Renal patho, NP, pharm Flashcards
patho
Poorly controlled diabetes could have led to Mr Tan’s chronic kidney disease. How should the nurse explain the pathogenesis of chronic kidney disease resulting from diabetes mellitus type 2?
A. High blood sugar can damage small blood vessels in the kidneys eventually affecting filtration and other kidney functions.”
B. “Elevated sugar levels can increase the risk for infections which can ultimately affect kidney function.”
C. “If sugar levels are not maintained, they can cause an inflammatory response in the kidneys which results in damage.”
D. “Increased blood sugar affects the large blood vessels within the kidneys that reduces the kidneys’ filtering capacity.”
A
patho
The doctor advised Mr Song’s nurse to observe if the ulcer becomes open with partial thickness loss of skin. This is an indication that the pressure ulcer has progressed to:
A. stage 1
B. stage 2
C. stage 3.
D. stage 4
B
patho
ABG analysis was done on an AKl patient and revealed metabolic acidosis. What parameter changes should the nurse expect from the results that support this acid-base imbalance?
A. Increased pH, decreased PaCO2 decreased HCO3
B. Increased pH, Increased PaCO2 increased HCO3
C. Decreased pH, Increased PaCO2 Increased HCO3
D. Decreased pH, decreased PaCO2 decreased HCO3
D
Respi acidosis: HCO3 normal
Metabolic acidosis: HCO3 decreased because they bind to H+ to form carbonic acid H2CO3
Patho
Digital rectal examination was performed on Mr Chew. Which of the following findings suggest the presence of benign prostatic hyperplasia? The prostate is:
A. warm to touch.
B. nodular and hard,
C. enlarged and rubbery
C
patho
Increaged uric acid levels is a risk factor for gouty arthritis. What process(es) is/are involved in its development?
A. Urate super saturation and crystallisation
B. Filtration of urate
C. Hydrolysation of uric acid
D. Electrochemical oxidation of uric acid
A.
NPQ: The nurse educates the patient with osteoarthritis (OA) about the importance of:
- Maintaining a sedentary lifestyle
- Balancing rest and activity
- Eating a high-fiber dieta
2
NPQ: What is the primary goal of pharmacological therapy in managing gout?
- Relief of pain and inflammation during acute attacks
- Reducing blood pressure
- Increasing fluid intake
1
NPQ: What is the primary goal of nutritional managementin CKD?
- Increase protein intake
- Promote dietary fiber intake
- Prevent malnutrition and electrolyte imbalances
3
NPQ: Which parameter is closely monitored during -haemodialysis to assess fluid removal?
- Blood pressure
- Blood glucose level
- Blood urea nitrogen (BUN)
- Body Weight
4
NPQ: Which nursing intervention is important to preventcomplications associated with continuous bladder irrigation?
- Monitoring urine output hourly
- Changing the irrigation solution every 12 hours
- Assessing for signs of fluid overload
3
NPQ: Which of the following signs or symptoms should prompt immediate medical attention in a post-TURP patient?
- Mild hematuria with small blood clots
- Temperature elevation of 1°C above baseline
- Severe hematuria with large blood clots or decreased urineoutput
- Mild discomfort at the surgical site
3
WEB
A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply:
A. Hypervolemia
B. Hypokalemia
C. Increased BUN level
D. Decreased Creatinine level
A and C
The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney’s ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood…hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine.
WEB
_____________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine.*
A. Urea
B. Creatinine
C. Potassium
D. Magnesium
B.
Creatinine is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a creatinine clearance test is used as an indicator for determining renal function and for calculating the glomerular filtration rate.
WEB
A 55-year-old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury?
A. Post-renal
B. Intra-renal
C. Pre-renal
D. Intrinsic renal
C.
Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding…patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged.
WEB
Select all the patients below that are at risk for acute intra-renal injury?
A. A 45 year old male with a renal calculus.
B. A 65 year old male with benign prostatic hyperplasia.
C. A 25 year old female receiving chemotherapy.
D. A 36 year old female with renal artery stenosis.
E. A 6 year old male with acute glomerulonephritis.
F. An 87 year old male who is taking an aminoglycoside medication for an infection.
The answers are: C, E, and F.
These patients are at risk for an intra-renal injury, which is where there is damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury because there is an obstruction that can cause back flow of urine into the kidney, which can lead to decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is an issue with perfusion to the kidney.
WEB
A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient?
A. Low-sodium, high-protein, and low-potassium
B. High-protein, low-potassium, and low-sodium
C. Low-protein, low-potassium, and low-sodium
D. High-protein and high-potassium
C.
The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein, low-potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products, excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown (creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for hyperkalemia and fluid overload (needs low-potassium and sodium foods).
** from notes: sodium and fluid restriction diet**
WEB CKD
Which patient below is NOT at risk for developing chronic kidney disease?
A. A 58 year old female with uncontrolled hypertension.
B. A 69 year old male with diabetes mellitus.
C. A 45 year old female with polycystic ovarian disease.
D. A 78 year old female with an intrarenal injury.
The answer is C.
risk factors are:
Hypertension (A)
Diabetes mellitus (B)
Recurrent pyelonephritis
Glomerulonephritis
Polycystic kidney disease
Family history of CKD
History of exposure to toxins
Age over 65
Ethnicity
Options A, B, and D are all at risk for developing CKD. However, option C is not at risk for CKD
WEB CKD
A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood?
A. Calcium
B. Urea
C. Phosphate
D. Erythropoietin
The answer is B.
FROM NOTES: #2 Uraemic syndrome
Retention of metabolic wastes; could manifest as impaired healing, pruritus, dermatitis, uraemic frost (crystallised urea deposits on the skin)
.
.
This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this as well.
WEB CKD
You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply:
A. “This medication will help keep my calcium level normal.”
B. “I will take this medication with meals or immediately after.”
C. “It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication.”
D. “This medication will help prevent my phosphate level from increasing.”
The answers are B and D.
FROM NOTES: Calcium acetate treats calcium deficiency and control hyperphosphotemia (D). side effect of abdomen discomfort –> take with food (B)
;
;
Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient’s phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.
WEB CKD
A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a:
A. Low protein, low sodium, low potassium, low phosphate diet
B. High protein, low sodium, low potassium, high phosphate diet
C. Low protein, high sodium, high potassium, high phosphate diet
D. Low protein, low sodium, low potassium, high phosphate diet
The answer is A. The patient should follow this type of diet because protein breaks down into urea (remember patients will have increased urea levels), low sodium to prevent fluid retention, low potassium to prevent hyperkalemia (remember glomerulus isn’t filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia.
WEB UTI
You’re caring for a patient with an indwelling catheter. The patient complains of spasm like pain at the catheter insertion site. Which of the following options below are other signs and symptoms the patient could experience or the nurse could observe if a urinary tract infection was present? SELECT-ALL-THAT-APPLY:
A. Increased WBC
B. Crystalluria
C. Positive McBurney’s Sign
D. Feeling the need to void even though a catheter is present
E. Dark and cloudy urine
F. Cramping
The answers are A, D, E and F. These are common signs and symptoms of a urinary tract infection. Options B and C are not.
WEB UTI
On your nursing care plan for a patient with a urinary tract infection, which of the following would be appropriate nursing interventions? SELECT-ALL-THAT-APPLY:
A. Encourage voiding every 2-3 hours while awake.
B. Restrict fluid intake to 1-2 liters per day.
C. Monitor intake and output daily.
D. The patient verbalizes the importance of using vaginal sprays to decrease reoccurrence of urinary tract infections prior to discharge home.
The answers are A and C.
Option D is wrong become this is not a nursing intervention but a patient goal. In addition, it is an incorrect patient goal for preventing UTIs. Vaginal sprays should be avoided. Option B is wrong because fluid intake should be encouraged of 2-3 liters per day. This will help the urinary system flush out the presenting infection.
WEB UTI
You’re providing discharge teaching to a female patient on how to prevent urinary tract infections. Which statement is INCORRECT?
A. “Void immediately after sexual intercourse.”
B. “Avoid wearing tight fitting underwear.”
C. “Try to void every 2-3 hours.”
D. “Use scented sanitary napkins or tampons during menstruation.”
The answer is D.
Options A, B, C are all correct statements in how to avoid a UTI. Option D is wrong because the patient should AVOID scented sanitary napkins or tampons during menstruation. It is also best to use sanitary napkins that are NOT SCENTED and AVOID using tampons (scented or not scented).
WEB UTI
A patient with a urinary tract infection is taking Bactrim (Sulfamethoxazole/Trimethoprim). As the nurse you know it is important that the patient consumes 2.5 to 3 L of fluid per day to prevent which of the following complications?
A. Brown urine
B. Crystalluria
C. Renal Stenosis
D. Renal Calculi
The answer is B. Antibiotics called sulfonamides such as Bactrim (Sulfamethoxazole/Trimethoprim) can cause crystalluria. This complication tends to happen when the urine is concentrated. Therefore, the patient should consume 2.5 to 3L of fluid per day to keep the urine diluted.
