Electrolytes

Which finding would the nurse expect during the assessment of a patient with a serum potassium level of 6.8 mEq/L? SATA 1 Bradycardia 2 Muscle twitching 3 Extremity numbness 4 Cardiac dysrhythmias 5 Hyperactive bowel sounds

1 Bradycardia 2 Muscle twitching 3 Extremity numbness 4 Cardiac dysrhythmias 5 Hyperactive bowel sounds

A patient admitted to the emergency department with facial burns and smoke inhalation requires high-flow oxygen therapy. Which oxygen delivery device would the nurse apply? 1 Face tent 2 Venturi mask 3 Nasal cannula 4 Nonrebreather mask

1 Face tent

Functions of MG

1. cardiac function 2. vasodilation / BP 3. enzyme cofactor (carb/protein metabolism) 4. DNA/RNA synthesis

Urine output between ___ to ___ mL per day is called oliguria or hypouresis.

100 / 400

Normal Hgb women

12-16

Normal Hgb men

14-17 mg/dL

Normal ratio of bicarbonate to carbonic acid

20:1

When a client who is taking a diuretic has been instructed to eat foods high in potassium, which fruit would the nurse suggest? 1 Apples 2 Grapes 3 Cantaloupe 4 Cranberries

3 Cantaloupe

Normal PACO2

35-45 mmHg

Which pressure change does the nurse determine to be the cause of edema for a client with albuminuria? 1 Decrease in tissue hydrostatic pressure 2 Increase in plasma hydrostatic pressure 3 Increase in tissue colloid osmotic pressure 4 Decrease in plasma colloid oncotic pressure

4 Decrease in plasma colloid oncotic pressure

Normal insensible water loss

500-1000 ml

Ca and Phosphorus

inversely related

7. Which patient is at most risk for hypomagnesemia?* A. A 55 year old chronic alcoholic B. A 57 year old with hyperthyroidism C. A patient reporting overuse of antacids and laxatives D. A 25 year old suffering from hypoglycemia

A. A 55 year old chronic alcoholic

Which patient is at a potential risk for Digoxin toxicity?* A. A patient with Cushing's syndrome taking Laxis 20 mg IV twice a day B. A patient with a calcium level of 8.9 C. A patient with a potassium level of 3.8 D. A patient presenting with painful muscle spasms and positive Trousseau's sign

A. A patient with Cushing's syndrome taking Laxis 20 mg IV twice a day *Hypokalemia > the risk of digoxin toxicity.

Which term describes leakage of urine despite voluntary control of urination? Urgency Dribbling Hesitancy Incontinence

Dribbling

Why would you give insulin + glucose?

For hyperkalemia: this will move K+ INTO the cell

Pt - severe dyspnea & wheezing. pH 7.26; PaCo2: 55 mmHg, PaO2: 68, HCO3-: 24 What is the dx?

High PaCo2 Low PH *Respiratory Acidosis

Which causes a rapid, thready pulse: hypovolemia or hypervolemia?

Hypovolemia

Watch for laryngospasm, strider, and dysrhythmias with hypo_______

calcemia

Deep furrows on the surface of the tongue

clinical manifestation of dehydration

Hypocalcemia causes increased/decreased DTRs

increased

Fatigue, weakness, and lethargy are associated with hypo________

kalemia

Abdominal cramps are assoc. with hyper______

kalmia

Atropine

muscarinic antagonist / treat the s/s of bradycardia

he nurse has taught a client about a low-sodium diet. Which food choice by the client indicates successful learning? 1 Banana 2 Carrots 3 Yogurt 4 Tomato juice

1 Banana

One lb of body weight = how many kg?

1 kg

A client with acute kidney injury is moved into the diuretic phase after 1 week of therapy. During this phase, which clinical indicators would the nurse assess? Select all that apply. One, some, or all responses may be correct. 1 Skin rash 2 Dehydration 3 Hypovolemia 4 Hyperkalemia 5 Metabolic acidosis

2 Dehydration 3 Hypovolemia

Which component of the client's nephron delivers blood from the glomerulus into the peritubular capillaries or the vasa recta? 1 Arcuate artery 2 Efferent arteriole 3 Afferent arteriole 4 Interlobular artery

2 Efferent arteriole

A client receiving a hemodialysis treatment asks the nurse which substances are being removed. Which substance can the nurse report is being removed during hemodialysis? 1 Blood 2 Sodium 3 Glucose 4 Bacteria

2 Sodium

An older adult with a history of small cell lung carcinoma reports muscle cramping, thirst, and fatigue. The primary health care provider diagnoses the client with a pituitary disorder and is treating the client accordingly. Which is an effective outcome of the treatment? 1 Urine output of 10 L/day 2 Urine specific gravity less than 1.025 3 Urine osmolarity of 80 mOsm/kg (80 mmol/kg) 4 Serum osmolarity of 600 mOsm/kg (600 mmol/kg)

2 Urine specific gravity less than 1.025

Normal phosphorus levels

2.5-4.5 mg/dL Phor: 4 Us (you and I = 2) If you and I get married and have a kid, it will be half of you and half of me.

A patient with normal renal function who does not have heart disease or alterations that require fluid restriction should have approximately ____ mL per 24-hour period.

2300

Normal blood osmolality

280-300 mOsm/kg

A client with severe hyperkalemia develops acidosis. Immediate administration of which medication can help prevent a life-threatening crisis? 1 50% dextrose 2 Furosemide 3 Sodium bicarbonate 4 Epinephrine

3 Sodium bicarbonate

The primary health care provider instructs the nurse to manage fluid replacement therapy in a client with cancer. Which type of care is the client receiving? 1 Palliative care 2 Comfort care 3 Supportive care 4 End-of-life care

3 Supportive care

A client with a history of ulcerative colitis has a large portion of the large intestine removed, and an ileostomy is created. For which potential life-threatening complication would the nurse assess the client after this surgery? 1 Infection caused by the excretion of feces 2 Injury caused by exposed intestinal mucosa 3 Altered bowel elimination caused by the ostomy 4 Limited water reabsorption caused by removal of intestine

4 Limited water reabsorption caused by removal of intestine

Which assessment would be brought to the health care provider's attention before administration of intravenous potassium chloride? 1 Progressively worsening muscle weakness 2 Poor tissue turgor with tenting 3 Urinary output of 200 mL during the previous 8 hours 4 Oral fluid intake of 300 mL during the previous 12 hours

4 Oral fluid intake of 300 mL during the previous 12 hours (may cause urinary retention)

An infant with a 3-day history of decreased fluid intake and diarrhea is admitted with dehydration and lethargy. Which explanation would the nurse give the parent for the infant's rapid deterioration? 1 Cellular metabolism is unstable in young children. 2 Renal function is immature in children until they reach school age. 3 The proportion of water in the body is less in infants than that in adults. 4 The ECF requirement per unit of body weight is greater in infants than in adults.

4 The ECF requirement per unit of body weight is greater in infants than in adults.

Which value falls within the range for the minimal amount of urine that needs to be produced in 24 hours? 1 150 mL/day 2 250 mL/day 3 350 mL/day 4 450 mL/day

450 mL/day

How does hypocalcemia affect the GI system?

Causes > peristalsis / diarrhea

Is Venti low-flow or high-flow?

High-flow

Should you give loop diuretics for hyper or hypo Mg?

Hyper

Anxiety and irritability are associated with hypo/hyper Kalemia

Hyperkalemia

How can laxatives affect Mg levels?

Laxatives such as MOM can INCREASE Mg levels

K IV

Never give with IV push; give with lidocaine in IV to prevent burning

The kidneys excrete all fluids except ________

carbonic acid

Trosseau's sign

carpal spasm when inflated BP cuff maintained between DBP and SBP for 3 minutes + = hypoparathyroidism / HYPOCALCEMIA

Hypocalcemia often occurs with ____________

hypomagnesemia

A priority symptom of ________ is seizure activity, which may manifest early on as muscle twitching

hyponatremia

7. Which arrhythmia is a patient who has a Mg+ level of 0.8 most likely to experience? A. Heart block B. Bradycardia C. Torsades de pointes D. Normal sinus rhythm

C. Torsades de pointes

How does Mg affect PTH?

Low Mg causes decreased PTH, which causes hypocalcemia

2. Which patient is at more risk for an electrolyte imbalance?* A. An 8 month old with a fever of 102.3 'F and diarrhea B. A 55 year old diabetic with nausea and vomiting C. A 5 year old with RSV D. A healthy 87 year old with intermittent episodes of gout

A. An 8 month old with a fever of 102.3 'F and diarrhea (Young children and infants have higher fluid exchange ratios, so they are at > risk of fluid & electrolyte imbalance.)

1. On morning assessment of your patient in room 2502 who has severe burns. You notice that fluid is starting to accumulate in his abdominal tissue. You note that his weight has not changed and his intake and output is equal. What do you suspect?* A. Third spacing B. This is normal and expected after a burn and it is benign C. Document this finding as non-pitting abdominal edema. D. Intravascular compartment syndrome

A. Third spacing

2nd biggest ICF electrolyte

Mg

The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is an appropriate choice for a client with this disorder? 1 Ham sandwich with cheese, whole milk, and potato chips 2 Penne pasta, spinach, banana, and decaffeinated iced tea 3 Baked lasagna with sausage, salad, and milkshake 4 Hamburger, french fries, and cola

2 Penne pasta, spinach, banana, and decaffeinated iced tea (needs to be low-fat and low-sodium)

Which common physiologic change with aging alters the hydration status of older adults? 1 Poor skin turgor 2 Adrenal gland growth 3 Decreased muscle mass 4 Increased thirst mechanism

3 Decreased muscle mass (fat cells contain much more water than adipocytes)

While caring for a client receiving hydrocortisone therapy, the nurse anticipates a dose adjustment in the client's prescription. Which observation in the client supports this anticipation? 1 Three episodes of vomiting 2 Passage of loose stools 3 Body temperature of 37.2°C (99°F) 4 Sudden weight gain of 8 kg

4 Sudden weight gain of 8 kg

. A patient is admitted to the ER with the following findings: heart rate of 110 (thready upon palpation), 80/62 blood pressue, 25 ml/hr urinary output, and Sodium level of 160. What interventions do you expect the medical doctor to order for this patient?* A. Restrict fluid intake and monitor daily weights B. Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output C. Administer hypotonic IV fluid and administer sodium tablets. D. No interventions are expected

B. Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output

7. A patient's calcium level is 11.2. Which option below could be the cause?* A. None, 11.2 is a normal calcium level B. Cushing's Syndrome C. Hydrochlorothiazide D. Hypoparathyroidism

C. Hydrochlorothiazide (Sodium and Calcium have an inverse relationship.)

9. A patient has a sodium level of 119. Which of the following is NOT related to this finding? A. Over secretion of ADH (antidiuretic hormone) B. Low salt diet C. Inadequate water intake D. Hypotonic fluid infusion (overload)

C. Inadequate water intake

Lithium is known to affect the parathyroid by increasing ______ levels and decreasing _____ levels? A. calcium, phosphate B. phosphate, calcium C. calcium, sodium D. sodium, calcium

C. calcium, sodium

How does hyperaldosteronism affect K+?

Causes hypo K+

unbound calcium

Free/ionized - PHYSIOLOGICALLY RELEVANT type

IV calcitonin

Given for hypercalcemia

Of the diagnoses documented in a patient's health record, which condition would the nurse attribute to the cause of the patient's sodium level of 130 mEq/L? 1 Diarrhea 2 Heart failure 3 Cushing syndrome 4 Fever unknown origin

Heart failure

Kayexalate

K cocktail -- used in hyperkalemia; excrete Potassium

Key player in RMP

K+

_______ is a vesicant and can cause tissue necrosis if it infiltrates into the intradermal or subcutaneous tissues. It is best infused through a central line, such as a PICC line.

NE

Functions of Calcium

Regulate BP by regulating cardiac contractility nerve conduction, muscle contraction/tone hormone release, cell signaling

How do thiazides affect calcium levels?

They excrete sodium through diuresis. Since Na and Ca have an inverse relationship, it causes hypercalcemia.

Which statement is accurate regarding fluid balance in older-adult patients? 1 They have less total body water. 2 They are prone to hyperkalemia. 3 They are prone to hypernatremia. 4 They have an increased thirst reflex.

They have less total body water.

How to remember hyper Mg

Think of a magnum (gun). When someone whips out a gun, everyone will be still/slow. (Response. depression, bradycardia, <DTR, <LOC, lethargic)

When is oxygen therapy needed?

When O2 sat levels are below 90

Which action is the priority when administering 20 mEq potassium chloride IV? a. Administer at a rate less than 10 mEq/hr. b. Monitor respiratory rate and depth. c. Monitor for pain or burning at the IV infusion site. d. Place the patient on a heart monitor during administration.

a. Administer at a rate less than 10 mEq/hr. *Giving K+ greater than 10mEq/hr. can cause arrhythmias.

Which action would the nurse take when providing care to a patient with hypokalemia? a. Question the continued administration of prescribed bumetanide. b. Administer prescribed oral potassium chloride (KCl) before a meal. c. Establish a peripheral IV, preferably in the hand, for administering IV potassium chloride (KCl). d. Obtain the prescribed vial of IV potassium chloride (KCl) from the pharmacy, and dilute before administration.

a. Question the continued administration of prescribed bumetanide. Bumetanide is a loop diuretic, which contributes to potassium loss and should be questioned.

What assessments does a nurse make before hanging an IV fluid that contains K+? a. urine output b. ABGs c. fullness of neck veins / JVD d. K lab value in EHR e. LOC

a. urine output d. K lab value in EHR

Which body system would the nurse reassess if a patient's laboratory result indicates a serum potassium level of 5.9 mEq/L? a. Respiratory b. Genitourinary c. Cardiovascular d. Integumentary

c. Cardiovascular

Decreased gastrointestinal motility occurs with _____kalemia; abdominal cramping is associated with _____kalemia

hypo / hyper

Muscle twitching is a sign of _______ and _______

hypocalcemia & hypomagnesemia

ICE CHIP VOLUME

record 1/2 of the volume

murder acronym

s/s of hyperkalemia: Muscle weakness, urine output reduced, respiratory depression, EKG changes, reflexes increased

Where is Mg absorbed?

small intestine

Perioral numbness is associated with

hypocalcemia

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

inability to suppress the secretion of ADH. If water intake exceeds the reduced urine output, the ensuing water retention leads to the development of hyponatremia.

0.45% NS

treatment for hyper NA

Which value indicates clinical hypoxemia? 1 Partial pressure of arterial oxygen (Pao2) of 50 mm Hg 2 Partial pressure of arterial carbon dioxide (PaCo2) of 30 mm Hg 3 Hemoglobin of 22 g/dL 4 Oxygen saturation of 90%

1 Partial pressure of arterial oxygen (Pao2) of 50 mm Hg A Pao2 of 50 mm Hg indicates low levels of oxygen in the arterial blood; this is considered hypoxemia. Hemoglobin measures oxygen-carrying capacity. PaCo2 of 30 mm Hg indicates low carbon dioxide levels in the blood. Oxygen saturation below 90% indicates tissue hypoxemia.

client reports vomiting and diarrhea for 3 days. Which clinical indicator is most commonly used to determine whether the client has a fluid deficit? 1 Presence of dry skin 2 Loss of body weight 3 Decrease in blood pressure 4 Altered general appearance

2 Loss of body weight

Which ECG finding is consistent with HYPERkalemia? 1 Absent T waves 2 Elevated P waves 3 Prolonged PR intervals 4 Shortened QRS complexes

3 Prolonged PR intervals

1. A patient has a sodium level of 123 and presents with confusion. The doctor diagnoses the patient with SIADH. Which type of hyponatremia is this?* A. Hypovolemic B. Euvolemic C. Hypervolemic D. Antivolemic

B. Euvolemic

A patient with a sodium level of 178 is ordered to be started on 0.45% Saline. What is the most IMPORTANT nursing intervention for this patient? A. Maintain patent IV B. Give rapidly to ensure fluids levels are shifted properly C. Clarify doctor's order because 0.45% saline is contraindicated in hypernatremia D. Give slowly and watch for signs and symptoms of cerebral edema

D. Give slowly and watch for signs and symptoms of cerebral edema The answer is D: Give slowly and watch for signs and symptoms of cerebral edema. The most important intervention is to give slowly and watch for S&S of cerebral edema because a hypotonic solution can cause rapid swelling of the cell.

When analysis of a patient's telemetry strip reveals a widened QRS complex with peaked T waves, which laboratory value would the nurse review before notifying the health care provider? 1 Sodium 2 Calcium 3 Potassium 4 Magnesium

Potassium

Severe hypocalcemia is characterized by skeletal muscle excitability and twitching, known as _________

tetany

The nurse discusses the implications of diet and fluid intake with a client who is receiving lithium therapy. Which instruction will the nurse give the client and family about nutrition? 1 A regular diet should be maintained. 2 Daily fluid intake should be limited to 1 L. 3 Daily salt intake should be limited to 2000 g. 4 A weight-reducing diet should be implemented.

1 A regular diet should be maintained. A regular diet maintains sodium balance; lithium DECREASES sodium resorption by the renal tubules.

hich serum blood level would the nurse expect to be decreased in a client with a diagnosis of hyperparathyroidism? 1 Calcium 2 Chloride 3 Phosphorus 4 Parathyroid hormone

3 Phosphorus (REMEMBER: Ca and phosphorus have an inverse relationship)

Hypokalemia causes which of the following s/s? (EAQ) a. Paresthesia b. Bradycardia c. Shallow Respirations d. Weak, thready pulse e. Musculoskeletal weakness

c. Shallow Respirations d. Weak, thready pulse e. Musculoskeletal weakness Paresthesia & bradycardia are sx. of HYPERkalemia. (Hyperkalemia is MURDER, with the D being "Decreased heart contractility")

Which nursing interventions would be the best practice for client safety and quality of care when placing a short peripheral venous catheter? Select all that apply. One, some, or all responses may be correct. 1 Choose a distal site. 2 Use the wrist of the client. 3 Choose the dominant hand. 4 Do not use the arm on the side of a mastectomy. 5 Choose a vein of appropriate length and width to fit the catheter's size.

1 Choose a distal site. 4 Do not use the arm on the side of a mastectomy. 5 Choose a vein of appropriate length and width to fit the catheter's size.

Which clinical indicators would the nurse expect when an intravenous (IV) line has infiltrated? 1 Heat 2 Pallor 3 Edema 4 Decreased flow rate 5 Increased blood pressure

2 Pallor 3 Edema 4 Decreased flow rate The accumulation of fluid in the tissues between the surface of the skin and the blood vessels makes the skin appear pale. The accumulation of fluid in the interstitial compartment causes swelling. As the needle/catheter is dislodged from the vein, the drip rate of the IV slows or ceases. Heat is associated with phlebitis; the accumulation of room-temperature IV fluid in the tissue makes the site feel cool. Increased blood pressure is a sign of circulatory overload; when an IV infusion has infiltrated, the intravascular fluid volume does not increase.

insensible water loss

the loss of water not noticeable by a person, such as through evaporation from the skin and exhalation from the lungs during breathing

A patient who has thick, sticky respiratory secretions requires high-flow, humidified oxygen delivery. Which oxygen delivery equipment would the nurse use for this patient? 1 Face tent 2 Venturi mask 3 Aerosol mask 4 Nonrebreather mask

3 aerosol mask An aerosol mask is used when high humidity is needed, as with thick secretions.

1. A patient with a magnesium level of 3.6 would exhibit which of the signs and symptoms EXCEPT?* A. Hypotension B. Profound Lethargy C. Respiratory failure D. Hyperreflexia of the deep tendons

D. Hyperreflexia of the deep tendons

Which condition commonly occurs in patients who are on long-term furosemide therapy? 1 Hypocalcemia 2 Hypercalcemia 3 Hyponatremia 4 Hypernatremia

Hyponatremia

Which principle would the nurse apply to planning care for a patient receiving supplemental oxygen? Select all that apply. One, some, or all responses may be correct. 1 Nitrogen helps prevent alveolar collapse because it does not cross over capillary membranes. 2 When a patient experiences air hunger, increasing the partial pressure of arterial carbon dioxide (PaCo2) improves the balance. 3 It is important to keep the patient's partial pressure of arterial oxygen (Pao2) above 90 mm Hg for optimal outcomes. 4 Oxygen is harmless; it is part of what we breathe normally, and toxicity is not possible. 5 High levels of oxygen dilute the nitrogen in the lungs and lead to alveolar collapse.

1 Nitrogen helps prevent alveolar collapse because it does not cross over capillary membranes. 5 High levels of oxygen dilute the nitrogen in the lungs and lead to alveolar collapse. Pao2 levels of greater than 90 mm Hg should be reported to the health care provider to minimize the risk for oxygen toxicity with excess oxygen administration.

Which assessment finding is characteristic of a client with hypoparathyroidism? 1 Serum phosphorus of 5 mg/dL (1.61 mmol/L); serum magnesium of 0.9 mEq/L (0.9 mmol/L) 2 Serum phosphorus of 4 mg/dL (1.29 mmol/L); serum magnesium of 2.4 mEq/L (2.4 mmol/L) 3 Serum phosphorus of 3 mg/dL (0.97 mmol/L); serum magnesium of 3.3 mEq/L (3.3 mmol/L) 4 Serum phosphorus of 2 mg/dL (0.65 mmol/L); serum magnesium of 4.1 mEq/L (4.1 mmol/L)

1 Serum phosphorus of 5 mg/dL (1.61 mmol/L); serum magnesium of 0.9 mEq/L (0.9 mmol/L)

Which interventions would the nurse implement when caring for a client with SIADH? Select all that apply. 1 frequent oral care. 2 fall risk precautions. 3. Restrict fluids to 2 L per day. 4 Place the client in high-Fowler position. 5 Monitor for and report neurological changes.

1 frequent oral care. 2 fall risk precautions. 5 Monitor for and report neurological changes. Fluids are restricted to no more than 1000 mL and to no more than 500 mL for the client with severe hyponatremia. Treatment of SIADH includes placing the bed flat or elevating the head of the bed no more than 10 degrees. This position promotes venous return to the heart, which increases left ventricular filling pressure. Increasing left ventricular filling pressure stimulates osmoreceptors to send a message to the pituitary (via the hypothalamus) that ADHrelease should be decreased. Because treatment includes restricting fluids, frequent oral care is provided to increase client comfort.

Which of these values are abnormal? A. White blood Cell count (WBC) 10,000/mm3 B. Hemoglobin (Hgb) 21 g/dl C. Hematocrit (Hct) 58% D. Blood urea nitrogen (BUN) 16 mg/dl E. Sodium (Na) 154 mEq/L F. Potassium (K) 2.9 mEq/L

B. Hemoglobin (Hgb) 21 g/dl C. Hematocrit (Hct) 58% E. Sodium (Na) 154 mEq/L F. Potassium (K) 2.9 mEq/LA hemoglobin (Hgb) of 21 g/dl is high. A hematocrit (Hct) of 58% is high. Artificially high Hct values occur with dehydration, secondary to hemoconcentration, resulting from a decreased intravascular fluid volume. Hct varies based on the percentage of red cells in the total blood volume. A serum sodium (Na) of 154 mEq/L is high. Fluid losses have exceeded sodium losses, resulting in an increased concentration of sodium. Hypernatremia characterizes dehydration. Variable amounts of sodium are lost with vomit and diarrhea. A serum potassium (K) of 2.9 mEq/L is low (hypokalemia). Large amounts of potassium are lost in vomit and diarrhea. Hypokalemia can cause cardiac dysrhythmias and cardiac arrest. Also, risk for digoxin toxicity is increased when hypokalemia is present.

How to remember SIADH

"I" in SIADH - In the body and not in the potty.

s/s of Hypercalcemia (too much calcium)

(Calcium levels >10.5 mEq/L) lethargy, confusion, coma, muscle weakness, polyuria and polydipsia (thirst), anorexia, constipation, abdominal pain, bone pain, EKG: shortened QT and ST

When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which medication will the nurse expect the health care provider to prescribe? 1 Calcium 2 Magnesium 3 Bicarbonate 4 Potassium chloride

1 Calcium

Which medication mimics the effect of antidiuretic hormone (ADH) on the body? 1 Insulin 2 Calcium 3 Potassium 4 Vasopressin

4 Vasopressin

The minimum volume of urine per day needed to excrete toxic waste products is ________ mL and is called obligatory urine output.

400 to 600

Which 2 of the 4 major electrolytes, when increased, will cause constipation?

Ca & Na * How to remember? The letters, C, A, and N are all in constipation. K and Mg are not!! An increase in K and Mg both cause diarrhea, not constipation. * Also, an increase in Na implies a decrease in water, so that will cause constipation.

Food sources of Mg

Always: avocado Get: green leafy Plenty: pork, peanut butter Of: oatmeal Foods: fish Containing: Cauliflower Large: Legumes Numbers: Nuts Of: Oranges Mg: Milk

___ and __ both decrease NM excitability

Ca / Mg

A patient's potassium level is 3.0. Which foods would you encourage the patient to consume?* A. Cheese, collard greens, and fish B. Avocados, strawberries, and potatoes C. Tofu, oatmeal, and peas D. Peanuts, bread, and corn

B. Avocados, strawberries, and potatoes

__ may reverse cardiac effects of hyper Mg

Ca+

Why does hypocalcemia increase neuromuscular excitability?

Bc Ca & Na are inversely related; if Ca decreases, Na increases. More Na rushes into the cell, causing greater depolarization.

Why would you give 0.9% sodium chloride to someone with HYPOnatremia?

Because it replaces BOTH sodium and fluids

8. In report from a transferring facility you receive information that your patient's Magnesium level is 1.2. When the patient arrives you are ordered by the doctor to administer Magnesium Sulfate via IV. Which of the following interventions takes priority? A. Set-up bedside suction B. Set-up IV Atropine at bedside due to the bradycardia effects of Magnesium Sulfate C. Monitor the patient's for reduced deep tendon reflexes and initiate seizure precautions D. None of the above

C. Monitor the patient's for reduced deep tendon reflexes and initiate seizure precautions

How does cancer affect calcium?

CA cells act like PTH, so they can cause hypercalcemia

A patient reports numbness and a tingling sensation in the fingers and toes. The nurse observes facial muscle contractions in response to a tap on the facial nerve. The patient's electrocardiogram shows a prolonged ST segment. Which electrolyte imbalance does the nurse suspect? Sodium Calcium Potassium Magnesium

Calcium (*hypo)

Signs of hyponatremia

Cells SWELLING (cerebral edema) N&V Lethargy Weakness <DTR Muscle twitching/spasms Headache, coma, AMS Diarrhea / Hyperactive bowel Why?? Because more sodium is going INTO the cell, causing greater depolarization. < DTRs, bc not enough of the electrolyte to maintain an impulse.

Antacids can increase/decrease calcium levels

Increase

What health care-acquired infection (HCAI) occurs most frequently? A. Pneumonia B. Surgical site infection (SSI) C. Catheter-related bloodstream infection (CR-BSI) D. Catheter-associated urinary tract infection (CA-UTI)

D. Catheter-associated urinary tract infection (CA-UTI)

Signs of hypernatremia

FRIED Fever/flush Restless/irritable Increased BP Edema Decreased urinary output Other: > thirst, twitching, seizures. Why?? Bc there is more sodium to enter the cell and cause depolarization

Which respiratory device can be used to provide a patient with an 80% fraction of inspired oxygen (Fio2)? 1 Face tent 2 Aerosol mask 3 T-piece 4 Venturi mask 5 Simple mask

Face tent Aerosol mask T-piece An aerosol mask or face tent could deliver the ordered 80% Fio2 with a flow rate of at least 10 L/min. A patient with an endotracheal tube could use a T-piece to receive 80%. *A Venturi mask can deliver 24% to 50% oxygen. *A simple mask can deliver 40% to 60% oxygen.

ACE inhibitors and ARBs can cause hyper/hypo kalemia

Hyper (because they inhibit aldosterone. Aldosterone retains NA+ and excrete K+).

Which causes high BP: hypovolemia or hypervolemia?

Hypervolemia

Tetany is assoc. with hypo/hyper calcemia

Hypocalcemia

Who should be on seizure precautions?

Hypocalcemia

hich electrolyte imbalance should be anticipated in a patient with hyperphosphatemia? 1 Hypokalemia 2 Hypocalcemia 3 Hypernatremia 4 Hypermagnesemia

Hypocalcemia

Chvostek's sign

Hypocalcemia (facial muscle spasm upon tapping)

How can massive blood infusions affect Mg levels?

It can decrease Mg levels, because blood transfusions bind and inactivate Mg

Both hyper and hypo ___ cause flaccid muscle weakness

K

Both of these aid in protein and carb metabolism

K and Mg

Which electrolyte suppresses the effects of Ach?

Mg

Which electrolyte triggers the Na/K pump?

Mg

Assess DTRs hourly with hypo ___

Mg (DTRs are super active)

If Mg is low, K is low. Replace __ first.

Mg (K chases Mg)

__ helps convert T3 to T4

Mg (Therefore, hypothyroidism can cause hypo Mg)

Alcohol abuse is a huge cause of hypo_______

Mg+

Which device is an example of a low-flow oxygen delivery system used for long-term therapy? 1 T-piece 2 Face tent 3 Nasal cannula 4 Simple facemask

NASAL CANNULA A nasal cannula is an example of a low-flow oxygen delivery system that is used to treat chronic lung disease and for any patient in need of long-term oxygen therapy. A simple facemask is used to deliver oxygen concentrations of 40% to 60% for short-term oxygen therapy or in an emergency.

Are flat neck veins when upright a sign of dehydration?

No; flat neck veins when upright is a normal sign

Which oxygen delivery equipment could provide a fraction of inspired oxygen (Fio2) GREATER than 80%? 1 Simple facemask 2 Venturi mask 3 Nonrebreather mask 4 Partial rebreather mask

Nonrebreather mask Nonrebreather masks allow the highest oxygen level of the low-flow systems and are often used for patients whose respiratory status is unstable and who may require intubation. The simple facemask provides 40% to 60% Fio2. The partial rebreather mask provides 60% to 75% Fio2. The Venturi mask provides up to 50% Fio2.

A client is admitted with dehydration. Which findings should the nurse expect the client to exhibit? Select all that apply. One, some, or all responses may be correct. Supple skin turgor Rapid, thready pulse Decreased hematocrit Elevated specific gravity Adventitious breath sounds

Rapid, thready pulse Elevated specific gravity *Hct will actually be > because of > hemoconcentration

The nurse weighs a patient with renal failure and finds the body weight to be 112 pounds. The patient's weight on the previous day was 110 pounds. Which interpretation would the nurse make from the finding? Retention of a liter of fluids. Experiencing a healthy weight gain. Improved kidney function. Not passing urine for a long time.

Retention of a liter of fluids *1 L of body fluid = 1 kg/2.2 lb

Causes of hyponatremia

SIADH Adrenal Insufficiency GI losses Salt wasting diseases Post-op (increases vasopressin) CF

The nurse would consider the development of dehydration if acute ________ occurs in an older client with an infection.

confusion

Which test would the nurse monitor when determining whether a client's newly transplanted kidney works effectively? Renal scan Serum creatinine 24-hour urine output White blood cell (WBC) count

Serum creatinine

Which electrolyte deficiency would the nurse expect to find when reviewing the laboratory data for a patient who presents with seizure activity, decreased deep tendon reflexes, and diarrhea? 1 Sodium 2 Calcium 3 Potassium 4 Magnesium

Sodium

Which electrolyte excess results in cellular irritability and severe cellular dehydration? 1 Sodium 2 Calcium 3 Phosphorus 4 Magnesium

Sodium

Which electrolyte deficiency would the nurse expect to find when reviewing the laboratory data for a patient who presents with seizure activity, decreased deep tendon reflexes, and diarrhea? Sodium Calcium Potassium Magnesium

Sodium (big s/s are change in mental status)

How can a blood transfusion cause hypocalcemia?

They contain citrate, which binds Ca+

To evaluate the effectiveness of treatment for a client with exacerbation of left ventricular failure, which clinical indicators will the nurse monitor? Select all that apply. One, some, or all responses may be correct. a. Lung sounds b. Heart sounds c. Heart rate d. Peripheral edema e. Dyspnea on exertion f. JVD

a. Lung sounds b. Heart sounds c. Heart rate e. Dyspnea on exertion

A pt has hypo K+ with stable cardiac function. What are the priority interventions? a. fall prevention 2. teaching r/t Na restriction c. encouraging > fluids d. monitor for constipation e. explain how to take daily weights

a. fall prevention d. monitor for constipation

circumoral tingling is associated with a. hypocalcemia b. hypercalcemia c. hyperkalemia d. hypokalemia

a. hypocalcemia

salmon and sardines are good sources of

calcium

Ca is a potent vaso constrictor/dilator

vasoconstrictor

Causes of hypernatremia

-Vomiting/diarrhea -Inadequate ADH (DI) -Oversecretion of aldosterone -Major burns

Hyponatremia

<135 mEq/L

Which amount of fluid does a healthy adult typically consume each day? 2 L/day 2.3 L/day 2.6 L/day 2.9 L/day

2.3 L/day Remember: we limit Na+ intake to about 2.3 grams/day!

Normal Calcium range

8.5-10.5 mg/dL

How does hypocalcemia affect peristalsis?

> Peristalsis & diarrhea

Foods high in potassium

*"POTASSIUM"* P: Potatoes, pork O: Oanges T: Tomatoes A: Avocado S: Strawberries S: Spinach I: f(I)sh U: m(U)shrooms M: Musk melon: cantaloupe ** Also: carrots, raisins, bananas

A client with ascites has a paracentesis, and 1500 mL of fluid is removed. Which clinical manifestation would indicate an immediate adverse response to the fluid removal? 1 Tachycardia 2 Decreased peristalsis 3 Respiratory congestion 4 Fever

1 Tachycardia

When a patient reports disturbed deep sleep because of frequent cramping in the calves, which electrolyte would the nurse review in the patient's health record? 1 Correct 2 Calcium 3 Potassium 4 Magnesium

3 Potassium

Hypernatremia

>145 mEq/L

A patient with chronic obstructive pulmonary disorder (COPD) who has been receiving oxygen via nasal cannula is becoming increasingly dyspneic with increased use of accessory muscles to breathe. The nurse auscultates markedly diminished breath sounds in all lung fields. Which oxygen delivery method would the nurse recommend that the provider prescribe? 1 Venturi mask 2 Transtracheal oxygen catheter 3 Noninvasive positive-pressure ventilation (NPPV) 4 Face tent

Noninvasive positive-pressure ventilation (NPPV) The patient is experiencing atelectasis, as evidenced by diminished breath sounds, and may benefit from NPPV, which helps open alveoli, improve gas exchange, and relieve dyspnea. A Venturi mask helps deliver a precise amount of oxygen but does not help open alveoli. Transtracheal oxygen is used to provide oxygen without the discomfort of a mask or nasal cannula. A face tent provides oxygen without direct contact to the face and is useful for patients with facial burns or injuries.

Hyper Mg can cause an increased/decreased QT interval, widened/narrowed QRS, and increased/decreased T wave

increased/widened/increased