Exam 20: Kidney Disorders and Therapeutic Management

The patient is a gravida 6, para 1.She is admitted after a cesarean section after an amniotic embolus.Her heart rate (HR)is more than 150 beats/min with a systolic BP less than 80 mm Hg.Her temperature is 38°C, and her condition has caused her to develop prerenal azotemia.The patient was fluid resuscitated through a double-lumen catheter, which was placed into her right femoral access, and started on vasopressors with a fair response (BP, 80/50 mm Hg; HR, 122 beats/min).Because of her diagnosis and a concern regarding fulminating sepsis, the patient was begun on CVVH.Why would this therapy be chosen for this patient?

A patient with renal failure reports all of the following during the medical history.Which is most likely to have precipitated the patient's renal failure?

A patient has been hospitalized for a subtotal gastrectomy.After the procedure, an infection developed that eventually had to be treated with gentamicin, an aminoglycoside antibiotic.After 3 days of administration, oliguria occurred, and subsequent laboratory values indicated elevated BUN and creatinine levels.The patient is transferred to the critical care unit with acute kidney injury (previously known as acute tubular necrosis).The fluid that is removed each hour is not called urine; it is known as

Which of the following laboratory values is the most help in evaluating a patient for acute renal failure?

What is the dose for low-dose dopamine?

Which of the following conditions is associated between kidney failure and respiratory failure?

A patient in acute renal failure presents with a potassium level of 6.9 mg/dL.He has had no urine output in the past 4 hours despite urinary catheter insertion and Lasix 40 mg intravenous push.Vital signs are as follows: HR, 76 beats/min; respiratory rate, 18 breaths/min; and BP, 145/96 mm Hg.He is given 100 mL of 50% dextrose in water and 20 U of regular insulin intravenous push.A repeat potassium level 2 hours later shows a potassium level of 4.5 mg/dL.What order would now be expected?

To prevent catheter-associated UTI (CAUTI), the nurse should

A patient with chronic renal failure receives hemodialysis treatments 3 days a week.Every 2 weeks, the patient requires a transfusion of 1 or 2 U of packed red blood cells.What is the probable reason for this patient's frequent transfusion needs?

An alert and oriented patient presents with a pulmonary artery wedge pressure of 4 mm Hg and a cardiac index of 0.8.The BUN is 44 mg/dL, creatinine is 3.2 mg/dL, and BP is 88/36 mm Hg.Urine output is 15 mL/hr.Lungs are clear to auscultation with no peripheral edema noted.Which of the following treatments would the physician most likely order?

What is a continuous venovenous hemodialysis filter permeable to?

Which electrolytes pose the most potential hazard if not within normal limits for a person with renal failure?

The patient is a gravida 6, para 1.She is admitted after a cesarean section after an amniotic embolus.Her heart rate (HR)is more than 150 beats/min with a systolic BP less than 80 mm Hg.Her temperature is 38°C, and her condition has caused her to develop prerenal azotemia.The patient was fluid resuscitated through a double-lumen catheter, which was placed into her right femoral access, and started on vasopressors with a fair response (BP, 80/50 mm Hg; HR, 122 beats/min).Because of her diagnosis and a concern regarding fulminating sepsis, the patient was begun on CVVH.  Identify three complications of CVVH therapy.

To assess whether or not an arteriovenous fistula is functioning, what must be done and why?

Which of the following medications is considered a loop diuretic?

One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin.How do these agents lower potassium?

A patient has been hospitalized for a subtotal gastrectomy.After the procedure, an infection developed that eventually had to be treated with gentamicin, an aminoglycoside antibiotic.After 3 days of administration, oliguria occurred, and subsequent laboratory values indicated elevated BUN and creatinine levels.The patient is transferred to the critical care unit with acute kidney injury (previously known as acute tubular necrosis).Which dialysis method would be most appropriate for the patient's condition?

A patient has sepsis and is placed on broad-spectrum antibiotics.Her temperature is 37.8°C.Her BUN level is elevated.She continues on vasopressor therapy.What other steps should be taken to protect the patient from inadequate organ perfusion?

To control azotemia, the recommended nutritional intake of protein is

The patient is a gravida 6, para 1.She is admitted after a cesarean section after an amniotic embolus.Her heart rate (HR)is more than 150 beats/min with a systolic BP less than 80 mm Hg.Her temperature is 38°C, and her condition has caused her to develop prerenal azotemia.The patient was fluid resuscitated through a double-lumen catheter, which was placed into her right femoral access, and started on vasopressors with a fair response (BP, 80/50 mm Hg; HR, 122 beats/min).Because of her diagnosis and a concern regarding fulminating sepsis, the patient was begun on CVVH.Which of the statements best describes CVVH?