Renal Failure and Management Quiz

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Questions and Answers

What is indicated by a GFR that falls below 50 mL/min?

Severe kidney impairment (correct)

Complete renal failure

Normal renal function

Mild kidney injury

What does hyperkalemia primarily result from in this context?

High sodium diet

Decreased potassium secretion (correct)

Excessive fluid intake

Increased physical activity

Which complication is associated with metabolic acidosis in renal failure?

Normal serum pH levels

Decreased acid secretion (correct)

Enhanced potassium conservation

Increased bicarbonate production

What is the relationship between serum phosphorus and calcium levels in this condition?

Elevated phosphorus causes decreased calcium levels Signup and view all the answers

What is a likely cause of edema in patients with hypoalbuminemia?

Decreased oncotic pressure Signup and view all the answers

Which finding might be observed on an ECG due to hyperkalemia?

Tented T waves Signup and view all the answers

What nutritional strategy is recommended to prevent further kidney damage?

Proteins of high biological value Signup and view all the answers

What is a key aspect of early medical management of kidney disease?

Immediate dialysis treatment Signup and view all the answers

What is the recommended duration to retain Kayexalate for effective potassium removal?

6 to 10 hours Signup and view all the answers

Which of the following medications requires dosage adjustment in patients with acute kidney injury (AKI)?

Phenytoin Signup and view all the answers

Which treatment is appropriate for managing severe acidosis in a patient with AKI?

Sodium bicarbonate therapy or dialysis Signup and view all the answers

What consequence might indicate fluid retention in a patient with negative nitrogen balance?

Daily weight gain or no weight loss Signup and view all the answers

In cases of respiratory problems in AKI patients, what is a priority action?

Implementing ventilatory measures Signup and view all the answers

What is a common outcome of AKI that affects nutritional status?

Increased tissue catabolism Signup and view all the answers

What should be monitored to manage elevated serum phosphate levels in AKI patients?

Absorption of phosphate with binding agents Signup and view all the answers

Which of the following statements about the use of diuretics in AKI is correct?

Diuretics have not been shown to enhance recovery from AKI. Signup and view all the answers

What is the primary function of erythropoietin produced by the kidneys?

Stimulate the production of red blood cells Signup and view all the answers

Which form of vitamin D is activated by the kidneys?

1,25-dihydroxycholecalciferol Signup and view all the answers

What is one function of prostaglandins produced by the kidneys?

Causing vasodilation to maintain renal blood flow Signup and view all the answers

Which metabolic waste product is primarily excreted through the kidneys?

Urea Signup and view all the answers

What role do leukotrienes play in the kidneys?

They are mediators of renal diseases Signup and view all the answers

What is the main excretory function of the kidneys?

Excretion of metabolic waste products Signup and view all the answers

Which part of the nervous system mediates the filling and emptying of the bladder?

Both sympathetic and parasympathetic nervous systems Signup and view all the answers

What is end-stage kidney disease (ESKD)?

A final stage of chronic kidney disease requiring renal replacement therapies Signup and view all the answers

What triggers the consciousness of bladder filling?

Peripheral nerve innervation from T10 through T12 Signup and view all the answers

Which factor is NOT considered a risk factor for chronic kidney disease (CKD)?

Genetic predisposition Signup and view all the answers

What primarily causes damage to the kidneys in the early stages of CKD?

Prolonged acute inflammation that is systemic Signup and view all the answers

What clinical manifestation might indicate the development of CKD?

Decreased erythropoietin production leading to anemia Signup and view all the answers

Which is an important assessment in evaluating kidney function?

Glomerular filtration rate (GFR) Signup and view all the answers

What is a recommended blood pressure target for managing CKD?

130/80 mmHg Signup and view all the answers

What is the relationship between creatinine levels and CKD symptoms?

As creatinine levels increase, symptoms of CKD begin to appear Signup and view all the answers

What is the primary goal of medical management in CKD?

To prevent progression and manage symptoms effectively Signup and view all the answers

What is the primary purpose of accurate daily weights and I&O records?

To assess fluid and electrolyte status Signup and view all the answers

Which of the following strategies helps to reduce the metabolic rate during acute stages of a disorder?

Providing bed rest Signup and view all the answers

What is the best method to prevent respiratory complications like atelectasis?

Providing assistance to turn, cough, and breathe deeply Signup and view all the answers

What should be prioritized to minimize the risk of infection when using invasive lines?

Aseptic technique during insertion and maintenance Signup and view all the answers

What can be a consequence of using an indwelling urinary catheter?

Increased risk of urinary tract infection (UTI) Signup and view all the answers

What is essential in providing skin care for patients with edema?

Meticulous skin care to prevent breakdown Signup and view all the answers

Which treatment method is indicated for severe fluid and electrolyte disturbances?

Hemodialysis, PD, or CRRT Signup and view all the answers

Why is it important to provide psychosocial support to patients undergoing treatment?

To address psychological needs and family concerns Signup and view all the answers

What is the primary cause of death in patients with end-stage kidney disease (ESKD)?

Cardiovascular disease Signup and view all the answers

Which symptom is associated with uremic peripheral neuropathy in ESKD?

Restless leg syndrome Signup and view all the answers

What factors influence the progression rate of end-stage kidney disease?

Underlying disorder and hypertension Signup and view all the answers

Which of the following is a neurologic manifestation of ESKD?

Confusion Signup and view all the answers

What skin condition may be observed in a patient with ESKD?

Dry, flaky skin Signup and view all the answers

Which cardiovascular symptom is commonly associated with end-stage kidney disease?

Hyperkalemia Signup and view all the answers

Which of the following is NOT a systemic sign associated with end-stage kidney disease?

Bounding pulses Signup and view all the answers

What leads to the development of uremia in patients with declining renal function?

Accumulation of waste products in the blood Signup and view all the answers

Study Notes

Course Information

Course: NCM 112
Topic: Care of Clients with Fluid and Electrolyte Problems in Renal Disorders
Focus: Nursing care for adult clients with fluid and electrolyte imbalances in any setting.

Course Outline

Week 10 & 12: Unit II: Fluid and Electrolyte Imbalances in Renal Disorders
Week 13 & 14: Unit III: Fluid and Electrolytes Imbalances of Patient with Burn Injury
Week 15 & 17: Unit IV: Fluid and Electrolytes Imbalances of Patient with Neurogenic Disorders
Week 18: Final Examination
Week 10 & 12: Introduction to urinary system structure and function, fluids and electrolytes imbalances in renal disorders, acute and chronic glomerulonephritis, nephrotic syndrome, renal failure, end-stage renal disease, dialysis (peritoneal and hemodialysis)

Rationale

This module helps students learn concepts, theories, and principles of fluid and electrolyte imbalances in renal disorders.
Provides guidance and equips student nurses for comprehensive care planning.

Instructions to Users

Students answer provided activities to demonstrate understanding of concepts and theories.
Developmental activities will include applications, discussions, and analysis.
Closure activities consist of case studies, critical thinking exercises, and evaluation examinations.

Learning Objectives

Describe the structure and function of the renal and urinary systems.
Explain the role of the kidneys in regulating fluids and electrolytes.
Identify diagnostic studies for urinary tract function and nursing implications.
Describe factors in kidney disorder development.
Differentiate acute and chronic kidney disease.
Explain pathophysiology, clinical manifestations, and medical/nursing management for kidney disorders.
Apply nursing process to care for patients with renal disorders.
Develop a comprehensive care plan and health education for patients with renal disorders.
Ensure comprehensive, accurate, and secure documentation.

Structure and Functions of the Kidney

Paired bean-shaped organs located outside the peritoneal cavity
Each kidney is around 10-12 cm long, 5-6 cm wide, and 2.5 cm deep
Weighs 113-170g
Protected by a fibrous external capsule and fatty connective tissue
Contains internal structures: cortex and medulla, renal pyramids, papillae, renal pelvis, and calyces

Nephron Structure and Function

Functional unit of the kidneys.
Each nephron has blood filtration and tubular structures that reabsorb materials from the filtrate and secrete materials from the blood into filtrate.
Two divisions: cortex and medulla
Contains glomerulus, peritubular capillaries, and tubular structures which process glomerular filtrate.

Renal Blood Supply

Supplied by a single renal artery branching into segmental, lobular, interlobular, arcuate, and intralobular arteries.
Blood flow to the kidneys passes mostly through the cortex
Decreased perfusion or sympathetic stimulation can redistribute blood flow from cortex to medulla.

Nephron (Basic Unit)

Each kidney has more than 1 million nephrons
Functions: Filtration, reabsorption, and secretion of water, electrolytes, and other molecules to maintain internal balance.
Components: glomerulus (filtration), proximal convoluted tubule (reabsorption), loop of Henle (concentration), distal convoluted tubule (reabsorption), collecting duct (final concentration, secretion).

Glomerulus

A network of capillaries where blood is filtered within Bowman's capsule
Three layers: capillary endothelial layer, basement membrane, and single-celled capsular epithelial layer, (podocytes)
Size of the pores in the basement membrane prevents red blood cells and large proteins from entering the filtrate
Mesangial cells help regulate blood flow and filter waste products.

Tubular Components

Proximal convoluted tubule - Highly coiled, drains Bowman's capsule
Loop of Henle - Thin, looped structure
Distal convoluted tubule - Distal coiled portion joining several tubules to form collecting tubules, the filtrate passes through these segments before entering renal pelvis.

Functions of Kidneys

Urine formation
Excretion of waste products
Regulation of electrolytes
Regulation of acid-base balance
Control of water balance
Control of blood pressure
Renal clearance
Regulation of red blood cell production
Synthesis of vitamin D to active form
Secretion of prostaglandins

Urine Formation Steps (Process of Filtrate Formation)

Filtration by glomerulus- Water and soluble substances smaller than proteins form the filtrate.
Tubular Reabsorption- Electrolytes and nutrients are reabsorbed into bloodstream.
Tubular Secretion- Waste products and excess substances are secreted into filtrate.

Glomerular Filtration Rate

Rate at which glomeruli filter blood
Approximately 125 mL/min in adults.

Regulation of Water Excretion

Kidney regulates urine volume in response to fluid intake
Hormonal controls, such as ADH, control water reabsorption and concentration.

Regulation of Electrolyte Excretion

Aldosterone regulates sodium excretion.
Kidney plays roles in controlling other electrolytes as well.

Regulation of Acid-Base Balance

Kidney regulates acid-base through reabsorption/secretion of bicarbonate and hydrogen ions and production of ammonia.

Excretion of Waste Products

Kidney excretes urea, creatinine, phosphates, sulfates.
Uric acid.

Urine Storage

Reservoir for urine (bladder) coordinated via sympathetic and parasympathetic systems.
Filling and emptying controlled by the detrusor muscle, which contracts to empty the bladder.
Signals from sensory receptors convey need for urination.

Bladder Emptying

Micturition reflex involving sympathetic and parasympathetic pathways.
Voiding occurs upon relaxation of the external sphincter and contraction of the bladder.

Gerontologic Considerations

GFR progressively declines with age, making older adults more susceptible to kidney injury.
Changes in thirst perception and bladder function may occur.

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Description

Test your knowledge on the complications and management strategies associated with renal failure. This quiz covers key aspects such as GFR levels, electrolyte imbalances, and nutritional recommendations. Perfect for students and healthcare professionals in the field.