NUR 276 FINAL EXAM QUESTIONS WITH COMPLETE
SOLUTIONS
4 types of stressors and examples Correct Answer 1. Acute
and time limited (roller coaster ride, nursing final exams)
2. Sequential events following an initial stressor (losing a job
and subsequently filing for bankruptcy)
3. Chronic intermittent (strained relationship with in-laws,
shared caretaking for an elderly parent)
4. Chronic permanent (paralysis, disability such as blindness or
deafness)
Actual loss Correct Answer Loss that is identified and
recognized by others
1. Loss of a spouse
Acute Renal Failure Correct Answer i. major trauma or
surgery, infection, hemorrhage, severe heart failure, severe liver
disease, and lower urinary tract obstruction
ii. Drugs and radiological contrast media that are toxic to the
kidney also increase the risk for ARF.
iii. Older adults develop ARF more frequently because of their
higher incidence of serious illness: hypotension, major surgeries,
diagnostic procedures, and treatment with nephrotoxic drugs.
Decrease in kidney function associated with aging also puts
older adults at greater risk for kidney failure.
iv. The child with renal insufficiency (decrease in the kidneys'
ability to conserve sodium and concentrate the urine) is at
greater risk for fluid loss with illness. In cases of acute
gastrointestinal (GI) illness, these children are at greater risk for
dehydration and ARF
,Lab values: proteinuria, specific gravity outside of 1.005-1.025,
decreased RBCs/moderate anemia/low hematocrit, elevated
creatinine and BUN, elevated potassium, metabolic acidosis
Acute renal failure Correct Answer Rapid decline in renal
function with azotemia, electrolyte imbalances
Acute kidney injury is the more accurate term
Most common causes of acute renal failure: ischemia, exposure
to nephrotoxins
Prerenal failure: most common type, results from conditions that
affect renal blood flow and perfusion (trauma, surgery, critically
ill patients, hypotension) reverses rapidly when blood flow is
restored
Post renal ARF: obstructive causes (any condition that prevents
urine excretion)
BPH most common precipitating factor, renal tumors, urinary
tract caluli. Children may have oliguria or normal or increased
urine output
Without oliguria= less severe injury
Intrinsic ARF: acute damage to renal parenchyma and nephrons
Caused by kidney disease, acute tubular necrosis
Acute glomerulonephritis: inflammation reduces renal blood
flow, causes ARF. Vascular disorders affecting kidneys can
damage nephrons, result in ARF
,Nursing interventions ARF: Maintain fluid and electrolyte
balance, identify underlying cause, prevent additional damage,
restore urine output/kidney function, compensate for renal
impairment. Interdisciplinary approach/nutritional support
Diagnostic tests: urinalysis, specific gravity, proteinuria,
presence of RBCs, cell casts, serum creatinine, BUN levels,
electrolytes, ABGs, CBC
Pharmacologic therapy: dopamine, loop diuretics, osmotic
diuretics, electrolytes, electrolyte modifiers, blood volume
expanders, IV fluids, GI drugs, discontinue nephrotoxic drugs,
adjust drug dosages because elimination slowed, drug half-life
prolonged in ARF
Fluid management: restrict fluids, monitor fluid balance, initial
emergency treatment of children with fluid depletion, rapid fluid
replacement with IV fluid
nutritional management: limit protein to 0.6 g/kg, increase
carbohydrates, parenteral nutrition as necessary
hemodialysis: r
Acute Renal Failure Nursing Management Correct Answer
Maintain hourly I&Os
Weigh client daily
vital signs q 4 hours
breath sounds, heart sounds
assess for JVD, edema
semi-Fowler position
, report abnormal electrolyte values
turn client frequently
skin care
restrict fluids as ordered
administer medications with meals
address nutrition imblanaces
administer antiemetics
client teaching (avoid nephrotoxic drugs)
Acute Stress Disorder Correct Answer i. Individual
experiencing, learning of, or witnessing an extremely stressful
event that involves the threat of death, actual or threatened
serious injury, or actual physical or sexual violation
ii. Symptoms
1. Sense of numbing or detachment
2. Altered sense of reality
3. Inability to remember some aspect of the trauma
4. Spontaneous memories of the event
5. Recurrent distressing dreams
6. Intense or prolonged psychological distress
7. Persistent and effortful avoidance of thoughts and places
reminiscent of the event
iii. Disturbance must cause clinically significant distress in
important areas of functioning, not attributable to drugs, medical
condition, or a psychotic disorder
Anemia nonpharmacological treatment: Correct Answer a.
Nutritional deficiencies: diet modifications such as addition of
iron, B12, or folic acid.
SOLUTIONS
4 types of stressors and examples Correct Answer 1. Acute
and time limited (roller coaster ride, nursing final exams)
2. Sequential events following an initial stressor (losing a job
and subsequently filing for bankruptcy)
3. Chronic intermittent (strained relationship with in-laws,
shared caretaking for an elderly parent)
4. Chronic permanent (paralysis, disability such as blindness or
deafness)
Actual loss Correct Answer Loss that is identified and
recognized by others
1. Loss of a spouse
Acute Renal Failure Correct Answer i. major trauma or
surgery, infection, hemorrhage, severe heart failure, severe liver
disease, and lower urinary tract obstruction
ii. Drugs and radiological contrast media that are toxic to the
kidney also increase the risk for ARF.
iii. Older adults develop ARF more frequently because of their
higher incidence of serious illness: hypotension, major surgeries,
diagnostic procedures, and treatment with nephrotoxic drugs.
Decrease in kidney function associated with aging also puts
older adults at greater risk for kidney failure.
iv. The child with renal insufficiency (decrease in the kidneys'
ability to conserve sodium and concentrate the urine) is at
greater risk for fluid loss with illness. In cases of acute
gastrointestinal (GI) illness, these children are at greater risk for
dehydration and ARF
,Lab values: proteinuria, specific gravity outside of 1.005-1.025,
decreased RBCs/moderate anemia/low hematocrit, elevated
creatinine and BUN, elevated potassium, metabolic acidosis
Acute renal failure Correct Answer Rapid decline in renal
function with azotemia, electrolyte imbalances
Acute kidney injury is the more accurate term
Most common causes of acute renal failure: ischemia, exposure
to nephrotoxins
Prerenal failure: most common type, results from conditions that
affect renal blood flow and perfusion (trauma, surgery, critically
ill patients, hypotension) reverses rapidly when blood flow is
restored
Post renal ARF: obstructive causes (any condition that prevents
urine excretion)
BPH most common precipitating factor, renal tumors, urinary
tract caluli. Children may have oliguria or normal or increased
urine output
Without oliguria= less severe injury
Intrinsic ARF: acute damage to renal parenchyma and nephrons
Caused by kidney disease, acute tubular necrosis
Acute glomerulonephritis: inflammation reduces renal blood
flow, causes ARF. Vascular disorders affecting kidneys can
damage nephrons, result in ARF
,Nursing interventions ARF: Maintain fluid and electrolyte
balance, identify underlying cause, prevent additional damage,
restore urine output/kidney function, compensate for renal
impairment. Interdisciplinary approach/nutritional support
Diagnostic tests: urinalysis, specific gravity, proteinuria,
presence of RBCs, cell casts, serum creatinine, BUN levels,
electrolytes, ABGs, CBC
Pharmacologic therapy: dopamine, loop diuretics, osmotic
diuretics, electrolytes, electrolyte modifiers, blood volume
expanders, IV fluids, GI drugs, discontinue nephrotoxic drugs,
adjust drug dosages because elimination slowed, drug half-life
prolonged in ARF
Fluid management: restrict fluids, monitor fluid balance, initial
emergency treatment of children with fluid depletion, rapid fluid
replacement with IV fluid
nutritional management: limit protein to 0.6 g/kg, increase
carbohydrates, parenteral nutrition as necessary
hemodialysis: r
Acute Renal Failure Nursing Management Correct Answer
Maintain hourly I&Os
Weigh client daily
vital signs q 4 hours
breath sounds, heart sounds
assess for JVD, edema
semi-Fowler position
, report abnormal electrolyte values
turn client frequently
skin care
restrict fluids as ordered
administer medications with meals
address nutrition imblanaces
administer antiemetics
client teaching (avoid nephrotoxic drugs)
Acute Stress Disorder Correct Answer i. Individual
experiencing, learning of, or witnessing an extremely stressful
event that involves the threat of death, actual or threatened
serious injury, or actual physical or sexual violation
ii. Symptoms
1. Sense of numbing or detachment
2. Altered sense of reality
3. Inability to remember some aspect of the trauma
4. Spontaneous memories of the event
5. Recurrent distressing dreams
6. Intense or prolonged psychological distress
7. Persistent and effortful avoidance of thoughts and places
reminiscent of the event
iii. Disturbance must cause clinically significant distress in
important areas of functioning, not attributable to drugs, medical
condition, or a psychotic disorder
Anemia nonpharmacological treatment: Correct Answer a.
Nutritional deficiencies: diet modifications such as addition of
iron, B12, or folic acid.
