Quiz Unit 7 & 8

Question 1

What should you teach a client who has had a vascular access device installed for hemodialysis?

Answer 1

How to assess for a bruit/thrill, assess these often, how to assess for s/s of infection, how to find distal pulses, why not to have BP taken in that arm

Question 2

What is the difference between pre-renal causes of kidney failure, intra-renal, and post-renal?

Answer 2

Pre-renal are caused before the kidney, like stenosis, high BP, atherosclerosis, diabetes. Intra-renal are caused by things within the kidney, like PKD. In post-renal something is blocking the renal pelvis/ureters, like stones, infection, cancer

Question 3

What drugs did she mention that are very hard on the renal system?

Answer 3

NSAIDS and Myacind (Gentamyacin)

Question 4

Is ESRD acute or chronic?

Answer 4

It isn’t cute, so it must be chronic!

Question 5

What is considered the second stage of chronic kidney disease and what is done for it?

Answer 5

Renal insufficiency. Low protein diet, manage sodium and fluid intake, non-potassium sparing diuretics (Lasix/Aldactone/HCZ, diamox)

Question 6

What is the first stage of chronic kidney disease?

Answer 6

Diminished renal reserve. GFR is still within normal range

Question 7

What is the last stage of chronic kidney disease called?

Answer 7

ESRD

Question 8

What happens to sodium levels during chronic kidney disease?

Answer 8

At first, hyponatremia may occur due to damaged nephrons being unable to reabsorb enough sodium and from polyuria. As the disease progresses sodium excretion diminishes as excretion slows, but sodium levels may appear normal, or even low, due to fluid retention and dilution.

Question 9

What labs are elevated in ESRD?

Answer 9

Creatinine/BUN/Urea (from protein breakdown), sodium, K+, phosphorous, lipids

Question 10

What labs decrease with ESRD?

Answer 10

Creatinine clearance, erythropoietin secretion (anemia), calcium, Hct, Hgb, HCO3

Question 11

What does ESRD do to the acid-base balance?

Answer 11

Becomes acidotic as kidneys fail to excrete hydrogen ions, Kussmaul respirations begin

Question 12

What do high phosphorous levels cause?

Answer 12

Calcium is released from the bones. May cause osteodystrophy

Question 13

What happens to the heart during ESRD?

Answer 13

Dysrhythmias, cardiomegally, cardiomyopathy, tamponade

Question 14

What supplements may need to be given to a pt with ESRD?

Answer 14

Folic acid, ferrous sulfate, Epigen, calcium

Question 15

What are the physical symptoms of ESRD?

Answer 15

Tachypnea, hyperventilation, bad breath, sighing, yellow skin, lesions, itching, ecchymosis, purpura, uremic frost, lethargy, slurred speech, anorexia, N/V, oliguria, bone pain, fractures, osteodystrophy, weakness, cramping

Question 16

Name some major nursing diagnosis for ESRD?

Answer 16

Fluid volume excess, imbalanced nutrition, decreased cardiac output

Question 17

What happens to protein restrictions when dialysis is started?

Answer 17

They need lots of protein when on dialysis, but sodium is still limited

Question 18

What is monitored during dialysis?

Answer 18

N/V (stop if during hemodialysis), fever chills (s/s of infection with peritoneal)

Question 19

If dialysate effluent is brown (peritoneal), what is indicated? Cloudy?

Answer 19

Perforated bowel (stool). Infection

Question 20

What is the disequilibrium syndrome? S/S? What is the proper response?

Answer 20

Rapid loss of volume during dialysis. N/V, decrease in LOC, cramps. Stop dialysis

Question 21

What is used for critically ill pts who cannot tolerate the fluid shifts associated with dialysis?

Answer 21

CRRT. Continuous Renal Replacement Therapy. It is a slow dialysis. Can last 12-24 hrs and is often done daily

Question 22

Where is a transplanted kidney placed? Why?

Answer 22

It is placed within the bony structures of the hips for protection

Question 23

What is Azotemia?

Answer 23

It is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood. It is largely r/t insufficient filtering of blood by the kidneys. Pre-renal azotemia is caused by DM and HTN (anything that decreases blood flow to the kidneys), while post-renal is caused by blockage of urine flow in the renal pelvis/ureters/bladder

Question 24

What are the s/s of digoxin toxicity?

Answer 24

N/V, visual changes, restlessness/confusion, H/A, fatigue, tachycardia

Question 25

What is isosthernuria?

Answer 25

The excretion of urine that is of the same specific gravity of protein free plasma (1.008-1.012), usually indicating renal tubular damage and loss of renal medullary function

Question 26

What is steal syndrome?

Answer 26

Pallor, diminished pulse, or necrosis, distal to a fistula, due to decreased circulation in the extremity