Name:__________________________________________ I. Multiple Choice ___1.

) Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? a. Infection b. Disequilibrium syndrome c. Air embolus d. Acute hemolysis ___2.) The most common early sign of kidney disease is: a. Sodium retention b. Elevated BUN level c. Development of metabolic acidosis d. Inability to dilute or concentrate urine ___3.) A 22 y.o. patient with diabetic nephropathy says, I have two kidneys and Im still young. If I stick to my insulin schedule, I dont have to worry about kidney damage, right? Which of the following statements is the best response? a. You have little to worry about as long as your kidneys keep making urine. b. You should talk to your doctor because statistics show that youre being unrealistic. c. You would be correct if your diabetes could be managed with insulin. d. Even with insulin, kidney damage is still a concern. ___4.) A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching? a. Take cool baths b. Avoid tampon use c. Avoid sexual activity d. Drink 8 to 10 eight-oz glasses of water daily ___5.) What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease? a. Activity intolerance b. Fluid volume excess c. Knowledge deficit d. Pain

___6.) A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? a. Low-protein diet with unlimited amounts of water b. Low-protein diet with a prescribed amount of water c. No protein in the diet and use of a salt substitute d. No restrictions ___7.) . A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure . Which substance must be reduced in this patients diet? a. Carbohydrates b. Fats c. Protein d. Vitamin C ___8.) Diabetic nephropathy results from an elevation of blood pressure, increasing the workload of the glomeruli. The glomeruli thicken and allow serum albumin to pass into the urine. Which of the following signs and symptoms indicate diabetic nephropathy? a. Edema around the eyes upon awakening, progressing to general swelling of the legs and body b. Weight gain, malaise, fatigue, and frothy urine c. Rust-colored urine, weight loss, and back pain d. A and C e. A and B ___9.) A patient is with the following signs and

___10.) Damaged kidneys lose their ability to produce erythropoietin, a hormone that stimulates the formation of red blood cells. What is usually prescribed to stimulate erythropoiesis in patients with chronic kidney disease? a. Epoetin alfa (Epogen, Procrit) b. Cinacalcet HCl (Sensipar) c. Furosemide (Lasix) or bumetanide (Bumex) d. Sevelamer hydrochloride (Renagel) II. True / False: ________11.) Diabetic nephropathy, or renal disease secondary to diabetic macrovascular changes in the kidney, is a common complication of diabetes. ________12.) Presence of albuminuria, elevated blood pressure, declining glomerular filtration are the common signs of Diabetic Nephropathy. ________13.) About 20% to 30% of people with type 1 or type 2 diabetes develop nephropathy, but fewer of those with type 2 diabetes progress to ESRD. ________14.) There are 6 Stages of Kidney Disease ________15.) In managing Diabetic Nephropathy: early prevention measures include the control of hypertension and blood glucose levels III. Identification:

symptoms: edema around the eyes upon awakening, progressing to general swelling of the legs and body; weight gain; fatigue; headache; nausea; vomiting; frequent hiccoughs; and itching. A urine specimen is obtained, and the urine is frothy. The patient has a history of insulin-dependent diabetes (type 1 diabetes), which is poorly controlled, and high blood pressure, and his blood work comes back showing an elevated cholesterol level. Which of the following disease processes would you suspect?
a. Nephrosclerosis b. Diabetic nephropathy c. Polycystic kidney disease d. Amyloidosis

_________________16.) A part of the health care team who treats diabetic foot problems. (Dietitian, Podiatrist) _________________17.) DM patients that frequently show initial signs of renal disease after 10 to 15 yrs. (Type I ,Type II) _________________18.) Normal Albumin level per day/24hrs. (<30mg/day , >30mg/day) _________________19.) Often developed in patients (with and without diabetes) who are in the early stages of renal disease. Occurs in as many as 50% of all people with diabetes (for unknown reasons). (Hypotension, Hypertension) _________________20.) If Diabetic Renal Disease in Patients with Diabetes progresses it is said to be (Reversible , Irreversible)

Answers: I. Multiple Choice: 1.b. Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures. 2. b. Increased BUN is usually an early indicator of decreased renal function 3. d. Kidney damage is still a concern. Microavascular changes occur in both of the patients kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management 4. d. Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity 5. b. Fluid volume excess because the kidneys arent removing fluid and wastes. The other diagnoses may apply, but they dont take priority 6. b. The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldnt be used without a doctors order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed 7. c. Because of damage to the nephrons, the kidney cant excrete all the metabolic wastes of protein, so this patients protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patients tissues 8. e. Symptoms and signs of diabetic nephropathy include edema around the eyes upon awakening, progressing to general swelling of the legs and body, weight gain, frothy urine, malaise, fatigue, nausea and vomiting, headache, hiccoughs, and pruritus. Serum creatinine and blood urea

nitrogen levels elevate at this stage. The additional diagnosis of retinopathy may be evident. 9. b. Diabetic nephropathy is the most common cause of chronic kidney disease in Western countries. It affects insulin-dependent diabetics, or type 1 diabetes, and noninsulin dependent diabetics, or type 2 diabetes. Those with poorly controlled blood sugar levels, uncontrolled high blood pressure, and elevated cholesterol levels are at highest risk. This disease process involves an increase in the blood flow to the kidney, caused by hyperglycemia. This results in an elevation of blood pressure, increasing the workload of the glomeruli. The glomeruli thicken and allow serum albumin to pass into the urine (albuminuria). This sign is detectable only by medical testing and begins several years before symptoms are apparent. At this stage, kidney biopsy confirms the diagnosis. Nephrosclerosis is the hardening of the arterioles of the kidneys caused by uncontrolled high blood pressure. Polycystic kidney disease is a genetic disorder in which fluid-filled cysts replace normal healthy kidney tissue. Amyloidosis refers to a condition in which proteins (amyloid proteins) have been altered and become insoluble, then deposit in various organs. 10. a. Recombinant human erythropoietin, or epoetin alfa, (Epogen, Procrit) is used to stimulate red blood cell production in patients with end state renal disease. Cinacalcet HCl (Senispar) is a drug used for lowering the level of parathyroid in the blood. Furosemide (Lasix) and bumetanide (Bumex) are commonly used diuretics. Sevelamer hydrochloride (Renagel) is one of the latest drugs used for phosphate-binding II. True / False: 11. False 12. True 13. True 14. False 15. True III. Identification: 16. Podiatrist 17. Type I 18. <30mg/day 19. Hypertension 20. Irreversible