Renal System

Question 1

Functions of the kidneys

Answer 1

Maintenance of proper fluid volume, regulation of electrolytes and acid-base balance, elimination of waste products such as urea, uric acid, ammonia, creatinine, regulation of BP through renin, enable RBC production through release of erythropoietin, convert vitamin D to active form essential for calcium absorption

Question 2

Urinalysis should NOT include

Answer 2

Glucose, ketones, blood, protein, bilirubin, nitrates, leukocyte esterase

Question 3

Normal creatinine

Answer 3

0.6-1.2

Question 4

Normal BUN

Answer 4

10-20

Question 5

Small amount of urine loss that occurs with abdominal pressure from laughing, coughing, sneezing caused by a weakened pelvic floor

Answer 5

Stress incontinence

Question 6

Stress incontinence risk factors

Answer 6

Menopause, obesity, constipation, pelvic surgery

Question 7

Stress incontinence treatment

Answer 7

Kegel exercises, weight reduction, estrogen, vaginal cone therapy

Question 8

With _________ incontinence, the patient is unable to reach the bathroom in time due to an overactive destructor muscle (smooth muscle in bladder)

Answer 8

Urge

Question 9

Urge incontinence treatment

Answer 9

Anticholinergics (oxybutynin), bladder training, toileting schedule, avoid caffeine and alcohol

Question 10

Bladder analgesic that can decrease pain and urgency associated with UTI

Answer 10

Phenazopyridine

Question 11

S/S of acute pyelonephritis

Answer 11

Costovertebral tenderness, flank or back pain, fever, chills, N/V, tachycardia, tachypnea, hypertension

Question 12

Labs associated with pyelonephritis

Answer 12

Elevated WBC, creatinine, BUN, CRP, ESR

Question 13

Autosomal dominant genetic disorder that causes the formation of fluid filled cysts in the kidneys

Answer 13

Polycystic kidney disease (PKD)

Question 14

PKD S/S

Answer 14

Abdominal distention, flank or back pain, hypertension, hematuria

Question 15

Glomerulonephritis risk factor

Answer 15

Strep infection

Question 16

S/S of glomerulonephritis

Answer 16

Oliguria, s/s of fluid volume excess, brown cola-colored urine

Question 17

Labs associated with glomerulonephritis

Answer 17

Elevated creatinine, BUN, WBC, ESR, CRP, (+) ASO titer, proteinuria, hematuria

Question 18

Glomerulonephritis treatment

Answer 18

Antibiotics to treat strep infection, diuretics, Anti-hypertensive agents, corticosteroids, Plasmapharesis, dialysis, kidney transplant

Question 19

Glomerulonephritis nursing care

Answer 19

Monitor I&Os, daily weight, decreased fluid, sodium, and protein intake until kidneys heal

Question 20

Kidney disorder characterized by massive loss of protein in urine

Answer 20

Nephrotic syndrome

Question 21

Symptoms of nephrotic syndrome

Answer 21

Edema — periorbital, ascites, peripheral; frothy urine

Question 22

Labs associated with nephrotic syndrome

Answer 22

Hypoalbuminemia, hyperlipidemia, massive proteinuria (2+)

Question 23

Nephrotic syndrome treatment

Answer 23

Corticalsteroids, diuretics, 25% albumin, statins

Question 24

Nephrotic syndrome nursing care

Answer 24

Monitor I&Os, I&Os, daily weight, abdominal girth daily, implement fluid and sodium restrictions, moderate protein intake, prevent skin breakdown, monitor for infection d/t corticosteroids

Question 25

S/S of urolithiasis

Answer 25

Severe pain on the flanks, the back, lower abdomen, dysuria, fever, diaphoresis, N/V, tachycardia, tachypnea, oliguria, hematuria

Question 26

Urolithiasis post-lithotripsy nursing care

Answer 26

Screen urine for stone fragments that may be passed, monitor I&Os

Question 27

Urolithiasis patient education

Answer 27

Increase fluid intake (3 L/day), limit foods according to type of calculi

Question 28

Sudden loss of kidney function that is typically reversible

Answer 28

Acute kidney injury (AKI)

Question 29

The gradual, irreversible loss of kidney function

Answer 29

Chronic kidney disease (CKD)

Question 30

General underlying causes of acute kidney injury

Answer 30

Prerenal AKI: decrease blood flow to the kidneys due to sepsis, shock, hypovolemia Intrarenal AKI: direct damage to the kidneys by trauma, hypoxic injury, or chemical injury due to toxins or medication‘s such as gentamicin Post renal AKI: mechanical obstruction to urine leaving the kidneys caused by stone, tumor, or BPH

Question 31

Phases of AKI

Answer 31

Onset, oliguria, diuresis, recovery

Question 32

Labs associated with AKI

Answer 32

Hyperkalemia, hyponatremia, hypocalcemia, hypermagnesemia, metabolic acidosis, anemia

Question 33

AKI nursing care

Answer 33

Implement seizure precautions,monitor I&Os and daily weight, educated patient to reduce/restrict potassium, sodium, phosphorus, and magnesium intake

Question 34

CKD risk factors

Answer 34

Older age, dehydration, AKI, hypertension, diabetes, medication’s, autoimmune disorders

Question 35

S/S of CKD

Answer 35

Fluid volume overload, pruritis, N/V, uremic frost

Question 36

Labs associated with CKD

Answer 36

Elevated potassium, phosphorus, magnesium, creatinine, BUN Decreased Sodium and calcium, Hgb, Hct, GFR

Question 37

Stage five (end stage) renal disease GFR

Answer 37

<15

Question 38

CKD nursing care

Answer 38

Monitor I&Os, daily weight, restrict fluid, sodium, potassium, phosphorus, and magnesium

Question 39

CKD patient education

Answer 39

Avoid nephrotoxic drugs (NSAIDs, contrast dye, magnesium-containing antacids)

Question 40

Nursing care/consideration of hemodialysis patient with AV fistula

Answer 40

Do NOT take BP or venipuncture on that arm, if advice, patient not to carry heavy objects or sleep on that arm

Question 41

Nursing care for AV fistula

Answer 41

Auscultate bruit, palpate thrill

Question 42

Nursing actions prior to dialysis

Answer 42

Obtain patient, vital signs, weight, and labs, hold certain medications until after dialysis

Question 43

Nursing actions during dialysis

Answer 43

Monitor for hypotension and adverse effects like cramping, N/V, bleeding associated with heparin

Question 44

Nursing actions post-dialysis

Answer 44

Measure patient weight and vitals (decrease in weight and BP is expected), compare weight to pre-procedure weight

Question 45

Solution used for peritoneal dialysis

Answer 45

Hypertonic

Question 46

Peritoneal dialysis nursing considerations

Answer 46

Sterile technique, keep outflow lower than patients abdomen, monitor color of outflow (should be clear or light yellow; if bloody or cloudy — could mean infection)

Question 47

Complications of hemodialysis

Answer 47

Disequilibrium syndrome (neurologic deterioration associated with cerebral edema and increased ICP), hypotension (administer IV fluids and colloids, slow infusion rate and lower HOB)

Question 48

Complications of peritoneal dialysis

Answer 48

Peritonitis (fever, cloudy outflow, N/V, abdominal pain and tenderness)

Question 49

Kidney transplant post-op nursing care

Answer 49

Closely monitor UOP, monitor bladder irrigation for clots, monitor for infection, monitor for signs of organ rejection (fever, pain, weight gain, HTN, increased creatinine, BUN, WBC)

Question 50

Kidney transplant patient education

Answer 50

No contact sports, monitor for infection and rejection, monitor BP daily, immunosuppression such as cyclosporine for life