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Questions and Answers

What is the primary consequence of hypovolemia on kidney function?

  • Enhanced erythropoietin production
  • Damage due to insufficient blood volume (correct)
  • Decreased potassium levels
  • Increased glomerular filtration rate (GFR)

    • Which medication is potassium-sparing and requires monitoring for hyperkalemia?

  • Spironolactone (correct)
  • Hydrochlorothiazide
  • Furosemide
  • Atenolol

    • At what GFR level is chronic kidney disease stage 5 indicated?

  • 15 or lower (correct)
  • Between 30-59
  • Above 60
  • 90 or higher

    • Which of the following is correct regarding the management of acute kidney injury (AKI)?

    <p>Aim for a minimum urine output of 30 mL per hour</p> Signup and view all the answers

    How should a dialysis fistula be monitored post-operation?

    <p>Listen for a bruit using a stethoscope</p> Signup and view all the answers

    Which electrolyte channels do procainamide primarily affect during rapid depolarization?

    <p>Sodium and Calcium</p> Signup and view all the answers

    What is the major function of Diltiazem in treating coronary artery conditions?

    <p>Dilate coronary arteries</p> Signup and view all the answers

    What should be prioritized when administering whole blood in cases of severe blood loss?

    <p>Prime with normal saline only</p> Signup and view all the answers

    Which factor can indicate a possible blood transfusion reaction during administration?

    <p>Temperature increase of 1 degree</p> Signup and view all the answers

    What is the primary effect of administering antiarrhythmics like procainamide in a clinical setting?

    <p>Managing life-threatening dysrhythmias</p> Signup and view all the answers

    What is the minimum mean arterial pressure (MAP) considered acceptable to ensure adequate kidney perfusion?

    <p>65 mmHg</p> Signup and view all the answers

    Which condition may result in reduced production of erythropoietin after severe damage to the kidneys?

    <p>Chronic kidney disease</p> Signup and view all the answers

    Which of the following medications is associated with monitoring potassium levels due to the risk of hyperkalemia?

    <p>Spironolactone</p> Signup and view all the answers

    In chronic kidney disease stages 1-3, what symptom may patients typically not notice?

    <p>Elevated potassium levels</p> Signup and view all the answers

    What is the preferred GFR level for optimal kidney function?

    <p>90 or above</p> Signup and view all the answers

    Which drug is commonly used to treat fluid overload due to its potency compared to hydrochlorothiazide?

    <p>Furosemide</p> Signup and view all the answers

    What is the desired output of urine in volume per day for proper kidney function?

    <p>2 liters</p> Signup and view all the answers

    Which dietary restriction should individuals taking spironolactone observe due to its potassium-sparing effect?

    <p>Avoid high-potassium foods</p> Signup and view all the answers

    In the case of a fistula created for dialysis access, what assessment should be made to ensure the fistula is functioning properly?

    <p>Listen for a bruit</p> Signup and view all the answers

    For managing unstable angina, which class of medication is essential?

    <p>Calcium channel blockers</p> Signup and view all the answers

    What is the primary action of procainamide in emergency situations?

    <p>Blocking sodium and calcium channels</p> Signup and view all the answers

    What effect does administering Diltiazem have on the cardiovascular system?

    <p>Causes vasodilation of coronary arteries</p> Signup and view all the answers

    Which observation is crucial when monitoring a patient receiving a blood transfusion?

    <p>Vital signs should be recorded at the beginning and end</p> Signup and view all the answers

    Which of the following factors indicates a possible transfusion reaction during blood administration?

    <p>A rise of more than 1 degree in temperature</p> Signup and view all the answers

    When using vasopressors in hypovolemic shock, which is essential to monitor?

    <p>Mean arterial pressure (MAP)</p> Signup and view all the answers

    What describes the role of cranberries in urinary health?

    <p>They make urine more acidic, helping to prevent infections</p> Signup and view all the answers

    Which of the following is a characteristic of hypovolemic shock?

    <p>Decreased urine output and low MAP</p> Signup and view all the answers

    Which of the following describes the anatomy of PQRST waves in an ECG?

    <p>T wave corresponds to ventricular repolarization</p> Signup and view all the answers

    In acute treatment regimens, ambioterone is specifically indicated for which condition?

    <p>Managing lung congestion</p> Signup and view all the answers

    What potential side effects should be monitored with Diltiazem administration?

    <p>Hypotension and bradycardia</p> Signup and view all the answers

    What is the primary function of antiarrhythmic medications like procainamide during critical care?

    <p>Stabilize cardiac rhythm by blocking sodium channels</p> Signup and view all the answers

    Which physiological change occurs during depolarization in cardiac muscle cells?

    <p>Sodium ions enter the cells</p> Signup and view all the answers

    What monitoring sign may indicate a possible blood transfusion reaction during whole blood administration?

    <p>Slight elevation in temperature</p> Signup and view all the answers

    Which therapeutic effect is associated with the administration of Diltiazem?

    <p>Causes significant peripheral vasodilation</p> Signup and view all the answers

    In cases of hypovolemic shock, which of the following is a consequence of potent vasoconstriction?

    <p>Diminished blood flow to skin and extremities</p> Signup and view all the answers

    What is the role of cranberries in urinary health as mentioned?

    <p>Make urine highly acidic, contributing to bactericidal properties</p> Signup and view all the answers

    During whole blood transfusion, why is it important to prime the blood products with normal saline only?

    <p>To avoid compatibility issues with other fluids</p> Signup and view all the answers

    What indicates effective treatment in patients receiving antiarrhythmic agents for life-threatening dysrhythmias?

    <p>Stabilization of heart rhythm without new arrhythmias</p> Signup and view all the answers

    In monitoring a patient on vasopressors for hypovolemic shock, what is crucial to ensure adequate perfusion?

    <p>Maintaining mean arterial pressure (MAP) at a specific level</p> Signup and view all the answers

    What potentially dangerous side effect should be monitored with the use of Diltiazem?

    <p>Bradycardia and hypotension</p> Signup and view all the answers

    How does chronic kidney disease (CKD) primarily affect fluid balance in the body?

    <p>Severe edema and swelling due to fluid retention</p> Signup and view all the answers

    What are the potential consequences of a GFR dropping below 15?

    <p>Severe kidney damage and need for dialysis</p> Signup and view all the answers

    When caring for patients with acute kidney injury (AKI), what should be closely monitored aside from urine output?

    <p>Mean arterial pressure (MAP)</p> Signup and view all the answers

    What is the recommended action if a nurse hears a bruit over a dialysis fistula?

    <p>Document and ignore, as this is expected</p> Signup and view all the answers

    In patients undergoing treatment with spironolactone, which dietary factor must be considered?

    <p>Reduce potassium-rich foods to prevent hyperkalemia</p> Signup and view all the answers

    What effect does severe hypovolemia have on kidney function?

    <p>Reduced blood flow leading to potential damage</p> Signup and view all the answers

    Which medication is most potent for managing fluid overload in patients with renal impairment?

    <p>Furosemide</p> Signup and view all the answers

    What is the primary purpose of calcium channel blockers in the context of unstable angina?

    <p>To relax coronary arteries and reduce heart workload</p> Signup and view all the answers

    What defines the distinction between stable and unstable angina?

    <p>Stable angina is predictable, while unstable is unpredictable and possibly severe.</p> Signup and view all the answers

    What should be assessed to understand fluid status in a patient with acute kidney injury?

    <p>Strict intake and output measurements</p> Signup and view all the answers

    Study Notes

    Kidney Perfusion and Function

    • Hypovolemia: Low blood volume negatively impacts kidney function, potentially causing damage. Pre-renal conditions can harm the kidneys.
    • Sepsis: Kidney damage can result from sepsis.
    • GFR (Glomerular Filtration Rate): A crucial indicator of kidney function. Maintaining a GFR above 90 is desirable.
    • Peripheral Shunts: Constant assessment is necessary.
    • Erythropoietin: Kidney injury impairs the production of erythropoietin, a hormone essential for red blood cell production.
    • Chronic Kidney Disease (CKD): Characterized by edema or swelling. Higher potassium (hyperkalemia) is a common complication due to kidney impairment.
    • Potassium-Sparing Diuretics: Spironolactone retains potassium in the body, so potassium-rich foods like spinach, tomatoes, bananas, and potatoes should be moderate or avoided.
    • Hydrochlorothiazide: This diuretic acts on the early distal tubule. Take it in the morning. Monitor potassium levels closely.
    • Furosemide: A more potent diuretic acting on the loop of Henle. Given if lung crackles are present. Monitor potassium levels.
    • CKD Stages: Stages range from 1-5. Stages 1-3 may be asymptomatic. Stage 5 shows severely low GFR (around 15). Aim for a GFR above 60 (ideally above 90).
    • Kidney Transplant Considerations: If waitlisted, don't take blood pressure or insert IVs on the dialysis fistula side. Listen for bruits using a bell.
    • Acute Kidney Injury (AKI): Maintaining a mean arterial pressure (MAP) of 65 or higher is key. Monitor fluid balance (Strict I&O).
    • Lethargy (in AKI): A sign of inadequate perfusion; blood flow preferentially going to heart & lungs.

    Cardiovascular Issues

    • Angina: Chest pain.
      • Stable: Often activity-related; Treat with beta-blockers (atenolol).
      • Unstable: Urgent; Treat with beta-blocker (atenolol) plus sublingual nitroglycerin PRN.
      • Prinzmetal: Requires calcium channel blockers (e.g., diltiazem).
    • Myocardial Infarction (MI): Heart attack.
      • STEMI: Full-blown heart attack.
      • NSTEMI: Possible heart attack; Check troponin levels.
    • MONA: Treatment protocol for heart attacks: Morphine, Oxygen, Nitroglycerin, Aspirin.
    • Congestive Heart Failure: Pulmonary edema treated with ambuterone, which is toxic to the lungs.
    • Antiarrhythmics: Medications to treat abnormal heart rhythms.
      • Sodium Channel Blockers: Procainamide. Works on both Na and some Ca channels; use only as needed.
      • Calcium Channel Blockers: Diltiazem dilates coronary arteries and can cause hypotension and bradycardia. Be aware of patient position changes.
    • Heart Action Potentials: Depolarization = contraction; Repolarization = resting. The PQRST waves represent different phases of the heartbeat.
      • P Wave - atrial contraction/depolarization
      • QRS Complex - ventricular contraction/repolarization
      • T Wave - ventricular repolarization

    Cardiovascular Shock

    • Shock: Conditions impacting blood pressure and blood flow.
    • Hypovolemic Shock: Blood loss reduces blood volume, leading to low MAP (mean arterial pressure), fatigue, and decreased urine output. Treats with potent vasoconstrictors (norepinephrine, Vasopressin).
      • Norepinephrine may be used as initial treatment for shock.
      • If no results or undesirable effects then alternative medicine is petolomine injection
    • Severe Cases of Hypovolemic Shock: Expect whole blood transfusions to be administered.

    Blood Products and Transfusions

    • Blood Administration: Prime with normal saline only. MUST obtain consent. Ensure ABO/Rh matching and double-check RN information. Monitor vital signs (temperature, blood pressure, heart rate) at beginning and end of transfusion, and during administration. Observe for signs of reaction(single degree rise).
    • Blood Reaction Window: Administration takes 30 minutes, watch for reactions within that window. Whole blood is used for severe losses, and is given for 50% blood loss.

    Other Topics

    • Urinary System: Cranberries are acidic and make urine bacteriocidal (to a certain degree).
    • Neutropenia: Filgrastim for low neutrophils.
    • Low Platelets:

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    Description

    This quiz covers essential aspects of kidney perfusion and function. Topics include the impact of hypovolemia on kidney health, the significance of GFR, as well as complications related to chronic kidney disease. Test your knowledge on renal indicators and medications affecting kidney function.

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