NURS480 Comprehensive Practice Exam With Answers (55 Solved Questions)

Name: 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

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.

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

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

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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University

Chamberlain College of Nursing

Subject

Nursing

NURS480 Comprehensive Practice Exam With Answers (55 Solved Questions)

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