Renal

Question 1

The nurse’s HIGHEST PRIORITY when caring for a patient with ESRD is the measurement of

Answer 1

I&O

Question 2

Lactated Ringer’s solution is contraindicated for patients with ESRD because it

Answer 2

May disturb electrolyte imbalance

Question 3

What dietary element is restricted in ESRD?

Answer 3

Protein

Question 4

Which food should the patient with ESRD avoid?

Answer 4

Bananas

Question 5

Which antacid is NOT appropriate for a patient with ESRD?

Answer 5

Antacids that contain magnesium

Question 6

When would antacids be administered to a patient with ESRD?

Answer 6

Within one hour after meals

Question 7

Which side effect is MOST COMMONLY associated with the antacids given to patients with ESRD?

Answer 7

Constipation

Question 8

Why are antacids given to patients with ESRD?

Answer 8

Antacids regulate the calcium level in the blood

Question 9

When should an insulin-dependent dialysis patient receive his insulin?

Answer 9

At the regularly prescribed time

Question 10

Which medications should be held before dialysis?

Answer 10

Antihypertensives
Nitro
Digoxin
Aminoglycosides
PCN
Cephalosporins
WATER SOLUABLE or DIALYZABLE DRUGS (analgesics Tylenol, ASA, GI drugs -dine)

Question 11

Which drugs can be administered during hemodialysis?

Answer 11

Protein-bound drugs
(analgesics codeine, methadone, morphine)
(antimicrobials doxy, erythromycin, Naf, Rif, Vanco)
Nitro
Corticosteroids
GI- Carafate
INSULIN

Question 12

1 kg of fluid equals how many mL?

Answer 12

1000 mL

Question 13

After dialysis, the nurse observes the patient’s gums bleeding. She expects the PCP to:

Answer 13

Lower the heparin dosage for the next dialysis treatment

Question 14

Which of the following is administered immediately after hemodialysis to stimulate RBC production?

Answer 14

Epogen

Question 15

The patient with a left arm access site should have a sign over the bed that reads?

Answer 15

No IVs or BP in the left arm

Question 16

When the nurse observes blood oozing from the access site, the most appropriate action is to

Answer 16

Apply direct pressure to the site

Question 17

When a fistula used for hemodialysis does not have a thrill, the nurse should?

Answer 17

Notify the PCP immediately

Question 18

Which activity order is most appropriate for a patient following dialysis?

Answer 18

Rest for several hours

Question 19

Dialyzable drugs are

Answer 19

water-soluable

Question 20

What hormone lowers blood calcium and phosphate levels?

Answer 20

Calcitonin (stores IN)

Question 21

Which hormone regulates serum calcium?

Answer 21

parathyroid hormone (pulls OUT of bone, muscle)

Question 22

Which hormone is overproduced in Cushing’s Syndrome?

Answer 22

Excess ACTH, which stimulates the adrenal cortex to overproduce glucocorticoids and androgens

Question 23

Signs of Cushing’s

Answer 23

Moon face
Buffalo hump
Truncal obesity
Osteoporosis (increase in fractures)

Question 24

Hirsutism in females in a sign of?

Answer 24

Cushing’s Syndrome

Question 25

Intervention: Increase calcium, vitamin D, and protein in the diet. Syndrome?

Answer 25

Cushing's

Question 26

Reassure pt that physical changes are a result of the increased hormone levels and will most likely resolve when levels return to normal is an intervention for?

Answer 26

Disturbed body image r/t abnormal fat distribution, muscle wasting, striae Cushings' and Thyroid

Question 27

What interventions can be done for a pt with dx of disturbed body image?

Answer 27

1. promote coping methods to help pt deal with changes in appearance, clothing, and grooming. 2. Assist pt in locating a support group.

Question 28

What interventions can be done for a dx of risk for infx/altered protein metabolism and inflammatory response?

Answer 28

Assess patient frequency for signs of infx such as increase in temperature (100.4)

Question 29

Adrenal insufficiency is the cause of what disease?

Answer 29

Addison's

Question 30

Addison's Disease

Answer 30

Inadequate production of the steroid hormones cortisol and aldosterone by the adrenal cortex

Question 31

S&S of Addison's

Answer 31

1. dehydration! 2. poor skin turgor 3. electrolyte imbalances - hyponatremia, hyperkalemia, hypoglycemia 4. fatigue 5. weight loss, anorexia 6. Peaked T waves on EKG (hyperK) 7. postural hypotension 8. diarrhea, GI cramping 9. muscle weakness

Question 32

IV glucose with parenteral hydrocortisone should be administered when?

Answer 32

Addison Crises - Medical Emergency

Question 33

What assessments will be seen in a pt with Addison's Disease?

Answer 33

``` Lethargy, fatigue, muscle weakness GI disturbances Weight loss hypoglycemia, hyponatremia Hyperkalemia, hypercalcemia Hypotension hyperpigmentation of the skin ```

Question 34

What assessments will be seen in a pt with Cushing's Disease?

Answer 34

``` Generalized muscle wasting and weakness moon face, buffalo hump truncal obesity with thin extremities hirsutism Hyperglycemia, hypernatremia Hypokalemia, hypocalcemia HTN Fragile skin that bruises easily reddish purple striae ```

Question 35

Addison Crisis precipitated by

Answer 35

stress, infection, trauma, surgery, or abrupt withdrawal of steroid use. Can cause shock.

Question 36

Intervention for Addison's dx of Risk for Deficient Fluid Volume r/t increase in Na and H2O excretion with K+ retention?

Answer 36

- Encourage oral fluids as tolerated - Instruct pt to ingest salt additives in conditions of excess heat or humidity - Administer parenteral fluids as ordered - Administer Kayexalate - Administer oral cortisone, hydrocortisone, prednisone

Question 37

Addison's interventions for dx risk for imbalanced nutrition?

Answer 37

- monitor weight trends - access foods pt can tolerate - monitor SERUM GLUCOSE - Assess for salt cravings