NURS 3210 EXAM 1 QUESTIONS & ANSWERS
When does discharge planning start? - Answers - Admission
Who is involved with discharge planning? - Answers - Patient, family, nurse, case
manager, physician, PT/OT
What is the goal of discharge planning? - Answers - Educate, keep patient out of
hospital
What do you assess in regards to discharge? - Answers - Stability, ability to
understand instructions, equipment needed at home, transport
What factors affect the discharge plan? - Answers - Dx, patient, environment
Who is responsible for patient and family education? - Answers - Nurse
What is the purpose of patient education? - Answers - informed decisions, medical
regimen adherence, cost
True or False: Health education is an independent function of nursing and is a primary
nursing responsibility - Answers - True
What factors impact patient education? - Answers - Demographic, support system,
medical dx, timing of education, environment
Nursing process of teaching plan: Assess - Answers - Readiness for learning,
disabilities, cultural assessment
Nursing process of teaching plan: Planning - Answers - Priorities, goals, strategies
What is the best strategy for patient learning? - Answers - Having the patient say what
they are doing while performing a task
Nursing process of teaching plan: Implementation - Answers - Nurse implements when
patient is ready to learn
Make sure patient verbalizes understanding and modify if necessary
Nursing process of teaching plan: Evaluation - Answers - Don't assume that teaching
was always successful, evaluate goals/outcomes (modify if not met)
A nurse identifies that a patient is unable to identify the correct number of oral
medication to take each morning. Which step of the nursing process does this problem
involve? - Answers - Assessment
,Acute Kidney Injury - Answers - Pre-renal
Intra-renal
Post-renal
Pre-renal assessment - Answers - Fluid volume deficit, decreased CO, hypotension,
decreased CVP
Increased: Specific gravity, BUN, creatinine, K+
Decreased: UO
Low urinary Na+
Urinary sediment normal
Intra-renal assessment - Answers - Fluid volume excess, oliguria/anuria
Increased: BUN, creatinine, CPK, K+, urine osmolarity
Decreased: H&H, UO, specific gravity
High urinary Na+
Post-renal assessment - Answers - Signs of obstruction (prostate/stones)
Decreased: UO (sometimes none)
BUN/creatinine= normal (elevated in later stages)
AKI stages - Answers - Oliguric/anuric phase
Diuretic phase
Recovery phase
Oliguric/Anuric phase - Answers - 24H to 1 week
Urine output less than 400 mL/24H
Duration: 1 day to 8 weeks (usually 8-15 days)
Major problem: hyperkalemia, build up of waste products
Diuretic phase - Answers - 2-6 weeks after oliguric stage
BUN/creatinine improve, but renal function is impaired
Increase in UO (up to 10L/day)
Major problem: dehydration (FVD), hypo Na+/K+
Recovery phase - Answers - Begins when lab values stabilize
Renal function has improved
Ends when patient can return to normal activity
Can take up to 1 year
,AKI treatment: Pre-renal azotemia - Answers - Optimize renal perfusion
fluid bolus, lasix, fluid volume expanders (lactated ringers/albumin--pulls fluid from
tissues), dopamine (renal dilation)
AKI treatment: Intra-renal - Answers - Supportive therapy
IV fluids, stop damaging medications
AKI treatment: Post-renal azotemia - Answers - Alleviate the obstruction
remove obstruction, flomax, break stones
AKI treatment: Oliguric phase - Answers - Fluid restriction
Hyperkalemia
Dialysis
Nutrition
Nursing Care
How do you treat hyperkalemia that results from the oliguric phase? - Answers -
Regular IV insulin (puts K+ back into the cells)
Kayexalate
Dialysis
K+ restricted diet
When do you use dialysis to treat the oliguric phase? - Answers - FVE, hyperkalemia,
metabolic acidosis, increased BUN, mental status changes, cardiac toxicity
What type of diet does a person in the oliguric phase need? - Answers - Low protein
(0.6-40 g/kg)/day
High CHO
High fat
Restrict K+/Na+
AKI Nursing Care - Answers - F&E balance
Reducing metabolic rate
Promoting respiratory function
Preventing infection
Skin care
Psychosocial support
AKI Prevention - Answers - Control nephrotoxic drugs
Prevent prolonged episodes of hypotension or FVD
Chronic Renal Failure: Diet - Answers - Protein (eggs)
High fat/CHO
, Multivitamins
Restrict fluids
Monitor: BUN/creatinine
CRF: electrolyte abnormals - Answers - Hyperphosphatemia (phosphate binder Phos-
Lo)
Hypocalcemia (tums, calcitonin)
Hyperkalemia (regular insulin, dialysis, kayexalate)
Hypernatremia (isotonic/hypotonic fluids, Na+ restricted)
CRF: Nursing Care - Answers - FVE
Imbalanced nutrition
Deficient knowledge
Activity intolerance
Risk fr situational low self-esteem
Collaborative issues
Safety (seizures)
Skin care (puritis-uremic frost)
CRF: Patient education - Answers - Strict adherence to diet
Medications
Follow-up care
Daily weights/BP
S&S FVE
Avoid (NSAIDs, laxatives/antacids containing Mg+)
Discuss end of life desires
CRF: Hemodialysis Nursing Care - Answers - Do not draw blood/BP on effected arm
Do not apply elastic bandages
Assess the site: bruit, thrill, discoloration
Medications: timing (SLIDE pg. 8)
A 68-year old woman has chronic kidney disease and a history of type II diabetes. Two
weeks ago, she had surgery to place a vascular graft access for hemodialysis. Which
precaution will the nurse follow to ensure the function of the AV graft? - Answers -
Check for bruit/thrill by auscultation and palpation over the site
Which drug should be held until after the dialysis treatment?
Atenolol (Tenormin)
When does discharge planning start? - Answers - Admission
Who is involved with discharge planning? - Answers - Patient, family, nurse, case
manager, physician, PT/OT
What is the goal of discharge planning? - Answers - Educate, keep patient out of
hospital
What do you assess in regards to discharge? - Answers - Stability, ability to
understand instructions, equipment needed at home, transport
What factors affect the discharge plan? - Answers - Dx, patient, environment
Who is responsible for patient and family education? - Answers - Nurse
What is the purpose of patient education? - Answers - informed decisions, medical
regimen adherence, cost
True or False: Health education is an independent function of nursing and is a primary
nursing responsibility - Answers - True
What factors impact patient education? - Answers - Demographic, support system,
medical dx, timing of education, environment
Nursing process of teaching plan: Assess - Answers - Readiness for learning,
disabilities, cultural assessment
Nursing process of teaching plan: Planning - Answers - Priorities, goals, strategies
What is the best strategy for patient learning? - Answers - Having the patient say what
they are doing while performing a task
Nursing process of teaching plan: Implementation - Answers - Nurse implements when
patient is ready to learn
Make sure patient verbalizes understanding and modify if necessary
Nursing process of teaching plan: Evaluation - Answers - Don't assume that teaching
was always successful, evaluate goals/outcomes (modify if not met)
A nurse identifies that a patient is unable to identify the correct number of oral
medication to take each morning. Which step of the nursing process does this problem
involve? - Answers - Assessment
,Acute Kidney Injury - Answers - Pre-renal
Intra-renal
Post-renal
Pre-renal assessment - Answers - Fluid volume deficit, decreased CO, hypotension,
decreased CVP
Increased: Specific gravity, BUN, creatinine, K+
Decreased: UO
Low urinary Na+
Urinary sediment normal
Intra-renal assessment - Answers - Fluid volume excess, oliguria/anuria
Increased: BUN, creatinine, CPK, K+, urine osmolarity
Decreased: H&H, UO, specific gravity
High urinary Na+
Post-renal assessment - Answers - Signs of obstruction (prostate/stones)
Decreased: UO (sometimes none)
BUN/creatinine= normal (elevated in later stages)
AKI stages - Answers - Oliguric/anuric phase
Diuretic phase
Recovery phase
Oliguric/Anuric phase - Answers - 24H to 1 week
Urine output less than 400 mL/24H
Duration: 1 day to 8 weeks (usually 8-15 days)
Major problem: hyperkalemia, build up of waste products
Diuretic phase - Answers - 2-6 weeks after oliguric stage
BUN/creatinine improve, but renal function is impaired
Increase in UO (up to 10L/day)
Major problem: dehydration (FVD), hypo Na+/K+
Recovery phase - Answers - Begins when lab values stabilize
Renal function has improved
Ends when patient can return to normal activity
Can take up to 1 year
,AKI treatment: Pre-renal azotemia - Answers - Optimize renal perfusion
fluid bolus, lasix, fluid volume expanders (lactated ringers/albumin--pulls fluid from
tissues), dopamine (renal dilation)
AKI treatment: Intra-renal - Answers - Supportive therapy
IV fluids, stop damaging medications
AKI treatment: Post-renal azotemia - Answers - Alleviate the obstruction
remove obstruction, flomax, break stones
AKI treatment: Oliguric phase - Answers - Fluid restriction
Hyperkalemia
Dialysis
Nutrition
Nursing Care
How do you treat hyperkalemia that results from the oliguric phase? - Answers -
Regular IV insulin (puts K+ back into the cells)
Kayexalate
Dialysis
K+ restricted diet
When do you use dialysis to treat the oliguric phase? - Answers - FVE, hyperkalemia,
metabolic acidosis, increased BUN, mental status changes, cardiac toxicity
What type of diet does a person in the oliguric phase need? - Answers - Low protein
(0.6-40 g/kg)/day
High CHO
High fat
Restrict K+/Na+
AKI Nursing Care - Answers - F&E balance
Reducing metabolic rate
Promoting respiratory function
Preventing infection
Skin care
Psychosocial support
AKI Prevention - Answers - Control nephrotoxic drugs
Prevent prolonged episodes of hypotension or FVD
Chronic Renal Failure: Diet - Answers - Protein (eggs)
High fat/CHO
, Multivitamins
Restrict fluids
Monitor: BUN/creatinine
CRF: electrolyte abnormals - Answers - Hyperphosphatemia (phosphate binder Phos-
Lo)
Hypocalcemia (tums, calcitonin)
Hyperkalemia (regular insulin, dialysis, kayexalate)
Hypernatremia (isotonic/hypotonic fluids, Na+ restricted)
CRF: Nursing Care - Answers - FVE
Imbalanced nutrition
Deficient knowledge
Activity intolerance
Risk fr situational low self-esteem
Collaborative issues
Safety (seizures)
Skin care (puritis-uremic frost)
CRF: Patient education - Answers - Strict adherence to diet
Medications
Follow-up care
Daily weights/BP
S&S FVE
Avoid (NSAIDs, laxatives/antacids containing Mg+)
Discuss end of life desires
CRF: Hemodialysis Nursing Care - Answers - Do not draw blood/BP on effected arm
Do not apply elastic bandages
Assess the site: bruit, thrill, discoloration
Medications: timing (SLIDE pg. 8)
A 68-year old woman has chronic kidney disease and a history of type II diabetes. Two
weeks ago, she had surgery to place a vascular graft access for hemodialysis. Which
precaution will the nurse follow to ensure the function of the AV graft? - Answers -
Check for bruit/thrill by auscultation and palpation over the site
Which drug should be held until after the dialysis treatment?
Atenolol (Tenormin)
