Semester 3: Unit 6 exam***

glomerulonephritis cause

-Drugs or toxin -Systemic disorder affecting many organs or idiopathic -May follow acute infections-most commonly streptococcal infections -Vascular pathology -Immune disorders

glomerulonephritis symptoms

-Headache -Increased BP -Edema -Fever -Proteinuria -Hematuria (blood) -Oliguria (volume) -Dysuria (pain) -hyperkalemia -flank pain

APSGN

*acute poststreptococcal glomerulonephritis* Most common postinfectious renal disease in childhood -glomeruli become edematous and infiltrated with WBCs -as a result, the glomerular filtration rate decreases -causing an accumulation of sodium and water in the blood -leads to circulatory congestion and edema -inflammation and damage to the glomeruli result in increased permeability - causes proteinuria and hematuria

indicator of kidney failure

- Calcium (serum) 8.6-10.3mg/dL - serum phosphorus 3.4-4.5 mg/dl (1.12 to 1.45 mmol/L) - BUN 7-20 mg/dL (2.5 to 7.1 mmol/L) - Creatinine 0.59-1.35 mg/dL - potassium level 3.6-5.2 mmol/L - magnesium 1.7-2.2 mg/dL (0.85 to 1.10 mmol/L) - albumin 2.0-20 mg/mmol men, 2.8-28 women - bicarbonate 23 to 30 mEq/L ratio of BUN to creatinine is usually between 10:1 and 20:1. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as congestive heart failure or dehydration. When there is too much phosphate in the blood it takes too much calcium with it and it decreases the calcium in the blood and vice versa.

Menopause

- cessation of menstruation (12 missed cycles) - typically 51 years old - decreased estrogen and progesterone - age of perimenopause is genetically programmed. Cigarette smoking, autoimmune disorder, and living at high altitudes can lead to earlier menopause. - test for elevated FSH (30 mIU/mL) *HAVOCS* *Hot flashes *Atrophy of the *Vagina *Osteoporosis *Coronary artery disease *Sleep disturbances - headaches - irritability - thinning hair

systemic lupus erythematosus (SLE)

- chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs - extremely variable in its course, and there is no way to predict its progression. - Women (black) are more at risk - Environmental trigger: Sun exposure/sun burns - Medication trigger: Procainamide (Pronestyl), Hydralazine (Apresoline), Quinidine

hormone replacement therapy

-Used for relief or prevention of menopausal symptoms (e.g., hot flashes, vaginal atrophy), osteoporosis (increased estrogen, decreased osteoclast activity). -Unopposed estrogen replacement therapy increases risk of endometrial cancer, so progesterone is added. Possible increased cardiovascular risk. -Ca++, Vit-D, Bisphosphonates, Calcitonin (slow Ca++ from bones) 1000mg per day

acute renal injury

-rapid loss of kidney function demonstrated by rise in serum creatinine &/or reduction in urine output -small increase in serum creatinine or reduction in urine output to the development of azotemia (accumulation of nitrogenous waste products) -develops over hours to days → progressive elevations of BUN, creatinine, potassium -50% mortality rate Etiology is classified according to categories -Pre-renal: above the kidneys -Intrarenal: in the kidneys -Post-renal: below the kidneys occurs when blood flow to the kidneys is significantly compromised

Normal urine output

1-2 ml/kg/hr

Hyperkalemia is a serious complication that can occur during AKI bc it can lead to dysrhythmias....Match each treatment with what they do: 1. removes K+ from the body in the most effectively and works w/i a short time 2. serves as a temporary measure for hyperkalemia by causing a shift of potassium into the cells 3. Raises the threshold at which dysrhythmias will occur 4. remove K+ from the body and is given via mouth or retention enema A. Calcium gluconate B. Insulin and NaHCO₃ (sodium bicarb) C. Kayexalate D. Hemodialysis

1. removes K+ from the body in the most effectively and works w/i a short time - D. Hemodialysis 2. serves as a temporary measure for hyperkalemia by causing a shift of potassium into the cells - B. Insulin and NaHCO₃ (sodium bicarb) 3. Raises the threshold at which dysrhythmias will occur - A. Calcium 4. remove K+ from the body and is given via mouth or retention enema - C. Kayexalate

A women is considered to be in menopause after she missed how many menstrual cycles?

12

albumin

3.5-5 g/dL protein in blood; maintains the proper amount of water in the blood essential component of the bloodstream that helps maintain both osmotic pressure and fluid and electrolytes.

At what age does menopause typically begin?

51

GFR (glomerular filtration rate)

90-120 mL/min Normal Stage 1: Kidney damage with normal renal function GFR >90 ml/min but with proteinuria (3 months or more); Stage 2: Kidney damage with mild loss of renal function GFR 60-89 ml/min with proteinuria (3 months or more) Stage 3: Mild-to-severe loss of renal function GFR 30-59 mL/min Stage 4: Severe loss renal function GFR 15-29 mL/min Stage 5: End stage renal disease GRF less 15 mL/min

A nurse is providing counseling to a client with the diagnosis of systemic lupus erythematosus (SLE). Which recommendations are essential for the nurse to include? Select all that apply. A. "Wear a large-brimmed hat." B. "Take your temperature daily." C. "Balance periods of rest and activity." D. "Use a strong soap when washing the skin." E. "Expose the skin to the sun as often as possible."

A. "Wear a large-brimmed hat." B. "Take your temperature daily." C. "Balance periods of rest and activity." A fever is the major sign of an exacerbation. A balance of rest and activity conserves energy and limits fatigue. Malaise, fatigue, and joint pain are associated with SLE. SLE can cause alopecia, and hair care recommendations include the use of mild protein shampoos and avoidance of harsh treatments, like permanents or highlights, and use of large-brimmed hat for skin protection. Mild, not strong, soap and other skin products should be used on the skin. The skin should be washed, rinsed, and dried well and lotion should be applied. Exposing the skin to the sun as often as possible is not recommended. Exposure to ultraviolet light may damage the skin and aggravate the photosensitivity associated with SLE.

Which patient below is at MOST RISK for developing acute glomerulonephritis? A. A 3 year old male who has a positive ASO titer. B. A 5 year old male who is recovering from an appendectomy. C. An 18 year old male who is diagnosed with HIV. D. A 6 year old female newly diagnosed with measles.

A. A 3 year old male who has a positive ASO titer. An ASO (antistreptolysin) titer is a test used to diagnose strep infections. Remember strep infections increase, especially in the pediatric population, the risk of developing AGN. Patients in options B, C, and D are not at risk for this.

Which factors can lead to intrarenal AKI (select all that apply) A. Acute glomerulonephritis B. BPH C. Dehydration D. SLE E. Nephrotoxins F. Prolonged ischemia

A. Acute glomerulonephritis D. SLE E. Nephrotoxins F. Prolonged ischemia

A nurse is taking care of a client with cirrhosis of the liver. Which clinical manifestations should the nurse assess in the client? Select all that apply. A. Ascites B. Hunger C. Pruritus D. Jaundice E. Headache

A. Ascites C. Pruritus D. Jaundice Ascites is a result of portal hypertension that occurs with cirrhosis. Pruritus is common because bile pigments seep into the skin from the bloodstream. Jaundice occurs because the bile duct becomes obstructed and bile enters the bloodstream. The appetite decreases because of the pressure on the abdominal organs from the ascites and the liver's decreased ability to metabolize food. Headache is not a common manifestation of cirrhosis of the liver.

A client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. The client reports frequent nausea, pain that increases after meals, and black, tarry stools. The client recently joined Alcoholics Anonymous. The nurse should give priority to which client history item? A. Black, tarry stools B. Frequent nausea C. Joining Alcoholics Anonymous D. Pain that increases after meals

A. Black, tarry stools The priority is black (tarry) stools that indicate upper gastrointestinal (GI) bleeding; digestive enzymes act on the blood, resulting in tarry stools. Hemorrhage can occur if erosion extends to blood vessels. Nausea is a common symptom of gastritis but is not life threatening. Attempts to control alcoholism should be supported, but this is a long-term goal; assessment of bleeding takes priority. Investigation of bleeding takes priority; later the nurse should help to identify irritating foods that may be increasing the pain after eating and are to be avoided

A nurse is interviewing a client who was diagnosed with systemic lupus erythematosus (SLE). Which common responses to this disease can the nurse expect the client to exhibit? Select all that apply. A. Butterfly facial rash B. Firm skin fixed to tissue C. Inflammation of the joints D. Muscle mass degeneration E. Inflammation of small arteries

A. Butterfly facial rash C. Inflammation of the joints The connective tissue degeneration of SLE leads to involvement of the basal cell layer, producing a butterfly rash over the bridge of the nose and in the cheek region. Polyarthritis occurs in most clients, with joint changes similar to those seen in rheumatoid arthritis. Firm skin fixed to tissue occurs in scleroderma; in an advanced stage the client has the appearance of a living mummy. Muscle mass degeneration occurs in muscular dystrophy; it is characterized by muscle wasting and weakness. Inflammation of small arteries occurs in polyarteritis nodosa, a collagen disease affecting the arteries and nervous system

The pathophysiology of systemic lupus erthematosus (SLE) is characterized by: A. Destruction of nucleic acids and other self-proteins by autoantibodies B. Overproduction of collagen that disrupts the functioning of internal organs C. Formation of abnormal IgG that attaches to cellular antigens, activating complement D. Increased activity of T-suppressor cells with B-cell hypoactivity, resulting in an immunodeficiency

A. Destruction of nucleic acids and other self-proteins by autoantibodies

Clinical manifestations of glomerulonephritis (select all that apply) A. Edema B. Hypotension C. Oliguria D. Hematuria E. Proteinuria F. Dysuria

A. Edema C. Oliguria D. Hematuria E. Proteinuria F. Dysuria HYPERtension will occur Protein is an irritant and will cause dysuria

Which blood test can help confirm if a mown is beginning menopause? A. FSH B. Testosterone C. Progesterone D. Cholesterol

A. FSH

What clinical manifestations does a nurse expect a client with systemic lupus erythematosus (SLE) most likely to exhibit? A. Facial rash B. Weigh gain C. Joint pain D. Pericarditis E. Hypotension

A. Facial rash C. Joint pain D. Pericarditis Facial rash, Joint pain, And Pericarditis SLE is a chronic, autoimmune disease that affects connective tissue; joint pain is common. A butterfly rash is characteristic of SLE. Pericarditis is the most common cardiac indicator of SLE. Weight loss, not gain, is a classic sign of SLE because of gastrointestinal effects. Renal impairment with SLE may cause hypertension, not hypotension.

Which of the following clinical findings should the nurse expect to find during the assessment of a child with acute glomerulonephritis (AGN)? Select all that apply. A. Flank pain B. Periorbital edema C. Intermittent fever D. Increased urine volume E. Decreased joint mobility

A. Flank pain B. Periorbital edema Flank pain is caused by inflammatory and degenerative changes in renal tissue; renal damage occurs because antigen-antibody complexes become trapped in the glomeruli. Because of glomerular dysfunction, filtration of plasma is decreased, causing fluid accumulation and sodium retention; this leads to congestion and edema. Fevers do not occur with AGN. There is usually a Decrease in urine volume. Decreased joint mobility does not occur with AGN.

What are the leading causes of CKD (select all that apply) A. HTN B. SLE C. Meningitis D. DM

A. HTN D. DM

Which of the following are NOT a sign and symptom of acute glomerulonephritis (poststreptococcal)? SELECT-ALL-THAT-APPLY: A. Hypotension B. Increased Glomerular filtration rate C. Cola-colored urine D. Massive proteinuria E. Elevated BUN and creatinine F. Mild swelling in the face or eyes

A. Hypotension B. Increased Glomerular filtration rate D. Massive proteinuria The patient with AGN may experience HYPERtension (not hypotension), DECREASED glomerular filtration rate (NOT increased), MILD (not massive) proteinuria. Massive proteinuria is a classic sign and symptom in Nephrotic Syndrome which doesn't present with hematuria. Options C, E, and F can be present in AGN.

The nurse must meet the hydration needs of a preterm infant. What should the nurse consider carefully regarding the preterm infant's kidney function? A. Large amounts of urine are excreted. B. It is the same as in a full-term newborn. C.Urine is concentrated, with an increased specific gravity. D. Acid-base and electrolyte balance are adequately maintained.

A. Large amounts of urine are excreted. The preterm infant has a reduced glomerular filtration rate and reduced ability to concentrate urine or conserve water. The preterm infant usually has a salt and water diuresis in the first 48-72 hours of life. Preterm infants have a restricted tubular capacity to reabsorb sodium and consequently have large amounts of urine excreted. All systems of the preterm neonate are less developed than in the full-term neonate. Urine is very dilute, not concentrated. Fluid and electrolyte balance in a preterm infant is easily upset.

A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a: A. Low protein, low sodium, low potassium, low phosphate diet B. High protein, low sodium, low potassium, high phosphate diet C. Low protein, high sodium, high potassium, high phosphate diet D. Low protein, low sodium, low potassium, high phosphate diet

A. Low protein, low sodium, low potassium, low phosphate diet The patient should follow this type of diet because protein breaks down into urea (remember patient will have increased urea levels), low sodium to prevent fluid excess, low potassium to prevent hyperkalemia (remember glomerulus isn't filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia. ******Pre-ESRD diet is individualized and during dialysis more protein is required

Which of these is a steroid sparing drug used to treat SLE A. Methotrexate B. Azathioprine C. Hydroxychloroquine (Plaquenil) D. Prasterone E. Lenalidomide

A. Methotrexate - steroid sparing, Chemotherapy and Immunosuppressive drug Azathioprine - Immunosuppressive drug Hydroxychloroquine - Immunosuppressive drug and Anti-parasite Prasterone - used to treat women with moderate to severe dyspareunia (painful intercourse) that is due to menopause Lenalidomide - Chemotherapy

Which statements are true about APSGN (select all that apply) A. Most common in children and young adults B. Will most likely lead to end stage kidney dz C. Develops 6 weeks after an infections of the tonsils, pharynx, or skin D. Pt may experience abdominal and/or flank pain

A. Most common in children and young adults D. Pt may experience abdominal and/or flank pain B is false bc in most cases, recovery from the acute glomerulonephritis is complete. However, if progressive involvement occurs and chronic glomerulonephritis develops, ESRD results. C is incorrect as well it develops 1-2 weeks after an infections of the tonsils, pharynx, or skin

Which phase of AKI is it the MOST important to monitor I&O's? A. Oliguric B. Diuretic C. Recovery

A. Oliguric

Which manifestations may indicate a client has systemic lupus erythematosus (SLE)? Select all that apply. A. Pericarditis B. Esophagitis C. Fibrotic skin D. Discoid lesions E. Pleural effusions

A. Pericarditis D. Discoid lesions E. Pleural effusions SLE is a chronic, progressive inflammatory connective tissue disorder that can cause major organs and systems to fail. Pericarditis is a cardiovascular manifestation of SLE. Discoid lesion is a skin manifestation that is a key indicator of the presence of SLE. Pleural effusion, a pulmonary manifestation, is a key indicator of the presence of SLE. Esophagitis is one of the gastrointestinal manifestations of systemic sclerosis. Fibrotic skin is one of the skin manifestations of systemic sclerosis.

The nurse is providing dietary teaching to a client who is receiving hemodialysis. What should the nurse encourage the client to include in the dietary plan? A. Rice B. Potatoes C. Canned salmon D. Barbecued beef

A. Rice Foods high or moderately high in carbohydrates and low in protein, sodium, and potassium are encouraged for clients on hemodialysis. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.

Which patient has the greatest risk for prerenal AKI? A. The patient is hypovolemic because of hemorrhage. B. The patient relates a history of chronic urinary tract obstruction. C. The patient has vascular changes related to coagulopathies. D. The patient is receiving antibiotics such as gentamicin.

A. The patient is hypovolemic because of hemorrhage. Prerenal causes of AKI are factors external to the kidneys. These factors reduce systemic circulation, causing a reduction in renal blood flow, and they lead to decreased glomerular perfusion and filtration of the kidneys.

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)? A. Use smallest gauge needle possible when giving injections or drawing blood. B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. D. Apply gentle pressure for the shortest possible time period after performing venipuncture. E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

A. Use smallest gauge needle possible when giving injections or drawing blood. B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present. Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding.

Which factors can lead to prerenal AKI (select all that apply) A. Dehydration B. MI C. Heart failure D. SLE E. Nephrotoxins

A. dehydration B. MI C. Heart failure Pre-renal AKI is caused by factors that reduce systemic circulations such as dehydration, decreased cardiac output, emboli, hemorrhage, etc

During the oliguric phase of AKI, you monitor the patient for (select all that apply) A. hypertension. B. electrocardiographic (ECG) changes. C. hypernatremia. D. pulmonary edema. E. urine with high specific gravity.

A. hypertension. B. electrocardiographic (ECG) changes. D. pulmonary edema. You monitor the patient in the oliguric phase of AKI for hypertension and pulmonary edema. When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (anuria and oliguria), the neck veins may become distended and have a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure, pulmonary edema, and pericardial and pleural effusions. The patient is monitored for hyponatremia. Damaged tubules cannot conserve sodium, and the urinary excretion of sodium may increase, resulting in normal or below-normal levels of serum sodium. Monitoring may reveal ECG changes and hyperkalemia. Initially, clinical signs of hyperkalemia are apparent on electrocardiogram, which demonstrate peaked T waves, widening of the QRS complex, and ST-segment depression. Urinary specific gravity is fixed at about 1.010.

azotemia

AKI, presence of urea or other nitrogenous elements in the blood

The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of a(n): a. liver biopsy. b. elevated aspartate aminotransferase (AST). c. elevated alanine aminotransferase (ALT). d. liver US

ANS: A Liver biopsy is the definitive test. The other tests will be elevated, but they are not specific for cirrhosis.

AGN

Acute Glomerulonephritis This is a sudden inflammation of the Glomerulus, inflamed because of an antigen, antibody reaction to STREP, that damages the glomerulus. Causes the Glomerulus membrane to thicken so it doesn't filter. Will show high protein and RBC's in the urine.

ASO titer

ASO (antistreptolysin) titer Blood draw used to detect prior infection by group A Streptococcus, the bacteria responsible for diseases such as: Bacterial endocarditis, glomerulonephritis, rheumatic fever, scarlet fever, strep throat. APSGN is a sequela of group A beta-hemolytic streptococcal infection. The antistreptolysin O (ASO) titer is an indication of the presence of circulating serum antibodies to streptococci.

Cirrhosis S/S

Ascites, spider angiomata (vascular lesions), increased risk of infection, jaundice, splenomegaly, nail changes, bruising/bleeding, itching, edema

A patient with CKD has a low erythropoietin (EPO) level. The patient is at risk for? A. Hypercalcemia B. Anemia C. Blood clots D. Hyperkalemia

B. Anemia EPO (erythropoietin) helps create red blood cells in the bone marrow. The kidneys produce EPO and when the kidneys are damaged in CKD they can decrease in the production of EPO. Therefore, the patient is at risk for anemia.

The parents of a 6-year-old child tell a nurse at the pediatric clinic that their child is weak and lethargic, has headaches, has no appetite, and has dark, cloudy urine. The nurse suspects acute poststreptococcal glomerulonephritis (APSGN). What should the nurse ask the mother? A. "Has your child lost weight recently?" B. "Did your child have a sore throat during the past 3 weeks?" C. "Does your child have migratory pains in the shoulders and knees?" D. "Has your child had a rash on the palms and soles in the past 2 weeks?

B. "Did your child have a sore throat during the past 3 weeks?"

Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says: A. "I should expect to have a low fever all the time with this disease. B. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms. C. "I should try to ignore my symptoms as much as possible and have a positive outlook. D. "I can expect a temporary improvement in my symptoms if I become pregnant."

B. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms. Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period.

You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply: A. "This medication will help keep my calcium level normal." B. "I will take this medication with meals or immediately after." C. "It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication." D. "This medication will help prevent my phosphate level from increasing."

B. "I will take this medication with meals or immediately after." D. "This medication will help prevent my phosphate level from increasing." Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient's phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.

Women taking estrogen replacement therapy need how much calcium a day? A. 500mg B. 1000mg C. 1250 mg D. 1500mg

B. 1000mg

A patient with polyarthralgia with joint swelling and pain is being evaluated for systemic lupus erythematosus (SLE). The nurse knows that the serum test result that is the most specific for SLE is the presence of: A. Rheumatoid factor. B. Anti-Smith antibody (Anti-Sm). C. Antinuclear antibody (ANA). D. Lupus erythematosus (LE) cell prep.

B. Anti-Smith antibody (Anti-Sm). The anti-Sm is antibody found almost exclusively in SLE. The other blood tests are also used in screening but are not as specific to SLE.

Which of these is an immunosuppressant drug used to treat SLE A. Methotrexate B. Azathioprine C. Hydroxychloroquine (Plaquenil) D. Prasterone E. Lenalidomide

B. Azathioprine Cyclophosphamide is also an immunosuppressant discussed Hydroxychloroquine (Plaquenil) --> antimalaria used to treat fatigue in SLE Prasterone--> combat corticosteroid-induced osteoporosis Lenalidomide--> improve cutaneous lupus without adverse neurologic effects

A client is admitted to the hospital for acute gastritis and ascites secondary to alcoholism and cirrhosis. For which condition is it most important for the nurse to assess this client? A. Nausea B. Blood in the stool C. Food intolerances D. Hourly urinary output

B. Blood in the stool Erosion of blood vessels may lead to hemorrhage, a life-threatening situation further complicated by decreased prothrombin production, which occurs with cirrhosis. Although food intolerances should be identified, there is no immediate threat to life. Although increased intraabdominal pressure because of ascites may precipitate nausea, there is no immediate threat to life. Hourly urine output measurements are unnecessary

MOST common causes of cirrhosis in the United States: (select all that apply) A. Environmental factors B. Chronic hepatitis C C. Alcohol induced liver disease D. Smoking

B. Chronic hepatitis C C. Alcohol induced liver disease

A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? A. Facial flushing B. Edema and pruritus C. Dribbling after voiding and dysuria D. Diminished force and caliber of stream

B. Edema and pruritus The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease

An adolescent has been admitted with symptoms of fatigue, intermittent fever, weight loss, and arthralgia, and the diagnosis is systemic lupus erythematosus. What is the best intervention at this time? A. Implementation of corticosteroids B. Education about diet, rest, and exercise C. Sun avoidance and calcium supplements D. Avoidance of destructive coping mechanisms

B. Education about diet, rest, and exercise Education about diet, rest, and exercise. Client education about the integrative interventions of diet, rest, and exercise will be of the most help to the adolescent client with newly diagnosed lupus. These are interventions that the client has some control over, and this is important to the adolescent Corticosteroids may not be used until other therapies are unsuccessful. Although sun avoidance and calcium supplements may be helpful, they are not most important. Avoidance of negative coping strategies may be helpful if they are noted, but control over diet, rest, and exercise is a positive coping strategy.

Early signs of cirrhosis (select all that apply) A. Skin changes B. Fatigue C. Enlarged liver D. Peripheral neuropathy E. Jaundice

B. Fatigue C. Enlarged liver Skin changes, peripheral neuropathy, and jaundice are all late signs

A patient with septic shock is also experiencing AKI, which abx would you question? A. Ciprofloxacin B. Gentamicin C. Clindamycin D. Azithromycin

B. Gentamicin

A 19-year-old patient who is taking azathioprine (Imuran) for systemic lupus erythematosus has a check-up before leaving home for college. The health care provider writes all of these orders. Which one should the nurse question? A. Naproxen (Aleve) 200 mg BID B. Give measles-mumps-rubella (MMR) immunization C. Draw anti-DNA titer D. Famotidine (Pepcid) 20 mg daily

B. Give measles-mumps-rubella (MMR) immunization Live virus vaccines, such as rubella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.

A nurse is caring for a client with an impaired immune system. Which blood protein associated with the immune system is important for the nurse to consider? A. Albumin B. Globulin C. Thrombin D. Hemoglobin

B. Globulin (serum proteins, antibodies) A. Albumin - protein in blood; maintains the proper amount of water in the blood C. Thrombin - blood clotting D. Hemoglobin - carries oxygen in RBCs

A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication? A. Peritonitis B. Hepatitis B C. Renal calculi D. Bladder infection

B. Hepatitis B Hepatitis type B is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in end-stage renal failure constitute a high risk for exposure. Peritonitis is a danger for individuals receiving peritoneal dialysis. Renal calculi are not a complication of hemodialysis; they often occur in clients who are confined to prolonged bed rest. Dialysis does not involve the bladder and will not contribute to the development of a bladder infection.

A patient with newly diagnosed SLE asks the nurse how the disease will affect her life. The best response by the nurse is: A. You can plan to have a near-normal life since SLE rarely causes death B. It is difficult to tell because to disease is so variable in its severity and progression C. Life span is shortened somewhat in people with SLE, but the disease can be controlled with long-term use of corticosteroids D. Most people with SLE have alternating periods of remissions and exacerbations with rapid progression to permanent organ damage

B. It is difficult to tell because to disease is so variable in its severity and progression

While assessing morning labs on your patient with CKD. You note the patient's phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be? A. Elevated B. Low C. Normal D. Same as the phosphate level

B. Low A normal phosphate level is 2.7-4.5 mg/dL. This patient is experiencing HYPERphosphatemia. When hyperphosphatemia presents the calcium level DECREASES because phosphate and calcium bind to each. When there is too much phosphate in the blood it takes too much calcium with it and it decreases the calcium in the blood. Therefore, the nurse would expect to find the calcium level decreased.

A 5 year old male is admitted with acute glomerulonephritis. On assessment, you note mild edema predominately in the face and tea-colored urine. The patient's blood pressure is 165/110, heart rate 95, oxygen saturation 98% on room air, and temperature 98.9 'F. In your nursing care plan, what nursing interventions will you include in this patient's plan of care? SELECT-ALL-THAT-APPLY: A. Initiate and maintain a high sodium diet daily. B. Monitor intake and output hourly. C. Encourage patient to ambulate every 2 hours while awake. D. Assess color of urine after every void. E. Weigh patient daily on a standing scale. F. Encourage the patient to consume 4 L of fluid per day.

B. Monitor intake and output hourly. D. Assess color of urine after every void. E. Weigh patient every daily on a standing scale. Patients with acute glomerulonephritis experience proteinuria and hematuria. In addition, they may experience mild edema (mainly in the face/eyes), hypertension, and in severe cases renal failure/oliguria. Therefore, it is very important the nurse monitors intake and output every hour, assesses color of urine, and weighs the patient every day on a standing scale. Option A is wrong because the patient should be consuming a LOW (not high) sodium diet. Option C is wrong because the patient should maintain bed rest until recovered due to experiencing hypertension. Option F is wrong because the patient will be on a fluid restriction...4 L is a lot of fluid to consume. It is generally 2 L or less of fluids per day.

A client is admitted to the hospital with a diagnosis of severe chronic kidney disease. Which assessment findings should the nurse expect the client to exhibit? Select all that apply. A. Polyuria B. Paresthesia C. Hypertension D. Metabolic alkalosis E. Widening pulse pressure

B. Paresthesias C. Hypertension Paresthesias occur as a result of excess nitrogenous wastes, altered fluid and electrolytes, and altered regulatory functions. Nonfunctioning kidneys cause fluid retention that may result in hypervolemia and hypertension. Polyuria occurs because of extensive nephron damage and may occur in the early stage of kidney disease but not in the severe stage. Metabolic acidosis, not alkalosis, results from the inability to excrete hydrogen ions and retain bicarbonate. Widening pulse pressure occurs with increased intracranial pressure, not with kidney dysfunction.

While providing care to a pediatric patient with acute glomerulonephritis, you note the urine output to be 10 mL/hr. The patient weighs 30 lbs. As the nurse, you will want to limit what type of foods from the patient's diet? A. Calcium-rich foods B. Potassium-rich foods C. Purine -rich foods D. None of the above because the patient's urinary output is normal based on the patient's weight.

B. Potassium-rich foods This patient is experiencing OLIGURIA (low urinary output). The patient weighs 30 lbs. which is 13.6 kg (30/2.2= 13.6). Remember a normal urinary output for a pediatric patient should be 1 mL/kg/hr. Based on the patient's weight, their urinary output is 10 mL/hr...it should be 13.6 mL/hr. Therefore, the patient is at high risk for retaining POTASSIUM due to decreased renal function. The nurse should limit foods high in potassium

Which drugs are thought to cause/trigger SLE? (select all that apply) A. Propanolol B. Procainamide (Pronestyl) C. Vancomycin D. Hydralazine (Apresoline) E. Quinidine

B. Procainamide (Pronestyl) D. Hydralazine (Apresoline) E. Quinidine

A nurse is caring for a client with chronic kidney failure. What should the nurse teach the client to limit the intake of to help control uremia associated with end-stage renal disease (ESRD)? A. Fluid B. Protein C. Sodium D. Potassium

B. Protein The waste products of protein metabolism are the main cause of uremia. The degree of protein restriction is determined by the severity of the disease. Fluid restriction may be necessary to prevent edema, heart failure, or hypertension; fluid intake does not directly influence uremia. Sodium is restricted to control fluid retention, not uremia. Potassium is restricted to prevent hyperkalemia, not uremia.

The nurse monitors a patient to have Systemic Lupus Erythematosus. Which of the following symptoms is characteristic of this diagnosis? A. Increased T-cell count B. Scaley, inflamed rash on shoulders, neck, and face C. Swelling of the extremities D. Decreased erythrocyte sedimentation rate (ESR)

B. Scaley, inflamed rash on shoulders, neck, and face

A client who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. Which substance removal should the nurse share with the client? A. Blood B. Sodium C. Glucose D. Bacteria

B. Sodium Sodium is an electrolyte that passes through the semipermeable membrane during hemodialysis. Red blood cells do not pass through the semipermeable membrane during hemodialysis. Glucose does not pass through the semipermeable membrane during hemodialysis. Bacteria do not pass through the semipermeable membrane during hemodialysis.

What is the most common environmental trigger for SLE? A. Start of menses B. Sun exposure/sun burns C. Smoking D. Air pollution

B. Sun exposure/sun burns

A client is experiencing an exacerbation of systemic lupus erythematosus. To reduce the frequency of exacerbations, what would be important for the nurse to include in the client's teaching plan? A. Basic principles of hygiene B. Techniques to reduce stress C. Measures to improve nutrition D. Signs of an impending exacerbation

B. Techniques to reduce stress Systemic lupus erythematosus is an autoimmune disorder, and physical and emotional stresses have been identified as contributing factors to the occurrence of exacerbations. Although basic principles of hygiene should be performed, inadequate hygiene is not known to produce exacerbations. Although measures to improve nutrition should be done, nutritional status is not significantly correlated to exacerbations. Knowledge of the symptoms will not decrease the occurrence of exacerbations.

When assessing a client during peritoneal dialysis, a nurse observes that drainage of the dialysate from the peritoneal cavity has ceased before the required volume has returned. What should the nurse instruct the client to do? A. Drink a glass of water B. Turn from side to side C.Deep breathe and cough D. Rotate the catheter periodically

B. Turn from side to side Turning from side to side will change the position of the catheter, thereby freeing the drainage holes of the tubing, which may be obstructed. Drinking a glass of water and deep breathing and coughing do not influence drainage of dialysate from the peritoneal cavity. The position of the catheter should be changed only by the primary healthcare provider.

A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood? A. Calcium B. Urea C. Phosphate D. Erythropoietin

B. Urea The answer is B. This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this.

Which laboratory finding is suggestive of mild kidney disease in male clients? A. Serum creatinine - 0.9 mg/dL B. Urinary albumin - 24 mg/mmol C. Blood urea nitrogen (BUN) - 18 mg/dL D. Blood urea nitrogen (BUN)/creatinine ratio - 23

B. Urinary albumin - 24 mg/mmol Increased levels of albumin in the urine indicate mild or moderate kidney disease. The normal levels of albumin in the urine range between 2.0 and 20 mg/mmol in men and between 2.8 and 28 mg/mmol in women. An albumin level of 24 mg/mmol is higher than the normal range for men. Therefore a urinary albumin of 24 mg/mmol suggests mild kidney failure. The normal levels of serum creatinine range between 0.6-1.2 mg/dL in men and between 0.5-1.1 mg/dL in women. Therefore a serum creatinine value of 0.9 mg/dL is normal. Blood urea nitrogen (BUN) in the range of 10-20 mg/dL is normal. Therefore a BUN value of 18 mg/dL is a normal finding. The normal range of a BUN/creatinine ratio is between 6 and 25. Therefore a BUN/creatinine ratio of 23 is a normal value.

A client is to have hemodialysis. What must the nurse do before this treatment? A. Obtain a urine specimen to evaluate kidney function. B. Weigh the client to establish a baseline for later comparison. C. Administer medications that are scheduled to be given within the next hour. D. Explain that the peritoneum serves as a semipermeable membrane to remove wastes

B. Weigh the client to establish a baseline for later comparison. A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis

(med surg) AKI is characterized by a rapid loss of kidney function. This loss is accompanied by (select all that apply) A. increase in urine output B. a rise in serum creatinine C. reduction in urine output D. decrease in edema

B. a rise in serum creatinine C. reduction in urine output

Most characteristic symptom of menopause? A. hot flashes B. it varies from woman to woman C. Mood swings D. Vaginal dryness and painful intercourse

B. it varies from woman to woman

Management of ascites focuses on (select all that apply ) A. administration of blood products B. sodium restriction C. diuretics D. fluid removal (paracentesis)

B. sodium restriction C. diuretics D. fluid removal (paracentesis)

A client with an intractable infection is receiving vancomycin. Which laboratory blood test result should the nurse report? Hematocrit: 45% Calcium: 9.0 mg/dL (2.25 mmol/L) White blood cells (WBC): 10,000 mm 3 (10 X 10 9/L) Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L)

Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L) Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a healthy adult is 10 to 20 mg/dL (3.6-7.1 mmol/L). This hematocrit is expected in a healthy adult; the range is from 40 to 52. The expected range of the WBC count is 5,000 to 10,000 mm 3 (5-10 X 10 9/L) for a healthy adult. This calcium level is within the expected range of 9.0 to 10.5 (2.25-2.75 mmol/L) for a healthy adult

Select all the patients below that are at risk for acute intra-renal injury? A. A 45 year old male with a renal calculus. B. A 65 year old male with benign prostatic hyperplasia. C. A 25 year old female receiving chemotherapy. D. A 36 year old female with renal artery stenosis. E. A 6 year old male with acute glomerulonephritis. F. An 87 year old male who is taking an aminoglycoside medication for an infection.

C. A 25 year old female receiving chemotherapy. E. A 6 year old male with acute glomerulonephritis. F. An 87 year old male who is taking an aminoglycoside medication for an infection. The answers are: C, E, and F. These patients are at risk for an intra-renal injury, which is where there is damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury because there is an obstruction that can cause back flow of urine into the kidney, which can lead to decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is an issue with perfusion to the kidney.

What is the most common intrarenal cause of AKI A. SLE B. Prolonged ischemia C. Acute tubular necrosis (ATN) D. Acute glomerulonephritis

C. Acute tubular necrosis (ATN) Acute tubular necrosis (ATN) is the most common intrarenal cause of AKI and is primarily the result of ischemia, nephrotoxins, or sepsis. Ischemic and nephrotoxic ATN is responsible for 90% of intrarenal AKI cases. Acute tubular necrosis (ATN) is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure. The tubules are tiny ducts in the kidneys that help filter the blood when it passes through the kidneys.

The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care knowing that this disorder is: A. A local rash that occurs as a result of allergy B. A disease caused by overexposure to sunlight C. An inflammatory disease of collagen contained in connective tissue D. A disease caused by the continuous release of histamine in the body

C. An inflammatory disease of collagen contained in connective tissue Use the process of elimination. Eliminate option 1 because SLE is a systemic disorder, not a local one. Next eliminate option 2 because of its similarity to option 1. From the remaining options, select option 3 because of its systemic characteristic. If you are unfamiliar with this disorder, review its characteristics.

A nurse is caring for a child with a tentative diagnosis of acute poststreptococcal glomerulonephritis (APSGN). What test does the nurse expect to be used to confirm the diagnosis? A. Renal biopsy B. Pharyngeal culture C. Antistreptolysin O titer D. Urinary tract sonogram

C. Antistreptolysin O titer APSGN is a sequela of group A beta-hemolytic streptococcal infection. The antistreptolysin O (ASO) titer is an indication of the presence of circulating serum antibodies to streptococci. A renal biopsy is not performed to confirm APSGN, but it may be employed if a complication arises. A pharyngeal culture may be negative, because APSGN occurs 10 to 21 days after the streptococcal infection. Sonography of the kidneys, ureters, and bladder will not confirm a diagnosis of APSGN

A 9-year-old child with chronic kidney disease is undergoing peritoneal dialysis. For which associated complication should the nurse monitor the child? A. Petechiae B. Abdominal bruit C. Cloudy return dialysate D. Increased blood glucose leve

C. Cloudy return dialysate The returned dialysate should be clear; cloudy return dialysate solution is indicative of infection. Petechiae do not occur during dialysis treatments. There is no danger of developing an abdominal bruit during dialysis. Dialysis does not affect the blood glucose level.

A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In teaching the patient about the disease, the nurse includes the information that SLE is a(n): A. Hereditary disorder of women but usually does not show clinical symptoms unless a woman becomes pregnant. B. Autoimmune disease of women in which antibodies are formed that destroy all nucleated cells in the body. C. Disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression. D. Disease that causes production of antibodies that bind with cellular estrogen receptors, causing an inflammatory response.

C. Disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression. SLE has an unpredictable course, even with appropriate treatment. Women are more at risk for SLE, but it is not confined exclusively to women. Clinical symptoms may worsen during pregnancy but are not confined to pregnancy or the perinatal period. All nucleated cells are not destroyed by the antinuclear antibodies. The inflammation in SLE is not caused by antibody binding to cellular estrogen receptors.

If a patient is in the diuretic phase of AKI, you must monitor for which serum electrolyte imbalances? A. Hyperkalemia and hyponatremia B. Hyperkalemia and hypernatremia C. Hypokalemia and hyponatremia D. Hypokalemia and hypernatremia

C. Hypokalemia and hyponatremia In the diuretic phase of AKI, the kidneys have recovered their ability to excrete wastes but not to concentrate the urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed? A. It equals the expected urinary output for the next 24 hours. B. It will prevent the development of pneumonia and a high fever. C. It will compensate for both insensible and expected output over the next 24 hours. D. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.

C. It will compensate for both insensible and expected output over the next 24 hours. Insensible losses are 500 to 1000 mL in 24 hours, with an average of about 600 mL; the measured output is about 400 mL in 24 hours based on the available history (about 200 mL in 12 hours). Based on the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900 mL. More than 900 mL daily is necessary to help prevent pneumonia and its associated fever. Hyperkalemia in acute kidney injury is caused by inadequate glomerular filtration and is not related to fluid intake.

What is the typically the first complaints of SLE A. Discord lesions B. Fever C. Joint pain that is worse in the morning D. Weight loss

C. Joint pain that is worse in the morning Pain in multiple joints (polyarthralgia) with morning stiffness is often the first complaint.

A patient who is experiencing poststreptococcal glomerulonephritis has edema mainly in the face and around the eyes. As the nurse, you know to expect the edema to be more prominent during the? A. Evening B. Afternoon C. Morning D. Bedtime

C. Morning Patients will experience the most prominent swelling in the face in the morning when they awake. This is a common finding with kidney disorders. The skin of the eyes is fragile, folded, and pocketed which makes it easier for fluid to collect around the eyes. In addition, this is where the swelling looks more noticeable.

(powerpoints) Which vaccination would you question giving to a SLE patient? A. Flu shot B. Gardasil C. MMR and Varicella D. Tetanus

C. MMR and Varicella Vaccinations are safe for patients with SLE ...however, they need to AVOID live virus vaccinations Live-attenuated vaccines Measles, mumps, rubella (MMR combined vaccine) Rotavirus. Smallpox. Chickenpox (varicella) Yellow fever Flu mist FYI: Unlike the flu shot, the nasal spray flu vaccine (also known as the "live attenuated influenza vaccine" or "LAIV") does contain live influenza viruses, but the viruses are attenuated (weakened), so that they will not cause flu illness

A nurse educates the client about the relationship between the kidneys and blood pressure. Which term should the nurse use to describe the part of the kidney that senses changes in blood pressure? A. Calices B. Glomerulus C. Macula densa D. Juxtaglomerular cells

C. Macula densa The macula densa, a part of the distal convoluted tubule, consists of cells that sense changes in the volume and pressure of blood. Calices are cup-like structures, present at the end of each papilla that collect urine. The glomerulus is the initial part of the nephron, which filters blood to make urine. Juxtaglomerular cells secrete renin when cells in the macula densa sense changes in blood volume and pressure.

A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care? A. Institute seizure precautions. B. Reorient to time and place PRN. C. Monitor intake and output. D. Place on cardiac monitor.

C. Monitor intake and output. Lupus nephritis is a common complication of SLE, and when the patient is taking corticosteroids, it is especially important to monitor renal function. There is no indication that the patient is experiencing any nervous system or cardiac problems with the SLE.

A client with Laënnec cirrhosis has ascites and jaundice and is confused. What is the nursing priority when caring for this client? A. Correcting nutritional deficiencies B. Measuring abdominal girth every day C. Providing for the client's physical safety D. Placing the client in the high-Fowler position

C. Providing for the client's physical safety Hepatic encephalopathy, related to high ammonia levels, results in central nervous system derangement; physical safety is the priority. Although correcting nutritional deficiencies is important, it is not the priority. Although measuring abdominal girth is important, it is not the priority. The high-Fowler position will be uncomfortable because of the pressure of the distended abdomen against the legs; the semi-Fowler position is more appropriate, and it promotes respiration

A patient with a hx of CAD has and acute bleed of an esophageal varix. Which med would you expect to be given ? A. Propanolol B. Vasopressin C. Sandostain D. NSAID

C. Sandostain - moderate or severe upper GI bleed, inhibits release of glucagon Propanolol is preventive. Vasopressin is given for an acute bleed but not to someone with hx of CAD

Nurse is caring for a client with acute kidney injury who is receiving a protein-restricted diet. The client asks why this diet is necessary. Which information should the nurse include in a response to the client's questions? A. A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses. B. Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis. C. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. D. Urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amino acid synthesis must come from the dietary protein.

C. This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. The amount of protein permitted in the diet depends on the extent of kidney function; excess protein causes an increase in urea concentration, excess metabolic waste, and added stress on the kidneys, which should be prevented. Adequate calories are provided to prevent tissue catabolism that also results in an increase in metabolic waste products. In kidney failure the kidneys are unable to eliminate the waste products of a high-protein diet, which is to be avoided. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.

A client is admitted with systemic lupus erythematosus (SLE). The laboratory report shows the presence of neutrophils and monocytes as mediators of injury. Which type of hypersensitivity reaction most likely occurred in the client? A. Type I B. Type II C. Type III D. Type IV

C. Type III Type III hypersensitivity reaction involves immunoglobulin IgG- and IgM-mediated release of neutrophils and monocytes as mediators of injury. It is an immune complex-mediated hypersensitivity reaction that occurs in SLE or rheumatoid arthritis. Allergic rhinitis and asthma may occur when mediators such as histamine and prostaglandins are involved, resulting in a type I hypersensitivity reaction. Type II hypersensitivity reaction is cytotoxic mediated, which occurs in transfusion reaction and Goodpasture syndrome. Type IV hypersensitivity reaction is a delayed hypersensitivity reaction that may occur in contact dermatitis involving T cytotoxic cells.

What is the etiology of SLE? A. Mismanaged diabetes B. Diets high in protein C. Unkown D. Epstein-bar virus

C. Unkown etiology of the abnormal immune response in SLE is unknown However factors that are thought to influence/trigger dz include: Genetics Hormones Environmental factors Certain medication

Pre-renal

CAUSES: Acute renal failure Hypotension from any cause -congestive heart failure or severe pulmonary dz -Volume depletion: vomiting, diarrhea, burns, dehydration, hemorrhage (hypovolemia) -Hypercalcemia (which may result in afferent arteriolar vasconstriction) -Medications: cyclosporine, ACE-I, NSAIDs, osmotic diuretics

A 5-year-old child in renal failure who has undergone creation of an arteriovenous fistula access begins hemodialysis three times a week. The nurse teaches the mother the specific care her child needs. What statement indicates that further teaching is necessary? A. "I'll offer more drinks in warm weather." B. "I should call the clinic if he vomits or has diarrhea." C. "I'll check his pulse at the wrist on each arm every day." D. "It's OK to take his blood pressure on the arm with the fistula."

D. "It's OK to take his blood pressure on the arm with the fistula." Taking the blood pressure on the arm with the arteriovenous fistula is contraindicated because the pressure of the inflated cuff may disrupt the integrity of the fistula. Consumption of more fluids is desirable because inadequate fluid intake can result in dehydration and an acid-base imbalance. Calling the clinic is desirable because vomiting or diarrhea may lead to dehydration and an acid-base imbalance. Not only should the pulse be monitored to assess vascular function distal to the arteriovenous fistula, but it should be done on both extremities and the results compared.

A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. Which is an appropriate nursing response? A. "The staff will provide total care, because the infection causes severe fatigue." B. "Mood elevators will be prescribed to improve depression and irritability." C. "Vitamin B will be prescribed for the anemia, and the stools will be dark." D. "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."

D. "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products." One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron and folic acid supplements are used for anemia in chronic kidney disease; Vitamin B 12 is used for pernicious anemia and does not make the stools dark; iron makes the stools dark.

Within the past month, the admission rate of patients with poststreptococcal glomerulonephritis has doubled on your unit. You are proving an in-service to your colleagues about this condition. Which statement is CORRECT about this condition? A. "This condition tends to present 6 months after a strep infection of the throat or skin." B. "It is important the patient consumes a diet rich in potassium based foods due to the risk of hypokalemia." C. "Patients are less likely to experience hematuria with this condition." D. "This condition is not caused by the streptococcal bacteria attacking the glomerulus, but by the immune system's response to the bacteria by creating an antigen-antibody complex which inflames the glomerulus."

D. "This condition is not caused by the streptococcal bacteria attacking the glomerulus, but by the immune system's response to the bacteria by creating an antigen-antibody complex which inflames the glomerulus." This is the only correct statement. Option A is wrong because this condition tends to present 10-14 days (not 6 months) after a strep infection of the throat or skin. Option B is wrong because the patient is at risk for HYPERkalemia (not HYPOkalemia) especially if low urinary output is present. Option C if wrong because patients with this condition will experience hematuria which is a hallmark of this condition

Which client is at the highest risk for systemic lupus erythematous (SLE)? A. An Asian male B. A white female C. An African-American male D. An African-American female

D. An African-American female

The nurse observes a client with kidney failure has increased rate and depth of breathing. Which laboratory parameter does the nurse suspect is associated with this client's condition? A. Potassium 8 mEq/L B. Hemoglobin 10 g/dL C. Phosphorous 7 mg/dL D. Bicarbonate 15 mEq/L

D. Bicarbonate 15 mEq/L An increased rate and depth of breathing is called Kussmaul respiration and occurs due to metabolic acidosis in clients with kidney disease. Serum bicarbonate level decreases in metabolic acidosis. The normal range of serum bicarbonate is 23-30 mEq/L. Therefore the bicarbonate value of 15 mEq/L is associated with Kussmaul respirations in the client. The normal serum potassium is 3.5-5 mEq/L. Therefore a potassium level of 8 mEq/L indicates hyperkalemia and is associated with changes in cardiac rate and rhythm. The normal range of hemoglobin is 12-16 g/dL in females and 14-18 g/dL in males. Therefore a Hgb of 10 g/dL indicates anemia; this is associated with fatigue, pallor, and shortness of breath. The normal range of serum phosphorous is 3-4.5 mg/dL. Therefore a phosphorous value of 7 mg/dL indicates hyperphosphatemia, which is associated with hypocalcemia and demineralization of bone.

What can a women do to decrease the vasomotor effect of menopause? A. Perform aerobic exercise B. increase the amount of calcium and vitamin D in the diet C. Increase caffeinated beverages D. Dress in layers of cotton clothing

D. Dress in layers of cotton clothing

Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality? A. Phosphate 3.2 mg/dL B. Calcium 9.3 mg/dL C. Magnesium 2.2 mg/dL D. Potassium 7.1 mEq/L

D. Potassium 7.1 mEq/L The patient's potassium level is extremely elevated. A normal potassium level is 3.5-5.1 mEq/L. This patient is experiencing hyperkalemia, which can cause tall peak T-waves. Remember in CKD (especially prior to dialysis), the patient will experience electrolyte imbalances, especially hyperkalemia.

A client with hepatitis B (HBV) develops cirrhosis and is hospitalized. One potential sequela of chronic liver disease is fluid and electrolyte imbalance. The nurse determines that this may be attributed to a decrease in serum albumin level. Which of these conditions results from this imbalance? A. Hemorrhage with subsequent anemia B. Diminished resistance to bacterial insult C. Malnutrition of cells, especially hepatic cells D. Reduction of colloidal osmotic pressure in the blood

D. Reduction of colloidal osmotic pressure in the blood Albumin is an essential component of the bloodstream that helps maintain both osmotic pressure and fluid and electrolytes. This is not a cause of hemorrhage. Blood components such as platelets, thrombin, and erythrocytes are involved in the prevention of hemorrhage or anemia. Diminished resistance to bacterial insult is not involved directly with immunity and resistance. Blood components, such as T and B lymphocytes, are involved in this process; the liver synthesizes specific proteins intrinsic to the function of antibodies. The serum albumin level is not related to nutrition of cells.

A nurse is evaluating a client's understanding of peritoneal dialysis. Which information in the client's response indicates an understanding of the purpose of the procedure? A. Reestablishing kidney function B. Cleaning the peritoneal membrane C. Providing fluid for intracellular spaces D. Removing toxins in addition to other metabolic wastes

D. Removing toxins in addition to other metabolic wastes Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution. Peritoneal dialysis acts as a substitute for kidney function; it does not reestablish kidney function. The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity. Fluid in the abdominal cavity does not enter the intracellular compartment.

A client reports hair loss, joint pain, and a facial rash. The nurse documents the presence of a butterfly rash on the face in the client's medical record. Which disorder does the nurse suspect? A. Scleroderma B. Angioedema C. Rheumatoid arthritis D. Systemic lupus erythematosus

D. Systemic lupus erythematosus Systemic lupus erythematosus is an autoimmune connective tissue disorder characterized by joint pain, alopecia, and rashes on the face. A characteristic butterfly rash is a major skin manifestation of systemic lupus erythematosus

In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes: A. Circulating immune complexes formed from IgG autoantibodies reacting with IgG B. An autoimmune T-cell reaction that results in destruction of the deep dermal skin layer C. Immunologic dysfunction leading to chronic inflammation in the cartilage and muscles D. The production of a variety of autoantibodies directed against components of the cell nucleus

D. The production of a variety of autoantibodies directed against components of the cell nucleus Systemic lupus erythematosus (SLE) is characterized by the production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions characteristically are directed against constituents of the cell nucleus (e.g., antinuclear antibodies [ANAs]), particularly DNA. Circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Complement is activated, and inflammation occurs. The overaggressive antibody response is also related to activation of B and T cells. The specific manifestations of SLE depend on which cell types or organs are involved. SLE is a type III hypersensitivity response.

The patient admitted to the intensive care unit after a motor vehicle accident has been diagnosed with AKI. Which finding indicates the onset of oliguria resulting from AKI? A. Urine output less than 1000 mL for the past 24 hours B. Urine output less than 800 mL for the past 24 hours C. Urine output less than 600 mL for the past 24 hours D. Urine output less than 400 mL for the past 24 hours

D. Urine output less than 400 mL for the past 24 hours The most common initial manifestation of AKI is oliguria, a reduction to urine output to less than 400 mL/day

oliguria

Decreased urine output

What factors can cause premature menopause? A. smoking B. autoimmune disorders C. mother had early D. menopause E. all of the above

E. all of the above

TRUE or FALSE: Poststreptococcal glomerulonephritis is a type of NEPHROTIC SYNDROME

FALSE Poststreptococcal glomerulonephritis is a type of NEPHRITIC (which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate. In Nephrotic Syndrome, there is only leakage of PROTEIN (not red blood cells) into the filtrate

True or False SLE is considered and immunodeficient disease

FALSE any dz that is autoimmune is an exaggerated (hypersensitive) response ...your immune system is over active and attacking your body

Which s/sx are commonly seen prior a SLE exacerbation A. Weight gain B. Fever C. Weight loss D. Hyperglycemia E. Joint pain F. Excessive fatigue

General complaints such as fever, weight loss, joint pain (arthralgia), and excessive fatigue can precede can exacerbation B. Fever C. Weight loss E. Joint pain F. Excessive fatigue

Chronic Kidney Disease (CKD)

Inability of kidneys to excrete wastes; staged from 1 (mild damage to kidney) to 5 (complete kidney failure requiring either dialysis or a renal transplant). Stage 5 is also called end stage renal disease (ESRD) Caused by hypertension and diabetes mellitus

ESRD (end stage renal disease)

Irreversible damage to the kidney tissue. (Uremic Syndrome- Fluid and electrolyte imbalance due to increase in nitrogenous wastes in the blood). Requiring transplantation or dialysis

SLE treatment

NSAIDs, corticosteroids, immunosuppressants, hydroxychloroquine, plasmapheresis

Pt with AKI will have HYPERkalemia while in the oliguric phase...what EKG changes will you see with HYPERkalemia ?

Peaked T waves Widening of the QRS complex ST segment depression

Lupus symptoms

Petechiae fatigue fever weight loss joint pain, stiffness (first symptom) (polyarthralgia) butterfly shape rash on the face that covers the cheeks and bridge of nose or rashes elsewhere to the body skin lesions that appear or worsen with sun exposure fingers and toes to turn white or blue when exposed to cold or during stressful periods (Raynauds phenomenon) Pericarditis Hypertension Discoid lesions Pleural effusions alopecia shortness of breath chest pain dry ice headaches, confusion, and memory loss

Why might Lactulose given to a patient with cirrhosis ?

Pt with cirrohsis may suffer from hepatic encephalopathy; which is caused by an elevated ammonia level. Lactulose is given to decrease ammonia levels. It does this by trapping ammonia in the gut. It can be given orally, via edema, or NG tube → laxative effect of the drug expels the ammonia from the colon.

RIFLE staging

Serum creatinine or urine output from baseline R - Risk creatinine up x1.5 or GFR down by 25% UO <0.5 mL/kg/hr for 6 hours I - Injury Creatinine up x2 or GFR down by 50% UO <0.5 mL/kg/hr for 12 hours F - Failure Creatinine up x3 or GFR down by 75% UO <0.5mL/kg/hr for 24 hours (oliguria) OR Anuria for 12 hours L - Loss Persistent Acute Kidney Failure - complete loss of kidney function >4 weeks E - End stage kidney disease Complete loss of kidney function >3 months

The kidneys are responsible for performing all the following functions EXCEPT? A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production

The answer is D. The adrenal glands are responsible for maintaining cortisol production not the kidneys. Vitamin D - kidneys convert vitamin D from supplements or the sun to the active form for intestinal absorption of calcium, magnesium, and phosphate Renin - enzyme secreted by and stored in the kidneys which regulates BP. Erythropoietin - hormone in the kidney plays a key role in RBC production

Name 7 indications for renal replacement therapy (RRT)

Techniques include continuous hemofiltration and hemodialysis, intermittent hemodialysis, and peritoneal dialysis. Volume overload Elevated serum potassium levels Metabolic acidosis BUN greater than 120 Significant changes in mental status Pericarditis Cardiac tamponade (blood/fluids fill the space between the sac that encases the heart and muscle can't expand)

A 65 year old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys? A. Lisinopril B. Metoprolol C. Amlodipine D. Verapamil

The answer is A. There are two types of drugs that can be used to treat hypertension and protect the kidneys in patients with CKD. These drugs include angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). The only drug listed here that is correct is Lisinopril. This drug is known as an ACE inhibitor. Metoprolol is a BETA BLOCKER. Amlodipine and Verapamil are calcium channel blockers.

Which patient below is NOT at risk for developing chronic kidney disease? A. A 58 year old female with uncontrolled hypertension. B. A 69 year old male with diabetes mellitus. C. A 45 year old female with polycystic ovarian disease. D. A 78 year old female with an intrarenal injury.

The answer is C. Options A, B, and D are all at risk for developing CKD. However, option C is not at risk for CKD.

A 55 year old male patient is diagnosed with chronic kidney disease. The patient's recent GFR was 25 mL/min. What stage of chronic kidney disease is this known as?* A. Stage 1 B. Stage 3 C. Stage 4 D. Stage 5

The answer is C. This is known as Stage 4 of CKD because the GFR (glomerular filtration rate) for this stage is 15-29 mL/min (patient's GFR is 25 mL/min). The other stage's criteria are as follows: Stage 1: Kidney damage with normal renal function GFR >90 ml/min but with proteinuria (3 months or more); Stage 2: Kidney damage with mild loss of renal function GFR 60-89 ml/min with proteinuria (3 months or more) Stage 3: Mild-to-severe loss of renal function GFR 30-59 mL/min Stage 4: Severe loss renal function GFR 15-29 mL/min Stage 5: End stage renal disease GRF less 15 mL/min

peritoneal dialysis (PD)

The removal of wastes, electrolytes and fluids from the body using peritoneum as dialysis membrane, uses a catheter to introduce fluid into the peritoneal (abdominal) cavity

nephritic vs. nephrotic syndromes

Think nephrite is slight. Nephritic = RBCs & little protein in urine Nephrotic = Pre-ecclampsia (HEP (hypertension, edema & proteinurea)), Ecclampsia = HEP + convulsions & coma and is potentially fatal nephrItic = Inflammatory (hematuria) nephrOtic = massive prOteinuria

What are the clinical manifestations of​ menopause?​(Select all that ​apply.) a Vaginal dryness b Thinning hair c Headaches d Hot flashes e Cold intolerance

a Vaginal dryness b Thinning hair c Headaches d Hot flashes

Cirrhosis

a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. Cause: alcoholism or hepatitis. Portal hypertension (increase in the pressure in portal vein, which carries blood from the digestive organs to the liver.) Test: liver biopsy tx: cutting alcohol, liver transplant

A​ 52-year-old woman complains of hot​ flashes, night​ sweats, irritability, decreased vaginal​ lubrication, and no menstrual period in the past 15 months. Over the past several​ weeks, the hot flashes and night sweats have increased in​ frequency, and she has noticed that she is more irritable. Laboratory values reveal increased​ follicle-stimulating hormone and luteinizing hormone levels. Which intervention should the nurse​ initiate?​(Select all that​ apply.) a Asking​ open-ended questions about the​ client's body image b Instructing the client to avoid​ over-the-counter vaginal lubricants c Explaining such physiological manifestations of menopause as hot flashes and night sweats d Providing information about medications that might be prescribed to help with menopausal symptoms e Encouraging discussion of how menopausal symptoms are affecting sexual functioning

a. Asking​ open-ended questions about the​ client's body image c. Explaining such physiological manifestations of menopause as hot flashes and night sweats d. Providing information about medications that might be prescribed to help with menopausal symptoms e. Encouraging discussion of how menopausal symptoms are affecting sexual functioning The client is undergoing menopause. The client with menopause may have problems understanding the natural female aging​ process, sexual​ dysfunction, low​ self-esteem, or disturbed body image. Interventions to help the client with these problems include explaining the physiological manifestations of​ menopause; providing information about medications that might be prescribed to help with menopausal​ symptoms; encouraging discussion of how menopausal symptoms are affecting sexual​ functioning; and instructing the client to use vaginal lubricants if experiencing decreased lubrication. Asking​ open-ended questions will further explore the client​'s thoughts and feelings about body image in a therapeutic manner.

The nurse is discussing menopause with a​ 40-year-old client. During this​ discussion, the nurse identified which factor that determines when perimenopause may​ occur? a. Genetics b. Age of menarche c. Being sexually active d. Alcohol use

a. Genetics The age of perimenopause is genetically programmed and unrelated to the age of menarche. Cigarette smoking and living at high altitudes can lead to earlier menopause. Alcohol use and being sexually active does not influence perimenopause.

Which descriptions characterize acute kidney injury (select all that apply)? a. Primary cause of death is infection. b. It almost always affects older people. c. Disease course is potentially reversible. d. Most common cause is diabetic nephropathy. e. Cardiovascular disease is most common cause of death.

a. Primary cause of death is infection. c. Disease course is potentially reversible.

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)? a. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. b. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. c. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity. d. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally. e. Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.

a. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. b. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. c. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity. Decreased colloid oncotic pressure from the lack of albumin from liver inability to synthesize it and the portal hypertension that shifts the protein from the blood vessels to the peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention. The intake of fluids orally and the removal of blood cells by the spleen do not directly contribute to ascites.

Patients with chronic kidney disease experience an increased incidence of cardiovascular disease related to (select all that apply) a. hypertension. b. vascular calcifications. c. a genetic predisposition. d. hyperinsulinemia causing dyslipidemia. e. increased high-density lipoprotein levels.

a. hypertension. b. vascular calcifications. d. hyperinsulinemia causing dyslipidemia.

Nurses must teach patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply) a. older African Americans. b. patients more than 60 years old. c. those with a history of pancreatitis. d. those with a history of hypertension. e. those with a history of type 2 diabetes.

a. older African Americans. b. patients more than 60 years old. d. those with a history of hypertension. e. those with a history of type 2 diabetes.

One of the nurse's most important roles in relation to acute poststreptococcal glomerulonephritis is to a. promote early diagnosis and treatment of sore throats and skin lesions. b. encourage patients to obtain antibiotic therapy for upper respiratory tract infections. c. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence. d. monitor patients for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane

a. promote early diagnosis and treatment of sore throats and skin lesions. One of the most important ways to prevent APSGN is to encourage early diagnosis and treatment of sore throats and skin lesions. If streptococci are found in the culture, treatment with appropriate antibiotic therapy (usually penicillin) is essential. Encourage the patient to take the full course of antibiotics to ensure that the bacteria have been eradicated. Good personal hygiene is an important factor in preventing the spread of cutaneous streptococcal infections.

When admitting a patient with acute glomerulonephritis, it is most important that the nurse ask the patient about a. recent sore throat and fever. b. history of high blood pressure. c.frequency of bladder infections. d. family history of kidney stones.

a. recent sore throat and fever. Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by hypertension, urinary tract infection (UTI), or kidney stones.

Which medication is used​ off-label to reduce the occurrence of hot flashes associated with​ menopause? a Raloxifene​ (Evista) b Venlafaxine​ (Effexor) c Levothyroxine​ (Synthroid) d Triphenylethylene​ (Tamoxifen)

b Venlafaxine​ (Effexor)

The nurse is providing education to a client who has been diagnosed with menopause. Which health promotion intervention should the nurse discuss with the​ client? ​(Select all that​ apply.) a. Wearing tight clothing b. Eating a balanced diet that includes​ fruits, vegetables, and​ high-fiber foods c. Doing Kegel exercises d. Avoiding alcohol and cigarette use e. Participating in yoga classes

b. Eating a balanced diet that includes​ fruits, vegetables, and​ high-fiber foods c. Doing Kegel exercises d. Avoiding alcohol and cigarette use e. Participating in yoga classes Exercise can help manage the anxiety and mood swings associated with perimenopause. Dressing in loose layers of clothing that can be added or removed will increase comfort during hot flashes. Keeping the bedroom cool will help control and provide comfort during night sweats. Caffeine should be decreased during perimenopause because it can trigger hot flashes. Sexual intercourse does not have to be avoided during​ perimenopause, but lubricants may be used to decrease discomfort from vaginal dryness.

A dehydrated patient is in the injury stage of RIFLE staging of AKI. What would the nurse first anticipate in the treatment of this patient? a. assess daily weight b. IV administration of fluid and furosemide (Lasix) c. IV administration of insulin and sodium bicarbonate d. reversal of oliguria occurs with fluid replacement

b. IV administration of fluid and furosemide (Lasix) Injury is the stage of RIFLE classification when urine output is less than 0.5 ml/kg/hr for 12 hours, the serum creatinine is increased times two or the glomerular filtration rate is decreased by 50%. This stage maybe reversible by treating the cause or in, this patient, the dehydration by administering IV fluid a low dose of a loop diuretic, furosemide (Lasix)

The nurse is preparing to examine a client who is experiencing menopause. What information should the nurse obtain when performing a health​ history?​(Select all that​ apply.) a. Posture b. Menstrual history c. Medications d. Sleep pattern e. Vital signs

b. Menstrual history c. Medications d. Sleep pattern When performing a health history on a client experiencing​ menopause, the nurse should obtain information on the client​'s menstrual​ history, medications, and sleep pattern. Posture and vital signs are assessments that the nurse will include when completing the physical examination.

Which of the following is not usually prescribed during perimenopause? A. SERMs B. Birth control C. Benzodiazepines D. SSRI antidepressants

b. birth control Selective estrogen receptor modulators, benzos and SSRI could be prescribed.

The immunologic mechanisms involved in acute poststreptococcal glomerulonephritis include a. tubular blocking by precipitates of bacteria and antibody reactions. b. deposition of immune complexes and complement along the GBM. c. thickening of the GBM from autoimmune microangiopathic changes. d. destruction of glomeruli by proteolytic enzymes contained in the GBM.

b. deposition of immune complexes and complement along the GBM (glomerular basement membrane). Although the specific mechanism is not known, tissue injury occurs as the antigen-antibody complexes are deposited in the glomeruli, complement is activated, and inflammation result

The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that a. a lack of clotting factors promotes the collection of blood in the abdominal cavity. b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space. c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel. d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.

b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.

A 68 year-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2mEq/l (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum HCO3- is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. loop diuretics b. renal replacement therapy c. insulin and sodium bicarbonate d. sodium polystyrene sulfonate (Kayexalate)

b. renal replacement therapy This patient has at least three of six common indications for RRT, including high potassium level, metabolic acidosis and changed mental status. The other indications are volume overload, resulting in compromised cardiac status (this patient has a history of HTN), BUN greater than 120 mg/dL, and pericarditis, pericardial effusion, or cardiac tamponade

hematuria

blood in the urine

During the examination portion of her annual checkup, a 55-year-old client has several new complaints. Which subjective symptoms of menopause would the nurse expect to find during data collection? a Hair growth on the upper lip b Decreased skin elasticity c Night sweats d Rise in vaginal Ph

c. Night sweats is the only symptom that is subjective, reported by the client. Facial hair, decreased skin elasticity, and a rise in vaginal pH are all objective signs that can be observed by the nurse.

The nurse assesses that a patient with cirrhosis is deteriorating when there is evidence of: a. an increase in urine output related to the effect of the diuretics. b. a decrease in total bilirubin. c. confusion related to rising ammonia levels. d. a decrease in jaundice.

c. confusion related to rising ammonia levels. The rising ammonia level indicates that the various therapies have not been effective and the patient continues to deteriorate.

A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in her treatment to a. remove T lymphocytes in her blood that are producing antinuclear antibodies. b. remove normal particles in her blood that are being damaged by autoantibodies. c. exchange her plasma that contains antinuclear antibodies with a substitute fluid. d. replace viral-damaged cellular components of her blood with replacement whole blood

c. exchange her plasma that contains antinuclear antibodies with a substitute fluid. Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and complement from blood. T-lymphocytes, foreign antibodies, eosinophils, and basophils do not contribute to the tissue damage in SLE.

A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin (Garamycin) 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient's a.blood glucose. b.urine osmolality c.serum creatinine d.serum potassium

c. serum creatinine Gentamicin is nephrotic When a patient at risk for chronic kidney disease (CKD) receives a potentially nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in assessing for the adverse effects of the gentamicin.

A​ 34-year-old client presents to the family practice clinic with complaints of not having a menstrual period in the past 14 months. What data should the nurse obtain when performing a physical examination on the​ client? a Drug and alcohol use b Sexual history c Menstrual history d Weight and height

d Weight and height When performing a physical examination on a perimenopausal​ client, the nurse needs to obtain the client​'s weight and height. The client​'s sexual and menstrual history and use of alcohol and drugs are data obtained when performing the health history.

Which finding by the nurse for a patient admitted with glomerulonephritis indicates that treatment has been effective? a.The patient denies pain with voiding. b.The urine dipstick is negative for nitrites. c.Peripheral and periorbital edema is resolved. d.The antistreptolysin-O (ASO) titer is decreased.

c.Peripheral and periorbital edema is resolved. Since edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Antibodies to streptococcus will persist after a streptococcal infection. Nitrites will be negative and the patient will not experience dysuria since the patient does not have a urinary tract infection.

Prior paracentesis for a patient with ascites, the nurse should: a. increase patients fluid intake 30 minutes prior procedure b. assists the patient to lie flat in bed. c. asks the patient to empty the bladder d. administer sedation medication

c.asks the patient to empty the bladder The patient should empty the bladder to decrease the risk of bladder perforation during the procedure.

Hepatic encephalopathy

central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma s/s: change in LOC, memory loss, asterixis (flapping tremor) impaired handwriting, hyperventilation w/ resp alkalosis. Rx: lactulose, low protein, safety, rest

The nurse is interviewing Melinda Britt during her annual gynecologic exam. Which statement by Melinda would cause you to believe she is experiencing​ perimenopause? a. ​"I am so cold​ lately." b. ​"I feel that my appetite is really​ increasing." ​c. "I have problems with​ constipation." ​d. "I often experience sweating at​ night."

d. "I often experience sweating at​ night." Sweating at night is a manifestation during perimenopause. Cold​ intolerance, increased​ appetite, and constipation are not symptoms manifested with perimenopause.

Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. patient with DM. b. a patient with HTN crisis c. patient who tried to overdose on acetaminophen d. patient with major surgery who required a blood transfusion

d. patient with major surgery who required a blood transfusion ATN is primarily the result of ischemia, nephrotoxins, or sepsis. DM, HTN, and acetaminophen overdose will not contribute to ATN. Major surgery is most likely to cause severe kidney ischemia in the patient requiring a blood transfusion. A blood transfusion hemolytic reaction produces nephrotoxic injury if it occurs. Diabetes mellitus, hypertension, and acetaminophen overdose will not contribute to ATN

RIFLE defines three stages of AKI based on changes in a. blood pressure and urine osmolality. b. fractional excretion of urinary sodium. c. estimation of GFR with the MDRD equation. d. serum creatinine or urine output from baseline

d. serum creatinine or urine output from baseline

Intrarenal AKI

direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply. EX: APSGN

Postrenal AKI

due to obstruction of urine flow - can occur anywhere post kidney (ureter, bladder, urethra) EX: BPH, renal calculus, kidney stone

splenomegaly

enlargement of the spleen due to infection, cirrhosis, or anemia

Lupus causes

exact cause unknown; - may be impacted by genetics - UV rays - prior infections - stress - estrogen (women more likely to contract) - Medications: Procainamide (Pronestyl), Hydralazine (Apresoline), Quinidine

glomerulonephritis

inflammation of the glomeruli in the kidneys from injury or illness; leads to impaired kidney function; also called glomerular disease

ascites

portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space tx: Reduce sodium, Diuretics, Bedrest, paracentesis, Albumin (pulls fluids back to the vascular space)

hemodialysis (HD)

procedure for removing impurities from the blood because of an inability of the kidneys to do so Nitrogen, creatinine, and sodium filtered out A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate

proteinuria

protein in the urine

Acute Kidney Injury (AKI)

rapid-onset disease of the kidneys resulting in a failure to produce urine Oliguric phase: 10-14 days, Signs of fluid volume overload, such as edema, distended neck veins, hypertension, pulmonary edema, and heart failure. Metabolic acidosis, hyponatremia, hyperkalemia, hyperphosphatemia, and uremic symptoms may also be present. Diuretic Phase: 1-3 weeks, Cannot concentrate the urine. Hypovolemia and hypotension may occur due to massive volume loss. Loss of large volumes of fluid and electrolytes leads to hyponatremia, hypokalemia, metabolic alkalosis, and dehydration. Fluid and electrolytes, acid-base balance, and BUN and creatinine start to normalize. Recovery Phase: This phase begins when the GFR increases, allowing plateau of the BUN and creatinine, then a gradual decline. May take 12 months or never occur.

plasmapheresis

removal of plasma from withdrawn blood by centrifuge, treatment of systemic lupus erythematosus Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and complement from blood.

paracentesis

surgical puncture to remove fluid from the abdomen semi fowler's or upright on edge of bed. Prior empty bladder. post VS--report elevated temp. watch for hypovolemia

chronic kidney failure symptoms

• polyuria, oliguria, anuria • electrolyte imbalances • nitrogen retention • anemia • HTN • weakness, SOB • fatigue, thirst, appetite loss • bleeding • muscular twitching, paresthesia • Uremia (BUN>100; Creatinine >10-12) • Albuminuria • GFR <60 ml/min for 3+ months • Microcytic anemia • Iron deficiency • metabolic acidosis