Module 4 Thyroid/Para/Adrenal/Pituitary/AKI/CKD/Bioterrorism

Postrenal Injury: blockage in the urinary tract after the kidneys to the urethra (injury found AFTER the kidneys) What are causes of POSTRENAL?

Renal calculi Enlarged prostate BPH A bladder doesn't empty properly due to neuro damage "stroke" or cancer

Which interventions are necessary for a patient with acute adrenal insufficiency (addisonian crisis)? (select all that apply) a iv infusion of normal saline b iv infusion of 3% saline c hourly glucose monitoring d insulin administration e iv potassium therapy

a iv infusion of normal saline c hourly glucose monitoring d insulin administration

In making the care plan for a client with Cushing's disease, the nurse would choose which diagnosis as a priority? a.Activity Intolerance b.Pain, Chronic c.Risk for Fluid Volume Deficit d.Risk for Injury

ANS: D The client should be protected against falls and accidents. Clients with Cushing's syndrome have osteoporosis and tend to develop fractures with even minor trauma.

What nursing measure would be included in the plan of care for a client with acute renal failure? 1) Observe for signs of a secondary infection 2) Provide a high protein, low carbohydrate diet 3) In and out catheterization for residual urine 4) Encourage fluids to 2000 mL in 24 hours

1: Secondary infections are the cause of death in 50-90% of clients with acute renal failure. A low protein diet is most often offered. Catheterizations are avoided. Fluids may be limited if the client is in ARF.

The client with chronic renal failure is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: 1. During dialysis. 2. Just before dialysis. 3. The day after dialysis. 4. On return from dialysis.

4. Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure.

The nurse has instructed a patient who is receiving hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful? a. Scrambled eggs, English muffin, and apple juice b. Oatmeal with cream, half a banana, and herbal tea c. Split-pea soup, whole-wheat toast, and nonfat milk d. Cheese sandwich, tomato soup, and cranberry juice

A Scrambled eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.

You respond to the scene of a dialysis clinic where you presented with a​ 64-year-old male patient with blood soaked bandages noted around his right arm at the site of his​ A-V fistula. How should you manage this​ patient's hemorrhage? A. Direct pressure on the​ A-V fistula with elevation. B. Immediately place the patient on​ high-flow oxygen, and then treat the hemorrhage. C. Immediately place a tourniquet directly on the​ A-V fistula. D. Place tourniquet as close to the​ A-V fistula as possible.

A. Direct pressure on the​ A-V fistula with elevation.

Important nursing interventions for the patient with AKI are (select all that apply) A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. D. increase intake of vitamin A and D. E. frequent mouth care.

A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. E. frequent mouth care. You have an important role in managing fluid and electrolyte balance during the oliguric and diuretic phases of AKI. Observing and recording accurate intake and output are essential. Measure daily weights with the same scale at the same time each day to assess excessive gains or losses of body fluids. Mouth care is important to prevent stomatitis, which develops when ammonia (produced by bacterial breakdown of urea) in saliva irritates the mucous membrane.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which nursing actions should the nurse take? Select all that apply. 1. Contact the physician. 2. Check the level of the drainage bag. 3. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.

ANS: 2, 3, 4, 5 Rationale: If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the physician. Increasing the flow rate is an inappropriate action and is not associated with the amount of outflow solution.

The nurse recognizes that the manifestations of Addison's disease are primarily related to the pathophysiology of a.adrenal insufficiency. b.increased intracranial pressure. c.renal disease. d.thyroid hyperfunction.

ANS: A Commonly known as Addison's disease, primary adrenal insufficiency results from idiopathic atrophy or destruction of the adrenal glands by an autoimmune process or another disease. The other three options are not involved in Addison's disease.

The nurse explains to a client with chronic renal failure that the rationale for receiving calcium carbonate is that it a.binds with phosphorus to eliminate it from the body. b.binds with potassium to eliminate it from the body. c.helps prevent constipation. d.helps prevent ulcer formation.

ANS: A To improve excretion of phosphorus, the client with chronic renal failure is given calcium-based phosphate binders, such as calcium acetate or calcium carbonate.

The nurse explains the pathophysiology of diabetes insipidus as arising from a deficiency in a.antidiuretic hormone (ADH). b.follicle-stimulating hormone (FSH). c.growth hormone (GH). d.oxytocin.

ANS: A Diabetes insipidus results from a deficiency in ADH and leads to an inability to conserve water. *THINK D=DOWN & s-I-adh I=INCREASE ADH*

When formulating the teaching plan for a client with hyperpituitarism being prepared for transsphenoidal hypophysectomy, the nurse would give priority to a.alerting the client to the need for constant monitoring after surgery. b.instructing the client to avoid activities such as coughing and sneezing. c.reviewing the clinical manifestations of infection. d.teaching coughing and deep-breathing techniques.

ANS: B A priority nursing diagnosis for this preoperative client is Risk for Injury. Prevention of elevated intracranial pressure is accomplished by avoiding activities that raise intracranial pressure, similar to the care of a client undergoing craniotomy.

To assess the effect of epoetin alfa on a client with chronic renal failure, the nurse would monitor a.blood urea nitrogen level. b.hematocrit level. c.leukocyte count. d.serum creatinine level.

ANS: B Anemia in clients with chronic renal failure is treated primarily with erythropoietin, a hormone produced in the kidney that stimulates red blood cell production.

A 35-year-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function? a. Urine volume b. Creatinine level c. Glomerular filtration rate (GFR) d. Blood urea nitrogen (BUN) level

ANS: C GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status and protein intake. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function. *Per PPT GFR is a more timely indicator*

Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful? a.Split-pea soup, English muffin, and nonfat milk b.Oatmeal with cream, half a banana, and herbal tea c.Poached eggs, whole-wheat toast, and apple juice d.Cheese sandwich, tomato soup, and cranberry juice

ANS: C Poached eggs would provide high-quality protein, and apple juice is low in potassium. Cheese is high in salt and phosphate, and tomato soup would be high in potassium. Split-pea soup is high in potassium, and dairy products are high in phosphate. Bananas are high in potassium, and the cream would be high in phosphate.

The nurse explains to a pt with renal failure that Kayexalate will a.decrease diastolic blood pressure. b.stimulate diuresis by osmosis. c.increase appetite by decreasing insulin degradation. d. increase gastrointestinal potassium excretion.

ANS: D Hyperkalemia is probably the most dangerous imbalance because of its contribution to cardiac dysrhythmias and arrest. Sodium polystyrene sulfonate (Kayexalate) may be administered orally or rectally to facilitate excretion of potassium from the gastrointestinal (GI) tract.

In a client with addisonian crisis, assessment would indicate that the drug Kayexalate is not effective when the nurses assesses the clinical manifestation of a.decreasing blood pressure. b.low back pain. c.pedal edema. d.rapid or erratic pulse.

ANS: D Sodium polystyrene sulfonate (Kayexalate) is given to reduce hyperkalemia. If Kayexalate is not effective, hyperkalemia results and can cause cardiac dysrhythmias. *THIS WAS ON OUR MED LIST JUST KNOW IT REMOVES K+*

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

Answer C. During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

Which sign indicated the dieresis phase of acute renal failure? 1. Urine output (4 to 5 L/day) 2. Urine output less than 400 ml/day 3. Urine output less than 100 ml/day 4. Stabilization of renal function

Answer: 1. Urine output (4 to 5 L/day) insreased urine output indicates that the nephrons are healing. This means the patient is passing into the dieresis phase of acute renal failure *per ppt can last 1-3 weeks UOP can be as high as 5L/day MONITOR Fluids and Electrolytes Acid/Base imbalances REPLACEMENT is focus for volume*

A client with renal insufficiency has a magnesium level of 3.5 mEq/L . On the basis of this laboratory result, the nurse interprets which sign as significant? 1. Hyperpnea 2. Drowsiness 3. Hypertension 4. Physical hyperactivity

Answer: 2 . The normal magnesium level is 1.5 to 2.5 mEq/L. A magnesium level of 3.5 mEq/L indicates hypermagnesemia. Neurological manifestations begin to occur when magnesium levels are elevated and are noted as symptoms of neurological depression, such as drowsiness, sedation, lethargy, respiratory depression, muscle weakness, and areflexia. Bradycardia and hypotension also occur.

Which cause of hypertension is the most common in acute renal failure? 1. Pulmonary edema 2. Hypervolemia 3. Hypovolemia 4. Anemia

Answer: 2. Hypervolemia Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of renin. Therefore, hypervolemia causes hypertension.

Your patient returns from the operating room after surgery. Which symptom is a sign of acute renal failure? 1. Anuria 2. Diarrhea 3. Oliguria 4. Vomiting

Answer: 3. Oliguria Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders. *PER PPT less than 400 ml/24 hours is OLIGURIA & OVERLOAD is the focus for volume*

70-year-old man being assessed for HD access. He has a history of diabetes mellitus and hypertension but is otherwise healthy. Which one of the following dialysis accesses has the lowest rate of complications and the longest life span? A. Subclavian catheter. B. Tenckhoff catheter. C. Arteriovenous graft. D. Arteriovenous fistula.

Answer: D A native arteriovenous fistula is the preferred access for chronic HD. If an arteriovenous fistula cannot be constructed, a synthetic arteriovenous graft (Answer C) is considered second line. A subclavian catheter (Answer A) is a poor choice because of the increased risk of infection and thrombosis and because of the poor blood flow obtained through a catheter. A Tenckhoff catheter (Answer B) is incorrect because this is a catheter for peritoneal dialysis.

Which foods will the nurse instruct a patient with hypoparathyroidism to avoid? (SATA) a. Canned vegetables b. yogurt c. Fresh fruit d. Red meat e. Milk f. Processed cheese

B E f *PER PPT Diet needs to be High in calcium and low in phosphorous, avoid milk-suggest milk alternatives*

All of the following are treatments for myxedema coma EXCEPT? A. Corticosteroids B. IV glucose C. Hypotonic IV solutions D. IV Synthroid

C HYPERtonic or normal saline solutions are used to treat myxedema coma due to the present of hyponatremia....not HYPOtonic solutions. Treatment is Corticosteroids, IV glucose &IV Synthroid

The patient was diagnosed with prerenal AKI. The nurse should know that what is most likely the cause of the patient's diagnosis? A.IV tobramycin (Nebcin) B.Incompatible blood transfusion C.Poststreptococcal glomerulonephritis D.Dissecting abdominal aortic aneurysm

D.Dissecting abdominal aortic aneurysm A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. *Know that the other 3 are INTRARENAL CAUSES-Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and poststretpcoccal glomerulonephritis are intrarenal causes of AKI.*

AKI phases

Oliguric, diuretic, recovery

To prevent the most common serious complication of PD, what is important for the nurse to do? a. Infuse the dialysate slowly. b. Use strict aseptic technique in the dialysis procedures. c. Have the patient empty the bowel before the inflow phase. d. Reposition the patient frequently and promote deep breathing.

b. Peritonitis is a common complication of peritoneal dialysis (PD) and may require catheter removal and termination of dialysis. Infection occurs from contamination of the dialysate or tubing or from progression of exit-site or tunnel infections and strict sterile technique must be used by health professionals as well as the patient to prevent contamination. Too-rapid infusion may cause shoulder pain and pain may be caused if the catheter tip touches the bowel. Difficulty breathing, atelectasis, and pneumonia may occur from pressure of the fluid on the diaphragm, which may be prevented by elevating the head of the bed and promoting repositioning and deep breathing.

In reviewing laboratory data for a client with Cushing's syndrome, the nurse might expect to see the laboratory abnormalities of (Select all that apply) a.hypercalcemia. b.hyperglycemia. c.hyperproteinemia. d.hypoglycemia. e.hypokalemia. f.hypernatremia.

ANS: B, E. F The exaggerated physiologic action of glucocorticoids appears as persistent hyperglycemia (steroid diabetes) and potassium depletion, leading to hypokalemia.

What meds/illness/etc can lead to the damage of the nephrons in the kidneys? (note I am asking about Intrarenal Injury: damage to the nephrons of the kidney injury WITHIN the kidneys)

Nephrotoxic drugs: NSAIDS Antibiotics "aminoglycosides Chemo drugs Contrast dyes used in procedures Infection "glomerulonephritis" Injury When the nephrons are damaged the kidneys can't filter the blood, maintain electrolyte levels, and remove excessive waste and fluid from the body.

What manifestations should the nurse expect to find in a client with Cushing's syndrome? Select all that apply. A) Moon face B) Truncal obesity C) Barrel-shaped chest D) Loss of bone density E) Enlarged hands and feet

A, B, D The client with Cushing's syndrome has increased total body fat which is redistributed, producing moon face and truncal obesity. Depletion of nitrogen and mineral loss leads to loss of bone density. The client with acromegaly has a barrel-shaped chest and enlarged hands and feet due to an excess of growth hormone

Dialysis patients who receive dialysis at home typically​ receive: A. peritoneal dialysis B. ​in-patient dialysis. C. hemodialysis. D. osmotic dialysis.

A. peritoneal dialysis

A nurse is caring for a client with chronic kidney disease who is admitted for pneumonia. The nurse would expect that an appropriate antibiotic that the physician might consider is a/an a.aminoglycoside. b.cephalosporin. c.penicillin. d. sulfonamide.

ANS: C High-risk antibiotics include cephalosporins, sulfonamides, polymyxins, *aminoglycosides*, and amphotericin B.

A patient with AKI: which of the following medications is best to discontinue at this time? A. Lisinopril. B. Naproxen. C. Metformin and lisinopril. D. Metformin, naproxen, and lisinopril.

Answer: D One of the strategies in the management of AKI is to remove potentially nephrotoxic drugs, either direct toxins or medications that alter intrarenal hemodynamics. *It is common to see the following orders for patients in AKI: no ACEIs, ARBs, NSAIDs, or intravenous contrast. It is also important to remove (or reduce the dose of) agents that are cleared renally* Metformin, which accumulates in decreased kidney function with an increased risk of lactic acidosis, should be temporarily discontinued at this time. In this case, metformin, naproxen, and lisinopril should be discontinued

Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance

B Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate

A client with hypoparathyroidism tells the nurse, "my lips feel funny"and complains of numbness and tingling in his fingers. Which assessment of the client should the nurse immediately make? A. Hyponatremia B. Hypocalcemia C. Hyperkalemia D. Hypermagnesemia

B. Hypocalcemia Hypoparathyroidism can cause *low serum calcium levels*. Numbness and tingling in extremities and in the circumoral area around the mouth are the hallmark signs of hypocalcemia. Normal calcium level is 9 to 11 mg/dl.

The nurse is reviewing lab values for a patient recently admitted to the medical-surgical unit. Which lab result is severely abnormal? A. Potassium, 3.5 mEq/L B. Sodium, 137 mEq/L C. Chloride, 107 mEq/L D. Magnesium, 6.2 mEq/L

D A magnesium level of 6.2 mEq/L is greatly elevated. Patients with severe hypermagnesemia are in danger of cardiac arrest. The normal magnesium level is 1.3-2.1 mEq/L. The sodium and potassium results are within normal limits. The chloride level is just slightly elevated, with the normal range being between 98-106 mEq/L.

Which of the following assessment findings are associated with *​hypercalcemia?* (SATA) A. Seizures B. Tachycardia C. Dysrhythmias D. Behavioral changes E. Polyuria

C. Dysrhythmias D. Behavioral changes E. Polyuria rationale: Behavioral changes may be manifested because of decreased neuromuscular excitability. Dysrhythmias occur from the decreased neuromuscular activity of the cardiac muscle. Increased urine production results from the body​'s response to the elevated calcium​ level, which causes excess sodium and water loss.

A client with a recent thyroidectomy complains of numbness and tingling around the mouth. Which of the following findings indicates the serum calcium is low? A. Bone pain B. Depressed deep tendon reflexes C. Positive Chvostek's sign D. Nausea

C. Positive Chvostek's sign *positive Chvostek sign is NOT A POSITIVE SIGN :)*

The patient's T3 and T4 levels are decreased, and the TSH (thyroid-stimulating hormone) level is increased. The nurse suspects what condition?

Hypothyroidism

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a) Decreased blood urea nitrogen (BUN) b) Decreased potassium c) Increased serum albumin d) Increased serum creatinine

D) Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

What contributes MOST to the acutely serious complications from​ end-stage renal​ disease? A. Failure to control hypertension adequately B. Consumption of foods that should be avoided C. Use of medications that should be avoided D. Failure to make regularly scheduled dialysis appointments

D. Failure to make regularly scheduled dialysis appointments *Per the PPT Renal replacement therapies are a must for survival in ESRD*

You are preparing to administer a dose of PhosLo to a patient with chronic kidney disease (CKD). This medication should have a beneficial effect on which laboratory value? A. Sodium B. Potassium C. Magnesium D. Phosphorus

D. Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen in CKD.

A patient with Diabetes insipidus would have a low or high specific gravity?

Low Normal os 1.003 to 1.030

The patient has chronic kidney disease and ate a lot of nuts, bananas, peanut butter, and chocolate. The patient is admitted with loss of deep tendon reflexes, somnolence, and altered respiratory status. What treatment should the nurse expect for this patient? - Renal dialysis - IV potassium chloride - IV furosemide (Lasix) - IV normal saline at 250 mL per hour

Renal dialysis will need to be administered to remove the excess magnesium that is in the blood from the increased intake of foods high in magnesium. If renal function was adequate, IV potassium chloride would oppose the effects of magnesium on the cardiac muscle. IV furosemide and increased fluid would increase urinary output which is the major route of excretion for magnesium.

The patient shows a positive Trousseau's or Chvostek's sign. The nurse prepares to give the patient which urgent treatment? a. IV calcium b. Calcitonin (Calcimar) c. IV potassium chloride d. Large doses of oral calcium

a. IV calcium is given when severe symptoms are present

Which conditions cause the patient to be at risk for hypernatremia? (Select all that apply) a. Renal failure b. Immobility c. Use of corticosteroids d. Watery diarrhea e. Cushing's syndrome

a. Renal failure b. Immobility c. Use of corticosteroids d. Watery diarrhea e. Cushing's syndrome

A patient in the emergency department who reports lethargy, muscle weakness, nausea, vomiting, and weight loss of the past weeks is diagnosed with addisonian crisis). Which drugs does the nurse expect to administer to this patient? a beta blocker to control the hypertension and dysrhythmias b Solu-cortef IV along with IM injections of hydrocortisone c iv fluids of d5ns with KCI added for dehydration d spironolactone (aldactone) to promote diuresis b Solu-cortef IV along with IM injections of hydrocortisone

b Solu-cortef IV along with IM injections of hydrocortisone

The patient with CKD asks why she is receiving nifedipine (Procardia) and furosemide (Lasix). The nurse understands that these drugs are being used to treat the patient's a. anemia. b. hypertension. c. hyperkalemia. d. mineral and bone disorder.

b. Nifedipine (Procardia) is a calcium channel blocker and furosemide (Lasix) is a loop diuretic. Both are used to treat hypertension.

What causes about 50% of CKD?

diabetes