NUR425 EXAM 4 PRACTICE QUESTIONS AND CORRECT ANSWERS
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Course
NUR 425
Institution
NUR 425
Which kidney disease is sudden? Acute kidney injury (AKI)
Which kidney disease is gradual, often occurring over many years? Chronic kidney disease
What is the most common cause of AKI? Acute tubular necrosis
What is the most common cause of chronic kidney disease? Diabetic nephropathy
What are ...
NUR425 EXAM 4 PRACTICE QUESTIONS
AND CORRECT ANSWERS
Which kidney disease is sudden? ✅Acute kidney injury (AKI)
Which kidney disease is gradual, often occurring over many years? ✅Chronic kidney
disease
What is the most common cause of AKI? ✅Acute tubular necrosis
What is the most common cause of chronic kidney disease? ✅Diabetic nephropathy
What are the two main diagnostic criteria for AKI? ✅-Acute reduction in urine output
-Elevation in serum creatinine
The diagnostic criteria for chronic kidney disease includes a GFR of less than
_______mL/min for more than ________ months. ✅-GFR less than 60mL/min/1.73m2
for more than three months
-Kidney damage greater than three months
Which kidney disease is possibly reversible? Which is progressive and irreversible?
✅AKI is potentially reversible, chronic kidney disease is progressive and irreversible.
The primary cause of death for AKI is __________ ✅Infection
The primary cause of death for chronic kidney disease is ______________
✅Cardiovascular disease
What are the three types of AKI? ✅-Prerenal (decreased perfusion - think of things that
cause reduced blood flow to kidneys)
-Intrarenal (damage in kidney)
-Postrenal (damage restriction/blockage in kidney)
This term means increased nitrogen waste like urea and creatinine in the blood
✅Azotemia
This term means reduced urine output ✅Oliguria
What happens with high potassium that we are concerned about? ✅Cardiac
dysrhythmias
,This phase of AKI is when there is fluid volume excess from the kidneys inability to
process anything. High sodium and potassium in the blood result. Waste products
accumulate and neurologic disorders can occur, including a low specific gravity.
Metabolic acidosis tends to occur. It usually lasts 10-14 days if we can catch it.
✅Oliguric phase
Oliguric phase means a daily urine output of ________ or less ✅400mL
This phase of AKI is when we begin treating a patient in the oliguric phase. Urine output
skyrockets and the buildup of electrolytes in the blood begind to drop rapidly. Because
of this we should monitor closely to make sure the kidneys don't overshoot the mark and
bring potassium/sodium too low. ✅Diuretic phase
This phase of AKI is LONG TERM as the kidneys continue returning to baseline
function. ✅Recovery phase
May take up to ____ months for kidney function to stabalize ✅12
Nursing assessment of AKI ✅Cause of AKI, signs and symptoms, associated health
history. A big one is to kind out if they take way too much OTC drugs. Look for
edema/HTN, neuro changes. Monitor for the signs we talked about.
Nursing implementation for AKI ✅-Health promotion
-Acute intervention-support elimination of cause and symptom management
-Possibly include a fluid restriction, maybe daily weights. We want to discover the
reason for their injury and treat it.
What is our primary collaborative care therapies for AKI? ✅-Fluid restriction related to
acute nature of kidney injury and ability to function
-Nutritional therapy
-Renal replacement therapy (dialysis)
As part of our nutritional therapy for AKI, we usually encourage __________ dietary fat
intake while ____________ sodium and protein. ✅-Reduce sodium and protein
-Increase dietary fat
-Maintain adequate calorie intake and maybe need enteral feeds
This is the last resort for someone with AKI to assist them with doing what their kidneys
cant ✅-Renal replacement therapy (dialysis)
Leading causes of chronic kidney disease ✅
This term describes a common characteristic of chronic kidney disease which is
characterized by frequent unination, but the inability of the kidneys to concentrate urine,
,occuring most often at night, with a specific gravity fixed around 1.010. Frequent, low-
density urine output. ✅Polyuria
This term means a urine output lower than 40mL in 24 hours ✅Anuria
What type of metabolic disturbances occur in chronic kidney disease? ✅-Waste
product accumulation
Urea Nitrogen, creatinine, hormones,
What can we do for the hyperkalemia seen often in the oliguric phase of kidney issues?
✅-Give glucose and insulin
-Insulin makes your glucose and potassium go back into the cell
Why do we give calcium to someone with hyperkalemia? ✅Not because it helps with
potassium, but it will protect the heart from the irritability that occurs from the
hyperkalemia. It's not a long-term fix.
What medication can we give to our patients for a high potassium? ✅-Kayexelate
-Binds to the potassium and they will defecate it out
What happens to phosphate and calcium? ✅-Increase in phosphate and decrease in
calcium
What happens with magnesium in kidney injuries? ✅May be borderline high. We
usually don't need to do much about it, but watch what we give to the patient that has
mag in it.
What do we see happen to the cardiovascular system in chronic kidney disease?
✅Hypertension
Heart failure
Left ventricular hypertrophy
Peripheral edema
Dysrhythmias
Uremic pericarditis
Effects on the neurologic system ✅-Neurologic changes are expected as renal failure
progresses
-Attributed to: ↑ Nitrogenous waste products,
electrolyte imbalances,
Metabolic acidosis,
, Atrophy,
Demyelination of nerve fibers
What will we see in the hematologic system in these patients with CKD? ✅-Anemia
-Bleeding tendencies
-Infection
-"Epogen" is a supplement that can help with EPO.
-Folic acid and iron can help with anemia as well
Why do we want to know if patient is taking NSAIDS (ibuprofen, aspirin, etc) ✅It can
be toxic to the kidneys if taken in excess
Nursing diagnosis for these types of kidney injuries ✅-Excess fluid volume
-Risk for injury
Imbalanced nutrition: Less than body requirements
-Grieving
-Risk for infection
Goals for patients with chronic kidney disease ✅-Demonstrate knowledge and ability to
comply with therapeutic regimen.
-Participate in decision making.
-Demonstrate effective coping strategies.
-Continue with activities of daily living within physical/psychologic limitations.
Drug therapy for CKD ✅Hyperkalemia
Hypertension
CKD—mineral and bone disease
Anemia
Dyslipidemia
Nutritional therapy for CKD ✅-Protein restriction (some doctors encourage normal
intake, you need enough for nitrogen balance (1.2g/kg/day)
Water: not routinely restricted in pts with stages 1-5 not on HD- diuretics instead
HD pts- more restricted fluid intake than PD patients- HD pts with diminishing urine
output, fluids restricted
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