Fluid and Electrolytes chapter 13 #1

_________, the most characteristic manifestation of hypocalcemia and hypomagnesemia, refers to the entire symptom complex induced by increased neural excitability.

Tetany

The major waste product of protein metabolism is urea. True or False

True

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, PaCO2 of 43 mm Hg, PaO2 of 75 mm Hg, and HCO3− of 42 mEq/L. Based on these findings, the nurse documents that the patient is experiencing which type of acid-base imbalance? a) Respiratory alkalosis b) Metabolic alkalosis c) Respiratory acidosis d) Metabolic acidosis

b) Metabolic alkalosis

Baroreceptors

monitor blood pressure

Sodium-Potassium Pump

moves sodium and potassium ions against large concentration gradients. It moves two potassium ions into the cell where potassium levels are high, and pumps three sodium ions out of the cell and into the extracellular fluid

Although the patient with SIADH retains water abnormally and therefore gains body weight, there is no peripheral edema; instead, fluid accumulates inside the cells. This phenomenon sometimes manifests as pitting edema.

true

Bottled water can have a sodium content that ranges from 0 to 1200 mg/L; therefore, if sodium is restricted, the label must be carefully examined for sodium content before purchasing and drinking bottled water.

true

Decreased respiratory function can cause impaired pH regulation in older adults with major illness or trauma.

true

Urine sodium levels are used to assess:

volume status and are useful in the diagnosis of hyponatremia and acute kidney injury.

in hypernatremia when is D5W indicated?

when water needs to be replaced without sodium.

FVD (hypovolemia) IS THE SAME AS DEHYDRATION

FALSE!! FVD should not be confused with dehydration, which refers to loss of water alone, with increased serum sodium levels.

Potassium can be administered IV push. True or False

False

primary determinant of ECF volume and osmolality

Sodium (Na+)

Preventing Hypervolemia

- sodium-restricted diets -If fluid retention persists despite adherence to a prescribed diet, hidden sources of sodium, such as the water supply or use of water softeners, should be considered.

Tissue turgor is best measured by pinching the skin over:

- the sternum - inner aspects of the thighs - forehead.

Approximately ___________ of body fluid is in the intracellular fluid (ICF) compartment and is located primarily in the skeletal muscle mass. Approximately __________ is in the extracellular fluid (ECF) compartment

- two thirds - one third

Hematocrit measures the volume percentage of red blood cells (erythrocytes) in whole blood and normally ranges from _____ to _____ for men and _____ to _____ for women.

-42% to 52% -35% to 47%

An average daily diet not restricted in sodium contains ___ to ___ g of salt, whereas low-sodium diets can range from a mild restriction to as little as mg of sodium per day, depending on the patient's needs.

-6 to 15 - 250

Contributing factors Hypervolemia

-heart failure, kidney injury, and cirrhosis of the liver - consumption of excessive amounts of table or other sodium salts

ECF

-intravascular space (the fluid within the blood vessels) contains plasma - interstitial space (lymph) - transcellular space (CSF)

Where are baroreceptors located?

-left atrium - carotid and aortic arches.

Urine-specific gravity how is it assessed?

-measures the kidneys' ability to excrete or conserve water - measured by sending approximately 20 mL of urine to the laboratory for testing, or carefully assessed with dipstick.

As a general rule, the serum sodium level is reduced at a rate no faster than _____________ to allow sufficient time for readjustment through diffusion across fluid compartments.

0.5 to 1 mEq/L/h

The normal serum creatinine is approximately ______ to ______ mg/dL

0.7 to 1.4

1 L of fluid weighs approximately ___ kg, or ____lb

1 2.2

usual daily urine volume in the adult?

1 to 2 L

In a volume-depleted patient, the urine specific gravity should be greater than _________, indicating healthy renal conservation of fluid.

1.020

Three other terms are associated with osmosis:

1.osmotic pressure 2. oncotic pressure 3. osmotic diuresis

Normal BUN levels

10-20

the usual daily sodium requirement in adults is approximately _____ mEq, provided there are not excessive losses.

100

Actual sweat losses can vary from 0 to _______ mL or more every hour, depending on factors such as the environmental temperature. Continuous water loss by evaporation (approximately _______ mL/day) occurs through the skin as insensible perspiration, a nonvisible form of water loss

1000 500

The ratio of BUN to creatinine is usually between

10:1 and 20:1

In hypernatremia, the serum sodium level exceeds _____________ and the serum osmolality exceeds ___________

145 mEq/L (145 mmol/L) 300 mOsm/kg (300 mmol/L).

kidneys normally filter ____ L of plasma every day in the adult and excrete ___ to ____ L of urine

180 1 to 2

hock can occur when the volume of fluid lost exceeds _______% of the intravascular volume or when fluid loss is rapid.

25%

In healthy adults, normal serum osmolality is ______ to _________ mOsm/kg

275 to 290

A patient with a diagnosis of thyroid cancer is postoperative day 1 following a total thyroidectomy in which her parathyroid gland was also removed. When assessing for related electrolyte imbalances, what question should the nurse ask the patient? A. "Are you feeling any tingling in your hands or around your mouth?" B. "How thirsty are you feeling right now?" C. "Do you feel like you're having heart palpitations where your heart feels like it skips a beat?" D. "How would you rate your energy level right now?"

A. "Are you feeling any tingling in your hands or around your mouth?" Removal of the parathyroid can precipitate hypocalcemia, which often results in tetany. Arrhythmias, increased thirst, and fatigue are not common assessment findings associated with low serum calcium.

You are caring for a patient and the physician has just ordered a urine dip for specific gravity (SG). You find her SG is 1.038. This indicates: A. The patient is dehydrated. B. The patient's intake is adequate. C. The patient should be placed on NPO (nothing by mouth) status. D. The patient is overhydrated

A. The patient is dehydrated

The major effect of acidosis is overexcitement of the central nervous system: A. True B. False C. Both Acidosis and Alkalosis result in overexcitement of the central nervous system.

A. True Rationale: ABG's are blood tests that are useful in identifying the cause and extent of the acid-base disturbance and in guiding and monitoring treatment.

Water excretion is controlled by

ADH, aldosterone, and baroreceptors

Sodium is regulated by

ADH, thirst, and the renin-angiotensin-aldosterone system.

27. A critical care nurse is planning assessments in the knowledge that patients in shock are vulnerable to developing fluid replacement complications. For what signs and symptoms should the nurse monitor the patient? Select all that apply. A) Hypovolemia B) Difficulty breathing C) Cardiovascular overload D) Pulmonary edema E) Hypoglycemia

B,C,D

Which finding in a client's history would alert the nurse to assess for signs of hypophosphatemia? A. Short-term gastric suction. B. Alcohol abuse. C. Occasional use of aluminum-containing antacids. D. The oliguric phase of acute tubular necrosis.

B. Alcohol Abuse

You are caring for a patient with hypercalcemia. You as the student nurse know that one of the most common causes of hypercalcemia is: A. Alcoholism B. Cancer C. Alkalosis D. Hypoparathyroidism

B. Cancer

You are caring for a patient with hypercalcemia. You as the student nurse know that one of the most common causes of hypercalcemia is: A. Alkalosis B. Cancer C. Alcoholism D. Hypoparathyroidism

B. Cancer

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? A. Hypovolemia B. Dehydration C. Fluid volume excess D. Hypervolemia

B. Dehydration

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? A. Hypernatremia B. Hyperkalemia C. Hypercalcemia D. Hyperglycemia

B. Hyperkalemia

A 3 y.o. ♂ is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child reports to the nurse on duty that she has witnessed slight tremors and behavioral changes in her child over the past four days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-base disorder is shown? A. Respiratory Acidosis, Uncompensated B. Respiratory Acidosis, Fully Compensated C. Respiratory Alkalosis, Fully Compensated D. Metabolic Alkalosis, Partially Compensated

B. Respiratory Acidosis, Fully Compensated Rationale: The patient has respiratory acidosis (raised carbon dioxide) resulting from asthma and respiratory distress syndrome, with compensation having normal pH value within 7.35to 7.45, increased PaCO2 which is acidic and increased HCO3 which is basic.

7. You are performing an admission assessment on an older adult newly admitted for end-stage liver disease. What principle should guide your assessment of the patient's skin turgor? A) Overhydration is common among healthy older adults B) Dehyrdration causes the skin to appear spongy C) Inelastic skin turgor is a normal part of aging D) Skin turgor cannot be assessed in patients over 70

C

Hypokalemia occurs with

GI and renal losses.

Isotonic IV fluids are fluids with a total osmolality close to that of the ECF. Most IV fluids contain either dextrose or electrolytes in water. When would you infuse electrolyte-free water intravenously? A. When the patient is in an excess of an electrolyte, i.e. hypercalcemia B. When the patient is in a deficit of an electrolyte, i.e. hypocalcemia C. Never, it rapidly enters red blood cells, causing them to rupture. D. When the patient is severely dehydrated

C. Never, it rapidly enters red blood cells, causing them to rupture.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? A. Hypovolemic shock B. Severe hyperkalemia C. Tetany D. Cerebral edema

D. Cerebral edema

You are working on a burn unit. One of your patients is exhibiting signs and symptoms of third spacing, which occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, what would you expect the patient to demonstrate? A. Hypervolemia B. Hypertension C. Bradycardia D. Hypovolemia

D. Hypovolemia Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Hypertension, bradycardia, and hypervolemia are not indicators of third-spacing fluid shift

Tongue turgor is affected by age

FALSE, evaluating this may be more valid than evaluating skin turgor

Skin and tongue turgor pat with FVD

In a person with severe FVD, the skin may remain elevated for many seconds.

seasoning substitutes

Lemon juice, onions, and garlic are excellent substitute flavorings

Fluid volume deficit (hypovolemia) Contributing Factors

- Loss of water and electrolytes - decreased intake - Diabetes insipidus - uncontrolled diabetes

Major functions of the kidneys in maintaining normal fluid balance include the following:

- Regulation of ECF volume and osmolality by selective retention and excretion of body fluids - Regulation of normal electrolyte levels in the ECF by selective electrolyte retention and excretion - Regulation of pH of the ECF by retention of hydrogen ions - Excretion of metabolic wastes and toxic substances

Early evidence of a third-space fluid shift

- decrease in urine output despite adequate fluid intake. - Urine output decreases because fluid shifts out of the intravascular space - the kidneys then receive less blood and attempt to compensate by decreasing urine output. -increased heart rate, decreased blood pressure, decreased central venous pressure, edema, increased body weight, and imbalances in fluid intake and output (I&O).

The ____________ manufactures ADH, which is stored in the ______________________and released as needed to conserve water.

- hypothalamus - posterior pituitary gland

Functions of ADH include:

- maintaining the osmotic pressure of the cells by controlling the retention or excretion of water by the kidneys - regulating blood volume

first sign of fluid and electrolyte disturbances in older adult vs young adult

- older adult= delirium - yonger adult= thirst

A general rule is that the output is approximately ___ mL of urine per kilogram of body weight per hour (1 mL/kg/h) in all age groups.

1

An acute weight gain of 1 kg (2.2 lb) is equivalent to a gain of approximately ___L of fluid.

1

As FVD develops, body fluid losses exceed fluid intake through excessive urination (polyuria), diarrhea, vomiting, or other mechanisms. Once FVD has developed, the kidneys attempt to conserve body fluids, leading to a urine output of less than ___ mL/kg/h in an adult. Urine in this instance is concentrated and represents a healthy renal response.

1

The lungs normally eliminate water vapor (insensible loss) at a rate of approximately _________ mL every day

300

Normal urine sodium levels range from ____ to ____

75 to 200 mEq/24 hours (75 to 200 mmol/24 hours).

13. You are precepting a new graduate nurse in the ICU. You are collaborating in the care of a patient who is receiving large volumes of crystalloid fluid to treat hypovolemic shock. In light of this intervention, for what sign would you teach the new nurse to monitor the patient? A) Hypothermia B) Bradycardia C) Coffee ground emesis D) Pain

A

14. A patient who is being treated for pneumonia starts complaining of sudden shortness of breath. An arterial blood gas is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 24 mm Hg. What does the ABG reflect? A) Respiratory acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Metabolic acidosis

A

14. The nurse is caring for a patient in the ICU whose condition is deteriorating. The nurse receives orders to initiate an infusion of dopamine. What would be the priority assessment and interventions specific to the administration of vasoactive medications? A) Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration B) Reviewing medications, performing a focused cardiovascular assessment, and providing patient education C) Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema D) Routine monitoring of vital signs, monitoring the peripheral IV site, and providing early discharge instructions

A

15. The nurse in the ICU is admitting a 57-year-old man with a diagnosis of possible septic shock. The nurses assessment reveals that the patient has a normal blood pressure, increased heart rate, decreased bowel sounds, and cold, clammy skin. The nurses analysis of these data should lead to what preliminary conclusion? A) The patient is in the compensatory stage of shock. B) The patient is in the progressive stage of shock. C) The patient will stabilize and be released by tomorrow. D) The patient is in the irreversible stage of shock.

A

16. The nurse, a member of the health care team in the ED, is caring for a patient who is determined to be in the irreversible stage of shock. What would be the most appropriate nursing intervention? A) Provide opportunities for the family to spend time with the patient, and help them to understand the irreversible stage of shock. B) Inform the patients family immediately that the patient will likely not survive to allow the family time to make plans and move forward. C) Closely monitor fluid replacement therapy, and inform the family that the patient will probably survive and return to normal life. D) Protect the patients airway, optimize intravascular volume, and initiate the early rehabilitation process.

A

19. The nurse in the ED is caring for a patient recently admitted with a likely myocardial infarction. The nurse understands that the patients heart is pumping an inadequate supply of oxygen to the tissues. Forwhathealth problem should the nurse assess? A)Dysrhythmias B) Increase in blood pressure C)Increase in heart rate D) Decrease in oxygen demands

A

19. You are the nurse evaluation a newly admitted patient's laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone? A) Increased serum sodium B) Decreased serum potassium C) Decreased hemoglobin D) Increased platelets

A

2. In an acute care setting, the nurse is assessing an unstable patient. When prioritizing the patient's care, the nurse should recognize that the patient is at risk for hypovolemic shock in which of the following circumstance? A) Fluid volume circulating in the blood vessels decreases. B) There is an uncontrolled increase in cardiac output. C) Blood pressure regulation becomes irregular. D) The patient experiences tachycardia and a bounding pulse.

A

2. You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patients most recent lab reports, you note that the patient's magnesium levels are high. You should prioritize assessment for which of the following health problems? A) Diminished deep tendon reflexes B) Tachycardia C) Cool, clammy skin D) Acute flank pain

A

isotonic solution

A solution in which the concentration of solutes is essentially equal to that of the cell which resides in the solution

21. The nurse is providing care for a patient with chronic obstruction pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process? A) Diffusion B) Osmosis C) Active transport D) Filtration

A

24. You are the nurse caring for a 77 year old male patient who has been involved in a motor vehicle accident. You and your colleague note that the patients labs indicate minimally elevated serum creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older adults? A) Substantially reduced renal function B) Acute kidney injury C) Decreased cardiac output D) Alterations in ration of body fluids to muscle mass

A

25. You are the nurse caring for a patient who is to receive IV daunorubicin, a chemotherapeutic agent. You start the infusion and check the insertion site as per protocol. During your most recent check, you note that the IV has infiltrated so you stop the infusion. What is your main concern with this infiltration? A) Extravasation of the medication B) Discomfort to the patient C) Blanching at the site D) Hypersensitivity reaction to the medication

A

26. The ICU nurse is caring for a patient with multiple organ dysfunction syndrome (MODS) due to shock. What nursing action should be prioritized at this point during care? A) Providing information and support to family members B) Preparing the family for a long recovery process C) Educating the patient regarding the use of supportive fluids D) Facilitating the rehabilitation phase of treatment

A

31. A patient has questioned the nurse's administration of IV normal saline asking whether sterile water would be a more appropriate choice than saltwater. Under what circumstances would the nurse administer electrolyte-free water intravenously? A) Never, because it rapidly enters red blood cells, causing them to rupture B) When the patient is severely dehydrated resulting in neurologic signs and symptoms C) When the patient is in excess of calcium and/or magnesium ions D) When a patient's fluid volume deficit is due to acute or chronic renal failure

A

33. The ICU nurse caring for a patient in shock is administering vasoactive medications as per orders. The nurse should know that vasoactive medications should be administered in what way? A) Through a central venous line B) By a gravity infusion IV set C) By IV push for rapid onset of action D) Mixed with parenteral feedings to balance osmosis

A

35. The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the medication orders? A) Cimetidine B) Maalox C) Potassium chloride elixir D) Furosemide

A

37. A patient is responding poorly to interventions aimed at treating shock and appears to be transitioning to the irreversible stage of shock. What action should the intensive care nurse include during this phase of the patients care? A) Communicate clearly and frequently with the patients family. B) Taper down interventions slowly when the prognosis worsens. C) Transfer the patient to a subacute unit when recovery appears unlikely. D) Ask the patients family how they would prefer treatment to proceed.

A

38. A critical care nurse is aware of the high incidence of ventilator-associated pneumonia in patients who are being treated for shock. What intervention should be specified in the patient's plan of care while the patient is ventilated? A) Performing frequent oral care B) Maintaining the patient in a supine position C) Suctioning the patient every 15 minutes unless contraindicated D) Administering prophylactic antibiotics, as ordered

A

4. The nurse is caring for a patient who is exhibiting signs and symptoms of hypovolemic shock following injuries suffered in a motor vehicle accident. The nurse anticipates that the physician will promptly order the administration of a crystalloid IV solution to restore intravascular volume. In addition to normal saline, which crystalloid fluid is commonly used to treat hypovolemic shock? A) Lactated Ringers B) Albumin C) Dextran D) 3% NaCl

A

39. A patient is being treated in the ICU for neurogenic shock secondary to a spinal cord injury. Despite aggressive interventions, the patient's mean arterial pressure has fallen to 55 mm Hg. The nurse should gauge the onset of acute kidney injury by referring to what lab findings? Select all that apply A) Blood urea nitrogen (BUN) level B) Urine specific gravity C) Alkaline phosphatase level D) Creatinine level E) Serum albumin level

A,B,D

37. You are doing discharge teaching with a patient who has a hypophosphatemia during his time in the hospital. The patient has diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? Select all that apply A) Milk B) Beef C) Poultry D) Green vegetables E) Liver

A,C,E

22. The intensive care nurse is responsible for the care of a patient with shock. What cardiac signs or symptoms would suggest to the nurse that the patient may be experiencing acute organ dysfunction? Select all that apply. A) Drop in systolic blood pressure of 40 mm Hg from baselines B) Hypotension that responds to bolus fluid resuscitation C) Exaggerated response to vasoactive medications Feedback: Serum lactate >4 mmol/L D) E) Mean arterial pressure (MAP) of 65 mm Hg

A,D,E

29. A team of nurses are reviewing the similarities and differences between the different classifications of shock. Which subclassifications of circulatory shock should the nurses identify? Select all that apply. A) Anaphylactic B) Hypovolemic C) Cardiogenic D) Spetic E) Neurogenic

A,D,E

32. A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply A) Decreased kidney mass B) Increased conservation of sodium C) Increased total body water D) Decreased renal blood flow E) Decreased excretion of potassium

A,D,E

A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for a fluid volume deficit? A. A client with a colostomy B. A client with CHF C. A client recieving frequent wound irrigations D. A client on long-term corticosteroids

A. A client with a colostomy

Hypomagnesemia is a common yet often overlooked imbalance in acutely and critically ill patients. Which of the following patients is most likely at the highest risk of experiencing low serum magnesium levels? A. A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use B. A patient who is temporarily receiving total parenteral nutrition (TPN) as a result of complications from gastric bypass surgery C. A teenage patient who is currently being treated for non-Hodgkin's lymphoma (NHL) D. An obese male patient who has a history of atherosclerosis and a previous non-ST wave elevation myocardial infarction

A. A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use Alcoholism is currently the most common cause of symptomatic hypomagnesemia in the United States. Hypomagnesemia is particularly troublesome during treatment of alcohol withdrawal. Therefore, the serum magnesium level should be routinely measured in patients undergoing withdrawal from alcohol. TPN, heart disease, and lymphoma are not identified as central risk factors for the development of hypomagnesemia.

Nursing Actions related to Fluid Volume status are: (Choose all that apply.) A. Closely monitor intake and output. B. Percentage of meal eaten. C. Checking capillary refill. D. Checking pupillary response. E. Taking vital signs. F. Daily weights

A. Closely monitor intake and output. C. Checking capillary refill. E. Taking vital signs. F. Daily weights

The baroreceptors, located in the left atrium, and the carotid and aortic arches respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what? A. Decrease in glomerular filtration B. Increase of filtration in the Loop of Henele C. Decrease in the reabsorption of sodium D. Decrease in the release in aldosterone

A. Decrease in glomerular filtration Sympathetic stimulation constricts renal arterioles; this decreases glomerular filtration, increases the release of aldosterone, and increases sodium and water reabsorption

You are caring for a patient admitted with a diagnosis of renal failure. When you review your patient's laboratory reports, you note that the patient's magnesium levels are high. What would be important for you to assess? A. Diminished deep tendon reflexes B. Increased serum magnesium C. Cool, clammy skin D. Tachycardia

A. Diminished deep tendon reflexes

A patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The patient's ileostomy output has been unexpectedly high in the 2 days since surgery, and the patient's most recent blood work indicates a K+ level of 2.7 mEq/L. This potassium level should prompt the nurse to assess for which of the following physical manifestations? A. Fatigue, cramps and weakness B. SOB, rales and peripheral edema C. Dsypahgia, tetany and emotional liabilty D. Confusion and decreased LOC

A. Fatigue, cramps and weakness A serum potassium level of 2.7 mEq/L constitutes hypokalemia. Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias (numbness and tingling), arrhythmias, and increased sensitivity to digitalis. Respiratory symptoms, dysphagia, and tetany are not typically associated with hypokalemia.

A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; PERRLA is intact. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed and 40 ml of urine is present. What is the nurse's most likely explanation for the urine output? A. He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine outpu. B. The man is in heart failure and is releasing atrial natriuretic peptide that results in decreased urine output. C. The man has a brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin. D. The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.

A. He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output. As the sympathetic nervous system is stimulated, aldosterone is released in response to an increased release of rennin, which decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most likely cause of the lower urine output. The man urinating prior to his arrival to the ED is unlikely; the fall and hip injury would make his ability to urinate difficult. There is no assessment information that indicates he has a head injury or heart failure.

You are caring for a patient on the oncology floor with a diagnosis of metastatic brain cancer. During your assessment, you note the patient complains of abdominal pain and constipation. What electrolyte imbalance would you anticipate? A. Hypercalcemia. B. Hypomagnesemia. C. Hypernatremia. D. Hyperphosphatemia.

A. Hypercalcemia

You are the nurse caring for a 65-year-old female patient who is in renal failure. During your shift assessment, the patient complains of tingling in her hand and fingers whenever anyone takes her blood pressure. What would you suspect? A. Hypocalcemia B. Hyperkalemia C. Hypermagnesemia D. Hypophosphatemia

A. Hypocalcemia

What two organs in the body serve as a compensatory function to maintain acid base balance? A. Kidneys and Lungs B. Lungs and Spleen C. Heart and Liver D. Gallbladder and Appendix

A. Kidneys and Lungs Rationale: The carbonic acid concentration is controlled by the amount of carbon dioxide excreted by the lungs. The bicarbonate concentration is controlled by the kidneys, which selectively retain or excrete bicarbonate in response to the body's needs.

A client involved in a motor vehicle crash (MVC) presents to the emergency department with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates that which IV solution will most likely be prescribed to increase intravascular volume, replace immediate blood loss volume, and increase blood pressure? A. Lactate Ringers (LR) B. 0.45% sodium chloride (1/2 normal saline) C. 0.33% sodium chloride (1/3 NS) D. 0.225% sodium chloride (1/4 NS)

A. Lactate Ringers (LR)

Decreased plasma bicarbonate (HCO3-): A. Metabolic Acidosis B. Respiratory Alkalosis C. Metabolic Alkalosis D. Respiratory Acidosis

A. Metabolic Acidosis Rationale: The body compensates by using body fat for energy, producing abnormal amounts of ketone bodies. In an effort to neutralize the ketones and maintain the acid-base balance of the body, plasma bicarbonate is exhausted. This condition can develop in anyone who does not eat an adequate diet and whose body fat must be burned for energy. Symptoms include headache and mental dullness.

A patient who is comatose is admitted to the hospital with an unknown history. Respirations are deep and rapid. Arterial blood gas levels on admission are pH, 7.20; PaCO2, 21 mm Hg; PaO2, 92 mm Hg; and HCO3-, 8. You interpret these laboratory values to indicate: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis The low pH indicates acidosis. The low PaCO2 is caused by the hyperventilation, either from primary respiratory alkalosis (not compatible with the measured pH) or as a compensation for metabolic acidosis. The low HCO3- indicates metabolic acidosis or compensation for respiratory alkalosis (again, not compatible with the measured pH). Thus metabolic acidosis is the correct interpretation.

You are an emergency room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results? A. Metabolic acidosis with a compensatory respiratory alkalosis B. Metabolic acidosis with no compensation C. Metabolic alkalosis with a compensatory alkalosis D. Respiratory acidosis with no compensation

A. Metabolic acidosis with a compensatory respiratory alkalosis A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO2 is also low, which causes alkalosis. The bicarb is low, which causes acidosis. The pH bicarb more closely corresponds with a decrease in pH, making the metabolic component the primary problem

The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse goes to attach the distal end of the IV tubing to a needleless device, the exposed tubing drops and hits the top of the medication cart. Which of the following is the appropriate action by the nurse? A. Obtain a new IV tubing B. Wipe the distal end of the tubing with Betadine C. Attach a new needleless device D. Scrub the needleless device with an alcohol swab

A. Obtain new IV tubing

A nursing student needs to administer potassium chloride intravenously as prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium? A. Preparing the medication for bolus administration B. Diluting the medication in appropriate amount of normal saline C. Obtaining a controlled intravenous (IV) infusion pump D. Monitoring urine output during administration

A. Preparing the medication for bolus administration

CV was brought to the emergency department of a hospital after she fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does this mean? A. Respiratory Alkalosis, Uncompensated B. Respiratory Acidosis, Partially Compensated C. Metabolic Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated

A. Respiratory Alkalosis, Uncompensated Rationale: The primary disorder is acute respiratory alkalosis (low CO2) due to the pain and anxiety causing her to hyperventilate. There has not been time for metabolic compensation.

A patient in the ICU starts complaining of being "short of breath." An arterial blood gas (ABG) is drawn. The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A. Respiratory acidosis

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? A. Serum sodium level of 124 mEq/L B. Serum blood urea nitrogen (BUN) level of 8.6 mg/dl C. Hematocrit of 52% D. Serum creatinine level of 0.4 mg/dl

A. Serum sodium level of 124 mEq/L

You are caring for a patient who is renal failure. Morning Lab results indicate that the patient's phosphorus level is 7.2 mg/dL. Symptoms you would monitor your patient for include: A. Tetany B. Respiratory depression C. Poor wound healing D. Decreased tissue turgor

A. Tetany

A 2-year-old child was brought into the emergency department after ingesting several morphine tablets from a bottle in his mother's purse. The nurse knows that the child is at greatest risk for which acid-base imbalance? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis

ANS: A Morphine overdose can cause respiratory depression and hypoventilation. Hypoventilation results in retention of CO2 and respiratory acidosis. Respiratory alkalosis would result from hyperventilation, causing a decrease in CO2 levels. Metabolic acid-base imbalance would be a result of kidney dysfunction, vomiting, diarrhea, or other conditions that affect metabolic acids.

The nurse is caring for a diabetic patient in renal failure. Which laboratory findings would the nurse expect? a) pH 7.3, PaCO2 36 mm Hg, HCO3- 19 mEq/L b) pH 7.5, PaCO2 35 mm Hg, HCO3- 35 mEq/L c) pH 7.3, PaCO2 47 mm Hg, HCO3- 23 mEq/L d) pH 7.35, PaCO2 40 mm Hg, HCO3- 25 mEq/L

ANS: A Patients in renal failure develop metabolic acidosis. The laboratory values that reflect this are pH 7.3, PaCO2 36 mm Hg, HCO3- 19 mEq/L. A laboratory finding of pH 7.5, PaCO2 35 mm Hg, HCO3- 35 mEq/L is metabolic alkalosis. pH 7.3, PaCO2 47 mm Hg, HCO3- 23 mEq/L is respiratory acidosis. pH 7.35, PaCO2 40 mm Hg, HCO3- 25 mEq/L values are within normal range.

A patient has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. The nurse interprets these results as a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

ANS: A The pH and HCO3 indicate that the patient has a metabolic acidosis. The ABGs are inconsistent with the other responses.

A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low intermittent suction for the past 3 days. The patient's respiratory rate has decreased to 12 breaths per minute. The nurse would expect the patient to have which of the following arterial blood gas values? a) pH 7.78, PaCO2 40 mm Hg, HCO3- 30 mEq/L b) pH 7.52, PaCO2 48 mm Hg, HCO3- 28 mEq/L c) pH 7.35, PaCO2 35 mm Hg, HCO3- 26 mEq/L d) pH 7.25, PaCO2 47 mm Hg, HCO3- 29 mEq/L

ANS: B Compensated metabolic alkalosis should show alkalosis pH and HCO3- (metabolic) values, with a slightly acidic CO2 (compensatory respiratory acidosis). In this case, pH 7.52 is alkaline (normal = 7.35 to 7.45), PaCO2is acidic (normal 35 to 45 mm Hg), and HCO3- is elevated (normal = 22 to 26 mEq/L). A result of pH 7.78, PaCO2 40 mm Hg, HCO3- 30 mEq/L is uncompensated metabolic alkalosis. pH 7.35, PaCO2 35 mm Hg, HCO3- 26 mEq/L is within normal limits. pH 7.25, PaCO2 47 mm Hg, HCO3- 29 mEq/L is compensated respiratory acidosis.

The nurse would not expect full compensation to occur for which acid-base imbalance? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis

ANS: B Usually the cause of respiratory alkalosis is a temporary event (e.g., an asthma or anxiety attack). The kidneys take about 24 hours to compensate for an event, so it is unlikely to see much if any compensation for respiratory alkalosis. Respiratory acidosis usually results from longer-term conditions such as chronic lung disease, narcotic overdose, or another event that causes respiratory depression. The kidneys still do not respond for about 24 hours, but usually the event is still occurring. For both metabolic imbalances, the respiratory system is quick to attempt to compensate: however, it may have difficulty sustaining that compensation.

A patient with a lower respiratory infection has pH of 7.25, PaCO2 of 55 mm Hg, and HCO3- of 20 mEq/L. The physician has been notified. Which is the priority nursing intervention for this patient? a) Check the color of the patient's urine output. b) Place the patient in Trendelenburg position. c) Encourage the patient to increase respirations. d) Place the patient in high Fowler's position.

ANS: C The patient has respiratory acidosis from CO2 retention. Increasing rate and depth of respiration will allow the patient to blow off excess carbon dioxide, and this will begin to correct the imbalance. Checking the urine color is not a necessary assessment. The Trendelenburg position likely would make it more difficult for the patient to breathe and should be avoided. Placing the patient in high Fowler's position may make the patient more comfortable, but it is not necessary.

Which laboratory value should the nurse examine when evaluating uncompensated respiratory alkalosis? a) PaO2 b) Anion gap c) PaCO2 d) HCO3-

ANS: C Uncompensated respiratory imbalances are seen in the PaCO2 levels. PaO2 indicates oxygen status. Anion gap is used for metabolic acidosis. HCO3- is used to evaluate compensation for respiratory imbalances or uncompensated metabolic imbalances.

A patient who has required prolonged mechanical ventilation has the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L. The nurse interprets these results as a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

ANS: D The pH indicates that the patient has alkalosis and the low PaCO2 indicates a respiratory cause. The other responses are incorrect based on the pH and the normal HCO3.

Signs/Symptoms Fluid volume excess (hypervolemia)

Acute weight gain, peripheral edema and ascites, distended jugular veins, crackles, elevated CVP, shortness of breath, ↑ BP, bounding pulse and cough, ↑ respiratory rate, ↑ urine output

Fluid volume deficit (hypovolemia) Signs/Symptoms

Acute weight loss, ↓ skin turgor, oliguria, concentrated urine, capillary filling time prolonged, low CVP, ↓ BP, flattened neck veins, dizziness, weakness, thirst and confusion, ↑ pulse, muscle cramps, sunken eyes, nausea, increased temperature; cool, clammy, pale skin

______ is currently the most common cause of symptomatic hypomagnesemia in the United States

Alcoholism

________________ , a mineralocorticoid secreted by the zona glomerulosa (outer zone) of the adrenal cortex, has a profound effect on fluid balance.

Aldosterone

___________ (increased nitrogen levels in the blood) can occur with FVE when urea and creatinine are not excreted owing to decreased perfusion by the kidneys and decreased excretion of wastes.

Azotemia

1. A nurse in the ICU is planning the care of a patient who is being treated for shock. Which of the following statements best describes the pathophysiology of this patient's health problem? A) Blood is shunted from vital organs to peripheral areas of the body B) Cells lack an adequate blood supply and are deprived of oxygen and nutrients C) Circulating blood volume is decreased with a resulting change in the osmotic pressure gradient D) Hemorrhage can occur as a result of trauma, depriving vital organs of adequate perfusion

B

10. You are the surgical nurse caring for a 65year old female patient who is postop day 1 following a thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should you first suspect? A) Hypophosphatemia B) Hypocalcemia C) Hypermagensemia D) Hyperkalemia

B

16. The community health nurse is performing a home visit to an 84 year old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom. What would be the nurse's best response? A) I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup B) Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids C) It is normal to be a little confused following surgery, and it is safe not to urinate at night D) If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress

B

18. The nurse in the ICU is caring for a 47 year old, obese male patient who is in shock following a motor vehicle accident. The nurse is aware that patients in shock possess excess energy requirements. What would be the main challenge in meeting this patient's elevated energy requirements during prolonged rehabilitation? A) Loss of adipose tissue B) Loss of skeletal muscle C) Inability to convert adipose tissue to energy D) Inability to maintain normal body mass

B

23. An adult patient has survived an episode of shock and will be discharged home to finish the recovery phase of his disease process. The home health nurse plays an integral part in monitoring this patient. What aspect of his care should be prioritized by the home health nurse? A) Providing supervision to home health aides in providing necessary patient care B) Assisting the patient and family to identify and mobilize community resources C) Providing ongoing medical care during the familys rehabilitation phase D) Reinforcing the importance of continuous assessment with the family

B

26. The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated a 3 out of 10. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes and you suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to exhibit? A) Diarrhea B) Dilute urine C) Increased muscle tone D) Joint pain

B

28. A medical nurse educator is reviewing a patient's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? A) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance B) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance C) The kidneys react rapidly to compensate for imbalances in the body D) The kidneys regulate the bicarbonate level in the intracellular fluid

B

30. A triage nurse in the ED is on shift when a grandfather carries his 4 year old grandson into the ED. The child is not breathing, and the grandfather states the boy was stingy a bee in a nearby park while they were waiting for the boy's mother to get off work. Which of the following would lead the nurse to suspect that the body is experiencing anaphylactic shock? A) Rapid onset o acute hypertension B) Rapid onset of respiratory distress C) Rapid onset of neurologic compensation D) Rapid onset of cardiac arrest

B

36. An 11-year-old boy has been brought to the ED by his teacher, who reports that the boy may be having a really bad allergic reaction to peanuts after trading lunches with a peer. The triage nurses rapid assessment reveals the presence of respiratory and cardiac arrest. What interventions should the nurse prioritize? A) Establishing central venous access and beginning fluid resuscitation B) Establishing a patent airway and beginning cardiopulmonary resuscitation C) Establishing peripheral IV access and administering IV epinephrine D) Performing a comprehensive assessment and initiating rapid fluid replacement

B

36. You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a vague historian. The patient appears malnourished and on day 3 of the patient's admission total parenteral nutrition has been started. Why would you know to start the infusion of TPN slowly? A) Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia D) Patients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to accumulate

B

4. A patient with a longstanding diagnosis of generalized anxiety disorder presents to the ER. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid base imbalance? A) Respiratory acidosis B) Respiratory alkalosis C) Increased PaCO2 D) CNS disturbances

B

5. A patient who is in shock is receiving dopamine in addition to IV fluids. What principle should inform the nurses care planning during the administration of a vasoactive drug? A) The drug should be discontinued immediately after blood pressure increases. B) The drug dose should be tapered down once vital signs improve. C) The patient should have arterial blood gases drawn every 10 minutes during treatment. D) The infusion rate should be titrated according the patients subjective sensation of adequate perfusion.

B

6. A nurse in the ICU receives report from the nurse in the ED about a new patient being admitted with a neck injury he received while diving into a lake. The ED nurse reports that his blood pressure is 85/54, heart rate is 53 beats per minute, and his skin is warm and dry. What does the ICU nurse recognize that that patient is probably experiencing? A) Anaphylactic shock B) Neurogenic shock C) Septic shock D) Hypovolemic shock

B

8. The nurse is transferring a patient who is in the progressive stage of shock into ICU from the medical unit. The medical nurse is aware that shock affects many organ systems and that nursing management of the patient will focus on what intervention? A) Reviewing the cause of shock and prioritizing the patients psychosocial needs B) Assessing and understanding shock and the significant changes in assessment data to guide the plan of care C) Giving the prescribed treatment, but shifting focus to providing family time as the patient is unlikely to survive D) Promoting the patients coping skills in an effort to better deal with the physiologic changes accompanying shock

B

8. The physician has ordered a peripheral IV to be inserted before the patient goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter? A) Choose a hairless site if available B) Consider potential effects on the patient's mobility when selecting a site C) Have the patient briefly hold his arm over his head before insertion D) Leave the tourniquet on for at least 3 minutes

B

9. A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? A) Hydrostatic pressure B) Osmosis and osmolarity C) Diffusion D) Active transport

B

A patient has been admitted to the medical unit from the emergency department with a peripheral IV in situ and normal saline infusing by gravity. How should the nurse best ensure that the patient's ordered solution infuses at the correct rate? Selected Answer: A. Assess the patient often for signs and symptoms of fluid overload. B. Change from gravity infusion to an electronic IV pump. C. Monitor the patient's IV infusion hourly. D. Label the patient's bag of IV solution with a time-calibrated strip of tape.

B. Change from gravity infusion to an electronic IV pump. Monitoring a patient's IV infusion, labeling gravity infusions, and assessing patients for fluid overload are all prudent measures in the care of a patient who is receiving IV fluids by gravity. However, the most accurate way to ensure that a patient's ordered fluid is infusing at the correct rate is to use an electronic IV pump.

The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance does a positive Chvostek's sign indicate? A. Hyperkalemia B. Hypocalcemia C. Hypermagnesemia D. Hypercalcemia

B. Hypocalcemia You can induce Chvostek's sign by tapping the patient's facial nerve adjacent to the ear. A brief contraction of the upper lip, nose, or side of the face indicates Chvostek's sign. Both hypomagnesemia and hypocalcemia may be tested using the Chvostek's sign.

MW, who underwent post-abdominal surgery, has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment? A. Metabolic Acidosis, Uncompensated B. Metabolic Alkalosis, Uncompensated C. Respiratory Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated

B. Metabolic Alkalosis, Uncompensated Rationale: The postoperative client's ABG results show that he has metabolic alkalosis because of an increased pH and HCO3. It is uncompensated due to the normal PaCO2 which is within 35 to 45 mmHg.

A client has just undergone insertion of a peripherally inserted central venous catheter (PICC) at the bedside. The nurse would be sure to check the results of which of the following before initiating the flow rate of the client's IV solution at 100ml/hr? A. Serum electrolyte levels B. Portable chest x-ray C. Serum osmolality D. Intake and output record

B. Portable chest x-ray

GK is a 54 year old widower with a history of chronic obstructive pulmonary disease and was rushed to the emergency department with increasing shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has difficulty in communicating because of his inability to complete a sentence. One of his sons, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this? A. Respiratory Acidosis, Uncompensated B. Respiratory Acidosis, Partially Compensated C. Metabolic Alkalosis, Uncompensated D. Metabolic Acidosis, Partially Compensated

B. Respiratory Acidosis, Partially Compensated Rationale: The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease, with partial compensation.

MJ, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to arouse two hours following surgery. Nurse Florence in the PACU has been administering Morphine Sulfate intravenously to the client for complaints of post-surgical pain. The client's respiratory rate is 7 per minute and demonstrates shallow breathing. The patient does not respond to any stimuli! The nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGs STAT! Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does this mean? A. Respiratory Alkalosis, Partially Compensated B. Respiratory Acidosis, Uncompensated C. Metabolic Alkalosis, Partially Compensated D. Metabolic Acidosis, Uncompensated

B. Respiratory Acidosis, Uncompensated Rationale: The results show that Mrs. Johansson has respiratory acidosis because of decreased pH and increased PaCO2 which mean acidic in nature. Meanwhile, it is uncompensated because HCO3 is within the normal range.

The nurse would not expect full compensation to occur for which acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

B. Respiratory alkalosis Usually the cause of respiratory alkalosis is a temporary event (e.g., an asthma or anxiety attack). The kidneys take about 24 hours to compensate for an event, so it is unlikely to see much if any compensation for respiratory alkalosis. Respiratory acidosis usually results from longer-term conditions such as chronic lung disease, narcotic overdose, or another event that causes respira-tory depression. The kidneys still do not respond for about 24 hours, but usually the event is still occurring. For both metabolic imbalances, the respiratory system is quick to attempt to compensate: however, it may have difficulty sustaining that compensation.

In the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur? A. The number of dissolved particles contaoned in a unit of blood B. The hydrostatic pressure resulting from the pumping action of the heart C. The active transport of H+ ions across the capillary walls D. The pressure of blood in the renal capillary walls

B. The hydostatic pressure from the pumping action of the blood

10. The nurse is caring for a patient in the ICU who has been diagnosed with multiple organ dysfunction syndrome (MODS). The nurses plan of care should include which of the following interventions? A) Encouraging the family to stay hopeful and educating them to the fact that, in nearly all cases, the prognosis is good B) Encouraging the family to leave the hospital and to take time for themselves as acute care of MODS patients may last for several months C) Promoting communication with the patient and family along with addressing end-of-life issues D) Discussing organ donation on a number of different occasions to allow the family time to adjust to the idea

C

11. A nurse is planing care a nephrology patient with a new nursing graduate. The nurse starts, a patient in renal failure partially loses the ability to regulate changes in pH. What is the cause of this partial inability? A) The kidneys regulate and reabsorb carbonic acid to change and maintain pH B) The kidneys buffer acids through electrolyte changes C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH D) The kidneys combine carbonic acid and bicarbonate to maintain a stable pH

C

11. The acute care nurse is providing care for an adult patient who is in hypovolemic shock. The nurse recognizes that antidiuretic hormone (ADH) plays a significant role in this health problem. What assessment finding will the nurse likely observe related to the role of the ADH during hypovolemic shock? A) Increased hunger B) Decreased thirst C) Decreased urinary output D) Increased capillary perfusion

C

12. The nurse is caring for a patient whose progressing infection places her at high risk for shock. What assessment finding would the nurse consider a potential sign of shock? A) Elevated systolic blood pressure B) Elevated mean arterial pressure (MAP) C) Shallow, rapid respirations D) Bradycardia

C

12. You are caring for a 65 year old male patient admitted to your medical unit 72 hours ago with pyloric stenosis. A nasogastric tube places upon admission has been on low intermittent suction ever since. Upon review of the morning's blood work, you notice that the patients potassium is below reference range. You should recognize that the patient may be at risk for what imbalance? A) Hypercalcemia B) Metabolic acidosis C) Metabolic alkalosis D) Respiratory acidosis

C

13. The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV antibiotics. How should the nurse always start the process of insertion? A) Leave one hand ungloved to assess the site B) Cleanse the skin with normal saline C) Ask the patient about allergies to latex or iodine D) Remove excessive hair from the selected site

C

15. One day after a patent is admitted to the medical unit, you note that the patient is oliguric. You notify the acute care nurse practitioner who ordered a fluid challenge of 200 mL or normal saline solution over 15 minutes. This intervention will achieve which of the following? A) Help distinguish hyponatremia from hypernatremia B) Help evaluate pituitary gland function C) Help distinguish reduced renal blood flow from decreased renal function D) Help provide an effective treatment for hypertension induced oliguria

C

17. The nurse in a rural nursing outpost has just been notified that she will be receiving a patient in hypovolemic shock due to a massive postpartum hemorrhage after her home birth. You know that the best choice for fluid replacement for this patient is what? A) 5% albumin because it is inexpensive and is always readily available B) Dextran because it increases intravascular volume and counteracts coagulopathy C) Whatever fluid is most readily available in the clinic, due to the nature of the emergency D) Lactated Ringer's solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure

C

18. A nurse education is reviewing peripheral IV insertion with a group of novice nurses. How should these nurses be encouraged to deal with excess hair at the intended site? A) Leave the hair intact B) Shave the area C) Clip the hair in the area D) Remove the hair with a depilatory

C

21. The nurse is providing care for a patient who is in shock after massive blood loss from a workplace injury. The nurse recognizes that many of the findings from the most recent assessment are due to compensatory mechanisms. What is a compensatory mechanism to increase cardiac output during hypovolemic states? A) Third spacing of fluid B) Dysrhythmias C) Tachycardia D) Gastric hypermotility

C

24. A critical care nurse is aware of similarities and differences between the treatments for different types of shock. Which of the following interventions is used in all types of shock? A) Aggressive hypoglycemic control B) Administration of hypertonic IV fluids C) Early provision of nutritional support D) Aggressive antibiotic therapy

C

29. The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequate ventilation. What diagnosis could the patient have that could causes inadequate ventilation? A) Endocarditis B) Multiple myeloma C) Guilllain-Barr syndrome D) Overdose of amphetamines

C

31. The ICU nurse is caring for a patient in neurogenic shock following an overdose of antianxiety medication. When assessing this patient, the nurse should recognize what characteristic of neurogenic shock? A) Hypertension B) Cool, moist skin C) Bradycardia D) Signs of sympathetic stimulation

C

33. You are called to your patient' room by a family member who voices concern about the patient's status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patient's signs and symptoms? A) Hypocalcemia B) Hyponatremia C) Hyperchloremia D) Hypophosphatemia

C

34. The ICU nurse is caring for a patient in hypovolemic shock following a postpartum hemorrhage. For what serious complication of treatment should the nurse monitor the patient? A) Anaphylaxis B) Decreased oxygen consumption C) Abdominal compartment syndrome D) Decreased serum osmolality

C

40. The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance would a positive Chvostek's sign indicate? A) Hypermagnesemia B) Hyponatremia C) Hypocalcemia D) Hyperkalemia

C

6. You are making initial shift assessments on your patients. While assessing one patient's peripheral IV site, you note edema around the insertion site. How should you document this complication related to IV therapy? A) Air emboli B) Phlebitis C) Infiltration D) Fluid overload

C

7. The intensive care nurse caring for a patient in shock is planning assessments and interventions related to the patients nutritional needs. What physiologic process contributes to these increased nutritional needs? A) The use of albumin as an energy source by the body because of the need for increased adenosine triphosphate (ATP) B) The loss of fluids due to decreased skin integrity and decreased stomach acids due to increased parasympathetic activity C) The release of catecholamines that creates an increase in metabolic rate and caloric requirements D) The increase in GI peristalsis during shock and the resulting diarrhea

C

A nurse is caring for several patients, all of whom require IV medications. Which of the following situations requires an incident report to be filled out A. The patient's central line becomes occluded B. Multiple attempts to start an IV are made by nursing staff C. An IV is started on the same side as a fistula that is used exclusively for dialysis D. The client's central line is tender and there is erythema at the insertion site

C. An IV is started on the same side as a fistula that is used exclusively for dialysis

Two days after surgery, Mr. Webb complains of muscle cramps and tingling in his lips. The nurse will call the physician to share these findings, which are most likely the result of: A. Residual effects of general anesthesia. B. Increasing serum magnesium following surgery. C. Damage to the parathyroid glands during surgery. D. Endotracheal intubation.

C. Damage to the parathyroid glands

You are caring for a patient admitted with a diagnosis of renal failure. When you review your patient's laboratory reports, you note that the patient's magnesium levels are high. What would be important for you to assess? A. Tachycardia B. Cool, clammy skin C. Diminished deep tendon reflexes D. Increased serum magnesium

C. Diminished deep tendon reflexes

You are the nurse caring for a patient who is to receive IV daunorubicin. You start the infusion and check the insertion site as per protocol. This time when you look at the IV site, you note that the IV has infiltrated. You stop the infusion. What is your main concern with this infiltration? A. Blanching at the site B. Discomfort to the patient C. Extravasation of the medication D. Reaction to the medication

C. Extravasation of the medication Medications such as dopamine, calcium preparations, and chemotherapeutic agents can cause pain, burning, and redness at the site. Blistering, inflammation, and necrosis of tissues can occur. The extent of tissue damage is determined by the concentration of the medication, the quantity that extravasated, the location of the infusion site, the tissue response, and the duration of the process of extravasation. With this medication, options A and D are valid concerns but not your main concerns. Blanching at the site would not be a concern.

A client receiving normal saline 0.9% as maintenance fluid should be monitored for: (Choose all that apply.) A. Weight loss. B. Hyponatremia. C. Fluid overload. D. Hyperchloremia. E. Rales on auscultation of the lungs

C. Fluid Overload D. Hyperchloremia E. Rales on ascultation

You are doing an admission assessment on an elderly patient newly admitted for end-stage liver disease. You must assess the patient's skin turgor. What should you remember when evaluating skin turgor? A. Normal skin turgor is moist and boggy. B. Dehydration causes the skin to appear edematous and spongy. C. Inelastic skin turgor is a normal part of aging. D. Overhydration causes the skin to tent.

C. Inelastic skin turgor is a normal part of aging. Inelastic skin turgor is a normal part of aging. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy. Normal skin turgor is dry and firm.

Baby LR was rushed to the Emergency Room following her mother's complaint that the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 3 days. The infant's respiratory rate is elevated and the fontanels are sunken. The Emergency Room physician orders ABGs after assessing the ABCs. The results from the ABG results show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean? A. Respiratory Alkalosis, Fully Compensated B. Metabolic Acidosis, Uncompensated C. Metabolic Acidosis, Fully Compensated D. Respiratory Acidosis, Uncompensated

C. Metabolic Acidosis, Fully Compensated Rationale: The infant has metabolic acidosis due to decreased HCO3 and slightly acidic pH. Her pH value is within the normal range which made the result fully compensated.

Increased plasma bicarbonate (HCO3-): A. Metabolic Acidosis B. Respiratory Alkalosis C. Metabolic Alkalosis D. Respiratory Acidosis

C. Metabolic Alkalosis Rationale: In metabolic alkalosis, breathing becomes depressed in an effort to conserve carbon dioxide for combination with water in the blood to raise the blood level of carbonic acid. Symptoms include confusion, dizziness, numbness or tingling of fingers or toes.

A 71 y.o ♀ has been suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown? A. Respiratory Alkalosis, Uncompensated B. Respiratory Acidosis, Partially Compensated C. Metabolic Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated

C. Metabolic Alkalosis, Uncompensated Rationale: The primary disorder is uncompensated metabolic alkalosis (high HCO3 -). As CO2 is the strongest driver of respiration, it generally will not allow hypoventilation as compensation for metabolic alkalosis.

After several diagnostic tests, a client is diagnosed with diabetes insipidus (DI). The nurse performing an assessment on the client knows that which symptom is most indicative of this disorder? A. Weight gain. B. Diarrhea. C. Polydipsia. D. Fatigue.

C. Polydipsia

Disorders, fluids, and medications that may lead to hypernatremia include: (Select all that apply) A. Syndrome of Inappropriate Antidiuretic Hormone (SIADH). B. Hypoaldosteronism. C. Profuse sweating. D. Diabetes insipidus. E. Saline 3%.

C. Profuse Sweating D. Diabetes Insipidus ( HIGH urine output, low ADH, DEHYDRATED) E. Saline 3% hypernatremia can be due to hyperaldosteronism (Aldosterone, by inducing renal reabsorption of sodium at the distal convoluted tubule (DCT), enhances secretion of potassium and hydrogen ions, causing hypernatremia), excessive administration of intravenous 3% normal saline or sodium bicarbonate, or rarely from eating too much salt.

AP, was drinking a glass of wine when she syncopized and hit her head. Her friend dials "911" because AP is unconscious, with depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is AP at risk for if medical attention is not provided? A. Metabolic Acidosis B. Metabolic Alkalosis C. Respiratory Acidosis D. Respiratory Alkalosis

C. Respiratory Acidosis Rationale: One of the risk factors of having respiratory acidosis is hypoventilation which may be due to brain trauma, coma, and hypothyroidism or myxedema. Other risk factors include COPD, Respiratory conditions such as pneumothorax, pneumonia and status asthmaticus. Drugs such as Morphine and MgSO4 toxicity are also risk factors of respiratory acidosis.

CZ is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings? A. Metabolic Acidosis, Uncompensated B. Respiratory Alkalosis, Partially Compensated C. Respiratory Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated

C. Respiratory Alkalosis, Uncompensated Rationale: The results show that the pt has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3 which is within 22-26 mEq/L.

A 22-year-old man with a diagnosis of schizophrenia has been transferred from the psychiatric unit to the medical unit after drinking 5 liters of water over the past hour. Assessment reveals that the patient is oriented to person but not to time or place and that he is drowsy but rousable by touch. When reviewing this patient's most recent blood work, the nurse should pay particular attention to the patient's levels of: A. Phosphate B. Calcium C. Sodium D. BUN

C. Sodium Ingestion of large volumes of free water results in hyponatremia. As such, the patient's sodium levels would be monitored closely.

You are caring for a patient who has been admitted for changes in level in consiousness, muscle twitching, and abnormal speech. The patient was sent for a computed tomography, and cerebral vascular accident (stroke) was ruled out. Serum sodium is noted to be 162 mEq/dL. you note the patient has weak thready pulses, dry mucous membranes, and poor tissue turgor. You as the student nurse anticipate: A. Hypertonic saline 3% at 100 ml/hr B. Spironolactone (Aldactone) C. Sodium restriction and Normal Saline 0.45% at 80ml/hr. D. Furosemide (Lasix) E. Normal saline 0.9% at 100 ml/hr

C. Sodium restriction and Normal Saline 0.45% at 80 ml/hr

An elderly patient has developed Clostridium difficile-related diarrhea and been subsequently diagnosed with fluid volume deficit (FVD). The nurse providing care for this patient should anticipate: A. The administration of a hypertonic IV solution B. A decreased level of blood urea nitrogen (BUN) C. The administration of hypotonic or isotonic IV solution D. An increased level of serum potassium

C. The administration of hypotonic or isotonic IV solution FVD necessitates the administration of isotonic IV solutions (in hypotensive patients) or hypotonic solutions (in normotensive patients). FVD is associated with increased levels of BUN and hypokalemia, especially in patients whose losses are due to vomiting or diarrhea.

The parathyroid glands regulate __________ and phosphate balance by means of the parathyroid hormone (PTH).

Calcium

a contraction of the facial muscles elicited in response to light tap over the facial nerve in front of the ear.

Chvostek sign (hypocalcemia)

Fluid volume excess (hypervolemia) Contributing Factors

Compromised regulatory mechanisms, such as kidney injury, heart failure, and cirrhosis; overzealous administration of sodium-containing fluids; and fluid shifts (i.e., treatment of burns). Prolonged corticosteroid therapy, severe stress, and hyperaldosteronism augment fluid volume excess.

_________________, the end product of muscle metabolism, is a better indicator of renal function than BUN

Creatinine

1. You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Your patient's plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the patient's health? A) Nutritional status B) Potassium balance C) Calcium balance D) Fluid volume status

D

40. An immunocompromised older adult has developed a urinary tract infection and the care team recognizes the need to prevent an exacerbation of the patients infection that could result in urosepsis and septic shock. What action should the nurse perform to reduce the patients risk of septic shock? A) Apply an antibiotic ointment to the patients mucous membranes, as ordered. B) Perform passive range-of-motion exercises unless contraindicated C) Initiate total parenteral nutrition (TPN) D) Remove invasive devices as soon as they are no longer needed

D

17. A 73 year old man comes into the ED by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and orients; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed and 40 mL of urine is present. What is the nurse's most likely explanation for the low urine output? A) The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place B) The man likely has a traumatic brain injury, lacks ADH, and needs vasopressin C) The main is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output D) The man is having a sympathetic reaction, which has stimulated the reninangiotensinaldosterone system that results in diminished urine output

D

20. A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurse's preceptor is going over the patient's past lab reports with the new nurse. The nurse takes note that the patient's PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurse's best response? A) The patient's calcium will rise dramatically due to pituitary stimulation B) Oxygen will increase the patients intracranial pressure and create confusion C) Oxygen may cause the patient to hyperventilate and become acidotic D) Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia

D

20. The nurse is caring for a patient admitted with cardiogenic shock. The patient is experiencing chest pain and there is an order for the administration of morphine. In addition to pain control, what is the main rationale for administering morphine to this patient? A) It promotes coping and slows catecholamine release. B) It stimulates the patient so he or she is more alert. C) It decreases gastric secretions. D) It dilates the blood vessels.

D

22. When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur? A) Active transport of hydrogen ions across the capillary walls B) Pressure of the blood in the renal capillaries C) Action of the dissolved particles contained in a unit of blood D) Hydrostatic pressure resulting from the pumping action of the heart

D

23. The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect? A) Decrease in the release of aldosterone B) Increase of filtration in the Loop of Henle C) Decrease in the reabsorption of sodium D) Decrease in glomerular filtration

D

25. In all types of shock, nutritional demands increase rapidly as the body depletes its stores of glycogen. Enteral nutrition is the preferred method of meeting these increasing energy demands. What is the basis for enteral nutrition being the preferred method of meeting the bodys needs? A) It slows the proliferation of bacteria and viruses during shock. B) It decreases the energy expended through the functioning of the GI system. C) It assists in expanding the intravascular volume of the body. D) It promotes GI function through direct exposure to nutrients.

D

27. You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. During your assessment, you note the patient complains of a new onset of weakness with abdominal pain. Further assessment suggests that the patient likely has a fluid volume deficit. You should recognize that this patient may be experiencing what electrolyte imbalance? A) Hypernatremia B) Hypomagnesemia C) Hypophosphatemia D) Hypercalcemia

D

28. When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock should know that the pooling of blood in the periphery leads to what pathophysiological effect? A) Increased stroke volume B) Increased cardiac output C) Decreased heart rate D) Decreased venous return

D

3. The emergency nurse is admitting a patient experiencing a GI bleed who is believed to be in the compensatory stage of shock. What assessment finding would be most consistent with the early stage of compensation? A) Increased urine output B) Decreased heart rate C) Hyperactive bowel sounds D) Cool, clammy skin

D

3. You are working on a burn unit and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance? A) Metabolic alkalosis B) Hypermagnesemia C) Hypercalcemia D) Hypovolemia

D

32. The critical care nurse is preparing to initiate an infusion of a vasoactive medication to a patient in shock. The nurse knows that vasoactive medications are given in all forms of shock. What is the primary goal of this aspect of treatment? A) To prevent the formation of infarcts of emboli B) To limit stroke volume and cardiac output C) To prevent pulmonary and peripheral edema D) To maintain adequate mean arterial pressure

D

34. Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis? A) Metastases B) Excessive potassium intake C) Water intoxication D) Excessive administration of chloride

D

35. Sepsis is an evolving process, with neither clearly definable clinical signs and symptoms nor predictable progression. As the ICU nurse caring for a patient with sepsis, the nurse knows that tissue perfusion declines during sepsis and the patient begins to show signs of organ dysfunction. What sign would indicate to the nurse that end-organ damage may be occurring? A) Urinary output increases B) Skin becomes warm and dry C) Adventitious lung sounds occur in the upper airway D) Heart and respiratory rates are elevated

D

38. You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis? A) Hypertension B) Kussmaul respirations C) Increased DTRs D) Shallow respirations

D

39. A patient's most recent lab results show a slight decrease in potassium. The physician has opted to forego drug therapy but has suggested increasing the patient's dietary intake of potassium. Which of the following would be a good source of potassium? A) Apples B) Asparagus C) Carrots D) Bananas

D

5. You are an ER nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results? A) Respiratory acidosis with no compensation B) Metabolic alkalosis with a compensatory alkalosis C) Metabolic acidosis with no compensation D) Metabolic acidosis with a compensatory respiratory alkalosis

D

9. When caring for a patient in shock, one of the major nursing goals is to reduce the risk that the patient will develop complications of shock. How can the nurse best achieve this goal? A) Provide a detailed diagnosis and plan of care in order to promote the patients and familys coping. B) Keep the physician updated with the most accurate information because in cases of shock the nurse often cannot provide relevant interventions. C) Monitor for significant changes and evaluate patient outcomes on a scheduled basis focusing on blood pressure and skin temperature. D) Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment.

D

The ICU nurse is caring for a patient who experienced trauma in a workplace accident. The patient is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3 23 mEq/L. The nurse should recognize the likelihood of what acid base disorder? A) Respiratory acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Mixed acid base disorder

D

Vitamin __________ therapy is instituted to increase calcium from the GI tract.

D

MJ, an 8 y.o. ♂, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment? A. Respiratory Acidosis, Uncompensated B. Respiratory Acidosis, Partially Compensated C. Metabolic Alkalosis, Uncompensated D. Metabolic Acidosis, Partially Compensated

D. Metabolic Acidosis, Partially Compensated Rationale: The patient was diagnosed having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).

A 43-year-old patient with a history of alcohol abuse has been admitted to an acute medical unit with complications resulting from liver failure. Upon assessment, the patient's abdomen is distended, firm to touch, and nontender. The nurse recognizes that the patient has excess fluid in his peritoneal space (ascites), a problem that results from the disruption of normal movement of water and electrolytes. What process is primarily responsible for maintaining fluid balance along a concentration gradient? A. Filtration B. Active transport C. Hydrostatic pressure D. Osmosis

D. Osmosis The movement of water caused by a concentration gradient is known as osmosis. A lack of albumin, as in cases of liver failure, results in a disruption in osmotic function. Filtration is a result of hydrostatic pressure, and hydrostatic pressure itself is not a result of a concentration gradient. Active transport implies that energy must be expended for the movement to occur against a concentration gradient.

Which medication reported by a client during a nursing history could be associated with the development of hypocalcemia? A. Calcitriol. B. Hydrochlorothiazide (HydroDIURIL). C. Calcium Carbonate (TUMS). D. Phenytoin (Dilantin).

D. Phenytoin (Dilantin).

High plasma PaCO2: A. Metabolic Acidosis B. Respiratory Alkalosis C. Metabolic Alkalosis D. Respiratory Acidosis

D. Respiratory Acidosis Rationale: An excess of carbon dioxide (hypercapnia) can cause carbon dioxide narcosis. In this condition, carbon dioxide levels are so high that they no longer stimulate respirations but depress them.

You are caring for a patient with chronic renal failure with a phosphorus level of 6.8. You notice the patient is experiencing muscle twitching and has hyperreflexia. You anticipate the physician orders will include: A. Fluid restriction B. Potassium/Sodium Phosphate (Neutra Phos) C. Sodium polystyrene sulfonate (Kayexelate) D. Sevelamer (Renagel)

D. Sevelamer (Renagel)

A nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.4mEq/L. Which of the following would the nurse expect to note on the electrocardiogram as a result of the laboratory value? A. Prominent U wave B. ST depression C. Inverted T wave D. Tall peaked T waves

D. Tall peaked T waves

A nurse is reading a physician's progres notes in the client's record and reads that the physician has documented "insensible fluid loss of approximately 800ml daily". The nurse interprets that this type of fluid loss can occur through: A. Wound drainage B. Urinary output C. The GI tract D. The skin

D. The skin

A patient's most recent arterial blood gases reveal pH = 7.5; HCO3- = 29 mEq/L, and PaCO2 = 51 mm Hg. What health problem could account for these findings? A. Diabetic ketoacidosis (DKA) B. Atelectasis C. Hyperventilation D. Volume depletion from vomiting

D. Volume depletion from vomiting The patient is in metabolic alkalosis.

is the natural tendency of a substance to move from an area of higher concentration to one of lower concentration

Diffusion

You are caring for a patient who has been admitted for changes in level in consiousness, muscle twitching, and abnormal speech. The patient was sent for a computed tomography, and cerebral vascular accident (stroke) was ruled out. Serum sodium is noted to be 162 mEq/dL. you note the patient has weak thready pulses, dry mucous membranes, and poor tissue turgor. You as the student nurse anticipate: A. Hypertonic saline 3% at 100 ml/hr B. Normal saline 0.9% at 100 ml/hr C. Spironolactone (Aldactone) D. Furosemide (Lasix) E. Sodium restriction and Normal Saline 0.45% at 80 ml/hr.

E. Sodium restriction and Normal Saline 0.45% at 80 ml/hr

pt has a decrease in urine output despite adequate fluid intake. What should the nurse suspect?

Early evidence of a third-space fluid shift

In metabolic alkalosis, the respiratory rate increases, causing greater elimination of CO2. True or False

False In metabolic alkalosis, the lungs are going to compensate by retaining CO2 through slower respirations.

Fluid volume deficit (hypovolemia) Laboratory Findings

Labs indicate: ↑ hemoglobin and hematocrit, ↑ serum and urine osmolality and specific gravity, ↓ urine sodium, ↑ BUN and creatinine, ↑ urine specific gravity and osmolalit

Fluid volume excess (hypervolemia) Laboratory Findings

Labs indicate: ↓ hemoglobin and hematocrit, ↓ serum and urine osmolality, ↓ urine sodium and specific gravity

___________ is the concentration of fluid that affects the movement of water between fluid compartments by osmosis. It measures the solute concentration per kilogram in blood and urine. I

Osmolality

___________ ions, which are positively charged, far outnumber the other cations in the ECF.

Sodium

When there is a decrease in the circulating plasma osmolality, blood volume, or blood pressure, arginine vasopressin (AVP) is released from the posterior pituitary. Oversecretion of AVP can cause _________

SIADH.

most abundant electrolyte in the ECF

Sodium (Na+)

Sodium is important in regulating the volume of body fluid, because sodium concentration affects the overall concentration of extracellular fluid. True or False

True

When the kidneys are functioning normally, the volume of electrolytes excreted per day is equal to the amount ingested. True or False

True

Early evidence of a third-space fluid shift is a decrease in urine output despite adequate fluid intake. why is there a decrease in urine output?

Urine output decreases because fluid shifts out of the intravascular space; the kidneys then receive less blood and attempt to compensate by decreasing urine output.

When analyzing an arterial blood gas report of a pt with COPD & respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms? a) The kidneys retain bicarbonate. b) The kidneys excrete bicarbonate. c) The lungs will retain carbon dioxide. d) The lungs will excrete carbon dioxide.

a) The kidneys retain bicarbonate.

Which of the following may occur with respiratory acidosis? a. Increased intracranial pressure b. Mental alertness c. Decreased pulse d. Decreased blood pressure

a. Increased intracranial pressure

A nurse notes that a client's arterial blood gas results reveal a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse monitors that client for which clinical manifestations associated with these ABG results? Select all the apply. a. Nausea b. Confusion c. Bradypnea d. Tachycardia e. Hyperkalemia f. Lightheadedness

a. Nausea b. Confusion d. Tachycardia f. Lightheadedness

Ascites

abnormal accumulation of fluid in the abdomen

Hyperkalemia occurs with

adrenal insufficiency

Natriuretic peptide hormones

affect fluid volume and cardiovascular function through the excretion of sodium (natriuresis), direct vasodilation, and the opposition of the rennin-angiotensin-aldosterone system.

mild sodium restricted diet

allows only light salting of food (about half the usual amount) in cooking and at the table, and no addition of salt to commercially prepared foods that are already seasoned.

Severe generalized edema is called

anasarca.

A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? a. Sodium level of 145 mEq/L b. Potassium level of 3 mEq/L c. Magnesium level of 2 mg/dL d. Phosphorus level of 4 mg/dL

b. Potassium level of 3 mEq/L

A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, PCO2 of 30 mm Hg, and HCO3 of 22 mEq/L. The nurse analyzes these results as indicating which condition? a. Metabolic acidosis, compensated b. Respiratory alkalosis, compensated c. Metabolic alkalosis, uncompensated d. Respiratory acidosis, uncompensated

b. Respiratory alkalosis, compensated

The client's ABGs on room air are: pH 7.33, PaO2 77, HCO3 23. The nurse would instruct the client to: a. Try to breathe more slowly b. Used the bedside inspirometer hourly when awake. c. Where nasal cannula oxygen at 6 L/min. d. Increase fluid intake to flush the kidneys.

b. Used the bedside inspirometer hourly when awake.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? a. PaCO2 36 b. pH 7.48 c. HCO3 21 mEq/L d. O2 sat 95%

b. pH 7.48

Older adults and those with disabilities, who spend an increased amount of time in bed, have an increased risk of hypocalcemia, . why?

because bed rest increases bone resorption.

Hypotonic sodium solution is thought to be safer than D5W. Why?

because it allows a gradual reduction in the serum sodium level, thereby decreasing the risk of cerebral edema.

Sodium has a major role in controlling water distribution throughout the body. why?

because it does not easily cross the cell wall membrane and because of its abundance and high concentration in the body.

Creatinine is the end product of muscle metabolism. It is a better indicator of renal function than BUN. Why?

because it does not vary with protein intake and metabolic state.

Dehydration in older adults is common. Why?

because of decreased kidney mass, decreased glomerular filtration rate, decreased renal blood flow, decreased ability to concentrate urine, inability to conserve sodium, decreased excretion of potassium, and a decrease of total-body water.

in hypovolemia the BUN to creatinine ratio is above 20:1. why?

because of dehydration or decreased renal perfusion and function.

Rapid infusion of an excessive volume of IV fluids may produce fluid overload and cardiac failure in older patients. These reactions are likely to occur more quickly and with the administration of smaller volumes of fluid than in healthy young and middle-aged adults. Why?

because of the decreased cardiac reserve and reduced renal function that accompany aging.

assessment of skin turgor is not as valid in older adults. why?

because the skin has lost some of its elasticity * other assessment measures (e.g., slowness in filling of veins of the hands and feet) become more useful in detecting FVD

if fluid losses are acute or severe, the IV route is required. Isotonic electrolyte solutions (e.g., lactated Ringer solution, 0.9% sodium chloride) are frequently the first-line choice to treat the hypotensive patient with FVD. WHY

because they expand plasma volume

The body's major extracellular buffer system is the __________________________ buffer system, which is assessed when arterial blood gases are measured.

bicarbonate-carbonic acid

BUN

blood urea nitrogen

How is pitting edema assessed?

by pressing a finger into the affected part, creating a pit or indentation that is evaluated on a scale of 1+ (minimal) to 4+ (severe)

The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial intervention to correct this problem? a) Immediately administer oxygen via a mask & monitor oxygen saturation. b) Prepare to start an intravenous fluid bolus using isotonic fluids. c) Encourage the pt to breathe in & out slowly into a paper bag. d) Anticipate the administration of intravenous sodium bicarbonate.

c) Encourage the pt to breathe in & out slowly into a paper bag.

The 30 year old client with asthma is brought into the emergency department by a friend because of difficulty breathing throughout the day and is now confused. The client's ABGs are: pH 7.19, PaO2 46, PaCO2 88, HCO3 25. The nurse would anticipate that the client's immediate treatment will be directed at. a. increasing O2 via nasal cannula to maintain pulse oximetry saturation greater than 94% b. Starting IV with Solu-Medrol c. Intubation and mechanical ventilation d. Administration of STAT bronchodilator via handheld nubulizer

c. Intubation and mechanical ventilation

sodium, mannitol, glucose, and sorbitol are effective osmoles. What does this mean?

capable of affecting water movement

Trousseau sign:

carpopedal spasm induced by inflating a blood pressure cuff above systolic blood pressure

major anions

chloride, bicarbonate, phosphate, sulfate, proteinate ions

A pt's blood gases show a pH greater of 7.53 & bicarbonate level of 36 mEq/L. The nurse realizes that the acid-base disorder this pt is demonstrating is which of the following? a) respiratory acidosis b) metabolic acidosis c) respiratory alkalosis d) metabolic alkalosis

d) metabolic alkalosis

A client with a 3-day history or nausea and vomiting presents to the emergency department. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following? a. A decreased pH and an increased CO2 b. An increased pH and a decreased CO2 c. A decreased pH and a decreased HCO3- d. An increased pH with an increase HCO3-

d. An increased pH with an increase HCO3-

Which of the following would be a potential cause for respiratory acidosis? a. Diarrhea b. Vomiting c. Hyperventilation d. Hypo-ventilation

d. Hypo-ventilation

A client with emphysema has the following blood gas values: PCO2 35, PO2 78, and pH 7.40. The nurse's action should be to: a. Give O2 at 1L immediately for hypoxia. b. Take no action, these values are normal for the condition. c. Tell the client to breathe slower. d. Question the report and call the physician.

d. Question the report and call the physician.

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PCO2 is 90 mm Hg, and HCO3- is 22 mEq/L. The nurse interprets the results as indicating which condition? a. Metabolic acidosis with compensation b. Respiratory acidosis with compensation c. Metabolic acidosis without compensation d. Respiratory acidosis without compensation

d. Respiratory acidosis without compensation

Hypovolemia

decreased blood volume

Factors that increase BUN include:

decreased renal function, GI bleeding, dehydration, increased protein intake, fever, and sepsis.

In many older patients, the clinical manifestations of fluid and electrolyte disturbances may be subtle or atypical. For example, fluid deficit may cause _________ in the older person

delirium

Examples of _____________ are the exchange of oxygen and carbon dioxide (CO2) between the pulmonary capillaries and alveoli and the tendency of sodium to move from the ECF compartment, where the sodium concentration is high, to the ICF, where its concentration is low.

diffusion

third-space fluid shift

distributional shift of body fluids into potential body spaces

factors that decrease BUN include:

end-stage liver disease, a low-protein diet, starvation, and any condition that results in expanded fluid volume (e.g., pregnancy).

Treatment of hypernatremia

gradual lowering of the serum sodium level by the infusion of a hypotonic electrolyte solution (e.g., 0.3% sodium chloride) or an isotonic nonsaline solution (e.g., dextrose 5% in water [D5W]).

The direction of fluid movement depends on the differences in these two opposing forces

hydrostatic vs. osmotic pressure

Oral intake is controlled by the thirst center located in the _____________

hypothalamus

_____________, occurs when loss of ECF volume exceeds the intake of fluid. It occurs when water and electrolytes are lost in the same proportion as they exist in normal body fluids; thus, the ratio of serum electrolytes to water remains the same.

hypovolemia

In patients with relatively normal cardiopulmonary function, a low central venous pressure is indicative of ________

hypovolemia.

Hypernatremia results from

increased insensible losses and diabetes insipidus.

Hyponatremia occurs with

increased thirst and ADH release.

Continuous water loss by evaporation (approximately 500 mL/day) occurs through the skin as ____________ , a nonvisible form of water loss

insensible perspiration

Oncotic pressure

is the osmotic pressure exerted by proteins (e.g., albumin).

transcellular space

is the smallest division of the ECF compartment Examples of transcellular fluids include cerebrospinal, pericardial, synovial, intraocular, and pleural fluids, sweat, and digestive secretions.

what effects can occur to a older patient that recieves routine procedures, such as vigorous administration of laxatives or enemas before colon x-ray studies?

may produce a serious FVD, necessitating the use of intravenous (IV) fluids to prevent hypotension and other effects of hypovolemia.

Dehydration (resulting in hypernatremia) is often overlooked as the cause of mental status and behavioral changes in ______ patients.

older

decrease in systolic pressure exceeding 20 mm Hg when the patient moves from a lying to a sitting position

orthostatic hypotension

Osmolarity, another term that describes the concentration of solutions, is measured in milliosmoles per liter (mOsm/L). However, the term ______ is used more often in clinical practice.

osmolality

The magnitude of this force depends on the number of particles dissolved in the solutions, not on their weights. The number of dissolved particles contained in a unit of fluid determines the ____________ of a solution, which influences the movement of fluid between the fluid compartments

osmolality

When two different solutions are separated by a membrane that is impermeable to the dissolved substances, fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration. This diffusion of water caused by a fluid concentration gradient is known as ___________

osmosis

The ___________ glands, embedded in the thyroid gland, regulate calcium and phosphate balance

parathyroid

Because special techniques are required to measure electrolyte concentrations in the ICF, it is customary to measure the electrolytes in the most accessible portion of the ECF—namely, the ________.

plasma.

Fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesias, and dysrhythmias are signals that warrant assessing the serum _________ concentration.

potassium

Most salt substitutes contain potassium and must therefore be used cautiously by patients taking ____________ diuretics (e.g., spironolactone, triamterene, amiloride).

potassium-sparing

BUN is made up of urea, which is an end product of the metabolism of ______ (from both muscle and dietary intake) by the liver.

protein

Potassium is never given by IV push or intramuscularly to avoid replacing potassium too quickly. IV potassium must be given using an infusion ______

pump.

If dyspnea or orthopnea is present, the patient is placed in a ___________ position to promote lung expansion.

semi-Fowler

How osmoreceptors work

sense changes in sodium concentration. As osmotic pressure increases, the neurons become dehydrated and quickly release impulses to the posterior pituitary, which increases the release of ADH, which then travels in the blood to the kidneys, where it alters permeability to water, causing increased reabsorption of water and decreased urine output.

The most common treatment for hyponatremia is careful administration of _____by mouth, nasogastric tube, or a parenteral route.

sodium

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) may be associated with ______ imbalance.

sodium

decreased secretion of aldosterone causes

sodium and water loss and potassium retention.

importance of sodium

sodium is important in regulating the volume of body fluid.

Increased secretion of aldosterone causes

sodium retention (and thus water retention) and potassium loss.

major cations

sodium, potassium, calcium, magnesium, hydrogen ions

nursing management for hypovolemia prevention:

take measures to minimize fluid losses. For example, if the patient has diarrhea, measures should be implemented to control diarrhea and replacement fluids given. This includes administering antidiarrheal medications and small volumes of oral fluids at frequent intervals.

Osmotic pressure

the amount of hydrostatic pressure needed to stop the flow of water by osmosis. It is primarily determined by the concentration of solutes.

osmolality

the concentration of solutes in body fluids

Osmotic diuresis

the increase in urine output caused by the excretion of substances, such as glucose, mannitol, or contrast agents in the urine.

When fluid balance is critical, all routes of systemic gain and loss must be recorded and all volumes compared. Organs of fluid loss include:

the kidneys, skin, lungs, and GI tract.

intestinal obstruction, pancreatitis, crushing traumatic injuries, bleeding (trauma or dissected aortic aneurysm), peritonitis, and major venous obstruction are examples of?

third-space fluid losses

Loss of ECF into a space that does not contribute to equilibrium between the ICF and the ECF is referred to as a __________________ or third spacing

third-space fluid shift,

A primary characteristic of hypernatremia is ____

thirst.

third spacing

translocation of fluid from the intravascular or intercellular spaces to tissue compartments, where it becomes trapped and useless

Excessive administration of sodium-containing fluids in a patient with impaired regulatory mechanisms may predispose him or her to a serious FVE

true

For patients who can eat and drink, sodium is easily replaced, because sodium is consumed abundantly in a normal diet.

true

Highly hypertonic sodium solutions (2% to 23% sodium chloride) should be given slowly and the patient monitored closely, because only small volumes are needed to elevate the serum sodium concentration from a dangerously low level.

true

Hypervolemia occurs when aldosterone is chronically stimulated (i.e., cirrhosis, heart failure, and nephrotic syndrome). Therefore, the urine sodium level does not increase in these conditions.

true

Hyponatremia is a frequently overlooked cause of confusion in older patients, who are at increased risk because of decreased renal function and subsequent inability to excrete excess fluids.

true

Serum osmolality primarily reflects the concentration of sodium, although blood urea nitrogen (BUN) and glucose also play a major role in determining serum osmolality.

true

The ECF has a low concentration of potassium and can tolerate only small changes in potassium concentrations. Therefore, the release of large stores of intracellular potassium, typically caused by trauma to the cells and tissues, can be extremely dangerous.

true

identify if the patient is a performance athlete. Performance athletes (i.e., marathon runners) may use salt tablets to decrease sweating, thus decreasing the sodium loss during prolonged exercise

true

use of multiple medications by older adults can affect renal and cardiac function, thereby increasing the likelihood of fluid and electrolyte disturbances.

true

azotemia

urea in the blood

most reliable indicator of urine concentration.

urine osmolality

Sensible perspiration

visible water and electrolyte loss through the skin (sweating).