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Renal > ATI medications > Flashcards

ATI medications Flashcards

1
Q

drugs used to treat BPH:

5-Alpha reductase inhibitors

A

prototype: finasteride (Propecia or Proscar)

dutasteride (Avodart)

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2
Q

S/E of finasteride (Propecia)

A

reduced libido and ejaculate volume
gynecomastia
reduced PSA levels

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3
Q

drugs used to treat BPH:

alpha-adrenergic receptor antagonists

A 
prototype: tasulosin (Flomax)
silodosin (Rapaflo)
alfuzosin (Uroxatral)
terazosin (Hytrin)
doxazosin (Cardura)
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4
Q

S/E of tamsulosin

A 
reduced ejaculate volume
ejaculation failure
retrograde ejaculation
headache
hypotension
fainting
dizziness
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5
Q

one primary type of drug used in treatment of urinary incontinence and over active bladder

A

anticholinergics

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6
Q

anticholinergic drugs used to treat incontinence

A

prototype drug: oxybutynin (Ditropan)
tolterodine (Detrol)
darifenacin (Enablex)

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7
Q

anticholinergic side effects

A 
dry mouth
constipation
pupil dilation (mydriasis)
dry eyes
blurred vision
headache
dizziness, drowsiness
fever, heat exhaustion
urinary retention
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8
Q

contraindications for anticholinergics

A 
narrow angle glaucoma
myasthenia gravis
GI obstruction
genitourinary obstruction
active cardiac dysfunction
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9
Q

cholinergic drug used to treat urinary retention

A

bethanechol (Urecholine)

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10
Q

side effects of cholinergic drugs

A 
hypotension
bradycardia
excessive gastric acid and salvation
diarrhea
fecal incontinence
bronchoconstriction  
dizziness, fainting
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11
Q

Serum creatinine produced due to ____

A

produced due to protein and muscle breakdown.
■■ Kidney disease is the only condition that increases serum creatinine level.
■■ Kidney function loss of at least 50% will cause an elevation of serum creatinine values.
■■ Serum creatinine values remain constant in older adults unless kidney disease is present.

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12
Q

what is normally not found in urine and what can it mean if these are found

A

Glucose, ketone bodies, and protein, including leukoesterase and nitrites, are not normally
present in urine. These abnormal findings may indicate the client has diabetes mellitus, fat
metabolism, infection, or if a cytology analysis is performed, cancer.

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13
Q

purpose of x-raying the kidneys

A

Allows for visualization of structures and to detection of renal calculi, strictures, calcium deposits, or obstructions.

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14
Q

purpose of CT when scanning kidneys

A

Provides three‑dimensional imaging of renal/urinary system to assess for kidney size and obstruction, cysts, or masses.
IV contrast dye (iodine‑based) may be used to enhance images.

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15
Q

purpose of cystography; cystourethrography; VCUG

A

Detects urethral or bladder injury when contrast dye is instilled through a urinary catheter to provide an image of the bladder (cystography), and image of the ureters
(cystourethrography).
VCUG detects whether urine refluxes into the ureters as an x-ray is taken while the client is voiding.

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16
Q

nursing interventions with cystography

A

››Monitor client for infection for the first 72 hr after the procedure.
›› Encourage increased fluid intake to dilute urine and minimize burning on urination.
››Monitor urine output (less than 30 mL/hr) if suspected pelvic or urethral trauma.

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17
Q

nursing interventions for kidney biopsy

A

Client receives sedation and is monitored for procedure.

›› Preprocedure
»»Review coagulation studies.
»»Nothing by mouth for 4 to 6 hr.

›› Postprocedure
»»Monitor vital signs following sedation.
»»Assess dressings and urinary output (hematuria).
»»Review Hgb and Hct values.
»»Administer PRN pain medication.

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18
Q

nursing interventions for cystography; cystourethrography

A

›› Client is given anesthesia for the procedure.
›› Check for signs of bleeding and infection. Monitor client for infection for the first 72 hr after the procedure.

›› Preprocedure
»»NPO after midnight.
»»Administer laxative or enemas for bowel preparation the night before the procedure.

›› During the procedure
»»Monitor vital signs if local anesthetic is administered.
»»General anesthesia is an option.
»»Place in lithotomy position.

›› Postprocedure
»»Monitor vital signs and urine output.
»»Document color of urine; may be pink-tinged.
»»Irrigate urinary catheter with 0.9% normal saline if blood clots are present or urine output is decreased or absent.
»»Encourage oral fluids to increase urine output and reduce burning sensation with voiding.

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19
Q

purpose of retrograde pyelogram, cystogram, urethrogram

A

›› Used to identify obstruction or structural disorders of the ureters and renal pelvis of the kidneys (pyelogram) by instilling contrast dye during a cystoscopy.
›› Fistulas, diverticula, and tumors are identified in the bladder (cystogram) and urethra (urethrogram) by instilling contrast dye during a cystoscopy.

20
Q

nursing interventions for venography (kidney scan)

A

›› Postprocedure
»»Assess BP frequently during and after procedure if captopril (Capoten) is given during the procedure to change blood flow to the kidneys.
»»Alert client about possible orthostatic hypotension following the procedure if captopril is used.
»»Increase fluid intake if hypotension occurs.
»»Implement standard precautions when handling urine after procedure.

21
Q

nursing interventions for excretory urography

A

Same as KUB
›› Preprocedure
»»Encourage increased fluids the day before procedure.
»»Bowel cleansing with laxative or enema to remove fecal contents, fluid, and gas from the colon for a more clear visualization.
»»NPO after midnight.
»»Determine client allergy to iodine, seafood, eggs, milk, chocolate; or if client has asthma.
»»Check the client’s creatinine and BUN levels.
»»Hold metformin (Glucophage) for 24 hr before procedure (risk for lactic acidosis from contrast dye with iodine).

›› Postprocedure
»»Administer parenteral fluid, or encourage oral fluids to flush dye through the renal
system and prevent complications.
»»Diuretics may be administered to increase dye excretion.
»»Follow-up creatinine and BUN serum levels before metformin is resumed.

22
Q

elderly renal considerations

A

Kidney size and function decrease with aging.
Blood flow adaptability decreases, especially during a hypotensive or hypertensive crisis.
Glomerular filtration rate (GFR) decreases
Medical conditions – diabetes, hypertension, and heart failure can affect GFR.
Kidney injury can occur more easily from contrast dyes and medication
Tubular changes can cause urgency and nocturnal polyuria.
Weak urinary sphincter muscle and shorter urethra in women can cause incontinence and urinary
tract infections.
Enlarged prostate in men can cause urinary retention and infection.

23
Q

A nurse is providing teaching to a client who is to have an x-ray of the kidneys, ureters, and bladder (KUB).
Which of the following statements should the nurse include in the teaching?

A. “Contrast dye is given during the procedure.”
B. “An enema is necessary before the procedure.”
C. “You will need to lie in a prone position during the procedure.”
D. “The procedure determines whether a kidney stone is present.”

A

D. “The procedure determines whether a kidney stone is present.”

A KUB can identify renal calculi, strictures, calcium deposits, or obstructions.

24
Q

A nurse is monitoring for postoperative complications in a client who had a kidney biopsy. Which of
the following complications causes the most immediate risk to the client?

A. Infection
B. Hemorrhage
C. Hematuria
D. Kidney failure

A

Hemorrhage is the most immediate client risk following a kidney biopsy if clotting does
not occur at the puncture site.

25
Q

A nurse is reviewing a client’s laboratory findings for urinalysis. The findings indicate the urine is
positive for leukoesterase and nitrites. Which of the following is an appropriate nursing action?

A. Repeat the test early the next morning.
B. Start a 24-hr urine collection for creatinine clearance.
C. Obtain a clean-catch urine specimen for culture and sensitivity.
D. Insert a urinary catheter to collect a urine specimen.

A

C. Obtain a clean-catch urine specimen for culture and sensitivity.

Obtaining a clean-catch urine specimen for culture and sensitivity is an appropriate nursing action because this determines the antibiotic that will be most effective for treatment of the urinary tract infection.

26
Q

A nurse administered captopril (Capoten) to a client during renography (kidney scan). Which of the
following is an appropriate action by the nurse?

A. Assess the client for hypertension.
B. Limit the client’s fluid intake.
C. Monitor for orthostatic hypotension.
D. Encourage early ambulation.

A

C. Monitor for orthostatic hypotension.

The appropriate action by the nurse is to monitor for orthostatic hypotension because the antihypertensive effect of captopril results in a change in blood flow to the kidneys when an initial dose is administered.

27
Q

functions of dialysis

A

Rids the body of excess fluid and electrolytes
Achieves acid-base balance
Eliminates waste products
Restores internal homeostasis by osmosis, diffusion, and ultrafiltration

28
Q

precautions to take with AV fistula

A

Avoid taking blood pressure, administering injections, performing venipunctures or inserting IV lines on an arm with an access site. Elevate the extremity following surgical development of AV fistula to reduce swelling.

29
Q

complications to monitor for during dialysis

A

Dialysis circuit clotting, air bubbles in blood tubing, temperature of the dialysate (37.8° C [100° F]), regulation of the ultrafiltration.
Hypotension, cramping, vomiting, bleeding at the access site, contamination of equipment.

30
Q

disequilibrium syndrome

A

caused by too rapid a decrease of BUN and circulating fluid volume.
It may result in cerebral edema and increased intracranial pressure

31
Q

signs of disequilibrium syndrome

A

nausea, vomiting, change in level of consciousness, seizures, and agitation.

32
Q

patients who are candidates for peritoneal dialysis

A

treatment of choice for older adult
pt unable to tolerate anticoagulation
pt with vascular access difficulty
pt has chronic infections or are unstable

33
Q

s/s of infection with peritoneal dialysis

A 
fever
purulent drainage
redness, swelling
bloody, cloudy, frothy dialysate
drainage at access site
34
Q

complications of PD

A

respiratory distress
abd pain
insufficient outflow
discolored outflow

35
Q

A nurse is providing teaching to a client who has chronic kidney disease and is to start hemodialysis.
Which of the following information should the nurse include in the teaching?

A. Hemodialysis restores renal function.
B. Hemodialysis replaces hormonal function of the renal system.
C. Hemodialysis allows an unrestricted diet.
D. Hemodialysis returns a balance to serum electrolytes.

A

Hemodialysis returns a balance to serum electrolytes.

Hemodialysis returns a balance to serum electrolytes by removing excess sodium, potassium, fluids, and waste products; and restores acid-base balance.

36
Q

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury and has been
hospitalized. Which of the following are appropriate nursing actions? (Select all that apply.)

A. Review the client’s current medication history.
B. Assess the client’s arteriovenous fistula for a bruit.
C. Calculate the client’s total urine output during the shift.
D. Obtain the client’s weight.
E. Check the client’s serum electrolytes.
F. Use the client’s access site area for venipuncture.

A

Reviewing the client’s current medication history will determine what medications to hold until after dialysis.

Assessing the client’s AV fistula for a bruit determines the patency of the fistula for dialysis.

Obtaining the client’s weight before dialysis is needed to compare with the client’s weight after dialysis.

Checking the client’s serum electrolytes determines the need for dialysis.

37
Q

A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following
should the nurse include in the plan of care? (Select all that apply.)

A. Check BUN and serum creatinine.
B. Administer medications held prior to dialysis
C. Observe for signs of hypovolemia
D. Assess the access site for bleeding.
E. Evaluate blood pressure on side of AV access.

A

The nurse should check the BUN and serum creatinine to determine the presence and degree of uremia or waste products that remain following dialysis.

Medications that can be partially dialysed during the treatment should be withheld. After the treatment, the nurse should administer the medications.

A client who is post-dialysis is at risk for hypovolemia due to a rapid decease in fluid volume.

The nurse should assess the access site for bleeding because heparin is administered during the procedure to prevent clotting of blood with the dialyzing surfaces.

38
Q

A nurse is caring for a client who is receiving hemodialysis and develops disequilibrium syndrome.
Which of the following is an appropriate action by the nurse?

A. Administer an opioid medication.
B. Monitor for hypertension.
C. Assess level of consciousness.
D. Increase the dialysis exchange rate.

A

The nurse should assess the client’s level of consciousness. A change in urea levels can cause
increased intracranial pressure, and subsequently, the client’s level of consciousness is decreased.

39
Q

A nurse is planning care for a client who is having peritoneal dialysis. Which of the following are
appropriate nursing actions? (Select all that apply.)

A. Monitor serum glucose levels.
B. Report cloudy dialysate return.
C. Warm the dialysate in a microwave.
D. Assess for shortness of breath.
E. Check the access site dressing for wetness.
F. Maintain medical asepsis when accessing the catheter insertion site.

A

The nurse should monitor serum glucose levels because the dialysate solution contains glucose.

The nurse should monitor for cloudy dialysate return, which indicates an infection. Clear, light yellow solution is expected during the outflow process.

The nurse should assess for shortness of breath, which may indicate the client’s inability to tolerate a large volume of dialysate.

The nurse should check the access site dressing for wetness and determine whether the tubing is kinked, pulled, clamped, or twisted, which can increase the risk for exit site infections.

40
Q

subjective data for end stage kidney disease may include;

A

Anorexia, fatigue, numbness and tingling of extremities, shortness of breath, dry itchy skin, metallic taste in the mouth, muscle cramping

41
Q

objective data for end state kidney disease may include:

A 
Decreased attention span
seizures, tremor, heart failure, 
edema of hands and feet,
dyspnea, distended jugular veins, 
anemia, vomiting, pulmonary edema, 
hypertension,
cardiac dysrhythmias, 
pallor, dry itchy skin, bruising, 
halitosis, and 
diminished or dark‑colored urine
42
Q

diet recommendations following kidney transplant

A

Low fat to decrease cholesterol, high fiber to avoid constipation, increased protein to promote healing, rebuild and maintain muscle mass.
Normal intake of potassium, calcium, and phosphorus.
Restrict sodium intake to prevent fluid retention and hypertension especially when taking prednisone.
Avoid concentrated sugars or carbohydrates to control glycemic factors when on prednisone.
Magnesium supplements because cyclosporine (Neoral) can reduce magnesium levels.
Avoid grapefruit when taking cyclosporine, which causes increased cyclosporine blood levels.

43
Q

findings and treatment of hyper acute kidney rejection

A

Findings – fever, hypertension, pain at the transplant site within 48 hours after surgery

Treatment – immediate removal of the donor kidney.

44
Q

acute kidney rejection etiology

A

An antibody mediated response causing vasculitis in the donor kidney, and cellular destruction starts with inflammation that causes lysis of the donor kidney

45
Q

findings and treatment of acute kidney rejection

A

occurs 1 week to 2 years after surgery
Findings – Oliguria, anuria, low-grade fever, hypertension, tenderness over the transplanted kidney, lethargy, azotemia, and fluid retention.

Treatment – Involves increased doses of immunosuppressive medications

Renal (5 decks)

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