NURS 315 Final Exam: Questions And Proper Solutions
You notice orders of peritoneal dialysis for your patient. What is this and why
is it completed? Right Ans - - Used for tx of end-stage renal disease
- Tube is placed into the abdomen (peritoneum) and a cleansing fluid flows
into it -> peritoneum acts as acts as a filter and removes wastes from blood.
- Aseptic technique is required to avoid peritonitis
PHASES:
- Inflow (fill) 2 to 3 L over 10 mins
- Dwell: dialysate sits in peritoneal cavity for 20 to 30 minutes
- Drain to gravity: 15 to 30 minutes
- Repeat
What assessments would you perform on a patient who is receiving peritoneal
dialysis? Right Ans - - Weight, BP, peripheral edema, heart and lung sounds
done B4 procedure
- Weight from last post-dialysis and current weight predialysis determines
how much fluid will be removed
- Assess access
- Assess temp
- Monitor VS q30-60min
What complications can arise in a patient who is receiving peritoneal dialysis?
Right Ans - Exit site infection
- redness, tenderness, drainage
- Caused by staph
- Treated w/ antibiotics
Peritonitis
- commonly from improper technique
- Abdominal pain, rebound tenderness, or cloudy effluent w/ increased WBC
or bacteria, fever
- GI: diarrhea, vomiting, distention, increased BS
- Tx: antibiotics
Adhesions may form w/ repeated infections
Bleeding
- Common w/ initial placement: only for first couple days
,- New: check bp and hct
Pulmonary complications
- Decreased lung expansion leads to atelectasis, pneumonia, bronchitis
- Tx: elevated HOB, reposition, deep breathing
Protein loss
- IMPORTANT TO MONITOR NUTRITION
- Due to loss during dialysate drainage, can be as high as 10-20g/day
You determine outflow does not equal inflow in your patient receiving
peritoneal dialysis. Where is it going and what interventions should you
perform to fix this? Right Ans - Solution is going into the abdomen
- Have pt turn on sides to see if cath is stuck (reposition)
- Check for kinks in cath
- Lower bag
You are reviewing your patients laboratory results to determine what stage of
kidney failure they are experience. What do you expect to see in a patient who
is set to receive peritoneal dialysis? Right Ans - - A GFR of less than 15
Stage 1: 90 or below
Stage 2: 89 - 60
Stage 3a: 59-45 -> under 60 is when dx w/ renal disease
Stage 3b: 44-30
Stage 4: 29-15
Stage: less than 15: need dialysis
Your patient asks why they are scheduled for an IVP. What is this and why are
they having it performed? Right Ans - Intravenous pyelogram
- x-ray exam that uses an injection of contrast material to evaluate the
function of kidneys, ureters and bladder
- IV contrast is used -> need to check for shellfish allergy, can still get it but
will need benadryl after
- Can tell you where kidney stone is as well
You are told that your patient is suspected of having BPH. What symptoms do
you suspect them to have? Right Ans - Irritative signs and symptoms:
- Nocturia, frequency, incontinence, bladder pain, dysuria
,Obstructive signs and symptoms:
- Difficulty starting stream, urgency, dribbling
What diagnostic testing and treatments are associated with BPH? Right
Ans - Diagnostic:
- Digital Rectal exam,
- Penile ultrasound,
- Uroflowmetry (measures strength of flow),
- post-void residual (catheter after urination),
- PSA levels (will be elevated)
Treatment:
TURP
Which condition am I:
- A complication of an ascending urinary tract infection (UTI) which spreads
from the bladder to the kidneys and their collecting systems
- Can lead to urosepsis
Clinical manifestations:
- Fever/chills
- N&V
- malaise
- flank pain
- dysuria
- urgency
- frequency
- CVA tenderness Right Ans - Pyelonephritis
What treatments are typically provided to a patient with Pyelonephritis?
Right Ans - - Fluids,
- NSAIDs,
- f/u cultures & imaging
- Antibiotics: oral 7 to 14 days, IV to oral -> 14 to 21 says (start IV first, then
transition to oral)
, What education would you expect to provide a patient who has the medical
diagnosis of Pyelonephritis on future prevention? Right Ans - - Increase
fluids -> at least 2000mL / day
- Reduce caffeine, alcohol intake
- Use Cranberry supplements
- Urinate after sex
- NO douching, spanx
- Proper hygiene -> wipe front to back
What condition am i:
- Caused by damage to small blood vessels in the kidney, leads to too much
protein in the urine
Clinical manifestations:
- Peripheral edema
- Massive proteinuria
- HTN
- Hyperlipidemia
- Foamy urine Right Ans - Nephrotic Syndrome
What treatments who you expect to provide to a patient with the medical
diagnosis of Nephrotic Syndrome? Right Ans - GOAL: cure or control
primary disease and relieve symptoms
- Corticosteroids and cyclophosphamide
- Manage diabetes
- ACE inhibitor, ARB, diuretics- decrease protein loss in urine
- Antihyperlipidemic drugs- can improve blood lipid levels
- Anticoagulants- reduce vascular defects
- Low-sodium (less than 2.3 gram/day), moderate protein diet (1 to 2
g/kg/day); small, frequent meals
The nursing interventions associated with nephrotic syndrome include what?
Right Ans - manage edema;
Daily weights, accurate I & O, measure abdomen or extremities
Avoid infection- check V.S's and lab's
How do Ileal Conduit and Kock pouch differ? Right Ans - Ileal Conduit
- Patient is incontinent
You notice orders of peritoneal dialysis for your patient. What is this and why
is it completed? Right Ans - - Used for tx of end-stage renal disease
- Tube is placed into the abdomen (peritoneum) and a cleansing fluid flows
into it -> peritoneum acts as acts as a filter and removes wastes from blood.
- Aseptic technique is required to avoid peritonitis
PHASES:
- Inflow (fill) 2 to 3 L over 10 mins
- Dwell: dialysate sits in peritoneal cavity for 20 to 30 minutes
- Drain to gravity: 15 to 30 minutes
- Repeat
What assessments would you perform on a patient who is receiving peritoneal
dialysis? Right Ans - - Weight, BP, peripheral edema, heart and lung sounds
done B4 procedure
- Weight from last post-dialysis and current weight predialysis determines
how much fluid will be removed
- Assess access
- Assess temp
- Monitor VS q30-60min
What complications can arise in a patient who is receiving peritoneal dialysis?
Right Ans - Exit site infection
- redness, tenderness, drainage
- Caused by staph
- Treated w/ antibiotics
Peritonitis
- commonly from improper technique
- Abdominal pain, rebound tenderness, or cloudy effluent w/ increased WBC
or bacteria, fever
- GI: diarrhea, vomiting, distention, increased BS
- Tx: antibiotics
Adhesions may form w/ repeated infections
Bleeding
- Common w/ initial placement: only for first couple days
,- New: check bp and hct
Pulmonary complications
- Decreased lung expansion leads to atelectasis, pneumonia, bronchitis
- Tx: elevated HOB, reposition, deep breathing
Protein loss
- IMPORTANT TO MONITOR NUTRITION
- Due to loss during dialysate drainage, can be as high as 10-20g/day
You determine outflow does not equal inflow in your patient receiving
peritoneal dialysis. Where is it going and what interventions should you
perform to fix this? Right Ans - Solution is going into the abdomen
- Have pt turn on sides to see if cath is stuck (reposition)
- Check for kinks in cath
- Lower bag
You are reviewing your patients laboratory results to determine what stage of
kidney failure they are experience. What do you expect to see in a patient who
is set to receive peritoneal dialysis? Right Ans - - A GFR of less than 15
Stage 1: 90 or below
Stage 2: 89 - 60
Stage 3a: 59-45 -> under 60 is when dx w/ renal disease
Stage 3b: 44-30
Stage 4: 29-15
Stage: less than 15: need dialysis
Your patient asks why they are scheduled for an IVP. What is this and why are
they having it performed? Right Ans - Intravenous pyelogram
- x-ray exam that uses an injection of contrast material to evaluate the
function of kidneys, ureters and bladder
- IV contrast is used -> need to check for shellfish allergy, can still get it but
will need benadryl after
- Can tell you where kidney stone is as well
You are told that your patient is suspected of having BPH. What symptoms do
you suspect them to have? Right Ans - Irritative signs and symptoms:
- Nocturia, frequency, incontinence, bladder pain, dysuria
,Obstructive signs and symptoms:
- Difficulty starting stream, urgency, dribbling
What diagnostic testing and treatments are associated with BPH? Right
Ans - Diagnostic:
- Digital Rectal exam,
- Penile ultrasound,
- Uroflowmetry (measures strength of flow),
- post-void residual (catheter after urination),
- PSA levels (will be elevated)
Treatment:
TURP
Which condition am I:
- A complication of an ascending urinary tract infection (UTI) which spreads
from the bladder to the kidneys and their collecting systems
- Can lead to urosepsis
Clinical manifestations:
- Fever/chills
- N&V
- malaise
- flank pain
- dysuria
- urgency
- frequency
- CVA tenderness Right Ans - Pyelonephritis
What treatments are typically provided to a patient with Pyelonephritis?
Right Ans - - Fluids,
- NSAIDs,
- f/u cultures & imaging
- Antibiotics: oral 7 to 14 days, IV to oral -> 14 to 21 says (start IV first, then
transition to oral)
, What education would you expect to provide a patient who has the medical
diagnosis of Pyelonephritis on future prevention? Right Ans - - Increase
fluids -> at least 2000mL / day
- Reduce caffeine, alcohol intake
- Use Cranberry supplements
- Urinate after sex
- NO douching, spanx
- Proper hygiene -> wipe front to back
What condition am i:
- Caused by damage to small blood vessels in the kidney, leads to too much
protein in the urine
Clinical manifestations:
- Peripheral edema
- Massive proteinuria
- HTN
- Hyperlipidemia
- Foamy urine Right Ans - Nephrotic Syndrome
What treatments who you expect to provide to a patient with the medical
diagnosis of Nephrotic Syndrome? Right Ans - GOAL: cure or control
primary disease and relieve symptoms
- Corticosteroids and cyclophosphamide
- Manage diabetes
- ACE inhibitor, ARB, diuretics- decrease protein loss in urine
- Antihyperlipidemic drugs- can improve blood lipid levels
- Anticoagulants- reduce vascular defects
- Low-sodium (less than 2.3 gram/day), moderate protein diet (1 to 2
g/kg/day); small, frequent meals
The nursing interventions associated with nephrotic syndrome include what?
Right Ans - manage edema;
Daily weights, accurate I & O, measure abdomen or extremities
Avoid infection- check V.S's and lab's
How do Ileal Conduit and Kock pouch differ? Right Ans - Ileal Conduit
- Patient is incontinent
