FREE CHBT Patient Safety and Quality Assurance Questions and Answers
The most likely cause of post-renal failure is:
Acute renal failure (ARF) is usually classified by the anatomic location of the damage. Pre-renal failure is typically caused by hypotension, resulting from trauma, dehydration, or blood loss in which the renal blood flow is markedly diminished. Intrarenal failure is caused by intrinsic kidney diseases, such as glomerulonephritis, or renal toxic drugs, such as certain antibiotics, chemotherapy agents, or radiologic contrast materials. Post-renal failure may be caused by problems distal to the kidney that cause obstruction to urine flow, such as ureteral calculi, kinked ureter, neoplastic invasion, or prostatic hypertrophy in men. ARF may proceed to chronic renal failure but may resolve with careful medical treatment and sometimes hemodialysis.
Which hemodialysis schedule is likely to be most efficient?
Most hemodialysis in the United States is done in centers, usually 3-4 hours a session, 3 days a week. The presence of nurses, technicians, and other patients is often reassuring to the individual undergoing treatment. However, the time commitment may interfere with work schedules or the parenting of young children. Some centers offer night treatment with the patient sleeping over while having hemodialysis. Home hemodialysis, using dialyzers appropriately designed for home use, is another option, but the patient and spouse or partner must undergo training regarding techniques and standard procedures and a plan of action in emergencies. Nocturnal home hemodialysis during sleep allows prolonged treatment and has been shown to reduce many of the symptoms of chronic renal disease. Probably the most efficient schedule is that of the newer short daily home hemodialysis, usually 2-3 hours a session, 5-7 days a week. The initial 2 hours of dialysis are the most efficient, and the shortened time schedule allows more time for work and recreational activities.
Which of the following conditions is LEAST likely to be caused by uremia?
Uremia is the term given to a constellation of symptoms resulting from kidney failure, with a resultant buildup of waste products in the circulation (e.g., urea), Some of the typical symptoms include fatigue (often resulting from anemia, which is common in chronic renal disease), itching, myalgias, dyspnea or edema from fluid retention, skin pallor or yellowish cast, foamy urine (due to protein), and nocturia. Loss of protein in the urine greater than 3.5 g/d is referred to as nephrotic syndrome and may be a cause of excessive fluid retention. Often these symptoms develop gradually so frequent inquiry of the patient is indicated. Hemodialysis may improve uremic symptoms, but it only reproduces about 15% of normal kidney function; thus, an increased frequency and duration of hemodialysis may be indicated if the symptoms persist. Urinary tract infections are caused by the introduction of bacteria, not by uremia.
All of the following conditions are associated with chronic kidney failure EXCEPT:
Numerous abnormalities of the blood, protein, and electrolytes occur in chronic renal failure. Anemia is very common due to frequent blood loss with resulting iron deficiency and diminished secretion of erythropoietin by the diseased kidney. Calcium absorption is impaired due to inadequate calcitriol, and phosphate is not adequately excreted by the tubules, resulting in elevated phosphate levels. A low calcium level stimulates the parathyroid gland to produce more parathyroid hormone, producing so-called secondary hyperparathyroidism. This may result in calcium deposition in the heart and blood vessels. Elevated potassium levels are also quite common in these patients and may be life-threatening.
What percentage of transplanted kidneys are functional 1 year after transplantation?
Kidney transplant has become a major form of treatment for chronic renal disease. About 15,000 are done each year in the United States. The donor kidney may be from a living related individual (e.g., brother or sister), a living non-related donor (e.g., spouse or friend), or a cadaver kidney, usually from a non-related individual who has died recently. In the latter case, the patient is usually matched from the national donor list. Living donors should be in good physical and mental health, and in all cases, blood and tissue type (human leukocyte antigen) matching is very important for the survival of the organ in the recipient. The transplanted kidney may last up to 20 years or more, nearly always with the use of immunosuppressant drugs that lower the chance of rejection. About 89%-95% of transplanted kidneys are functional at 1-year post-surgery.
The most common cause of chronic kidney disease in the United States is:
Diabetes mellitus is the most common cause of chronic renal failure (CRF) in the United States. Because of the obesity epidemic, type 2 diabetes (90% of diabetic patients) is on the rise, and thus, there may be even more cases of CRF in the future. Diabetic nephropathy is most likely caused by endovascular damage to the renal vessels. Hypertension is the second leading cause of CRF. It is most often of the so-called essential type in which the exact cause is unknown. In the first few years of this decade, about 27% of patients on dialysis had kidney failure as a result of hypertension. Renal disease or renal artery stenosis may also cause hypertension with its deleterious effects. Additional causes of CRF include glomerular diseases and polycystic disease. Less common causes of CRF are cancer, kidney infections, AIDS, systemic lupus erythematosus, and sickle cell disease.
Peritoneal dialysis (PD) differs from hemodialysis in which of the following ways?
Hemodialysis requires vascular access since the blood flows out of the patient, through the dialysis machine's semipermeable membrane, and then back into the patient. The membrane keeps certain waste products or excess water from returning to the patient, while electrolytes and blood cells are returned. Peritoneal dialysis is performed with an intra-abdominal catheter without blood ever leaving the body. Vascular access is not required. The blood vessels of the abdominal cavity act as a filter similar to the semipermeable membrane used in hemodialysis. Peritoneal dialysis may be performed at home with a cycler machine to exchange fresh sterile dialysate, often overnight 7 days a week. Manual exchange of dialysate may also be done.