NUR 445. Final Exam (STUDY GUIDE)
Kidney Transplant: Nursing interventions pre-transplant. (5 points- "Connie loves baking
cookies everyday) - answer- Consent
- Labs (ex. BUN, Cr, CBC)
- Baseline vital signs
- Cardiology (ex. EKG)
- Education
Kidney Transplant: Nursing interventions post-transplant. (6 points- "Dennis is very sad,
Lisa's away") - answer- Daily weight
- I&O
- Vitals (ex. BP, temp.)
- Signs of pain, infection
- Labs (ex. WBC, Cr, BUN)
- Administer medications (ex. antibiotic, immunosuppressant’s)
Acute Renal Failure: What are the four key assessments findings? ("Chris' a B.U.M) -
answer- Creatinine over 1.3 = bad kidney
- BUN over 20
- Urine output 30 mL/hr less = kidney in distress
- Metabolic acidosis pH below 7.35
What is acute kidney injury (AKI)? - answerA condition characterized by an acute, rapid
loss of renal function.
Note: An accumulation of nitrogenous waste products such as urea, nitrogen, and
creatinine and progressive increases in potassium.
What are six risk factors for AKI? ("Susan and Eddie often cooks chorizo") - answer-
Sepsis
- Administration of contrast medication
- Exposure to nephrotoxins
- Older population
- Clients who undergone major surgery
- Clients with acute illness
AKI: Causes- Pre-renal - answerExternal factors that reduce renal blood flow
Examples: Obstruction, low blood pressure, and low cardiac output
AKI: Causes- Intrarenal - answerInvolve direct damage to the renal system.
,Examples: CT contrast, antibiotics (ex. vancomycin, gentamicin), untreated infection,
overuse of NSAIDs.
Note: Creatine over 1.3 = bad kidney
AKI: Causes- Postrenal - answerMechanical obstruction of the lower urinary tract.
Examples: BPH, prostate cancer, calculi, trauma, and tumors.
Assessment of an AV fistula - answerA functional AV fistula or graft has a palpable
pulsation, a thrill, and a bruit on auscultation.
What is SIADH? - answerSyndrome of inappropriate antidiuretic hormone secretion
Important: Too much ADH is released = kidney retain excess water.
What are five symptoms of SIADH? ("Silly Sam Hides His Sweaty Socks") - answer-
Stop in urination (Urine output reduced)
- Sticky, thick concentration (High specific gravity >1.030)
- Hypoosmolality and hyponatremia
- High blood pressure
- Swelling (ex. edema)
- Seizures (watch for headache/confusion)
What are five nursing interventions for SIADH? ("Reyna Loves Consuming Some Ice
Cream" - answer- Restrict fluids
- Loop diuretics
- Correct sodium deficit (Hypertonic solution, IV 3% saline)
- Seizure preauction
- If able, give (per order) oral sodium tablets
Describe Cushing's syndrome. - answerThe adrenal glands do produce too much
steroid hormones, specifically cortisol.
Remember, cushion of steroids.
What are some interventions for Cushing's syndrome? (7 interventions- "Randy Ask
Andy About Monitor Skin Infections") - answer- Remove underlying cause (ex. tumor,
reduce steroid dosage)
- Administration of medication (ex. Dexamethasone replacement)
- Assessment of fluid loss
- Adrenalectomy
- Infection control
- Skin and wound care
- Monitor electrolytes
, What is thyroid storm? - answerA life-threatening condition that occurs with uncontrolled
hyperthyroidism.
What are some symptoms of thyroid storm? (9 symptoms) - answer- Weight loss
- Exophthalmos (budging eyes)
- Tachycardia
- Fever
- Severe agitation
- Systolic HTN
- Abdominal pain
- Tremors
- Changes of LOC
What is DKA? - answerA deficiency of insulin leading to the use of stored fats for
energy.
Note: Associated with type one. Faster onset, easier to treat.
What are the seven S/S of DKA? - answer- Polyuria
- Polydipsia
- Polyphagia
- Kussmaul respirations (rapid, deep respirations)
- Fruity, acetone smell to the breath
- Nausea and vomiting
- Abdominal pain
What are the expected labs for DKA? (6 points) - answer- Blood glucose level greater
than 250 mg/dL
- Ketonuria (ketones in the urine)
- Arterial pH of less than or equal to 7.3
- Serum bicarbonate level of less than or equal to 18 mEq/L
- Positive anion gap
- Hyperkalemia
What are interventions for DKA? - answer- Fluid replacement with isotonic normal saline
- Correction of electrolyte imbalances (Focusing on monitoring and correction of
decreased potassium level if necessary, prior to insulin administration)
- Insulin administration, usually by intravenous delivery
What are two client education regarding DKA? - answer- Manage "sick" days
- Maintain insulin, monitor blood sugar
What is hyperosmolar hyperglycemic state (HHS)? - answerA life-threatening syndrome
that can occur in the patient with DM who is unable to produce enough insulin to
prevent DKA but not enough to prevent serve hyperglycemia.
Kidney Transplant: Nursing interventions pre-transplant. (5 points- "Connie loves baking
cookies everyday) - answer- Consent
- Labs (ex. BUN, Cr, CBC)
- Baseline vital signs
- Cardiology (ex. EKG)
- Education
Kidney Transplant: Nursing interventions post-transplant. (6 points- "Dennis is very sad,
Lisa's away") - answer- Daily weight
- I&O
- Vitals (ex. BP, temp.)
- Signs of pain, infection
- Labs (ex. WBC, Cr, BUN)
- Administer medications (ex. antibiotic, immunosuppressant’s)
Acute Renal Failure: What are the four key assessments findings? ("Chris' a B.U.M) -
answer- Creatinine over 1.3 = bad kidney
- BUN over 20
- Urine output 30 mL/hr less = kidney in distress
- Metabolic acidosis pH below 7.35
What is acute kidney injury (AKI)? - answerA condition characterized by an acute, rapid
loss of renal function.
Note: An accumulation of nitrogenous waste products such as urea, nitrogen, and
creatinine and progressive increases in potassium.
What are six risk factors for AKI? ("Susan and Eddie often cooks chorizo") - answer-
Sepsis
- Administration of contrast medication
- Exposure to nephrotoxins
- Older population
- Clients who undergone major surgery
- Clients with acute illness
AKI: Causes- Pre-renal - answerExternal factors that reduce renal blood flow
Examples: Obstruction, low blood pressure, and low cardiac output
AKI: Causes- Intrarenal - answerInvolve direct damage to the renal system.
,Examples: CT contrast, antibiotics (ex. vancomycin, gentamicin), untreated infection,
overuse of NSAIDs.
Note: Creatine over 1.3 = bad kidney
AKI: Causes- Postrenal - answerMechanical obstruction of the lower urinary tract.
Examples: BPH, prostate cancer, calculi, trauma, and tumors.
Assessment of an AV fistula - answerA functional AV fistula or graft has a palpable
pulsation, a thrill, and a bruit on auscultation.
What is SIADH? - answerSyndrome of inappropriate antidiuretic hormone secretion
Important: Too much ADH is released = kidney retain excess water.
What are five symptoms of SIADH? ("Silly Sam Hides His Sweaty Socks") - answer-
Stop in urination (Urine output reduced)
- Sticky, thick concentration (High specific gravity >1.030)
- Hypoosmolality and hyponatremia
- High blood pressure
- Swelling (ex. edema)
- Seizures (watch for headache/confusion)
What are five nursing interventions for SIADH? ("Reyna Loves Consuming Some Ice
Cream" - answer- Restrict fluids
- Loop diuretics
- Correct sodium deficit (Hypertonic solution, IV 3% saline)
- Seizure preauction
- If able, give (per order) oral sodium tablets
Describe Cushing's syndrome. - answerThe adrenal glands do produce too much
steroid hormones, specifically cortisol.
Remember, cushion of steroids.
What are some interventions for Cushing's syndrome? (7 interventions- "Randy Ask
Andy About Monitor Skin Infections") - answer- Remove underlying cause (ex. tumor,
reduce steroid dosage)
- Administration of medication (ex. Dexamethasone replacement)
- Assessment of fluid loss
- Adrenalectomy
- Infection control
- Skin and wound care
- Monitor electrolytes
, What is thyroid storm? - answerA life-threatening condition that occurs with uncontrolled
hyperthyroidism.
What are some symptoms of thyroid storm? (9 symptoms) - answer- Weight loss
- Exophthalmos (budging eyes)
- Tachycardia
- Fever
- Severe agitation
- Systolic HTN
- Abdominal pain
- Tremors
- Changes of LOC
What is DKA? - answerA deficiency of insulin leading to the use of stored fats for
energy.
Note: Associated with type one. Faster onset, easier to treat.
What are the seven S/S of DKA? - answer- Polyuria
- Polydipsia
- Polyphagia
- Kussmaul respirations (rapid, deep respirations)
- Fruity, acetone smell to the breath
- Nausea and vomiting
- Abdominal pain
What are the expected labs for DKA? (6 points) - answer- Blood glucose level greater
than 250 mg/dL
- Ketonuria (ketones in the urine)
- Arterial pH of less than or equal to 7.3
- Serum bicarbonate level of less than or equal to 18 mEq/L
- Positive anion gap
- Hyperkalemia
What are interventions for DKA? - answer- Fluid replacement with isotonic normal saline
- Correction of electrolyte imbalances (Focusing on monitoring and correction of
decreased potassium level if necessary, prior to insulin administration)
- Insulin administration, usually by intravenous delivery
What are two client education regarding DKA? - answer- Manage "sick" days
- Maintain insulin, monitor blood sugar
What is hyperosmolar hyperglycemic state (HHS)? - answerA life-threatening syndrome
that can occur in the patient with DM who is unable to produce enough insulin to
prevent DKA but not enough to prevent serve hyperglycemia.
