NURS480 Comprehensive Practice Exam With Answers (55 Solved Questions)

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NURS 480 EXAM 1–3 WITH SATISFIED SOLUTIONSWhere does MODS occur first? - Organ failure begins in lungs - progrssivedypnea, resp failure, ARDSPt presentation of MODS - IV fluids/vasoactive meds needed to support BP/COHyperglycemic/hyperlactic acidemia -----severe loss of skeletal muscleElevated bilirubin and LFTsDecreased bowl sounds and translocation of gut floraElevtaed creatinine, BUN, anuriaComa or unresponsiveDIC - Sign of underlying disorderInflammatory response initiates clotting cascadePlatelets will be decreased on CBC do to use during clotsPt presentation of DIC - EccymosisPetechiaeHematomaDypsneaTachypneaHemoptysis

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Pul EmbolismHypotensionChest PainHematemesisRectal bleedingMelenaLab test - Low platelet (<150,000)Fibrinogen (<170)Prolonged PT (>12.5sec)aPTT(>35 sec)Thrombin (>11)D-dimer = check for clots, "leftovers" liek sawdust = clot breakdownRN considerations of DIC - Sepsis and leukemias are comon causes of DICMonitor trends over timeATN in kidneysAlveolar compromise in lungsHeadache, visual changes, LOCAvoid activities that would increase introcranial pressureA high cardiac output and low CVP suggest septic shock, and massive fluidreplacement is indicated. - Increased PAWP indicates that the patient hasexcessive fluid volume (and suggests cardiogenic shock), and diuresis is indicated.

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Bradycardia and a low systemic vascular resistance (SVR) suggest neurogenicshock, and fluids should be infused cautiously. - The renal hypoperfusion thataccompanies cardiogenic shock results in increased BUN and creatinine levels.What are the 3 functions of renal? - Urine formationRegulatory Function(acidBase/electrolytes)Hormonal FunctionsHormonal functions of the kidney - -renin to help regulate or control BP,potassium and sodium- erythropoietin: stimulates RBC production-regulation of calcium/phosphorus balance through activation of Vitamin D- bradykinins/prostaglandinsDoes osmolality increase or decrease with decreased H20 intake? - Increases --stimulates release of ADHsmall vol of urine can be excretetdWhat is normal BUN range? - 8-21If BUN is elevated, what dx test is used to assess/dx renal dysfunction? -Creatinine clearanceCauses of increased BUN? - Liver diseaseInfection

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High protein dietGI BleedSteriod use/traumeCauses of decreased BUN? - Severe liver damageMalnutritionLow protein dietFluid volume excessSerum Creatinine range? - 0.5-1.2Normal range for SG? - 1.010 - 1.025When fluid intake INCREASES, specifc gravity DECREASES - DI, Glomerulonephritis,severe renal damageWhen fluid intake DECREASES, specific gravity INCREASES - Diabetes, Nephritis,Fluid deficitAcute Nephritic Syndrome - Allows RBC and protein movement into filtrate d/tpost infection (such as glomerulonephritis or antibotics r/t strep)Glomerular Inflammation*Clinical Manifestations of Acute Nephritic Syndrome - Azotemia: Abnormal Conc.Nitrogenous wastes in bloodProteinuriaHematuriaCola-colored urineCasts in urine

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Increased BUN/Creat d/t decreased U/OMed. Man. of Nephritic - Protein and sodium restrictionGive abx r/t stepCorticosteriodsImmunosuppresantsRN of Nephritic - **Give Carbs liberally**Strict i/oIVF - if fluids are effective = diuresis, decreased BP/edemaChronic Glomerulonephritis Patho - Repeated nephritis,HTN Nephrosclerosis, HyperlipidemiaClinical Mani of GlomNeph - *Asymptomatic for years as damage increases befores/s develop*Abnormal dx: Urine w/ fixed SG, casts, proteinElectrolyte imbalancesHypoalbuminiaMed MGT of GlomNeph - If pt has HTN = Na+ & water restriction/antihypertensiveDaily wts & diuretics to tx fluid overloadProtein- dairy, eggs, meats

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Dialysis if neededRn of GlomNeph - Changes in fluid and electrolyte status and in cardiac andneurologic status are reported promptly to the primary provider.Nephrotic Syndrome - Damages the glomerlar membrane and increasespermeability of plasma proteins3.5 or > in urine/day **hallmark dx**(Massive Proteinuria)What does nephrotic syndrome result in? - Hypoalbuminemiapitting edemaHyperlipidemia/lipiduriaVit. D deficiencyManifestions of Nephro - Periorbital edemaDependent edemaAscitesDx of Nephro - Needle biopsy of kidney to confirmComplications of Nephro - InfectionThromboembolismPul. EmbolismAKI d/t hypovoemiaAccelerated atheroscclerosis d/y hyperlipidemiaMed MGT of Nephro - DiureticsAce Inhibitors for proteinruia (Captopril,enalapril,lisinopril)

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Lipitor, ezetimibe, niacin r/t hyperlipidemiaPreRenal **external factors** - Hypoperfusion of kidneyHypovolemiaHypotensionsDecreased COCHFBurns/SepsisHemorrhageIntraRenal - direct damage to the kidneys by inflammation, toxins, drugs, infection,or reduced blood supplyPostrenal - sudden obstruction of urine flow due to enlarged prostate, kidneystones, bladder tumor, or injuryPrerenal Vs. Renal - Urinalysis: <20 (40-100)BUN/Creat: 20:1 (10:1)Fluid Chall: U/O yes (no u.o)How much fluid to give for fluid challenge - 200 mL NS over 15 min - expectedoutcome is Urine output increasesThe 4 phases of AKI - InitiatingOliguricDiureticRecoverClinical mani of AKI - Signs of fluid overload**

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Increased potassium, phosphate, BUN/CreatDecreased Calcium, Sodium, pHMedical MGT of AKI - Volume assessment**Assess VS, I/O, head to toeMeds: loop diuretics, Bumex, Lasix, Mannitol, AVOID NEPHROTOCC MEDS = contrastdyeHyperkalemia of AKI - Tall, tented, or peaked T wavesabdominal cramping, irritability, parethesiaas level increases, CO/other fucntions decline --**med emergency*How to decrease potassium levels? - Kayexalate orally or retention enemaInsulin and IV dextrose 50%Calcium replacementIV sodium bicarbonateESKD - Irreversible loss of renal failurerenal insuffiency 75% = BUN/creat elevationEnd stage renal disease = dialysis or transplantCommon causes of ESKD - Uncontrolled DM/HTN

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MalnutritionESKD Profession - SLOW increase in BUN/CreatinineGFR1-90mL/min = structural changes indicating renal damage3-30 to 60mL/min = moderate to poor function5-15 mL/min - end stage**Cardiovascular disease is the predominant cause of death in these pts**ESKD complications - OsteodystrophyBone resorptions,osteopenia,fractures r/t stimulation of parathyroid hormoneESKD Erythropeotin - Decreased Hg/HCT r/t production of thisnurse should admin epoetin alfa(epogen) and monitor rbc/hctNutrition restrictions of ESKDsodium, potassium, phosphate restrictions*** - 2-4 g/day of potassiumavoid oranges, bananas, melons, prunes, deep green/yellow veggies, beans1000mg/day phosphateavoid dairyWhen is dialysis initiated? - When patient cannot maintain a reasonable lifestylewith conservative treatment

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GFR <15hemodialysis - A technique in which an artificial kidney machine removes wasteproducts from the bloodperitoneal dialysis - the lining of the peritoneal cavity acts as the filter to removewaste from the bloodCCRT - Continuous renal replacement therapiesacutely ill pts, manages acid/base statuscan use a single lumen with arterial lineWhen is urgent dialysis indicated? - High and increasing level of K+-Fluid overload-Impending pulmonary edema-Increasing acidosis-Pericarditis-Advanced UremiaArteriovenous Fistula - type of vascular access for dialysis; created by surgicallyconnecting radial artery to cephalic vein"mature" fistula = large, bluging, and tortousS/S of Arterial Steal Syndrome - Ischemia d/t vascular accessVascular insufficiency = cold, numb fingers

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s/s = pallar, pulses decreased/pain distal to fistula, necrosisRN assesssment of fistula/graft - Palpable pulsationthrill/bruit hear on auscultation w/ stethoscopeNO BP or PIV on affected sideDialysis Complications - Chest pain may occur in pts w/ anemia or aterioscleoticheart diseasedysrhythumiasHypotensionAnemiaGastric ulcersPts with uremia report metallic taste and nauseaDialysis Complications Continued - Poor calcium metabolismRenal OsteodystrophyPhosphorus deposits in the skin=itchingSleep problems/muscle crampingRN of Dialysis - Protect vascular access***

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Assess site for patencysigns of potential infectiondo not use for bp/blood drwasWhen is peritoneal dialysis indicated? - For pts w/vascular access problems ORrespond poorly to HD/Hemodynamic instabilityWhat are the types of Peritoneal Dialysis - Ambulatory = 4-5x/dayAutomated = OvernightIntermitted = 30-40/WEEKWhen is PD contraindicated? - Hx of ab. surguries/pancratitis/diverticulitisRecurrent ab wall/inguinal herniasSevere COPDCompensatory Stage of Shock - SNS causes vasoconstriction, increased HR,increased heart contractility◦Maintains BP, Cardiac Output (CO)◦Maintenance of BP within normal limits is the hallmark of Compensatory Shock◦"fight-or-flight" responseManifestations of Comp -•Body shunts blood from skin, kidneys, GI tract

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