Renal
A patient with chronic kidney disease asks how to prevent further kidney damage. Which response by the nurse shows correct teaching?
A. “Take NSAIDs for mild pain since they don’t affect the kidneys.”
B. “Avoid contrast dye unless absolutely necessary.”
C. “Increase protein intake to prevent muscle loss.”
D. “Use over-the-counter antacids containing magnesium for heartburn.”
➡️ Answer: ✅ B — Avoid contrast dye unless absolutely necessary.
NSAIDS and Magnesium antacids are nephrotoxic.
What is the first indicator of shock?
A. Drop in blood pressure
B. Increased heart rate
C. Decreased urine output
D. Cool, clammy skin
➡️ Answer: B
B. Increased heart rate
What is an Increased Heart Rate?
Which step must be done before administering antibiotics in suspected sepsis?
A. Start vasopressors
B. Draw blood cultures
C. Insert Foley catheter
D. Give oxygen
➡️ Answer: B
B. Draw blood cultures
A PR interval of 0.24 seconds indicates:
A. Normal sinus rhythm
B. 1st-degree AV block
C. 2nd-degree Type I
D. 2nd-degree Type II
➡️ Answer: B
B. 1st-degree AV block
Norepinephrine acts on which receptors?
A. Beta-1
B. Alpha-1 and Beta-1
C. Alpha-2
D. Beta-2
➡️ Answer: B
B. Alpha-1 and Beta-1
Define prerenal AKI and give one common cause.
➡️ Answer:Decreased renal perfusion (e.g., dehydration, hypotension, shock).
Name two major goals of treatment in any type of shock.
➡️ Answer: Restore tissue perfusion and correct underlying cause.
List three components of the 1-hour sepsis bundle.
➡️ Answer: Measure lactate, obtain cultures, give antibiotics, start fluids (30 mL/kg), apply vasopressors if hypotension persists.
Explain the difference between 2nd-degree Type I and Type II heart blocks in ECG patterns.
➡️ Answer: Type I: PR interval progressively lengthens before a dropped QRS. Type II: constant PR intervals with sudden dropped QRS.
Why must vasopressors like norepinephrine be given through a central line?
➡️ Answer: To prevent tissue necrosis from extravasation; central line allows rapid dilution and accurate delivery.
A patient receiving hemodialysis suddenly becomes restless and short of breath; the nurse notes crackles and hypertension. What complication should you suspect?
A. Air embolism
B. Disequilibrium syndrome
C. Fluid overload
D. Hypovolemia
➡️ Answer: C
✅ C — Fluid overload.
What is Fluid Overload?
A patient with spinal cord injury develops hypotension and bradycardia. What type of shock is this?
A. Cardiogenic
B. Neurogenic
C. Septic
D. Hypovolemic
➡️ Answer: B
B. Neurogenic
What is Neurogenic Shock?
Which lactate level indicates tissue hypoperfusion and severe sepsis?
A. <1 mmol/L
B. 1–2 mmol/L
C. >2 mmol/L
D. >10 mmol/L
➡️ Answer: C
C. >2 mmol/L
What’s the primary treatment for complete (3rd-degree) heart block?
A. Atropine
B. Cardioversion
C. Temporary pacing
D. Amiodarone
➡️ Answer: C
C. Temporary pacing
Which medication improves contractility without increasing heart rate significantly?
A. Dopamine
B. Dobutamine
C. Epinephrine
D. Vasopressin
➡️ Answer: B
B. Dobutamine
Differentiate between AKI and CKD in onset, reversibility, and management.
➡️ Answer: AKI = sudden, often reversible with early tx (fluids, stop nephrotoxins); CKD = gradual, irreversible, managed with dialysis or transplant.
Differentiate between cardiogenic and hypovolemic shock in terms of causes, cardiac output, and key nursing management.
➡️ Answer:
Cardiogenic: Caused by pump failure (e.g., MI), ↓CO, treat with inotropes/vasopressors, avoid fluid overload.
Hypovolemic: Caused by blood/fluid loss, ↓preload, treat with fluids and stop source of loss.
Explain why early recognition and rapid treatment are critical in sepsis pathophysiology.
➡️ Answer: Sepsis triggers a dysregulated inflammatory response leading to vasodilation, capillary leak, and multi-organ failure—early fluids and antibiotics improve perfusion and survival.
A patient in complete heart block has HR 30 bpm and BP 78/50. Outline immediate nursing actions.
➡️ Answer: Assess airway, apply O₂, establish IV, prepare transcutaneous pacing, administer atropine if ordered, monitor ECG continuously.
Compare how dopamine and vasopressin act in managing shock.
➡️ Answer: Dopamine stimulates beta and dopaminergic receptors to increase HR and CO; vasopressin causes vasoconstriction independent of catecholamine receptors—useful in refractory hypotension.
A CKD patient’s labs: K⁺ 6.2, BUN 90, Cr 5.0. Which order should the nurse question?
A. Furosemide IV
B. Lactated Ringer’s IV
C. Kayexalate PO
D. Prepare for dialysis
➡️ Answer: B
✅ B — Lactated Ringer’s (contains potassium).
Which clinical manifestation is specific to septic shock compared to other types?
A. Bradycardia
B. Warm, flushed skin early on
C. Cyanosis
D. Narrow pulse pressure
➡️ Answer: B
B. Warm, flushed skin early on
Describe how fluid resuscitation and vasopressors work together in septic shock management and the nurse’s priority assessments.
➡️ Answer: Fluids restore intravascular volume → vasopressors (norepinephrine) maintain perfusion when fluids aren’t enough → monitor BP, urine output, mental status, and lactate.
Which electrolyte imbalance can mimic heart block?
A. Hypercalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypomagnesemia
➡️ Answer: B
B. Hyperkalemia
What is Hyperkalemia?
Before administering a blood transfusion for a patient with anemia, list the five safety checks a nurse must perform.
➡️ Answer: Verify patient ID, crossmatch, inspect blood, confirm consent, baseline vitals, use correct tubing, stay with patient for 15 min.