NURS 5461 FINAL EXAM| ADULT
GERONTOLOGY MANAGEMENT ACROSS
THE CONTINUUM OF CARE ACTUAL
EXAM QUESIONS WITH ANSWERS
Most common cause of AKI
Acute tubular necrosis (ATN) followed by prerenal azotemia
Acute Tubular Necrosis (ATN)
Damage to the renal tubules due to presence of toxins in the urine or to
ischemia. Results in oliguria.
Prerenal azotemia
Due to decreased blood flow to kidneys; common cause of acute renal failure -
increase bun and decreased renal flow - treat with volume resuscitation
acute tubular necrosis diagnostic criteria
Page 1 of 59
,DIAGNOSIS: URINE SEDIMENT WILL INCLUDE TUBULAR
EPITHELIAL CELLS & GRANULAR MUDDY BROWN CASTS - in oliguria
FENa >2% - TREATMENT IS SUPPORTIVE CARE AND OFTEN TIMES
REVERSIBLE
Acute interstitial nephritis
Drug-induced hypersensitivity involving the interstitium and tubules; results in
acute renal failure (intrarenal azotemia) - most commone antibiotics to cause
this are PENICILLINS, CEPHLOSPORINS, AND FLUOROQUINOLONES
(floxacins)
multiple myeloma "myeloma kidney"
malignant neoplasm of bone marrow. Proteins light & heavy chains will deposit
in parenchyma - pt will present with lower back pain - seen AA women - will
see sever proteinurea, low anion gap, hypercalcemia, anemia, and bone pain -
treat w chemotherapy (melphalan and prednisone)
3 types of glomerular disease
Acute nephritic syndrome
Post infection glomerulonephritis (step/staph)
IgA nephropathy
Page 2 of 59
,Renal issues that occur with normal aging
Decreased GFR, decreased diluting capacity, decreased concentration ability,
decreased sodium conservation (volume depletion) decreased sodium excreation
(salt sensitivity/HTN), decreased ammonium & bicarb production (metabolic
acidosis)
Most accurate indicator of renal function in older adults
GFR - declines 8mls per decade starting at age 40
Small amounts of protein in urine
Chronic nephrosclerosis from HTN
renal artery stenosis
partial or complete blocking of one or both renal arteries - THIS ACTIVATES
THE RENIN ANGIOTENSION ALDOSTERONE SYSTEM AND CAUSES
SYSTEMIC HYPERTENSION TO ATTEMPT TO PERFUSE THE KIDNEY -
if pt has a 30% increase in creatinine after starting an ACE or ARB - think renal
Page 3 of 59
, artery stenosis - risk factors include smoking, HTN, hyperlipidemia, DM,
aneurysms - renal stenting isn't indicated except in extreme cases when you
can't control BP or there is progressive kidney failure.
Nephrotic syndrome
URINATING >3.5G OF PROTEIN PER DAY! WITH
HYPOALBUMINEMIA, HLD, AND EDEMA - Can be from primary
glomerular disease, infection, malignancy, exposure to allergen/medication,
DM, or HTN.
◦ RENAL BIOPSY IS ESSENTIAL FOR EARLY DIAGNOSIS
◦ THERAPY - CONTROLL BP, USE RASS BLOCKERS, SODIUM
RESTICTION, STATINS, ANTICOAGULATION WHEN ALBUMIN IS <2.8
What do RAAS inhibitors do?
Decrease proteinuria
Chronic Kidney Disease (CKD)
progressive, irreversible loss of kidney function - RENAL GLOMERULAR
AND TUBULOINTERSTITIAL FIBROSIS INCREASES WITH AGE
Page 4 of 59
GERONTOLOGY MANAGEMENT ACROSS
THE CONTINUUM OF CARE ACTUAL
EXAM QUESIONS WITH ANSWERS
Most common cause of AKI
Acute tubular necrosis (ATN) followed by prerenal azotemia
Acute Tubular Necrosis (ATN)
Damage to the renal tubules due to presence of toxins in the urine or to
ischemia. Results in oliguria.
Prerenal azotemia
Due to decreased blood flow to kidneys; common cause of acute renal failure -
increase bun and decreased renal flow - treat with volume resuscitation
acute tubular necrosis diagnostic criteria
Page 1 of 59
,DIAGNOSIS: URINE SEDIMENT WILL INCLUDE TUBULAR
EPITHELIAL CELLS & GRANULAR MUDDY BROWN CASTS - in oliguria
FENa >2% - TREATMENT IS SUPPORTIVE CARE AND OFTEN TIMES
REVERSIBLE
Acute interstitial nephritis
Drug-induced hypersensitivity involving the interstitium and tubules; results in
acute renal failure (intrarenal azotemia) - most commone antibiotics to cause
this are PENICILLINS, CEPHLOSPORINS, AND FLUOROQUINOLONES
(floxacins)
multiple myeloma "myeloma kidney"
malignant neoplasm of bone marrow. Proteins light & heavy chains will deposit
in parenchyma - pt will present with lower back pain - seen AA women - will
see sever proteinurea, low anion gap, hypercalcemia, anemia, and bone pain -
treat w chemotherapy (melphalan and prednisone)
3 types of glomerular disease
Acute nephritic syndrome
Post infection glomerulonephritis (step/staph)
IgA nephropathy
Page 2 of 59
,Renal issues that occur with normal aging
Decreased GFR, decreased diluting capacity, decreased concentration ability,
decreased sodium conservation (volume depletion) decreased sodium excreation
(salt sensitivity/HTN), decreased ammonium & bicarb production (metabolic
acidosis)
Most accurate indicator of renal function in older adults
GFR - declines 8mls per decade starting at age 40
Small amounts of protein in urine
Chronic nephrosclerosis from HTN
renal artery stenosis
partial or complete blocking of one or both renal arteries - THIS ACTIVATES
THE RENIN ANGIOTENSION ALDOSTERONE SYSTEM AND CAUSES
SYSTEMIC HYPERTENSION TO ATTEMPT TO PERFUSE THE KIDNEY -
if pt has a 30% increase in creatinine after starting an ACE or ARB - think renal
Page 3 of 59
, artery stenosis - risk factors include smoking, HTN, hyperlipidemia, DM,
aneurysms - renal stenting isn't indicated except in extreme cases when you
can't control BP or there is progressive kidney failure.
Nephrotic syndrome
URINATING >3.5G OF PROTEIN PER DAY! WITH
HYPOALBUMINEMIA, HLD, AND EDEMA - Can be from primary
glomerular disease, infection, malignancy, exposure to allergen/medication,
DM, or HTN.
◦ RENAL BIOPSY IS ESSENTIAL FOR EARLY DIAGNOSIS
◦ THERAPY - CONTROLL BP, USE RASS BLOCKERS, SODIUM
RESTICTION, STATINS, ANTICOAGULATION WHEN ALBUMIN IS <2.8
What do RAAS inhibitors do?
Decrease proteinuria
Chronic Kidney Disease (CKD)
progressive, irreversible loss of kidney function - RENAL GLOMERULAR
AND TUBULOINTERSTITIAL FIBROSIS INCREASES WITH AGE
Page 4 of 59
