S3 test 3 extras
what happens to BP with fluid overload
elevated
is oliguria metabolic acidosis or alkalosis
acidosis
Which class of medications is frequently prescribed for a client with bipolar disorder (BPD) to induce sedation? 1 Antipsychotics 2 Antidepressants 3 Benzodiazepines 4 Mood stabilizers
3
Which test result would the nurse anticipate in the laboratory reports of a client with a diagnosis of end-stage renal disease? 1 Arterial pH of 7.5 2 Hematocrit of 54% 3 Potassium of 6.3 mEq/L (6.3 mmol/L) 4 Creatinine of 1.2 mg/dL (106 mcmol/L)
3 Clients with end-stage renal disease have impaired potassium excretion, so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L (3.5-5 mmol/L). Clients with end-stage renal disease usually have a serum pH that is less than 7.35 because of metabolic acidosis.
how much urine output should there be in 1 hour
30 ml
does LR treat acidosis or alkalosis
acid
does excess cortisol cause acidosis or alkalosis
alkalosis cortisol - increases resistance to stress, increases blood glucose levels, and decreases inflammation
RR, pulse, and BP in fluid overload
SHOB, increased RR bounding pulse HTN
BUN in dehydration and overhydration
de - increased over - decreased
assessment findings of moderate dehydration
dry mucous membranes restless irritability increased and weak pulse long skin tugor long cap refill cold extremities decreased concentrated urine tachycardia thirsty
Histoplasmosis
fungal infection of the lungs
dka is what acid base imbalance and how do you fix it
metabolic acidosis insulin
diuretics run the risk for what acid base balance
metabolic alkalosis
norepinephrine stands for
no hesitation on alert recall memory
2 most important things to monitor with rehydration
pulse rate and urine output quality
HR, BP, and RR for fluid deficit
tachycardia hypotension increased RR
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 These signs may indicate calcium depletion as a result of accidental removal of parathyroid glands during thyroidectomy. Symptoms associated with hypomagnesemia include tremor, neuromuscular irritability, and confusion. Symptoms associated with metabolic acidosis include deep, rapid breathing, weakness, and disorientation. Symptoms associated with hypokalemia include muscle weakness and dysrhythmias.
The nurse is working with an adolescent who reports cutting on a regular basis. The client states, "Life is so hard; it is difficult to handle the stress." Which action made by the client indicates part of the six-step approach to recovery? 1 Administering antidepressants 2 Implementing new coping skills 3 Refraining from further self-harm 4 Encouraging support group attendance
2
tetany
tension; prolonged, continuous muscle contraction s/s of hypocalcemia
Which statement is inaccurate regarding the mechanisms of antiviral medications to control human immunodeficiency virus (HIV) infections? 1 "Maraviroc blocks C-C chemokine receptor type 5 (CCR5) receptors on CD4 + T cells." 2 "Saquinavir blocks the fusion between HIV and the host cell." 3 "Zidovudine acts as a counterfeit base for reverse transcriptase." 4 "Nelfinavir prevents the breakup of viral protein strand into smaller fragments."
2
The nurse prepares an intravenous (IV) solution of lactated Ringer solution to replace the T-tube output of a client who had a cholecystectomy and common bile duct exploration. Which condition will improve if the administration of lactated Ringer solution is effective? 1 Urinary stasis 2 Paralytic ileus 3 Metabolic acidosis 4 Increased potassium level
3 Lactated Ringer solution is an alkaline solution that replaces bicarbonate ions lost from T-tube bile drainage, thus preventing or treating acidosis. Urinary stasis is unrelated to the effectiveness of the administration of IV lactated Ringer solution. Paralytic ileus is unrelated to the effectiveness of the administration of IV lactated Ringer solution. An increased potassium level is unrelated to the effectiveness of the administration of IV lactated Ringer solution.
Surgery is performed on a client with a parotid tumor. Postoperative arterial blood gas values are pH 7.32, PCO2 53 mm Hg, and HCO3 25 mEq/L (25 mmol/L). Which action would the nurse take? 1 Administer a potent diuretic. 2 Obtain a prescription for an alkalinizing agent. 3 Have the client breathe into a rebreather bag at a slow rate. 4 Encourage the client to cough and then take deep breaths between coughs.
4 The client is in respiratory acidosis, probably caused by depressant effects of the anesthetic or a plugged airway. Coughing clears the airway, and deep breaths blow off carbon dioxide. Administering a diuretic will not correct respiratory acidosis and may aggravate hypokalemia if present. An alkalinizing agent is not necessary if clearing the airway rectifies the problem. Having the client breathe into a rebreather bag at a slow rate is the appropriate treatment for respiratory alkalosis; the client is in respiratory acidosis.
The significant other of a client who is dying of acquired immunodeficiency syndrome (AIDS) tells the nurse, "Life is not worth living without my partner." Which intervention would the nurse implement to help the significant other cope with the impending death? 1 Involve the significant other's support system. 2 Explore the significant other's psychotic thoughts. 3 Suggest a bereavement group to the significant other. 4 Reinforce the current self-image of the significant other.
1 Involving the support system will decrease the person's feelings of isolation. Anticipatory grieving would not involve psychotic thoughts. Suggesting a bereavement group to the significant other is premature. The concern is about loss and loneliness, not self-image.
Which statements provided by the student nurse about neuromuscular manifestations of alkalosis with hypocalcemia indicate the need for further learning? Select all that apply. One, some, or all responses may be correct. 1 "The client would show signs of twitching." 2 "The client would show signs of hyporeflexia." 3 "The client would show signs of paresthesias." 4 "The client would show signs of muscle cramping." 5 "The client would show signs of skeletal muscle weakness."
23 The neuromuscular manifestation of alkalosis with hypocalcemia is hyperreflexia, not hyporeflexia. Paresthesias is a symptom of alkalosis, which is manifested in the central nervous system not the neuromuscular system. The neuromuscular manifestation of alkalosis can be observed through twitching, muscle cramping, and skeletal muscle weakness.
blood transfusions run the risk for what acid base balance
metabolic alkalosis
Which factors would the nurse consider when assessing a client's increased risk for suicide? Select all that apply. One, some, or all responses may be correct. 1 Impulsivity 2 Panic attacks 3 Unemployment 4 Religious beliefs 5 Substance abuse 6 Sense of responsibility to family
1235 Impulsivity, panic attacks, unemployment, and substance abuse have all been linked with an increased risk for suicide. Religious beliefs and a sense of responsibility to family are considered protective factors that may decrease the risk of suicide, not increase the risk.
Which clinical manifestations would the nurse associate with the development of histoplasmosis in the client with acquired immunodeficiency syndrome (AIDS)? Select all that apply. One, some, or all responses may be correct. 1 Cough 2 Seizures 3 Confusion 4 Difficulty with speech 5 Enlarged lymph nodes
15 Histoplasmosis is a respiratory infection caused by Histoplasma capsulatum, which progresses to widespread infection in a client with AIDS. The symptoms of histoplasmosis are a cough and enlarged lymph nodes. Seizures and confusion are symptoms of cryptococcosis. Difficulty speaking is a symptom of toxoplasmosis encephalitis.
Which rationale explain why intravenous (IV) potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? 1 Potassium loss occurs rapidly from diaphoresis present during coma. 2 Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. 3 Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. 4 Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.
4 Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. Potassium is not lost from the body by profuse diaphoresis. Potassium moves from the extracellular to the intracellular compartment rather than being excreted in the urine. Anabolic reactions are stimulated by insulin and glucose administration; potassium is drawn into the intracellular compartment, necessitating a replenishment of extracellular potassium.
The primary health care provider for a client with chronic kidney disease prescribed immediate hemodialysis for the first time. Which clinical manifestation indicates the need for immediate hemodialysis in this client? 1 Ascites 2 Acidosis 3 Hypertension 4 Hyperkalemia
4 Protein breakdown liberates cellular potassium ions, leading to hyperkalemia, which can cause a cardiac dysrhythmia and standstill. The failure of the kidneys to maintain a balance of potassium is one of the main indications for dialysis. Ascites occurs in liver disease and is not an indication for dialysis. Dialysis is not the usual treatment for acidosis; usually acidosis responds to administration of alkaline medications.
Which response would the nurse make to a manipulative client who says, "Please stay. I'm afraid that the evening staff doesn't like me. They're always punishing me"? 1 "I'll ask the staff not to punish you." 2 "Tell me more about what you're feeling now." 3 "Don't worry. I told you, everything will be all right." 4 "You know I leave at this time. We'll talk about this in the morning."
4 Reminding the client that the nurse leaves at this time each day and telling the client that the nurse will discuss the issue in the morning demonstrates acceptance of the client and sets limits on the client's manipulative behavior.
A dehydrated 15-month-old toddler is admitted to the pediatric unit. Which finding indicates the child's hydration status has improved? 1 Increased heart rate 2 Decreased blood pressure 3 Increased capillary refill time 4 Decreased urine specific gravity
4 Signs of rehydration include increased urinary output and dilution of the urine, which results in a decrease in specific gravity. A classic sign of dehydration is oliguria and a concomitant increase in the urine specific gravity as the body attempts to compensate for the fluid loss by releasing antidiuretic hormone. With rehydration the heart rate and capillary refill time should decrease and return to their expected ranges, and blood pressure should increase to the normal range.
major cause of death with hypokalemia
respiratory depression check on then q2h
assessment findings of severe dehydration
thready pulse bradycardia minimal urine output weight loss lethargic poor ability to drink
rehydration without electrolytes increases the risk for
water intoxication (dilutional hyponatremia)
Assessment findings of a client with smoke inhalation include a negative chest x-ray and arterial blood gases that show a PO 2 of 85 mm Hg, a PCO 2 of 45 mm Hg, and a pH of 7.35. Which interventions would the nurse anticipate will be prescribed? Select all that apply. One, some, or all responses may be correct. 1 Coughing 2 Deep breathing 3 Bronchodilators 4 Humidified oxygen 5 Bronchial suctioning
124 Coughing moves secretions toward the mouth to be expectorated. Deep breathing expands the alveoli and increases the amount of oxygen being delivered to the alveolar capillary beds. Humidified oxygen increases the amount of oxygen that is being delivered to the alveolar capillary beds. Bronchodilators are not indicated at this time because the x-ray, PCO2, and pH are still within acceptable limits. Bronchial suctioning is not indicated at this time because the x-ray, PCO2, and pH results are still within acceptable limits.
what iv fluid is given for dehydration
isotonic .9% NS
recumbent position
lying down
stupor
a state of near-unconsciousness or insensibility s/s of hyponatremia
what happens to urines specific gravity with dehydration
increased with decreased urine output
Dopamine mneumonic
determination obsession pleasure
Anhedonia
inability to experience pleasure s/s of depression
what does increased creatinine indicate
poor kidney function not dehydration
serotonin stands for
sleep emotion remember
Which nutritional interventions would the nurse include when planning care for a client with acquired immunodeficiency syndrome (AIDS)? Select all that apply. One, some, or all responses may be correct. 1 Offer ice chips throughout the day. 2 Instruct on the use of oral antifungal medication. 3 Collaborate with the dietitian for small, frequent meals. 4 Emphasize an eating plan incorporating high-fat food items. 5 Schedule routine mouth care, avoiding alcohol-based mouthwashes. 6 Increase the intake of vitamin D micronutrients
1235 Ice chips will keep the oral mucous membranes moist. Antifungal medication is often prescribed to treat oral candidiasis. Small, frequent meals are better tolerated than large meals. Foods that are high in fat should be avoided because fat intolerance often occurs as a result of the disease and as a side effect of some antiretroviral medications. Mouth care can improve appetite; however, alcohol-based mouthwashes should be avoided because of the drying action to the oral mucous membranes. Vitamin D assists in the absorption of calcium and is not critical in AIDS; however, an increase in vitamin A is needed.
A client with severe gastritis vomits a large amount of blood. The nurse performs gastric lavage, as prescribed, using an irrigating solution that is room temperature. Which response would the nurse expect? 1 Coagulation of blood 2 Neutralization of acids 3 Constriction of blood vessels 4 Stimulation of the vagus nerve
3 Lavage removes blood from the stomach, and the irrigating solution produces vascular constriction, which helps control bleeding by limiting blood flow to the area. Lavage does not cause the blood to clot. Neutralization of acid by water irrigation will take time; antacids may be instilled to alter the pH. Stimulation of the vagus nerve is not the purpose of a lavage for gastric hemorrhage.
Which essential action would the nurse take for a depressed client who expresses doubts about living and admits to thinking about suicide while denying having developed a plan? 1 Have a staff member stay with the client continuously. 2 Plan to involve the client in activities that foster independence. 3 Explain in detail to the client how the staff will prevent self-harm. 4 Make frequent unobtrusive observations of the client's moods and activities.
4 The nurse would make frequent unobtrusive observations of the client's moods and activities. It is necessary to assess behavior changes that indicate impending suicidal acting out. Because there is no overt acting out and there is no plan, continuous observation is not necessary. The depressed client has little energy and has difficulty making decisions so it is too early for activities that foster independence. Structured activities that foster success are needed. Detailed explanations are inappropriate and overwhelming for a depressed client.
