Final

Question 1

Acute renal failure: Pre renal

Answer 1

Decrease in CO
Hemorrhage
Low BP
MI, sepsis

Question 2

Acute renal failure: Renal

Answer 2

Aminoglycosides
NSAIDS
Aspirin 
ACE inhibitors
Burns
Metformin

Question 3

Acute renal failure: Post renal

Answer 3

Kidney stone
BPH
UTI
Pylonephritis
Stricture secondary to STI

Question 4

Nursing interventions for pt in acute renal failure

Answer 4

Monitor I/O
Limit Na and fluid intake 
Diet low in K+
Administer HCO3 IV
Administer lasix
Monitor ABG
Cardiac monitor 
Give Ca+/ decrease P
Kayaxelate

Question 5

How is acute renal failure diagnosed

Answer 5

Increased BUN and creatinine 
Decreased urinary output 
Hyperkalemia 
Hyponatremia 
Increased specific gravity 
Hypocalcemia 
Hyperphosphatemia 
Edema
Altered mental status
Increased BP

Question 6

Causes of chronic renal failure

Answer 6

HTN, DM, chronic urinary obstruction, autoimmune disorder

Question 7

Phases of renal failure: Oliguric

Answer 7

Lasts 8-15 days, Urine output is less than 400ml/day. Increased BUN/creatinine. Hyperkalemia, HTN, edema, pulmonary edema, N/V, metabolic acidosis, tingling in extremities, drowsiness, uremic breath. Restrict fluid intake and administer diuretics

Question 8

Phases of renal failure: Diuretic

Answer 8

Urine output rises slowly , excess urine output indicates damaged nephrons are recovering. Decline in BUN, creatinine, hypokalemia, hyponatremia, hypovolemia, tachycardia, dehydration, hypotension. Urine output may be up to 4,000ml/day. Administer IVF

Question 9

Phases of renal failure: recovery

Answer 9

May take 1-2 years. Urine volume returns to normal. Increased GFR

Question 10

Anemia occurs during renal failure because

Answer 10

Of decreased secretion of erythropoietin by damaged nephrons

Question 11

Manifestations of chronic RF

Answer 11

Ataxia, lethargy, slurred speech, HF, HTN, pericardial effusion, edema, crackles, SOB, anemia, anorexia, constipation, hematuria, oliguria, polyuria, proteinuria, dry skin, yellow gray pallor

Question 12

S/S of hyperkalemia

Answer 12

Bradycardia, muscle weakness, diarrhea

Question 13

What is used to treat emergency hyperkalemia

Answer 13

Insulin or Calcium gluconate

Question 14

What is used to treat/prevent polycythemia

Answer 14

Hydroxyurea

Question 15

Aplastic anemia is when

Answer 15

Bone marrow is replaced by fat, may be idiopathic

Question 16

What is the treatment for aplastic anemia

Answer 16

Bone marrow transplant

Question 17

What is the only anemia to give you neuro complications

Answer 17

Vitamin B12 deficiency

Question 18

S/S of iron deficiency anemia

Answer 18

Smooth sore red tongue, rigid nails, angular cheilosis,

Question 19

What should not be take with iron because they diminish absorption

Answer 19

Antacid and dairy products

Question 20

Reactions during blood transfusions occur

Answer 20

Within the first 15 min

Question 21

Transfusions should be given over ____ hrs to preven circulatory overload

Answer 21

2 hrs

Question 22

If giving multiple transfusions what medication should be given in between

Answer 22

Lasix (prevents fluid overload)

Question 23

Most common cause of hypothyroidism

Answer 23

Hashimoto thyroiditis (Thyroid is invaded by WBC causing inflammation. Autoimmune)

Question 24

S/S of hyporthyroidism

Answer 24

Weight gain
Dry skin
Constipation
Bradycardia
Fatigue
Lethargy
Cold intolerance
Slow thinking
Amenorrhea

Question 25

Myxedema coma is treated with

Answer 25

T3, T4 IV

Question 26

Hyperthyroid is caused by

Answer 26

Graves disease (thyroid is larger than normal)

Question 27

S/S of hyperthyroidism

Answer 27

``` Weight loss Diarrhea Tachycardia Increased sweating Nervousness Heat intolerance Exopthalmus Irritable, HTN ```

Question 28

Manifestations of myxedema coma

Answer 28

``` Respiratory failure Hypotension Hyponatremia Hypothermia Hypoglycemia ```

Question 29

Interventions for treating myxedema coma

Answer 29

``` Maintain airway Replace fluids (NS, yperonic saline) IV synthroid IV glucose Corticosteriods Monitor V/S hourly Warm blankets ```

Question 30

S/S of Addisons disease

Answer 30

hypoglycemia(sweating, HA, tremors) hyponatremia hyperkalemia (cardiac problems) hyperpigmentation in mouth and lips

Question 31

Addisons is diagnosed by

Answer 31

Low early serum cortisol, low fasting blood glucose, low sodium, and elevated potassium levels

Question 32

Manifestations of Addisonian crisis

Answer 32

``` Cyanosis Pallor, apprehension Rapid, weak pulse Rapid resp Confusion, restlessness Extreme weakness Diarrhea ```

Question 33

Addisonian crisis can be caused by

Answer 33

``` Slight overexertion Exposure to cold Acute infection Decrease in salt intake Dehydration Stress ```

Question 34

Management of Addisonian crisis

Answer 34

``` Encourage fluids IVF and glucose IV electrolytes Diet high in Na+ Florinef or prednisone IV Vasopressors to increase BP Minimize stress ```

Question 35

Manifestations of Cushings

Answer 35

``` Central obesity Diabetes and peptic ulcer Buffalo hump Moon face Thin extremities Thin, fragile skin Bruises Striae Muscle wasting Osteoporosis ```

Question 36

Laboratory findings for CUshings

Answer 36

Hypernatremia Hyperglycemia Hypokalemia

Question 37

Cushings is diagnosed by

Answer 37

Overnight Dexamethasone suppression test.

Question 38

Diet for a pt with Cushings

Answer 38

``` High protein High calcium High vitamin D Low sodium Low calories ```

Question 39

Key manifestations of thyroid storm

Answer 39

Fever Tachycardia Systolic hypertension Temperature increase of 1 degree

Question 40

Radioactive iodine

Answer 40

May take 4-8 wks for results Oral dose Antithyroid meds are stopped 3 days before and started 3 days after

Question 41

Preop care for thyroidectomy

Answer 41

Administer antithyroid meds and iodine prep to decrease the secretion of thyroid hormones and reduce thryroid size. Ensure HTN and tachycardia are under control. Teach pt to support the neck when coughing or moving by placing both hands behind the neck when moving

Question 42

Post op care for thyroidectomy

Answer 42

Use sandbags or pillows to support the head and neck. Place pt in Semi Fowlers. Avoid neck extension. Monitor for laryngeal stridor. Keep emergency trach kit in room

Question 43

After a thyroidectomy the pt may experience

Answer 43

Hypoparathyroidism

Question 44

Other things to monitor in pt post thyroidectomy

Answer 44

Muscle twitching Tingling around the mouth or toes Assess pt voice at 2hr intervals

Question 45

Management of thyroid storm

Answer 45

``` Maintain airway Give PTU 300-900mg daily Methimazole up to 60mg daily Administer Na iodide IV Cardiac monitor Central venous pressure cath Glucocorticoids, hydrocirtisone, dexamethasone Antipyretics Cooling blankets NS infusions ```