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NURS480 Comprehensive Practice Exam With Answers (55 Solved Questions)

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    NURS 480 EXAM 1 – 3 WITH SATISFIED SOLUTIONS Where does MODS occur first? - Organ failure begins in lungs - progrssive dypnea, resp failure, ARDS Pt presentation of MODS - IV fluids/vasoactive meds needed to support BP/CO Hyperglycemic/hyperlactic acidemia -----severe loss of skeletal muscle Elevated bilirubin and LFTs Decreased bowl sounds and translocation of gut flora Elevtaed creatinine, BUN, anuria Coma or unresponsive DIC - Sign of underlying disorder Inflammatory response initiates clotting cascade Platelets will be decreased on CBC do to use during clots Pt presentation of DIC - Eccymosis Petechiae Hematoma Dypsnea Tachypnea Hemoptysis

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    Pul Embolism Hypotension Chest Pain Hematemesis Rectal bleeding Melena Lab 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 breakdown RN considerations of DIC - Sepsis and leukemias are comon causes of DIC Monitor trends over time ATN in kidneys Alveolar compromise in lungs Headache, visual changes, LOC Avoid activities that would increase introcranial pressure A high cardiac output and low CVP suggest septic shock, and massive fluid replacement is indicated. - Increased PAWP indicates that the patient has excessive fluid volume (and suggests cardiogenic shock), and diuresis is indicated.

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    Bradycardia and a low systemic vascular resistance (SVR) suggest neurogenic shock, and fluids should be infused cautiously. - The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. What are the 3 functions of renal? - Urine formation Regulatory Function(acidBase/electrolytes) Hormonal Functions Hormonal 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/prostaglandins Does osmolality increase or decrease with decreased H20 intake? - Increases -- stimulates release of ADH small vol of urine can be excretetd What is normal BUN range? - 8-21 If BUN is elevated, what dx test is used to assess/dx renal dysfunction? - Creatinine clearance Causes of increased BUN? - Liver disease Infection

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    High protein diet GI Bleed Steriod use/traume Causes of decreased BUN? - Severe liver damage Malnutrition Low protein diet Fluid volume excess Serum Creatinine range? - 0.5-1.2 Normal range for SG? - 1.010 - 1.025 When fluid intake INCREASES, specifc gravity DECREASES - DI, Glomerulonephritis, severe renal damage When fluid intake DECREASES, specific gravity INCREASES - Diabetes, Nephritis, Fluid deficit Acute Nephritic Syndrome - Allows RBC and protein movement into filtrate d/t post infection (such as glomerulonephritis or antibotics r/t strep) Glomerular Inflammation* Clinical Manifestations of Acute Nephritic Syndrome - Azotemia: Abnormal Conc. Nitrogenous wastes in blood Proteinuria Hematuria Cola-colored urine Casts in urine

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    Increased BUN/Creat d/t decreased U/O Med. Man. of Nephritic - Protein and sodium restriction Give abx r/t step Corticosteriods Immunosuppresants RN of Nephritic - **Give Carbs liberally** Strict i/o IVF - if fluids are effective = diuresis, decreased BP/edema Chronic Glomerulonephritis Patho - Repeated nephritis, HTN Nephrosclerosis, Hyperlipidemia Clinical Mani of GlomNeph - *Asymptomatic for years as damage increases before s/s develop* Abnormal dx: Urine w/ fixed SG, casts, protein Electrolyte imbalances Hypoalbuminia Med MGT of GlomNeph - If pt has HTN = Na+ & water restriction/antihypertensive Daily wts & diuretics to tx fluid overload Protein- dairy, eggs, meats

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    Dialysis if needed Rn of GlomNeph - Changes in fluid and electrolyte status and in cardiac and neurologic status are reported promptly to the primary provider. Nephrotic Syndrome - Damages the glomerlar membrane and increases permeability of plasma proteins 3.5 or > in urine/day **hallmark dx**(Massive Proteinuria) What does nephrotic syndrome result in? - Hypoalbuminemia pitting edema Hyperlipidemia/lipiduria Vit. D deficiency Manifestions of Nephro - Periorbital edema Dependent edema Ascites Dx of Nephro - Needle biopsy of kidney to confirm Complications of Nephro - Infection Thromboembolism Pul. Embolism AKI d/t hypovoemia Accelerated atheroscclerosis d/y hyperlipidemia Med MGT of Nephro - Diuretics Ace Inhibitors for proteinruia (Captopril,enalapril,lisinopril)

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    Lipitor, ezetimibe, niacin r/t hyperlipidemia PreRenal **external factors** - Hypoperfusion of kidney Hypovolemia Hypotensions Decreased CO CHF Burns/Sepsis Hemorrhage IntraRenal - direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply Postrenal - sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury Prerenal 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 - expected outcome is Urine output increases The 4 phases of AKI - Initiating Oliguric Diuretic Recover Clinical mani of AKI - Signs of fluid overload**

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    Increased potassium, phosphate, BUN/Creat Decreased Calcium, Sodium, pH Medical MGT of AKI - Volume assessment** Assess VS, I/O, head to toe Meds: loop diuretics, Bumex, Lasix, Mannitol, AVOID NEPHROTOCC MEDS = contrast dye Hyperkalemia of AKI - Tall, tented, or peaked T waves abdominal cramping, irritability, parethesia as level increases, CO/other fucntions decline --**med emergency* How to decrease potassium levels? - Kayexalate orally or retention enema Insulin and IV dextrose 50% Calcium replacement IV sodium bicarbonate ESKD - Irreversible loss of renal failure renal insuffiency 75% = BUN/creat elevation End stage renal disease = dialysis or transplant Common causes of ESKD - Uncontrolled DM/HTN

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    Malnutrition ESKD Profession - SLOW increase in BUN/Creatinine GFR 1-90mL/min = structural changes indicating renal damage 3-30 to 60mL/min = moderate to poor function 5-15 mL/min - end stage **Cardiovascular disease is the predominant cause of death in these pts** ESKD complications - Osteodystrophy Bone resorptions,osteopenia,fractures r/t stimulation of parathyroid hormone ESKD Erythropeotin - Decreased Hg/HCT r/t production of this nurse should admin epoetin alfa(epogen) and monitor rbc/hct Nutrition restrictions of ESKD sodium, potassium, phosphate restrictions*** - 2-4 g/day of potassium avoid oranges, bananas, melons, prunes, deep green/yellow veggies, beans 1000mg/day phosphate avoid dairy When is dialysis initiated? - When patient cannot maintain a reasonable lifestyle with conservative treatment

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    GFR <15 hemodialysis - A technique in which an artificial kidney machine removes waste products from the blood peritoneal dialysis - the lining of the peritoneal cavity acts as the filter to remove waste from the blood CCRT - Continuous renal replacement therapies acutely ill pts, manages acid/base status can use a single lumen with arterial line When is urgent dialysis indicated? - High and increasing level of K+ -Fluid overload -Impending pulmonary edema -Increasing acidosis -Pericarditis -Advanced Uremia Arteriovenous Fistula - type of vascular access for dialysis; created by surgically connecting radial artery to cephalic vein "mature" fistula = large, bluging, and tortous S/S of Arterial Steal Syndrome - Ischemia d/t vascular access Vascular insufficiency = cold, numb fingers

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    s/s = pallar, pulses decreased/pain distal to fistula, necrosis RN assesssment of fistula/graft - Palpable pulsation thrill/bruit hear on auscultation w/ stethoscope NO BP or PIV on affected side Dialysis Complications - Chest pain may occur in pts w/ anemia or aterioscleotic heart disease dysrhythumias Hypotension Anemia Gastric ulcers Pts with uremia report metallic taste and nausea Dialysis Complications Continued - Poor calcium metabolism Renal Osteodystrophy Phosphorus deposits in the skin=itching Sleep problems/muscle cramping RN of Dialysis - Protect vascular access***

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    Assess site for patency signs of potential infection do not use for bp/blood drwas When is peritoneal dialysis indicated? - For pts w/vascular access problems OR respond poorly to HD/Hemodynamic instability What are the types of Peritoneal Dialysis - Ambulatory = 4-5x/day Automated = Overnight Intermitted = 30-40/WEEK When is PD contraindicated? - Hx of ab. surguries/pancratitis/diverticulitis Recurrent ab wall/inguinal hernias Severe COPD Compensatory 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" response Manifestations of Comp - •Body shunts blood from skin, kidneys, GI tract

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