Select all limitations for using CrCl to assess renal function.
Creatinine is a metabolic by-product of muscle so elderly or cachectic patients may have falsely low CrCl estimates, due to high SCr.
It's unreliable in rapidly changing patients.
10-15% of creatinine is eliminated by active tubular secretion so it overestimates GFR, especially in patients with reduced renal functioning.
Creatinine clearance is difficult to measure so instead we use serum phosphorous levels as the gold standard for estimating GFR.
What might be done to manage hyperkalemia in a patient with acute renal failure? Select all that apply.
Give PO or PR cationic exchange resins to increase GI excretion of K.
Give an insulin and glucose infusion, which is highly effective and rapid.
Give sodium bicarbonate if the patient is acidotic.
Give fluid boluses stat.
Give packed RBCs and plasma expanders.
Which drug is used to attempt to delay the progression of CKD in patients with diabetes?
ACE inhibitors (ACEI) and/or angiotensin receptor blockers (ARB)
What lab is a good indicator of nutritional status in monitoring patients with CKD?
Why are patients with CKD told to avoid using OTC multivitamins?
Because fat soluble vitamins can accumulate and cause toxicity.
Because they can't digest or absorb supplemental vitamins via PO route due to GI problems associated with CKD (e.g. PUD, gastroparesis).
Because they will cause CKD patients to experience a metallic taste in their mouth.
Because patients with CKD don't need supplemental B complex, C, or folic acid, which are common ingredients in OTC multivitamins.
A patient with CKD has developed peptic ulcer disease (PUD). To relieve his symptoms, he has been using OTC chewable antacids liberally. What should you say to this patient?
"I'm glad to hear that the antacids are working for you. If you would like to discuss taking a prescription for your ulcers, I can mention it to the physician."
"Make sure to stay hydrated and drink lots of water when you are taking chewable antacids."
"Due to your kidney disease, there is a risk that you might accumulate toxic levels of magnesium in your body due to the antacids."
"If you are taking antacids, you should also be taking supplemental vitamin D and calcium."
As a nurse, you know that hemodialysis can cause hypotension. What might be an appropriate intervention to prevent your patient with CKD from experiencing hypotension?
Withhold diuretics and other antihypertensives until post-dialysis.
Give the patient packed RBCs and plasma expanders prophylactically if they have experienced hypotension due to hemodialysis in the past.
There is nothing you can do to prevent hypotension. Monitor the patient closing during and after dialysis.
Hypotension is very normal after hemodialysis. No interventions are required.
As a nurse, you know that the following is true of diuretics for patients with CKD:
Diuretics should be used cautiously to avoid volume depletion.
Diuretics should be used in all patients with CKD to prevent edema.
Loop diuretics (e.g. Lasix or furosemide) are no longer effective when CrCl is less than 25 ml/minute.
if a patient is on diuretics, the dose should be increased prior to hemodialysis.
Anemia in patients with CKD is primarily due to which of the following?
Reduction in renal production of EPO in response to tissue hypoxia and/or iron deficiency
Internal bleeding due to concurrent peptic ulcer disease
Bone marrow dysfunction
A patient with CKD reports to you that he is experiencing shortness of breath, sexual dysfunction, and pain that starts in the centre of his chest, but spreads to his left arm, neck, back, throat or jaw. He also complains of a feeling of moderate to severe indigestion that is persistent. You suspect that this client has developed which of the following?
Peptic ulcer disease
You are caring for a patient with CKD. You notice on the chart that she is receiving epoetin alfa (Eprex). This drug is prescribed to patients with anemia because it does which of the following?
Increases release of reticulocytes from bone marrow, causing a rise in serum Hgb
Increases the iron stores in the body, thus reducing the need for patients to take supplemental iron
Repairs bone marrow that can no longer release adequate reticulocytes
Which of the following statements is true regarding the pharmacological treatment of anemia in patients with CKD?
The main side effect of erythropoiesis stimulating agents (ESAs) is hypertension. Patients may need a 30% increase in their dose of antihypertensive medication.
Oral iron supplementation is the safest, most effective, and most cost efficient form of supplementation.
Iron supplementation is most effective when delivered via IV and iron dextran is the preferred product.
Erythropoiesis stimulating agents (ESAs) can be given regardless of the patient's iron stores.
What are the most common side effects of taking oral iron supplements that result in low adherence?
Nausea/vomiting, heartburn, bloating, and constipation
Nausea/vomiting, heartburn, bleeding, and constipation
Pruritus, abdominal distension, and difficulty concentrating
Bad breath, anorexia, constipation, and GI bleeding
Patients with chronic kidney disease often have a dysregulation of phosphorus, calcium, and parathyroid hormone (PTH). Which of the following statements best describes this dysregulation?
Elevated P leads to a drop in Ca. Low Ca stimulates PTH secretion, which mobilizes Ca from bone, leading to bone disease.
Low P leads to a drop in Ca. Low Ca stimulates PTH secretion, which further damages kidneys, leading to even lower Ca because of decreased activation of vitamin D.
High PTH secretion leads to decreased activation of vitamin D, which leads to low levels of Ca. Low Ca leads to elevated P.
Peptic ulcer disease, common in CKD patients, leads to low absorption of Ca in gut. Low Ca stimulates PTH secretion, which mobilizes Ca from bone, leading to bone disease. High PTH also leads to elevated P.
Which is the most effective non-pharmacologic therapy for hyperphosphatemia?
Dialysis to remove excess P from the blood
Dietary restrictions of high P-containing foods, such as dairy, chocolate, beer, meat, and cola
Supplementation of vitamin B complexes and vitamin D, which decrease levels of P in blood
Subtotal or total parathyroidectomy
Which of the following statements is true regarding the use of phosphate binders for patients with hyperphosphatemia?
Calcium carbonate (e.g. Tums) should not be given to patients with CKD because there is a high risk of the patient developing hypercalcemia
Calcium carbonate (e.g. Tums) is a cheap and effective treatment that is only effective when given with meals
Sevelamer (Renagel) is used when patients cannot tolerate Ca because it increases fecal elimination of both calcium and phosphorus
Sevelamer (Renagel) is most effective when used in combination with calcium carbonate (Tums) to treat hyperphosphatemia
You are caring for Mr. Jones, a 68-year-old patient with CKD. At the start of your shift, Mr. Jones reports that he is experiencing pain in his joints and is feeling stiff. What should you do first?
Ask Mr. Jones if he usually experiences stiffness in the morning and whether or not it lasts for less or more than 30 minutes.
Offer Mr. Jones an aspirin to relieve his joint pain. Reassess his pain in 20 minutes.
Offer Mr. Jones hot packs to place on his sore joints. Reassess his pain in 20 minutes.
Encourage Mr. Jones to take a short walk down the hallway and back to ease up his stiff joints.
Which of the following statements is true regarding dose adjustment in patients with renal failure?
Drug dosing adjustments are based on CrCl
All lab results are taken into consideration when determining drug dosing adjustments
Common drugs that do not need to be adjusted are antibiotics, antihypertensives, and hypoglycemic agents because they are not renally eliminated
Recent exposure to vancomycin or aminoglycoside decrease susceptibility for drug-induced nephrotoxicity
What is the basic function of cyclooxygenase?
It is an enzyme that converts arachadonic acid into various forms of prostaglandin
It is an enzyme that activates various forms of prostaglandins
It is an enzyme that is vital for absorption of fat-soluble vitamins in the gut
It is a serum protein that plays a crucial role in the coagulation cascade
Which of the following statements comparing COX-1 and COX-2 is true?
COX-1 is constitutive, meaning it's found in almost all tissues. COX-2 is inducible, meaning it is not there all the time (it's mostly found at sites of tissue injury).
COX-1 is the "bad" COX. COX-2 is the "good" COX.
COX-2 is "bad" because it promotes vasoconstriction, which can lead to further renal dysfunction.
COX-1 is inducible, meaning it is not there all the time (it's mostly found at sites of tissue injury). COX-2 is constitutive, meaning it's found in almost all tissues.
Which of the following statements best describes cyclooxygenase?
It is an enzyme that converts arachadonic acid into various forms of prostaglandin.
It is an enzyme that converts various forms of prostaglandin into arachadonic acid.
It is an enzyme that is inducible, meaning it is found mostly at sites of tissue injury.
It is an enzyme that is constitutive, meaning it is found in almost all tissues.
COX has many functions throughout the body. Select all the correct functions from the following list.
Promotes synthesis of TXA2, which stimulates platelet aggregation
Mediates fever and contributes to perception of pain
Bronchial smooth muscle is constricted by various prostaglandins, which are derived from COX
COX-derived prostaglandins relax the walls of the uterus to prevent contractions during pregnancy
COX catalyzes synthesis of prostaglandins that protect gastric mucosa by decreasing secretion of gastric acid and increasing secretion of bicarb and cytoprotective mucous.
COX catalyzes synthesis of prostaglandins that promote vasodilation and maintain renal blood flow
COX-2 has mostly negative effects. Its one beneficial role is that it supports renal function and promotes vasodilation.
Traditional NSAIDs are characterized by their irreversible, non-selective effects on both COX-1 and COX-2, whereas second generation NSAIDs selectively inhibit COX-2.
Low-dose daily Aspirin (81 mg PO) is used for the prevention of CV and cerebrovascular events in high risk patients because of it's inhibition of platelet aggregation. However, with all other traditional NSAIDs (e.g. ibuprofen, diclofenac, etc), the risk of CV events increases with chronic use.
Your friend tells you that her child is recovering from chickenpox and is still running a low fever. She says that she has been giving her daughter Aspirin. What is the most important thing to tell your friend?
"You should not give your child Aspirin but you can give her Tylenol instead because it is safe for use in children."
"You should make sure to keep your daughter well hydrated and monitor the fever."
"You should make sure that you do not exceed the maximum daily dose."
"You should get your child to the hospital right away."
You are caring for a patient who has overdosed on Aspirin. What is the best treatment?
IV insulin and glucose
Which statement most accurately describes the relationship between alcohol and acetaminophen (Tylenol)?
Acetaminophen is metabolized via two pathways. The product from the major pathway is a nontoxic metabolite. The minor pathway requires glutathione to convert the toxic metabolite to a nontoxic metabolite. Alcohol depletes glutathione. Therefore, you should not take Tylenol in combination with alcohol.
Acetaminophen is metabolized via two pathways. The product from the minor pathway is a nontoxic metabolite. The major pathway requires glutathione to convert the toxic metabolite to a nontoxic metabolite. Alcohol depletes glutathione. Therefore, you should not take Tylenol in combination with alcohol.