F & E
3. distinguish between serum and urine osmolality.
Serum osmolality primarily reflects the concentration of sodium, although blood urea nitrogen (BUN) and glucose also play a major role in determining serum osmolality. Urine osmolality is determined by urea, creatinine, and uric acid. When measured with serum osmolality, urine osmolality is the most reliable indicator of urine concentration. Osmolality is reported as miliosmoles per kilogram of water (mOsm/kg).
3. identify three treatment goals for the patient with intermittent claudication
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3. stent placements are used
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3. which of the following assessment results is considered a major risk factor for PAD? a. LDL of 100 mg/dL b. BP of 160/110 mm Hg c. cholesterol of 200 mg/dL d. triglyceride level of 150 mg/dL
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4. List three treatment goals for a patient with intermittent claudication: _________,__________, and ____________.
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4. abnormally dilated, superficial veins caused by incompetent valves
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5. a localized weak point in the wall of an artery
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5. edema will be minimal unless the leg is frequently dependent
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6. Edema may be severe with aching, throbbing and heaviness
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6. List five common symptoms associated with varicose veins:
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3. prolonged capillary filling time
a Fluid volume deficit
whay % of K+ that is excreted daily . Leaves the body by way of the kidneys?
80% to maintain the K+ balance, the renal system must function, because 80% of the potassium excreted daily leaves the body by way of the kidneys
normal serum chloride
96 to 106 mEq/L
G Peripheral Arterial Disease pete is a 55 yr old construction worker with a history of hypertension; he has smoked two packs of cigs a day for the last 35 yrs. his current concern is calf pain during minimal exercise that decreases with rest. He is worried about losing his job. The nurse is aware that his description of pain is consistent with a dx of intermittent claudication.
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H 1. The most important factor regulating the caliber of blood vessels, which determines resistance to flow, is: a. hormonal secretion b. independent arterial wall activity c. the influence of circulating chemicals d. the sympathetic nervous system
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skip 10
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a 160 lb pt, Dx with hypovolemia, is weighed everyday. The health care provider asked to be notified if the pt loses 1000 mL of fluid in 24 hrs. choose the weight that would be consistent with this amount of fluid loss a. 159 b. 158 c. 157 d. 156
B. A loss of 0.5 kg or 1 lb represents a fluid loss of about 500 mL. Therefore, a loss of 1,000 mL would be equivalent to the loss of 2 lbs (160-2=158lbs)
13. A nurse reviews the results of an electrocardiogram (ECG) for a pt who is being assessed for hypokalemia. which of the following would the nurse notice as the most significant diagnostic indicator? a. widened QRS wave b. flat P wave c. elevated U wave d. peaked T wave
C an elevated U wave is specif for hypokalemia. Flat or inverted T waves may also be present. the other tracings are consistent with hyperkalemia
3. A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 would have a serum osmolality of ? a. 210 b. 230 c. 250 d. 280
D. Serum osmolality can be estimated by doubling the serum sodium or using the formula: Na x 2 = glucose/18 + BUN/3. therefore, the nurse could estimate a serum osmolality of 280 mOsm/kg
5. explain how a fluid challenge is administered.
During a fluid challenge test, volumes of fluid are administered at specific rates and intervals while the pt's hemodynamic response to this treatment is monitored ( vital signs, breath sounds, sensorium, central venous pressure, pulmonary capillary wedge pressure values, and urine output). An example of a typical fluid challenge involves administering 100 to 200 mL of NS solution over 15 minutes.
short answer 1. explain the concept of interstitial fluid shift, or "third-spacing."
Early evidence of third-space fluid shifting is a 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
factors that increase BUN include -
GI bleeding, dehydration, increased protein intake, and fever
The calcium level of the blood is regulated by which mechanism?
PTH parathyroid hormone and calcitonin
9. The body's major extracellular buffer system is ________, which maintains a ratio of ___________.
The bicarbonate-carbonic acid buffer system that maintains a ratio of 20 parts of bicarbonate (HCO3) to one part of carbonic acid (H2CO3)
3. effects of extracellular sodium level on cell size. describe what happens to the cell in hyponatremia and hypernatremia -
a. cells swell as water is pulled in from ECF; low solute-to-water ratio; b. cells shrink as water is pulled out into ECF; jigh solute-to-solvent ratio
which of the following electrolytes is a major anion in body fluid? a. chloride b. potassium c. soldium d. calcium
a. chloride chloride is a major anion found in extracellular fluid. potassium, sodium, and calcium are cations.
6. The most common cause of symtomatic hypomagnesemia in the united states is -
alcoholism
osmotic pressure is the
amount of pressure needed to stop the flow of water by osmosis
9. a form of edema in which fluid accumulation in the peritoneal cabity
ascites
Increased nitrogen levels in the blood
azotemia
4. distended jugular veins
b Fluid volume excess
an example of insensible mechanism of fluid loss-
breathing loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is unnoticeable and immeasurable. losses from urination and bowel elimination are measurable
which of the following electrolytes is a major cation in body fluid? a. chloride b. bicardonate c. potassium d. phosphate
c. potassium is a major catium affects cardiac muscle functioning.
anions in the body-
chloride, bicarbonate, and phosphate
Dextran in NS is a -
colloid solution
8. Tall, tented T waves and absent P waves
d Potassium excess
write the sequence of the fluid regulation cycle-
decreased blood volume and blood pressure stimulates baroreceptors -> fewer impulses are transmitted from the carotid sinuses and aortic arch -> the sympathetic nervous system (SNS) is stimulated and parasympathetic nervous system (PNS) is inhibited -> the heart rate increases and ADH is released-> the kidneys reabsorb water -> sodium and water reabsorption is increased and there is a loss of potassium
4. the natural tendency of a substance to move from an area of higher concentration to one of lower concentration.
diffusion
2. numbness and tingling of the fingers and toes
e calcium deficit
hypokalemia can cause which of the following symptoms to occur?
excessive thirst if prolonged, hypokalemia can lead to an inability of the kidneys to concentrate urine, causing dilute urine and excessive thirst. Potassium depletion depresses the release of insulin and results in glucose intolerance.
6. flat or inverted T waves
f Magnesium deficit
across 2. the movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure.
filtration
7. Nystagmus and paresthesias
g Phosphorus deficit
5. hypertonicity and tetany
h Chloride deficit
down 1. a term used to describe the balance of fluid and electrolytes as a dynamic process
homeostasis
5. the pressure exerted by the fluid on the walls of the blood vessel by the heart
hydrostatic
a solution that is 5% NaCl is and 3% NaCl are -
hypertonic
when serum sodium levels dips below 135 mEq/L , there is ______
hyponatremia
half-strength saline is - ( 0.45% NaCl )
hypotonic
early signs of hypervolemia include-
increased breathing effort and weight gain early signs include weight gain, elevated BP, and increased breathing effort. Eventually, fluid congestion in the lungs leads to moist breath sounds
3. List the three causes of edema, a common manifestation of fluid volume excess ( FVE) :
increased capillary fluid pressure, decreased capillary oncotic pressure, or increased interstitial oncotic pressure
lactated ringers solution and normal saline ( 0.9% NaCl) are -
isotonic
manifestations of hyponatremia include-
mental confusion, muscular weakness, anorexia, restlessness, elevated body temp, tachycardia, nausea, vomiting, and personality changes, convulsions or coma can occur if the deficit is severe.
potassium may be adminstered through the -
oral route potassium is never administered by IV push or IM to avoid replacing potassium too quickly. Potassium is not administered sub Q
6. the concentration of fluid that affects compartments by osmosis.
osmolality
The movement of water caused by a concentration gradient when two solutions are separated by an impermeable membrane
osmosis
oncotic pressure refer to the -
osmotic pressure exerted by proteins oncotic pressure is a pulling pressure exerted by protiens, such as albumin.
matching 1. increased serum sodium, urine specific gravity, and osmolality
sodium volume excess
osmolality refers to -
the number of dissolved particles contained in a unit of fluid.
osmotic diuresis occurs when -
the urine output increases due to excretion of substances such as glucose
an earlist symptom of hypovolemia is
thirst
7. name five foods, high in chloride, that should be encouraged for a pt with hypochloremia:
tomoto juice, bananas, dates, eggs, cheese, milk, salty broth, canned veges, and processed meats
8. the ability of all the solutes in a solutin to cause an osmotic driving force.
tonicity
1. The normal pH of the blood is within a range of
7.35 to 7.45
normal serum calcium is
8.5 to 10.5 mg/dL
1. associated with an ankle-brachial index ( ABI)>0.9
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1. Reduced blood flow through blood vessels leads to a medical condition that causes ________
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1. describe the initial assessments that the nurse should do to verify a dx of intermittent claudication.
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10. The major vein that is normally used to replace a varicose vein.
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10. the surrounding tissue is usually pale and cooler than the other skin areas.
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2. List four physiologic processes that result from the influence of nicotine, a risk factor for peripheral vascular disease: _________,___________,___________, and _________.
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2. The presence, location, and extent of arterial occlusive disease are determined by a physical examination. describe how the nurse should assess peripheral pulses and changes in skin appearance and temp
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2. health teaching includes advising patients on ways to reduce PAD . The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is a. cigarette smoking b. lack of exercise c. obesity d. stress
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2. sclerotherapy is a type of operative procedure
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2. the type of circulation that develops when blood vessels are rerouted to take over for blocked vessels
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3. The hallmark symptom of peripheral arterial disease (PAD) is ___________.
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4. A pt complains of a "stabbing pain and a burning sensation" in his left foot. The nurse notices that the foot is a lighter color than the rest of the skin. The artery that the nurse suspects is occluded would be the: a. internal iliac b. common femoral c. popliteal d. posterior tibial
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4. explain the pharmacologic therapy that is recommended for the medical management of intermittent claudication.
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4. pulses mauy be absent or dimished
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5. To promptly reverse the effects of heparin, ________ would be administered; to reverse the effects of coumadin, ___________ and/or __________ or _________ would be given.
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6. malnourished tissue as the result of decreased blood flow
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7. name two important management goals for a pt with venous insufficiency:
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7. the procedure that involves injection of an irritating chemical into a vein
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7. the shape of the ulcer is characterized by an irregular border
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8. The most serious complication of chronic venous insufficiency is __________.
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8. a popular diuretic used to prevent fluid edema
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8. the ulcer base is dry and pale gray or yellow
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9. inflammation of a blood vessel
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9. the location is usually around the ankle or the lower third of the leg
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Describe the clinical picture of cellulitis.
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across 3. a reddish-blue color that occurs when an extremity is placed in a dependent position after elevation
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describe the pathophysiology that occurs when an aneurysm develops
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describe the physiology of how arteries become damaged or obstructed
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describe the three pathophysiologic factors ( Virchow's triad) that are involved in the development of a venous thrombosis
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distinguish between arteriosclerosis and atherosclerosis
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down 1. the most common disease of the arteries
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explain the etiology of intermittent claudication
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write the sequence of the pathophysiology of post phlebitis syndrome
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write the sequence of the physiologic responses to a venous embolus -
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4. When the serum sodium level is less than _____, signs of increased intracranial pressure occur. In SIADH, the serum sodium level can be as low as _______.
115mEq/L; 100 mEq/L
normal serum sodium-
135 - 145 mEq/L
14. the nurse monitors a pt who is being evaluated for hyperkalemia. she is aware that ECG changes and serum potassium levels are diagnostic. which of the following are the earlist changes that the nurse should report? a. K+=5 mEq/L; prolonged T waves b. K+ = 6 mWq/L ; elevated ST segment c. K+= 7 mEq/L ; peaked T waves d. K+= 8 mEq/L ; shortened PR interval
14. C the earliest changes occur when the serum potassium level is 7 mEq/L. cardiac tracing include peaked and narrow T waves, ST segment depression and a shortened QT interval. refer to figure 4-6
20. a nurse caring for a pt who is receiving an IV solution via a central vein suspects the complication of an air embolism. which of the following are signs and symptoms consistent with that diagnosis? select all that apply a. crackles on auscultation b. cyanosis c. hypertension d. shoulder pain e. dyspnea f. tachycardia
20. B, D, E , F hypotension, along with the other correct choices, is a manifestation of an air embolism. crackles on auscultation is a major indicator of circulatory system overload.
activity B 1. approximate size of body compatrments in a 70 kg man. choose the correct amount of water from the list below and fill in each blank in the figure on the right 1 liter 3.5 liters 10 liters 28 liters
28 liters intracellular water 10 liters interstitial 3.5 liters plasma 1 liter transcellular
normal serum value of potassium
3.5 to 5.5 mEq/L serum potassium must be within normal limits to prevent cardiac dysrhythmia.
2. The presence of pitting edema is associated with a gain of ______ of fluid in the interstitial space.
4.5 L
H The nurse assesses a cardiac pt's urinary output. The pt weighs 175 lbs. Based on the normal daily range of urine volume, the nurse expects a 4 hr output of - a. 40 -80 mL b. 80 - 160 mL c. 120-240 mL d. 160 - 320 mL
A standard measurement is 0.5 to 1 mL/kg/hr. A 175 lb adult weighs 79.5 kg. therefore, 79.5x0.5mL=39.75 or 40 mL/hr x 4 hrs=160 mL; 79.5 x 1 mL = 79.5 or 80 mL/hr x 4 hrs = 320 mL
5. a 54 yr old male pt is admitted to the hops with a case of severe dehydration. The nurse reviews the pt's lab results. which of the following results are consistent with the diagnosis? select all that apply a. BUN of 23 mg/dL b. Serum osmolality of 310 mOsm/kg c. serum sodium of 148 mEq/L d. Serum glucose of 90 mg/dL e. urine specific gravity of 1.03 f. hematocrit level of 48%
A,B,C,E Severe dehydration is associated with an increased BUN (N=10 to 20 mg/dL), serum osmolality (N=275to 300 mOsm/kg, serum sodium 135-145 and urine specific gravity (1.01-1.025) Glucose and hematocrit levels would also be elevated but are within normal range for this question
a 73 yrs old female patient with cirrhosis of the liver is evaluated for clinical manifestationsnof FVE. which of the following signs are consistent with that diagnosis? all that apply a. crackles b. BP of 90/60 c. central venous pressure ( CVP) reading of 4 mm Hg d. hematocrit level of 32% e. BP of 140/110 f. BUN of 8 mg/dL
A,D,E,F the blood pressure is increased with FVE. Crackles are abnormal lung sounds found in fluid retention. Hematocrit and BUN may be decreased due to plasma dilution.
15. a pt is diagnosed with hypocalcemia. the nurse advises the pt anf his family to immediately report the most characteristic manifestation? a. tingling or twitching sensation in the fingers b. confusion and depression c. dyspnea and laryngospasm d. hyperactive bowel sounds
A. all the choices are signs and symptoms of hypocalcemia, but tetany is the most characteristic manifestation that occurs when the calcium level is less than 4.4 mg/dL
11. treatment of FVE involves dietary restrictions of sodium. which of the following food choices would be part of a low-sodium diet, mild restrictions (2 to 3 g/day)? a. three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad b. three ounces of sliced ham, beets, and a salad c. a frozen, packaged low fat dinner with a side salad d. tomato juice, low fat cottage cheese, and three slices of bacon
A. ham (1,400 mg Na for 3 oz) and bacon ( 155 mg Na/slice) are high in sodium as is tomato juice ( 660 mg Na/ 3/4 cup) packages meals are high in sodium
16. it is important for a nurse to know how to calculate the corrected serum calcium level for a pt when hypocalcemia is seen along with low serum albumin levels. calculate the correct serum calcium when the serum calcium is 9 mg/dL and the serum albumin is 3 g/dL. a. 9.8 mg/dL b. 10.3 mg/dL c. 11 mg/dL d. 12 mg/dL
A. to calculTe corrected serum calcium, subtract the normal serum albumin level of 4g/dL from the report albumin level of 3 g/dL, multiply the value (1) by 0.8(constant factor) and then add that result ( 0.8mg) to the reported serum level of 9 mg/dL. therefore, 9 + 0.8 = 9.8 mg/dL ( correct value) . Note: a constant factor of 0.8 is used because, for every decrease in serum albumin of 1g/dL below 4g/dL, the total serum calcium level is underestimated by 0.8mg/dL
6. A volume-depleted pt would present with which of the following diagnostic lab results? a. BUN-to - creatine ratio of 24:1 b. urinary output of 1.2L/ 24 hrs c. urine specific gravity of 1.02 d. capillary refill time of 3 seconds
A. a BUN-to-creatinine concentration ratio greater than 20:1 is indicative of volume depletion. The other results are within normal range
12. a pt. diagnosed with hypernatremia needs IV sodium replacement. select the solution that is considered the safest to administer? a. 0.45% sodium chloride b. 0.9% sodium chloride c. 5% dextrose in water d. 5% dextrose in NS solution
A. a hypotonic solution ( half strength saline) is the solution of choice and considered safer than D5W because it allows a gradual reduction in the serum sodium level, thereby decreasing the risk of cerebral edema. an isotonic solution ( 0.9%) is not desirable as a supplement because it provides Na and CL
2. Contrast hydrostatic and osmotic pressure.
At the arterial end of the capillary, fluids are filtered through its wall by a hydrostatic pressure that exceeds the oncotic pressure exerted by plasma protein; thus, water and electrolytes leave the bloodstream to feed the interstitial and intracellular space. The oncotic pressure ( exerted primarily by albumin) is greater than hydrostatic pressure in the venous end of the capillary; thus, fluids reenter the capillary. The direction of fluid movement depends on the difference in these two opposing forces ( hydrostatic versus osmotic pressure).
19. the health care provider ordered an IV solution for a dehydrated with a head injury. select the IV solution that the nurse knows would be contraindicated. a. 0.9 % NaCl b. 5% DW c. 0.45% NS d. 3% NS
B a solution of D5W is an isotonic IV solution that is contraindicated in head injury because it may increase intracranial pressure
2. a febrile pt's fluid output is in excess of normal because of diaphoresis. The nurse should plan fluid replacement based on the knowledge that insensible losses in an afebrile person are normally not greater than: a. 300 b. 600 c. 900 d. 1200
B. Continuous water loss by evaporation ( approx 600 mL/day) occurs through the skin as insensible perspiration, a nonvisible form of water loss.
7. a pt with diabetes insipid us presents to the ER for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators? a. sodium level of 137 b. potassium level of 3.8 c. sodium of 150 d. potassium of 150
C. Hypernatremia ( normal serum sodium is 135 - 145) is consistent with increased fluid loss and dehydration in diabetes insipidus.
4. a patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for : a. dehydration b. hyperglycemia c. hyponatremia d. acidosis
C. decreased serum sodium is a factor associated with decreased serum osmolality. Dehydration and hyperglycemia are associated with increased serum osmolality; acidosis is associated with increased urine osmolality
4. describe the four major functions of the kidneys in maintaining fluid balance.
Regulation of ECF volume and osmolality by selective retention and excretion of body fluids; regulation of electrolyte levels in the ECF by selective retention of needed substances and excretion of unneeded substances; bregulation of the pH of the ECF by retention of hydrogen ions and /or bicarbonate (HCO3); and excretion of metabolic wastes and toxic substances.
6. describe how the nurse would assess for Trousseau's and chvostek's sign.
Trousseau's sign can be elicited by inflating a BP cuff on the upper arm to about 20 mm Hg above systolic pressure; within 2 to 5 minutes, carpal spasm will occur as ischemia of the ulnar nerve develops. Chvostek's sign consist of twitching of muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch
a pt. with severe hypervolemia is prescribed a loop diuretic. The nurse knows that this drug can cause a significant loss of sodium and has to be carefully monitored. which of the followingndrugs is most likely the one that was prescribed? a. lasix b. hydrodiuril c. mykrox d. zaroxolyn
a lasix is the only loop diuretic choice. the other choices are thiazide diuretics that block sodium reabsorption
5. List five of the ten manifestations of hypokalemia:
fitigue, anorexia, nausea, vomitting, muscle weakness, leg cramps , decreased bowel motility, paresthesia ( umbness and tingling), arrhythmias, and increased sensitivity to digitalis
3. a condition that occurs when loss of ECF volume exceeds the intake of fluid
hypovolemia
The mgmt goal of hypervolemia is to-
reduce fluid volume for this reason , fluid is rationed and the patien is advised to take a limited amount of fluid when thirsty
write the sequence of the renin-angiotension-aldosterone system-
renin is released in response to decreased renal perfusion -> Angiotension I is converted to angiotensin II -> Angiotensin II increases arterial perfusion pressure -> aldosterone is released by the adrenal cortex in response to SNS stimulation -> Sodium is reabsorbed, plasma volume is increased, and BP is increased.
8. list the six major signs and symptoms of hyperchloremia:
tachypnea, weakness, lethargy, deeprapid respirations, diminished cognitive anility, and hypertension
