Quiz 5 Study # 2

Question 1

anatomy of the renal system

Answer 1

Glomerulus,Proximal convoluted tubule,Loop of Henle

Distal convoluted tubule,Collecting Duct

Question 2

glomerulus

Answer 2

initial filtering of blood takes place here, comprosed of a cluster of capillaries surrounded by glomerular capsule .

Question 3

proximal tubule

Answer 3

follows glomerulus anatomically & returns 60-70% of sodium and water from filtered fluid back into bloodstream.

Question 4

loop of Henle

Answer 4

20-25% of sodium is resorbed back in bloodstream here. Chloride actively resorbed an sodium passively follows.

Question 5

distal tubule

Answer 5

anatomically follows loop, remaining 5-10% of sodium resorption takes place here.

Question 6

collecting duct

Answer 6

final common pathway for filtrate. here antidiuretic hormone acts acts to increase absorption of water back into bloodstream, preventing it from being lost in urine

Question 7

effects of aldosterone on the distal tubule

Answer 7

in distal tubule, sodium is actively filtered in exchange for potassium or hydrogens ions, which is regulated by aldosterone hormone

Question 8

physiology of the renal system

Answer 8

Cleansing of extracellular fluid (ECF), excretion of metabolic wastes and foreign substances
Maintenance of extracellular volume and composition
Maintenance of acid-base balance

Question 9

Kidney has three basic processes

Answer 9

Filtration,Reabsorption,Active secretion

Question 10

MOA loop diuretics

Answer 10

Blocks reabsorption of sodium and chloride in the ascending limb of the loop of Henle which prevents reabsorption of water. Ex. furosemide (Lasix), bumetanide (Bumex), torsemide (Demadex

Question 11

therapeutic/drug effects loop diuretics

Answer 11

it produces extensive diuresis. reduces blood pressure, reduces pulmonary vascular resistance,reduces systemic vascular resistance,reduces central venous pressure,reduces left ventricular end-diastolic pressure

Question 12

indications loop diuretics

Answer 12

Pulmonary edema caused by heart failure, hepatic or renal failure, control HTN, increase renal excretion of calcium in hypercalcemia pt.

Question 13

contraindications loop diuretics

Answer 13

End stage renal disease, anuria, known drug allergy, hepatic coma, severe electrolye loss

Question 14

adverse effects loop diuretics

Answer 14

Severe dehydration,Hypotension,Hypokalemia (14-60%)

Ototoxicity, hyperglycemia, hyperuricemia (40%)

Question 15

nursing responsibilities including important lab values loop

Answer 15

Monitor fluid volume status,Monitor blood pressure
Monitor electrolytes (especially K+)

Question 16

interactions loop

Answer 16

digoxin

Question 17

patient education loop

Answer 17

Monitor weight and blood pressure,Change positions slowly, Eat potassium rich foods, take early in the day

Question 18

MOA Thiazide diuretics

Answer 18

Blocks reabsorption of sodium and chloride in the early distal tubule which prevents reabsorption of water.Ex.
Chlorthalidone, hydrochlorothiazide (HydroDiuril, HCTZ),indapamide, metolazone chlorothiazide (Diuril)

Question 19

therapeutic/drug effects thiazide

Answer 19

Since only 10% of filtered Na+ and Cl- is reabsorbed at this site, the maximum diuresis is less than Loop

Question 20

indications thiazide

Answer 20

First-line treatment for HTN

Question 21

contraindications thiazide

Answer 21

Renal insufficiency, anuria, hepatic coma, known drug allergy

Question 22

adverse effects thiazide

Answer 22

Dehydration,Hypotension,Hypokalemia,Hyperglycemia, hyperuricemia

Question 23

nursing responsibilities including important lab values thiazide

Answer 23

Monitor fluid volume status,Monitor blood pressure
Monitor electrolytes (especially K+)

Question 24

patient education thiazide

Answer 24

Monitor weight and blood pressure,Change positions slowly,Eat potassium rich foods
Take early in the day to avoid nocturia

Question 25

MOA Potassium-sparing diuretics

Answer 25

Blocks the action of aldosterone in the distal tubule which results in potassium retention and the excretion of sodium and water. Ex. (spironolactone, Aldactone)

Question 26

therapeutic/drug effects potassium-sparing

Answer 26

Counter acts the potassium-wasting effect of more powerful diuretics. Mild diuresis effect.

Question 27

indications potassium sparing

Answer 27

Frequently combined with thiazide and loop diuretics to counterbalance potassium-wasting

Question 28

contraindications potassium sparing

Answer 28

Renal failure or anuria,Hyperkalemia

Question 29

adverse effects potassium sparing

Answer 29

Hyperkalemia (if used alone), Gynecomastia, impotence, menstrual irregularities

Question 30

nursing responsibilities including important lab values potassium sparing

Answer 30

``` Monitor fluid volume status,Monitor blood pressure Monitor electrolytes (especially K+) ```

Question 31

interactions potassium sparing

Answer 31

Angiotensin converting enzyme (ACE) inhibitors,Angiotensin receptor blockers (ARBs),Direct renin inhibitors,Potassium supplements

Question 32

patient education potassium sparing

Answer 32

Teach patients to keep a log of blood pressure and weight,Avoid salt substitutes that contain potassium

Question 33

MOA Osmotic diuretics

Answer 33

Decreases cerebral edema by raising serum osmolality which draws fluid into the vascular space. Creates osmotic effect in nephron causing increased secretion of water. Ex. mannitol (Osmitrol) IV only.

Question 34

therapeutic/drug effects osmotic

Answer 34

The greater the amount of mannitol the greater the diuresis (available in 5-25%). may prevent kidney damage during renal failure, used in intracranial and intraocular pressure.

Question 35

indications osmotic

Answer 35

Cerebral edema,Prevention of kidney injury in hypovolemic shock

Question 36

contraindications osmotic

Answer 36

Renal failure, Pulmonary edema caused by heart failure, active intracranial bleeding

Question 37

adverse effects osmotic

Answer 37

Can precipitate heart failure & pulmonary edema

Question 38

nursing responsibilities including important lab values osmotic

Answer 38

Monitor fluid volume status,Monitor blood pressure Monitor electrolytes,Use a filter in the intravenous (I.V.) tubing,Monitor for signs/symptoms of heart failure and notify prescriber immediately

Question 39

Foods rich in potassium

Answer 39

bananas, potatoes, dried fruit, tomatoes, spinach, citrus fruits

Question 40

Normal serum potassium level

Answer 40

approximately 3.5-5.0 mEq/L

Question 41

Urine output

Answer 41

30 mL/hr

Question 42

Serum creatinine level

Answer 42

0.6-1.2 mg/dL

Question 43

BUN levels

Answer 43

10 to 20 mg/dL

Question 44

S&S of hypokalemia

Answer 44

weakness, fatigue, constipation, and muscle cramping. In more severe cases, heart arrhythmias, or abnormal rhythms may occur.

Question 45

S&S of hyperkalemia

Answer 45

fatigue or weakness, a feeling of numbness or tingling, nausea or vomiting ,problems breathing, chest pain, palpitations or skipped heartbeats