NR507 FINAL EXAMS WITH CORRECT ANSWERS

NR507 FINAL EXAMS WITH CORRECT ANSWERS Acute renal failure - CORRECT ANSWER-Reversible Determining prognosis- kidneys respond to diuretic with good output; this indicates that kidneys are functioning well Acute Pyelonephritis - CORRECT ANSWER-Diagnosing by clinical symptoms alone can be difficult; can be similar to cystitis Diagnosis established by: -Urine culture -Urinalysis (WBC casts indicates pyelonephritis, but may not always be present) -Signs/Symptoms -Complicated pyelonephritis requires blood cultures and urinary tract imaging Renal Calculi (Renal Stones) - CORRECT ANSWER-Goals of Treatment: Manage acute pain Promote passage of stone Reduce size of stone Prevent new stone formation Chronic Renal Failure - CORRECT ANSWER-Chronic Kidney Disease (CKD) is a progressive loss of renal function associated with systemic disease such as hypertension, diabetes mellitus (most significant risk factor), systemic lupus erythematosus or intrinsic kidney disease CKD stage is determined by estimates of GFR and albuminuria Who is a candidate for dialysis? - CORRECT ANSWER-End-stage renal disease (ESRD) is the final stage of CKD with the number one cause being diabetes mellitus combined with hypertension. At this point, the patient is completely dependent on dialysis to survive. CKD is classified into five stages and is based on the patient's GFR rather than symptoms. Patients will need dialysis when the following symptoms are present: --Metabolic acidosis. --Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an indication for dialysis. --Hyperkalemia by itself is not an indication for dialysis. --Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol). --Fluid volume overload that is not responsive to diuretics. --Uremic symptoms due to nitrogenous wastes in the blood stream. Stage I CKD - CORRECT ANSWER-There is kidney damage with normal or elevated GFR 90-120 Stage II CKD - CORRECT ANSWER-There is kidney damage with mild decrease in GFR 60-89 Stage III CKD - CORRECT ANSWER-There is a moderate decrease in GFR 30-59 Stage IV CKD - CORRECT ANSWER-There is a severe decrease in GFR 15-29 Stage V CKD - CORRECT ANSWER-Kidney failure- End-stage renal disease <15 (dialysis) Once Stage IV is reached, progression to Stage V is inevitable as well as dialysis or kidney transplant Complications of Decreased GFR - CORRECT ANSWER-Anemia Hypertension Decreased calcium absorption Hyperlipidemia Heart failure Left ventricular hypertrophy Fluid volume overload Hyperkalemia Hyperparathyroidism Hyperphosphatemia Metabolic acidosis Malnutrition (late complication) GERD - CORRECT ANSWER-Warning signs include: Symptoms over age of 50: -Dysphagia (difficulty swallowing) -Odynophagia (pain on swallowing) -Nausea and vomiting -Weight loss -Melena -Early satiety (feeling full after eating very little food Hiatal Hernia - CORRECT ANSWER-Often asymptomatic Generally, a wide variety of symptoms develop later in life and are associated with other GI disorders, primarily GERD --Sliding hiatal hernia: treatment usually conservative. Individuals can diminish reflux by eating small, frequent meals and avoiding the recumbent position after eating. Abdominal supports and tight clothing are avoided and weight control recommended for obese individuals. Duodenal Ulcer - CORRECT ANSWER-Characteristic manifestation = chronic intermittent pain in epigastric area Pain begins 30 minutes to 2 hours after eating when stomach is empty Not unusual for pain to occur in middle of the night and disappear by morning Peptic Ulcer Disease - CORRECT ANSWER-Peptic ulcer is a break or ulceration in the protective mucosal lining of the lower esophagus, stomach or duodenum Least likely to occur in the large intestine Major Depressive Disorder - CORRECT ANSWER-SSRIs are the standard first-line treatment for major depression Initial selection of an antidepressant includes: -Assessment of symptoms -Age -Side effects -Safety -Cost Social Anxiety Disorder - CORRECT ANSWER-Fear and avoidance of social situations Example: anxious person may feel very uncomfortable having a conversation or interacting with others and very conscious of being scrutinized and humiliated or rejected by others Schizophrenia Diagnosis: - CORRECT ANSWER-Advanced neuroimaging techniques have revealed structural brain abnormalities A consistent finding is the enlargement of the lateral and third ventricles and the widening of frontocortical fissures and sulci . Schizophrenia Positive symptoms - CORRECT ANSWER-("More" symptoms): Hallucinations