NSG 302- Exam 2 Practice Questions
All Answers Solved Correctly.
Acute Kidney Injury (AKI) - Answer sudden, rapid loss of renal function due to damage to the
kidneys; formerly called acute renal failure
AKI category- Prerenal (before kidneys) - Answer Decrease blood flow to the kidneys
(hypoperfusion)
Hypovolemia
-Severe dehydration
-Heart failure (decreased cardiac output).
-Burns (volume depletion and dehydration. With no skin, no fluids).
-Hemorrhage
-Severe diarrhea and extreme vomiting (hyperemesis)
-Septic shock/ hypotension
Vasoconstriction to renal arteries (stenosis).
-Clots
AKI category- Intrarenal/ intrinsic (inside kidney) - Answer - Polycystic kidney: an inherited
disorder in which clusters of cysts develop primarily within your kidneys, causing your kidneys
to enlarge and lose function over time
- Contrast media (nephrotoxic medications)
AKI category- postrenal - Answer Obstruction
-Trying to excrete urine but goes back up.
-Benign prostatic hyperplasia- urinary retention, bladder pain, dribbling
Biopsy, Prostate surface antigen (bloodwork. Tells you if it's cancer or BPH).
-Trauma- cause structural damage (no bleeding).
- Cancer
- Pregnancy- pressure to bladder or ureter
- Ureter stretchers
AKI phase: initiation - Answer initiation of kidney injury
AKI phase: oliguria - Answer - Decreased urine output (less than 400 ml per day)
- Bladder and stomach pain
,- Distended neck vein, bounding pulse
- Pulmonary edema, crackles
- Hyponatremia (because holding on to a lot of fluids). Hyperkalemia
o Confusion, headache, EKG changes (elevated T waves in hyperkalemia).
- Hyperphosphatemia and Hypocalcemia
o Twitching
- Renal function starts to go down. BUN and creatine go up.
o Creatine is more reliable because more sensitive. Kidney excretes but doesn't reabsorb.
o BUN is highly influenced by hydration and food.
AKI phase: diuresis - Answer - Patient is starting to pee more (not a lot but more than when
they were in the oliguric phase).
- BUN and creatine may start stabilizing but peeing too much can lead to dehydration, so BUN
and creatine can stay high (maybe even get worse but doesn't always mean kidneys are getting
worse).
If AKI is worse, wouldn't be in the diuresis phase.
AKI phase: recovery - Answer - BUN, creatine, and GFR normalize.
- Takes 1-3 months to get back to baseline.
- Sometimes permanent GFR changes (depending on how severe the AKI was).
Anuria - Answer absence of urine production (less than 50 ml per day)
GFR (glomerular filtration rate) - Answer amount of plasma filter through the glomeruli
(responsible for filtration in the kidneys) in a given unit of time (normal GFR is 125
mL/min/1.73m2); the lower the GFR, the worse the condition
AKI signs/ symptoms - Answer Urine output: decrease (rarely anuric). hematuria (blood in
urine- can happen not always though)
CNS: lower mental status, sleepy, seizure, coma (change of baseline)
Electrolyte-related: hyperphosphatemia, hypocalcemia, hyperkalemia, and hyponatremia.
Pain: back or flank pain. Costovertebral angle tenderness.
Fluid volume: fluid volume excess
AKI labs and diagnostics - Answer Serum creatinine
- Most important indication. Most sensitive.
, Renal ultrasound
- To measure kidney size (structural changes),
- If not definitive, can do CT but do not use contrast
Electrolytes:
Potassium= high
Phosphorus= high
Calcium= low
Sodium= low
Hemoglobin = low Hemorrhage. Impaired erythropoietin in kidneys. anemia
AKI treatment - Answer Aim to minimize/avoid long-term loss of renal function.
Restore normal renal function.
Treat the cause:
-Prerenal= PERFUSION. treat the bleeding. Give fluids.
-Intrarenal= remove the nephrotoxic agent, treat infection,
-Post-renal= remove obstruction,
Renal replacement therapy (RRT)
- Renal dialysis (hemo, paratenial, continual, )
Pharmacologic Therapy
Hyperkalemia
- Insulin because drives potassium into cells. Also dextrose to balance (want to prevent
hypoglycemia).
- Kayexalate (side effect is diarrhea.)
Nutritional Therapy
-High-carb diet= because carb will compensate for protein. Gives the body energy and leaves
the protein to heal. If no carb, protein will be used.
-Restrict: K, phos, Na (Na because fluid retention)
- Bananas, spinach, grapefruit, kiwi, orange juice, processed fluids
All Answers Solved Correctly.
Acute Kidney Injury (AKI) - Answer sudden, rapid loss of renal function due to damage to the
kidneys; formerly called acute renal failure
AKI category- Prerenal (before kidneys) - Answer Decrease blood flow to the kidneys
(hypoperfusion)
Hypovolemia
-Severe dehydration
-Heart failure (decreased cardiac output).
-Burns (volume depletion and dehydration. With no skin, no fluids).
-Hemorrhage
-Severe diarrhea and extreme vomiting (hyperemesis)
-Septic shock/ hypotension
Vasoconstriction to renal arteries (stenosis).
-Clots
AKI category- Intrarenal/ intrinsic (inside kidney) - Answer - Polycystic kidney: an inherited
disorder in which clusters of cysts develop primarily within your kidneys, causing your kidneys
to enlarge and lose function over time
- Contrast media (nephrotoxic medications)
AKI category- postrenal - Answer Obstruction
-Trying to excrete urine but goes back up.
-Benign prostatic hyperplasia- urinary retention, bladder pain, dribbling
Biopsy, Prostate surface antigen (bloodwork. Tells you if it's cancer or BPH).
-Trauma- cause structural damage (no bleeding).
- Cancer
- Pregnancy- pressure to bladder or ureter
- Ureter stretchers
AKI phase: initiation - Answer initiation of kidney injury
AKI phase: oliguria - Answer - Decreased urine output (less than 400 ml per day)
- Bladder and stomach pain
,- Distended neck vein, bounding pulse
- Pulmonary edema, crackles
- Hyponatremia (because holding on to a lot of fluids). Hyperkalemia
o Confusion, headache, EKG changes (elevated T waves in hyperkalemia).
- Hyperphosphatemia and Hypocalcemia
o Twitching
- Renal function starts to go down. BUN and creatine go up.
o Creatine is more reliable because more sensitive. Kidney excretes but doesn't reabsorb.
o BUN is highly influenced by hydration and food.
AKI phase: diuresis - Answer - Patient is starting to pee more (not a lot but more than when
they were in the oliguric phase).
- BUN and creatine may start stabilizing but peeing too much can lead to dehydration, so BUN
and creatine can stay high (maybe even get worse but doesn't always mean kidneys are getting
worse).
If AKI is worse, wouldn't be in the diuresis phase.
AKI phase: recovery - Answer - BUN, creatine, and GFR normalize.
- Takes 1-3 months to get back to baseline.
- Sometimes permanent GFR changes (depending on how severe the AKI was).
Anuria - Answer absence of urine production (less than 50 ml per day)
GFR (glomerular filtration rate) - Answer amount of plasma filter through the glomeruli
(responsible for filtration in the kidneys) in a given unit of time (normal GFR is 125
mL/min/1.73m2); the lower the GFR, the worse the condition
AKI signs/ symptoms - Answer Urine output: decrease (rarely anuric). hematuria (blood in
urine- can happen not always though)
CNS: lower mental status, sleepy, seizure, coma (change of baseline)
Electrolyte-related: hyperphosphatemia, hypocalcemia, hyperkalemia, and hyponatremia.
Pain: back or flank pain. Costovertebral angle tenderness.
Fluid volume: fluid volume excess
AKI labs and diagnostics - Answer Serum creatinine
- Most important indication. Most sensitive.
, Renal ultrasound
- To measure kidney size (structural changes),
- If not definitive, can do CT but do not use contrast
Electrolytes:
Potassium= high
Phosphorus= high
Calcium= low
Sodium= low
Hemoglobin = low Hemorrhage. Impaired erythropoietin in kidneys. anemia
AKI treatment - Answer Aim to minimize/avoid long-term loss of renal function.
Restore normal renal function.
Treat the cause:
-Prerenal= PERFUSION. treat the bleeding. Give fluids.
-Intrarenal= remove the nephrotoxic agent, treat infection,
-Post-renal= remove obstruction,
Renal replacement therapy (RRT)
- Renal dialysis (hemo, paratenial, continual, )
Pharmacologic Therapy
Hyperkalemia
- Insulin because drives potassium into cells. Also dextrose to balance (want to prevent
hypoglycemia).
- Kayexalate (side effect is diarrhea.)
Nutritional Therapy
-High-carb diet= because carb will compensate for protein. Gives the body energy and leaves
the protein to heal. If no carb, protein will be used.
-Restrict: K, phos, Na (Na because fluid retention)
- Bananas, spinach, grapefruit, kiwi, orange juice, processed fluids
