BSN 445 KIDNEY DYSFUNCTION: HISTORY, PHYSICAL EXAMINATION, AND ADDITIONAL ASSESSMENTS.

BSN 445 KIDNEY DYSFUNCTION:
HISTORY, PHYSICAL EXAMINATION,
AND ADDITIONAL ASSESSMENTS.
Questiony1yofy3
Whichyquestionywouldytheynurseyaskywhenyconductingyayhealthyhistoryyforyaypatient
yreportingygenitourinaryysymptoms?ySelectyallythatyapply.yOne,ysome,yoryallyresponse

symayybeycorrect.
"Haveyyouyhadyanyyrecentydiagnosticyprocedures?"
"Howylongyhaveyyouyhadyyouryurinaryysymptoms?"
"Doesyanythingyimproveyyouryurinaryysymptoms?"
"Doyyouytakeyanyyover-the-counterymedications?"
"Haveyyouyeverybeenydiagnosedywithyhighybloodypressure?"y-yCORRECTyANSWER-
"Haveyyouyhadyanyyrecentydiagnosticyprocedures?"
Theynurseywouldyassessyforyanyyrecentydiagnosticyproceduresythatymayyhaveyusedyc
ontrastydye,ywhichyisyclassifiedyasynephrotoxic.
"Howylongyhaveyyouyhadyyouryurinaryysymptoms?"
Theydurationyandylocationyofyanyyurinaryysymptomsywouldybeyassessedybyytheynurs
e.
"Doesyanythingyimproveyyouryurinaryysymptoms?"
Theynurseywouldyassessyforyfactorsyorystrategiesythatylessenyoryaggravateytheyproble
m.
"Doyyouytakeyanyyover-the-counterymedications?"
Theyuseyofyover-the-
counterymedications,ywhichymayybeynephrotoxic,ywouldybeyassessedybyytheynurse.
"Haveyyouyeverybeenydiagnosedywithyhighybloodypressure?"
Hypertensionyisyayriskyfactoryforykidneyycomplications,yandysomeyantihypertensivesy
areyclassifiedyasynephrotoxic.

Questiony2yofy3
Whichyfindingywouldyindicateytheysuddenydevelopmentyofyuremia?
Anorexia
Newymurmur
Difficultyybreathing
Metallicytasteyinymouthy-yCORRECTyANSWER-Metallicytasteyinymouth
Uremiaycausesyaymetallicytasteyinytheymouth,ywhichyoftenyoccursysuddenly.

Questiony3yofy3
Whenycollectingyayhealthyhistoryyforykidneyydisease,ytheynurseywouldyassessyforythey
useyofywhichymedication?
Acetaminophen

,Amiodarone
Furosemide
Pantoprazoley-yCORRECTyANSWER-Furosemide
Furosemideyisyayloopydiuretic,ywhichycanybeynephrotoxic.

Questiony1yofy3
Whichyassessmentyfindingywouldyindicateytheypresenceyofykidneyytrauma?
Grey-Turnerysign
Concaveyabdominalyappearance
Pittingyedema
Jugularyveinydistentiony-yCORRECTyANSWER-Grey-Turnerysign
Grey-
Turnerysignyisyaypurplishydiscolorationyonytheyflankythatyindicatesykidneyytrauma.

Questiony3yofy3
Inywhichyorderywouldytheynurseyperformytheystepsytoyassessyforyorthostaticyhypoten
sion?
CorrectyAnswery
Exactly!
Assessybloodypressureyandyheartyrateywithytheypatientylyingydown.y
Assistytheypatientytoyaysittingyposition.y
Waity3yminutes.y
Assessybloodypressureyandyheartyrateywithytheypatientysitting.y
Assistytheypatientytoyaystandingypositionyandywaity3yminutes.y
Assessybloodypressureyandyheartyrateywithytheypatientystanding.y-
yCORRECTyANSWER-



Questiony1yofy9
Theynurseywouldydocumentywhichypatientystatementywhenycollectingyayhealthyhistor
yyrelatedytoykidneyystatus?ySelectyallythatyapply.yOne,ysome,yoryallyresponsesymayybey
correct.
"Iyregularlyytakeyacetaminophenyforychronicyheadachesyandybackypain."
"IyhadyayCTyscanylastyweekytoylookyforycausesyofymyystomachypain."
"Iytakeylisinoprilytoycontrolymyyhypertension."
"IyfeelylikeyIyconstantlyyhaveytoypee,ybutyIyneverygetyityallyout."
"WhenyIydrinkyorangeyjuice,yitydoesn'tyburnyasymuchywhenyIypee."y-
yCORRECTyANSWER-

"IyhadyayCTyscanylastyweekytoylookyforycausesyofymyystomachypain."
Computedytomographyyscansyuseynephrotoxicydye,yandytheynurseywouldywantytoydo
cumentytheyrecentyuseyofycontrastydye.

"Iytakeylisinoprilytoycontrolymyyhypertension."
Lisinoprilyisyanyangiotensin-
convertingyenzymeyinhibitorythatyhasynephrotoxicyproperties.yHypertensionyalsoyda
magesyrenalyvessels.

,"IyfeelylikeyIyconstantlyyhaveytoypee,ybutyIyneverygetyityallyout."
Theynurseywouldycloselyydocumentytheypatient'sychiefycomplaintyinytheypatient'syow
nywords.

"WhenyIydrinkyorangeyjuice,yitydoesn'tyburnyasymuchywhenyIypee."
Theynurseywouldyuseytheypatient'syownywordsytoydocumentyaggravatingyoryalleviati
ngyfactorsyforytheysymptoms.

Questiony2yofy9
Whichypatientystatementywouldyindicateytheydevelopmentyofyayrapidyfluidyvolumeyga
in?
"Myymouthyfeelsysoydryyallyofytheytime."
"Iyneedytoysleepyonytwoyextraypillowsyatynight."
"Iyhaveyaymetallicytasteyinymyymouth."
"MyyskinytentsyupywhenyIypinchyit."y-yCORRECTyANSWER-
"Iyneedytoysleepyonytwoyextraypillowsyatynight."
Suddenlyyrequiringyextraypillowsytoysleepyatynightyindicatesyorthopnea,yaysignyofyrap
idyfluidyvolumeygainyandypotentialycardiacystress.

Questiony3yofy9
Whichypatientystatementywouldyindicateyaypotentialycauseyofykidneyydysfunction?
"IyhadynephroticysyndromeywhenyIywasyaychild."
"Myyskinyisysoydryyandyitchyyallyofytheytime."
"Iyhaveylosty10ypoundsyinytheylasty2ymonths."
"Iyalwaysyhaveytoypeeyduringytheynight."y-yCORRECTyANSWER-
"IyhadynephroticysyndromeywhenyIywasyaychild."
Nephroticysyndromeycausesykidneyydamageyandywouldybeynotedyinytheyhealthyhistor
y.

Questiony4yofy9
Theynurseywouldyprepareytoyadministeryintravenousy(IV)yfluidsytoyaypatientydemons
tratingywhichyassessmentyfinding?
+2ypittingyedema
Moistymucousymembranes
Distendedyjugularyveins
Pooryskinyturgory-yCORRECTyANSWER-Pooryskinyturgor
Pooryskinyturgorycanyindicateyvolumeydepletion,ywhichywouldyrequireyIVyfluidyadmi
nistrationyforytreatment.

Questiony5yofy9
Whichyassessmentyfindingywouldyindicateyfluidyvolumeyoverload?
Distentionyofytheyjugularyveinsy1ycmyaboveytheysternalynotchywhenytheybedyisyaty45yd
egrees
Delayedyreturnytoyshapeyafterypinchingytheyskinyoverytheyforearm
Distentionyofyhandyveinsyfory8ysecondsywhenytheyhandyisyelevated

, Drynessyofytheyoralycavityyandymucousymembranesy-yCORRECTyANSWER-
Distentionyofyhandyveinsyfory8ysecondsywhenytheyhandyisyelevated
Ifydistentionydoesynotydisappearywithiny5ysecondsyafterytheyhandyisyelevated,yfluidyo
verloadyisysuspected.

Questiony6yofy9
Theynurseyassessesyforyedemaybyyapplyingyfingertipypressureytoytheyanklesyandynote
syay6-
mmyindentionythatyremainsyforyabouty45yseconds.yInywhichywayywouldytheynurseydo
cumentytheseyfindings?
+1yPittingyedema
+2yPittingyedema
+3yPittingyedema
+4yPittingyedemay-yCORRECTyANSWER-+3yPittingyedema
+3yPittingyedemaycreatesyanyindentationyabouty6-
mmydeepythatylastsyupytoy60yseconds.

Questiony7yofy9
Whenytheynurseyisyperformingypercussionyofytheykidneys,ytheypatientystates,y"Ow!yIty
hurtsywhenyyouypressythere!"yBasedyonytheyassessmentyfindings,ytheynurseywouldyas
sessyforywhichycondition?
Pyelonephritis
Kidneyystones
Fluidyvolumeydeficit
Fluidyvolumeyoverloady-yCORRECTyANSWER-Pyelonephritis
Painyonypercussionyindicatesyaykidneyyinfection,ysuchyasypyelonephritis.

Questiony8yofy9
Whichyassessmentyfindingywouldyindicateyfluidyvolumeyoverload?
Respiratoryyrateyofy18ybreaths/min
Centralyvenousypressurey(CVP)yofy12ymmyHg
Decreasedyskinyturgor
Meanyarterialypressurey(MAP)yofy50ymmyHgy-yCORRECTyANSWER-
Centralyvenousypressurey(CVP)yofy12ymmyHg
AynormalyCVPyisybetweeny2yandy5ymmyHg;yanyincreasedyCVPyindicatesyfluidyvolumey
overload.

Questiony9yofy9
Whichyassessmentyfindingywouldyindicateyanyimbalanceyinycalcium?
Trousseauysign
Changeyinymuscleystrength
Nauseayandyvomiting
Alteredymentalystatusy-yCORRECTyANSWER-Trousseauysign
AypositiveyTrousseauysignyindicatesyanyimbalanceyinycalcium.

LaboratoryyAssessmentyofyKidneyyFunction,yImagingyStudies,yandyKidneyyBiopsy