Renal

Question 1

Acute Glomerulonephritis
* Symptoms
* Causes

Answer 1

Symptoms:
* Hematuria – leads to cola-colored urine
* Proteinuria

Causes:
* Group A beta-hemolytic streptococcal infection of the throat may proceed glomerulonephritis by 2-3 weeks
* Repeated episodes of acute nephritic syndrome

Question 2

What is acute glomerulonephritis?

Answer 2

Inflammation of glomeruli (filters in the kidneys)

Question 3

When does acute glomerulonephritis usually occur?

Answer 3

2-3 weeks after a strep infection

Question 4

List the GFR for each stage of Chronic Kidney Disease

Answer 4

Stage 1:
* GFR >/= 90

Stage 2:
* GFR = 60-89

Stage 3:
* GFR = 30 - 59

Stage 4:
* GFR = 15-29

Stage 5:
* GFR > 15

Question 5

What are the 3 types of acute renal failure / acute kidney injury (AKI)?

Answer 5

1.) Pre-renal
2.) Intrinsic
3.) Post-renal

Question 6

What 3 key factors increase a patient’s risk of chronic kidney disease?

Answer 6

• AGING
• Heart failure (& HTN)
• Contrast

Question 7

What should be done to prevent kidney damage due to contrast in patients with AKI or CKD?

Answer 7

Pre-procedure hydration

Question 8

What is Grey-Turner’s Sign and what does it indicate?

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Answer 8

purplish discoloration on the flank or near 11th / 12th rib

• indicates retroperitoneal bleed / kidney injury

Question 9

What is Grey-Turner’s Sign?

Answer 9

Purplish discoloration on the flank or near 11th / 12th rib

Question 10

What does Grey-Turner’s sign indicate?

Answer 10

Sign of kidney injury

Question 11

What is normal Creatinine?

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Answer 11

0.6 - 1.2 mg/dL

Question 12

What is normal blood urea nitrogen?

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Answer 12

8 - 20 mg/dL

Question 13

What kind of disease is polycystic kidney disease & what can it lead to?

Answer 13

• Genetic disorder (autosomal dominant)
• Can lead to kidney failure

Question 14

What is the main sign of acute renal failure (/ AKI)?

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Answer 14

Oliguria = < 300 mL / 24 hr of urine

Question 15

What is acute renal failure (ARF) / acute kidney injury (AKI)?

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Answer 15

RAPID decline (over hours to days) in GFR
* leads to rapid ↑ in BUN & ↑ creatinine, & possibly ↓ urine output

Question 16

What is the treatment for acute renal failure (ARF) / acute kidney injury (AKI)?

Answer 16

• Give fluid
• Treat electrolyte imbalance

Question 17

What is nephrotic syndrome?

Answer 17

• Excess fluid volume
• Generalized edema

• body excretes too much protein in the urine (proteinuria)

Question 18

What is acute tubular necrosis?

Answer 18

destruction / death of tubules in the kidneys

Question 19

What are causes of acute tubular necrosis (ATN)?

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Answer 19

• Nephrotoxic medications
• Environmental exposures
• Sepsis
• Prolonged severe HTN

Question 20

What type / classification of kidney injury is acute tubular necrosis (ATN)?

Answer 20

Acute Kidney Injury (AKI) – intrinsic
* within the kidney)

Question 21

What are the stages of acute tubular necrosis (ATN)?

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Answer 21

1.) Onset phase: lasts hours to days

2.) Oliguric / Anuric Phase: 5-16 days
* nectrotic cellular debris blocks urine & damage is done to the tubular wall

3.) Diuretic Phase: 7 - 14 days
* ↑ GFR & polyuria
* Monitor for dehydration

4.) Recovery / Convalescent Phase
* even more ↑ in urine output
* BUN & creatinine either ↑ or stay at their new normal

Question 22

What is the treatment for hyperkalemia?

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Answer 22

• Glucose (hypertonic)
• Insulin infusion
• Calcium
• Kayexalate can also be given – it will bind K+ in the bowel & eliminate K+ in the feces

Question 23

What is the treatment for a creatinine level over 2?

Answer 23

Acetylcysteine
* make sure pt is hydrated before CT contrast is administered

Question 24

What can hyperkalemia lead to?

Answer 24

• Peaked T-waves
• Widening QRS
• may cause V-tach

Question 25

**What are the dietary restrictions for patients with acute renal failure?**

Answer 25

* ↓ K+ * ↓ Na+ * ↓ Phosphorus * ↓ Protein * ↓ fluids

Question 26

**What are common complications of acute renal failure (ARF)?** | **KNOW THIS!!!!!!!!!**

Answer 26

* **Hyperkalemia** * **Metabolic acidosis** * Anemia & prolonged bleeding time * Infections * Cardiac complications (arrhythmias, pericarditis, pericardial effusion) * Malnutrition

Question 27

**What leads to the development of nephrosclerosis & end-stage renal disease (ESRD)?**

Answer 27

* due to *prolong HTN & DM*

Question 28

**What medication is given for renal patients with hyperphosphatemia?**

Answer 28

**Calcium acetate** * main sx of hyperphosphatemia = pruritus & it may lead to hypocalcemia

Question 29

**List the stages of GFR** | **KNOW THIS!!!!! ON EXAM**

Answer 29

* **Stage 1:** GFR over 90 * **Stage 2:** GFR = 60-89 * **Stage 3:** GFR = 30-59 * **Stage 4:** 15-29 * **Stage 5:** 15 or less

Question 30

**Signs & Symptoms of acute glomerular inflammation.**

Answer 30

* Edema around the eyes & flank * B/l flank tenderness

Question 31

**What is Continuous Renal Replacement Therapy (CRRT)?**

Answer 31

**continuous dialysis over 24 hours** * usually done in the ICU * need a quinten catheter to be done

Question 32

**What is peritoneal dialysis?**

Answer 32

* Catheter is placed in the peritoneum (lining of the abdomen) * Peritoneum serves as filtering membrane * Can be done automatically at night during sleep

Question 33

**What is the most life-threatening fluid and electrolyte imbalance that can occur in patients with renal disturbances?**

Answer 33

**HyperKALEMIA** (↑ K+)

Question 34

**An athlete is brought to the ER after blunt trauma injury from a game. There is suspicion that he has sustained injuries to his kidneys. The ER nurse receives an order to collect all voided urine & send it to the lab for analysis. The nurse understands taht this nursing intervention is most important because...** **a.)** Hematuria is common in renal trauma & the blood may be microscopic so lab analysis is essential. **b.)** I/O calculations are essential & the lab will calculate the precise output. **c.)** A creatinine clearance study may be ordered at a later time & the lab will hold all urine until it's deemed if the test is necessary. **d.)** There is risk of electrolyte imbalances & the lab will monitor for soidum concentration in the urine.

Answer 34

**a.) Hematuria is common in renal trauma & the blood may be microscopic so lab analysis is essential**

Question 35

**A patient waiting for a kidney transplant asks the nurse what signs & symptoms most likely indicate rejection. What is the nurse's best response?** **a.)** Shortness of breath **b.)** Oliguria **c.)** Decreasing blood pressure **d.)** Weight loss

Answer 35

**b.) Oliguria**

Question 36

**The nurse is caring for a patient in acute renal failure. THe nurse expects hypertonic glucose, insulin infusion, & sodium bicarbonate to treat what electrolyte imbalance?** **a.)** Hypernatremia **b.)** Hypokalemia **c.)** Hypercalcemia **d.)** Hyperkalemia

Answer 36

**d.) Hyperkalemia**

Question 37

**A patient presents with acute renal fialure. If the cause is found to be pre-renal, which ocndition most likely caused it?** **a.)** Heart failure **b.)** Glomerulonephritis **c.)** Ureterolithiasis **d.)** Aminoglycoside toxicity

Answer 37

**a.) Heart failure**

Question 38

**An ESRD patient asks for information about hemodialysis. What should the nurse include in the teaching?** **a.)** It's required three times a week. **b.)** It's required daily. **c.)** You will have surgery & a catheter will be inserted into the abdomen. **d.)** It's a treatment that is used for a few months until your kidneys heal & you produce urine again.

Answer 38

**a.) It's required three times a week**

Question 39

**What is the most common complication with peritoneal dialysis?** **a.)** Blood loss **b.)** Peritonitis **c.)** Constipation **d.)** Dehydration

Answer 39

**b.) Peritonitis**

Question 40

**The nurse is educating a patient about their procedure to get a fistula. What should the nurse include in the teaching?** **a.)** The arm should be immobilized for 4-6 weeks. **b.)** One needle is inserted into the fistula for each dialysis treatment. **c.)** A vein & artery in your arm are attached surgically. **d.)** The fistula can be used immediately after surgery for dialysis.

Answer 40

**c.) A vein & artery in your arm are attached surgically**

Question 41

**A patient with ESRD is having his first hemodialysis treatment & asks the nurse what the most common complication is. How should the nurse respond?** **a.)** High blood sugar levels may occur **b.)** Excessive bleeding & double vision may occur **c.)** Confusion & diarrhea may occur **d.)** Hypotension & cramping may occur

Answer 41

**d.) Hypotension & cramping may occur**

Question 42

**The critical nurse notices that a patient who is 1 hour post-operative from a kidney transplant is clammy & pale. The nurse recognize this as a sign of what?** **a.)** Urinary retention **b.)** Shock **c.)** Hypertension **d.)** Expected symptoms from anesthesia

Answer 42

**b.) Shock**

Question 43

**A patient in the ICU develops acute renal failure (ARF). They are hemodynamically unstable but they need renal replacement therapy to manage their hypervolemia & hyperkalemia. Which treatment will they most tolerate?** **a.)** Hemodialysis **b.)** Peritoneal dialysis **c.)** Continuous venovenous hemodialysis **d.)** Plasmapheresis

Answer 43

**c.) Continuous venovenous hemodialysis**

Question 44

**A 71-year-old patient has ESRD & is on the renal transplant list. The patient expresses that they are unsure if they want to undergo the transplant. What is an appropriate response from the nurse?** **a.)** "The decision is yours, just don't make the wrong one". **b.)** "Kidney transplants in patients your age are as successful as they are in younger patients". **c.)** "I understand your hesitancy, it's not as successful as it is in younger people". **d.)** "Have you talked this over with your family?"

Answer 44

**b.) "Kidney transplants in patients your age are as successful as they are in younger patients".**

Question 45

**What should be included in the teaching plan for a patient who is post resection of a renal tumor?** **a.)** Signs & symptoms of rejection **b.)** To inspect & care for the incision **c.)** Post-surgical urine retention **d.)** All of the above

Answer 45

**b.) To inspect & care for the incision**

Question 46

**The nurse is aware that bleeding is a major post-op complication of kidney surgery & may cause hypovolemic & hemorrhagic shcok if it goes undetected. What assessment parameters are necessary to assess for bleeding in the post-operative patient?** **a.)** Skin condition **b.)** Pain **c.)** Level of consciousness **d.)** Oral intake

Answer 46

**c.) Level of consciousness**

Question 47

**As renal failure progresses & the GFR falls below 50 mL/min, which changes occur?** **a.)** Metabolic acidosis **b.)** Hypokalemia **c.)** Hypercalcemia **d.)** Hypophosphatemia

Answer 47

**a.) Metabolic acidosis**

Question 48

**What 2 types of percussive sounds are heard with renal injuries?** | **KNOW THIS!!!!! IN RED**

Answer 48

* **Hyperresonance = Air** * **Dullness = fluid**

Question 49

**How is acute glomerular inflammation diagnosed?** | **KNOW THIS!!!!!**

Answer 49

urinalysis