CCN Exam 2 Renal

Peripheral edema

1. Loss of albumin from the vascular space may result in which condition? Decreased albumin levels in the vascular space result in Plasma-to-interstitium fluid shift, creating peripheral edema Can occur as a result of protein-calorie malnutrition? decreased albumin level Occurs in many critically ill patients in whom available stores of albumin are depleted. protein-calorie malnutrition

- Cations - Anions - Other substances in the fluid compartments

A balance exists between?

Anion gap

A calculation of the difference between the measurable extracellular plasma cations and the measurable anions

- Urea - Creatinine - Uric acid - Sodium - Potassium - Ionized calcium - Drugs not bound by proteins

A continuous venovenous hemodialysis filter is permeable to solutes such as?

Fluid excess

A gallop and dependent edema are indicative of?

Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg

A patient has been admitted in acute heart failure. Which parameter would indicate to the nurse that the patient is fluid overloaded?

Daily weights

A patient has been admitted with acute kidney injury. The nurse knows the most important consideration for evaluating the patient's fluid status is what parameter?

- Blood urea nitrogen (BUN) - Creatine

A patient has been admitted with acute kidney injury. Which serum laboratory values would the nurse expect to be ordered to confirm this diagnosis?

Lab - Serum creatinine

A patient has developed acute kidney injury (AKI) secondary to cardiogenic shock. Which laboratory value would the nurse find helpful in evaluating patient's renal status?

Normal saline

A patient has developed acute kidney injury (AKI) secondary to hemorrhage shock. Which intravenous solution would the nurse expect to be ordered for this patient?

- Blood urea nitrogen (BUN) - Creatinine - Hemoglobin and hematocrit

A patient is admitted in acute heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. A diagnosis of renal failure is made. The nurse would expect to see elevated values in which laboratory results?

Volume overload

A patient is admitted in acute heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. The nurse suspects the main cause of ascites is what condition?

Intravenous pyelography (IVP)

A patient is admitted in acute heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. Which diagnostic tests would provide the best information about the internal kidney structures, such as the parenchyma, calyces, pelvis, ureters, and bladder?

Recent computed tomography of the brain with and without contrast

A patient is admitted with acute kidney injury (AKI). Which event from the patient's history was the most probable cause of the patient's AKI?

3600 mL

A patient is admitted with renal failure. The patient's weight upon admission was 176 lb, and the next day it is 184 lb. What is the approximate amount of fluid retained with this weight gain?

Decreases blood flow to the kidney, GFR, urine output

A patient is admitted with respiratory failure and is being mechanically ventilated. The nurse understands there is a significant association between acute kidney injury and respiratory failure. How does mechanical ventilation alter kidney function?

Ultrafiltrate

A patient is admitted with sepsis and acute kidney injury (AKI). The patient is started on continuous renal replacement therapy (CRRT). The nurse knows that fluid that is removed each hour is charted as what on the CRRT flowsheet?

Volume deficit

A patient was admitted with acute heart failure a few days ago. Today the patient's urine has a specific gravity of 1.040. What could be the potential cause for this value?

Specific gravity of 1.000

A patient was admitted with acute kidney failure. Which urinalysis value reflects a decreased ability of the kidneys to concentrate urine?

Hemodialysis

A patient was admitted with an infection that had to be treated with an aminoglycoside antibiotic. After a few days the patient developed oliguria and elevated blood urea nitrogen and creatinine levels. The patient's vital signs are stable. The nurse would anticipate the practitioner ordering which dialysis method for this patient?

Intrarenal

A patient was admitted with an infection that had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of the administration, the patient developed oliguria, and elevated blood urea nitrogen and creatinine levels. The nurse suspects the patient has developed what type of kidney injury?

Lactated Ringer solution

A patient was admitted with liver failure and acute kidney injury (AKI). Which intravenous solution should the nurse question if it were ordered for this patient?

- Muscle cramps - Low blood pressure

A patient who receives peritoneal dialysis is admitted after a 3-day history of flulike symptoms. The patient reports muscle cramps and is noted to have a low blood pressure and tachycardia. This patient has dehydration and is showing signs and symptoms of?

Dehydration

A patient who receives peritoneal dialysis is admitted after a 3-day history of flulike symptoms. The patient reports muscle cramps and is noted to have a low blood pressure and tachycardia. The nurse suspects the patient may be experiencing what condition? This patient has dehydration and is showing signs and symptoms of muscle cramps and low blood pressure.

Filter clotting, access failure, and air embolism

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodiafiltration (CVVHDF). The nurse understands the patient should be closely monitored for what circuit-related complications of the therapy?

Electrolytes

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse knows the hemodialyzer filter used in this type of therapy is permeable to what substance?

Maximum fluid and solute removal

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands that this type of continuous renal replacement therapy (CRRT) is indicated for the patient who needs what type of treatment?

- Infection - Hypotension - Electrolyte imbalances

A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands the patient should be closely monitored for what patient-related complications of the therapy?

Sodium Kayexalate 15 g PO

A patient with acute kidney injury has a potassium level of 6.9 mg/dL. The patient has had no urine output in the past 4 hours despite administration of Lasix 40 mg intravenous push. To correct the hyperkalemia the patient is given 50 mL of 50% dextrose in water and 10 U of regular insulin intravenous push. A repeat potassium level 2 hours later shows a potassium level of 4.5 mg/dL. What order would the nurse expect now?

Lack of production of erythropoietin to stimulate red blood cell formation

A patient with chronic kidney disease receives hemodialysis treatments 3 days a week. Every 2 weeks, the patient requires a transfusion of 1 or 2 U of packed red blood cells. What is the probable reason for this patient's frequent transfusion needs?

Hypokalemia

A patient with chronic kidney disease was admitted with severe electrolyte disturbances. The patient had been ill and missed several hemodialysis sessions. The patient is disoriented, dizzy, cold, clammy, and complains of severe abdominal cramping. The patient's electrocardiogram appears normal. Which electrolyte disturbance would the nurse suspect the patient may be experiencing?

Angiotensin II

A powerful vasoconstrictor.

- Chlorothiazide (Diuril) - Metolazone (Zaroxolyn)

A thiazide diuretic may be administered and followed by a loop diuretic to take advantage of the fact that these medications work on different parts of the nephron. Thiazide diuretics such as?

Creatinine

Accumulates when the glomerulus is unable to filter it from the blood, like urea?

Aldosterone

Acts on the distal tubule facilitating sodium and water resorption?

- Insulin - Glucose

Acute hyperkalemia can be treated temporarily by intravenous administration of?

- 50 mL of 50% dextrose - 10 units of regular insulin

Acute hyperkalemia treated with an infusion of?

- Not eliminated from the body - Shifted intracellularly

Acute hyperkalemia treatment: Potassium?

- Cell membrane structure - Acid-base balance - Oxygen delivery to the tissues - Cellular immunity - Bone strength

Additional functions of phosphorus include?

Magnesium level

Admit: - Severe hypokalemia Labs: - Serum K 2.2 mEq/L - Blood urea nitrogen (BUN) 15 mg/dL - Creatinine 1.2 mg/dL - Urine output averaging 45 mL/h Tx: - Potassium 80 mEq over 4 hrs Labs repeated: - Potassium 2.4 mEq/L What other information would be beneficial at this time?

Contrast dye

Aggressive fluid resuscitation with normal saline is recommended with?

Distal tubules

Aldosterone acts on?

- Expand circulating blood volume - Increased blood pressure

Aldosterone stimulated resorption of sodium and water distal tubules, increases arterial blood pressure by?

Sodium

Aldosterone tells the distal tubules to resorb what electrolyte back into the circulation?

Intravenous pyelography

Allows visualization of the internal kidney parenchyma, calyces, pelvis, ureters, and bladder?

- Bleeding within the urinary tract - Kidney trauma

Although a few red blood cells (RBCs) in the urine are normal, discernibly bloody urine usually indicates?

Inadequate blood flow

An alert and oriented patient presents with a pulmonary artery occlusion pressure (PAOP) of 4 mm Hg, blood pressure of 88/50 mm Hg, cardiac index of 1.8, and urine output of 15 mL/h. The patient's blood urea nitrogen (BUN) is 44 mg/dL and creatinine is 3.2 mg/dL. Lungs are clear to auscultation with no peripheral edema noted. The acute kidney injury would probably be prerenal from?

Hypovolemia

An alert and oriented patient presents with a pulmonary artery occlusion pressure (PAOP) of 4 mm Hg, blood pressure of 88/50 mm Hg, cardiac index of 1.8, and urine output of 15 mL/h. The patient's blood urea nitrogen (BUN) is 44 mg/dL and creatinine is 3.2 mg/dL. Lungs are clear to auscultation with no peripheral edema noted. The patient's hemodynamic parameters are most consistent with?

0.9% normal saline at 125 mL/h

An alert and oriented patient presents with a pulmonary artery occlusion pressure (PAOP) of 4 mm Hg, blood pressure of 88/50 mm Hg, cardiac index of 1.8, and urine output of 15 mL/h. The patient's blood urea nitrogen (BUN) is 44 mg/dL and creatinine is 3.2 mg/dL. Lungs are clear to auscultation with no peripheral edema noted. Which treatment would the nurse expect the practitioner to order?

Prerenal

An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage. The nurse knows the patient is at risk for developing what type of acute kidney injury (AKI)?

Forces potassium out of the serum and into the cells

An infusion of 50 mL of 50% dextrose accompanied by 10 units of regular insulin does what?

Blood plasma

An isotonic solution has roughly the same concentration particles as?

Renal blood flow

Angiography allows for visualization of?

- Stenosis - Cysts - Clots - Trauma - Infarction

Angiography may also visualize?

- Kidney blood flow - Available glomerular filtrate

Angiotensin II induces renal vasculature constriction, leading to reduced?

- Kidney blood flow - Available glomerular filtrate

Antidiuretic hormone is released by the posterior pituitary in response to reduced?

Intrarenal AKI

Any condition that produces an ischemic or toxic insult directly at parenchymal nephron tissue places the patient at risk for development of?

Postrenal AKI

Any obstruction that hinders the flow of urine from beyond the kidney through the remainder of the urinary tract may lead to?

True

Are a few red blood cells (RBCs) in the urine normal? - True - False

- Low cardiac output - Hemorrhage - Vasodilation - Thrombosis - Anything that reduces the blood flow to the - - - Kidney - - - Glomerular filtration decreases - - - Consequently urine output decreases

Arterial hypoperfusion is caused by?

Renin, consequently decreasing renin-angiotensin-aldosterone system activity

As arterial blood pressure increases, the juxtaglomerular apparatus reduces the release of?

Antidiuretic hormone

As serum osmolality rises, intravascular fluid equilibrium will be maintained by the release of what substance?

Volume Overload

Ascites caused by?

Fluid volume excess

Ascites may or may not represent?

- Interstitial space - Abdominal cavity

Ascites occurring because increased vascular pressure associated with liver dysfunction forces fluid and plasma proteins from vascular space into?

Proteinuria

Associated with complications in both the kidney and cardiovascular systems.

Fluid volume excess

Because of the dilutional effect of the extra fluid load, decreased hematocrit value can indicate?

Prerenal acute kidney injury (AKI)

Before arterial blood reaches the renal artery that supplies the kidney may be anatomically described as?

- True

Blood flows out toward the dialyzer and flows back to the patient through the same catheterized vein. - True - False

Mechanical ventilation

Can alter kidney function?

Intravenous contrast media

Can be nephrotoxic, especially with the patient's preexisting cardiac disease

Diamox

Carbonic anhydrase inhibitor diuretic

Isotonic solution

Cells maintain consistency and do not lose or gain fluid to their surroundings in?

Serum osmolality

Chloride plays a major role in maintaining what physiologic process?

- Air embolism - Clotted hemofilter - Poor ultrafiltration - Blood leaks - Broken filter - Disconnection - Access failure - Catheter dislodgement

Circuit-related complications of continuous renal replacement therapy include:

Hypertonic solution

Contains a greater concentration of particles than inside cells and causes fluid to be drawn out of the cells?

Hypotonic solution

Contains a lesser concentration of particles than that inside the cell and causes fluid to be drawn into the cells?

Low Magnesium levels

Could explain the lack of response to the potassium infusions.

Osmotic pressure

Created by solutes and other substances (eg, albumin, globulin, fibrinogen) suspended in fluid.

Colloid osmotic pressure

Created primarily by the presence of plasma proteins in the intravascular space.

- Kidney status - Fluid status

Daily weight is one of the most important assessments of?

Kidney function

Declines gradually with age, but this usually does not affect homeostasis in the healthy older adult unless proteinuria is present.

- Anemias - Blood loss - Liver damage - Hemolytic reactions

Decreases also can result from?

Kidney-ureter-bladder flat-plate radiography of the abdomen

Determines the position, size, and structure of the kidneys, urinary tract, and pelvis?

A thiazide is added to a loop

Diuretics to compensate for the development of loop diuretic resistance?

Effective in increasing urine output in the short term

Dopamine

Positive end-expiratory pressure (PEEP)

Effects of positive-pressure ventilation are intensified with the addition of?

Uremia

Elevations in the BUN can be correlated with the clinical manifestations of?

Phosphorus abnormalities

Evident early in the course of kidney failure

Plasma proteins

Exert a pull on water molecules and therefore produce osmotic pressure, which retains fluid within the intravascular compartment.

- Increased Potassium excretion by kidneys - Hypokalemia

Extracellular Potassium causes?

Creatinine levels

Fairly constant and are affected by fewer factors than BUN

- Blood pressure measurements - Intravenous infusions

Fistula - Extremity should be pink and warm to the touch - No?

- 5 to 20 mL/min - Up to 7 to 30 L/24 h

Fluid is removed by ultrafiltration in volumes of?

Exerting pressure to abdominal midline while one hand placed on the right or left flank

Fluid wave is elicited by?

- True

For short-term vascular access for immediate hemodialysis, a dual-lumen venous catheter is most commonly used? - True - False

- Low-dose dopamine (2 to 3 mcg/kg/min) - Previously known as renal-dose dopamine

Frequently infused to stimulate blood flow to the kidney?

Most frequently used diuretic in critical care

Furosemide

- Orally - Intravenous (IV) bolus - Continuous IV infusion

Furosemide may be administered

180 mg/dL

Glucose Serum Threshold

- Tubules are unable to reabsorb all - Some spills into the urine

Glucose levels above threshold?

- Electrolytes - Fluids - Toxins

Hemodialysis separates and removes from the blood excess by means of a hemodialyzer?

Medication toxicity

Hemodialysis would be the first choice for managing a patient with?

- Too much fluid enters the cell - Cells swell and burst

Hemolysis

Ultrasonography

High-frequency sound waves transmitted to the kidneys and urinary tract?

- Baseline metabolism - Environmental temperature - Humidity

Important criteria when calculating fluid volume replacement include?

Intracellular enzyme reaction co-factor

Important function of Magnesium?

Eliciting a fluid wave

In a patient with a distended abdomen, differentiating ascites from solid bowel contents is accomplished by performing what assessment?

Low

In fluid volume deficit, PAOP?

Rises

In fluid volume excess, PAOP?

- Glomerular filtration rate - Kidney function

In the acutely ill patient, small changes in the serum creatinine level and urine output may signal important declines in?

Hemolysis

Incorrectly usage of hypotonic solution can cause?

Azotemia

Increased blood urea nitrogen level

- Expands vascular space - Serum osmolality back to normal - More concentrated urine - Elevated urine osmolality level

Increased water resorption in the kidney tubules?

Continuous venovenous hemodialysis (CVVHD)

Indicated for patients who require large-volume removal of fluid and solutes

Ascites

Individuals with kidney failure may have?

Angiography

Injection of contrast into arterial blood perfusing the kidneys?

- Acute decompensated heart failure - Kidneys are unresponsive to diuretics

Intermittent ultrafiltration using a peripheral venous catheter is more likely to be used to remove excess volume from patients with?

- Calcium - Potassium

Intracellular electrolytes affected by Magnesium level?

True

Is laboratory phlebotomy performed on the arm with the fistula? - True - False

- Prolonged hypotension - Low cardiac output

Ischemic damage may be caused by?

- Evaluating the presence of calculi and masses - Usually followed by additional tests

Kidney-ureter-bladder flat-plate radiography of the abdomen is useful for?

False - The urine output does not seem to suggest oliguria

Laboratory results come back on a newly admitted patient: Serum blood urea nitrogen, 64 mg/dL; serum creatinine, 2.4 mg/dL; urine osmolality, 210 mOsm/kg; specific gravity, 1.002; and urine sodium, 96 mEq/L. The patient's urine output has been 120 mL since admission 2 hours ago. These values are most consistent with a diagnosis of intrarenal acute kidney injury. Does the urine output seem to suggest oliguria? - Ture - False

Intrarenal acute kidney injury

Laboratory results come back on a newly admitted patient: Serum blood urea nitrogen, 64 mg/dL; serum creatinine, 2.4 mg/dL; urine osmolality, 210 mOsm/kg; specific gravity, 1.002; and urine sodium, 96 mEq/L. The patient's urine output has been 120 mL since admission 2 hours ago. These values are most consistent with which diagnosis?

- Kidney - Liver diseases - Lactic acidosis

Lactated Ringer solution is contraindicated for patients with?

Anuria

Lasix is not expected to work in the presence of?

Potassium

Liberated to the extracellular fluid by Magnesium depletion?

- Furosemide - Bumetanide - Torsemide

Loop diuretics include

- Sodium - Potassium

Magneism functions to ensure transportation, across the cell membrane, of?

Nervous impulse conduction

Maintaining a normal range of serum potassium is important for what physiologic process?

- Intravascular space is volume depleted - Hypovolemic

Marked edema

Anemia

May occur early in the disease In individuals with acute kidney failure?

Toxic injury reaction

May occur in response to substances that damage the kidney tubular endothelium

Urea

Measured as blood urea nitrogen?

Specific gravity

Measures the density or weight of urine compared with that of distilled water?

- RBCs - Myoglobin is present instead

Microscopic examination of the urine fails to reveal?

Serum creatinine level

More sensitive and specific indicator of kidney function than BUN

Venous lines only

Most temporary catheters are?

Diffusion

Movement of solutes along a concentration gradient from a high concentration to a low concentration across a semipermeable membrane.

- Skeletal muscle damage - - Such as, traumatic crush injury - Rhabdomyolysis

Myoglobin in the urine may result from?

Anions

Negatively charged ions

- Fluid accumulation or obstruction - Cysts - Stones or calculi - Masses

Noninvasive ultrasonography, useful for evaluating the kidneys before biopsy, identifies?

5 to 12 mm Hg

Normal PAOP?

1.005 to 1.025

Normal urinary specific gravity?

Glucose

Normally completely reabsorbed from tubules

- Hyperkalemia - Hypocalcemia - Hyponatremia - Hyperphosphatemia - Acid-base imbalances

Occur in kidney disease?

Creatinine excess

Occurs most often in persons with kidney failure resulting from impaired excretion?

Convection

Occurs when a pressure gradient is set up so that the water is pushed or pumped across the dialysis filter and carries the solutes from the bloodstream with it

- 1 kg, which is 2.2 lb - 8 lb equals 3.6 kg, which is 3.6 L - 3.6 L is equal to 3600 mL

One liter of fluid equals

Glucose and insulin force potassium into the cells, lowering it on a serum level

One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. Which statement regarding how this treatment works is accurate?

Mannitol

Osmotic diuretic

- Albumin - Globulin - Fibrinogen

Osmotic pressure is created by solutes and what other substances suspended in fluid?

Left ventricular preload

PAOP is a measures?

- Dehydration - Hypotension - Electrolyte imbalances - Acid-base imbalances - Blood loss - Hemorrhage - Hypotension - Infection

Patient-related complications of continuous renal replacement therapy (CRRT) include?

Presence of pain in the renal area

Percussion of kidneys is usually done to assess what parameter?

- Location - Size - Possible problems

Percussion of the kidneys also provides information about kidney?

Detect pain in the area of a kidney

Percussion performed to?

Determine excess accumulation of air, fluid, or solids around the kidneys

Percussion performed to?

Formation of adenosine triphosphate (ATP)

Phosphorus primary function is?

Threshold

Plasma level of a substance at which none of the substance appears in the urine

Chloride

Plays a major role in maintaining serum osmolality, water balance, and acid-base balance.

- Reduces blood flow to the kidney - Lowers the glomerular filtration rate (GFR) - Decreases urine output

Positive-pressure ventilation

Cations

Positively charged ions

- Volume overload - Interrenal AKI

Possible causes for decreased specific gravity values include?

- Volume deficit - Glycosuria - Proteinuria - Prerenal acute kidney injury (AKI)

Possible causes for increased specific gravity values include?

- Nervous impulse conduction - Muscle contraction

Potassium functions in the body to aid in?

- Sodium - Chloride

Predominant cation in plasma? Predominant anion in plasma?

- Decreased perfusion - Flow to the kidney

Prerenal acute kidney injury (AKI) caused by?

- Trauma - Hemorrhage - Hypotension - Major fluid losses

Prerenal acute kidney injury (AKI) is often associated with?

- Blood flow - Blood pressure - Kidney perfusion

Prerenal is any condition that decreases?

Control sodium and water

Primary function of aldosterone?

- Urea - Creatinine

Primary waste products measured in determining kidney function?

Tapping the opposite flank

Produces a wave in the accumulated can be felt under the hands

Adenosine triphosphate (ATP)

Provides intracellular energy for active transport mechanisms across the cell membrane.

- Energy: 20 and 30 kcal/kg/day - Protein: 1.2 to 1.5 g/kg/day

Recommended intake to control azotemia?

Convection

Removal of solutes such as urea, creatinine, and other small non-protein-bound toxins is accomplished by?

Angiotensin I

Renin is converted to?

- Reduced glomerulus pressure - Sympathetic stimulation of the kidneys - Decreased sodium in the distal convoluted tubule

Renin is released in response to?

Pulmonary artery occlusion pressure (PAOP)

Represents the left atrial pressure required to fill the left ventricle

- Traumatic injury - Cocaine abuse - Status epilepticus - Heat prostration - Collapse during intense physical exercise - - Such as, running a marathon race on a hot day

Rhabdomyolysis may develop in patients admitted to a critical care unit for many reasons, including?

Kidney

Serum creatinine is the most reliable predictor of which function?

Decreased plasma proteins

Severe ascites in persons with compromised liver function may result from?

- Disorientation - Muscle twitching - Nausea - Vomiting - Abdominal cramps - Headaches - Dizziness - Cold, clammy skin - Tachycardia - Seizures

Signs of hyponatremia include?

- Vital signs do not support hypovolemia - Anuria

Signs that a large fluid infusion can precipitate acute heart failure?

Kayexalate

Soon after acute hyperkalemia treatment, potassium returns to the bloodstream, help permanently remove it from the body with?

1.000

Specific gravity of distilled water?

1.003 to 1.030

Specific gravity ranges from

Adrenal glands

Stimulated by Angiotensin II to secrete aldosterone?

BUN

Symptoms of uremia become more pronounced as what rises?

- Fluid extraction - - known as ultrafiltration, from the vascular space

The difference between the (two values (expressed in millimeters of mercury [mm Hg]) represents the transmembrane pressure and results in?

- Avoid unnecessary use - Insert using aseptic technique - Adopt evidence-based standards for maintenance - Review need daily - Remove promptly

The key components of catheter-associated urinary tract infection (CAUTI) prevention are?

Parathyroid hormone (PTH)

The mobilization of calcium from bone stores is accomplished through the influence of which hormone?

- Thrill when palpated gently with the fingers - Bruit when auscultated with a stethoscope

The nurse frequently assesses the quality of blood flow through the fistula. A patent fistula has?

- Insert using aseptic techniques - Review need daily - Removing promptly - Avoid unnecessary indwelling urinary catheter

The nursing management plan for the patient with a urinary drainage catheter would include which interventions to prevent catheter-associated urinary tract infection (CAUTI)?

Continuous venovenous hemofiltration (CVVH)

The practitioner has ordered continuous renal replacement therapy (CRRT) for a patient with acute kidney injury. The patient needs both the removal of fluids and a moderate amount of solutes. Which type of CRRT would the nurse anticipate being started on this patient?

Intermittent ultrafiltration

The practitioner has ordered dialysis for a patient with acute heart failure who is unresponsive to diuretics. Which type of dialysis would the nurse anticipate being started on this patient?

- Cardiopulmonary reserve - Adequacy of kidney function - Urine output - Fluid balance - Ongoing loss - Type of fluid replaced

The rate of replacement for hypovolemia depends on?

Metolazone

Thiazide diuretic

Isotonic

This intravenous fluid will not create a shift of fluids within the vascular space?

- Palpate gently over the site of the fistula to determine whether a thrill is present - Listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow

To assess whether or not an arteriovenous fistula is functioning, what must the nurse do and why?

1 mEq of carbonic acid to 20 mEq of bicarbonate

To prevent acid-base disturbances, what is the ratio between carbonic acid and bicarbonate?

Ultrafiltration

To remove fluid during hemodialysis, a positive hydrostatic pressure is applied to the blood and a negative hydrostatic pressure is applied to the dialysate bath. What is this process called?

Dialysate bath

To remove fluid, a positive hydrostatic pressure is applied to the blood, and negative hydrostatic pressure is applied to the?

Acute kidney injury

Tolerance of the dopamine renal receptor to the medication is theorized to develop in the critically ill patients who are most at risk for?

- Some antimicrobial medications - Contrast dye used in radiologic diagnostic studies

Toxic injury reaction may occur in response to substances that damage the kidney tubular endothelium, such as?

Pulls and squeezes excess fluid from the blood

Transmembrane pressure does what?

Acute hyperkalemia

Treated temporarily by intravenous (IV) administration of insulin and glucose?

Fluid resuscitation

Treatment of choice for hypovolemia is?

Transmembrane pressure

Two forces, positive hydrostatic pressure and negative hydrostatic pressure, together are called?

Continuous renal replacement therapy

Typically, some of the ultrafiltrate is replaced with sterile replacement fluid, through what therapy circuit?

Urine

Ultrafiltrate is the fluid removed each hour is not called?

Oscilloscope

Ultrasonography image is viewed on?

- End product of protein metabolism - Results from the breakdown of ammonia in the liver

Uria

Less than 10 mEq/L (low)

Urinary sodium suggests a prerenal condition?

- Greater than 40 mEq/L - Presence of elevated serum creatinine - Absence of a high salt load

Urinary sodium suggests intrarenal damage has occurred?

Myoglobin

Urine can appear red in the presence of?

- Subclavian - Femoral

Veins catheterized when short-term access is required or when a graft or fistula vascular access is nonfunctional in a patient requiring immediate hemodialysis.

Left ventricular preload

Volume of blood available for ejection?

Increased capillary hydrostatic pressures

Volume overload forces fluid into the abdomen because of?

- Bleeding - Traumatic damage to the skeletal muscle - Rhabdomyolysis - Cocaine abuse

What causes the presence of myoglobin in urine?

Insulin

What forces potassium out of the serum and into the cells?

2 to 3 mcg/kg/min

What is the dose for low-dose dopamine?

Subclavian vein

What is the most common site for short-term vascular access for immediate hemodialysis?

1.2 to 1.5 g/kg/day

What is the recommended nutritional intake of protein to control azotemia in the patient with acute kidney injury?

Intravascular plasma proteins

What substance is the most responsible for maintaining the colloid osmotic pressure?

Sodium

When calculating the anion gap, what is the predominant cation?

Serum osmolality level increases

When is antidiuretic hormone is released from the posterior pituitary gland, stimulating increased water resorption in the kidney tubules?

- Acute Kidney Dysfunction - Chronic Kidney Dysfunction

When older adults become ill, the decline in kidney function can be accelerated, making older adults especially susceptible to?

Volume of blood available for ejection

When the left ventricle is full at the end of diastole, this represents?

Posterior pituitary

Where is antidiuretic hormone released?

Reduced pressure in the glomerulus

Which condition would result in an increased release of renin?

- Loop - Thiazide

Which diuretics may be combined to work on different parts of the nephron?

Phosphorus

Which electrolyte abnormality is evident early in the course of kidney failure?

- Chloride - Bicarbonate

Which electrolytes are anions?

- Sodium - Potassium - Magnesium

Which electrolytes are cations?

- Sodium - Potassium -Magnesium - Calcium

Which electrolytes are cations?

- S3 or S4 may develop. - Dependent edema may be present

Which findings may be present in the patient with significant fluid volume overload?

Erythropoietin

Which hormone secreted by the kidneys, controls erythrocyte (red blood cell) production in bone marrow?

Furosemide

Which medication is classified as a loop diuretic?

Kidney function declines with age but usually does not affect homeostasis.

Which statement regarding kidney function and aging is accurate?

Urine is composed of many solutes and substances suspended in water

Why should the specific gravity always be higher than that of water?

0.75 mL/min/year

With aging, the GFR declines by about how much?

Serum creatinine

With an older adult, you may not see a rise in what level?

Decreased glomerular filtration rate - - Leading to decreased urea excretion

With kidney dysfunction, the blood urea nitrogen (BUN) is elevated because of?

Crenation

Withering of the cell

Parenchymal nephron tissue places

the patient at risk for development of intrarenal kidney injury with any condition that produces an ischemic or toxic insult directly at?