NUR 411-AC-Exam # 2
Exam Blueprint
Spring 2021
Exam # 2 will consist of approximately 60 questions. The test breakdown is
approximately as follows:
Nursing Care of the Client Experiencing an Alteration in Renal Function (17)
Acute Renal Failure rapid reduction in kidney function
- Occurs over a few hours – days
- Causes systemic effects/complications LIFE THREATENING
- Can result in death
Causes of AKI:
- Prerenal failure: reduced kidney perfusion
o Hypoperfusion limited perfusion
o Hypovolemia = blood loss, clotting, dehydration
o Liver failure, renal artery stenosis, MI, CAD, HF
o Sepsis, anaphylaxis, burns = trauma
o Blood pressure drugs & NSAID use (anti-inflammatory)
- Intrarenal failure: kidney tissue damage – irreversible
o Trauma damage to the vascular
o Can lead to limited perfusion also
o Drugs = chemo, antibiotics (kill functioning of kidneys =
vancomycin), calcium meds
o Thrombi, thrombotic thrombocytopenia purpura (TTP)
o Lupus, scleroderma affect the connective tissues
o Infections continuous = damages kidneys
o Ingested toxins, metals, alcohol, cocaine, pain meds
- Postrenal failure: obstruction of urine outflow
o Obstruction anything that obstructs the flow
o Cancer = bladder, cervical, colon, prostate
o Kidney stones (renal calculi) – blocks excretion
o Nerve damage, blood clots = blocks excretion
, o Prostate hypertrophy can’t get the urine out
Common Diagnostic Testing
- Creatinine addresses the muscle and protein breakdown of the
kidney function = best indicator of kidney function **
o Normal value: 0.5-1.2 mg/dL
o Will be elevated if not working properly
- BUN shows kidney’s ability to excrete urea and nitrogen
o Normal value: 10-20 mg/dL
o Will be elevated if not working properly
- Creatinine clearance measures GFR + kidney function
o Look at excretion, age, gender, height + weight
o Impact on elimination process of urine
o 24-hour diagnostic test (gallon jug w/ diff chemicals inside to
maintain the composition of the urine store in ice)
- Urinalysis identify different kidney functions
o Yellow color
o Slight odor
o Clear
o Specific Gravity = 1.005-1.030 (determines concentration)
Increased concentration = poor kidney function
o Ketones, glucose, RBCs, WBCs, casts, crystals, bilirubin, proteins
shouldn’t be in urine (or very little)
o Can see casts and crystals in the urine in the tubing
o Bacteria (E.coli), parasites, trichomonas (women)
- ABGs tells us about patient’s oxygenation
o Treatment: give Bicarb if <7.2
- CT scan give us idea of kidney’s size, masses, obstructions, etc.
- IVP Intravenous Polygram = inject a die to outline kidney structure
- Cystoscopy scope looks inside for trauma/tumors, can also dilate
- Osmolarity how many solutes are present (concentration =
hydration) – serum osmolarity = 280-300 mosm (milli-osmolarity)/kg
, Clinical Manifestations Electrolyte Imbalance
- Prerenal: Hypoperfusion
o Increased BUN, Creatinine, Urine osmolarity (^500)
o Increased Specific gravity
o Decreased urine output
o Decreased urine sodium (<20 mEq/dL = early phases)
- *** Intrarenal: Damage
o Increased BUN, Creatinine
o Increased urine sodium (>40 mEq)
o Decreased urine osmolarity (~350) but still high
o Decreased urine output, urine casts + debris
- Postrenal: Obstruction
o Increased BUN, Creatinine, urine output varies (or anuric)
o Specific gravity varies, osmolarity varies
o Urine sodium varies, <20 mEq
- Potassium: Normal: 3.5-5 mg/dL will be elevated
o Treatment: D50 + insulin, and Kayexalate = make them pee
(exchange potassium with ions = loose stools)
o < BP, < HR, EKG, tingling/numbness, weak muscles, GI issues
- Calcium: Normal: 9-10 mg/dL decreased
- Phosphorus: Normal: 3-4.5 mg/dL will be elevated
- Sodium: Normal: 135-145 mg/dL (can vary)
o Early signs confusion, weakness, seizures, weak thready
pulse, <BP
o Treatment: 3% NS IV, Vaprisol + Samsca = excrete water,
o Low sodium diet
Hallmark sign OLIGURIA
S/S of Hypocalcemia
Exam Blueprint
Spring 2021
Exam # 2 will consist of approximately 60 questions. The test breakdown is
approximately as follows:
Nursing Care of the Client Experiencing an Alteration in Renal Function (17)
Acute Renal Failure rapid reduction in kidney function
- Occurs over a few hours – days
- Causes systemic effects/complications LIFE THREATENING
- Can result in death
Causes of AKI:
- Prerenal failure: reduced kidney perfusion
o Hypoperfusion limited perfusion
o Hypovolemia = blood loss, clotting, dehydration
o Liver failure, renal artery stenosis, MI, CAD, HF
o Sepsis, anaphylaxis, burns = trauma
o Blood pressure drugs & NSAID use (anti-inflammatory)
- Intrarenal failure: kidney tissue damage – irreversible
o Trauma damage to the vascular
o Can lead to limited perfusion also
o Drugs = chemo, antibiotics (kill functioning of kidneys =
vancomycin), calcium meds
o Thrombi, thrombotic thrombocytopenia purpura (TTP)
o Lupus, scleroderma affect the connective tissues
o Infections continuous = damages kidneys
o Ingested toxins, metals, alcohol, cocaine, pain meds
- Postrenal failure: obstruction of urine outflow
o Obstruction anything that obstructs the flow
o Cancer = bladder, cervical, colon, prostate
o Kidney stones (renal calculi) – blocks excretion
o Nerve damage, blood clots = blocks excretion
, o Prostate hypertrophy can’t get the urine out
Common Diagnostic Testing
- Creatinine addresses the muscle and protein breakdown of the
kidney function = best indicator of kidney function **
o Normal value: 0.5-1.2 mg/dL
o Will be elevated if not working properly
- BUN shows kidney’s ability to excrete urea and nitrogen
o Normal value: 10-20 mg/dL
o Will be elevated if not working properly
- Creatinine clearance measures GFR + kidney function
o Look at excretion, age, gender, height + weight
o Impact on elimination process of urine
o 24-hour diagnostic test (gallon jug w/ diff chemicals inside to
maintain the composition of the urine store in ice)
- Urinalysis identify different kidney functions
o Yellow color
o Slight odor
o Clear
o Specific Gravity = 1.005-1.030 (determines concentration)
Increased concentration = poor kidney function
o Ketones, glucose, RBCs, WBCs, casts, crystals, bilirubin, proteins
shouldn’t be in urine (or very little)
o Can see casts and crystals in the urine in the tubing
o Bacteria (E.coli), parasites, trichomonas (women)
- ABGs tells us about patient’s oxygenation
o Treatment: give Bicarb if <7.2
- CT scan give us idea of kidney’s size, masses, obstructions, etc.
- IVP Intravenous Polygram = inject a die to outline kidney structure
- Cystoscopy scope looks inside for trauma/tumors, can also dilate
- Osmolarity how many solutes are present (concentration =
hydration) – serum osmolarity = 280-300 mosm (milli-osmolarity)/kg
, Clinical Manifestations Electrolyte Imbalance
- Prerenal: Hypoperfusion
o Increased BUN, Creatinine, Urine osmolarity (^500)
o Increased Specific gravity
o Decreased urine output
o Decreased urine sodium (<20 mEq/dL = early phases)
- *** Intrarenal: Damage
o Increased BUN, Creatinine
o Increased urine sodium (>40 mEq)
o Decreased urine osmolarity (~350) but still high
o Decreased urine output, urine casts + debris
- Postrenal: Obstruction
o Increased BUN, Creatinine, urine output varies (or anuric)
o Specific gravity varies, osmolarity varies
o Urine sodium varies, <20 mEq
- Potassium: Normal: 3.5-5 mg/dL will be elevated
o Treatment: D50 + insulin, and Kayexalate = make them pee
(exchange potassium with ions = loose stools)
o < BP, < HR, EKG, tingling/numbness, weak muscles, GI issues
- Calcium: Normal: 9-10 mg/dL decreased
- Phosphorus: Normal: 3-4.5 mg/dL will be elevated
- Sodium: Normal: 135-145 mg/dL (can vary)
o Early signs confusion, weakness, seizures, weak thready
pulse, <BP
o Treatment: 3% NS IV, Vaprisol + Samsca = excrete water,
o Low sodium diet
Hallmark sign OLIGURIA
S/S of Hypocalcemia
