NURS 316 COMPREHENSIVE EXAM UPDATED
QUESTIONS AND SOLUTIONS GRADED A+
✔✔Acute Kidney injury - ✔✔Abrupt insult to the kidney
Azotemia elevated Cr, fluid retention are common
Prerenal--> decreased perfusion
Intrarenal--> medications infection
Postrenal--> obstruction
Tx: Must address underlying cause
Initial insult: Condition disrupts kidney function
Oliguria: Low GFR, lack of urine output
Diuresis: Large unconcentrated urine outflow
Recovery: Healthy nephrons take over function or damaged nephrons
✔✔Chronic renal failure - ✔✔Irreversible and progressive with gradual onset
90-95% of the nephrons affected
Usually progresses to ESRD
Hemodialysis or kidney transplant needed
DM, HTN, glomerulopritis and PKD are leading causes
Uremic encephalopathy, proteinuria, hypoalbuminemia, edema, fluid overload, oliguria,
electrolyte imbalances, anemia
Tx: Fluid and electrolyte management along with BP management, GFR less than 10-
20, dialysis, kidney transplant evaluation
✔✔Glomerulonephritis - ✔✔Immunological mechanism
Triggers inflammation that damages the membranes of the glomerulus
Autoimmune or post-streptococcal disorder
Can progress to ESRD
Antigen-antibody reaction damages glomeruli leading to hyperpermeability
Damaged glomeruli leads to: Protein loss, Edema, Oliguria, Hypervolemia (HTN),
PGSN: 7-21 days post strep infection, Dark urine
Diagnosis: Elevated serum Cr and BUN low serum albumin, Urinalysis, Antibodies to
streptococcal bacteria may be present
Tx: antibiotics, dietary modifications, diuretics
✔✔Incontinence - ✔✔Stress: leakage due to weak pelvic support, cough or sneeze
Urge: Detrusor muscle overactivity
Overflow: overdistention or urinary retention in bladder
Neurogenic: interruption of the sensory nerve fibers between bladder and spinal cord
Functional: Inability to hold urine due to CNS problems
Mixed: Combination of stress and urge
✔✔nephrolithiasis - ✔✔Stones in kidneys
Urolithiasis: Stone travels to ureter
Presentation based on stone's location
Stones: Calcium most common, struvite, uric acid, cystine
, Kidneys secrete stone-inhibitors
Risk factors: Genetic susceptibility, dehydration, hypercalcemia, hyperparathyroidism,
Gout
Severe abdominal pain, flank pain, Colicky pain caused by ureter spasms, Hematuria,
Crystalluria, Hydronephrosis may develop
Tx: Pain relief, Prevent recurrence and UTI, Strain urine to catch, High fluid intake,
Lithotripsy, Surgery
✔✔pyelonephritis/UTI - ✔✔Infection of renal pelvis
Other factor: Obstructive uropathy, Vesicoureteral reflux, Neurogenic bladder,
Urological instrumentation, Pregnancy
s/s: Fever, Abdominal pain, Flank pain, N/V, Chills, Dysuria, Urinary frequency, Pyuria
Tx: Antibiotics, Analgesics, Fluid intake greater than 3L, Remover urological obstruction
✔✔RAAS - ✔✔Helps monitor BP
✔✔Electrolytes - ✔✔Intracellular fluid, Extracellular fluid, Interstitial fluid
Hydrostatic and osmotic pressure
✔✔Electrolyte Imbalances - ✔✔Sodium
Potassium
Magnesium
Calcium
✔✔Hyponatremia vs. Hypernatremia - ✔✔Renal causes Adrenal insufficiency, Nonrenal
Excessive sweating, Thirst, hypotension, and tachycardia, Neurological deficits may
develop, Tx: Slow replacement of sodium with adequate fluid
Levels greater than 145, Cells become dehydrated and shrink, CNS manifestations,
Changes in membrane potentials and cell responsiveness to signals
✔✔Hypokalemia vs. Hyperkalemia - ✔✔Blood concetration less then 3.5, Diuretic
therapy most common cause, loss from body through renal system Cues: Anorexia,
cardiac arrhythmias, leg cramps, ECG changes, Adrenergic agents or use of IV
dextrose, Tx: Replace potassium at acceptable rate, rapid infusion can cause cardiac
arrest
Serum greater than 5.2, decreased renal perfusion can lead to retention, Early s/s:
numbness, muscle cramps, diarrhea, ECG: wide QRS, tall and peaked T waves,
bradycardia
✔✔Hypercalcemia vs. Hypocalcemia - ✔✔Levels greater than 1o, causes Elevated PTH
and Cancer, Decreased neuromuscular excitability, weakness, renal calculi, cardiac
arrhythmias
Less then 8.7, Neuromuscular excitability, Paresthesia, Hypotension cardiac
arrhythmias, Chronic: Bone pain and fragility
QUESTIONS AND SOLUTIONS GRADED A+
✔✔Acute Kidney injury - ✔✔Abrupt insult to the kidney
Azotemia elevated Cr, fluid retention are common
Prerenal--> decreased perfusion
Intrarenal--> medications infection
Postrenal--> obstruction
Tx: Must address underlying cause
Initial insult: Condition disrupts kidney function
Oliguria: Low GFR, lack of urine output
Diuresis: Large unconcentrated urine outflow
Recovery: Healthy nephrons take over function or damaged nephrons
✔✔Chronic renal failure - ✔✔Irreversible and progressive with gradual onset
90-95% of the nephrons affected
Usually progresses to ESRD
Hemodialysis or kidney transplant needed
DM, HTN, glomerulopritis and PKD are leading causes
Uremic encephalopathy, proteinuria, hypoalbuminemia, edema, fluid overload, oliguria,
electrolyte imbalances, anemia
Tx: Fluid and electrolyte management along with BP management, GFR less than 10-
20, dialysis, kidney transplant evaluation
✔✔Glomerulonephritis - ✔✔Immunological mechanism
Triggers inflammation that damages the membranes of the glomerulus
Autoimmune or post-streptococcal disorder
Can progress to ESRD
Antigen-antibody reaction damages glomeruli leading to hyperpermeability
Damaged glomeruli leads to: Protein loss, Edema, Oliguria, Hypervolemia (HTN),
PGSN: 7-21 days post strep infection, Dark urine
Diagnosis: Elevated serum Cr and BUN low serum albumin, Urinalysis, Antibodies to
streptococcal bacteria may be present
Tx: antibiotics, dietary modifications, diuretics
✔✔Incontinence - ✔✔Stress: leakage due to weak pelvic support, cough or sneeze
Urge: Detrusor muscle overactivity
Overflow: overdistention or urinary retention in bladder
Neurogenic: interruption of the sensory nerve fibers between bladder and spinal cord
Functional: Inability to hold urine due to CNS problems
Mixed: Combination of stress and urge
✔✔nephrolithiasis - ✔✔Stones in kidneys
Urolithiasis: Stone travels to ureter
Presentation based on stone's location
Stones: Calcium most common, struvite, uric acid, cystine
, Kidneys secrete stone-inhibitors
Risk factors: Genetic susceptibility, dehydration, hypercalcemia, hyperparathyroidism,
Gout
Severe abdominal pain, flank pain, Colicky pain caused by ureter spasms, Hematuria,
Crystalluria, Hydronephrosis may develop
Tx: Pain relief, Prevent recurrence and UTI, Strain urine to catch, High fluid intake,
Lithotripsy, Surgery
✔✔pyelonephritis/UTI - ✔✔Infection of renal pelvis
Other factor: Obstructive uropathy, Vesicoureteral reflux, Neurogenic bladder,
Urological instrumentation, Pregnancy
s/s: Fever, Abdominal pain, Flank pain, N/V, Chills, Dysuria, Urinary frequency, Pyuria
Tx: Antibiotics, Analgesics, Fluid intake greater than 3L, Remover urological obstruction
✔✔RAAS - ✔✔Helps monitor BP
✔✔Electrolytes - ✔✔Intracellular fluid, Extracellular fluid, Interstitial fluid
Hydrostatic and osmotic pressure
✔✔Electrolyte Imbalances - ✔✔Sodium
Potassium
Magnesium
Calcium
✔✔Hyponatremia vs. Hypernatremia - ✔✔Renal causes Adrenal insufficiency, Nonrenal
Excessive sweating, Thirst, hypotension, and tachycardia, Neurological deficits may
develop, Tx: Slow replacement of sodium with adequate fluid
Levels greater than 145, Cells become dehydrated and shrink, CNS manifestations,
Changes in membrane potentials and cell responsiveness to signals
✔✔Hypokalemia vs. Hyperkalemia - ✔✔Blood concetration less then 3.5, Diuretic
therapy most common cause, loss from body through renal system Cues: Anorexia,
cardiac arrhythmias, leg cramps, ECG changes, Adrenergic agents or use of IV
dextrose, Tx: Replace potassium at acceptable rate, rapid infusion can cause cardiac
arrest
Serum greater than 5.2, decreased renal perfusion can lead to retention, Early s/s:
numbness, muscle cramps, diarrhea, ECG: wide QRS, tall and peaked T waves,
bradycardia
✔✔Hypercalcemia vs. Hypocalcemia - ✔✔Levels greater than 1o, causes Elevated PTH
and Cancer, Decreased neuromuscular excitability, weakness, renal calculi, cardiac
arrhythmias
Less then 8.7, Neuromuscular excitability, Paresthesia, Hypotension cardiac
arrhythmias, Chronic: Bone pain and fragility
