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CHA 2- Exam 3 | Comprehensive Questions and Answers Latest Updated 2025/2026 With 100% Verified Solutions -Nephrons affected by fluid filled cysts -Blood supply and nephrons compressed-function is lost -Renal tissue atrophies and becomes nephrotic -Increased in RBC's -Affects other organs - colon, liver, spleen, heart valve, ect. - What is the pathophysiology of polycystic kidney disease? -slow -progressive -flank pain -hematuria -proteinuria -polyuria -HTN -UTI and renal calculi -distended abdomen -Inc. RBC's - What are the signs and symptoms of polycystic kidney disease? -Ultrasound -IVP -CT -Renal biopsy (watch out for hemorrhaging) - Diagnostics of PCKD? -genetic counseling -teaching (prevent UTI's, renal lithiasis, stones, avoid renal toxic meds, watch for s/s of worsening disease -support with dialysis and transplant
-manage pain -control HTN/low Na diet if progression -daily weights, VS, 2-2.5L fluid restriction -low protein diet to slow kidney failure progression -surgical removal/dialysis or transplant - What is the nursing management of PCKD? -Radiocontrast agents -Aminoglycosides -Antibiotics -NSAIDS -Diuretics/ACE/ARBS -Lithium -Calcineurin inhibitors -Amphothericin B -Chemotherapy - What are nephrotoxic drugs? -Excess fluid RT impaired renal function -Anticipatory grieving: Rt potential loss of renal function; genetic link of disease -knowledge deficient -risk of ineffective coping RT potential genetic transmission of disorder to offspring -constipation RT compression of intestinal tract - What are nurse diagnoses for PCKD? -Glomerulonephritis (GN) -Nephrotic syndrome (NS) - What are the two glomerular diseases for this class? A variety of renal disorders, usually due to immune reaction -Hampers kidneys ability to remove waste and excess fluids - What is glomerulonephritis?
-heparin to reduce urine protein and thromboembolism risk -treatment for acute and chronic renal disease - What are nursing cares for nephrotic syndrome? type 1: rapid hypersensitivity reaction type 2: cytotoxic reaction type 3: immune complex reaction type 4: delayed hypersensitivity reaction - What are the four types of reactions? -Helper T (CD4) cells -Macrophages -Cells in the CNS - What three cells are affected by HIV? 500-1,200 cells/mm3 - What is the normal CD4 count range for adults and teens? Human Immunodeficiency virus Acquired Immunodeficiency syndrome - What does HIV and AIDS stand for? The time period during which a specific antibody develops and becomes detectable in the blood. it can be detected in blood tests for the antibody -6 weeks to 6 months post infection - What is seroconversion and when can HIV be detected one infected? -want viral load low -want CD4 cells high - Do you want the viral load and CD4 cells high or low in the body? 30% -Kaposi's sarcoma (most common) -lymphomas
-squamous cell cancer of conjunctiva (eye) -cervical carcinoma - What percentage of people with AIDS develop cancer and what are some of those common cancers? Yes through placenta, delivery, and breastfeeding - Can pregnancy cause HIV to the newborn? -monitor, begin antiretroviral therapy -prevent and treat opportunistic infections -prevent spread -heath promotion -support services - What is the management for HIV? -Enzyme Immunoassay (EIA) or enzyme-linked immunosorbent assay (ELISA): they detect HIV antibodies. could be negative in early course. if negative follow up in 3-6 months. If positive repeat. -If positive twice do the western blot test -CD4 cell count: used to monitor progress of disease. If less than 200, may have AIDS - What is the HIV diagnostics? Highly Active Anti-Retroviral Therapy -costs $15,000 a year -4 different classes of antiretroviral drugs prescribed in many different combinations - What does HAART stand for? When CD4 cells are less than 350 - When does someone start HAART therapy?
- positive for HIV
- opportunistic infection or CD4 T cell count of less than 200 - What is the diagnosis for AIDS? -Sexual
-cross matching serum vs donor lymphocytes -HLA histocompatibility testing -mixed lymphocyte culture - what are 4 diagnostic testing for transplants? -Azotemia (build of of wastes) -Oliguria -Edema -electrolyte imbalances -HTN -itchy skin -fatigue, anemia -anorexia, N/v -confusion, diorintation - What are s/s of renal failure? -hypernatremia -hyperkalemia -hyperphosphatemia -Hypocalcemia - What are the common electrolyte imbalances of kidney failure and are they high or low? -UA: shows acute renal failure, fixed specific gravity of 1.010, proteinuria, presence of WBC, WBC and renal tubular epithelial cells, cell casts -Serum creatinine and BUN (both increased) -creatinine clearance test (best indicator of renal reserve) -Electrolytes -ABG: metabolic acidosis -CBC: erythropoietin secretion and RBC production down - What are diagnostic tests (labs) for renal failure? -renal ultrasound with contrast (see if obstruction or inflammation)
-CT without dye -IVP: intravenous pyelogram (x-ray that shows the kidneys) -Renal biopsy - What are 4 diagnostic (imaging/surgery) for renal failure? -hydrate well before procedure -Acetylcysteine (mucomyst): may be used to prevent contrast-induced nephrotoxicity effects -Diuretics: may be given immediately after the dye is injected to enhance dye excretion -Bicarb after procedure to decrease the metabolic acidosis - What are intervention we can use to prevent induced contrast nephrotoxicity? Above 60 is normal 30-60: moderate kidney damage 15-30: severe kidney disease <15: means kidney failure with dialysis and/or transplant - What is the normal GFR and what number means kidney failure? -usually due to obstruction of urine outflow such as infections, kidney stones, cancer or BPH, stricture, scarring -usually very painful - What are causes of postrenal kidney failure? -Due to acute damage to the renal tissue and nephrons -HTN, DM, drugs, ischemia, vasculitis, glomerulonephritis - What are causes of intrarenal kidney failure? -Anything that causes less blood flow to the kidneys -hypovolemia, hemorrhage, dehydration, burns, shock, HF, cardiogenic shock, sepsis, anaphylaxis - What are causes of pre-renal kidney disease? -oliguric -diuretic -recovery - What are the three stages of acute kidney failure?
-antacids bind with phosphate and help reduce levels -acetylcysteine (mucomyst): help reverse acute renal when cause is thought to be from a nephrotoxic source -aggressive HTN management (ACE inhibitors and ARBS) - What are medications for AKI? -fluid restriction usually 1200 mL/day -daily weights (best indicator of fluid retention) -prevent protein catabolism (body proteins) -limit protein -restrict phosphorus, potassium, and sodium -increase carbs (for energy) -Folic acid and iron supplements - What are dietary changes/supplements for AKI? -meperidine -metformin and other oral antidiabetic agents -contrast dyes such as iodine -antibiotics like streptomycin and gentamicin -ASA/NSAIDS -potent vasoconstrictors -Diuretics/ARBs/ACEs -Lithium - What are some nephrotoxic meds? -Calcium chloride -Sodium Bicarbonate -Insulin with glucose -Kayexalate - What medications/fluids can you give to decrease hyperkalemia by moving K into the cells to decrease serum K? -Iron: ferrous sulfate, ferrous gluconate, and ferrous fumarate
-Take with vitamin C such as OJ (caffeine decreases absorption) -Folic acid/ or vitamin B -Erythropoietin or Darbepoetin alfa (longer acting, fewer injections) -Foods rich in iron -Blood transfusions - What are medications and foods to improve anemia? -Rid body of wastes -Normalize electrolytes and acid-base balance -Remove excessive fluids - What are three reasons for dialysis? Blood/peritoneal fluid -semi permeable membrane -dialyzing solution or dialysate - what are the three components of dialysis? takes 4 hours and needs to be done 3-4 times a week - How long does hemodialysis take and how many times a week? created by connecting a vein ot an artery using a plastic tube -graft allows for increased blood flow - What is a AV graft/fistula? -VS assessments -assess for edema in the inferioir areas and lungs (listen for bruits) -hold appropriate medications: anti hypertensives, antibiotics, vitamins (ABCD), and anti-coagulants -assess patency of access device -weigh patient to determine how much over "dry weight" to treatment -may need to bring own meal depending on time - What are nursing interventions pre-dialysis? -sterile technique for access -take VS every 15 minutes
-instruct to not take antacids with aluminum in it - What are complications of hemodialysis encephalopathy? -No heparinization -continous but slower -liberal fluid intake compared to hemo -management of hyperglycemia (regular insulin can be added to the infusion to manage hyperglycemia) -patient empowerment (able to self manage the treatment regimen, which reduces feelings of helplessness) - What are advantages of peritoneal dialysis? -less effective metabolite elimination and risk of infection (peritonitis) - What are two disadvantages of peritoneal dialysis? -peritonitis: use aseptic technique with catheter and site care -infection -pain: warm solution (not microwave) -poor dialysate flow (due to constipation, kinked tube, fibrin clot) -dialysate leakage - What are complications of peritoneal dialysis? -newest -blood continuously circulated through a highly porous hemofilter artery to vein or vein to vein -used for some types of acute renal failure -ICU setting -Similar to hemodialysis, but slower process to avoid complications associated with rapid change in ECF - What is CRRT (continuous renal replacement therapy)? Polycystic kidney disease (PKD) -The more common form is an autosomal-dominant form and has a 50% chance to pass -can be recessive but less common - What kidney disease is hereditary?
usually caused from an infection (beta hemolytic strep, TB, hepatits, herpes, HIV, vericella zoster, epstein-barr, lupus) 2-4 weeks before kidney problems -However, NOT AN INFECTION, prior infection may stimulate the antibody production but is not present or active at time of glomerular damage - What is the cause of glomerulonephritis? -Hx of beta-hemolytic strep infection -Hematuria coca-cola colored urine -Oliguria/anuria -edema (face, eyelids, hands, and other areas) - NA and fluid retention, increased weight -crackles, dyspnea, SOB, fluid overload s/s -smokey urine, from proteinuria - what are s/s of acute glomerulonephritis? UA: Proteinuria, hematuria -Creatinine and BUN elevated -Serial ASO-Antistreptolysin O (ASO) titer is a blood test to measure antibodies against Strep O, a substance produced by Group A strep bacteria -Elevated IGA: immunoglobulin A -CBC: anemia common -KUB abdominal x-ray, CT, US -Kidney biopsy - what are labs/diagnostic testing for GN? -High calories and reduce protein, fluid, and sodium -antibiotics-penicillin or others -loop-diuretics and anti-hypertensives -corticosteroids/immunosuppressive may be done if rapidly progressive -plasmapheresis - What are treatments for GN? 90% of children and 70% of adults recover without long standing problems - What is the recovery rate for people with GN?
-Foley: patent, hourly urine output, usually quite a bit more than for a normal surgery, monitor COCA, removed 3-7 days post-op -daily weights, I&O's, BP checks every 2-4 hours, -monitor renal labs -sutures are left in place for up to 3 weeks to accommodate for slow healing while on corticosteroids -monitor s/s of infection, bacterial most common, prophylactic antibiotic therapy - What are post-op cares for kidney transplant? -Increased temp, HTN, pain at transplant site, weight gain, edema, and diminished urine output - What are s/s of a kidney transplant rejection? -Inflow (up to 2L of fluid over 10 minutes) -Dwell time (diffusion/osmosis, 20 minutes to 8 hours) -Drain (takes 15-30 minutes and may be facilitated by gently massaging the abdomen or changing position - What are three phases of peritoneal dialysis (PD)?
