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D236 PATHOPHYSIOLOGY EXAM LATEST 2023/WGU PATHOPHYSIOLOGY LATEST EXAM -STUDY GUIDE-WITH 100% VERIFIED ANSWERS-2023 LESSON 1- LESSSON 12 LESSON 1

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D236 PATHOPHYSIOLOGY EXAM LATEST 2023/WGU PATHOPHYSIOLOGY LATEST EXAM -STUDY GUIDE-WITH 100% VERIFIED ANSWERS-2023 LESSON 1- LESSSON 12 LESSON 1 1. What is Starling's Law of Capillary forces? How does this explain why a nutritionally deficient child would have edema? Starling’s Law describes how fluids move across the capillary membrane. There are two major opposing forces that act to balance each other, hydrostatic pressure (pushing water out of the capillaries) and osmotic pressure (including oncontic pressure, which pushes fluid into the capillaries). Both electrolytes and proteins (oncontic pressure) in the blood affect osmotic pressure, high electrolyte and protein concentrations in the blood would cause water to leave the cells and interstitial space and enter the blood stream to dilute the high concentrations. On, the other hand, low electrolyte and protein concentrations (as seen in a nutritionally deficient child) would cause water to leave the capillaries and enter the cells and interstitial fluid which can lead to edema. 2. How does the RAAS (Renin-Angiotensin-Aldosterone System) result in increased blood volume and increased blood pressure? A drop in blood pressure is sensed by the kidneys by low perfusion, which in turn begins to secrete renin. Renin then triggers the liver to produce angiotensinogen, which is converted to Angiotensin I in the lungs and then angiotensin II by the enzyme Angiotensin-converting enzyme (ACE). Angiotensin II stimulates peripheral arterial vasoconstriction which raises BP. Angiotensin II is also stimulating the adrenal gland to release aldosterone, which acts to increase sodium and water reabsorption increasing blood volume, while also increased potassium secretion in urine. 3. How can hyperkalemia lead to cardiac arrest? Normal levels of potassium are between 3.5 and 5.2 mEq/dL. Hyperkalemia refers to potassium levels higher that 5.2 mEq/dL. A major function of potassium is to conduct nerve impulses in muscles. Too low and muscle weakness occurs and too much can cause muscle spasms. This is especially dangerous in the heart muscle and an irregular heartbeat can cause a heart attack. 4. The body uses the Protein Buffering System, Phosphate Buffering System, and Carbonic Acid-Bicarbonate System to regulate and maintain homeostatic pH, what is the consequence of a pH imbalance? Proteins contain many acidic and basic group that can be affected by pH changes. Any increase or decrease in blood pH can alter the structure of the protein (denature), thereby affecting its function as well. 5. Describe the laboratory findings associated with metabolic acidosis, metabolic alkalosis, respiratory acidosis and respiratory alkalosis. (ie relative pH and CO2 levels). 2 3 Normal ABGs (Arterial Blood Gases) Blood pH: 7.35-7.45 PCO2: 35-45 mm Hg PO2: 90-100 mm Hg HCO3-: 22-26 mEq/L SaO2: 95-100% Respiratory acidosis and alkalosis are marked by changes in PCO2. Higher = acidosis and lower = alkalosis Metabolic acidosis and alkalosis are caused by something other than abnormal CO2 levels. This could include toxicity, diabetes, renal failure or excessive GI losses. Here are the rules to follow to determine if is respiratory or metabolic in nature. -If pH and PCO2 are moving in opposite directions, then it is the pCO2 levels that are causing the imbalance and it is respiratory in nature. -If PCO2 is normal or is moving tin the same direction as the pH, then the imbalance is metabolic in nature. 6. The anion gap is the difference between measured cations (Na+ and K+) and measured anions (Cl- and HCO3-), this calculation can be useful in determining the cause of metabolic acidosis. Why would an increased anion gap be observed in diabetic ketoacidosis or lactic acidosis? The anion gap is the calculation of unmeasured anions in the blood. Lactic acid and ketones both lead to the production of unmeasured anions, which remove HCO3- (a measured anion) due to buffering of the excess H+ and therefore leads to an increase in the AG. 7. Why is it important to maintain a homeostatic balance of glucose in the blood (ie describe the pathogenesis of diabetes)? Insulin is the hormone responsible for initiating the uptake of glucose by the cells. Cells use glucose to produce energy (ATP). In a normal individual, when blood glucose increases, the pancreas is signaled to produced in insulin, which binds to insulin receptors on a cells surface and initiates the uptake of glucose. Glucose is a very reactive molecule and if left in the blood, it can start to bind to other proteins and lipids, which can lead to loss of function. AGEs are advanced glycation end products that are a result of glucose reacting with the endothelial lining, which can lead to damage in the heart and kidneys. 8. Compare and contrast Type I and Type II Diabetes Type I diabetes is caused by lack of insulin. With out insulin signaling, glucose will not be taken into the cell and leads to high blood glucose (hyperglycemia). Type I is usually treated with insulin injections. Type II diabetes is caused by a desensitization to insulin signaling. The insulin receptors are no longer responding to insulin, which also leads to hyperglycemia. Type II is usually treated with drugs to increase the sensitization to insulin (metformin), dietary and life-style changes or insulin injections. 9. Describe some reasons for a patient needing dialysis AEIOUacidosis. Electrolytes, Intoxication/Ingestion, overload, uremia. Patients with kidney or heart failure. A build up of phosphates, urea and magnesium are removed from the blood using a semipermeable membrane and dialysate. AEIOU: A—acidosis; E —electrolytes principally hyperkalemia; I—ingestions or overdose of medications/drugs; O—overload of fluid causing heart failure; U—uremia leading to encephalitis/pericarditis. 10. Compare and contrast hemodialysis and peritoneal dialysis. What are some reasons for a patient choosing one over the other? Hemodialysis uses a machine to pump blood from the body in one tube while dialysate (made of water, electrolytes and salts) is pumped in the separate tube in the opposite direction. Waste from the blood diffuses through the semipermeable membrane separating the blood from the dialysate. Peritoneal Dialysis does not use a machine, but instead injects a solution of water 4 and glucose into the abdominal cavity. The peritoneum acts as the membrane instead of dialysis tubing. The waste products diffuse into the abdominal cavity and the waste solution is then drained from the body. Peritoneal dialysis offers continuous filtration and is less disruption to the patient’s daily routines. However, it does require some training of the patient and is not recommended for individuals who are overweight or have severe kidney failure. Hemodialysis provides medical care, but 3 times a week for several hours sitting at a hospital or clinic. Individuals with acute kidney failure are recommended to use hemo

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DaVita (RN) FINAL REAL EXAM QUESTIONS AND 100%
VERIFIED ANSWERS 2022/2023 UPDATE




When dialyzing a patient with acute kidney injury, one task of the patient care
teammates is to monitor blood pressure and weight closely. Why is it important? --
ANSWER---hypovolemia and hypotensive episodes can cause renal ischemia and can
further damage the kidneys

CKD can have its orgin pre-renal , intra-renalm or post renal. Which of the following
conditions is an intra-renal cause of CKD ---ANSWER---HTN

Knowing what caused your patient's CKD ---ANSWER---is important because the
underlying disease could cause health complications that can impact the dialysis
treatment

When a PCT documents the extent of a patient's edema, for example as +3 --
ANSWER---the PCT is preforming an assessment which is not allowed legally
-


When a patient has an irregular heartbeat, ---ANSWER---the automatic BP reading may
not be accurate

Which of the following is a data collection ---ANSWER---HR 72

at what time should the post treatment data collection be completed ---ANSWER---after
the treatment has been completed

the A in smart communication stands for ---ANSWER---actual- just report the facts

which of the following events is defined as a near miss ---ANSWER---the wrong dialyzer
was set up and primed for a patient, but it was caught before dialysis was initiated and
the dialyzer was replaced

using the __________ approach is one way to fill out an REM ---ANSWER---SBAR

What is your main priority when returning a patient's blood with the hand crank during a
power outage? ---ANSWER---you must be vigilant in watching for air in the blood lines


1

, what problem will cause an increase in the patient's VP ---ANSWER---a clot in the
venous drip chamber

Which blood test must be performed at regular intervals on patients susceptible to HPB
---ANSWER---HBsAg

who is accountable for appropriate patient and teammate scheduling in the acute setting
---ANSWER---

you are dialyzing a patient and the only available HPB surveillance test is a HBsAb of 8.
What are the machine disinfection requirements after dialyzing this patient? ---
ANSWER---the machine must be heat disinfected at the end of each day

What is the most common factor contributing to bacteremia in dialysis patients? ---
ANSWER---use of catheters for HD

which infectious disease requires frequent hand washing instead of using alcohol based
hand gels ---ANSWER---active clostridioides difficile infection

What precautions must be used when handling lab specimens? ---ANSWER---universal
precautions

waiting only five seconds between lowering the blood pump speed and drawing the post
treatment blood sample could ---ANSWER---cause the post treatment BUN reading to
be falsely low (wait 15 seconds)

which may cause a decrease in the hemoglobin of a patient with ESRD ---ANSWER---
infection/inflammation

fluid overload and HTN lead to LVH, this means ---ANSWER---hypotensive episodes
are more likely to occur during the dialysis treatment

your role in CKD-MBD management includes ---ANSWER---reminding the patient who
is eating a snack during dialysis to take his phosphate binder

your role in anemia management includes ---ANSWER---rinsing back as much of the
patient's blood as you can at the termination of each treatment

the licensed nurse has delegated a specific task to a PCT, but the PCT gets called away
before performing this task. Can the PCT asek another PCT to take over? --ANSWER---



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