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Exam (elaborations)

NURS 5461 Final Exam – Questions With Perfect Solutions

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Practice questions for this set


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Five stages of sexual development in adolescence evaluating pubic hair, genitals
and breast development



Choose an answer



Renal issues that occur with normal
1 2 What do RAAS inhibitors do?
aging



3 Most common cause of AKI 4 Tanner stages



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Terms in this set (146)


Decreased GFR, decreased diluting capacity, decreased
concentration ability, decreased sodium conservation
Renal issues that occur with
(volume depletion) decreased sodium excreation (salt
normal aging
sensitivity/HTN), decreased ammonium & bicarb
production (metabolic acidosis)

,Most accurate indicator of GFR - declines 8mls per decade starting at age 40
renal function in older
adults

Small amounts of protein in Chronic nephrosclerosis from HTN
urine

partial or complete blocking of one or both renal
arteries - THIS ACTIVATES THE RENIN ANGIOTENSION
ALDOSTERONE SYSTEM AND CAUSES SYSTEMIC
HYPERTENSION TO ATTEMPT TO PERFUSE THE KIDNEY
- if pt has a 30% increase in creatinine after starting an
renal artery stenosis
ACE or ARB - think renal artery stenosis - risk factors
include smoking, HTN, hyperlipidemia, DM, aneurysms -
renal stenting isn't indicated except in extreme cases
when you can't control BP or there is progressive kidney
failure.

Acute tubular necrosis (ATN) followed by prerenal
Most common cause of AKI
azotemia

Acute Tubular Necrosis Damage to the renal tubules due to presence of toxins
(ATN) in the urine or to ischemia. Results in oliguria.

Due to decreased blood flow to kidneys; common
Prerenal azotemia cause of acute renal failure - increase bun and
decreased renal flow - treat with volume resuscitation

DIAGNOSIS: URINE SEDIMENT WILL INCLUDE
acute tubular necrosis TUBULAR EPITHELIAL CELLS & GRANULAR MUDDY
diagnostic criteria BROWN CASTS - in oliguria FENa >2% - TREATMENT IS
SUPPORTIVE CARE AND OFTEN TIMES REVERSIBLE

Drug-induced hypersensitivity involving the interstitium
and tubules; results in acute renal failure (intrarenal
Acute interstitial nephritis azotemia) - most commone antibiotics to cause this are
PENICILLINS, CEPHLOSPORINS, AND
FLUOROQUINOLONES (floxacins)

malignant neoplasm of bone marrow. Proteins light &
heavy chains will deposit in parenchyma - pt will
multiple myeloma present with lower back pain - seen AA women - will
"myeloma kidney" see sever proteinurea, low anion gap, hypercalcemia,
anemia, and bone pain - treat w chemotherapy
(melphalan and prednisone)

, Acute nephritic syndrome
3 types of glomerular
Post infection glomerulonephritis (step/staph)
disease
IgA nephropathy

URINATING >3.5G OF PROTEIN PER DAY! WITH
HYPOALBUMINEMIA, HLD, AND EDEMA - Can be from
primary glomerular disease, infection, malignancy,
exposure to allergen/medication, DM, or HTN.
Nephrotic syndrome
◦ RENAL BIOPSY IS ESSENTIAL FOR EARLY DIAGNOSIS
◦ THERAPY - CONTROLL BP, USE RASS BLOCKERS,
SODIUM RESTICTION, STATINS, ANTICOAGULATION
WHEN ALBUMIN IS <2.8

What do RAAS inhibitors Decrease proteinuria
do?

progressive, irreversible loss of kidney function - RENAL
GLOMERULAR AND TUBULOINTERSTITIAL FIBROSIS
Chronic Kidney Disease INCREASES WITH AGE LEADING TO CKD - presents
(CKD) with a decompensation of the pts preexisting medical
problems. - HTN AND DM ARE HIGH RISK FACTORS
FOR CKD

Renin is released by kidneys in response to decreased
blood volume; causes angiotensinogen to split &
RAAS (renin-angiotensin- produce angiotensin I; lungs convert angiotensin I to
aldosterone system) angiotensin II; angiotensin II stimulates adrenal gland to
release aldosterone & causes an increase in peripheral
vasoconstriction

-NSAIDs- block the synthesis of the renal
prostaglandins that promote vasodilation, and this can
worsen renal hypoperfusion
-DEMEROL: Metabolized to normeperidine in the liver,
which kidneys excrete
Medications to avoid in -AMINOGLYCOSIDES, PENICILLIN, AND
CKD TETRACYCLINES: Nephrotoxic


Medication use can be complicated by decreased renal
clearance - MEDS TO AVOID / USE W CATION NSAID,
CONTRAST, GADOLINIUM, AMINOGLYCOSIDES, AND
AMPHOTERICIN B

What stage to screen for CKD stage 3B - ferritin goal should be >100
Anemia

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