Nur 195 Test 1 Questions And 100% Correct An
p p p p p p p pp
swers
NursingpProcessp-pRenalpFailurep-
pANSWERp•pAssessmentp•pNursingpDiagnosisp/pOutcomesp•pPlanning
Implementation-renalpfailurep-pANSWERpMonitorpfluidpbalancep-pAdministerpmedications-
pMonitorplabpvaluesp-pMouthpcare-pSkinpcarep-pImpactponpindividual,pfamilypandpcommunity
Hemodialysisp -p ANSWERp Usesp ap dialyzingp membranep unit
Requirespvascularpaccess
-AVpshuntporpfistulap(arteriovenous)
-bruit
Peritonealpdialysisp-pANSWERpHighlypvascularpperitoneumpservespaspdialyzingpmembrane
Donepdaily-pPeritonealpcatheterp-pCanpleadptophighpglucosep-pMorepfreedomp-
pLesspdietaryprestriction
hemodialysisp-pANSWERp3x/week-pVascularpaccessp-pEfficient,pfastpclearance-
pPutspheavypdemandponpequipmentp-pLesspproteinplostp-pContributestopanemia
complicationspofphemodialysisp-pANSWERpInfection/clottingpofpvascularpaccess-
pHypotensionp-pMusclepcramps-pBloodplossp-pSepsis
ComplicationspofpPeritonealpDialysis-ANSWERpInfectionpofpexitpsitep-pPeritonitisp-
pAbdominalppainp-pLowerpbackppain-pBleeding-pProtein ploss
,Kidneyptransplantppre-operativepcare-ANSWERpEmotionalpandpphysicalppreparation
• Immunosuppressivep drugsp •p EKG,p CXR,p Bloodp tests
Post-kidneyptransplant-
ANSWERpMonitorpoutputp/pfluidpretention•pMonitorpelectrolytes,pBUN,pcreatinine,pCBCp•pO
bservepforpS/Spofprejection,pMonitorpforpS/Spofpinfection
glomularpfiltrationp-pANSWERpFirstpsteppinpthepprocesspofpurinepformation.
• GlomerularpFiltrationpRatep(GFR)pispthepvolumepofpplasmap(filtrate)pfilteredpperpminute,
normalp120mL/min.
• Efficientpfiltrationpdependsponpadequatepbloodpflowptopmaintainpconsistentppressure.
• Factorspaffectingpbloodpflow:phypotension,pdecreasedponcoticppressurepandpincreased
tubularppressurepfrompanpobstruction
• Aminopacidsp(proteinuria)pandpglucosep(glycosuria)pinpthepurinepindicatespglomerular
disorders.
TubularpReabsorptionp-pANSp•Thepsecondpprocesspinpthepformationpofpurine
• Filtratepmovespthroughptubules,pfiltratepispaltered;p45pgallonspofpfiltratepispfilteredpeach
day.
• 99%pofpwhatpispfilteredpispreturnedptopthepblood.
• Substancespreabsorbed:psodium,pchloride,pbicarbonate,ppotassium,pglucose,
creatinine,p andp uricp acid
• Selectivepreabsorptionpmaintainspacid-basepandpelectrolytepbalance
TubularpSecretionp-pANSp•Thepthirdpprocesspinpthepformationpofpurine.
• Collectingpsystempinptheptubulespispwherepconcentrationpandpsecretionpofpurineptakes
place.p(1000-1500pmLpperpday)
• Dailypminimump500pmLpu/opisprequiredptopexcretepenoughpsoluteploadptopkeeppwaste
productspdownpinpthepblood.
• Urinepflowspfromprenalppelvispintopthepureterspandpwithpsmoothpmusclepperistalsis,
,movespintopthepbladderp(holdsp300-500mL)pforpstorage.
UrinepStoragep-
pANSWERpBladder:papmuscularpsacpwithpstretchpreceptors;panatomicpcapacityp1500-
2000pmL,pfunctionalpcapacityp350pmL
Sympatheticpandpparasympatheticpinnervationpandpreflexes
Detrusorpmusclepcontractionpresultspinpmicturation;poncepcompleted,ppressurepdropspa
ndpeffluxpofpurinepresumesptopreplacepurinepinpbladder.pResidualpurinepvolumep50pmL.pU
rethrapispoutletpthatpcarriespurineptopexternalpmeatus.
Bladderpfillingppressurepmustpbeplowpsopthatpurinepmaypeasilypexitptheprenalppelvis.
Whichpofpthepfollowingpbestpdescribespthepglomerulus?p-
pANSWER pThepclusterpofpcapillariespwherepfiltration ptakespplace.
Osmolarityp(L)pandpOsmolalityp(kg)p-pANSWERp•Concentrationpratiopofpsolute-
substancesptopwater
• Oneplitrepliquidpispequalptoponepkilogram,psamepexaminations
• Isotonic,pHypertonicpandpHypotonicparepusedpforposmolarity.
• Controlpsaltpandpwaterptopmaintainposmolarity.
• Verypnarrowprange:pwithpjustpapmodestprisepinpsolutes,pthepsensationpofpthirstpisptriggered
alongpwithpapurinepexcretionpthatpminimizespwaterplosspfrompthepkidneys.
• Impairedpcognitionpresultspinpanpinabilityptoprehydratepwhichpresultspinpdehydration.
Whichpofpthepfollowingpisptrueporpfalse?
Aphypotonicpsolutionpwouldpcontainpfewerpmoleculespandpmorepwaterpthanpblood.p-
ANSWERp•True
Rationale:pAphypotonicpsolutionphaspfewerpmoleculespandpmorepwaterpinpthepsolution,pless
, thanp275pmOsm/Lpcomparedptopthepnormalposmolalitypofpthepblood,pwhichpispbetweenp275pt
op295pmOsm/kgpofpbodypweight.
AssessmentpofpthepPatient
withpUrinarypTractpDysfunctionp-pANSWERp•HealthpHistory:pRiskpfactors
• Chiefpcomplaints:
-Fatigue,pshortpofpbreath
-Pain
-Changesp inp Voiding
-GIp symptoms,p mimicsp GIp disorders
• Familyp andp Socialp History
Physicalp p Examination-p p Head-to-Toe
• Kidneyppalpation
• Abdominalpinspection,pauscultation,ppalpation,pandppercussion
• Bladderppalpationpandppercussion
• Palpationpofpthepprostatepandpinguinalpareap(males)
• Inspectionpandppalpationpofpthepfemalepgenitalia
• Assessmentp forp edemap andp bodyp weight
• Assessmentpofplowerpextremities
howptoppalpatepkidneysp-pANSWERpunderpthep12thpribpandpcostovertebralpangle
GerontologicpConsiderationsp-
pANSWER p•Structural pandpfunctionalpchangespinpupperpandplowerpurinaryptract
• Steadyp decreasep inp GFRp andp renalp reserve
• Proneptopacutepandpchronicprenalpfailure
• Increasedpriskpforpadversepdrugpreactions
p p p p p p p pp
swers
NursingpProcessp-pRenalpFailurep-
pANSWERp•pAssessmentp•pNursingpDiagnosisp/pOutcomesp•pPlanning
Implementation-renalpfailurep-pANSWERpMonitorpfluidpbalancep-pAdministerpmedications-
pMonitorplabpvaluesp-pMouthpcare-pSkinpcarep-pImpactponpindividual,pfamilypandpcommunity
Hemodialysisp -p ANSWERp Usesp ap dialyzingp membranep unit
Requirespvascularpaccess
-AVpshuntporpfistulap(arteriovenous)
-bruit
Peritonealpdialysisp-pANSWERpHighlypvascularpperitoneumpservespaspdialyzingpmembrane
Donepdaily-pPeritonealpcatheterp-pCanpleadptophighpglucosep-pMorepfreedomp-
pLesspdietaryprestriction
hemodialysisp-pANSWERp3x/week-pVascularpaccessp-pEfficient,pfastpclearance-
pPutspheavypdemandponpequipmentp-pLesspproteinplostp-pContributestopanemia
complicationspofphemodialysisp-pANSWERpInfection/clottingpofpvascularpaccess-
pHypotensionp-pMusclepcramps-pBloodplossp-pSepsis
ComplicationspofpPeritonealpDialysis-ANSWERpInfectionpofpexitpsitep-pPeritonitisp-
pAbdominalppainp-pLowerpbackppain-pBleeding-pProtein ploss
,Kidneyptransplantppre-operativepcare-ANSWERpEmotionalpandpphysicalppreparation
• Immunosuppressivep drugsp •p EKG,p CXR,p Bloodp tests
Post-kidneyptransplant-
ANSWERpMonitorpoutputp/pfluidpretention•pMonitorpelectrolytes,pBUN,pcreatinine,pCBCp•pO
bservepforpS/Spofprejection,pMonitorpforpS/Spofpinfection
glomularpfiltrationp-pANSWERpFirstpsteppinpthepprocesspofpurinepformation.
• GlomerularpFiltrationpRatep(GFR)pispthepvolumepofpplasmap(filtrate)pfilteredpperpminute,
normalp120mL/min.
• Efficientpfiltrationpdependsponpadequatepbloodpflowptopmaintainpconsistentppressure.
• Factorspaffectingpbloodpflow:phypotension,pdecreasedponcoticppressurepandpincreased
tubularppressurepfrompanpobstruction
• Aminopacidsp(proteinuria)pandpglucosep(glycosuria)pinpthepurinepindicatespglomerular
disorders.
TubularpReabsorptionp-pANSp•Thepsecondpprocesspinpthepformationpofpurine
• Filtratepmovespthroughptubules,pfiltratepispaltered;p45pgallonspofpfiltratepispfilteredpeach
day.
• 99%pofpwhatpispfilteredpispreturnedptopthepblood.
• Substancespreabsorbed:psodium,pchloride,pbicarbonate,ppotassium,pglucose,
creatinine,p andp uricp acid
• Selectivepreabsorptionpmaintainspacid-basepandpelectrolytepbalance
TubularpSecretionp-pANSp•Thepthirdpprocesspinpthepformationpofpurine.
• Collectingpsystempinptheptubulespispwherepconcentrationpandpsecretionpofpurineptakes
place.p(1000-1500pmLpperpday)
• Dailypminimump500pmLpu/opisprequiredptopexcretepenoughpsoluteploadptopkeeppwaste
productspdownpinpthepblood.
• Urinepflowspfromprenalppelvispintopthepureterspandpwithpsmoothpmusclepperistalsis,
,movespintopthepbladderp(holdsp300-500mL)pforpstorage.
UrinepStoragep-
pANSWERpBladder:papmuscularpsacpwithpstretchpreceptors;panatomicpcapacityp1500-
2000pmL,pfunctionalpcapacityp350pmL
Sympatheticpandpparasympatheticpinnervationpandpreflexes
Detrusorpmusclepcontractionpresultspinpmicturation;poncepcompleted,ppressurepdropspa
ndpeffluxpofpurinepresumesptopreplacepurinepinpbladder.pResidualpurinepvolumep50pmL.pU
rethrapispoutletpthatpcarriespurineptopexternalpmeatus.
Bladderpfillingppressurepmustpbeplowpsopthatpurinepmaypeasilypexitptheprenalppelvis.
Whichpofpthepfollowingpbestpdescribespthepglomerulus?p-
pANSWER pThepclusterpofpcapillariespwherepfiltration ptakespplace.
Osmolarityp(L)pandpOsmolalityp(kg)p-pANSWERp•Concentrationpratiopofpsolute-
substancesptopwater
• Oneplitrepliquidpispequalptoponepkilogram,psamepexaminations
• Isotonic,pHypertonicpandpHypotonicparepusedpforposmolarity.
• Controlpsaltpandpwaterptopmaintainposmolarity.
• Verypnarrowprange:pwithpjustpapmodestprisepinpsolutes,pthepsensationpofpthirstpisptriggered
alongpwithpapurinepexcretionpthatpminimizespwaterplosspfrompthepkidneys.
• Impairedpcognitionpresultspinpanpinabilityptoprehydratepwhichpresultspinpdehydration.
Whichpofpthepfollowingpisptrueporpfalse?
Aphypotonicpsolutionpwouldpcontainpfewerpmoleculespandpmorepwaterpthanpblood.p-
ANSWERp•True
Rationale:pAphypotonicpsolutionphaspfewerpmoleculespandpmorepwaterpinpthepsolution,pless
, thanp275pmOsm/Lpcomparedptopthepnormalposmolalitypofpthepblood,pwhichpispbetweenp275pt
op295pmOsm/kgpofpbodypweight.
AssessmentpofpthepPatient
withpUrinarypTractpDysfunctionp-pANSWERp•HealthpHistory:pRiskpfactors
• Chiefpcomplaints:
-Fatigue,pshortpofpbreath
-Pain
-Changesp inp Voiding
-GIp symptoms,p mimicsp GIp disorders
• Familyp andp Socialp History
Physicalp p Examination-p p Head-to-Toe
• Kidneyppalpation
• Abdominalpinspection,pauscultation,ppalpation,pandppercussion
• Bladderppalpationpandppercussion
• Palpationpofpthepprostatepandpinguinalpareap(males)
• Inspectionpandppalpationpofpthepfemalepgenitalia
• Assessmentp forp edemap andp bodyp weight
• Assessmentpofplowerpextremities
howptoppalpatepkidneysp-pANSWERpunderpthep12thpribpandpcostovertebralpangle
GerontologicpConsiderationsp-
pANSWER p•Structural pandpfunctionalpchangespinpupperpandplowerpurinaryptract
• Steadyp decreasep inp GFRp andp renalp reserve
• Proneptopacutepandpchronicprenalpfailure
• Increasedpriskpforpadversepdrugpreactions
