Pharm Ch. 16 Quiz
A patient in the postoperative period has tachycardia, hemoglobin 9 g/100 mL, and a slowly healing wound. Which fluid therapy would the nurse expect to administer to help resolve these problems? 50 mL of 5% albumin 450 mL of whole blood 100 mL of fresh frozen plasma 250 mL of red blood cells (RBCs)
250 mL of red blood cells (RBCs) The nurse should administer the RBCs to increase the patient's oxygen-carrying capacity because the patient has anemia. This therapy should also help alleviate tachycardia because the patient's tachycardia is most likely caused by the sympathetic nervous system (SNS) activation responding to hypoxemia. As the tissues receive more oxygenated blood from the infusion of additional hemoglobin found in the RBCs, the SNS stimulation should subside. In addition, improved tissue oxygenation should help improve healing. The patient needs improved oxygen-carrying capacity, so albumin and plasma are improper therapy because they do not provide hemoglobin. Whole blood can help replenish hemoglobin, but because whole blood contains more fluid than red blood cells, it increases the risk of fluid volume overload and is not indicated.
A patient has a blood pressure of 82/60 mm Hg with generalized edema. What is the nurse's priority patient assessment in evaluating the effectiveness of fluid therapy? Patient weight Breath sounds Blood pressure Serum albumin
Breath sounds The patient presents with hypotension and generalized edema, indicating that fluid has shifted into the interstitial spaces, and lacks sufficient oncotic pressure to hold fluid in the vessels to maintain the blood pressure. Because a significant proportion of the patient's fluid is in the interstitial space, the goal of therapy is to pull fluid from the interstitial space into the intravascular space; the proper fluid with which to achieve this is a colloid, such as albumin. Therefore, the nurse's priority is to monitor the patient's breath sounds because generalized edema can frequently involve pulmonary edema and because breathing is the second most basic need, between airway and circulation. The patient's weight should not necessarily change after therapy unless the patient also has hypervolemia. The nurse assesses the patient's blood pressure, breath sounds and peripheral edema to determine whether fluid is shifting into the intravascular space. The serum albumin can also be an important gauge of the patient's potential for maintaining intravascular fluid, but assessing breath sounds is more important because it is the second most basic patient need.
Which dietary supplement is critical to the proper function of nerve impulse transmission and muscle contractions? Calcium Chromium Pyridoxine Cobalamin
Calcium Calcium, in addition to helping strengthen bones, is important in the transmission of nerve impulses and vital for muscle contractions, among many other physiologic functions. Chromium helps to modulate the serum glucose level. Pyridoxine is important in hemoglobin synthesis, metabolic function and the conversion of tryptophan to niacin and serotonin. Cobalamin is important in cell metabolism, growth, cell replication, hematopoiesis, and nucleoprotein and myelin synthesis.
The nurse administers a diuretic that increases renal excretion of sodium to a patient with heart failure. The patient's assessment: blood pressure 154/88 mm Hg, oxygen saturation 92%, and peripheral edema. If therapy is successful, which effects on fluid and electrolyte balance does the nurse expect to see? (Select all that apply.) Low oncotic pressures Decreased body weight More intravascular fluid Higher oxygen saturation Decreased urinary sodium Decreased total body fluid
Decreased body weight Higher oxygen saturation Decreased total body fluid The patient is hypoxemic and exhibits peripheral edema with hypertension; this is consistent with clinical indicators for hypervolemia. A diuretic that inhibits sodium reabsorption increases renal excretion of sodium and water; thus, as a result of therapy, the nurse expects the patient's weight to decrease from fluid loss. The nurse also expects the oxygen saturation to increase because oxygenation and ventilation become more efficient as fluid is drawn from the lungs and excreted in the urine. The nurse also expects the patient's urinary sodium to increase as a direct result of the administration of a diuretic that excretes sodium. Because diuretics promote water excretion as a result of impaired sodium reabsorption, the nurse does not anticipate a fluid shift into the intravascular space or decreased oncotic pressure as a result of increased intravascular volume.
Patients with which conditions or circumstances are suitable candidates, potentially, for magnesium sulfate supplements by mouth? (Select all that apply.) Liver failure Heart failure Renal failure Pre-eclampsia Hypokalemia Vegetarian diet
Liver failure Heart failure Hypokalemia Vegetarian diet
Which dietary supplement is needed in combination with calcium to promote the development of strong bones and teeth? Zinc Vitamin C Cobalamin Phosphorus
Phosphorus Bone strength depends on the size and density of bone, and bone density depends on the bone concentrations of calcium, phosphorus and other minerals. Zinc is important in metabolic processes and tissue repair, vitamin C in tissue repair, and vitamin B12 is important for nucleic acid synthesis, erythrocyte production and nervous system functioning.
The nurse administers a low dose of a medication to a male patient who has normal hepatic and renal function and no contraindications to therapy; however, afterward, the patient experiences a toxic reaction, dypsnea and edema. The medication is highly protein-bound. Which parameter should the nurse assess to determine the most likely cause of these adverse effects? Urine output Fluid balance Serum albumin Blood pressure
Serum albumin The nurse checks the serum albumin level because unexplained dypsnea and edema are frequently related to hypoalbuminemia. As the serum albumin level falls in hypovolemia, the oncotic pressure (pulling power of protein in the vessels) of the intravascular fluid decreases until fluid starts to escape into the interstitial spaces of the lungs and periphery, leading to edema. This is the most likely cause of the edema because the patient developed a toxic reaction, which is caused by an excessive dose; however, the patient's dose was low. This means the blood did not have enough protein (albumin, primarily) to which the medication could bind. Urine output are related to fluid balance and renal function, but hypovolemia is not the patient's problem; if renal dysfunction was the cause, the nurse should check the serum creatinine or creatinine clearance. Because of low oncotic pressure and the loss of intravascular volume, the patient's blood pressure can fall; however, this is a potential result of hypoalbuminemia and not a cause of it.
