Test 1 Review

Renal - 19 questions

1. End stage renal disease – give erythropoietin (glycoprotein cytokine produced by kidney’s in response to cellular hypoxia) to ↑
RBGs in bone marrow
a. ↑ creatinine from damaged glomerulus
b. Anemia
c. Bone disease/osteoporosis

2. CKD skin color – sallow yellow tan

3. Pt w/acute glomerulonephritis – acute kidney injury cause by Group A beta-hemolytic strep from infectious injury, antigen-
antibody reaction affects the glomerular tissue resulting in swelling and capillary cell death (necrosis)
a. s/s –
i. flank pain
ii. dark colored urine (cola)
iii. periorbital edema, may have bilateral as well
iv. ↑ BP, HTN
v. Mild protein & hematuria from non-filtering
vi. WBCs (esterase) in urine

4. Teaching CKD – keep HTN in check,

a. Use HTN meds that protect renal system - use ACE inhibitors (prils)
b. H&H ↓, 160/92, ↑ HR - loss of erythropoietin makes H&H ↑

5. Adjust renal drugs if not good excretion

6. ESKD – ampigel (calcium based binder) removes phosphate, monitor for hypocalcemia

7. Acute Kidney Failure w/ L-sided HF on dialysis

a. Weight
b. BP
c. type of dialysate
d. how much dialysate input & removed

8. BUN ↓ from 94 to 32 following hemodialysis what assessment? – Disequilibrium syndrome

a. Confusion, NV, LOC changes

9. Primary goal in oliguric phase – regulate/monitor fluid mgmt (monitor daily weights)

10. Kidney biopsy – stop ASA 5 days before biopsy

11. Dx of CKD what greatest assessment – BP

12. Nephrotic syndrome – presence of > 2.5 g protein in urine/day

a. Hypercholesteremia (abdominal distention from proteinuria increasing fatty acids)
b. edema (periorbital & peripheral)
c. HTN
d. Oliguria
e. hypoalbumin

13. Client w/dehydration – creatinine 1.2 (indicator for kidney disfunction), BUN 50, HCT 54
a. creatinine levels WNL are indicative of normal kidney function

14. Don’t restrict pts w/dialysis of protein, normally protein is restricted for renal disease
a. Need ↑ calorie requirements to avoid catabolism, ↑ amino acids w/↓ in total protein giving pt ↑ calorie:protein ratio
 15. BPH w/acute kidney failure, is that pre-renal? Post

16. Kidney dysfunction in females b/c tubes are shorter have more UTI’s than men – pyelonephritis

F&E & Blood transfusions 32 questions:

17. Pt in ER needs blood & there’s no time for type & crossmatch, what do you give? type O-

18. Hypovolemic shock in early or compensatory w/confusion, 1st s/s is metal confusion in early stages

19. Delegation about UAP/nsg asst with deficient fluid volume – give oral fluids, provide straws

20. 1000cc w/40 mEq potassium without tele, can you monitor the level of K without tele? Depends on amt of K
a. Give call bell
b. Monitor pump site
c. Monitor K labs

21. Serum osmolality looks at fluid concentration, pt is in shock from massive fluid loss is going to need more fluids, their
concentration is ↓, what fluids do you provide?
a. Administer Hypotonic solution – ↑ concentration means they are dehydrated so you put fluid back into the cells

22. Bumex – loop diuretic, pt is allergic to sulfur - call doctor & ask for another type of diuretic

23. PICC line goes to superior vena cava, need CXT to verify placement

24. 4+ pitting edema, bilateral pleural effusions, Dr orders 25 G albumin in tubule, orders Lasix 40mg IV push, and pt becomes short
of breath – albumin goes out of cells into lungs, giving Lasix to avoid this

25. Pt has FVE & Hx of CHF w/possible pleural effusion. – most important assessment is lung sounds, crackles from fluid building up

26. Anemic pt w/Hx of transfusion allergic reactions – usually WBC on RBC, remind Dr. to wash RBGs w/sterile saline to get the
white cells off

27. Sluggish IV (wouldn’t know until you flush it), has little bit of redness is indication something wrong – what do you do? Stop it,
put warm compress to ↓ redness, tell pt what you’re doing
a. Cold compress for blood infiltrate

28. Food for hypokalemia – bananas, apricots, cantaloupe, melons, avocado

29. Lasix with oliguria is undesirable – only give Lasix to pt whose urinating

30. Pt w/↓ CO r/t plasma volume – in supine position their neck veins are flattened, not enough volume

31. PCA mgmt pump – most important thing – did it give pt relief?
a. Don’t give anymore narcotics of on PCA or you have to call physician
b. Did the pt. have relief?
c. Can the pt. push the pump?

32. Pt got 5 units of blood – blood ok for 42 days in fridge, all blood has CPD (citrate derivative in it) that binds with calcium in the
blood, pt will need calcium gluconate only with multiple transfusions or more than 5 units of blood
a. CBC w/diff to show Ca levels

33. D5W – causes neg nitro balance, lack of protein supplementation

 34. Pt w/FVD s/s – tenting, ↓ BP, normal pulse pressure (diff between SBP & DBP)
a. Normal range of pulse pressure is 40-60; so if pulse pressure is normal indicates just dehydration
b. In shock pt will display narrowing pule pressure from significant blood loss, low PP can be r/t CHF or cardiogenic shock
c. Widening(high) pulse pressure is a sign of changes in heart structure or function. Causes from is more from damaged aorta (high BP),
fatty deposits, severe iron deficiency, hyperthyroidism, aortic stiffening & pregnancy.

35. pt had Na 185, was given D5W, in 5 hrs Na went down to 145, the pt became unresponsive. Why? – causes cerebral edema

36. Pt has bounding pulses, weight gain of 2lbs on 2 day, moist crackles bilateral & pitting ankle edema. What should the RN
anticipate? – furosemide (Lasix) 40mg IVP

37. Pt post colon resection back on floor, BP 90/50, P 120, R 25, skin cool/clammy, restless, not adequate urine output – what’s
happening – 3rd spacing (ascites)- might need fluid challenge test

38. s/s hypokalemia –

a. confusion d. apathy
b. diarrhea (GI disturbances) e. ↓ HR
c. muscle weakness f. EKG changes (flat T-waves)

39. PICC lines w/infection, check with charge RN, find out how many infections. talk to infection control 1st

40. Client dehydrated from diabetic acidosis has ↑ glucose from DKA – give hypotonic solution to dilute
a. Hypotonic fluids (LR, 0.45% NaCl) put fluid back into dehydrated cells & dilute the acidosis

41. Pt w/fracture femur & chest contusion, maybe subdermal hematoma, leg in traction - 0.9% NaCI (normal saline) (isotonic)

42. N/V – hypovolemic what type of fluids would you give – crystalloids Isotonic

43. Fractured hip w/Ca 18.6, need to get rid of Ca. What to give – NS 0.9% then follow with Lasix - gets rid of extra Ca

44. Blood transfusion, VS: P 110, T 101 & shivering – stop transfusion having febrile reaction

45. Delegation for 1st yr student – cannot give any unstable pt!
a. Pt w/MI & high troponins – can’t give
b. Pt w/DT’s – can’t give
c. Pt w/chest pain – can’t give
d. Pt going to X-ray or some such procedure - GIVE

46. TPN I&O monitor daily weight

47. Pt says they have an allergy – is it true allergy? describe what happened when you took this medication – might be a side effect
instead of reaction

48. 1hr after pt given blood everything was fine, now pulse is up, flushing face, shivering – febrile nonhemolytic reaction

49. Hemolytic reaction occurs immediately, has terrible back pain

50. 4 hrs post op Abd surg - IV at 125mL and foley cath only has 100ml, 3:10 pain, what type of nsg Dx? FVD

Burns (10q)

51. Early vol replacement helps w/quality of urine output

52. Maintain positive nitrogen balance in pts w/severe burns – nitrogen is being burned up which is needed for calories, ↑ caloric
intake x 3
53. Burning car – remove person, determine airways status most important

54. Rule of 9’s

a. Arm 9%
b. Head & neck 9%
c. Anterior trunk 18%
d. Posterior trunk 18%
e. Leg 18%

55. Pt 60% burn w/smoke inhalation highest priority? Monitor resp status

56. Pt has major burns – NG to prevent GI problems such as Curling’s stress ulcer

57. Mafenide (sulfamylon) burn medication side effects: metabolic acidosis

a. converted by a carbonic anhydrase inhibitor which prevents conversion of hydrogen ions to carbonic acid, leading to metabolic acidosis

58. HCT & HGB in hemolytic shock – HCT is % of RBC cell, HGB is O2 in RGB – best thing to look at is HGB b/c it tells you amt of O2 in blood

59. High voltage power lines fall down on pt who sustains electric burns all over w/deep tissue & muscle damage. What is your high
priority nsg responsibility? EKG

60. Pulse pressure readings are more significant than BP when assessing clients who are in shock
a. In Hypovolemic pt it indicates falling ↓ CO & ↑ peripheral vascular resistance. Decreasing venous volume from blood loss &
sympathetic nervous system are attempting to ↑ or maintain the falling blood pressure though systemic vasoconstriction.

61. Pulse Pressure tends to parallel Stoke Volume – SV amt of blood pumped from L ventricle in 1 contraction
a. Preload, afterload, contractibility

62. What does the pulse pressure diff between Syst & Diastolic represent the force of heart when each time it contracts

63. Septic/Systemic shock – massive inflammatory response; severe, overwhelming infection; massive vascular dilation results in
poor organ perfusion. don’t fix it they die

64. Shock position – supine w/knees up, elevate extremities 12 inches, do not move head, do not drop head, keep warm &
comfortable

65. Assignment question, grad/new nurse CAN’T HAVE UNSTABLE PTS

a. No pts w/MI
b. No pts w/DT’s
c. OK for pts going to procedures like EGD or xray

66. Charge nurse w/2 RN’s, 2LPNS & 2 UAPS

a. RNs – assessments
b. LPNs – give all meds
c. UAPs – ADLs, pass trays, VS, assist with eating, bathing, turn pts

67. When you have 4 pts w/4diff Dx, who do you assess first?
a. Examples: DTs, MI w/troponin to high, car accident w/nitro drip

68. Prioritize who so you see 1st?

a. Diabetic w/cellulitis in L leg
b. diverticulitis w/cramping pain
c. sinus infection w/green goobers or
d. pneumonia w/no fever restless (hypoxic)-MOST LETHAL