2024 NR 570 FINAL EXAM STUDY
GUIDE WITH CORRECT ANSWERS
What is nephrolithiasis? - CORRECT-ANSWERSrenal calculi (kidney stones)
How does Renal calculi form? - CORRECT-ANSWERSformed d/t elevated
levels of minerals in the body
What minerals in excess can cause renal calculi? - CORRECT-
ANSWERScalcium oxalate (most common),
phosphate
uric acid
struvite
cystine
Frank-Starling Law and Cardiovascular Hemodynamics (6 components) -
CORRECT-ANSWERS1. Heart rate
-The number of heartbeats per minute.
2. Preload
-The volume of blood in the left atrium at the end of diastole determines the
amount of blood the left ventricle will pump.
3. Afterload
-The amount of pressure that the heart must pump against during systole.
The more resistance, the less blood that is pumped into the circulation.
4. Contractility
-The heart's intrinsic contractile ability (the force of the pump).
5. Stroke volume
-The volume of blood ejected from the left ventricle during systole.
6. Cardiac output
-The amount of blood that is pumped through the circulation in one minute.
symptoms of hyponatremia? - CORRECT-ANSWERSheadache
nausea & vomiting
fatigue or loss of energy
dizziness
orthostatic hypotension
muscle cramps and weakness
tachycardia
confusion
convulsions
,coma
death
dx & tx of hyponatremia - CORRECT-ANSWERSManagement begins with
determining the cause and involves a multi-step process. Serum osmolality is
required to distinguish between isotonic, hypotonic, or hypertonic
hyponatremia.
isotonic hyponatremia - CORRECT-ANSWERSSerum Osmolality
-280-285 mOsm/kg
Clinical Signs
-Pseudohyponatremia-
-Body water is normal; patient is asymptomatic
Underlying Condition
-Occurs with extreme hyperlipidemia or hyperproteinemia
Treatment
-Cut down on fat and proteins, do not restrict fluids
hypotonic hyponatremia - CORRECT-ANSWERSSerum Osmolality
< 280 mOsm/kg
Clinical Signs, Underlying Condition, & Treatment
Need to further assess volume status and urine sodium
hypertonic hyponatremia - CORRECT-ANSWERSSerum Osmolality
> 285 mOsm/kg
Clinical Signs
-Body fluid deficit-Clinical signs arise from water deficit
Underlying Condition
-Occurs with hyperglycemia (usually HHNK) or with mannitol and sorbitol use
Treatment
-Correct hyperglycemia and aggressive fluid resuscitation with isotonic saline
how to distinguish between renal vs non-renal cases of hyponatremia? -
CORRECT-ANSWERSMeasurement of the urine sodium (10-20 mEq/L) assists
in distinguishing renal from non-renal causes.
Urine sodium > 20 mEq/L suggests salt-wasting (renal disorder)
, whereas urine sodium < 10 mEq/L suggests renal retention of sodium to
compensate for extrarenal fluid loss (extrarenal disorder).
clinical PEARL
treatment of hyponatremia is based on cause; treat the underlying condition
- CORRECT-ANSWERSif hypovolemic, give IV NaCl
if hypervolemic, implement water restriction (with a loop diuretic if
symptomatic)
hypernatremia clinical presentation - CORRECT-ANSWERSthirst
flushed skin
dry mucus membranes
low UOP
tachycardia
seizures
hyperactive DTRs
hypernatermia - CORRECT-ANSWERSHypernatremia results from excessive
water loss or increased sodium retention, which produces a deficiency in
body water (rarely is it caused by excessive sodium intake).
This condition is less common than hyponatremia due to the body's natural
responses of increased thirst and increased antidiuretic hormone (ADH)
secretion.
However, it is more common in vulnerable patients without the ability to
rehydrate themselves (infants, elderly, and severely ill). Like hyponatremia,
hypernatremia may also be life-threatening.
dx and tx of hypernatremia - CORRECT-ANSWERSHypernatremia will always
result in hyperosmolality (>295 mOsm/L) because sodium is the major
contributor to total serum osmolarity.
Therefore, the assessment of hypernatremia begins with determining the
patient's fluid volume status and the urine sodium to differentiate between
renal and extrarenal causes of sodium and water loss.
The cause can usually be identified from the history and physical
examination.
hypovolemic hypernatremia - CORRECT-ANSWERSConditions
-Sweating
-Burns
-Vomiting & diarrhea
-Fistulas
-Osmotic diuresis (HHNK, mannitol)
GUIDE WITH CORRECT ANSWERS
What is nephrolithiasis? - CORRECT-ANSWERSrenal calculi (kidney stones)
How does Renal calculi form? - CORRECT-ANSWERSformed d/t elevated
levels of minerals in the body
What minerals in excess can cause renal calculi? - CORRECT-
ANSWERScalcium oxalate (most common),
phosphate
uric acid
struvite
cystine
Frank-Starling Law and Cardiovascular Hemodynamics (6 components) -
CORRECT-ANSWERS1. Heart rate
-The number of heartbeats per minute.
2. Preload
-The volume of blood in the left atrium at the end of diastole determines the
amount of blood the left ventricle will pump.
3. Afterload
-The amount of pressure that the heart must pump against during systole.
The more resistance, the less blood that is pumped into the circulation.
4. Contractility
-The heart's intrinsic contractile ability (the force of the pump).
5. Stroke volume
-The volume of blood ejected from the left ventricle during systole.
6. Cardiac output
-The amount of blood that is pumped through the circulation in one minute.
symptoms of hyponatremia? - CORRECT-ANSWERSheadache
nausea & vomiting
fatigue or loss of energy
dizziness
orthostatic hypotension
muscle cramps and weakness
tachycardia
confusion
convulsions
,coma
death
dx & tx of hyponatremia - CORRECT-ANSWERSManagement begins with
determining the cause and involves a multi-step process. Serum osmolality is
required to distinguish between isotonic, hypotonic, or hypertonic
hyponatremia.
isotonic hyponatremia - CORRECT-ANSWERSSerum Osmolality
-280-285 mOsm/kg
Clinical Signs
-Pseudohyponatremia-
-Body water is normal; patient is asymptomatic
Underlying Condition
-Occurs with extreme hyperlipidemia or hyperproteinemia
Treatment
-Cut down on fat and proteins, do not restrict fluids
hypotonic hyponatremia - CORRECT-ANSWERSSerum Osmolality
< 280 mOsm/kg
Clinical Signs, Underlying Condition, & Treatment
Need to further assess volume status and urine sodium
hypertonic hyponatremia - CORRECT-ANSWERSSerum Osmolality
> 285 mOsm/kg
Clinical Signs
-Body fluid deficit-Clinical signs arise from water deficit
Underlying Condition
-Occurs with hyperglycemia (usually HHNK) or with mannitol and sorbitol use
Treatment
-Correct hyperglycemia and aggressive fluid resuscitation with isotonic saline
how to distinguish between renal vs non-renal cases of hyponatremia? -
CORRECT-ANSWERSMeasurement of the urine sodium (10-20 mEq/L) assists
in distinguishing renal from non-renal causes.
Urine sodium > 20 mEq/L suggests salt-wasting (renal disorder)
, whereas urine sodium < 10 mEq/L suggests renal retention of sodium to
compensate for extrarenal fluid loss (extrarenal disorder).
clinical PEARL
treatment of hyponatremia is based on cause; treat the underlying condition
- CORRECT-ANSWERSif hypovolemic, give IV NaCl
if hypervolemic, implement water restriction (with a loop diuretic if
symptomatic)
hypernatremia clinical presentation - CORRECT-ANSWERSthirst
flushed skin
dry mucus membranes
low UOP
tachycardia
seizures
hyperactive DTRs
hypernatermia - CORRECT-ANSWERSHypernatremia results from excessive
water loss or increased sodium retention, which produces a deficiency in
body water (rarely is it caused by excessive sodium intake).
This condition is less common than hyponatremia due to the body's natural
responses of increased thirst and increased antidiuretic hormone (ADH)
secretion.
However, it is more common in vulnerable patients without the ability to
rehydrate themselves (infants, elderly, and severely ill). Like hyponatremia,
hypernatremia may also be life-threatening.
dx and tx of hypernatremia - CORRECT-ANSWERSHypernatremia will always
result in hyperosmolality (>295 mOsm/L) because sodium is the major
contributor to total serum osmolarity.
Therefore, the assessment of hypernatremia begins with determining the
patient's fluid volume status and the urine sodium to differentiate between
renal and extrarenal causes of sodium and water loss.
The cause can usually be identified from the history and physical
examination.
hypovolemic hypernatremia - CORRECT-ANSWERSConditions
-Sweating
-Burns
-Vomiting & diarrhea
-Fistulas
-Osmotic diuresis (HHNK, mannitol)
