Complex Exam #1

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clinical manifestation of DI or SIADH? can't limit intake, constant thirst

DI

clinical manifestation of DI or SIADH? deficiency of ADH (vassopressin)

DI

clinical manifestation of DI or SIADH? high serum osmolality high serum sodium

DI

clinical manifestation of DI or SIADH? hypernatremia

DI

clinical manifestation of DI or SIADH? hypotension, tachycardia, weakness, S&S dehydration

DI

t/f: oversecretion of adrenocorticotropic hormone (ACTH) or the growth hormone results in Graves Disease

False Over secretion of ACTH or growth hormone results in Cushing disease. Graves' disease results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins

What is the fluid deprivation test for DI? what should you monitor for?

Fluids withheld for 8-12 hours or 3-5% of body weight lost Plasma and urine osmolality at beginning and end of test No increase in sg and osmolality of urine indicative of DI - Continue to secrete large volumes urine; low sg Monitor for tachycardia, hypotension

what hormones are secreted from the anterior pituitary?

GH ACTH TSH FSH and LH (ICSH) prolactin

nutritional needs AKI

High carbs to meet energy requirement Restrict total protein and only intake high-biological-value protein Low sodium Low potassium Low phosphorus

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys." "Draining of the cysts and antibiotic therapy will cure your disease." "Genetic testing will determine the best treatment for your condition."

"As the disease progresses, you will most likely require renal replacement therapy."

K+ range

3.5-5.2

normal adult bladder capacity is ----

400-500 ml

widely accepted criterion for AKI is what

50%+ increase in serum creatinine above baseline, with or without change in urine volume

BUN range

6-20

fast for how long before kidney biopsy

6-8hrs

glucose range

70-110

sudden interruption of kidney function resulting from obstruction, reduced circulation, or disease of the renal tissue

AKI (acute kidney injury)

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? The kidneys can improve over a period of months. Once on dialysis, the need will be permanent. Kidney function will improve with transplant. Acute renal failure tends to turn to end-stage failure.

The kidneys can improve over a period of months.

management of hypothyroidism

Thyroid hormone replacement therapy/Levothyroxine - Increases effect of Warfarin, can increase need for digoxin and insulin Meds that decrease absorption - Cimetidine, lansoprazole, sucralfate, colestipol Meds that can accelerate metabolism of levothyroxine - Phenytoin, carbamazepine, rifampin, sertraline, phenobarbital Geriatric Consideration - Cautious use with history of coronary artery disease. - Observe for angina and dysrhythmia

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? Blood glucose level of 200 mg/dl White blood cell (WBC) count of 20,000/mm3 Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35%

White blood cell (WBC) count of 20,000/mm3

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder? Acute renal failure Acute glomerulonephritis Chronic renal failure Nephrotic syndrome

acute glomerulonephritis

Adrenocortical insufficiency: ---- disease; damage or dysfunction of the adrenal cortex diminished production of mineralcorticoids and glucocorticoids

addison

more than 100,000 colonies/ml

bacteriuria

AKI etiology: prolonged renal ischemia nephrotoxic agents infectious processes

intrarenal

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?

oliguria

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? Initiation Oliguria Diuresis Recovery

oliguria

urine output <0.5 mL/kg/hr

oliguria

increased volume of urine voided

polyuria

where is ADH and oxytocin secreted from?

posterior pituitary

AKI etiology: urinary tract obstruction benign prostatic hypertrophy tumors

postrenal

AKI etiology: volume depletion impaired cardiac efficiency vasodilation

prerenal

position of patient for kidney biopsy

prone

which organ is associated with pain in the perineum and rectum

prostatic

clinical manifestations of AKI

pt may appear ill or lethargic and display CNS s/s such as drowsiness, headache, muscle twitching and seizures skin and mucous membranes may show signs of dehydration fluid overload may result with edema, SOB, and crackles noted on physical exam and with diagnostic films

how often for neuro status checks with hypohysectomy

q 1hr x 24 hr, then q4h

kidneys secrete erythropoietin to maintain --- concentration

rbc

Calcitonin inhibits mobilization of calcium from bone thereby ---- Ca levels

reducing

management of DI

replace ADH adequate fluids correct underlying causes

Which of the following is the most sensitive indicator of renal function? Serum creatinine Blood urea nitrogen (BUN) Creatinine clearance Potassium

serum creatinine

As glomerular filtration decreases, which of the following occurs? Select all that apply. Serum creatinine increases Blood urea nitrogen (BUN) increases Creatinine clearance decreases BUN decreases Serum creatinine decreases

serum creatinine and BUN increases, creatinine clearance decreases

laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? Serum creatinine of 1.5 mg/dL BUN of 20 mg/dLb Creatinine clearance of 90 mL/min Urinary protein level of 150 mg/24h.

serum creatinine of 1.5 mg/dL

Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator? Blood pressure Urine protein Serum glucose pH and HCO3

serum glucose

GFR 15-29

severe decrease in GFR

sold cart

severity onset location duration characteristics aggravating/relieving factors treatment

what will a moderately distended bladder feel like?

smooth, firm, round mass in abdomen

what are some of the secondary causes of addison disease (adrenocortical insufficiency)?

steroid withdrawal, pituitary neoplasm, high dose radiation pituitary or brain

controls cellular metabolic activity

thyroid

how does TSH act on thyroid gland?

thyroid hormones

these hormones determine the rate of cellular metabolism

thyroid hormones

a noninvasive way to get an initial view of the GU system and can help identify fluid accumulations, masses, congenital abnormalities, and obstructions

ultrasound

which organ is associated with pain in the males: along penis to meatus; female: urethra to meatus

urethral

strong desire to void

urgency

provides information on kidney function and helps in the dx of other conditions

urinalysis (UA)

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? Blood urea nitrogen (BUN) level of 22 mg/dl Serum creatinine level of 1.2 mg/dl Temperature of 100.2° F (37.8° C) Urine output of 250 ml/24 hours

urine output of 250 ml/24 hours

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? Wear a mask while handling any dialysate solutions. Keep the catheter stabilized to the abdomen, below the belt line. Use an aseptic technique during the procedure. Clean the catheter insertion site daily with soap.

use an aseptic technique during the procedure

what does oxytocin act on?

uterus and breast

how does the RAAS system increase blood pressure

water and sodium retention increased circulating volume, increased renal perfusion

The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? With food 2 hours before meals 2 hours after meals At bedtime with 8 ounces of fluid

with food

rbc in urine

hematuria

voiding more than every 3 hours

frequency

glomerular filtration rate formula = ?

(volume of urine x urine creatinine) / serum creatinine

SCr

0.6-1.3

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 500 mL of fluid 1,000 mL of fluid 1,500 mL of fluid 2,000 mL of fluid

1,500 mL of fluid

DI manifestations - dilute uringe with sg ______ -_____

1.001 - 1.005

1 kg weight gain = -- ml of fluid

1000

NA+ range

135-147

DI manifestations Polydipsia (__-__ liters of fluid daily) -cold water

2-20

diagnostics for cushing syndrome

2/3 of the following abnormal for dx: serum cortisol urine cortisol (24hr urine) dexamethasone suppression test ------------ electrolytes - Na, Glu, K, CBCd

CO2 range

22-30

DI manifestations - nephrons produce large volume of urine w/o action of ADH (> -- mL/hr)

250

Clinical manifestation of addison disease or cushing syndrome? glucose intolerance or diabetes develops with weight gain

cushing syndrome

--- evaluate for masses, stones, infections, trauma, metastasis, and soft tissue abnormalities. Can be used with contrast to enhance visualization.

CT scans, computed tomography

should you restrict fluids in DI?

Can't restrict fluids b/c of the continued high volume of urine loss would lead to hypernatremia and dehydration

Clinical manifestation of addison disease or cushing syndrome? purple striae, moon face, buffalo hump, delayed healing easy bruising, decreased immune function

cushing syndrome

manifestations of SIADH include: Hyponatremia (<---mmol/L) Low serum osmolality (< --- mOsm/kg) High urine osmolality (> --- mOsm) Nausea and vomiting (---) Lethargy, irritability, confusion, delirium Muscle weakness Seizures Coma

Hyponatremia (<128mmol/L) Low serum osmolality (< 280 mOsm/kg) High urine osmolality (> 100 mOsm) Nausea and vomiting (early) Lethargy, irritability, confusion, delirium Muscle weakness Seizures Coma

what are the diagnostics of SIADH?

Hyponatremia with corresponding hypo-serum osmolality Continued renal excretion of sodium Urine less than maximally dilute No clinical evidence of volume depletion No other causes of hyponatremia Correction of hyponatremia occurs with fluid restriction

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Abdominal distention owing to reflex cessation of intestinal peristalsis Hypovolemic shock caused by hemorrhage Paralytic ileus caused by manipulation of the colon during surgery Pneumonia caused by shallow breathing because of severe incisional pain

Hypovolemic shock caused by hemorrhage

Hypthalamus releases ----- who tells the pituitary gland to release ------ causing T4 to be released into circulation. TH acts on the thyroid gland, the hypothalamus and pituitary to further regulate function

Hypthalamus releasers TRH Thyrotropin Releasing Hormone who tells the pituitary gland to release TSH Thyroid stimulating Hormone causing T4 to be released into circulation. TH acts on the thyroid gland, the hypothalamus and pituitary to further regulate function

management of cushing syndrome

If pituitary mediated: - Surgical removal of tumor/pituitary gland - Radiation therapy Adrenal surgery - Rapid and definitive control of cortisol - Induces Adrenal insufficiency Medications: - Ketoconazole: Inhibits adrenal corticosteroid synthesis - Mifepristone: Controls comorbidities (glucose intolerance); DM mediated dx - Adrenal enzyme inhibitors: reduce hyperadrenalism Corticosteroid Use - Take as prescribed, tapering required to discontinue or reduce therapy - Alternate day therapy - Potential side effects and measures to reduce side effects

ways to assess for and maintain fluid balance

JVD assess for edema and obtain daily weights auscultate for crackles from pulmonary edema maintain hydration and replace fluids as needed

increased --- from AKI can lead to v-tach and cardiac arrest

K+

-- studies are used to delineate size, shape, and position of kidneys and to reveal urinary system abnormalities. Since they can be performed at the bedside, it is often one of the initial diagnostics for workup of a GU patient

KUB (kidney, ureter, and bladder)

A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate? Lasix 80 mg IVP Normal saline bolus of 500 mL Chest x-ray Mannitol 12.5 g IVP

Lasix 80 mg IVP

What does prolactin stimulate?

Milk production for lactation.

describe 3 types of hypothyroidism

Primary (95-99%) - thyroid gland dysfunction - Autoimmune thyroiditis (Hashimoto thyroiditis) - Treatment for hyperthyroidism - Loss of thyroid gland Secondary - pituitary gland fails to stimulate thyroid gland Tertiary - failure of hypothalamus to produce TRH

management/actions of addisonian crisis

Restore circulation Insulin/Dextrose to reduce potassium Glucose for hypoglycemia NS infusion, Manage electrolyte imbalance Monitor closely Ulcer prophylaxis Hydrocortisone (Solu-Cortef) replacement therapy

Cannot excrete dilute urine, retain fluids and dilutional hyponatremia

SIADH

clinical manifestation of DI or SIADH? decreased urine output, concentrated high specific gravity high urine sodium

SIADH

clinical manifestation of DI or SIADH? dilute hyponatremia

SIADH

clinical manifestation of DI or SIADH? fluid restriction

SIADH

clinical manifestation of DI or SIADH? headache, muscle weakness, seizure and coma

SIADH

clinical manifestation of DI or SIADH? lethargy, irritability, confusion

SIADH

clinical manifestation of DI or SIADH? low serum osmolality low serum sodium

SIADH

clinical manifestation of DI or SIADH? oversecretion of ADH (vasopressin)

SIADH

clinical manifestation of DI or SIADH? water retention

SIADH

secreted in response to high plasma calcium level and increases calcium deposit in bone

calcitonin

A client who is blind is admitted for treatment of gastroenteritis. Which nursing diagnosis takes highest priority for this client? Deficient fluid volume Risk for injury Activity intolerance Impaired physical mobility

deficient fluid volume

`Clinical manifestation of hypo- or hyperparathyroidism? bone decalcification, pathologic fractures, deformities

hyper

clinical manifestations of hyper- or hypoparathyroidism? hypercalcemia hypophosphatemia

hyper

The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed:

hyperacute rejection

DI restricting fluids ineffective because of potential --- and severe ----

hypernatremia and severe dehydration

A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess? Hypertension Extremity pain Fever Periorbital edema

hypertension

The nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). What does the nurse know would be the daily urine output? 1.5 L 1.0 L Less than 400 mL Less than 50 mL

less than 400 mL

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? Encouraging coughing and deep breathing Promoting carbohydrate intake Limiting fluid intake Providing pain-relief measures

limiting fluid intake

arterial blood gas from AKI will show ------

metabolic acidosis

what do the kidneys excrete

metabolic waste products foreign substances such as drugs excess fluid excess electrolytes

GFR 30-59

moderate decrease in GFR (stage 3)

what are the nursing considerations of SIADH?

monitor VS and serum sodium Monitor I & O frequent neuro checks

nursing considerations for hypothyroidism

monitor cardiovascular changes, weight, mental status/safety, respiratory status, dysrhythmias antiembolism stockings and elevation low calorie, high bulk diet encourage activity, cathartics, stool softeners extra clothing and blankets to maintain temp (NO ELECTRIC BLANKETS OR HEATING DEVICES) cautious use with medications due to decreased metabolism INCREASED risk of DVTs falls

s/s of addison disease (adrenocortical insufficiency)

muscle weakness, anorexia, n/v, fatigue, weight loss, dark pigmentation of skin and mucosa, dehydration, hypotension, hypoglycemia, hyponatremia, hyperkalemia, apathy, emotional labillity, confusion

Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit: no symptoms. fever. headache. polyuria.

no symptoms

awakening at night to urinate

nocturia

decrease in GFR due to what

non-functioning glomeruli

how is serum cortisol normally? how is it in cushing syndrome?

normally, serum cortisol is higher in the morning (6-8am) and lower in the evening (4-6pm)/ This variation is lost in Cushing Syndrome

Which of the following is the most accurate indicator of fluid loss or gain? Weight Urine output Caloric intake Body temperature

weight

urine output less than 50 ml a day

anuria

possible cause of leukocyte esterase and nitrite

associated with increase wbc and infection

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Azotemia Proteinuria Hematuria Bacteremia

azotemia

kidneys secrete an active form of vitamin D for -- metabolism

calcium

Clinical manifestation of hypo- or hyperthyroidism? weight loss, increased appetite

hyper

GFR 60-89

kidney damage with mild decrease in GFR (stage 2)

GFR greater than or equal to 90

kidney damage with normal or increased GFR (stage 1)

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has?

calcium deficit

What type of drug should be withheld before hemodialysis?

cardiac glycosides

Clinical manifestation of hypo- or hyperthyroidism? speeds everything up

hyper

GFR less than 15 or dialysis

kidney failure

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Even a perfect match does not guarantee organ success." "Immunosuppressive drugs guarantee organ success." "The doctor may decide to delay the use of immunosuppressant drugs." "Let's wait until after the surgery to discuss your treatment plan."

"Even a perfect match does not guarantee organ success."

The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching? "I should limit foods high in potassium in my diet, such as bananas." "I should limit the amount of protein in my diet." "I should drink as much as possible to keep my kidneys working." "My intake of high sodium foods should be limited."

"I should drink as much as possible to keep my kidneys working."

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? "It is important to use strict aseptic technique." "It is appropriate to warm the dialysate in a microwave." "The infusion clamp should be open during infusion." "The effluent should be allowed to drain by gravity."

"It is appropriate to warm the dialysate in a microwave."

A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? "Try washing clothes with a strong detergent to ensure that all impurities are gone." "When you shower, use really warm water and an antibacterial soap." "Keep your showers brief, patting your skin dry after showering." "Liberally apply alcohol to the areas of your skin where you itch the most."

"Keep your showers brief, patting your skin dry after showering."

An investment banker with chronic renal failure informs the nurse of the choice for continuous cyclic peritoneal dialysis. Which is the best response by the nurse? "The risk of peritonitis is greater with this type of dialysis." "This type of dialysis will provide more independence." "Peritoneal dialysis will require more work for you." "Peritoneal dialysis does not work well for every client."

"This type of dialysis will provide more independence."

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6

Cl range

95-106

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2

A GFR of 30-59 mL/min/1.73 m2

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of an insulin drip Administration of a loop diuretic Administration of sodium bicarbonate Administration of sodium polystyrene sulfonate [Kayexalate])

Administration of sodium polystyrene sulfonate [Kayexalate])

kidneys secrete renin, which is used for -- regulation

BP

nitrogenous waste product of protein metabolism

BUN

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF? Increased pH with decreased hydrogen ions Increased serum levels of potassium, magnesium, and calcium Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL Uric acid analysis 3.5 mg/dL and phenolsulfonphthalein (PSP) excretion 75%

Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dL

The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. BUN of 18 mg/dL. Serum creatinine of 1.2 mg/dL. Glomerular filtration rate (GFR) of 100 mL/min.

Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20

Patient education regarding a fistulae or graft includes which of the following? Select all that apply. Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing. Cleanse site b.i.d.

Check daily for thrill and bruit. Avoid compression of the site. No IV or blood pressure taken on extremity with dialysis access. No tight clothing.

Clinical manifestation of hypo- or hyperthyroidism? tachycardia, palpitations

hyper

clinical manifestation of DI or SIADH? large volume of dilute colorless urine low urine osmolality low specific gravity (1.001-1.005) low urine sodium

DI

clinical manifestation of DI or SIADH? polydipsia

DI

Clinical manifestation of hypo- or hyperthyroidism? thin hair

hyper

what are the thyroid hormones

T3 - ATP production T4 - ATP production calcitonin - regulates calcium ion concentrations

what does the antidiuretic hormone (ADH, vassopressin) act on?

kidneys

clinical manifestation of DI or SIADH? dehydration can occur

DI

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? Decrease in the blood flow through the kidneys Obstruction of urine flow from the kidneys Blood clot formed in the kidneys interfered with the flow Structural damage occurred in the nephrons of the kidneys

Decrease in the blood flow through the kidneys

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake. Increase protein, carbohydrates, and fat intake.

Increase carbohydrates and limit protein intake.

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? Increased serum creatinine level Decreased serum potassium level Increased red blood cell count Increased serum calcium level

Increased serum creatinine level

phases of AKI

Initiation - Initial insult to cause the AKI Oliguria - Increase in serum concentration of substances normally excreted by kidneys and decrease in urine output Diuresis - Gradual increase in urine output with stabilization of lab values. Uremic symptoms may still be present Recovery - Improvement of renal function over 3-12 months with lab values WNL and likely 1-3% decrease in GFR

contained in thyroid hormone and required to prodice T3 and T4

Iodine

transphenoidal appraoch thats typical of hypohysectomy

Monitor electrolytes (Na, K, Glu, Cl) and ECG as indicated Infection Control Monitor for Bleeding and CSF leak - Sweet tasting, clear or drainage with halo - Headache

nursing interventions of kidney biopsy

Monitor vital signs and s/s of bleeding and infection Pallor, dizziness, flank/back pain seen with internal bleeding Administer IVF to clear kidney and prevent clots Blood in urine may be seen initially Stay supine for at least for 6-8 hours after biopsy. Maintain bed rest and pressure dressing to control bleeding Administer analgesics as needed

hypohysectomy: numbness at surgical site and diminished smell __-__ months possible avoid bending at the --- floss and rinse 2 weeks, NO -----

Numbness at surgical site and diminished smell 3-4 months possible Avoid bending at the waist Floss and rinse 2 weeks, NO tooth brushing

nursing interventions with contrast

Obtain allergy history, specifically with iodine, shellfish, other seafood, and contrast Stop nephrotoxic medications (e.g. NSAIDS, metformin, vancomycin, etc.) Monitor kidney function Administer IVF and acetylcysteine Monitor for allergic reactions, U/O, and hydration status

What is used to decrease potassium level seen in acute renal failure? Sodium polystyrene sulfonate Sorbitol IV dextrose 50% Calcium supplements

Sodium polystyrene sulfonate

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? Urine output of 35 to 40 mL/hour Pain of 3 out of 10, 1 hour after analgesic administration SpO2 at 90% with fine crackles in the lung bases Blood tinged drainage in Jackson-Pratt drainage tube

SpO2 at 90% with fine crackles in the lung bases

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? Encourage oral fluids. Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

which is more potent and rapid-acting: T3 or T4?

T3

An expected outcome for the hemodialysis client is: The client identifies signs and symptoms of rejection. The client verbalizes the dwell time for the dialysate. The client demonstrates how to administer the dialysate by gravity. The client explains how to assess the venous access site.

The client explains how to assess the venous access site.

why should a person with hypothyroidism not have a heating blanket?

Vasodilation from heat along with decreased sensation an decreased alertness BURNS

TSH (thyroid stimulating hormone) released from where?

anterior pituitary controls to release TH (thyroid hormone)

assessment of cushing syndrome

activity level and ability to carry out self-care skin assessment changes in physical appearance and patient responses to these changes mental function emotional status medications

Clinical manifestation of addison disease or cushing syndrome? adrenocortical insufficiency

addison disease

Clinical manifestation of addison disease or cushing syndrome? apathy, lethargy, confusion

addison disease

Clinical manifestation of addison disease or cushing syndrome? dehydration, hyponatremia, hyperkalemia

addison disease

Clinical manifestation of addison disease or cushing syndrome? hyperpigmentation muscle weakness

addison disease

Clinical manifestation of addison disease or cushing syndrome? hypoglycemia

addison disease

Clinical manifestation of addison disease or cushing syndrome? hypotension due to cardiac insufficiency

addison disease

Clinical manifestation of addison disease or cushing syndrome?anorexia, N/V, weight loss

addison disease

gland that secretes glucocorticoids, mineralcorticoids, androgens, and estrogens

adrenal cortex

gland that functions as part of the autonomic nervous system catecholamines; epinephrine (90%) and norepinephrine

adrenal medulla

dx test of addison disease (adrenocortical insufficiency)?

adrenocortical hormone levels, ACTH (adrenocorticotropic hormone) levels, ACTH stimulation test early morning serum cortisol and plasma

how does ACTH affect the adrenal glands (adrenal cortex)?

adrenocorticosteroids

The nurse cares for a client diagnosed with chronic glomerulonephritis. The nurse will observe the client for the development of hypokalemia. anemia. metabolic alkalosis. hypophosphatemia.

anemia

A client has a decreased secretion of erythropoietin from the kidneys due to end-stage kidney disease. What outcome will the decrease in erythropoietin have? Anemia from the decrease in maturation of red blood cells Decrease in blood sugar levels due to alteration in insulin levels Increase in blood sugar levels due to alteration in insulin levels Development of male sex characteristics

anemia from the decrease in maturation of RBCs

possible cause of proteinuria

benign finding (fever, exercise), DMII, HF, medications

--- of the kidney help to diagnose and evaluate extent of kidney disease, particularly unexplained AKI, persistent proteinuria/hematuria, transplant rejection and glomerulopathies.

biopsy

which organ is associated with pain in the suprapubic area

bladder

what does RAAS regulate

blood pressure

what do the kidneys regulate

body osmolarity and volume electrolytes acid-base balance blood pressure

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Pats skin dry after bathing Uses moisturizing creams Keeps nails trimmed short Brief, hot daily showers

brief, hot daily showers

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? Check for thrill or bruit over the access site. Inspect the catheter insertion site for infection. Add the prescribed drug to the dialysate. Warm the solution to body temperature.

check for thrill or bruit over the access site

Diet modifications are part of nutritional therapy for the management of ARF. Select the high-potassium food that should be restricted. Citrus fruits White rice Salad oils Butter

citrus fruits

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find? Hyperalbuminemia Peripheral neuropathy Cola-colored urine Hypotension

cola-colored urine

no vasopressin = no ---- of urine

concentration

causes of cushing syndrome

corticosteriud medications (most common) excessive adrenocortical activity - pituitary tumor causing unneeded release of ACTH (adrenocorticotropic hormone) -hyperplasia of adrenal glands w/o tumor overproduction of adrenocortical hormone - growth retardation, obesity, musculoskeletal changes, glucose intolerance excessive protein vatabolism -muscle wasting and osteoporosis increased mineralcorticoid activity - retention of sodium and water - htn and heart failure classic moon face hyperglycemia or diabetes w/ weight gain and delayed healing

waste product of muscle energy metabolism

creatinine

helps in determining microorganisms and appropriate antimicrobial therapy.

culture and sensitivity

Clinical manifestation of addison disease or cushing syndrome? excessive adrenocortical activity

cushing syndrome

Clinical manifestation of addison disease or cushing syndrome? mood swings, psychosis

cushing syndrome

Clinical manifestation of addison disease or cushing syndrome? retention of sodium and water

cushing syndrome

Clinical manifestation of addison disease or cushing syndrome? truncal obesity, weight gain, Gi disturbances

cushing syndrome

Clinical manifestation of addison disease or cushing syndrome?hypertension due to cardiac hypertrophy, heart failure

cushing syndrome

Clinical manifestation of addison disease or cushing syndrome?muscle wasting and osteoporosis

cushing syndrome

Excessive adrenocortical activity

cushing syndrome

fatty buffalo hump, central obesity, thin extremities

cushing syndrome

muscular weakness/fatigue buffalo hump hyperglycemia acne ecchymosis thin/fragile skin

cushing syndrome

During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? Dehydration Hypokalemia Oliguria Renal calculi

dehydration

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? Dehydration Hyperkalemia Crackles Hypertension

dehydration

possible cause of casts

dehydration, fever, heart failure, many kidney diseases

Deficiency of ADH (vasopressin) - polydipsia - large volume dilute urine

diabetes insipidus

possible cause of glucose

diabetes, pregnancy, kidney pathology

potential nursing dx of addisonian crisis

disturbed body image self care deficit r/t weakness, fatigue, muscle wasting, altered sleep patterns risk for injury r/t weakness risk for fluid volume deficit activity intolerance and fatigue risk for infection knowledge deficit

A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? Donors are selected from compatible living donors. Donors must be relatives. Donors with hypertension may qualify. The client is placed on a transplant list at the local hospital.

donors are selected from compatible living donors

painful or difficulty urinating

dysuria

Clinical manifestation of hypo- or hyperthyroidism? warm skin, sweaty palms, flushed face

hyper

management of SIADH?

eliminate underlying causes fluid restriction loop diuretics with saline infusion 3% saline to correct hyponatremia if severe symptoms - correct the deficit at a rate that does not cause neurologic symptoms - raise serum sodium by 0.5-1 mEq/hr vasopressin-2 antagonist

A nurse identifies a nursing diagnosis of risk for ineffective breathing pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? Administer isotonic fluid therapy as ordered. Keep the drainage catheter below the level of insertion. Encourage use of incentive spirometer every 2 hours. Monitor temperature every 4 hours.

encourage use of incentive spirometer every 2 hours

involuntary urinating during sleep

enuresis

what do the kidney and urinary systems secrete

erythropoietin for rbc production 1, 25 - dihydrocycholecalciferol renin prostaglandin

what systems are affected by the endocrine system?

every single system

hallmark clinical signs of hypothyroidism

fatigue, lethargy slow thought process/speech cold intolerance weight gain bradycardia, hypotension, dysrhythmias hoarse speech decreased libido

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Diuresis Fever Absence of pain Weight loss

fever

Which of the following is the priority nursing diagnosis for the client in the oliguric phase of acute renal failure? Fluid volume excess Urinary retention Activity intolerance Disturbed body image

fluid volume excess

how do you give a decadron suppression test

give the decadron late in the evening or bedtime and obtain plasma cortisol level in the morning. If it is Cushing Syndrome, suppression is absent

Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? Glomerulonephritis Hypovolemia Ureteral calculus Dysrhythmia

glomerulonephritis

should you take medications that treat hyperthyroidism with or without food

has to be taken on an empty stomach

what are some causes of DI?

head trauma brain tumor surgical ablation or irradiation of pituitary CNS infections

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? Hemodialysis Peritoneal dialysis Continuous arteriovenous hemofiltration (CAVH) Continuous venovenous hemofiltration (CVVH)

hemodialysis

delay or difficulty in initiating void

hesitancy

diet for addison crisis

high sodium, low potassium

during kidney biopsy, patient should --- when needle is inserted

hold breath

The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take?

hold meds until after dialysis

A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? Performing the test without contrast Administering Garamycin (gentamicin) prophylactically Hydrating with saline intravenously before the test Administering sodium bicarbonate after the procedure

hydrating with saline intravenously before the test

possible cause of altered specific gravity

hydration status

Clinical manifestation of hypo- or hyperparathyroidism? N/V, constipation

hyper

Clinical manifestation of hypo- or hyperparathyroidism? fatigue, apathy

hyper

Clinical manifestation of hypo- or hyperparathyroidism? htn, cardiac dysthmias

hyper

Clinical manifestation of hypo- or hyperparathyroidism? irritability, neurosis, psychoses

hyper

Clinical manifestation of hypo- or hyperparathyroidism? muscle weakness

hyper

Clinical manifestation of hypo- or hyperparathyroidism? renal calculi

hyper

Clinical manifestation of hypo- or hyperparathyroidism? skeletal pain or tenderness

hyper

Clinical manifestation of hypo- or hyperthyroidism? diarrhea

hyper

Clinical manifestation of hypo- or hyperthyroidism? exophthalmos

hyper

Clinical manifestation of hypo- or hyperthyroidism? heat intolerance

hyper

Clinical manifestation of hypo- or hyperthyroidism? hyperreflexia, tremors, hyperkinesia

hyper

Clinical manifestation of hypo- or hyperthyroidism? increased libido initially, overtime decreased

hyper

Clinical manifestation of hypo- or hyperthyroidism? nervousness, hyperactivity, anxiety, irritability, decreased attn span, mood swings, insomnia

hyper

Clinical manifestation of hypo- or hyperthyroidism? normal or enlarged thyroid firm nodules, possibly tender

hyper

Clinical manifestation of hypo- or hyperthyroidism? pretibial myxedema

hyper

A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would be expected? Select all that apply. hypertension pain from retroperitoneal bleeding normal urinalysis no renal stones

hypertension pain from retroperitoneal bleeding

Clinical manifestation of hypo- or hyperparathyroidism? ECG changes

hypo

Clinical manifestation of hypo- or hyperparathyroidism? anxiety or depression

hypo

Clinical manifestation of hypo- or hyperparathyroidism? broncho/laryngospasms

hypo

Clinical manifestation of hypo- or hyperparathyroidism? chvostek and trousseau sign

hypo

Clinical manifestation of hypo- or hyperparathyroidism? hypocalcemia hyperphosphatemia

hypo

Clinical manifestation of hypo- or hyperparathyroidism? neuromuscular irritability, stiffness of hands and feet

hypo

Clinical manifestation of hypo- or hyperparathyroidism? numbness or tingling in extremities, cramps

hypo

Clinical manifestation of hypo- or hyperparathyroidism? painful menstruation

hypo

Clinical manifestation of hypo- or hyperparathyroidism? tetany

hypo

Clinical manifestation of hypo- or hyperthyroidism? bradycardia, hypotension, dysrhythmias

hypo

Clinical manifestation of hypo- or hyperthyroidism? cold intolerance, low temperature

hypo

Clinical manifestation of hypo- or hyperthyroidism? comm dx: hashimoto thyroiditis

hypo

Clinical manifestation of hypo- or hyperthyroidism? common dx: Graves Disease

hypo

Clinical manifestation of hypo- or hyperthyroidism? constipation

hypo

Clinical manifestation of hypo- or hyperthyroidism? decreased bone density (osteoporosis)

hypo

Clinical manifestation of hypo- or hyperthyroidism? decreased libido

hypo

Clinical manifestation of hypo- or hyperthyroidism? fatigue, irritability, lethargy, depression, apathy, slows thought process/speech

hypo

Clinical manifestation of hypo- or hyperthyroidism? loss of hair/brittle coarse hair, thick fingernails

hypo

Clinical manifestation of hypo- or hyperthyroidism? muscle and joint pain

hypo

Clinical manifestation of hypo- or hyperthyroidism? normal, enlarged, or small thyroid soft bruit

hypo

Clinical manifestation of hypo- or hyperthyroidism? pale, dry flakey skin, brittle nails

hypo

Clinical manifestation of hypo- or hyperthyroidism? periorbital edema/puffy face

hypo

Clinical manifestation of hypo- or hyperthyroidism? slows everything down

hypo

Clinical manifestation of hypo- or hyperthyroidism? weight gain

hypo

hypo/per calcemia and hypo/per phosphatemia can result from AKI

hypocalcemia and hyperphosphatemia

removal of the pituitary gland

hypohysectomy

symptoms of addisonian crisis

hypotension, cyanosis, fever, n/v, shock, pallor, abd pain, diarrhea can lead to circulatory collapse, shock, or death can occur

TRH (throtropin releasing hormone) is released from where?

hypothalamus

inadequate circulating thyroid hormones decreased basal metabolic rate mimics aging process -women ages 30-60 more likely frequently undiagnosed

hypothyroidism

Acute dialysis is indicated during which situation? Dehydration Impending pulmonary edema Metabolic alkalosis Hypokalemia

impending pulmonary edema

involuntary loss of urine

incontinence

why should you start with a very low dose and advance slowly over 1-2 months with hypothyroidism?

increase thyroid increase metabolism and oxygen demand

A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction? "Be sure to eat meat at every meal." "Eat plenty of bananas." "Increase your carbohydrate intake." "Drink plenty of fluids, and use a salt substitute."

increase your carb intake

What is a characteristic of the intrarenal category of acute kidney injury (AKI)? Decreased creatinine Increased BUN High specific gravity Decreased urine sodium

increased BUN

what is a characteristic of the intrarenal category of acute renal failure?

increased BUN

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? Increased serum creatinine level Decreased serum potassium level Increased red blood cell count Increased serum calcium level

increased serum creatinine level

possible cause of 3+ RBC (hematuria)

infection, stones, neoplasm

renal parenchyma divided into 2 main parts: the outer cortex and the

inner medulla

physical examination of thyroid gland

inspection (anterior or posterior) gentle palpation - size, shape, consistency, symmetry, tenderness auscultation for bruit

kidneys secrete prostaglandin for --- perfusion

kidney

which organ is associated with costovertebral angle location pain, may extend to umbilicus

kidney

assessment for addison disease (adrenocortical insufficiency)

note any illness or stressors that may precipitate problems fluid and electrolyte status vs and orthostatic bp note s/s r/t adrenocortical insufficiency such as: weight changes, muscle weakness, fatigue monitor for s/s of addisonian crisis (acute adrenal insufficiency)

A group of students are reviewing the phases of acute renal failure. The students demonstrate understanding of the material when they identify which of the following as occurring during the second phase? Diuresis Oliguria Acute tubular necrosis Restored glomerular function

oliguria

what do the nephrons regulate

osmolarity, electrolytes, and acid-base balance

how does FSH and LH work on the ovary and corpus luteum

ovary - estrogen corpus luteum - progesterone

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? Penicillin Gentamicin Tobramycin Neomycin

penicillin

Which of the following occurs late in chronic glomerulonephritis? Peripheral neuropathy Nosebleed Stroke Seizure

peripheral neuropathy

what are some of the primary causes of addison disease (adrenocortical insufficiency)?

primary: autoimmune or idiopathic atrophy of glands; adrenalectomy, cancer, radiation abdomen, tuberculosis, histoplasmosis

what protects the kidneys

protected externally by bone (ribs) and by muscles of the abdomen and back

protein in urine

proteinuria

what is the hallmark of the dx of nephrotic syndrome?

proteinuria

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? Previous episode of acute pyelonephritis History of hyperparathyroidism Recent history of streptococcal infection History of osteoporosis

recent history of streptococcal infection

3 main fxns of kidneys and urinary system

regulation, excretion, secretion

A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? Acute pyelonephritis Osmotic dieresis. Dysrhythmias Renal calculi

renal calculi

where is the specimen obtained from in a kidney biopsy

renal cortex

One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: restricting sources of potassium usually found in fresh fruits and vegetables. allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally.

restricting sources of potassium usually found in fresh fruits and vegetables

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Impaired urinary elimination Toileting self-care deficit Risk for infection Activity intolerance

risk for infection

potential nursing dx for cushing syndrome

risk for injury risk for infection self-care deficit impaired skin integrity disturbed body image disturbed thought processes

Which of the following would a nurse classify as a prerenal cause of acute renal failure? Polycystic disease Ureteral stricture Prostatic hypertrophy Septic shock

septic shock

Excessive ADH (vasopressin) secretion from Pituitary - Water retention - Hyponatremia (dilutional) Causes - CNS disorders (head injury, brain tumors or infection) - Stimulate production of ADH in pituitary - Medications

syndrome of inappropriate antidiuretic hormone (SIADH)

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Tall, peaked T waves Shortened QRS complex Multiple spiked P waves Prolonged ST segment

tall, peaked T waves

A client has undergone a renal transplant and returns to the health care agency for a follow-up evaluation. Which finding would lead to the suspicion that the client is experiencing rejection? Hypotension Weight loss Polyuria Tenderness over transplant site

tenderness over transplant site

how does FSH and LH act on the testes?

testosterone

The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? Notify the health care provider. Turn the client from side to side. Lower the head of the bed. Push the catheter further into the abdomen.

turn the client from side to side

which organ is associated with pain in the cosovertebral angle, flank, lower abdominal area, testis or labium

ureteral

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? Serum potassium level of 4.9 mEq/L Serum sodium level of 135 mEq/L Temperature of 99.2° F (37.3° C) Urine output of 20 ml/hour

urine output of 20 ml/hr


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