Fluid/Elec/Acid Base/Urinary - Test 1

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Magnesium - normal range

1.5-2.5

Hemoglobin

11-16 (female) 13-18 (male)

Sodium - normal range

135-145

Platelets

150,000-450,000

WBC range

5,000-10,000

Glucose - normal range

60-100

BUN - normal range

8-23

Calcium - normal range

9-11

Chloride - normal range

98-106

Hypernatremia manifestations

- thirst - elevated temperature - dry, swollen tongue - sticky mucosa - neurologic symptoms - restlessness - weakness

Hypokalemia causes

*GI losses*, medications, alterations of acid-base balance, hyperaldosteronism, poor dietary intake

Hypophosphatemia causes

*alcoholism*, refeeding of patients after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, major burns, low potassium, diarrhea, vitamin D deficiency, *use of diuretic and antacids*

FVE risk factors

*heart failure*, renal failure, cirrhosis of liver

Hypophosphatemia manifestations

*neurologic symptoms*, confusion, muscle weakness, *tissue hypoxia, muscle and bone pain*, increased susceptibility to infection

Hypomagnesemia manifestations

*neuromuscular irritability*, muscle weakness, tremors, athetoid movements, *ECG changes and dysrhythmias*, alterations in mood and level of consciousness

Potassium - normal range

3.5-5.0

Hematocrit

37% (female) 42-52% (male)

Hypocalcemia manifestations

*tetany*, circumoral numbness, paresthesias, *hyperactive DTRs*, *Trousseau's sign*, *Chovstek's sign*, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety

What would most likely indicate respiratory alkalosis?

- decreased PaCO2 <35 mmHg - *hyperventilation* - *anxiety* - brainstem stimulation - head injury - shock - Chvostek's & Trousseau's sign - lightheadedness - increased pH >7.45 - tingling lips/fingers

FVE medical management

- directed at cause - restriction of fluids and sodium (possible 1500mg Na diet) - administration of diuretics (hydrochlorothiazide is gentle) - watch for hyperkalemia

Routes of Loss

- kidney (urine output 30 mL/hr at min) - skin loss (sensible and insensible loss) - lungs - GI tract

Hyponatremia manifestations

- poor skin turgor - dry mucosa - headache - decrease salivation - decreased BP - nausea - abd cramps - neuro changes

FVE nursing management

-I&O and daily weights; assess lung sounds, edema, etc -monitor responses to medications - diuretics -promote adherence to fluid restrictions, pt. teaching related to Na and fluid restriction -monitor, avoid sources of excessive Na including meds -Semi-fowlers position for orthopnea ("position of comfort") -skin care, positioning/turning

Hyperkalemia causes

-treatment related -impaired renal function -hypoaldosteronism -tissue trauma -acidosis

Creatinine - normal range

0.5-1.2 *best indicator of kidney function*

*Things to remember with hyperkalemia*

1. drawing of blood above IV site may result in false lab result *2. salt substitutes and medications can contain potassium* 3. diuretics may elevate potassium levels and shouldn't be used in patients with renal dysfunction

The nurse is caring for a patient with a diagnosis of hyponatremia. What nursing intervention is appropriate to include in the plan of care for this patient. a. assessing for symptoms of nausea and malaise b. encouraging the intake of low-sodium liquids c. monitoring neurological status d. restricting tap water intake e. encouraging the use of salt substitute instead of salt

A, C, D.

The nurse is reviewing a patient's lab results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all. a. red blood cells in the urine b. polyuria c. proteinuria d. white cell casts in the urine e. hemoglobin of 12.8 g

A, C, D.

A 24 hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? a. after discarding the 8:00 am specimen b. at 8:00 am with or without a specimen c. 6 hours after the urine is discarded d. with the first specimen voided after 8:00 am

A.

A 76 year old female is admitted due to a recent fall. The patient is confused and agitated. The family members report that this isn't normal behavior for the patient. They explain the patient is very active in the community and cares for herself. Based on the information you have gathered, which order takes priority? a. collect a urinalysis. b. collect a T3 and T4 level. c. insert a foley catheter. d. keep patient NPO.

A.

A nurse is assessing a client with a UTI who takes an antihypertensive drug. The nurse reviews the client's urinalysis results; pH 6.8, color yellow, specific gravity 1.030. The nurse should a. encourage client to increase fluid intake b. without the next dose c. restrict clients sodium intake d. encourage client to eat at least half a banana a day

A.

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes and a positive Chvostek sign. What deficit does the nurse suspect the patient has? a. a calcium deficit b. a magnesium deficit c. a phosphorus deficit d. a sodium deficit

A.

A patient is scheduled for a TURP procedure for BPH and tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur. b. information about penile implants used for ED is available if interested. c. there are many methods of sexual expression that can be alternatives to sexual intercourse. d. sterility will not be a problem after surgery because sperm production will not be affected.

A.

The healthcare provider has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? a. 0.45% sodium chloride b. 0.90% sodium chloride c. 5% dextrose in water d. 5% dextrose in normal saline

A.

The healthcare provider prescribes finasteride (Proscar) for a 56-year-old male patient who has a BPH symptom score of 12 on the AUA Symptom Index. When teaching the patient about the drug, the nurse informs him that a. his interest in sexual activity may decrease while he is taking the medication. b. he should change position from laying to standing slowly to avoid dizziness. c. improvement in the obstructive symptoms should occur within 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

A.

The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse document that oliguria is present? a. urine output is less than 30 mL/h b. urine output is about 100 mL/h c. urine output is between 300-500 mL/h d. urine output is between 500-1000 mL/h

A.

The nurse should assess the patient for signs of lethargy, increasing intracranial pressure and seizures when the serum sodium reaches what level? a. 115 b. 130 c. 145 d. 160

A.

What foods can the nurse recommend for the patient with hypokalemia? a. fruits - bananas & apricots b. green, leafy vegetables c. milk and yogurt d. nuts and legumes

A.

Hypochloremia causes

Addison's disease, reduced chloride intake, GI loss, diabetic ketoacidosis, excessive sweating, fever, burns, medications, and metabolic alkalosis

Interventions for decreasing UTIs a. insert indwelling catheters b. perform hand hygiene prior to patient care c. assist the patients with frequent toileting d. provide careful perineal care e. encourage patients to wear briefs

B, C, D.

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line antibacterial agent for UTIs has been found to be significantly effective? a. Trimethoprim-sulfamethoxazole b. ciprofloxacin c. nitrofurantoin d. phenazopyridine

B.

A patient is scheduled for a test with contrast to determine kidney function. What statement needs to be communicated? a. I don't like needles b. I'm allergic to shrimp c. I take medication to sleep at night d. I had had a test similar to this one in the past

B.

A patient with a urinary tract infection is taking Bactrim. The nurse knows it is important for patient to consume 2.5 to 3 L of fluid per day to prevent which complication? a. brown urine b. crystalluria c. renal stenosis d. renal calculi

B.

The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium? a. butter b. citrus fruits c. cooked white rice d. salad oils

B.

The nurse is reviewing the laboratory studies for a patient suspected of acute kidney injury. What test would be the best indicator of the patient's renal function? a. BUN b. serum creatinine c. specific gravity d. urine osmolality

B.

The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate? a. "The bladder irrigation is needed to stop the postoperative bleeding in the bladder." b. "The irrigation is needed to keep the catheter from being occluded by blood clots." c. "Normal production of urine is maintained with the irrigations until healing occurs." d. "Antibiotics are being administered into the bladder with the irrigation solution."

B.

Which electrolyte is found in concentration of 98% within the cell? a. calcium b. potassium c. sodium d. magnesium

B.

Which medication does the nurse anticipate administering to antagonize the effects of potassium on the heart for a patient in severe metabolic acidosis? a. sodium bicarbonate b. magnesium sulfate c. furosemide (Lasix) d. calcium gluconate

B.

Which of the following is the major cation in extracellular fluid? a. calcium b. sodium c. magnesium d. potassium

B.

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? a. rebound tenderness at McBurney point b. an output of 200 mL with each voiding c. cloudy urine d. urine specific gravity of 1.005 to 1.022

C.

A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing? a. urge incontinence b. functional incontinence c. stress incontinence d. iatrogenic incontinence

C.

A patient is admitted with severe vomiting for 24 hours, weakness and feeling exhausted. The nurse observes flat T waves and ST-segment depression on EKG. Which potassium level does the nurse observe when the laboratory studies are complete? a. 4.0 b. 8.0 c. 2.0 d. 2.6

C.

A patient reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau and Chvostek signs. Which decreased laboratory results does the nurse when the patients lab results comes back? a. potassium b. phosphorus c. calcium d. magnesium

C.

A patient who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue and a body temperature of 99.3. The urine specific gravity is 1.020. What is the most likely serum sodium value for this patient. a. 110 b. 140 c. 155 d. 165

C.

A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms? a. sulfamethoxazole/trimethoprim b. levofloxacin c. phenazopyridine d. amoxicillin

C.

In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours? a. 400 b. 600 c. 800 d. 1200

C.

The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse anticipate the daily urine output will be? a. 1.5 L b. 1.0 L c. less than 400 mL d. less than 50 mL

C.

The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

C.

The nurse is caring for a patient with end stage kidney disease in the hospital and smells a fetid odor from the patient's breath. What major manifestation of uremia will be present? a. a decreased serum phosphorus level b. hyperparathyroidism c. hypocalcemia with bone changes d. increased secretion of parathormone

C.

The nurse is caring for a patient with hypernatremia. What complication of hypernatremia should the nurse continuously monitor for? a. red blood cell crenation b. red blood cell hydrolysis c. cerebral edema d. kidney injury

C.

The physician orders a urine culture on your patient with a UTI. In addition, the patient is ordered to start IV Bactrim. How will you proceed? a. hang antibiotic, then collect urine sample. b. hang antibiotic, once antibiotic is finished collect sample. c. collect urine sample, then hang antibiotic. d. collect urine sample, hold antibiotic until urine culture is read from lab.

C.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. the presence of blood in the urine. b. any erectile dysfunction (ED). c. occurrence of a weak urinary stream. d. lower back and hip pain.

C.

Which of the following is a contributing factor of hyponatremia? a. heat stroke b. impaired renal function c. SIADH d. diabetes insipidus

C.

Respiratory Acidosis

CO2 retention *increased intracranial pressure* *aim to improve ventilation*

A female client in an outpatient clinic is being sent home diagnosed with a UTI. Which instruction should the nurse teach to prevent recurrence of a UTI? a. clean the perineum from back to front after a BM b. take warm tub paths instead of hot showers daily c. void immediately preceding sexual intercourse d. avoid coffee, tea, colas and alcoholic beverages

D.

A patient who has been treated with uric acid for stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient? a. low calcium diet b. high protein diet c. low phosphorus diet d. low purine diet

D.

A patient who is having spasms and burning while urinating due to a UTI, is prescribed Pyridium (Phenazopyridine). Which is a normal side effect of this drug? a. hematuria b. crystalluria c. urethra mucous d. orange colored urine

D.

The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate symptoms? a. antispasmodic agents b. urinary analgesics c. antibiotics d. anticholinergic agents

D.

What clinical indication of hypophosphatemia does the nurse assess in a patient? a. bone pain b. paresthesia c. seizures d. tetany

D.

You're assessing your patients during morning rounding. Which patient below is at MOST risk for developing a UTI? a. 25 year old patient who finished a regime of antibiotics for strep throat 10 weeks ago. b. 55 year old female who is post-op day 7 from hip surgery. c. 68 year old male who is experiencing nausea and vomiting. d. 87 year old female with Alzheimer's disease who is experiencing bowel incontinence.

D.

Potassium (Ka)

Heart - given on death row - abnormal rhythms

Hypermagnesemia medical management

IV calcium gluconate, loop diuretics, IV NS of RL, hemodialysis

Hypocalcemia medical management

IV of calcium gluconate, calcium and vitamin D supplements; diet

Calcium (Ca)

Muscle (heart is a muscle!)

Sodium (Na)

Neuro - fluid balance - brain (LOC change)

T/F - is it okay to push potassium via IV?

No - it could stop someone's heart.

Metabolic Acidosis

Renal failure, diarrhea, low bicarbonate *monitor potassium levels*

T/F - The effects of potassium on ECG are peaked T waves?

True

T/F - avocados, broccoli, dairy products, dried fruit, bananas, lean meats, milk, whole grains, citrus fruits, cantaloupe, melon are all foods high in potassium?

True

T/F - during a hypercalcemic crisis fluid overload for a bit to prevent cardiac issues?

True

T/F - dysphagia is common in magnesium-depleted patients - assess ability to swallow with water before administering food/medications.

True

T/F - hypomagnesemia is often accompanied by hypocalcemia?

True

T/F - loss of chloride occurs with loss of other electrolytes like potassium and sodium?

True

T/F - potassium influences both skeletal and cardiac muscle activity?

True

T/F - tetany a condition that is due usually to low blood calcium (hypocalcemia) and is characterized by spasms of the hands and feet, cramps, spasm of the voice box (larynx), and overactive neurological reflexes.

True

Metabolic Alkalosis

Vomiting/gastric suction *hypokalemia will produce alkalosis*

Hypochloremia manifestations

agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma

Hypomagnesemia causes

alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood; contributing causes include diabetic ketoacidosis, sepsis, burns, hypothermia

Hypernatremia nursing management

assessment and prevention, assess for OTC sources of sodium, *offer and encourage fluids to meet patient needs*, provide sufficient water with tube feedings

Hyponatremia nursing management

assessment and prevention, dietary sodium and fluid intake, identify and monitor at-risk patients, effects of medications (diuretics, lithium)

Hypercalcemia nursing management

assessment bc hypercalcemic crisis has high mortality, encourage ambulation, fluids of 3 to 4 L/d, provide fluids containing sodium unless contraindicated, fiber for constipation, ensure safety

Hypocalcemia nursing management

assessment bc severe hypocalcemia is life-threatening, weight-bearing exercises to decrease bone calcium loss, patient teaching related to diet and medications, and nursing care related to IV calcium administration

Hyperkalemia nursing management

assessment of serum potassium levels, mix IVs containing K+ well, monitor medication effects, dietary potassium restriction/dietary teaching for patients at risk

Hypochloremia nursing management

assessment, avoid free water, encourage high-chloride foods, patient teaching related to high-chloride foods

Hypermagnesemia nursing management

assessment, do not administer medications containing magnesium, patient teaching regarding magnesium-containing OTC medications

Hypokalemia nursing management

assessment, severe hypokalemia is life-threatening, monitor ECG and ABGs, dietary potassium, nursing care related to IV potassium administration

FVE causes

due to fluid overload or diminished homeostatic mechanisms

Hyperkalemia manifestations

cardiac changes and dysrhythmias, muscle weakness with potential respiratory impairment, paresthesias, anxiety, GI manifestations

FVE manifestations

edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased BP, pulse pressure, increased weight, increased UO, *SOB, wheezing*

Foods high in calcium

dairy products, canned salmon, sardines, fresh oysters, dark leafy green vegetables

FVD risk factors

diabetes insipidus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, third-space shifts

Hypomagnesemia medical management

diet, oral magnesium, magnesium sulfate IV

Routes of Gains

dietary intake of fluid and food or enteral feeding; parenteral fluids (IV fluids)

Hypernatremia causes

excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions

Hypokalemia manifestations

fatigue, anorexia, nausea, vomiting, *dysrhythmias*, *muscle weakness/changes*, cramps, paresthesias, glucose, intolerance, decreased muscle strength, deep tendon reflexes (DTRs), decreased cardiac output

Hypermagnesemia manifestations

flushing, lowered BP, nausea, vomiting, hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias

Respiratory Alkalosis

hyperventilation

Hypocalcemia causes

hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications

Hypernatremia medical management

hypotonic electrolyte solution or D5W

Hypokalemia medical management

increased dietary potassium, potassium replacement, IV for severe deficit

Normal saline

isotonic - doesn't shift electrolytes

Hypercalcemia causes

malignancy and hyperparathyroidism, bone loss related to immobility

Hyperkalemia medical management

monitor ECG, cation exchange resin (Kayexalate), IV sodium bicarbonate, IV calcium gluconate, regular insulin and hypertonic dextrose IV, limit dietary potassium and perform dialysis

FVD nursing management

monitor I&O, administer oral & parenteral fluids, provide oral care, monitor skin/tongue turgor, mucosa, urinary output, and mental status

Hypercalcemia manifestations

muscle weakness, incoordination, anorexia, constipation, nausea and vomiting, abdominal and bone pain, polyuria, thirst, ECG changes, dysrhythmias

Hypophosphatemia management

oral or IV phosphorus replacement assessment, encourage foods high in phosphorus, gradually introduce calories for malnourished patients receiving parenteral nutrition

FVD medical management

provide fluids to meet body needs (oral fluids/IV solutions)

FVD manifestations

rapid weight loss, decreased skin turgor, oliguria, concentrated urine, *orthostatic hypotension*, rapid weak pulse, increased temperature, cool clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness, cramps

Hypermagnesemia causes

renal failure, diabetic ketoacidosis, excessive administration of magnesium

Hypochloremia medical management

replace chloride-IV NS or 0.45% NS

Hypercalcemia medical management

treat underlying cause, administer fluids, furosemide, phosphates, calcitonin, biphosphonates

FVD causes

vomiting, diarrhea, GI suctioning, sweating, decreased intake, hemorrhaging, GSW, burns, marked ascites, third spacing

Hyponatremia causes

water intoxication, loss by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency

Hyponatremia medical management

water restriction, sodium replacement


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