1
Q
What is the normal range for serum creatinine and what does elevation indicate?
A
0.6–1.2 mg/dL; elevation means decreased renal filtration and kidney injury or disease.
2
Q
What is the normal range for BUN and what does an increase signify?
A
10–20 mg/dL; increase indicates renal dysfunction, dehydration, or high protein catabolism.
3
Q
Normal GFR range and its clinical importance?
A
90–120 mL/min; measures filtration rate. Decreasing GFR = worsening kidney function; < 60 for 3 mo = CKD; ≤ 15 = ESRD.
4
Q
How does CKD cause anemia?
A
Kidneys fail to produce erythropoietin → reduced RBC production → fatigue, pallor, SOB.
5
Q
Why are CKD clients often hypocalcemic and hyperphosphatemic?
A
Damaged kidneys can’t activate vitamin D → poor calcium absorption; phosphate rises because kidneys can’t excrete it → inverse Ca–Phos relationship.
6
Q
What acid–base imbalance is seen in renal failure and why?
A
Metabolic acidosis — kidneys can’t excrete hydrogen ions or reabsorb bicarbonate → low pH and low HCO₃⁻.
7
Q
Describe the diet for a client with ESRD on dialysis.
A
Low K⁺, low Na⁺, low phosphate, moderate protein (if on dialysis), high-calorie; avoid bananas, tomatoes, potatoes, citrus, and processed foods.
8
Q
How does dialysis correct hyperkalemia?
A
Removes K⁺ from blood through diffusion and ultrafiltration → rapid drop in serum K⁺ to prevent dysrhythmias.
9
Q
What medications are held before hemodialysis?
A
Antihypertensives (prevent hypotension), water-soluble vitamins, antibiotics until after dialysis; heparin is given during dialysis only.
10
Q
What is the most serious complication during hemodialysis?
A
Disequilibrium syndrome—rapid solute loss → cerebral edema; S/S: headache, N/V, seizures; treat by slowing dialysis rate.
11
Q
What should you hear and feel over a dialysis fistula?
A
Auscultate bruit (swishing sound) and palpate thrill (vibration)—absence = occlusion or clot.
12
Q
What are signs of infection in a dialysis access site?
A
Redness, warmth, purulent drainage, tenderness, fever; requires immediate culture and antibiotics.
13
Q
Which electrolyte is most concerning in AKI and CKD?
A
Potassium—hyperkalemia can cause lethal cardiac dysrhythmias.
14
Q
Which medication protects the heart during hyperkalemia?
A
Calcium gluconate—stabilizes cardiac membranes but does not lower K⁺.
15
Q
Why is Kayexalate given for hyperkalemia?
A
Exchanges sodium for potassium in the bowel → removes K⁺ through stool; slow but effective.
16
Q
What is the difference between hemodialysis and peritoneal dialysis?
A
HD: hospital/center, vascular access, rapid clearance. PD: home-based, peritoneal membrane filter, slower but gentler.
17
Q
What are early signs of peritonitis during PD?
A
Abdominal pain, tenderness, fever, cloudy effluent—indicates infection, requires immediate culture and antibiotics.
18
Q
Why must PD solution be warmed before infusion?
A
Cold fluid causes cramping and discomfort; warm under blanket or water bath—not microwave—to maintain sterility.
19
Q
What does it mean if PD drainage is less than instilled volume?
A
Possible catheter kink, blockage, or fluid retention; reposition client or check tubing.
20
Q
How often should weight be monitored in dialysis patients?
A
Daily; sudden gain > 2 lb = fluid retention, inadequate filtration, or dietary excess.
21
Q
Why should no blood pressure or IV be done on a fistula arm?
A
Prevents clot formation, bleeding, or fistula damage; use opposite arm.
22
Q
Why might a dialysis patient have hypotension post-session?
A
Excess fluid removal and vasodilation from heparin → volume depletion; monitor vitals closely.
23
Q
What is the urine output criteria suggesting oliguria?
A
< 400 mL in 24 hours (≈ < 0.5 mL/kg/hr); indicates poor renal perfusion.
24
Q
What does pink urine mean post-renal transplant?
A
Expected initially; persistent red or sudden darkening = bleeding or rejection—report immediately.
25
What are signs of renal transplant rejection?
Fever, oliguria, hypertension, pain/swelling at graft site, increasing creatinine—requires immunosuppressive adjustment.
26
Which medications prevent organ rejection after transplant?
Corticosteroids + immunosuppressants (cyclosporine, tacrolimus, azathioprine); suppress immune response to graft.
27
Why avoid crowds after transplant?
Immunosuppressed → high infection risk; even minor infections can cause sepsis.
28
Why is dialysis done before renal transplant surgery?
To remove toxins, normalize fluid/electrolytes, and prevent overload during anesthesia.
29
How does uncontrolled diabetes lead to CKD?
Chronic hyperglycemia damages glomeruli → proteinuria → nephron loss → GFR decline.
30
Why are NSAIDs avoided in CKD?
Nephrotoxic—reduce renal blood flow and worsen kidney injury.
31
Which urine finding suggests glomerulonephritis?
Brown/rusty urine with mild proteinuria and hematuria—caused by RBC leakage from inflamed glomeruli.
32
What teaching is essential for a patient on Epogen?
Monitor BP (can cause hypertension); report headaches; supplement iron and folate for RBC production.
33
Why is phosphorus restricted in CKD diet?
Phosphate retention worsens hypocalcemia and bone demineralization; limit dairy, nuts, and cola drinks.
34
What is the expected output after dialysis relative to intake?
Output should exceed intake; failure indicates fluid retention or poor clearance.
35
Why is hypertension common in renal failure?
RAAS activation and fluid retention increase vascular volume and peripheral resistance.
36
What diagnostic test best measures kidney filtration?
GFR (Glomerular Filtration Rate)—the lower it is, the worse the kidney function; < 60 = CKD, < 15 = ESRD.
37
Which two labs are most specific for renal function?
BUN and Creatinine—both rise when kidneys cannot excrete waste; creatinine is more specific for renal damage.
38
What is the primary cause of AKI?
Sudden reduction in blood flow (pre-renal), direct kidney injury (intrarenal), or obstruction (post-renal) → decreased filtration.
39
How does pre-renal AKI differ from intrarenal AKI?
Pre-renal = impaired perfusion (shock, dehydration). Intrarenal = tissue damage (nephrotoxins, ischemia, infection).
40
Why does AKI cause hyperkalemia?
Kidneys can’t excrete potassium → serum K⁺ rises → muscle weakness, dysrhythmias, cardiac arrest.
41
Why is metabolic acidosis common in AKI?
Hydrogen ions accumulate while bicarbonate is lost → pH drops.
42
During the diuretic phase of AKI, what is the main risk?
Dehydration and hypokalemia from rapid fluid/electrolyte loss.
43
What indicates recovery from AKI?
Gradual increase in urine output and GFR, stabilization of BUN/Cr, improved electrolyte balance.
44
What is the hallmark sign of glomerulonephritis?
Hematuria with brown/rusty urine and mild proteinuria from glomerular inflammation.
45
Which infection commonly precedes acute glomerulonephritis?
Group A β-hemolytic Strep infection—antibody complexes lodge in glomeruli.
46
Why are patients with glomerulonephritis at risk for fluid overload?
Inflamed glomeruli reduce filtration → sodium/water retention → edema and HTN.
47
What diet is recommended for glomerulonephritis?
Low sodium, low protein, low potassium, fluid restriction to reduce renal workload and BP.
48
What is the priority nursing action for glomerulonephritis?
Monitor daily weights and I&O for fluid retention; report > 2 lb gain in 24 h.
49
What is polycystic kidney disease?
Genetic disorder causing multiple fluid-filled cysts that compress tissue and reduce function—leads to ESRD.
50
Main symptoms of polycystic kidney disease?
HTN, hematuria (from ruptured cysts), abdominal pain, nocturia, enlarged abdomen.
51
Why is there no cure for PKD?
Genetic progressive degeneration of nephrons; treatment is symptom management until transplant.
52
What causes kidney stones (nephrolithiasis)?
High concentration of minerals and salts → crystallization in urinary tract; dehydration and diet contribute.
53
Typical signs of kidney stones?
Severe flank/abdominal pain, hematuria, N/V, frequency, cloudy or foul urine.
54
Immediate nursing priority for renal calculi?
Pain control (opioids first) and increase fluids ≥ 3 L/day unless contraindicated.
55
How is lithotripsy used for stones?
Ultrasound waves break stones into smaller pieces for easier passage; strain urine for fragments.
56
What causes benign prostatic hyperplasia (BPH)?
Aging and hormonal changes → prostate enlargement compresses urethra and obstructs flow.
57
Classic symptoms of BPH?
Hesitancy, weak stream, dribbling, incomplete emptying, urgency, frequency, nocturia.
58
Most accurate diagnostic test for BPH?
Digital rectal exam (DRE) and PSA to rule out prostate cancer.
59
First-line drugs for BPH?
Finasteride (Proscar) shrinks gland by lowering testosterone; Tamsulosin (Flomax) relaxes smooth muscle.
60
Key side effects of Proscar and Flomax?
Proscar = ↓ libido, impotence, teratogenic to pregnant women. Flomax = dizziness, orthostatic hypotension.
61
What post-TURP findings are expected?
Light pink urine and mild clots for 24 h; bright red bleeding = hemorrhage → notify provider.
62
Priority nursing care after TURP?
Maintain continuous bladder irrigation (CBI), keep flow unobstructed, monitor output color and clots.
63
Why avoid rectal suppositories after TURP?
Rectal pressure can traumatize the surgical site and cause bleeding or infection.
64
How does uncontrolled hypertension damage kidneys?
High pressure destroys glomeruli → nephrosclerosis → proteinuria and renal failure.
65
Why do CKD patients develop uremic frost?
Excess urea crystallizes on skin due to high BUN levels — late sign of ESRD.
66
What is the best indicator of fluid balance in renal patients?
Daily weight—more accurate than I&O for tracking retention or loss.
67
Why are older adults more prone to AKI?
Decreased renal reserve and slower renal perfusion make them susceptible to dehydration and nephrotoxins.
68
What is the normal urine output per hour for a healthy adult?
At least 30 mL/hr; less indicates poor renal perfusion or possible kidney injury.
69
How does the kidney regulate acid–base balance?
By excreting hydrogen ions and reabsorbing bicarbonate; failure leads to metabolic acidosis.
70
What electrolyte imbalance causes muscle twitching and seizures in renal failure?
Hypocalcemia—vitamin D cannot be activated, decreasing Ca²⁺ absorption.
71
Why does hyperkalemia occur in CKD?
Damaged kidneys fail to excrete potassium → cardiac irritability and peaked T waves.
72
What ECG change signals hyperkalemia?
Tall peaked T waves and widened QRS—immediate cardiac monitoring required.
73
How do loop diuretics help in renal patients?
Promote fluid excretion and lower K⁺; preferred over K⁺-sparing agents like spironolactone.
74
Why is sodium polystyrene sulfonate (Kayexalate) used?
Removes K⁺ by exchanging it for Na⁺ in intestines; works slower than insulin/dextrose combo.
75
What nursing action is most important for a patient on Kayexalate?
Monitor for diarrhea and sodium retention; check K⁺ and Na⁺ levels post-therapy.
76
Which electrolyte imbalance causes dysrhythmias in renal disease?
Hyperkalemia—affects cardiac conduction and contractility.
77
Why are renal failure patients often hypertensive?
RAAS activation from low perfusion → vasoconstriction + Na⁺/water retention.
78
Why should NSAIDs be avoided in kidney disease?
They constrict afferent arterioles, reducing GFR and worsening renal injury.
79
What causes anemia in renal failure?
Erythropoietin deficiency → decreased RBC production → fatigue and pallor.
80
How does dialysis improve metabolic acidosis?
Removes hydrogen ions and restores bicarbonate balance through diffusion.
81
Which laboratory result indicates metabolic acidosis?
Low pH (< 7.35) + low HCO₃⁻ (< 22 mEq/L).
82
Why are CKD patients prone to bone disease?
Phosphate retention + vitamin D deficiency → hypocalcemia → secondary hyperparathyroidism.
83
Which lab combination confirms end-stage renal disease?
GFR < 15 mL/min + very high BUN/creatinine + persistent symptoms.
84
What dietary advice prevents renal stone recurrence?
Increase fluids, limit sodium/protein/oxalate foods (spinach, nuts, chocolate).
85
Why are uric acid stones linked to gout?
Excess purines → hyperuricemia → uric acid crystal precipitation in kidneys.
86
Why are calcium stones linked to hyperparathyroidism?
Elevated PTH → calcium release from bone → stone formation.
87
What fluid goal should be maintained to prevent stones?
Urine output ≥ 2 L/day—dilution prevents crystal formation.
88
What is the purpose of continuous bladder irrigation after TURP?
Prevents clot formation and maintains catheter patency.
89
What finding during CBI requires immediate action?
Bright red urine with thick clots → possible hemorrhage → notify provider.
90
Why monitor sodium levels during CBI?
Absorption of irrigant can cause hyponatremia and water intoxication.
91
When is dialysis absolutely required?
Severe hyperkalemia, uremic symptoms, fluid overload, or GFR ≤ 15 mL/min.
92
Why must the patient’s weight be taken before and after dialysis?
Determines fluid removed; 1 kg = 1 L water.
93
What complications can occur during hemodialysis?
Hypotension, cramping, bleeding, clotting, air embolism, disequilibrium syndrome.
94
Which sign indicates a patent AV fistula?
Palpable thrill and audible bruit; absence = obstruction or thrombosis.
95
Why avoid venipuncture in the fistula arm?
Prevents trauma, bleeding, or loss of access.
96
What is peritoneal dialysis advantage over hemodialysis?
Gentler, can be done at home, less hemodynamic stress.
97
What is the most serious complication of peritoneal dialysis?
Peritonitis—causes fever, abdominal pain, cloudy drainage.
98
Why must the PD catheter site be kept sterile?
Contamination introduces bacteria into the peritoneum → sepsis risk.
99
What does cloudy or foul PD effluent mean?
Infection—notify provider and send culture.
100
Why are renal transplant patients on lifelong immunosuppression?
To prevent graft rejection by inhibiting T-cell response.
101
Early signs of kidney transplant rejection?
Fever, hypertension, oliguria, swelling, tenderness at graft site.
102
Why is a transplant patient instructed to avoid grapefruit juice?
Interferes with cyclosporine/tacrolimus metabolism → toxicity.
103
Why weigh daily after transplant?
Detects early fluid retention from rejection or renal dysfunction.
104
Which medications raise potassium in renal patients and should be avoided?
ACE inhibitors, ARBs, K⁺-sparing diuretics—they worsen hyperkalemia.
105
What are uremic symptoms of ESRD?
Anorexia, N/V, metallic taste, pruritus, confusion—indicate toxin accumulation.
106
Why is fluid intake restricted in ESRD?
Kidneys cannot excrete excess water → edema, HTN, pulmonary congestion.
107
Which vital sign change signals fluid overload in renal failure?
Rising BP and bounding pulse—excess volume raises vascular resistance; monitor for crackles and edema.
108
What physical finding suggests uremic encephalopathy?
Confusion, asterixis (flapping tremor), seizures—caused by toxin buildup affecting the brain.
109
What is the earliest sign of decreased kidney perfusion?
Decreased urine output < 30 mL/hr; kidneys are the first organs to respond to low circulation.
110
What lab combination confirms worsening renal failure?
↑ BUN + ↑ Creatinine + ↓ GFR—indicates poor filtration and toxin retention.
111
What causes pruritus in CKD?
Uremic toxin accumulation and calcium-phosphate deposits under the skin.
112
What should the nurse do first for a CKD patient with K = 6.8 mEq/L?
Place on cardiac monitor and prepare insulin + dextrose or calcium gluconate—hyperkalemia is life-threatening.
113
Which assessment finding suggests pericarditis in CKD?
Chest pain relieved by sitting up and friction rub; inflammation from retained waste products.
114
Why is aluminum hydroxide used in CKD?
Binds phosphate in GI tract to reduce serum phosphorus and correct hypocalcemia.
115
Why must phosphate binders be taken with meals?
They work only in the gut when phosphate from food is present.
116
What teaching is important for renal diet adherence?
Read labels for potassium, phosphorus, sodium; avoid processed foods and salt substitutes containing KCl.
117
What foods are high in phosphorus?
Dairy, nuts, cola, beans, organ meats; restrict to prevent bone disease.
118
Which symptom distinguishes ESRD from earlier CKD?
Uremic frost, pericarditis, severe anemia, and need for dialysis—end stage means < 10 % kidney function.
119
Why do renal patients develop pulmonary edema?
Fluid retention + LV dysfunction from HTN cause fluid shift into lungs.
120
What medication prevents pulmonary edema in CKD?
Loop diuretics (furosemide) and O₂ therapy; dialysis if severe.
121
What is the priority before starting dialysis?
Weigh the patient, assess BP, labs, and access site patency.
122
Why avoid administering antihypertensives before dialysis?
Dialysis removes fluid → BP can drop dangerously low; meds worsen hypotension.
123
What indicates disequilibrium syndrome during dialysis?
Headache, N/V, confusion, seizures from rapid solute removal; slow dialysis rate.
124
Why is patient positioning important during dialysis?
Keep in semi-Fowler’s to promote perfusion and reduce hypotension.
125
What should the nurse do if the dialysis machine alarms for air?
Stop the pump and clamp lines—risk of air embolism.
126
What is the treatment for air embolism during dialysis?
Left side-lying, Trendelenburg, give O₂—traps air in right atrium and prevents brain embolus.
127
What lab should be checked before giving Epogen?
Hemoglobin—hold if > 12 g/dL; risk of hypertension and thromboembolism.
128
Why are iron and folate supplements given with Epogen?
Needed for RBC production; without them therapy is ineffective.
129
Why might a renal patient require stool softeners?
Uremia + phosphate binders cause constipation; straining increases BP risk.
130
Why is infection a major risk in dialysis patients?
Frequent vascular access and immunosuppression compromise defenses.
131
What is the first sign of infection in a dialysis patient?
Fever, redness, warmth at access site—report immediately.
132
Why is aseptic technique critical for PD catheter care?
Prevents peritonitis; the peritoneum is a sterile cavity.
133
Which assessment finding after PD requires urgent action?
Cloudy outflow with abdominal pain—indicates infection.
134
What should be documented after dialysis?
Weight before/after, fluid removed, BP, symptoms, access status, and lab results.
135
How do you evaluate dialysis effectiveness?
Improved LOC, decreased edema, normalized electrolytes, lower BUN/Cr.
136
What teaching prevents hypotension post-dialysis?
Change positions slowly, eat small meals, report dizziness.
137
Why are immunosuppressive meds started pre-transplant?
To reduce immune activation before new kidney is introduced.
138
What vaccines should transplant patients avoid?
Live vaccines (MMR, varicella, nasal flu)—immune suppression increases risk.
139
Which dietary advice follows a kidney transplant?
High protein and calories for healing; avoid grapefruit juice.
140
Why are steroids continued after kidney transplant?
Prevent rejection but cause hyperglycemia, weight gain, HTN—monitor closely.
141
What indicates steroid toxicity?
Truncal obesity, moon face, fragile skin, high glucose—Cushing-like effects.
142
Why should transplant patients avoid crowds and sick contacts?
Immunosuppressants blunt immune response; even minor infections can be fatal.
143
Which post-transplant sign suggests acute rejection?
Oliguria, graft tenderness, fever, HTN, rising creatinine—notify provider immediately.
144
What diagnostic test best detects urinary obstruction?
Renal ultrasound—non-invasive and shows stones, tumors, or hydronephrosis without contrast dye.
145
Which diagnostic test should be avoided in renal failure?
CT with IV contrast—contrast dye is nephrotoxic and can worsen kidney damage.
146
What finding on urinalysis suggests infection?
Positive nitrites, leukocyte esterase, WBCs, cloudy urine, foul odor—confirm with culture and sensitivity.
147
Why might a renal patient have foamy urine?
Proteinuria—leakage of protein through damaged glomeruli, sign of nephrotic or glomerular disease.
148
What does hematuria indicate?
Bleeding within urinary tract—caused by stones, trauma, infection, or glomerular inflammation.
149
What does specific gravity tell about kidney function?
Ability to concentrate urine; high = dehydration, low = impaired renal concentrating ability.
150
Which medication is nephrotoxic and should be avoided?
Aminoglycosides (gentamicin), NSAIDs, contrast dye, amphotericin B—all damage renal tubules.
151
Why are diabetic patients at higher risk for CKD?
Chronic hyperglycemia damages glomeruli → proteinuria → nephron loss.
152
What is the purpose of a renal biopsy?
Determines cause and severity of kidney disease by tissue examination.
153
Post-renal biopsy nursing priority?
Lie on affected side 30–60 min, monitor for bleeding (flank pain, drop in BP, hematuria).
154
What should be done if urine turns bright red after biopsy?
Indicates hemorrhage—notify provider immediately.
155
Which medication class reduces proteinuria in CKD?
ACE inhibitors or ARBs—reduce intraglomerular pressure and protect nephrons.
156
Why should potassium-sparing diuretics be avoided in CKD?
They increase K⁺ levels → fatal hyperkalemia.
157
Why are opioids used cautiously in renal failure?
Metabolites accumulate → respiratory depression, sedation; lower doses needed.
158
Why are magnesium-containing antacids contraindicated?
Kidneys can’t excrete Mg²⁺ → hypermagnesemia → cardiac and CNS depression.
159
Why are antibiotics like vancomycin dose-adjusted?
Reduced clearance prolongs half-life; dosing based on GFR to prevent toxicity.
160
What does uremia cause to the GI system?
Nausea, anorexia, metallic taste, ulcer risk from toxin irritation.
161
Which nursing intervention prevents renal calculi recurrence?
Encourage 2–3 L/day fluids, limit oxalate and purine foods, promote ambulation.
162
Which lab finding suggests dehydration rather than renal disease?
High BUN with normal creatinine ratio (> 20:1).
163
What fluid type is used for AKI from dehydration?
Isotonic fluids (0.9 % NaCl) to restore circulation without shifting electrolytes.
164
Why is daily weight more reliable than intake/output?
Detects hidden fluid gain/loss; 1 kg = 1 L water change.
165
Which position relieves pain from renal colic?
Ambulation or knee-chest position helps move stone downward ureter.
166
Why is morphine preferred for renal colic?
Relieves pain without worsening renal vasoconstriction like NSAIDs would.
167
What complication is unique to nephrotic syndrome?
Severe proteinuria → edema and risk for infection due to immunoglobulin loss.
168
What medication reduces edema in nephrotic syndrome?
Loop diuretics + ACE inhibitors + low-sodium diet help remove fluid and reduce protein loss.
169
What electrolyte should be monitored with ACE inhibitors?
Potassium — ACE inhibitors can increase K⁺ and worsen hyperkalemia.
170
What lifestyle modifications slow CKD progression?
Control BP, glucose, avoid nephrotoxins, low-protein diet, stop smoking.
171
Why should high-protein diets be avoided in CKD?
Increase nitrogen waste → higher BUN and uremia.
172
What is the first sign of graft rejection after transplant?
Rising creatinine and oliguria — indicates decreased graft perfusion.
173
Why must immunosuppressants be taken at the same time daily?
Maintains steady blood levels to prevent graft rejection.
174
What patient teaching reduces infection risk post-transplant?
Hand hygiene, avoid raw foods, crowds, and sick contacts.
175
Which lab should be monitored with cyclosporine?
Trough level and creatinine — detects toxicity and nephrotoxic effects.
176
Why are corticosteroids tapered slowly?
Abrupt stop causes adrenal crisis and possible graft rejection.
177
What sign indicates chronic rejection of kidney transplant?
Gradual creatinine rise, fatigue, proteinuria — leads to return of ESRD.
Med Surg 2
flashcards
Decks in class (17)
# Cards
-
Week 1 Medications71
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week 1 lecture157
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Week 1 Chemo Man20
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week 2 cardiac anatomy and physiology of heart38
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Week 2 Cardiac91
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week 2 cardiac ATI115
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week 2 cardiac drugs120
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week 3 meds61
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week 3 lecture228
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week 3 ati157
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week 3 questions140
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midterm review94
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midterm medications180
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midterm neuro40
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week 6 endocrine135
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week 7177
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Final Exam154
