein intake

Rationale: Limiting protein intake is commonly recommended for

CKD patients to reduce the workload on the kidneys and minimize

the accumulation of waste products.

13. Which of the following is a potential cause of postrenal AKI?

a. Glomerulonephritis

b. Acute tubular necrosis

c. Bladder outlet obstruction

d. Renal artery stenosis

Answer: c. Bladder outlet obstruction

Rationale: Postrenal AKI can occur due to any obstruction in the

urinary tract, such as bladder outlet obstruction caused by an

enlarged prostate or urinary stones.

14. The primary mechanism leading to kidney injury in AKI is:

a. Tubular dysfunction

b. Glomerular damage

c. Vascular constriction

d. Nephron atrophy

Answer: a. Tubular dysfunction

Rationale: In AKI, tubular dysfunction is the primary mechanism

leading to kidney injury, often due to reduced blood flow to the

nephrons.

15. Which of the following medications is commonly used in CKD

patients to manage hypertension and protect kidney function?

a. Nonsteroidal anti-inflammatory drugs (NSAIDs)

b. Angiotensin-converting enzyme (ACE) inhibitors

c. Diuretics

d. Antibiotics

Answer: b. Angiotensin-converting enzyme (ACE) inhibitors

Rationale: ACE inhibitors are often prescribed to CKD patients as they help control

hypertension and have renoprotective effects, slowing the progression of kidney

disease.

I. TRACH CARE/SUCTIONING (1 Question) A. Indications a. Bypass an upper airway obstruction b. Facilitate removal of secretions c. Long-term mechanical ventilation d. Allow oral intake and speech for patients with long-term mechanical ventilation B. Trach Care a. Usually performed every 8 hours and as needed b. Do not change tracheostomy ties for 24 hours after tracheotomy procedure c. Always observe skin in the surrounding area C. Trach Suctioning a. Assess need for suctioning at least every 2 hours b. Do not suction routinely i. ONLY SUCTION WHEN IT IS NEEDED! c. Limit suction time to 10 seconds d. Always remember to oxygenate e. Always assess patient before and after suctioning

II. ARTERIAL BLOOD GASES (ABGs) (4 Questions) A. Acidosis/Alkalosis a. Respiratory breathing is driven by CO i. Acidosis

1. Lungs are unable to blow off CO2 (acidic)
2. Kidneys compensate by retaining more HCO3 (basic) ii. Alkalosis
3. Lungs increase respirations increases CO2 excretion (becomes less basic)
4. Kidneys compensate by increasing HCO3 excretion (becomes less acidic) b. Metabolic i. Acidosis
5. Loss of HCO3 from body fluids via the kidneys
6. Lungs compensate by increasing rate/depth of respirations get rid of more CO ii. Alkalosis
7. Kidneys retain HCO
8. Lungs compensate by retaining CO c. pH (7.35-7.45) 7.4 = ACIDOTIC 7.4 = ALKALOTIC

d. CO2 (35-45) controlled by lungs 35 = ALKALOSIS 45 = ACIDOSIS e. HCO3 (22-26) controlled by kidneys 22 = ACIDOSIS 26 = ALKALOSIS

• Determining Values- *CO = Respiratory *HCO3 = Metabolic
• Determine if pH is acidotic or alkalotic
• Whichever (CO2 or HCO3) has same imbalance as pH, pick that one
• If pH is within normal range Compensation
• If pH not within normal range Partial Compensation
• Look at ABG powerpoint for example questions (AT LEAST one question like this will probably be on the exam) III. COPD (6 Questions) A. COPD a. Preventable & treatable (not fully reversible) b. Limited airflow c. Exacerbation (showing s/s) and remission (not showing any symptoms) d. Progressive disease each exacerbation makes it progress more e. Causes and risk factors i. Smoking, pollution, genetics, age (probably have more exposure to risk factors) B. Complications a. Cor pulmonale – hypertrophy of the right side of the heart resulting from pulmonary HTN i. S/S – dyspnea, jugular vein distention , hepatomegaly, ascites, edema, weight gain ii. Treatments

1. Medications diuretics (get fluid off)
2. Labs electrolytes b. Exacerbations i. Primary causes respiratory infection
3. Need to seek treatment with ANY signs of resp. infection
4. Avoid people who are sick
5. 2 nd^ most common cause – air pollution ii. Treatments
6. Medications bronchodilator (inhaler), corticosteroids, Antibiotics for bacterial infection concern
7. Oxygen Therapy bipap or cpap (pressure keeps airway open)

3. Patient Education!!!! signs and symptoms of exacerbations, get flu shot, stay awake from sick people, stay away from pollutants STOP SMOKING , seek medical attention early c. Acute Respiratory Failure i. Treatments
4. Medications (supportive care) bronchodilators, corticosteroids
5. Pain Management many pain meds slow respirations,
6. Patient Education if you wait too long to report exacerbation, it can lead to this a. make sure pt. is taking meds; noncompliance can lead to ARF d. PUD (peptic ulcer disease) and GERD i. Using more accessory muscles to breathe, increases pressure in stomach e. Depression/Anxiety i. 4x more likely to develop than those without a chronic breathing problem ii. Wear out faster, have to be conscious of breathing, may prevent people from activities they used to participate in C. Goals of Care a. **Improve quality of life and reduce mortality risk b. Prevent disease progression c. Relieve symptoms and improve exercise (activity) intolerance d. Prevent and treat complications e. Promote patient participation in care f. Prevent and treat exacerbation D. Interventions (you cannot get rid of it) a. Prevention b. Treatments c. Drug Therapy d. Oxygen Therapy i. Don’t give too much O2 to someone with COPD
7. In normal person, high CO2 prompts us to breathe
8. In person with chronic lung disease, low O2 prompts breath
9. IF THEY ARE GETTING O2 THEY ARE NOT PROMPTED TO BREATHE ii. LTOT – (long-term oxygen therapy) IMPROVES PROGNOSIS AND QUALITY OF LIFE a. (Prognosis = future outlook) iii. Given to people with low, but stable o2 stats (only within reasonable range > ~85% iv. Can help with anxiety of someone struggling to breathe e. Respiratory Therapy

i. Pursed-lip breathing make sure exhalation is 3x longer than inhalation, breathe in through nose, purse lips and blow out ii. Purpose: Prevents air trapping, airway collapse iii. Effective coughing f. Nutritional Therapy i. Using calories all the time because they have to work hard to breathe (burns calories) ii. Tell them to rest 30 min. before eating (will take a lot of out them) iii. Take bronchodilator before eating iv. Should eat 5 - 6 small meals/day with snacks in between (especially bedtime) (high protein snack) v. High calorie, high protein meals vi. Avoid: carbohydrates break down into CO2 (not good) vii. Fluid intake drink between meals rather than with meals

1. 3 Liters a day g. Activity i. Physical therapy prevent loss of muscles (atrophy) ii. Energy saving need to take several breaks in some activities, may need to sit to do things iii. Walking and breathing exercises
2. Breathe in nose, take step breathe out, a few more steps IV. ACUTE RESPIRATORY DISTRESS (ARDS) (4 Questions) A. ARDS a. Sudden and progressive form of acute respiratory failure b. Mortality rate = 50% i. 75% with ARDS & Sepsis c. Three Phases i. Injury Phase ii. Reparative or Proliferative Phase iii. C. Fibrotic (chronic or late) Phase d. Risk Factors i. Sepsis ii. Pneumonia iii. Aspiration of Gastric Contents B. Signs and Symptoms a. Insidious slow progression b. Chest auscultation c. Respiratory discomfort C. Diagnostic Studies a. ABGs b. Chest x-ray shows fibrotic tissue

D. Complications a. Nosocomial pneumonia most commonly Ventilator Associated Pneumonia i. Catheter associated UTIs as well b. Barrel trauma – baroreceptors become damaged from pressure from vent c. Stress Ulcers d. Renal Failure – tissue perfusion/oxygenation is very low E. Nursing Interventions a. Collaboration bed that moves prevents pooling, breaks things up b. Positioning Prone position keeps fluid moving better c. Maintenance of Cardiac Output and Tissue Perfusion d. Oxygen Therapy e. Drug Therapy diuretics to move fluid out f. Nutrition high protein, TPN g. Fluid Balance mild fluid restriction (don’t want to add to fluid) F. 5 P’s a. P erfusion (don’t have well-oxygenated blood) b. P ositioning (prone, moving) c. P rotective Lung Ventilation (must keep lungs working, airways open) d. P rotocol Weaning (off vent as soon as possible) e. P reventing Complications V. PNEUMONIA (4 Questions) A. Risk Factor a. Air pollution, smoking, immobile, URI, aspiration b. Organism portal of entry i. Aspiration ii. Inhalation iii. Hematogenous spread B. Community-Acquired Pneumonia a. Onset in community / first 2 days of hospitalization b. Risk factor smoking (biggest) c. Therapy Antibiotics (macrolides) early treatment = better chance of survival, culture someone before antibiotics (will affect results) C. Aspiration Pneumonia a. Secretions or substances enter the lower airway (usually from the mouth or stomach into the trachea and then the lungs) b. Risk factors i. Low HOB, sedated c. Most common aspirated materials i. Food, water, vomit d. Lie on side to avoid aspiration e. Forms

i. Mechanical – food or water ii. Chemical - toxin D. Signs and Symptoms a. Sudden onset (MOST COMMON) – chills, fever, cough, SOB, chest pain b. Atypical – gradual onset, GI symptoms (diarrhea, N/V) c. Elderly – confusion (hypoxic) don’t think they are confused because they are old, think that something is wrong/causing this E. Prevention a. Identify at-risk population should be vaccinated i. Elderly ii. Extended care facilities iii. Health Care workers iv. COPD pts. b. Vaccination– key means of prevention i. Flu shot every year ii. Pneumococcal every 5 year F. Complications a. Pleurisy (inflammation of pleura) b. Pleural effusion (transudate fluid in pleural space) c. Atelectasis (collapsed alveoli) d. Bacteremia (bacterial infection in blood) e. Lung abscess f. Empyema (purulent exudate in pleural cavity) g. Pericarditis h. Meningitis i. Endocarditis G. Treatment a. Medication – Antibiotics (Macrolides), Analgesics for pain, antipyretics for fever b. Nutritional – stay well hydrated, small frequent meals (with dyspnea) c. Oxygen – administer o2 with hypoxemia d. *Discharge Teaching i. Requires adequate rest ii. Deep-breathing exercises, incentive spirometry VI. TUBERCULOSIS (3 Questions) A. Infectious disease – usually involves lungs B. S/S – asymptomatic at beginning, fatigue, weight loss, night sweats, low grade fever, airborne isolation C. Complication a. Hepatitis (comes with treatment of isoniazid)

D. Treatment a. Medication - isoniazid (INH) b. 6 - 24 months c. Cannot drink alcohol damaging to liver VII. INFLUENZA (2 Questions) A. Onset – abrupt, headache, fever, n/v, cough, sore throat, achy B. Most common complication – pneumonia C. Prevention – flu shot D. Treatment – viral (antivirals) < 24 hrs onset of symptoms, decreases severity, shortens duration no Antibiotics (cannot treat viral infection with antibiotics) VIII. PULMONARY EMBOLISM pg. 529- 531 (3 Questions) A. Signs and Symptoms a. Dyspnea, hypoxemia, symptoms vary greatly B. Complications a. Pulmonary Infarction – death of lung tissue b. Pulmonary Hypertension (explained below) C. Treatment a. O2 therapy, monitor aPTT and INR, Anticoagulants IX. PULMONARY HYPERTENSION pg. 531- 534 (1 Question) A. Signs and Symptoms a. Dyspnea, fatigue, exertional chest pain, dizziness, syncope B. Treatment a. Calcium channel blockers BP b. Vasodilators BP C. Complications a. Cor Pulmonale i. Enlargement of right ventricle (hypertrophy) ii. Has to work harder (greater resistance) so it gets bigger X. BRONCHITIS (1 Question)

• AECB (Acute Exacerbation of Chronic Bronchitis) o May lead to respiratory failure o Treatment: Antibiotics early if due to COPD exacerbation
• Chronic Bronchitis = form of COPD

XI. DX TESTING (BRONCHOSCOPY & THORACENTISIS) (4 Questions)

• Diagnose adult respiratory disorders A. Bronchoscopy a. Purpose i. Obtain biopsy specimens, assess changes, treatments, or can administer meds b. Nursing Care i. Conscious sedation ii. 6 - 12 hours NPO prior

1. Stay NPO until gag reflex returns iii. Requires informed consent iv. Assess throat for laryngeal edema
2. Could cut off airway B. Thoracentesis a. Insert large-bore needle into pleural space to obtain specimens, remove pleural fluid, or instill medication b. Nursing care i. Good respiratory assessment before the procedure so you have a good baseline 1. Assess: vitals, o2, sounds, color, behavior 2. Reassess afterwards ii. Informed consent iii. No NPO, no sedation iv. Sit on side of bed, feet on floor, pillow on table, need to be still, no talking/coughing v. Encourage deep breathing vi. Provide emotional support vii. Assess for pneumothorax hypoxia viii. Following Thoracentesis better breath sounds, ^ o2, pt. feels better