Intermediate Med Surg Final
Stage 1 renal disease GFR rate
Greater than, or equal to, 90
Stage 2 renal disease GFR rate
Stage 3 renal disease GFR rate
Stage 4 renal disease GFR rate
Stage 5 renal disease (kidney failure) GFR rate
Leading causes of chronic kidney failure
diabetes and hypertension
As GFR levels decrease, BUN and creatinine levels
__________ is considered the most accurate indicator of kidney function
Serum creatinine clearance determinations
Potassium in kidney disease causes
Fatal dysrhythmias have been reported when serum potassium levels reach 7 to 8 mEq/L
Potassium imbalance in kidney disease results from
The decreased secretion of potassium by the kidneys (hyperkalemia), the breakdown of cellular protein, bleeding, and metabolic acidosis.
Impaired sodium excretion, sodium and water are retained. Sodium retention can contribute to edema, hypertension, and heart failure.
Metabolic acidosis results from
The kidneys' impaired ability to excrete acid, and from defective reabsorption and regeneration of bicarbonate
Most common cause of death in patients with chronic kidney disease is
Cardiovascular diseases, such as: Myocardial infarction, ischemic heart disease, peripheral arterial disease, heart failure, cardiomyopathy, and stroke
In severe acidosis, the respiratory system may attempt to compensate with
Kussmaul breathing which results in increased carbon dioxide removal by exhalation.
Chronic kidney disease mineral and bone disorder (CKD-MBD) develops as
A systemic disorder of mineral and bone metabolism caused by progressive deterioration in kidney function.
Usually the first indication of kidney damage is
Screening for chronic kidney disease involves
A dipstick evaluation of protein in the urine or evaluation for microalbuminuria
RBCs, WBCs, protein, casts and glucose
Ultrasounds of the kidneys can detect
Obstructions and the size of the kidneys
Equations to estimate GFR are
Crockcroft-Gault formula and Modification of diet in Renal Disease Study equation
What is end stage renal disease (ESRD)?
Occurs when the GFR is less than 15 mL/min; dialysis or transplantation is required to maintain life
A nurse is caring for a client who has nephrotic syndrome and has been taking prednisone for 3 days. What adverse effect should the nurse monitor for and report to the provider?
Sore throat
Glucocorticoids depress the natural immune system and increase the client's risk for infection. A sore throat can indicate an infection
A nurse working in a women's health clinic is caring for a client who reports urinary urgency and dysuria. Which additional findings should the nurse identify as an indication of a UTI?
Pyuria
The RN should ID pyuria, which is WBCs in the urine, as a common manifestation of a UTI
A nurse is caring for a client following extracorporeal shock wave lithotripsy (ESWL) for the treatment of calcium phosphate kidney stones. Which action is appropriate for the nurse to take?
Strain all of the client's urine
A nurse is caring for a hospitalized client who received hemodialysis 1 hr ago. When evaluating the client's status after dialysis, which information should the nurse assess for first?
Vital Signs
When using the ABC approach to client care, the nurse should determine that the priority information to assess is the client's V/S.
A nurse is obtaining a voided urine culture and sensitivity for a client who has manifestations of a UTI. What instructions should the nurse give?
Instruct the client to initiate the flow of
urine before collecting the specimen
The nurse should instruct the client to pass a sterile container into the urine stream after initiating the flow of urine
A nurse is discussing hemodialysis with a newly licensed nurse. The nurse should ID that hemodialysis is contraindicated for which clients?
A client who cannot receive anticoagulants
Anticoagulants are required for clients receiving hemodialysis to prevent clot formation. Therefore,
hemodialysis is contraindicated for a client who cannot receive anticoagulants
A nurse is providing discharge teaching for a client who has chronic kidney disease. Which statement by the client indicates an understanding of the teaching?
I will decrease my intake of foods high in phosphorus"
Clients who have CKD should limit the intake of foods high in phosphorus due to the decrease in the kidney's ability to excrete it
A nurse is planning care for a client who has acute glomerulonephritis. The nurse should plan to provide which interventions?
Weigh the client daily
The nurse can monitor fluid retention by weighing the client daily
A nurse is caring for a client who has received hemodialysis. The nurse should ID that which of the following findings places the client at risk for seizures?
A rapid decrease in fluid
A rapid decrease in fluid can
result in cerebral edema and increased intracranial pressure, placing the client at risk for seizures
A newly licensed nurse and a nurse preceptor are caring for a client who has just had an arteriovenous shunt placed in her left arm. Which of the following actions by the newly licensed nurse requires intervention by the preceptor?
Measuring BP in the shunted arm every 4 hr
Measuring BP in the shunted arm requires intervention by the preceptor
A nurse is providing education regarding cyclosporine for a client who had a kidney transplant 2 days ago. Which statement by the nurse is appropriate?
You will need to continue taking this medication to protect your new kidneys"
Clients must take cyclosporine daily for the life of the transplanted organ.
A nurse is caring for a client the night before a scheduled IV urography. What is the nurse's priority intervention?
Determine if the client has an allergy to iodine or shellfish
The greatest risk to the client is injury or death from an allergic reaction to radiopaque contrast media. The nurse should determine if the client has an allergy to iodine or shellfish, which
A nurse is performing an admission assessment on a client who has severe chronic kidney disease. What findings should the nurse expect for this client?
Tachypnea
The nurse should
expect the client who has severe CKD to have tachypnea due to metabolic acidosis
A nurse working in the emergency department is caring for a client who reports costovertebral angle tenderness, nausea, and vomiting. Which laboratory values should the nurse notify the provider?
WBC 15,000/mm3
The WBC count is above the expected reference range and indicates the presence of an infection. The nurse should report the laboratory value to the provider
The nurse is providing teaching for a client who has urge urinary incontinence. The nurse should include which instructions?
Set an interval for toileting based on previous voiding pattern
When the client can maintain continence, the length of time between voids is gradually increased. The nurse should establish a toileting schedule to coincide with the client's voiding pattern
A nurse is providing instructions regarding reduced dietary intake of potassium for a client who has chronic kidney disease. Which food selections is appropriate for the nurse to recommend to the client?
One large apple
Of the listed foods, one large apple is the lowest in potassium, containing 239 mg per serving. Other high-potassium foods are: apricots, avocados, bananas, cantaloupe, dried fruits, grapefruit, honeydew, orange juice, prunes, raisins, bak
A nurse is planning care for a client who is post operative following a nephrectomy. Which assessment is the priority for the nurse to evaluate?
Blood pressure
The greatest risk to the client is acute adrenal insufficiency. The adrenal gland can be removed or damaged during nephrectomy. The nurse should evaluate the client for hypotension, decreased urine output, and decreased level of consciousne
A nurse is preparing a teaching plan for a male client who has a continent internal ileal reservoir following surgery to treat bladder cancer. Which statement should the nurse include in the teaching plan?
You must insert a catheter through your stoma to drain the urine.
A nurse is reviewing the laboratory reports of a client who has acute kidney injury. Which findings should the nurse expect?
- BUN 30 mg/dL
- Urine output of 40 mL in past 3 hr.
- Hematocrit 30%
BUN is expected to be elevated with
AKI
Oliguria with a urine output 100-400 mL per 24 hr is expected
Hematocrit level being decreased is expected
A nurse is caring for a client who has acute kidney injury. Which laboratory findings should the nurse report to the provider?
Serum creatinine 4.0 mg/dL
The nurse should report the client's serum creatinine level to the provider. This finding is outside of the expected reference range
A nurse is caring for a client who has continuous bladder irrigation following a transurethral resection of the prostate. Upon detecting an output obstruction, which actions should the nurse take first?
Check the irrigation tubing for kinks
The first action the nurse should take is to check the irrigation tubing for kinking or clots as these can prevent outflow of fluids
A nurse is providing teaching for a client who has chronic kidney disease. Which client statements indicates an understanding of the teaching?
I will weigh myself each morning"
The client who has CKD should monitor his weight every morning at the same time to provide an accurate assessment of fluid balance
A nurse is planning care for a client who is scheduled to undergo extracorporeal shock wave lithotripsy (WSWL) for urolithiasis. Which actions should the nurse plan to take?
Apply electrodes for cardiac
monitoring
The nurse should apply electrodes for continuous monitoring of the client's cardiac rhythm during ESWL. This monitoring allows the provider to deliver shock waves that are synchronized with the R wave
A nurse is caring for a client immediately following a kidney transplant. The nurse should ID which client findings as a possible indication of a delay in functioning of the transplanted kidney?
Urine output 30 mL/2 hr
A minimum urine
output of 30 mL/hr is expected following a renal transplant. The nurse should monitor for adequate output for a decrease in the hourly output
A nurse is planning care for a group of clients. Which clients should the nurse plan to monitor for signs of nephrotoxicity?
A client who is receiving gentamicin for treatment of a wound infection
Aminoglycoside antibiotics can injure cells of the proximal renal tubules, causing acute tubular necrosis. The
nurse should plan to monitor this client for nephrotoxicity and acute ki
A nurse is reviewing the medical records of four clients. Whichconditions is a risk factor for chronic pyelonephritis?
Diabetes mellitus
A client who has a history of diabetes mellitus is at risk for the development of chronic pyelonephritis due to reduced bladder tone.
A nurse is teaching a client who has a new diagnosis of acute pyelonephritis. Which instructions should the nurse include in the teaching?
Avoid the use of NSAIDs for pain
The nurse should instruct the client to avoid the use of NSAIDs for pain, which can further damage the kidney
A nurse is caring for a client who has chronic kidney failure and the following laboratory results: BUN 196 mg/dL, sodium 152 mEq/L, and potassium 7.3 mEq/L. Which of the following interventions should the nurse implement?
Infuse
regular insulin in dextrose 10% in water
The client who has an elevated potassium level should receive regular insulin with dextrose 10% in water by continuous IV infusion to facilitate moving potassium out of the extracellular fluid into intracell
A nurse is assessing a client who has chronic kidney disease and has completed her third peritoneal dialysis treatment. Which of the following findings should the nurse report to the provider?
Cloudy
dialysate effluent
Cloudy or opaque drainage is an early manifestation of peritonitis. The nurse should notify the provider immediately because infection can be a life-threatening complication.
A nurse is performing an admission assessment of a client who has acute glomerulonephritis. The nurse should expect which of the following findings?
Dark-colored urine
The client who has acute glomerulonephritis usually has urine that is a dark,
reddish-brown color
What are the classifications of antacids used in renal failure?
Kayexelate and calcium-based binders.
Bind phosphate to bowel, administer with each meal, may cause constipation.
Reasons behind contraindication of magnesium containing antacids?
Contraindicated for patients with kidney failure because of spontaneous hypermagnesia. Excessive aluminum preparations lead to osteomalacia. Decreases phosphate absorption. Take with meals, take 2 hours before or after digoxin.
Name some commonly used antacids in renal failure?
Aluminum hydroxide (amphojel)
Aluminum carbonate (Basaljel)
Calcium carbonate (Tums)
Diet for a patient with CKD?
Normal protein & water intake
Restrict phosphate (1,000)
Restrict potassium (2,000-3,000)
Restrict sodium (2,000-4,000)
Shunts the blood to a dialyzer then back to the body
Contraindications for hemodialysis
Extremely low BP
ICP/hemorrhage
Uncontrolled DM
Arrhythmia/MI
What is disequilibrium syndrome?
Rapid decrease of BUN. Signs and symptoms are ICP, cerebral edema, nausea, vomiting, seizures, and agitation
What is the treatment for disequilibrium syndrome?
Administer anticonvulsants and barbiturates & slow dialysis exchange rate
Which risk factors should the nurse discuss with the client concerning reasons for hearing loss? Select all that apply?
a. Perforation of the tympanic membrane
b. Chronic exposure to loud noises
c. Recurrent ear infections
d. Use of nephrotoxic medication
A (the tympanic membrane is the eardrum, if it is punctured it may lead to hearing loss)
B (Loud persistent noise,
such as heavy machinery, engines, and artillery, over time may cause noise-induced hearing loss)
C (Multiple ear infections scar the tympani
The nurse is preparing to administer otic drops into an adult client's right ear. Which intervention should the nurse implement?
a. Grasp the earlobe and pull it back and out when putting drops in the ear
b. Insert the eardrops without touching the outsid
D (This will straighten the ear canal so the eardrops will enter the ear canal and drain toward the tympanic membrane)
What is the most preventable cause of hearing loss?
a. Virus
b. Ototoxic substances
c. Noise
d. Otitis media
The nurse is speaking to a patient about his new hearing aid. The patient is upset, and tells the nurse he is reluctant to begin wearing a hearing aid. What are the reasons cited most often for reluctant use of a hearing aid? (select all that apply)
a. Ri
The nurse is teaching a class of new registered nursing students about presbycusis. Which statement by the student shows understanding of the sensory classification of presbycusis?
a. Sensory presbycusis is when there are degenerative changes in the cochl
A nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the
following as an associated risk factor?
a. Ag
The occupational health nurse is preparing a presentation to a group of factory workers about preventing colon cancer. Which information should be included?
a. Wear a high filtration mask around chemicals
b. Eat several servings of cruciferous vegetables
A nurse is admitting a male client with a diagnosis of adenocarcinoma of the rectosigmoid colon. Which assessment data support this diagnosis?
a. Reports
up to 20 bloody stools per day
b. States he has a feeling of fullness after a heavy meal
c. Has diarr
A nurse is reviewing the bowel prep using polyethylene glycol (GOLYTELY) with a client scheduled for a colonoscopy. Which of the following should be included in the teaching?
a. Check with the provider about taking current medications when consuming bowel
The 85 y.o. male client diagnosed with colon cancer asks the nurse, "Why did I get colon cancer?"
Which is the best risk factor for this client?
a. Lack of fiber in the diet
b. Greatest incidence among those younger than 50
c. Has no known risk factors
d.
While undergoing radiation therapy for lung cancer, the patient develops dry, itchy, and flakey skin. The health care provider will recommend the patient to:
1. Use an exfoliator to remove dead cells from the irritated area.
2. Cleanse the area with lukew
Which of the following is not a
risk factor for lung cancer?
1. smoking
2. exposure to chemicals
3. genetic links
4. diabetes
Which of the following symptoms is most characteristic of a client with a cancer of the lung?
A. Air hunger
B. Exertional dyspnea
c. Cough with night sweats
D. Persistent changing cough
A 62-year-old woman presents to your clinic for a regularly scheduled examination. She has no new complaints, but she is concerned about her risk of developing lung cancer. She has smoked one pack of cigarettes a day since she was 18 years old. She asks w
The nurse writes a problem of "Impaired Gas Exchange" for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care? (Select All That Apply)
1. Apply O2 via nasal cannula
2. Have the dietitian plan for six (6)
Hyperkalemia signs and symptoms
dysrhythmias, weakness, peaked-t wave, widened QRS complex
Myocardial Infarction EKG results
ST elevation, t wave inversion, abnormal Q wave
ST depression, T inversion
Positioning for peritoneal dialysis
Raise the head up so the fluid is not exerting pressure on the diaphragm
Renal failure electrolyte imbalances
Hyperkalemia, Hyperphosphatemia, Hypomagnesemia, Hypocalcemia, Hyponatremia (or normal depending on dilution)
Foods not high in phosphorus
Cataract signs and symptoms
Blurred vision, abnormal color perception, halos around light
Glaucoma signs and symptoms
Pain and loss of peripheral vision main difference
Early signs of laryngeal cancer
Late signs of laryngeal cancer
Dysphagia and difficulty swallowing
When does weight loss occur as a sign or symptom of cancer?
Bicarbonate normal level HCO3
Phosphorus/phosphate normal level
1.8 to 3.0 mg/dL or 1.5 to 2.5 mEq/L
Skin changes when undergoing radiation
Photosensitivity; have client wear protective clothing, go outside in the evening when the sun is down
What to do for the mark from chemotherapy
Nothing, leave it alone. Apply only aloe, wear loose fitting clothing
The colostomy should be which color
A colostomy that is purplish in color means
Impaired circulation which can indicate colorectal cancer
Intraocular pressure in glaucoma
Normal intraocular pressure
Mitotics method of action
Constrict the pupil and allows for better circulation
Main side effect of mitotics
Mydriatics method of action
Mydriatics main side effect
Reddening and flushing of the face
Signs and symptoms of peritonitis
Cloudy outflow during peritoneal dialysis
Nursing action if pain during peritoneal dialysis
Slow down, if the client is still in pain stop the treatment and call the HCP
Thrombocytopenia lab value and precautions
Low platelets, bleeding precautions
Neutropenia lab value and precautions
Low neutrophils, infection precautions
Cholecystitis signs and symptoms
Positive Murphy's sign and pain radiating to the back
Cholecystitis nutrition plan
Low-fat and low-cholesterol
Multiple sclerosis exacerbations
Fatigue, pregnancy, extreme weather, stress
How to relieve exacerbations of multiple sclerosis
Patient's who have __________ should not have a big meal at night
Stimulates erythropoiesis
Epogen contraindicated if
HGB >12 : risk for heart failure
Beta-blockers are contraindicated in
COPD and asthma patients (or any respiratory in general)
Adverse effects of beta-blockers
Bronchoconstriction, bradycardia, masks the effects of hypoglycemia
Position of patient after cataract surgery
Keep the head elevated and looking straight to keep intraocular pressure down
What to watch for with radiation treatment to the larynx
Biggest risk for kidney transplant
Precautions during chemotherapy treatment
No fresh fruit, change the water every 15 to 20 minutes, use special chemotherapy gloves when handling waste products, do not allow sick people to interact with the patient, do not allow pregnant patients in the room
Denial, anger, bargaining, depression, acceptance
Drug of choice for lung cancer
Cytoxin (cyclophosphamide)
Breast cancer drug of choice
Drug used to treat leukemia
What safety checks are needed when walking into a patient's room
2 side rails up, breaks are applied on the bed, call light is within reach, no-slip socks are on the feet of the client
Cause of glomerulonephritis
Main intervention for glomerulonephritis
What does bright red blood from an NG tube mean?
What does coffee ground blood from an NG tube mean?
When should a patient be weighed?
At the same time each day, preferably in the morning
How to give nitroglycerin
Up to 3 times, 5 minutes apart
Where to store nitroglycerin
Once opened, how long is nitroglycerin good for?
How will the client know if the nitroglycerin is working?
There will be tingling under the tongue
What is an expected side effect of nitroglycerin?
Headache, treat with acetaminophen (Tylenol)
Before giving Digoxin, the nurse needs to
Check the apical pulse for 1 full minute, hold if <60
When does colorectal screening begin?
50 years old, if African-American 45 years old, if there is a family history 30 years old
How to check for hypocalcemia
Percuss the facial nerve to check for Chvostek's sign, for Trusseau's sign there will be a muscle spasm of the hand when the blood pressure cuff is applied for 3 minutes
Who is at the highest risk for prostate cancer?
Teaching for a hearing aid
Reposition it if it begins buzzing, the battery is good for about 1 week,
What to do for neutropenia
The patient is predisposed to infection from opportunistic pathogens; infection precautions
Disequilibrium syndrome treatments
Antibarbituates and anticonvulsants
What is spironolactone indicated for?
It is a potassium-sparing diuretic used when potassium is being lost
Spironolactone adverse reaction
Lab test for heart failure
Lab test for myocardial infarction
Low protein until stage 5
Protein intake during peritoneal dialysis
Increase protein intake because of protein lost during dialysis
How much oxygen can be given via nasal cannula
Signs and symptoms of internal bleeding
Hypertension and tachycardia
Reason for Amphojel to be given for chronic kidney disease or renal failure
It decreases phosphate levels
Take with meals to bind the phosphate in food and stop phosphate absorption
Muscles of facial expression
Tues, Thurs, Sat
or
Mon, Wed, Fri
3 times per week
pt 11 to 12 seconds
INR 2 to 3
What to do if a client complains of leg cramps during hemodialysis
Primary issue for glaucoma
Early detection is best, place the client on fall risk precautions
After removal of an indwelling catheter, the client should be able to void
In no more than 6 hours, if it goes past 6 hours it requires a bladder scan
What not to do for a client who is unable to void
Do not increase fluid intake
Steps for administering a metered dose inhaler
Take off cap and shake the inhaler
Breathe out all the way
Hold the inhaler as instructed
As you
breathe in press down on the inhaler once
Breathe in deeply and slowly
Hold your breath and count to 10
For quick-relief medicine wait about 1 minute between
Complications of a thyroidectomy signs and symptoms
Difficulty swallowing, bleeding, swelling of the neck
Complications of a thyroidectomy treatments
Sit patient upright, have trach care ready, suction, IV calcium gluconate
Risk factors for Guillen-Barre Syndrome
Immunizations, preceded by mild respiratory or intestinal infections
Signs and symptoms of Guillen-Barre Syndrome
Symmetrical paralysis leading to difficulty breathing, talking, swallowing, and bowel and bladder dysfunction
apricots, avocados, bananas, cantaloupe, dried fruits, grapefruit, honeydew, orange juice, prunes, raisins, baked beans, butternut squash, refried and black beans, broccoli, carrots, greens (except kale), mushrooms, potatoes, spinach, tomatoes, vegetable
Diet for nephrotic syndrome
Low to moderate protein, low sodium (prevents edema), adequate carbohydrates and calories, low fat and cholesterol to prevent hyperlipidemia
Side effects of corticosteroids
GI bleeding, osteoporosis, immunosuppressive, hyperglycemia, hypernatremia, hypervolemia, hypokalemia, buffalo hump, moon face, purple striae
For continuous ambulatory peritoneal dialysis
The client can live a normal life without a lot of activity
Patient returning home from a kidney transplant
teaching includes how to recognize signs of rejection, infection and any complications of surgery
Transdermal nitroglycerine free period
10 to 12 hours (or 8, I think she said 8 so I will check with her)
Frequency, Intensity, Time, and Type