Diabetes & Renal

Which of the medications are sulfonylureas?

What medications are Biguanides?

Which medications are Meglitinides?

Which medications are TZD's (thiazolidinediones)?

Which medications are Alpha-Glucosidase Inhibitors?

Which medications are Depeptidyl Peptidase Inhibitors?

Sulfonylureas take effect in the

Biguanide takes effect in the

Meglitinides take effect in the

Thiazolidinediones (TZD's) take effect in the

Alpha-glucosidase Inhibitors take effect in the

Depeptidyl Peptidase inhibitors take effect in the

Nsaids can potentiate hypoglycemia, mask s/s of hypoglycemia (beta blockers), & is associated with weight gain. Which class?

Do NOT take if you have skipped a meal. Which class?

Side effect is gas/flatulence and diarrhea. Which class?

Can cause myocardial ischemia & is associated with severe liver disease. Which class?

S/E is the absence of weight gain. Which class?

Modest weight loss, dont use with kidney failure/liver failure/or CHF, less likely to cause hypoglycemia, and should stop before contrast procedures. Which class?

Which symptoms are signs of hypoglycemia?

Which are symptoms of hyperglycemia?

DKA is a sudden onset with sugars usually reaching 600 or higher

This type of diabetes does not produce any insulin and can send the body into metabolic acidosis

What is a normal range for A1C?

Which below are long term complications of diabetes?

Which below are acute complications of diabetes?

HHNS is a slow gradual onset with sugars around 600 or higher?

What are some common causes for DKA/HHNS

Which of these answers are included in sick day rules?

Which lab findings below will you find with DKA?

Which lab finding below will you find with HHNS

S/S: Dehydration, polydipsia, polyphagia, polyuria, lethargy, wt loss, fruity breath, nausea, abdominal pain, kussmaul respirations

S/S: Altered CNS function, dehydration, polydipsia, polyphagia, polyuria, lethargy, or coma

What is the treatment for both DKA or HHNS?

Which insulin has onset of 0.25 hr and duration 2.5-5 hours

Which insulin has onset of 0.5-1.5 hrs and duration of 5-24 hours?

Which insulin has onset of 0.5 - 4 hrs and duration of 10-24 hours?

Which insulin has onset of 1-4 hrs and duration of 24-42 hours?

Which one is the correct insulin and correct way to draw up in one syringe?

Which insulins are rapid acting?

Which insulins are short acting?

Which insulins are intermediate acting?

Which insulins are long-acting?

AKI is sudden, involves 50-95% of nephrons, and is reversible

CKD can take months to years to develop and is permanent

Kidney function - AWETBED - What is "A"

Kidney function - AWETBED - What is "W"

Kidney function - AWETBED - What is "E" in WET?

Kidney function - AWETBED - What is "T"

Kidney function - AWETBED - What is "B"

Kidney function - AWETBED - What is "E" in Bed?

Kidney function - AWETBED - What is "D"

Injury or problem is before it reaches the kidney's- Most common type of injury - Blood/fluid loss, MI, Infection, NSAIDS

Injury or problem is after the kidneys - usually an obstruction/blockage - Most common kidney stones

Injury or problem is in the kidney - damage to nephrons--ischemia. Most common NSAID use, blood clots, pyelnephritis, autoimmune disorder, rhabdomlosis.

What lab will tell you if it is a kidney issue or heart issue?

GFR is decreased for 3 months or ore, 75% nephrons lost, and is irreversible

Emergency medications for CKD- Pick all that apply

CKD Maintenance Medications-select all

CKD dietary restrictions are: Protein, K+, Dairy, Fluids, and sodium

With AKI and dialysis you want to increase their protein intake

You can give sodium polystyrene even if there is no bowel sounds

What is an important assessment with CKD?

CKD: which maintenance medications should you not give together at the same time?

It is ok to still give medications prior to dialysis as long as they are not short acting?

Why is a fistula better than a graft?

What are the "pros" to hemodialysis- SATA

What are the "pros" to peritoneal dialysis- SATA

When would CRRT/CVVH dialysis be utilized

Kidney rejection: usually happens within hours after surgery. Remove the kidney and resume dialysis.

Kidney rejection: can happen within months after surgery due to the body creating an immune defense. Patient would increase their immunosuppressants.

Kidney rejection: see gradual decreased in urine output. There is no treatment other than to resume back on dialysis.

Client is brought to the ED in an unresponsive state, and a dx of HHNS is made. The nurse would immediately prepare to initiate which anticipated primary health care providers prescription?

A client with DKA is being treated in the ED. Which findings support this dx? SATA

The nurse is teaching a client with DM about differentiating between hypoglycemia and ketoacidosis. Patient demonstrates an understanding of the teaching by stating that a form of glucose needs to be taken if which symptoms develop? -SATA

The nurse provided instructions to a client newly dx with DM-1 about measures to take if feeling sick to prevent DKA. The nurse recognizes accurate understanding of measures to prevent DKA when client makes which statement?

Client is admitted to hospital with dx of DKA. Initial blood glucose is 950 mg/dL. A continuous IV of short acting is initiated, along with IV rehydration w/ NS. Serum glucose level is now decreased to 240 mg/dL. The nurse would next prepare to administer which medication?

The nurse is monitoring the client newly dx with DM for s/s of complications. Which s/s is frequently exhibited that indicates that the client is at risk for chronic complications of DM if the bs is not adequately managed?

The nurse is preparing a plan of care for a client with DM who has hyperglycemia. The nurse places priority on which client problem?

Home health nurse visits a client with dx Type1 DM. Client reports history of vomiting & diarrhea. Tells the nurse no food has been consumed for the last 24 hrs. Which additional statement by the client indicates a need for further teaching?

Nurse is caring for a client admitted to the ED with DKA. In the acute phase, the nurse plans for which priority intervention?

A client with Type1-DM who takes NPH daily in the morning calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise?

The nurse is monitoring a client who was dx with Type1-DM and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to presence of possible hypoglycemic reaction? - SATA

The nurse performs a physical assessment on a client with Type 2-DM. FIndings include a fasting BS of 70, temperature of 101, pulse 82/min, respirations of 20/min, BP 118/62. Which finding would be the priority concern for the nurse?

A client with AKI has serum K+ level of 7.0. The nurse would plan which actions as priority? - SATA

A client with CKD being hemodialyzed suddenly becomes SOB and complains of CP. Client is tachycardic, pale, and anxious, and the nurse suspects air embolism. What are the priority nursing actions? - SATA

Client arrives to ED with complaints of low abdominal pain and hematuria. Client is afebrile. The nurse next assesses the client to determine a history of which condition?

The nurse is assessing the patency of a clients left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates the fistula is patent?

The nurse is monitoring a client receiving peritoneal dialysis notes that the clients outflow is less than the inflow. Which actions would the nurse take? - SATA

The nurse is reviewing a client's record and notes that the PCP has documented that client has CKD. On review of the laboratory results, the nurse would most likely would expect to note which finding?

A client with CKD returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that clients temperature is 101.2 degrees F. Which nursing action is most appropriate?

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action?

The nurse is instructing a client with DM about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for dialysis because of the risk of which complication?

A week after kidney tranplantation, a client develops a temperature of 101 degree F, the BP is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment?

S/S of which cancer: Flank pain that is dull/achy, palpable kidney mass, blood in urine, pallor, gynecomastia, darkening of nipples, muscle wasting, weakness, and weight loss.

S/S of which cancer: blood in urine, painless & intermittent, dysuria, frequency, and urgency.

Nurse is teaching the client with DM how to mix regular insulin and nPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching?

Glimepiride is prescribed for a client with DM. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? -SATA

A client with DM is taking Humulin NPH and regular insulin every morning. The nurse would provide which instructions to the client? - SATA

The home health care nurse is visiting a client who was recently dx with DM 2. Client was prescribed repaglinide and metformin. The nurse would provide which instructions to the client? -SATA

A client with diabetes mellitus visits a health care clinic. Previously had been well controlled with glyburide daily but recently his BS levels have been 180-200. Which medication, if added to regimen, may have contributed to the hyperglucemia?

Which AKI stage: Increase in serum concentration, urine volume decreases, can last 1-3 weeks. The longer the phase more renal damage occurs. Uremia & hyperkalemia are common.

Which AKI stage: Renal tissue is recovering & repairing itself. Gradual increase of urine output however can lose a large amount of fluids leading to dehydration.

Which AKI stage: Initial insult & ends with oliguria. It can span hours to about 2 days. Renal function deteriorates but is reversible.

Which AKI stage: Can take 3-12 months and usually will see patients labs go back to their normal.

T or F: Diagnostic criteria for diabetes include: s/s of diabetes, casual blood sugars greater than 200, fasting blood sugars (min 8 hours) greater than 126, 2 hr glucose greater than 200 with oral glucose tolerance test, and A1C greater than 6.5%

Which medication/class for diabetes reduces the production of glucose by the liver, increases tissue sensitivity to insulin, and slows carbohydrate absorption in the intestines?

Which medication classes for diabetes stimulates insulin release from pancreas and is administered for post-meal hyperglycemia? SATA

Which medication class for diabetes reduces production of glucose by the liver and increases tissue sensitivity to insulin?

Which medication class for diabetes slows carbohydrate absorption from the intestinal tract and reduces post-meal hyperglycemia?

Which medication class for diabetes augments naturally occurring intestinal incretin hormones, which promotes release of insulin and decreases secretion of glucagon. Lowers fasting/post-prandial glucose levels. Few adverse effects.

A nurse is caring for a client who has blood glucose 52 mg/dL. Client is lethargic but arousable. Which of the following actions should the nurse perform first?

A nurse is preparing to administer a morning dose of insulin to a client who has DM-I. Which of the following actions should the nurse take?

A nurse is preparing to administer morning doses of insulin glargine and regular insulin to a client who has a blood glucose of 278. Which of the following actions should the nurse take?

A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes. Which of the following should the nurse include in the in the information? SATA

A nurse is teaching foot care to a client who has diabetes. Which of the following information should the nurse include in the teaching? SATA

A nurse is reviewing the health history of a client who has diabetes type 2. Which of the following are risk factors for HHNS? SATA

A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? SATA

A nurse is reviewing laboratory reports of a client who has HHNS. Which of the following findings should the nurse expect?

A nurse is reviewing the medical record for a client who is to begin therapy for DKA. Which of the following prescriptions should the nurse expect?

A nurse is providing discharge teaching to a client who had diabetic ketoacidosis. Which of the following information should the nurse include about preventing DKA? SATA

A nurse is teaching a client who will have an x-ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include in the teaching?

A nurse is monitoring a client who had a kidney biopsy for postoperative complications. Which of the following complications should the nurse identify as causing the greatest risk to the client?

A nurse is caring for a client who has type 2 diabetes and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? SATA

A nurse administered captopril to a client during a renal scan. Which of the following actions should the nurse take?

A nurse is reviewing the results of a client's urinalysis. The findings indicate the urine is positive for leukocyte esterase and nitrates. Which of the following actions should the nurse take?

A nurse is teaching a client who has CKD and is to begin hemodialysis. Which of the following information should the nurse include in the teaching?

A nurse is preparing to initiate hemodialysis for a client who has AKI. Which of the following actions should the nurse take? SATA

A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in he plan of care? SATA

A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take?

A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? SATA

A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? SATA

A nurse is planning postoperative care for a client following a kidney transplant. Which of the following actions should the nurse include? SATA

A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include?

A client who is scheduled for a kidney transplant surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the clients risk of surgery? SATA

A nurse is teaching a client who is scheduled for a kidney transplant about organ rejection. Which of the following statements should the nurse include? SATA

A nurse is planning care for a client who has prerenal AKI following abdominal aortic aneurysm repair. Urinary output is 60 ml in the past 2 hr, and blood pressure is 92/58 mmHg. The nurse should expect which of the following interventions?

A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a blood creatinine of 5 mg/dL. Which of the following interventions should the nurse include in the plan? SATA

A nurse is planning care for a client who has Stage 4 CKD. Which of the following actions should the nurse include in the plan of care? SATA

A nurse is reviewing client laboratory data. Which of the following findings is expected for a client who has Stage 4 CKD?

A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? SATA