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NURS 6202 Exam 1 Questions With Complete Solutions 3 phases of peritoneal dialysis Correct Answers • The three phases of the PD cycle (called an exchange) are inflow (fill), dwell (equilibration), and drain (outflow). 5 major categories of urinary tract calculi Correct Answers calcium phosphate calcium oxalate uric acid cystine struvite Absolutely hypovolemia Correct Answers • Absolute hypovolemia results when fluid is lost through hemorrhage, gastrointestinal (GI) loss (e.g., vomiting, diarrhea), fistula drainage, diabetes insipidus, or diuresis. Acute Poststreptococcal Glomerulonephritis Correct Answers
- Acute poststreptococcal glomerulonephritis (APSGN) develops 5 to 21 days after an infection of the tonsils, pharynx, or skin by nephrotoxic strains of group A-hemolytic streptococci (important to know) Acute Poststreptococcal Glomerulonephritis clinical manifestations Correct Answers a) Generalized body edema b) Hypertension c) Oliguria d) Hematuria with a smoky or rusty appearance e) Proteinuria
Acute Poststreptococcal Glomerulonephritis management Correct Answers 1) APSGN management focuses on symptomatic relief which includes: a) Rest b) Edema c) Hypertension management d) Dietary protein restriction when an increase in nitrogenous wastes (e.g., elevated blood urea nitrogen [BUN] value) is present Acute Respiratory Distress Syndrome (ARDS) Correct Answers Acute respiratory distress syndrome (ARDS) is a sudden, progressive form of acute respiratory failure in which the alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid, causing the alveoli to fill with fluid. ARDS exists on a continuum. Progression of ARDS varies among patients, and several factors determine the course of ARDS, including the nature of the initial injury, extent and severity of coexisting diseases, and pulmonary complications. Acute Respiratory Failure Correct Answers Acute respiratory failure results when gas exchange, which involves the transfer of O2 and CO2 between the atmosphere and the blood, is inadequate. Respiratory failure is not a disease. It is a condition that occurs as a result of one or more diseases involving the lungs or other body systems. The major threat of respiratory failure is the inability of the lungs to meet the O2 demands of the tissues.
c) Protection against infection d) Assistance with daily hygiene. Addisonian Crisis Correct Answers 1) Patients with Addison's disease are at risk for acute adrenal insufficiency, a life- threatening emergency caused by a sudden decrease in adrenocortical hormones (this is key). Addisonian crisis manifestations Correct Answers a) Postural hypotension b) Tachycardia c) Dehydration d) Hyponatremia e) Hyperkalemia f) Hypoglycemia g) Hypocalcemia h) Fever i) Weakness j) Confusion Addisonian crisis treatment Correct Answers a) Shock management b) High-dose hydrocortisone replacement c) Large volumes of 0.9% saline solution and 5% dextrose are given to reverse hypotension and electrolyte imbalances until blood pressure (BP) normalizes. d) Maintain fluid and electrolyte balance Addisonian Crisis triggers Correct Answers a) Stress (e.g., surgery, trauma, psychologic distress) b) Sudden withdrawal of corticosteroid hormone therapy
c) Post-adrenal surgery Adrenocortical Insufficiency Correct Answers 1) Primary hypofunction of the adrenal cortex, or Addison's disease, results in a reduction of all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and androgens). Secondary disease results from pituitary dysfunction. Adrenocortical insufficiency cause Correct Answers 1) The most common cause in the United States is autoimmune, where the adrenal cortex is destroyed by autoantibodies. Adrenocortical insufficiency manifestations Correct Answers a) Weakness b) Weight loss c) Anorexia d) Due to increased ACTH, skin hyperpigmentation is seen in exposed and unexposed areas of the body, at pressure points, over joints, and in palmar creases. Adrenocortical insufficiency treatment Correct Answers 1) hormone therapy a) Hydrocortisone, the most commonly used form of hormone therapy, has both glucocorticoid and mineralocorticoid properties. During times of stress, glucocorticoid dosage is increased to prevent Addisonian crisis. b) Mineralocorticoid replacement with fludrocortisone acetate (Florinef) is given daily with increased dietary salt.
In some situations, the patient does not recover from AKI and chronic kidney disease (CKD) results, eventually requiring dialysis or a kidney transplant. AKI recovery phase Correct Answers • The recovery phase begins when the glomerular filtration rate (GFR) increases, allowing the BUN and serum creatinine levels to plateau and then decrease. Renal function may take up to 12 months to stabilize. Anaphylactic shock Correct Answers • Anaphylactic shock is an acute and life-threatening hypersensitivity (allergic) reaction. anaphylactic shock causes Correct Answers • The reaction is caused by a sensitizing substance (e.g., drug, chemical, vaccine, food, insect venom).
- Immediate reaction causes massive vasodilation, release of vasoactive mediators, and an increase in capillary permeability resulting in fluid leaks from the vascular space into the interstitial space. anaphylactic shock manifestations Correct Answers anxiety, confusion, dizziness, chest pain, incontinence, swelling of the lips and tongue, wheezing, stridor,
flushing, pruritus, urticaria, angioedema Anaphylactic shock treatment Correct Answers • Epinephrine is the drug of choice to treat anaphylactic shock.
- Maintaining the airway is critical. Endotracheal intubation or cricothyroidotomy may be necessary.
- Aggressive fluid replacement, predominantly with crystalloids, is necessary. ARDS and ABGs Correct Answers Early ABGs usually indicate mild hypoxemia and respiratory alkalosis caused by hyperventilation. The onset of hypercapnia signals hypoventilation and progression of ARDS. ARDS cause Correct Answers The most common cause of ARDS is sepsis. It may also develop as a consequence of the systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). ARDS complications Correct Answers Complications, including barotrauma, volutrauma, renal failure, and stress ulcers, may develop as a result of ARDS itself or its treatment. A frequent complication of ARDS is ventilator-associated pneumonia (VAP).
§ During PPV, it is common to apply positive end-expiratory pressure (PEEP) to maintain PaO2 at greater than or equal to 60 mm Hg. § Alternative modes of mechanical ventilation may be used and include airway pressure release ventilation, pressure control inverse ratio ventilation, high-frequency ventilation, and permissive hypercapnia. § Positioning strategies to improve oxygenation that can be considered for patients with ARDS include prone positioning, continuous lateral rotation therapy, and kinetic therapy. ARDS pathophysiologic change phases Correct Answers The pathophysiologic changes of ARDS are divided into three phases: injury or exudative, reparative or proliferative, and the fibrotic or chronic phases. ARDS progression of manifestations Correct Answers As ARDS progresses, tachycardia, diaphoresis, changes in mental status, cyanosis, and pallor may be present. Refractory hypoxemia and profound respiratory distress requiring endotracheal intubation and PPV may occur. ARDS X-rays Correct Answers Initially, chest x-ray may be normal or exhibit evidence of minimal scattered interstitial infiltrates. As ARDS progresses, diffuse and extensive bilateral opacities (termed whiteout or white lung) are common. arteriovenous fistulas (AVFs) Correct Answers • AVFs are created most commonly in the forearm with an anastomosis
between an artery (usually radial or ulnar) and a vein (usually cephalic). Native fistulas have the best overall patency rates and least number of complications. arteriovenous grafts (AVGs) Correct Answers • AVGs are made of synthetic materials and form a "bridge" between the arterial and venous blood supplies. Grafts are placed under the skin and are surgically anastomosed between an artery (usually brachial) and a vein (usually antecubital). Benign prostatic hyperplasia (BPH) Correct Answers 1) prostate gland enlargement caused by hyperplasia of prostate cells. BPH results from endocrine changes associated with the aging process. BPH initial treatment Correct Answers 1) Conservative and initial treatment for some men who have little to no symptoms is active surveillance or watchful waiting. a) Drug therapy with 5α-reductase inhibitors and α-adrenergic blockers may also be used. BPH minimally invasive therapies Correct Answers 1) Minimally invasive therapies that destroy prostatic tissue include: a) Lasers b) Radio waves c) Microwaves d) Electrical current BPH post op care (TURP) Correct Answers a) Care in the immediate postoperative period revolves around:
Cardiogenic shock causes Correct Answers acute myocardial infarction (MI), cardiomyopathy, blunt cardiac injury, severe systemic or pulmonary hypertension, myocardial depression from metabolic problems. Cardiogenic shock manifestations Correct Answers tachycardia, hypotension, a narrowed pulse pressure, tachypnea, pulmonary congestion, cyanosis, pallor, cool and clammy skin, diaphoresis, decreased capillary refill time, anxiety, confusion, agitation. Cardiogenic shock treatment Correct Answers • The overall goal is to restore blood flow to the myocardium by restoring the balance between O2 supply and demand
- Definitive measures include thrombolytic therapy, angioplasty with stenting, emergency revascularization, and valve replacement.
- Care involves hemodynamic monitoring, drug therapy (e.g., diuretics to reduce preload), and use of circulatory assist devices (e.g., intraaortic balloon pump, ventricular assist device). Care Instructions of Cushing Syndrome Correct Answers Care instructions are based on patient's inability to react physiologically to a stressor catheterization Correct Answers a) Short-term urinary catheterization may be performed to obtain a urine specimen for laboratory analysis. catheterization complications Correct Answers a) Complications from long-term use (more than 30 days) of indwelling catheters include: i) Bladder spasms ii) Periurethral abscess iii) Pain iv) Urosepsis catheterization nursing actions Correct Answers i) Maintaining patency of the catheter ii) Managing fluid intake iii) Providing for the comfort and safety of the patient iv) Preventing infection Catheterization uses Correct Answers a) The ureteral catheter is placed through the ureters into the renal pelvis as a stent, often following a lithotripsy procedure or in case of obstruction.
Chronic Glomerulonephritis treatment Correct Answers supportive and symptomatic CKD Correct Answers • Chronic kidney disease (CKD) involves progressive, irreversible loss of kidney function.
- CKD usually develops slowly over months to years.
- The prognosis of CKD is variable depending on the etiology, patient's condition and age, and adequacy of follow-up. Clinical manifestations of acute respiratory failure Correct Answers The patient may have a rapid, shallow breathing pattern or a respiratory rate that is slower than normal. A change from a rapid rate to a slower rate suggests progression of respiratory muscle fatigue and increased probability of respiratory arrest. Other signs that give indicators of the efforts associated with breathing include: § The position that the patient assumes § The ability of the patient to speak § Use of pursed-lip breathing § A change in the inspiratory (I) to expiratory (E) ratio § Presence of muscle retractions of the intercostal spaces or the supraclavicular area and use of the accessory muscles during inspiration or expiration § Work of breathing (WOB) or the effort used for muscle contraction during inhalation to accomplish lung ventilation
Common indications for nephrectomy Correct Answers a) A renal tumor b) Polycystic kidney disease (PKD) that are bleeding or severely infected c) Massive traumatic injury to the kidney d) The elective removal of a kidney from a donor Common peristomal skin problems associated with an ileal conduit include Correct Answers a) Dermatitis b) Yeast infections c) Product allergies d) Shearing-effect excoriations Compensatory stage of shock Correct Answers • The compensatory stage is clinically apparent and involves neural, hormonal, and biochemical compensatory mechanisms in an attempt to overcome the increasing consequences of anaerobic metabolism and to maintain homeostasis. complications of CKD Correct Answers infections, neurologic changes, peripheral neuropathy, CKD-mineral and bone disease, pruritus, infertility, personality and behavioral changes, lethargy, depression. Complications of hemodialysis Correct Answers hypotension, muscle cramps, blood loss.
Cushing Syndrome Most Common Causes Correct Answers The most common cause is administration of exogenous corticosteroids (e.g., prednisone). Most cases of endogenous Cushing syndrome are due to an adrenocorticotropic hormone (ACTH) secreting pituitary tumor (pituitary adenoma or adrenal tumor). Cushing Syndrome Therapy Correct Answers 1) Lifetime hormone therapy is required by patients who undergo adrenalectomy or hypophysectomy. Diagnosis of AKI Correct Answers • The diagnosis of AKI is based on the history and physical as well as changes in urine output and serum creatinine. Diagnostics for shock Correct Answers • There is no specific diagnostic study to determine shock. The diagnosis is established from a detailed history and physical examination findings.
- Studies that assist in the diagnosis include a serum lactate, base deficit, 12-lead ECG, continuous cardiac monitoring, chest x- ray, continuous pulse oximetry, and hemodynamic monitoring. Dialysis Correct Answers • Dialysis is a therapeutic intervention in which substances move from the blood through a semipermeable membrane and into a dialysis solution (dialysate). Dialysis solutions have an electrolyte composition similar to that of plasma.
- The two methods of dialysis are peritoneal dialysis (PD) and hemodialysis (HD). Discharge planning after an ileal conduit includes Correct Answers a) Teaching the patient symptoms of obstruction or infection b) Care of the ostomy evaluation of urinary incontinence and urinary retention Correct Answers a) A focused history b) Physical assessment c) Urinalysis d) A bladder log or voiding record Factors involved in the development of Urinary tract calculi Correct Answers a) Metabolic b) Dietary c) Genetic d) Climatic e) Lifestyle f) Occupational influences g) Other factors are obstruction with urinary stasis and urinary tract infection General management strategies for shock Correct Answers • General management strategies for a patient in shock begin with ensuring that the patient has a patent airway and O2 delivery is optimized. The cornerstone of therapy for septic, hypovolemic, and anaphylactic shock is volume expansion with the administration of the appropriate fluid.
