NUR 4030 FINAL EXAM QUESTIONS WELL ANSWERED LATEST UPDATE 2026
AKI - Answers -rapid onset
-can be reversible
-80% GFR loss before we see symptoms
-PERFUSION problem!
urinalysis of AKI - Answers 1. Azotemia: increase in waste products & low UOP
healthy kidney: BUN : Creatnine ratio = 20:1
unhealthy kidney: BUN : Creatnine ratio = 60: 2 -> some mismatch
2. Uremia: symptomatic azotemia
*LABS SHOW IF UR PT HAS AKI
Prerenal AKI - Answers -70% of most cases
-kidney is not being perfused
caused by: intravascular volume depletion (e.g. hemorrhage), decreased CO (e.g. MI), or altered
vascular resistance (e.g. sepsis)
Intrarenal AKI - Answers -25% of pts
-direct damage due ischemia, trauma, or nephrotoxic agents (e.g. NSAIDs)
-ATN (necrosis of tissue)
what can cause ATN? - Answers -ischemia
-nephrotoxic drugs (contrast, amioglycoside antibx, NSAIDs, chemo)
Postrenal AKI - Answers -most common in elderly
-mechanical obstruction of outflow or function = decreases GFR
causes: BPH, kidney stones, neurogenic bladder, spinal cord disease
Oliguric phase of AKI - Answers -intial phase
-UOP decreases (400ml/24hrs)
-urine cloudy and sediment noted
-fluid retention
-electrolyte imbalance (hyperkalemia)
-increased BUN/creatinine -> neuro changes
Diuretic phase of AKI - Answers -kidneys excrete 1-5L/day of pure water
-at risk for electrolyte imbalance (low everything), hypovolemia, and vascular collapse
*give fluids
Recovery Phase of AKI - Answers -increase in GFR
-BUN/Cr decrease
*takes awhile to stabilize
what diagnositcs are specific to AKI? - Answers -CREATININE!!!
-UOP
-urinalysis
-electrolytes
interventions of AKI - Answers -treat cause: volume (hypovolemia), pressors (decreased CO),
electrolyte balance (arrythmia/conduction defects)
-fluid management
What to do for dysrhythmias/hyperkalemia? - Answers 1. quickest way: insulin drip (K gets pulled into
cell but K is still in body)
2. K leaves body: Kayexalate -> stool removal
3. most invasive & critical: hemodialysis
what should we do for nutrition with someone who has AKI? - Answers 1. low protein, low K/Na
-supplement with TPN, tube feedings, lipid supplement
, why low protein with someone who has AKI and not on HD? - Answers -protein breaks down to
ammonia-> ammonia can pass through the blood-brain barrier
-kidneys can't remove the ammonia = build-up
what is the CKD patient at risk for? - Answers -hyperkalemia*
-fluid volume excess
-neurotoxicity 0-> drugs stay in the system longer
-HIGH PO4-> pt at risk for fx's
why is there high PO4 & how do we fix it? - Answers why: kidneys can't excrete PO4 -> buildup
how: calcium acetate -> phosphate binder
what is PD? - Answers -uses the peritoneum as the filter
-warmed sterile solution (filled with fluid, electrolytes, antibx, heparin, glucose)
*contraindications: any abd hx, obesity, severe obstructive pulmonary disease
care for someone with PD - Answers -run fast and warm (cold causes cramping)
-run it for 20, sit for 20, and let it drain -> mL should be atleast what you put in, if not more
*turn pts side to side
-pt should be semi-fowlers and never laying flat (impedes RR and airflow due to fluid pressure in
body)
what are the complications of PD? - Answers -INFECTION-> PERITONITIS (cloudy urine, crystallized,
etc.)
-hernia: pushing PD into abd and weakens the wall -> at risk for hernia
HD - Answers -removes blood waste, protein, excess fluid, & restores acid/base, electrolytes
-machine outside of body
what are some HD access? - Answers -Subclavian or femoral -> temporary vascath
-has heparin flush port
-if femoral-> check peripheal pulses
-external AV shunt - U shape-> at risk for infection
-interanal AV shunt -> hear bruit feel thrill (matures 1-2 weeks before use)
what are HD complications? - Answers 1. HYPOTENSION
2. infection
CRRT - Answers -continuous filtration
-exchange is slower: removes less volume per hour than hemodialysis-> perfect for those who cannot
handle the fluid shift or have refractory results to other interventions (critical pts)
what are the two phases of brain injury? - Answers primary: initial time of the injury
secondary: what we are concerned about -> it is the sequelae of the injury
how does decreased CO affect ICP? - Answers -decreased CO -> causes increase in ICP ( lack of blood
flow)
-think CPP (MAP-ICP) if CO decreases, MAP decreases, which causes CPP to decrease-> compensation,
brain vasodilates-> increase in cerebral blood volume-> increase ICP
How does being on the vent affect ICP? - Answers -You have forced air into the body
healthy brain: increased pressure to the brain and decreased pressure back to the heart
on vent: increased pressure to the brain, and then it hits an increase of air back to the heart
(increased ICP that way-> pressure has nowhere to go except back up)
how do we measure ICP? - Answers -pressure measured with a transducer (at the level of the mid-
ear)
-0-15mmHg
how should we place pt with a drain? - Answers - Semi-Fowler's -> helps drain without causing too
much struggle on venous return
AKI - Answers -rapid onset
-can be reversible
-80% GFR loss before we see symptoms
-PERFUSION problem!
urinalysis of AKI - Answers 1. Azotemia: increase in waste products & low UOP
healthy kidney: BUN : Creatnine ratio = 20:1
unhealthy kidney: BUN : Creatnine ratio = 60: 2 -> some mismatch
2. Uremia: symptomatic azotemia
*LABS SHOW IF UR PT HAS AKI
Prerenal AKI - Answers -70% of most cases
-kidney is not being perfused
caused by: intravascular volume depletion (e.g. hemorrhage), decreased CO (e.g. MI), or altered
vascular resistance (e.g. sepsis)
Intrarenal AKI - Answers -25% of pts
-direct damage due ischemia, trauma, or nephrotoxic agents (e.g. NSAIDs)
-ATN (necrosis of tissue)
what can cause ATN? - Answers -ischemia
-nephrotoxic drugs (contrast, amioglycoside antibx, NSAIDs, chemo)
Postrenal AKI - Answers -most common in elderly
-mechanical obstruction of outflow or function = decreases GFR
causes: BPH, kidney stones, neurogenic bladder, spinal cord disease
Oliguric phase of AKI - Answers -intial phase
-UOP decreases (400ml/24hrs)
-urine cloudy and sediment noted
-fluid retention
-electrolyte imbalance (hyperkalemia)
-increased BUN/creatinine -> neuro changes
Diuretic phase of AKI - Answers -kidneys excrete 1-5L/day of pure water
-at risk for electrolyte imbalance (low everything), hypovolemia, and vascular collapse
*give fluids
Recovery Phase of AKI - Answers -increase in GFR
-BUN/Cr decrease
*takes awhile to stabilize
what diagnositcs are specific to AKI? - Answers -CREATININE!!!
-UOP
-urinalysis
-electrolytes
interventions of AKI - Answers -treat cause: volume (hypovolemia), pressors (decreased CO),
electrolyte balance (arrythmia/conduction defects)
-fluid management
What to do for dysrhythmias/hyperkalemia? - Answers 1. quickest way: insulin drip (K gets pulled into
cell but K is still in body)
2. K leaves body: Kayexalate -> stool removal
3. most invasive & critical: hemodialysis
what should we do for nutrition with someone who has AKI? - Answers 1. low protein, low K/Na
-supplement with TPN, tube feedings, lipid supplement
, why low protein with someone who has AKI and not on HD? - Answers -protein breaks down to
ammonia-> ammonia can pass through the blood-brain barrier
-kidneys can't remove the ammonia = build-up
what is the CKD patient at risk for? - Answers -hyperkalemia*
-fluid volume excess
-neurotoxicity 0-> drugs stay in the system longer
-HIGH PO4-> pt at risk for fx's
why is there high PO4 & how do we fix it? - Answers why: kidneys can't excrete PO4 -> buildup
how: calcium acetate -> phosphate binder
what is PD? - Answers -uses the peritoneum as the filter
-warmed sterile solution (filled with fluid, electrolytes, antibx, heparin, glucose)
*contraindications: any abd hx, obesity, severe obstructive pulmonary disease
care for someone with PD - Answers -run fast and warm (cold causes cramping)
-run it for 20, sit for 20, and let it drain -> mL should be atleast what you put in, if not more
*turn pts side to side
-pt should be semi-fowlers and never laying flat (impedes RR and airflow due to fluid pressure in
body)
what are the complications of PD? - Answers -INFECTION-> PERITONITIS (cloudy urine, crystallized,
etc.)
-hernia: pushing PD into abd and weakens the wall -> at risk for hernia
HD - Answers -removes blood waste, protein, excess fluid, & restores acid/base, electrolytes
-machine outside of body
what are some HD access? - Answers -Subclavian or femoral -> temporary vascath
-has heparin flush port
-if femoral-> check peripheal pulses
-external AV shunt - U shape-> at risk for infection
-interanal AV shunt -> hear bruit feel thrill (matures 1-2 weeks before use)
what are HD complications? - Answers 1. HYPOTENSION
2. infection
CRRT - Answers -continuous filtration
-exchange is slower: removes less volume per hour than hemodialysis-> perfect for those who cannot
handle the fluid shift or have refractory results to other interventions (critical pts)
what are the two phases of brain injury? - Answers primary: initial time of the injury
secondary: what we are concerned about -> it is the sequelae of the injury
how does decreased CO affect ICP? - Answers -decreased CO -> causes increase in ICP ( lack of blood
flow)
-think CPP (MAP-ICP) if CO decreases, MAP decreases, which causes CPP to decrease-> compensation,
brain vasodilates-> increase in cerebral blood volume-> increase ICP
How does being on the vent affect ICP? - Answers -You have forced air into the body
healthy brain: increased pressure to the brain and decreased pressure back to the heart
on vent: increased pressure to the brain, and then it hits an increase of air back to the heart
(increased ICP that way-> pressure has nowhere to go except back up)
how do we measure ICP? - Answers -pressure measured with a transducer (at the level of the mid-
ear)
-0-15mmHg
how should we place pt with a drain? - Answers - Semi-Fowler's -> helps drain without causing too
much struggle on venous return
