NUR 8022 EXAM 3 LATEST ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES, Exams of Nursing

Download NUR 8022 EXAM 3 LATEST ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES and more Exams Nursing in PDF only on Docsity! NUR 8022 EXAM 3 LATEST ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) | ALREADY GRADED A+ 2024-2025 What hormone regulates sodium? where is it synthesized? Correct Answer Aldosterone. Synthesized in the adrenal cortex. When is aldosterone secreted? Correct Answer Decreased renal perfusion, low NA levels, high K levels. What are the effects of aldosterone secretion? Correct Answer Acts on the distule tubule of the kidney to reabsorb sodium and water and excrete K and H+ into urine. Describe the renin-angiotensin-aldosterone system Correct Answer decreased blood pressure causes the juxtaglomerular cells of kidney to secrete renin renin stimulates angiotensin I angiotensin I converted to angiotensin II by ACE in pulmonary vessels angiotensin II: - stimulates aldosterone secretion - causes vasoconstriction leads to reabsorption of Na/H20, rise of systemic BP restoring renal perfusion... all negative feedback that inhibits further release of renin What produces ANP? Urodilantin? Correct Answer myocardial atria urodilantin is similar to ANP and is secreted by kidney cells in response to increased renal blood flow. Where is BNP produced? Correct Answer ventricles ANP and BNP are antagonist to what Correct Answer RASS and stop secretion of aldosterone, renin, and AD and the action of angiotensin II Thirst perception is regulated by; Correct Answer 1. Osmolality receptors (cause thirst ex: dry mouth, plasma volume depletion) 2. Baroreceptors (stimulated by depleted plasma volume to cause release of ADH) What does ADH (arginine vasopressin) do? When is is released? Correct Answer - increases H20 absorption by increasing permeability of renal tubules in collecting ducts of kidneys - released with increased plasma osmolality, decreased circulating blood vol., decreased BP Water excess (hypotonic alteration) Correct Answer cause; too much water, decreased urine, SIADH signs; cerebral edema, muscle twitching, headache, weight gain Potassium normal values Correct Answer ECF cation 3.5- 5 Potassium what moves it INTO cell Correct Answer - aldosteron - insulin -epinephrine -alkalosis OUT? also strenuous excercise Causes of hypokalemia Correct Answer - increased K into cell - increased K loss - hyperaldosterone - respiratory alkalosis Manifestations of hypokalemia Correct Answer Membrane hyperpolarization causes a decrease in neuromuscular excitability, skeletal muscle weakness, smooth muscle atony, and cardiac dysrhythmias Cause of hyperkalemia Correct Answer - shift K ICF to ECF - decreased excretion - low aldosterone - hypoxia - acidosis - insulin low - cell trauma Manifestation of hyperkalemia Correct Answer Mild; lip/finger tingling, restless, cramping, diarrhea, peaked T waves, more excitable cell Severe; muscle weakness, loss muscle tone, flaccid, paralysis, cardiac arrest. near threshold membrane unexcitable leads to cardiac standstill Where is most of calcium and phosphate? Correct Answer Ca 99% in bone phosphate 85% Serum Ca normal? Correct Answer 8.6-10.5 What 3 hormones regulate calcium and phosphate? Correct Answer 1. PTH - increases plasma calcium levels via kidney reabsorption. Secreted in response to low serum Ca. 2. Vitamin D - fat soluble steroid that increases Ca absorption in GI 3. Calcitonin - decreases Ca Cause and symptoms of hypocalcemia Correct Answer cause; inadequate absorption, decreased PTH and vit. D, blood transfusion signs; increased neurmuscular excitability, muscle spasms, chvostek and troussea sign, convulsions, tetany Causes and manifestations of hypercalcemia Correct Answer cause; high PTH, bone mets, high Vit D., immobilization, acidosis signs; muscle weakness, kidney stones, constipation, heart block Causes and signs of hypophosphatemia Correct Answer causes; intestinal malabsorption, renal excretion low, vit d deficiency, antacid use, etoh signs; diminished release of o2, osteomalacia, muscle weakness, bleeding disorders, leukocyte alteration Causes and signs of hyperphosphatemia Correct Answer cause; addition of phosphate to ECF, long use of enemas/laxatives, renal failure often relation to low Ca levels signs; same as low Ca with possible calcification of soft tissue Respiratory muscle paralysis Disorders of chest wall Disorders of the lung parenchyma Manifestations of respiratory acidosis Correct Answer Headache, restlessness, blurred vision, apprehension, lethargy, muscle twitching, tremors, convulsions, coma Causes of respiratory alkalosis Correct Answer High altitudes Hypermetabolic states, such as fever, anemia, and thyrotoxicosis Early salicylate intoxication Anxiety or panic disorder Improper use of mechanical ventilators Manifestations of respiratory alkalosis Correct Answer Dizziness, confusion, tingling of extremities (paresthesias), convulsions, and coma with signs of hypocalcemia What is the functional unit of the kidney? Correct Answer Nephron What is the glomerulus? Correct Answer tuft of capillaries in the renal corpuscle What is the Bowman glomerular capsule? Correct Answer Bowman space, circular space between visceral and parietal epithelium in the renal corpuscle What are mesangial cells? Correct Answer -secrete mesangial matrix and lie between and support the glomerular capillaries. - contract similar to smooth muscle cells to regulate glomerular capillary blood flow. - phagocytic properties - release inflammatory cytokines/growth factors. In the renal corpuscle What does the glomerular endothelium do? Correct Answer - inner layer of filtration - synthesize nitric oxide (vasodilator) - synthesize endothelin- 1 (vasoconstrictor - has many small openings/fenestrae What does the visceral epithelium of the bowman capsule do? Correct Answer - outer layer of glomerulus in filtration - composed of podocytes (footlike, form filtration slits to modulate filtration) What supplies the glomerulus? What drains it? Correct Answer - Afferent arteriole - efferent arteriole What do juxtaglomerular cells do? Correct Answer release renin and have the ability to constrict the glomerular capillaries in afferent arteriole respond to decreased BP What do macula densa cells do? Correct Answer Regulates Na+ and Cl- in filtrate in afferent/efferent decreases resistance to blood flow, increases renin release What is the primary function of the juxtaglomerular apparatus? Correct Answer Regulates control of renal blood flow, glomerular filtration, and renin secretion The nephron contains the renal tubules, what are the 4 diff. types Correct Answer 1. Proximal 2. Loop of Henle 3. Distal tubule 4. Collecting duct What is the function of the proximal tubule? Correct Answer lined with microvilli to increase surface area and enhance reabsorption What is the function of the loop of Henle? Correct Answer transports solutes/water and contributes to hypertonic state of renal medulla. What is the function of the distal tubule? Correct Answer adjusts acid/base balance by excreting acid into the urine and forming new bicarbonate ions When Na filtration increases, GFR decreases. The macula densa cells stimulate afferent arteriolar vasoconstriction. What factors do neural regulation play in GFR? Correct Answer Sympathetic - vasoconstriction lowers GFR. Size of arterioles regulated Baroreceptors - vasoconstrict afferent arterioles by activating a1 adrenoreceptors Body position changes - activate renal sympathetic neurons, causing mild vasoconstriction Hypoxia - stimulate chemoreceptors. Decreases renal blood flow by sympathetic stimulation. What happens to the percentage of body water through the lifespan? Correct Answer Newborns; 75-90% Childhood; 60-65% Adults; 60% Older adults; declines with age Why do older adults experience a decrease in body percentage of water? Correct Answer - increased adipose tissue - decreased muscle mass - renal decline - diminished thirst What is the definition of osmotic force? Correct Answer Amt. of hydrostatic pressure required to oppose the osmotic movement of water. What is filtration? Correct Answer movement of fluid from the capillary into the interstitial space What is reabsorption? Correct Answer movement of fluid from interstitial space into the capillary What is capillary hydrostatic pressure? Correct Answer (blood pressure) facilitates the outward movement of water from the capillary to the interstitial space What is capillary oncotic pressure? Correct Answer Water pulling attracts water from the interstitial space back into the capillary osmotically What is interstitial hydrostatic pressure? Correct Answer Water pushing. facilitates the inward movement of water from the interstitial space into the capillary What is interstitial oncotic pressure? Correct Answer water pulling attracts water from the capillary into the interstitial space osmotically. What is Starlings hypothesis? Correct Answer Net filtration = forces favoring filtration - forces opposing filtration What forces favor filtration? Correct Answer 1. Capillary hydrostatic pressure (blood pressure) 2. interstitial oncotic pressure (water pulling) What forces oppose filtration? Correct Answer 1. Plasma (capillary) oncotic pressure (water pulling) 2. Interstitial hydrostatic pressure What is the major force of filtration and reabosoprtion? Correct Answer capillary pressures What happens at the arteriole end of the capillary in terms of fluid forces? Correct Answer hydrostatic pressure > interstitial oncotic pressure = water into the insterstitial space FILTRATION What happens at the venous end of a capillary in terms of fluid forces? Correct Answer capillary oncotic pressure > interstitial hydrostatic pressure = fluid back into ciruclation REABSORPTION What is the pathophysiology of edema? Correct Answer increased in forces favoring fluid filtration from the capillaries or lymphatic channels into the tissues What is different about pediatric renal function? Correct Answer Less ability to remove H20/solutes/concentration Narrower margin for balancing What changes in the elderly in relation to renal function? Correct Answer Decreased RBF/GFR Less nephrons delayed responses to acid/base changes Complications of upper urinary tract obstruction Correct Answer - hydroureter - dilation of ureters - hydronephrosis - dilation of renal pelvis - ureterohydronephrosis - dilation of ureters/renal pelvis/calyces - tubulointerstitial fibrosis - deposit of excessive amts of extracellular matrix leads to destruction/death of nephrons What can happen after the relief of upper obstruction? Correct Answer post- obstructive diuresis may cause fluid/electrolyte imbalances. Risk factors for developing kidney stones Correct Answer - male - develop before 50 - inadequate fluid intake - geographic location What is the composition of kidney stones? Most common? Correct Answer Calcium oxalate/calcium phosphate (most common) Struvite (Mg, Ammonium, phosphate) Uric Acid (gout) What is a staghorn calculus? Correct Answer A large stone that fills major/minor calcyces Describe the pathophysiology of kidney stone formation Correct Answer - supersaturation of salt. Too high for volume to dissolve - precipitation of salt from liquid to solid state (influenced by temp/pH, more pH) - Growth of stone via crystallization/aggregation (nidus to large stone) - embedding in matrix What factors inhibit or promote kidney stone formation? Correct Answer increased; alkaline urinary pH (calcium phosphate stones), acidic urine (uric acid stones) Prevention; potassium citrate, pyrophosphate, Mg. What causes lower urinary tract obstructions? Correct Answer - Neurogenic bladder - Overactive bladder syndrome - Anatomic obstructions (prostate, strictures, organ prolapse) What is dysnergia? Correct Answer UPPER motor neuron; Overactive or hyperreflexive bladder function causes loss of coordinated neuromuscular contraction. Ex: spinal cord injury (c2-t12), tranverse myelitis, MS, Guillian barre, disk probs. What is Detrusor hyperreflexia? Correct Answer UPPER motor neuron; also known as uninhibited/reflex bladder. Lesion is above the pontine micturition center (C2) Ex: strokes, TBI, MS, hyrodocephalus, CP, Alzeihmers, brain tumors What is detrusor areflexia? Correct Answer LOWER motor neuron; underactive, hypotonic, atonic bladder. Lesion involves the sacral micturition center (below S1) Ex: myelodysplasia, peripheral neuropathy, MS, spinal cord injury (T12-S), cauda equina, herpes simplex/zoster What are some clinical manifestations of lower urinary tract obstructions? Correct Answer - frequent voiding - nocturia - dysuria - urgency with hesistancy - poor stream -feelings of incomplete emptying What does a Lewis blood group pre-dispose you too? Correct Answer UTIs Most common pathogens of UTI? Correct Answer E. coli and Staphylococcus saprophyticus What is *Insterstitial Cystitis*? Correct Answer nonbacterial infectious cystitis thought to be result of autoimmune reaction responsible for inflammatory response (mast cell activation, altered epithelial permeability, increased sensory nerve sensitivity) Manifestations of interstitial cystitis Correct Answer Most common in women 20 to 30 years old Bladder fullness, frequency, small urine volume, chronic pelvic pain, negative cultures Where does acute pyelonephritis usually effect? Correct Answer Tubulues (not usually glomeruli) Most common bacteria for pyelo? Correct Answer E.Coli, proteus, pseudomonas Symptoms of acute pyelonephritis? Correct Answer Acute onset of fever, chills, flank/groin pain Complications of chronic pyelonephritis? Correct Answer Scarring increases risk of obstructive patholgic condition. Manifestations of chronic pyelo Correct Answer Early - mild HTN, frequency, dysuria, flank pain Late with loss of tubular function - inability to conserve Na, high K, metabolic acidosis... then renal failure What is the pathophysiology of glomerulonephritis? Correct Answer - immune complex deposit in glomerulus - antibodies produced cross react with glomerular endothelial cells - activation of complememt - immune cells/mediators recruited - Decreased GFR (inflammation, scarring, thickening of basement membrane, increased permeability to protein/RBCs) Manifestations of glomerulonephritis Correct Answer - hematuria/smoky brown tinged urine - proteinuria >3-5g/day - low serum albumi - edema - oliguria < 30ml/hr Nephrotic vs Nephritic Correct Answer O - massive amounts of protein/lipids. little to no blood. I - blood in urine, white cell casts, varying degrees of protein. What is nephrotic syndrome? Correct Answer Excretion of 3.0 g or more protein in urine from glomerular injury. slide 37* symptoms of nephrotic syndrome Correct Answer - foamy urine - low albumin - peripheral edema - prone to infection - Vit D deficiency - hyperlipidemia - hypothyroidism What is nephritic syndrome? Correct Answer proteinuria/hematuria caused by increased permeability of glomerular filtration membrane. Inflammation due to systemic immune complex disease (lupus) or infection leads to bleeding into urine and renal vascular changes that produce HTN. What happens in chronic glomerulonephritis? Correct Answer chronic kidney failure results from glomerular disease. reduction in mass of nephrons -> compensatory hypertrophy/hyperfiltraton. -> intraglomerular HTN to increase GFR in remaining nephrons ->sclerosis/more nephrons lost Differences btw. uremia and azotemia Correct Answer U: renal failure, high blood urea, high crt, fatigue, anorexia, N/V, prurities, neurologic changes, retention of toxic waste... manifestations of severe azotemia.