Got 100% on my Renal Exam

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I could not believe that I got 100 on a renal exam. I am the only person who got 100% so far on a renal exam with that instructor. I am so excited. I now have a 95.5 average. This is Med Surg IV, the hardest one.

Wow, awesome job. I've yet to get a 100% on any of my nursing exams I usually fall within an 88-94% range so kudos to you! Does your instructor allow for item analysis.. meaning does he/she throw out any of the questions?

I am in Med surge I (Fluid Electrolytes and Acid Base, Inflammation and Infection, Shock, Perioperative, Immune System, Cancer etc...) Did you all cover these topics in your first med surg rotation? My next rotation is med surg II which from what I understand are the body systems. Are you all in Med Surge II? The original poster mentioned she was in med surge IV? I know that all schools are different and I am just curious to know what you covered in med surg II and III.

Med Surg I: Diabetes, Endocrine disorders, preoperative/postop/GI/ Infection

Med Surg II: Psychiatric Nursing and Neuro

Med Surg III: Immune and blood disorders, fluid and electrolytes, Cancer, Hepatic disoders, burns

Med Surg IV: Cardiac, Respiratory, Renal and Shock

So far, I prefer Med surg 4, the hardest semester for me was Med Surg 3. It was too many systems at once.

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Specializes in CCU.

Excellent!

Renal is very complexe! I am a critical care nurse and my favorite doctors are the renal gals/guys. Always read their progress notes before others, than read the infectious NP/doc/PA notes. They are brillant, find diagnosis others don't, understand chemistry/physics/pathophys like no one. That is my way to learn quick about what is really going on with my patient.

If you understand renal... you are on the right track!

Keep up the good work!

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Specializes in LTC.

Thanks for the advice !!! I'll be sure to put my test taking strategies to work, this evening when taking finals.

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Future Nurse 35, I have my final exam next week which includes mostly renal. Do you have any advice for me on how to study or how to prepare. I have to pass this test with at least an 80%. Any help would be appreciated.

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If you need more of my notes, send me a private message and let me know where to send it.

Here is a sample of my notes:

Nephrons Job:

Produces 180 L for filtrate daily, 125 ml per minute

Increased urine outputàfluid volume deficit

Threshold: if 200 is renal threshold and client blood glucose is 400, there is 200 ml of urine excrete in urine

Stress incontinenceàhappens when pt sneezes, cough, and laugh

Could happen at any age, women after childbirth

Rennin over secretionàHTN

When there is a drop of B/Pàrennin is released

Aldosteroneàincreases reabsorption of water, sodium and promotes potassium excretion

Any medications that prevents aldosterone secretion and release, would cause dehydration and high potassium b/c aldosterone should flush out potassium

Erythropoietinàincreased bone marrow production of RBCs

Assessment of Kidney

Auscultation first before percussion and palpation

BUN and Creatinine

DehydrationàBUN

Kidney FailureàCreatinine

ADHàtriggers by an increased Osmolality (concentration of urine) when pt is dehydrated

Pyelonephritisàfever and chills

Acute glomerulonephritisàHematuria is the hallmark of this disorder

Capillaries look very thick when test is done

Can cause sodium and water retention, which can result in pulmonary edema.

Nurse would auscultate breath sounds b/c of pulmonary edema

Patient presents with reduced GFR, putting the client at risk for fluid volume overload

Fluid retention is a major problem for patient with this disorder. Nurse should monitor for weight lost when patient is been treated. That is the best way to know the treatment is working

Nephrotic syndromeàedema is the hallmark, high protein diet is important

Procedures:

Ultrasoundàinitial test before the other tests are done

Urographyàcheck patient for seafood allergies

Be careful with pt on Metforminàcan cause lactic acidosis and mess up the kidneys

Remember to make sure, patient drinks lots of fluids because that stuff is toxic to kidneys, will make things worst for patient

Normal glomerular filtration rate, nurse would increase intake of protein b/c renal loss of protein is severe.

Kidney Biopsy

Check patient’s B/P, Temp, Decreased LOC, and pulseàincreased pain may show signs of hemorrhage; remember patient can still hemorrhage weeks after the procedure, so NO heavy lifting and strenuous exercise for TWO weeks

Renogramàlet the patient know, the procedure is NOT painful, it is Small needle stick, don’t be a cry baby lol

Prerenal Azotemiaà pt will have Tachycardia, decreased urinary output and hypotension (decreased cvp), every is low except the HR

Kayexalateàtreat pt with hyperkalemia

This drug helps with loss of K+ in stool, also exchange potassium for sodium

Dialysis patientàneeds more protein

Angiotension-converting enzymes inhibitors (ACE-I)àmost effective drugs to slow progression of renal failure

AV fistulaàyou will hear thrill and bruit, which is a sign of a patent fistula without thrombosis

Do not take B/P in fistula arm

Peritoneal dialysis the purpose of it is to remove toxins and metabolic wastes

Certain drugs should be administered after dialysis, such as B/P meds (lisinopril, Ace-I, diuretics etc.), if not pt with have hypotension b/c the drugs will be removed during dialysis

Aldosterone affects kidneys by causing the distal tubule and collecting ducts to reabsorb increased levels of sodium.

Children with untreated strep may end up with what?

Glomerulonephritis.

ARFàcaused by certain conditions that cause inadequate perfusion to kidney

Good luck to you!!

I also do tone of nclex questions from Saunders, Nclex 4000 and Lippincotts

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Thanks for your help. How do I send a PM? I am sorry I am not familiar with it.Thanks again.

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I sent the entire semester notes to you. If I can help you with anything else, let me know. Good luck on the exam!

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Wow! Congrats!

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congrat!!!!! and please do tell how i am studying for mine now and word on the street is she pulls stuff out from everywehre homehealth you name it:yeah:

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hi future nurse 35 can you please please help me too can you send me your notes ...i'm waiting for you reply thanks

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:wink2: Your awesome!!!!!

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sorry i did not respond to you sooner. i had a big nursing grand round presentation that i was preparing for on chronic cardiac disease. i am glad it's over.

i have my notes if you like. give me an email and i will send them to you.

sample for my notes:

acute renal failure (arf)

- acute renal failure (arf) usually develops over hours or days with progressive elevations of blood urea nitrogen (bun), creatinine, and potassium with or without oliguria. it is a clinical syndrome characterized by a rapid loss of renal function with progressive azotemia.

- arf is often associated with oliguria (a decrease in urinary output to

- the causes of arf are multiple and complex. they are categorized according to similar pathogenesis into prerenal (most common), intrarenal (or intrinsic), and postrenal causes.

o prerenalcauses are factors external to the kidneys (e.g., hypovolemia) that reduce renal blood flow and lead to decreased glomerular perfusion and filtration.

intrarenal causes include conditions that cause direct damage to the renal tissue, resulting in impaired nephron function. causes include prolonged ischemia, nephrotoxins, hemoglobin released from hemolyzed rbcs, or myoglobin released from necrotic muscle cells. acute tubular necrosis (atn) is an intrarenal condition caused by ischemia, nephrotoxins, or pigments. atn is potentially reversible if the basement membrane is not destroyed and the tubular epithelium regenerates

o postrenalcauses involve mechanical obstruction of urinary outflow. common causes are benign prostatic hyperplasia, prostate cancer, calculi, trauma, and extrarenal tumors.

- clinically, arf may progress through four phases: initiating, oliguric, diuretic, and recovery. in some situations, the patient does not recover from arf and chronic kidney disease (ckd) results, eventually requiring dialysis or a kidney transplant.

hello

i know it was 2008, but i am preparing for the renal system in patho. would you please send me your notes thanks. lisa

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