Nursing Exam Questions on Chronic Kidney Disease and Acute Kidney Injury, Exams of Nursing

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NURS 223 Exam 1 Questions With Complete Solutions protein Patients with chronic kidney disease (CKD) who are on hemodialysis (HD) or peritoneal dialysis (PD) are known to lose ____ during these treatments. As a result, they are special diets. Sevelamer (Renagel) The nurse's patient has has chronic kidney disease (CKD) with elevated PHOSPHORUS levels according to the latest labs. Elevated phosphorus can lead to BONE RESORPTION and HYPERCALCEMIA. The nurse anticipates an order for _____, a PHOSPHATE BINDER to control the phosphorus levels and return them to WNL. muscles Urea and creatinine are excreted by the kidneys. Creatinine is a metabolic by product that is produced by the ____. 0.6-1. When serum creatinine is high the GFR (glomerular filtration rate) is low. The WNL range for SERUM creatinine is ___ (#.#- #.#) mg/dL. 7-

When the BUN (Blood Urea Nitrogen) level rises, the GFR (Glomerular Filtration Rate) is low. The WNL range for BUN is ____ (#-#) mg/dL. 3.5-5. The WNL range for potassium (K+) is ____ (#.#-#-#) mEq/L. 135- The WNL range for sodium (Na+) is ____ (#-#) mEq/L. creatinine A proxy (another way) for determining the glomerular filtration rate (GFR) is known as ____ clearance. A 24-hour urine specimen is collected to determine this. This is the most important lab value to understand kidney function. urine The glomerulus is the first part of the nephron where the blood gets filtered. Blood enters through the afferent arteriole to the proximal tubule and begins the process of ____ formation. The proximal and distal tubules are semi-selective membranes. Blood and proteins are reabsorbed into the circulation. kidneys Urine formation excretion of waste products electrolyte, water and acid-base balance renal clearance regulation of RBC prod'n via ERYTHROPOIETIN synthesis of active form of vitamin

D secretion of prostaglandins * All of these are key functions of the ____. hypertension The nurse knows that diabetes and ____ are major risk factors for chronic kidney disease (CKD) and end-stage renal disease (ESRD). reabsorption Urine is formed in the nephrons through a complex three-step process: glomerular filtration, tubular ____, and tubular secretion. Approximately 180L/day of filtrate results in 1-2 L of urine. secretion Tubular ___ occurs when substances move from the peritubular capillary (blood) into the tubular lumen (filtrate). It helps with the elimination of K+, H+, ammonia, uric acid, some drugs and other waste products. 125 The WNL GFR is ___ (#) mL/min. This is measured by (urine) creatinine clearance. decreases As renal function worsens, the level of creatinine clearance [ decreases / increases ].

older adult

• Decreased kidney size
• 50% fewer nephrons
• 50% decrease in renal blood flow
• kidney tubules less able to concentrate urine
• risk for dehydration due to decreased perception of thirst. These are all factors which affect the kidneys in the ____ (two words) population. toxicity Due to many factors that result in decreased GFR in older adults, the nurse knows that older adults are more susceptible to drug ____. lengthen The nurse knows to [ lengthen / shorten ] intervals between doses and use the "start low and go slow" method with elderly patients to avoid drug toxicity. NSAIDs (non-steroidal anti-inflammatory drugs) The nurse knows to monitor ELDERLY PATIENTS who may be taking aminoglycoside antibiotics like GENTAMICIN, TETRACYCLINE, CEPHALOSPORIN and ____ (acronym only) for acute kidney injury (AKI). anemia

The kidneys release a hormone known as ERYTHROPOIETIN that stimulates the production of red blood cells (RBCs) by the bone marrow. This is an important underlying cause of ____ in patients with AKI. nephrons The glomerulus, Bowman's capsule, and proximal and distal tubules comprise the functional units of the kidneys known as the ____. directly The GFR is [ directly / indirectly ] related to adequate blood flow (blood volume) to the kidneys. Kidneys receive 1300 mL/min of blood or 25% of cardiac output. ADH (antidiuretic hormone) During urine formation, 1) glomerular filtration occurs from the blood into the nephron; 2) reabsorption occurs from the filtrate into blood; 3) tubular secretion from the peritubular capillaries into the filtrate; and reabsorption of water under the effects of ____ (acronym only). Angiotensin II Dopamine, prostaglandins and nitric oxide are to vasodilation as ____ (two words) is to vasoconstriction. afferent

NSAIDs like IBUPROFEN result in decreased GFR through VASOCONSTRICTION of the [ afferent / efferent ] arteriole. vasodilation ACE Inhibitors like CAPTOPRIL (capoten) and ARBs like LOSARTAN (Cozaar) lead to decreased GFR resulting from [ vasoconstriction / vasodilation ] of the EFFERENT arteriole. azotemia The abnormal concentration of nitrogenous wastes like urea in the blood is known as ____. one-half By age 90, the GFR is [ one-third / one-half / three-fourths ] of what it was at the age of 30. osmolality Anti-diuretic hormone (ADH), also known as Vasopressin, is a hormone that is secreted by the posterior portion of the pituitary gland in response to changes in ____ of the blood. sodium The regulation of ____ volume that the kidneys excrete depends on a hormone synthesized and released by the adrenal cortex called aldosterone. RAAS (renin-angiotensin-aldosterone system)

This system is activated when pressure in the renal arterioles falls below normal levels, as occurs with shock, dehydration or decreased NaCl delivery to the tubules. Activation increases retention of water and expansion of intravascular fluid volume thereby maintaining blood pressure. It is the ____ (acronym only). aldosterone Angiotensin II is the most powerful vasoconstrictor known and causes blood pressure to increase. The adrenal cortex secretes ____ in response to stimulation by the pituitary gland (ADH), which occurs in response to poor perfusion or increasing serum osmolality. contrast dye During IV urography and retrograde pyelography ____ (two words) is injected IV or with a catheter via cystoscopy to visualize the kidneys, ureters or bladder via x-ray imaging. UTI A condition involving pathogenic microorganisms in the urinary tract. It is classified as involving the upper or lower urinary tract and as complicated (recurrent, hospital or catheter-acquired) or uncomplicated. This is a ____ (acronym only). Most occur in women, second most common infection in the body, and most common nosocomial infection. Often treated with anti- inflammatory CYCLOSPORINE (Sandimmune).

pyelonephritis Upper UTIs are much less common and include acute or chronic ____. This is a bacterial infection of the renal pelvis (INTRARENAL), tubules, and interstitial tissue that results in inflammation of one or both kidneys. When chronic, the kidneys become scarred, contracted, and nonfunctioning. It is an intra- renal kidney disorder. urinary frequency Symptoms of a lower UTI include burning on urination, ____ (two words), defined as voiding more than every 3 hours, urgency, nocturia, incontinence and suprapubic pain. urinary stasis Older women often have incomplete emptying of the bladder and ____ (two words). In the absence of estrogen, postmenopausal women are susceptible to colonization and increased adherence of bacteria to the vagina and urethra. 3 The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs because most cases are cured after ___ (#) days of treatment. The nurse knows to instruct the patient to TAKE ALL DOSES, and complete the course of therapy. sepsis

Patients with UTIs are at risk for acute bacterial ____. The risk is 15% for patients with a urinary catheter. Sepsis is the MOST COMMON CAUSE of ARDS. CVA tenderness The symptoms of PYELONEPHRITIS include chills, fever, malaise, vomiting, flank pain, urinary frequency and pain in the low back known as ____ (two words). A two-week course of antibiotics is recommended for this INTRARENAL problem. hydronephrosis When the ureter is obstructed by a kidney stone, distention of the renal pelvis/calyces occurs leading to POST-RENAL complications. The kidneys keep producing urine and it backs- up into the kidney resulting in unrelieved pressure called ____. cloudy Urine that is ____ in appearance is an indication of INFECTION. ureteral colic Kidney stones that are lodged in the URETER cause acute, excruciating, colicky, wavelike pain that radiates down the thigh and to the genitalia known as _____ (two words). There's desire to void but little urine with hematuria. renal colic

Intense, deep pain in the costovertebral region that radiates anteriorly and downward toward the umbilicus with nausea and vomiting is ____ (two words). This can occur when a kidney stone becomes lodged in the RENAL PELVIS. Ketorolac (Toradol) Effective drugs in treating kidney stone pain because they provide specific pain relief are NSAIDs like Ibuprofen. Also IV _____. oxalate Spinach, strawberries, rhubarb, chocolate, tea, peanuts and wheat bran contain high levels of ____ and increase some people's risk of this type of kidney stone. low-purine Shellfish, anchovies, asparagus, mushrooms, and organ meats should be avoided when a patient is on a ____ (two-words) diet to reduce the excretion of URIC ACID in the urine. ALLOPURINOL (Zyloprim), also prescribed for GOUT may be prescribed to reduce serum uric acid levels and promote urinary uric acid excretion. ESWL (extracorporeal shock wave lithotripsy) A non-invasive procedure used to break up kidney stones in the calyx of the kidney is ____ (acronym only). hematuria

The most common symptom of BLADDER CANCER is visible, painless ____. Infection of the urinary tract is a common complication, with frequency and urgency. diabetes The primary cause of chronic kidney disease (CKD) is ____. The second leading cause is HYPERTENSION. The nurse knows that control and management of these conditions helps to slow disease progression. CKD (chronic kidney disease) Anemia due to decreased ERYTHROPOIETIN production by the kidney, METABOLIC ACIDOSIS, and abnormalities in CALCIUM and PHOSPHORUS herald the development of ____ (acronym only). 24 CREATININE CLEARANCE is a measure of the amount of creatinine the kidneys are able to clear in a ___ (#) hour period. 125mL/min is WNL. 130/ Regular clinical and laboratory assessment is important for patients with CKD to keep the blood pressure below ____ (#/#) mmHg. Treating hyperglycemia, managing anemia, smoking cessation, and reduction in salt and alcohol intake are other forms of medical management.

Nephritic syndrome ANTIGEN-ANTIBODY COMPLEXES form in the blood and become trapped in the glomerular capillaries (the filtering portion of the kidney) inducing an inflammatory response. ____ (two words) occurs 7-12 days post STREPTOCOCCAL (throat) infection. There's a loss of normal kidney filtration function. nephritic Cola or cocoa colored urine is a sign of ____ syndrome. inflammation NEPHROTIC SYNDROME results from derangement of cells in the glomerular basement membrane which leads to increased permeability to plasma proteins. The glomerular basement membrane thickens but there is no ____. Leads to massive proteinuria. Sclerosis or scarring of the glomeruli from drug use is a frequent underlying cause. nephrotic syndrome Hyperlipidemia (high cholesterol), hypoalbuminemia, dependent edema then generalized and periorbital edema with massive proteinuria are signs and symptoms of ____ (two words). DVTs and PEs are common. albumin In nephrotic syndrome, which is characterized By massive proteinuria, the LIVER is capable of increasing the production

of ____, but it cannot keep up with the daily loss of this protein through the kidneys. edema The major manifestation of NEPHROTIC SYNDROME is _____. It is usually soft and pitting and commonly occurs around the eyes (periorbital), in dependent areas (sacrum, ankles and hands) and in the abdomen (ascites). loop diuretic Managing EDEMA is a nurse's priority with a patient who has nephrotic syndrome. For this reason, the nurse expects to see an order for FUROSEMIDE (Lasix), a type of ____ (two words). proteinuria The hallmark diagnosis of nephrotic syndrome is ____ that exceeds 3.5 g/day. PKD (polycystic kidney disease) A genetic disorder characterized by the growth of numerous FLUID-FILLED CYSTS in the kidneys which destroy the nephrons is known as ____ (acronym only). Palpation of the abdomen with often reveal enlarged kidneys but ultrasound is preferred method of diagnosis. It has no cure and can lead to kidney failure. cure

Polycystic kidney disease (PKD) has no _____. Treatment is largely supportive and includes blood pressure control <130/ mmHg, pain control, and antibiotic agents to resolve infections. metastasizes TOBACCO use is a significant risk factor for RENAL CANCER. Renal cancer is relatively rare but it ____ early-- often to the lungs, bone, liver, brain and the other kidney. Unexplained weight loss, increasing weakness, and anemia may be the first signs of this. nephrectomy Medical treatment of a RENAL TUMOR is a radical ____ with chemotherapy for lingering cells. deep breathe The nurse asks a patient who is in recovery from a radical NEPHRECTOMY to turn, cough and ____ (two words) to prevent atelectasis. The nurse demonstrates use of the IS and splinting, and encourages ambulation. operative The nurse monitors I's and O's for a patient who is in recovery from a radical NEPHRECTOMY, including drains. The nurse encourages the patient to lie on the ___ side while in bed to PROMOTE DRAINAGE. Wilms tumor

The most common renal and intra-abdominal cancer (tumors) in childhood is _____ (two words). Surgery occurs within 24- hours of confirmation. contact sports Patients who have undergone a radical nephrectomy d/t renal cancer are ask to avoid playing ____ (two words) to protect the remaining kidney. Prerenal HYPOPERFUSION of the kidney d/t volume depletion (e.g. hemorrhage, dehydration or burns), HYPOTENSION (sepsis or shock) and renal artery stenosis, are categorized as ____ causes of AKI. This type is the MOST COMMON. intrarenal Actual parenchymal damage to the kidney by NEPHROTOXIC DRUGS or intrinsic damage such as acute GLOMERULONEPHRITIS (GN) and ACUTE TUBULAR NECROSIS (ATN) are categorized as ____ causes of AKI. postrenal Obstruction of the urine outflow from the kidney (e.g. prostatic enlargement, clot, tumor, stone) results in HYDRONEPHROSIS and is categorized as a ____ cause of AKI. Tend to be TREATABLE. recovery

The 4 phases of acute kidney injury (AKI) are INITIATION, OLIGURIA (<500 mL/day, within 7 days of injury), DIURESIS (watch for hypovolemia/hydration) and ____ (3-12 months). pediatric WNL urine output is 1mL/kg/hr and OLIGURIA is 0.5mL/kg/hr for ____ patients. hyperkalemia In the OLIGURIA phase of AKI, the kidney starts to produce less and less urine (<400mL/day). It occurs within 1-7 days of the injury or insult. Serum concentration of creatinine, urea and organic acids increase. K+ and phosphorus increase and calcium decreases. This is the phase in which life threatening CARDIAC SYMPTOMS can appear due to ____. oliguria In this phase of AKI, the kidney starts to produce less and LESS URINE (<500mL/day). It occurs within 1-7 days of the injury or insult. Serum concentration of creatinine, urea and organic acids increase. K+ and phosphorus increase and calcium decreases. This is the phase in which life threatening symptoms like HYPERKALEMIA appear. This is the ____ phase of AKI. diuresis In this phase of AKI, URINARY OUTPUT INCREASES gradually and GFR starts to climb back up. Lab values stabilize

and then start to decrease. The nurse knows in the ____ phase of AKI to watch for HYPOVOLEMIA and DEHYDRATION. Keep the patient hydrated. nonoliguric A patient has decreased renal function with increasing NITROGEN retention but actually excretes normal amounts of urine (greater than 800 mL/day). This type of kidney injury occurs predominantly after exposure of the patient to NEPHROTOXIC AGENTS like aminoglycoside antibiotics like GENTAMICIN (i.e. any substance, medication or action that destroys kidney tissue), burns, traumatic injury and halogenated anesthetic agents. This is the ____ form of kidney injury. 50 A widely accepted criterion for AKI is a ___ (#) % or greater increase in serum creatinine above baseline. nephropathy The most common cause for people having to go on DIALYSIS is diabetic ____. This renal disease is related to diabetic microvascular changes in the kidneys that can lead to ESRD, dialysis and transplant. Diagnosed by renal biopsy. retinopathy Manifestations of diabetic nephropathy include hypertension and ____, i.e. blood vessels breaking in the eyes.

pyelogram A retrograde ____ uses a cystoscope and dye to visualize the kidneys and ureters. angiography A renal ____ provides an image of the renal arteries to evaluate renal blood flow. cystometry A voiding ____ uses fluoroscopy to identify vesicoureteral reflux. perfusion NSAIDs like IBUPROFEN, ACE-inhibitors like CAPTOPRIL (Capoten), and ARBs like LOSARTAN (Cozaar) are examples of drugs that decrease renal _____ and can result in INTRARENAL complications. MAP (mean arterial pressure) Maintain the ____ (acronym only) above 60mmHg for optimal KIDNEY PERFUSION. It is a function of cardiac output and RESISTANCE in the arterioles. 3- Recovery from Acute Kidney Injury (AKI) takes ____ (#-#) months. 60

Stages of chronic kidney disease (CKD) and GFR rates in #mL/min/1.73m^2: Stage 1: damage, WNL or increased GFR (>90mL) Stage 2: damage, MILD decrease, GFR (60-89mL) Stage 3: MODERATE decrease, GFR (30-59mL) Stage 4: SEVERE decrease, GFR (15-29mL) Stage 5: kidney FAILURE (two words) (<15mL) The nurse and providers begin to become concerned when the level drops below ____ (#)mL. heart failure Captopril (Capoten) is an ACE-Inhibitor that is used to treat HTN and ____ (two words). The nurse knows that ACE- Inhibitors can be harmful for patients with prerenal AKI (poor perfusion) because they inhibit beneficial effects of Ang II on GFR. HCTZ (hydrochlorothiazide) A common diuretic used to treat high blood pressure and that is also indicated to treat edema is _____ (acronym only). The kidneys excrete excess water and Na+. Aleve The nurse knows that NAPROXEN also known as _____ (trade name) is an NSAID which is nephrotoxic because by inhibiting PG production, it causes afferent arteriole vasoconstriction which can lead to INTRARENAL AKI.

hemodialysis *Collect patient weight before and after. *Patients may eat during procedure. *Nurse monitors 1:1 with frequent vitals and labs. *Floor nurse continues care. *Medications may be deferred until after. *Treatments ave. 3x per week, from 3-5hrs outpt. These are all key points for nursing care for a patient needing _____. Potassium The patient's EKG shows tall, peaked T - waves and bradycardia. The nurse calls a rapid response and notifies the provider for new orders. New orders for fluids include: *Calcium gluconate IV; *Sodium bicarbonate IV; and *Regular Insulin IV + D50. The nurse knows these medications rapidly help to shift _____ back into the cells. Kayexalate (sodium polystyrene sulfonate) In patients with hyperkalemia, IV fluids such as CALCIUM GLUCONATE IV, SODIUM BICARBONATE, and REG INSULIN + D50 help to SHIFT POTASSIUM back into cells. However, _____ (trade name) is what helps the patient's body to EXCRETE the potassium.

Captopril (Capoten) The nurse knows that administration of antihypertensives like METOPROLOL (a beta-blocker) and ____ (an ACE-inhibitor) will be HELD for risk of dropping BLOOD PRESSURE too much during dialysis treatment. Vancomycin (Vancocin) The nurse knows that WATER-SOLUBLE antibiotics like _____ can be dialyzed off and will often be deferred until after dialysis treatment. Ask the dialysis nurse ahead of time which meds need to be HELD. Hypocalcemia Chvostek's and Trousseau's signs may be used to assess the patient for ____. Chvostek's The nurse's patient appears to have hypocalcemia as evidenced by a positive _____ sign. Trousseau's The nurse's patient appears to have hypocalcemia as evidenced by a positive ____ sign.

peritonitis The nurse's patient receives PERITONEAL DIALYSIS 3-5 times a day. The nurse is attentive and monitors for CLOUDY DRAINAGE FLUID and REDNESS around the insertion site of the dialysis catheter, which could be EARLY signs and symptoms of _____. CRRT (continuous renal replacement therapy) The ICU nurse has a patient who is hemodynamically unstable and that is receiving dialysis treatment around-the-clock (24 hrs/day). This type of treatment known as _____ (acronym only) spreads out fluid and electrolytes shifts over a longer period of time. peritoneal membrane During peritoneal dialysis, dialysis occurs in the peritoneal cavity. The ____ (two words) is the filter across which the toxins and waste diffuse. blood pressure DIALYSIS treatment has a goal of pulling off a specific amount of fluid. The nurse knows to monitor the patient's ____ (two

words) frequently Q5MIN as it has a tendency to drop during treatment. diffusion During dialysis the nitrogenous WASTE in the blood moves by _____ from an area of higher concentration to an area of lower concentration in the dialysate. Excess FLUID is removed from the blood by OSMOSIS. osmosis During dialysis the nitrogenous WASTE in the blood moves by diffusion from an area of higher concentration to an area of lower concentration in the dialysate. Excess FLUID is removed from the blood by _____. peritoneal *Indicated for pts who have CKD but are stable. *Pt can work and play during dialysis "dwell period." *Fluid/electrolyte shifts more slowly than hemodialysis. *Peritonitis is the most common complication. *Effective for CVD, DM and elderly pts at risk for systemic heparin. *dextrose dialysate fluid is introduced into the abdominal cavity through a catheter by GRAVITY *after a "dwell period" the drainage tube is unclamped and fluid drains from the ABD cavity by gravity.

*treatment is 3 to 5 treatments daily! This describes _____ dialysis a.k.a. CAPD. dwell period When a patient is receiving peritoneal dialysis, dialysis is occurring during a period of time known as the ____ (two words). The treatment is less interruptive to the patient's daily life giving them freedom to work and play. PD (peritoneal dialysis) The nurse knows to teach the patient who is receiving [ HD / PD ] to eat a high-protein, low sugar (because they absorb Dextrose during treatment), and high fiber diet. The fluid limitation is not as high. Many patients gain 3-5 lbs within a month of beginning treatment. Dextrose The nurse knows to teach the patient who is receiving peritoneal dialysis to eat a high-protein, low sugar (because they absorb _____ during their treatment), and high fiber diet. The fluid limitation is not as high. Many patients gain 3-5 lbs within a month of beginning treatment. slow When the hospitalized patient on dialysis needs IV therapy, the rate of administration must be as [ fast / slow ] as possible. cardiac tamponade

A complication of dialysis is pericarditis. When pericarditis progresses to effusion, the friction rub disappears, hearts sounds become distant and muffled. Effusion may progress to life- threatening ____ (two words), noted by Beck's Triad: narrowing of the pulse pressure; muffled or inaudible heart sounds; and distended jugular veins. Crushing chest pain, dyspnea and hypotension are additional S/Sx. fluids, phosphorus, potassium, salt The nurse knows that ALL patients with chronic kidney disease (CKD) are on dietary restrictions for _____ (list, all, four, alphabetically). immunosuppressant Tacrolimus (Prograf) is an ____ to prevent rejection of a kidney, heart or liver transplant. It weakens the body's defense system to help the patient's body to accept the new organ. Others are cyclosporine and corticosteroids. aminoglycoside GENTAMICIN (Garamycin) is a broad-spectrum ____ antibiotic that is used to treat serious INFECTION and is used PROPHYLACTICALLY before surgery for patients with history of HEART VALVE repair/replacement. The nurse knows that this category of drug can be NEPHROTOXIC. AV graft