441 exam 2

gestational diabetes

fetal effects of ___ _____ are LGA, SGA, growth retardation due to vascular effects, spinabifida, shoulder dystocia, inc insulin (causing hypoglycemia post birth), inc Ca and inc bili

LR

given for lyte replacement in surgical and burns. dont give if ph over 7.5

dec

giving insulin will __ K (by hiding it in the cell) and it fixes heart until we get the K excreted

Sulfonylureas

glipizide, glyburide, glimepiride inc insulin secretion can cause hypoglycemia, monitor in renal failure XR given once daily safe during pregnancy give 30 min b4 meals

unconscious

glucagon given only when pt is __. make sure to put pt on their side incase they vomit

8

good diabetes control in an A1C that is _ or lower

hypertonic soln

greater than 300. ex 5% or 3% NaCl. given slowly. osmo greater than ours. need constant surveillance for fluid overload

140

greater than __ gluc post prandial is high

adrenal gland crisis

very low coritsol level, sudden pain, syncope, shock , super low BP, severe vomiting/diarrhea tx by giving IV cortisol push, and fluids for low gluc and hypotension

Incretin Mimetics

exenatide glucagon-like peptide 1 agonist, delays liver gluc production does not cause hypoglycemia

metabolic

one of the 2 main factors controlling ph. cause and soln is kidney.

respiratory

one of the 2 main factors controlling ph. cause and soln is lungs and breathing

diabetes

peeps w/ -- can have inc BP due to inc osmo (gluc) and fluid rupturing in the eyes, feet, and kidneys

hyperglycemia

polyuria, polydipsia, and polyphagia and fatigue

hyper

preggo women have a higher risk of __volemia due to edema, inc blood, and fluid

antianxiety

pt has 32 RR, tingling fingers, resp alk. so what kind of meds should he get

150

pt has BP of 55/30, HR of 140, dizziness, vomiting. tx w/ NS @ __mL/hr

metabolic acidosis

causes: dka, renal fail, diarhhea, shock, diuretic S+S: headache, lethargy, kussmaul, n/v, anorexia, coma, depression of NS

parathyroid

pt has low __ hormone, which causes a low Ca. they should eat more green leaf, milk and OJ

Na

pt has new onset conf, they have high __ (abbreviation), they need vitals q 4 hrs and a bed alarm

resp

pt has symp of ____ alk if they are nauseous, have chng in LOC, inc HR, and are lightheaded

meta

pt is vomiting alot, is irritable, muscle cramping, weakness. what do they have? _____ alk

ketones

t1 pts will be thin, young, and have -- present in the urine

anion gap

tells the diff btwn pos and neg anions, finding source of acidosis

SGLT-2 inhibitors

-gliflozin (invocana) helps w/ renal elimination of gluc, does not cause hypoglycemia risk for acidosis

2-3

chng needle in insulin pump q _-_ days

sensible

_ loss can be meas (urine),

Tx of respiratory acidosis

•treat underlying cause (COPD, opioid intoxication, •benzodiazepine overdose)

D. Measure blood glucose levels

When a client is receiving dexamethasone for adrenocortical insufficiency, what action does the nurse take to monitor for an adverse effect of the medication? A. Auscultate for bowel sounds. B. Assess deep tendon reflexes. C. Culture respiratory secretions. D. Measure blood glucose levels

A. Monitoring for signs of hypoglycemia resulting from treatment

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? A. Monitoring for signs of hypoglycemia resulting from treatment B. Withholding glucose in any form until the situation is corrected C. Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally D. Regulating insulin dosage according to the amount of ketones found in the client's urine

abdomen

area w. fastest rt of absorption of insulin

inc

assess for hypervolemia when giving isotonic fluids. can cause __ BP, inc pulse strength, crackles, edema, JVD, SOB

surgery

before having ___ know that with diabetes you need to stop metformin and sulfonylureas, switch from a long to an intermediate acting insulin, gluc needs to be less than 200, post need IV gluc till they can eat, dont take short or rapid the morning of, also you are at risk for HHNS

crystalloids

contain sm mlcls that flow easily into cell

albumin

contraindicated w. severe anemia and heart fail and ace inhibit

4.3 - 6.0

norm A1C

70-140

norm gluc

cloudy

nph color

magnesium

1.8 to 2.6 muscle contract, regulate K, strong bones, mostly excreted in stool

sodium

135-145, 90% of ECF cation. RDA is 1500. regulated by kidney (ADH)

glucose tolerance test

A test of the body's ability to metabolize glucose that involves the administration of a measured dose of glucose to the fasting stomach and the determination of blood glucose levels in the blood or urine at intervals thereafter and that is used especially to detect diabetes.

Dawn phenomenon

A nocturnal release of growth hormone, which may cause blood glucose level elevations before breakfast in the client with diabetes mellitus. Treatment includes administering an evening dose of intermediate acting insulin at 10 pm.

C. Fresh fruit

A nurse is caring for a school-aged child with nephrotic syndrome who has massive edema. The nurse teaches the parents about the low-sodium diet that has been ordered. Which food group has the lowest level of sodium compared with the other food groups? A. Meat B. Dairy C. Fresh fruit D. Fresh vegetables

C. Increased respiratory rate

A nurse is caring for a toddler with severe dehydration and its associated acid-base imbalance. What compensatory mechanism within the body is activated to counteract the effects of the child's acid-base imbalance? A. Profuse diaphoresis B. Increased temperature C. Increased respiratory rate D. Renal retention of hydrogen ions

B. Insulin lispro

A nurse is caring for several clients with type 1 diabetes, and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action? A. NPH insulin B. Insulin lispro C. Regular insulin D. Insulin glargine

C. Prevents overdistension of the lungs

Which statement is true regarding the Hering-Breuer reflex? A. increases tidal volume B. Decreases respiratory rate C. Prevents overdistension of the lungs D. Reduces the number of functional alveoli

phosphorus

2.5 to 4.5 muscular contract, ATP, offloading o2 to tiss, bone mineralization absorbed in jejunum, eliminated in kidney dairy eggs, meat, nut, bean

C. Excessive emotional stress D. Running a fever with the flu

A nurse is collecting information about a client with type 1 diabetes who is being admitted because of diabetic ketoacidotic coma. Which factors can predispose a client to this condition? Select all that apply. A. taking too much insulin B. Getting too much exercise C. Excessive emotional stress D. Running a fever with the flu E. Eating fewer calories than prescribed

more

ETOH abusers are __ likely to become acidotic

C. Take vital signs and notify the primary healthcare provider.

A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action should the nurse take first? A. Alert the cardiac arrest team. B. Call the laboratory to repeat the test. C. Take vital signs and notify the primary healthcare provider. D. Obtain an electrocardiogram (ECG) strip and obtain an antiarrhythmic medication

calcium

9-11 bonedensity, muscle contract, card contract, clotting, need vit D to absorb, inc PTH = inc __ also inc calcitonin = inc __

ions

Na, Cl, Mg, Ca, bicarb (aka lytes)

rapid

Onset: 15 min, Peak: 1 hour, Duration: 3

A. Sodium and chloride levels

A client is experiencing persistent vomiting, and serum electrolytes have been prescribed. The nurse should monitor which laboratory results? A. Sodium and chloride levels B. Bicarbonate and sulfate levels C. Magnesium and protein levels D. Calcium and phosphate levels

intermediate

Onset: 2 hours, Peak: 8 hours, Duration: 16 hours

A. Urinary output E. Last serum potassium level F. Patency of the intravenous access

A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, it is a priority for the nurse to assess which of the following? Select all that apply. A. Urinary output B. Deep tendon reflexes C. Last bowel movement D. Arterial blood gas results E. Last serum potassium level F. Patency of the intravenous access

won't

3 yr old __ regularly use a phrase to describe hypoglycemia, all they can do is choose an injection site

C. Computed tomography

A client suspected of a renal disorder is scheduled for an imaging procedure. The nurse instructs the client to drink lots of fluids after the procedure and informs that a contrast dye will be administered before the procedure. Which imaging procedure is the client undergoing? A. Renal scan B. Electromyography C. Computed tomography D. Kidney ultrasonography

potassium

3.5 to 5 maintain cell ele, nerve impulse, muscular contract, mostly injested in diet and mostly excreted in urine. dec aldosterone = dec in __ acidosis is inc in __ while alkalosis is dec in __ potatos, tomatoes, banana, green leaf, legumes, meat, dried fruit

lithium

A client taking --- requires serum sodium level monitoring because both sodium and --- are monovalent positive ions, and one can affect the other

Short (regular)

Onset: 30 minutes, Peak: 2 hours, Duration: 8 hours

C. Hypotonia

A client who received intravenous magnesium sulfate for preeclampsia gives birth. What clinical finding in the newborn indicates to the nurse that magnesium sulfate toxicity may have occurred? A. Pallor B. Tremor C. Hypotonia D. Tachycardia

swell up

hypotonic fluid causes cell to ___ given when cell is dehydrated such as HHNS and DKA 1/2 NS, 1/3 NS, 1/4 NS dont give w/ icp

loss

hypovolemia is shown in client w. colostomy due to fluid __ thru gi

B. 0.9% sodium chloride

A client with a history of severe diarrhea for the past 3 days is admitted for dehydration. The nurse anticipates that which intravenous (IV) solution will be prescribed initially? A. 3% sodium chloride B. 0.9% sodium chloride C. 5% dextrose and 0.9% sodium chloride D. 5% dextrose and lactated Ringer solution

sick

if a child is __ they should drink more than the maintenance amnt of fluid

B. Green leafy vegetables C. Black or baked beans E. Oranges F. Salmon and sardines

A parent expresses concern that the adolescent child is not ingesting enough calcium because of an allergy to milk. What alternative foods or liquids should the nurse suggest? Select all that apply. A. Cottage cheese B. Green leafy vegetables C. Black or baked beans D. Yogurt E. Oranges F. Salmon and sardines

A. Nasogastric tube for decompression

A client with colitis has had a hemicolectomy. Three days after surgery the nurse identifies that the client has abdominal distention and absent bowel sounds, and has vomited 300 mL of dark green viscous fluid. The nurse contacts the primary healthcare provider and recommends which intervention? A. Nasogastric tube for decompression B. Antiemetic for nausea/vomiting C. Intravenous (IV) lactated Ringer for fluid replacement D. Stat electrolytes to assess for probable electrolyte imbalance

A. Binding with phosphorus in the intestine

A client with phosphate-based urinary calculi asks why aluminum hydroxide gel has been prescribed. The nurse explains that the medication decreases serum phosphorus by which action? A. Binding with phosphorus in the intestine B. Preventing absorption of phosphorus in the stomach C. Promoting excretion of excessive urinary phosphorus D. Dissolving stones as they pass through the urinary tract

C. Notify the primary healthcare provider

A pregnant woman at 29 weeks is found to have an increased volume of amniotic fluid and an increase in blood pressure. Which initial nursing action is appropriate? A. Document the findings B. Reassess the client after 2 hours C. Notify the primary healthcare provider D. Methylergonovine is administered immediately

glucagon

A protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin.

up

if serum osmol goes ____, then fluid goes into the cell, causing inc BP bcuz h2o swells up into the caps. ring wont fit on finger

vasodilation

in resp acid, inc co2 leads to __ which leads to neuro symp

Somogyi phenomenon

A rebound phenomenon that occurs in clients with type 1 diabetes mellitus. Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at about 2 to 3 am. Counterregulatory hormones, produced to prevent further hypoglycemia, result in hyperglycemia (evident in the prebreakfast blood glucose level). Treatment includes decreasing the evening (predinner or bedtime) dose of intermediate acting insulin or increasing the bedtime snack.

contractility

inc K messes w/

ECF

infants and young children have a higher ___ vol, and therefore have a higher risk for dehydration

Meglitinides

-glinide inc insulin secretion does cause hypoglycemia take only if eating

DPPIV inhibitors

-gliptin pancreatitis risk does not cause hypoglycemia

6-8

infants are supposed to have a wet diaper q 6-8 hrs

Thiazolidinediones

-glitazone does not cause hypoglycemia inc tiss sensitivity to insulin

dependence

insulin ___ in t1

insulin

key to unlock cell

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

1

norm output for a older child and adolescent is _mL/kg/hr

1.5

norm output for a toddler is _mL/kg/hr

1.020-1.028

norm urine spec gravity

A. apply o2 mask

pt has dehydration induced confusion, what is priority? A. apply o2 mask B. increase rate of IV flow C. meas I+O for last 24 hrs

electrical

ATP gives ener for active transport, using the Na K pump. inc K causes ___ potential @ cell

angiopathy

BV damage (retinopathy and nephropathy are sm) and (HTN and stroke are lg)

B. The infusion is flowing too rapidly. (Rapid infusion of concentrated glucose into the vascular system does not allow time for adequate insulin release to transport glucose to the cells)

Six hours after initiation of total parenteral nutrition, the client's serum glucose level increases to 240 mg/dL (13.3 mmol/L). What does the nurse conclude is the most likely cause of the increase? A. the solution is too concentrated. B. The infusion is flowing too rapidly. C. The solution is exacerbating preexisting diabetes. D. The infusion is too slow to meet total nutritional needs

chvostek sign

Spasm of facial muscles after a tap over the facial nerve; evidence of tetany and hypocalcemia

Alk

pt has sm bowel obs and they are ng suck. this may lead to meta ____

tubular reabsorption

vasopressin aka adh inc __ ___ of h2o decreasing urination

A. Oliguria is an indication for withholding intravenous (IV) potassium.

A client is admitted to the hospital with a diagnosis of dehydration and hypokalemia. What is important for the nurse to consider when administering potassium chloride intravenously to this client? A. Oliguria is an indication for withholding intravenous (IV) potassium. B. Rapid infusion of potassium prevents burning at the IV site. C. Clients with severe deficits should be given IV push potassium. D. Average IV dosage of potassium should not exceed 60 mEq in 1 hour.

B. Rapid, thready pulse D. Elevated specific gravity

A client is admitted with dehydration. Which findings should the nurse expect the client to exhibit? Select all that apply. A. Supple skin turgor B. Rapid, thready pulse C. Decreased hematocrit D. Elevated specific gravity E. Adventitious breath sounds

A. Crackles in the lungs

A client who experienced extensive burns is receiving intravenous fluids to replace fluid loss. The nurse should monitor for which initial sign of fluid overload? A. Crackles in the lungs B. Decreased heart rate C. Decreased blood pressure D. Cyanosis

B. feet elevated with head at 20 degrees

A client with dehydration suddenly becomes diaphoretic, clammy, and pale. The client's blood pressure falls to 50/30 mm Hg. In which position will the nurse place the client? A. high fowlers B. feet elevated with head at 20 degree angle C. supine

C. Triple-lumen; for esophageal compression

A client with esophageal varices has severe hematemesis, and a Sengstaken-Blakemore tube is inserted. What design and purpose does the tube have? A. Single-lumen; for gastric lavage B. Double-lumen; for intestinal decompression C. Triple-lumen; for esophageal compression D. Multilumen; for gastric and intestinal decompression

B. Demonstrating how to test capillary glucose levels (Blood glucose should be monitored because total parenteral nutrition [TPN] may cause hyperglycemia.)

A client with postradiation enteritis is to continue receiving total parenteral nutrition (TPN) at home after discharge. What information should the nurse include in the client's teaching plan? A. Showing how to mix the nutritional solutions B. Demonstrating how to test capillary glucose levels C. Identifying the types of infusion pumps that can be used D. Checking for catheter placement by palpating the insertion site

A. A 65-year-old with pulmonary fibrosis

A client's arterial blood gas report indicates that they have respiratory acidosis, Which client should the nurse consider is most likely to exhibit these blood gas results? A. A 65-year-old with pulmonary fibrosis B. A 24-year-old with uncontrolled type 1 diabetes C. A 45-year-old who has been vomiting for 3 days D. A 54-year-old who takes sodium bicarbonate for indigestion

A. Calcitonin E. Parathyroid hormone

A client's laboratory report shows altered serum calcium concentration. Which hormones are responsible for this condition? Select all that apply. A. Calcitonin B. Thyroxine C. Glucocorticoids D. Growth hormone E. Parathyroid hormone

A. "I should avoid using salt substitutes."

A diet that contains restricted amounts of protein, sodium, and potassium has been prescribed for a client with end-stage renal disease who is receiving dialysis. The nurse is providing dietary instructions. Which statement by the client indicates that the teaching is effective? A. "I should avoid using salt substitutes." B. "I should exclude meat from my diet." C. "I may not add seasoning to my food." D. "I may eat low-sodium canned vegetables."

D. Potentiates the action of the digoxin preparation

A healthcare provider prescribes 10 mL of a 10% solution of calcium gluconate for a client with a severely depressed serum calcium level. The client also is receiving digoxin 0.25 mg daily and an intravenous (IV) solution of D 5W. What feature of calcium gluconate does the nurse consider? A. Can be added to any IV solution B. Must be administered via an intravenous piggyback C. Is nonirritating to surrounding tissues D. Potentiates the action of the digoxin preparation

D. Deep respirations and fruity odor to the breath

A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? A. Nervousness and tachycardia B. Erythema toxicum rash and pruritus C. Diaphoresis and altered mental state D. Deep respirations and fruity odor to the breath

B. Administering glucagon C. Administering IV glucose D. Administering oral hydrocortisone

A nurse is caring for a client with hypoglycemia. Which nursing intervention would be appropriate in managing the client's condition? Select all that apply A. Administering insulin B. Administering glucagon C. Administering IV glucose D. Administering oral hydrocortisone E. Administering somatostatin

b. Weight loss

A nurse is conducting an assessment of a young infant who is dehydrated. Which clinical sign is the most important indication of the degree of dehydration? A. Dry skin B. Weight loss C. Sunken fontanel D. Decreased urine output

B. Hypoglycemia

A small-for-gestational-age (SGA) newborn who has just been admitted to the nursery has a high-pitched cry, appears jittery, and exhibits irregular respirations. What complication does the nurse suspect? A. Hypovolemia B. Hypoglycemia C. Hypercalcemia D. Hypothyroidism

7

A1C should be less than _ in children with adequate control of diabetes

A. Administer the prescribed antiemetic drug

After cataract surgery, a client reports feeling nauseated. How can the nurse help relieve the nausea? A. Administer the prescribed antiemetic drug. B. Provide some dry crackers for the client to eat. C. Explain that this is expected following surgery. D. Teach how to breathe deeply until the nausea subsides.

A. Breathe into cupped hands.

An 18-year-old high school student arrives at the local blood drive center to donate blood for the first time. As the site is being prepared for needle insertion, the student becomes agitated, starts to hyperventilate, and complains of dizziness and tingling of the hands. What should the nurse instruct the student to do? A. Breathe into cupped hands. B. Pant using rapid, shallow breaths. C. Use a rapid deep-breathing pattern. D. Hold the breath for as long as possible.

alk compensation

K goes into the cell and H ions leave causing dec K low ph to be fixed

acid compensation

K leaves the cell and brings H ions into the the cell causing inc K and high pH to be fixed

Cl

Na and __ are found mostly in the ECF

Amylin Analog

Pramlintide slows gastric emptying to dec post prandial gluc does cause hypoglycemia

A. Tremors C. Confusion E. Diaphoresis

Several hours after administering insulin, the nurse is assessing a client for an adverse response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply. A. Tremors B. Anorexia C. Confusion D. Glycosuria E. Diaphoresis

SICK

Sugar can rise even if you arent eating, check it often Insulin should not be stopped Carb intake and fluids should be maintained Ketones should be checked q 2-4 hrs and give rapid acting insulin and fluids if present

D. The client has hyperparathyroidism.

The 1-day urine sample results of a client reveal that the calcium level is 800 mg/24 hr. What does the finding indicate? A. The client has nephritis. B. The client has nephrosis. C. The client has hypocalcemia. D. The client has hyperparathyroidism.

D. Blood glucose level of 36 mg/dL (3.8 mmol/L)

Which finding in a newborn whose temperature over the last 4 hours has fluctuated between 98.0° F (36.7° C) and 97.4° F (36.3° C) would be considered critical? A. Respiratory rate of 60 breaths/min B. White blood count greater than 15,000 mm 3 C. Serum calcium level of 8 mg/dL (2 mmol/L) D. Blood glucose level of 36 mg/dL (3.8 mmol/L)

D. Wear synthetic fiber socks when exercising (Research demonstrates that socks with synthetic fibers wick away moisture better than other fabrics when participating in vigorous activities. Self-removal of corns can result in injury to the feet. Shoes that do not fit appropriately will create friction causing sores, blisters, and calluses. The feet should be examined daily, not weekly.)

Which is the best advice the nurse can give regarding foot care to a client diagnosed with diabetes? A. Remove corns on the feet B. Wear shoes that are larger than the feet C. Examine the feet weekly for potential sores D. Wear synthetic fiber socks when exercising

A.Ensuring client safety

Which nursing intervention should the nurse consider to be a priority for clients with fluid overload? A.Ensuring client safety B. Providing drug therapy C. Providing nutritional therapy D. Preventing future fluid overload

K

ace inhibitors and sartans inc __ (abbr) foods that are rich in this include cantaloupes, bananas, and spinach

vasopressin

aka adh causes inc h2o reaborption

plasma proteins

albumin, globulins, fibrinogen, prothrombin

2/3

amnt of fluid in the ECF (3/4 of this is in the interstitial and 1/4 in the plasma)

1/3

amnt of fluid in the ICF

regular

can be kept outside of the fridge

T1

can cause weight loss because there isnt insulin to process the food they eat can also cause dehydration, sm and lg vessel damage

insulin, sulfonylureas, metformin

can give these 3 in gestational diabetes

proinflammatory state

cancer risk, inc cellular growth, factor, steatohepatitis

brain

cannot store glucose

respiratory alkalosis

causes: hyperventilation (pain anxiety, fever), blowing off co2 s+s: headache, restlessness, dysrthymia, high altitude, loss of co2, over exciteability of NS

d5w

considered isotonic in the bag but turns hypo after entering the body

dehydration

fever, burns, drains, vomiting, diarhea, sweating, tachypnea, polyuria, DKA, DI all lead to __

acid

generally ____osis causes dec cardiac stuff

fasting

greater than 100 gluc when __ is high

cushings

high cortisol, (inc gluc) aldosterone does not play a role due to meds (prednisone), stress, moon face, buffalo hump, brusing, obesity, HTN, hyperglycemia, hypokalemia tx removal of pituitary or adrenal gland, monitor high gluc, and potassium

tonicity

how easy it is to cross a cell membrane

neuropathy

hyperglycemia is toxic to nerves, make sure to wear shoes, podiatry should cut nails, use fishing line to check sensation, can lead to erectile dysfuction

gain

hyperinsulinemia causes weight __

speed up

hyperkalemia, hypernatremia, hypomagnesia, hypocalcemia, and hyperphosphatemia cause a __ __ response, which includes tetany and HTN

70

hypoglycemia number

cerebral

if fluids run to fast you can cause __ edema, chnging neuro funct

Hypomagnesemia

less than 1.8 caused by inadequate intake, dec aborption (gastric bypass or cholostomy), loop and thiazide diuretic, ETOH use, dec Ca or dec K S+S: dysrythmia, pvcs, afib, vfib, inc DTR, tingling and numb, tetany, seizure, chovstek and trousseau, illieus and constipation tx: oral Mg, IV (slow, dont push), assess DTR, EKG, dyphagia (dec sm muscle coordination), assess Ca and K, d/c diuretic

hyponatremia

less than 136 caused by Na deficit: dec adh, diuretics, sweating, NPO, renal disease, hyperglycemia, meds (antipsychotics) caused by h2o gain: heart failure, SIADH, inc ADH S+S: weakness, cramping, N/V, dec pulse, dec BP (hypovolemia), cerebral edema tx: I+O, wt, edema, spec grav, neuro, pulse strength, Na and K levs. prevent fluid overload, DO IT SLOWLY (to keep from damaging cells in brain)

Hypophosphatemia

less than 2.5 caused by: resp alk, inc insulin, dec absorption, phosphate binding antacids, vit d deficit, inc excretion, DKA, ETOH use, hyperparathyroid, diarrhea S+S: weakness, double vision, anorexia, rhabdo, conf and memory loss, bone pain and dec density, dec BP and contractility, dec o2 (anemia), WBC dec (inf risk), bleeding risk (dec plt) tx: oral supplement, IV (slow, 10meq/hr), fall risk, LOC, temp, bleeding signs, thiazide diuretic d/c, ETOH d/c, manage diabetes

hypotonic soln

less than 280. ex .5NS, dextrose 2.5 in water, given to hydrate. dont give for burns or liver disease or icp

hypokalemia

less than 3.5 caused by renal loss: k wasting diuretics, corticoid excess, and dec Mg caused by GI loss: diarrhea, vomiting, NG suck, laxatives, Alk S+S: spec grav, diet, diuretic use, shallow breath, weakness, hypo reflexia, brady and dysrhythmia, weak pulses, prominent U wave, flat T wave. slowed peristalsis, abd distention tx: promote gas exchng, prevent falls, chng diuretics, IV K, (dont give unless they have established urine output and max is 10meq/hr, largebore), monitor EKG and asses q 2 hrs

hypocalemia

less than 9 caused by actual deficit: poor intake, dec abosorption, vit D defict, renal probs, diarrhea caused by relative deficit: hyperproteinemia, citrate, parathyroid dysfunct S+S: laryngospasm, parasthesia, twitching, tingling, troussea and chovstek, tetany, weak pulses long QT and ST, inc peristalsis (cramps, inc abd sounds), risk for fracture tx: oral supplement (Ca and vit D), large bore IV (200mg/min), EKG, airway assess, reduce stimulation, prevent fracture, assess for breaks,

chemoreceptors

located in aortic and carotids and brain to use resp buffering to balance out co2 and H ions

addisons

low cortisol, (low gluc) and high aldosterone due to cancer, TB, or trauma, low Na, hypoglycemia, hyperkalemia, hypercalcemia, hypotension, increased pigmentation monitor hypoglycemia, and hyperkalemia, report stress, illness, and exercise, (inc steroid levels), eat diet high in protein, carbs and get norm Na, adrenal gland crisis

basal

low level on insulin that is made during fasting

80-110

mantain gluc level at __ to __ for a mother in labor

2400mL

max amnt of fluid a child should get ea day. norm amnt of fluid an adult should get ea day.

osmolarity

measure of total volume concentration of solute particles

baking soda

meta alk causes include __ __ consumption, acute pancreatitis, NG suck, untreated bulemia, eating too many tums

ICF

mg, K, are HPO4 are mostly found in the ___

twice

mom w. gestational diabetes puts her kid at __ the risk of T1 diabetes

hypercalcemia

more than 11 caused by actual excess: inc intake, renal fail, thiazide diuretic caused by relative excess: hyperparathyroid, malignancy, hyperthyroid, glucocorticoids S+S: tachycard (slows down l8r), poor perfusion, inc clotting, lethargy conf, weakness, inc output, kidney stones tx: EKG, fall risk, neuro assess, stop Ca fluids including LR and TPN, stop vit D, give fluid to inc urination, give loop diuretic, chelating agent (plicamyin), promote bone reabsorption and prevent DVT by moving

Hypernatremia

more than 145 caused by Na excess: inc ADH, cushings, inc intake caused by fluid deficit: dehydration, fever, hypotonic diarrhea, sweating, DI S+S: rapid membrane depolarization, twitching, weakness (l8r on), dec contractility, thirst, dec output, pulm edema, facial flushing tx: hydrate (hypotonic), lasix, bumex, dec Na intake, I+O, vasopressin/ desmopressin (DI)

Hypermagnesemia

more than 2.6 caused by: renal failure, inc intake, IV mg containing fluids (preeclampsia) S+S: long PR and wide QRS, peripheral vasodilation, resp depression, coma, dec DTR tx: fluids IV , diuretic, dialysis (bad kidneys), IV calcium glucinate, assess DTR and LOC, d/c all Mg, dec antacids

Hyperphosphatemia

more than 4.5 caused by impaired GFR, hypoparathyroid, acidosis, cell lysis, renal fail, inc intake (phos containing laxatives and enema), excess vit D S+S: tetany, parasthesia, twitching, chvostek and treaussou, , calcified iss (in heart valve or vasculature, kidneys, skin, eyes), tachycard, dysrhythmia, conduct probs, N/V and anorexia tx: dec absorption, phos binding agent, give IV fluid to inc excretion, antacids w/ meals ,avoid phos laxatives

hyperkalemia

more than 5.5 caused by inc intake (salt substitutes), adrenal insufficiency, renal failure, k sparing diuretics, hemolysis (chemo), ace inhibitors, uncontrolled diabetes S+S: bradycard, hypotension, tall T waves, long QRS, heart block, dec DTR, dec contract, oliguria, diarrhea tx: EKG, prevent fall risk, K wasting diuretic, kayexalate (diarrheal removal), insulin and gluc (hide in the cell), dialysis, beta adrenergic to activate K pump

2

norm output for a neonate to 1 yr is _mL/kg/hr

42-52 (men) 37-48 (women)

normal hct

colloids

packed RBCs, 5%albumin, pooled plasma. they expand plasma vol. anaphylaxis is rare but lethal, rxn is fever

clavicle

test for tenting in old people on the___. not on the back of the hand

Glucose challenge test

test to identify gestational diabetes in pregnant women

prandial

the glucose made w/in ten minutes of eating

Osmolality

the weight concentration of solutes in body fluids

hypervolemia

too much fluid balance

Tx of metabolic alkalosis

treat •Volume depletion: isotonic saline to increase urinary bicarbonate excretion and correct extracellular volume loss •Bicarbonate excess: diuretics •Electrolyte disturbances: correct potassium disorders

Tx of metabolic acidosis

treat Acute severe (pH < 7.1) intravenous sodium bicarbonate •Chronic: oral sodium bicarbonate along with treatment of the underlying cause (e.g., diarrhea, renal tubular acidosis) •Electrolyte disturbances: correct (e.g., hyperkalemia) If diabetic ketoacidosis, salicylate toxicity is the cause then they are treated

kussmaul

type of breathing assoc w/ meta acid from DKA

B. pt on NPO status getting D5W IV

which pt is at risk for hyponatremia? A. pt taking NSAIDs for pain B. pt on NPO status getting D5W IV C. pt with infection getting a sulfonamide antibiotic

mg

woman with preeclampsia is getting ___so4. need to assess for arrythmia

congenital adrenal hyperplasia

genetic disease in which the adrenal gland is overdeveloped, resulting in a deficiency of certain hormones and an overproduction of others

twitching

hypernatremia, hyperkalemia, hypomagnesia and hypocalemia all cause muscle ____

shrink

hypertonic makes the cell ___ indicated for cerebral edema 3% NS, 5% NS, 10% dextrose can cause overload fluid leading pulm edema

HTN

hypervolemia is shown in client w/ heart fail and chronic ___

resistance

insulin ____ in t2

pH

number of hydrogen ions in body, dec in H ions inc __ and inc in H ions dec __

intake

older people have a dec ___ of h2o and also take diuretics. putting them at higher risk of dehydration

good

pt has fast gluc of 70-80, post prandial less than 200, and a A1C of 5.5%. they have __ gluc control

into

pt has inc fluid in third space, dec Na, edema, and ascites. we tx this by moving h2o __ the vessel and can do this by giving hypertonic.

breath slowly

pt has metabolic alk, tx by encouraging them to __ __ to inc the co2

paper bag

pt has paO2 of 110, they have resp alk. tx w/ __ __

low

pt has thready weak pulse, ortho hypotension, dysrhythmia, shallow resp, muscle weakness, dec DTR, paresthesia, inc output, dec GI motility, flat T wave they have __ potassium

sodium bicarb

pt w. severe metabolic acid is tx w. __ ___ IV if not contraindicated

high

pt w/ dehydration is expected to have high Na, __ hct, high urine spec grav, (not low serum osmo)

slow

pt w/ hyperkalemia has ___, weak heart rate, dec BP, dysrhythmia, muscle twitching early on and then weakness later, inc GI motility, diarrhea, tall T waves

clear

rapid, and short color

aldosterone

regulates K and Na levels

pituitary gland

releases ACTH

Salicylates (Aspirin)

resp alk can be caused by fever, anxiety, and laryngeal obs. but not by __ toxicity

hypovolemic shock

shock resulting from blood or fluid loss

contraindicated

sodium bicarb is ____ w. renal fail.

neuro

sodium is the lyte that causes the most __ issues

glycogen

storage form of glucose in the liver

cotisol

stress hormone, inc gluc, regulates lytes

calcium and phosphate

thiazide diuretics spare what two lytes

Acanthosis nigricans

thickening and darkening of skin near axillary region, Diabetes Type II

prediabetes

this condition is characterized by a fasting gluc of 100-125, and a A1C of 5.5-6.0

dka

this is rare in T2 diabetes due to insulin being in the body still

chemical buffering

this type of buffering acts immediately

renal buffering

this type of buffering can take days but is more effective (retention of excretion)

respiratory buffering

this type of buffering can take sec to min

loop

this type of diuretic spares only phosphate

spec gravity

this will go up if you are dehydrated

exer

to treat gestational diabetes have mom work on diet and __, use insulin, and glyburide or metformin

D. Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring."

A 24-year-old client who has had type 1 diabetes for 6 years is concerned about how her pregnancy will affect both diet and insulin needs. How should the nurse respond? A. "Insulin needs will decrease; the excess glucose will be used for fetal growth." B. "Diet and insulin needs won't change, and maternal and fetal needs will be met." C. "Protein needs will increase, and adjustments to insulin dosage will be necessary." D. Insulin dosage and dietary needs will be adjusted in accordance with the results of blood glucose monitoring."

metformin

AKA biguanide cant give until 10 yr or older, helps the cell to utilize insulin better there is a risk of lactic acidosis, may cause fatigue, muscle aches, it is hard on the kidneys (check GFR and dont give if less than 30) safe to use in pregnancy

pressure

dec ___ in the BVs causes dec drop off and inc pick up which will not result in edema .

hct

dec fluid vol leads to dec __.

ICP

dont give a pt w/ a hypotonic soln

long

Onset: 2 hours, Peak: NONE, Duration: 24 hours

incretin

Stimulates insulin release Inhibits glucagon release Slows gastric emptying to reduce postprandial hyperglycemia

A. Metabolic alkalosis

The laboratory data for a client with prolonged vomiting reveal A. Metabolic alkalosis B. Respiratory acidosis

D. Parathyroid hormone (PTH)

The laboratory reports reveal that a client has a serum calcium level of 7.9 mg/dL (.43 mmol/L). Which hormone would be elevated in the client? A. Estrogen B. Thyroxine C. Growth hormone D. Parathyroid hormone (PTH)

hypertonic dehydration

Water loss exceeds electrolyte loss caused by excessive perspiration, hyperventilation, ketoacidosis, prolonged fever, diarrhea, early stage renal failure, and diabetes insipidus, inadequate fluid intake, insufficient ADH. cells shrink Replacement of water using hypotonic solutions 0.45% sodium chloride, 0.225% sodium chloride, and 0.33% sodium chloride S+S are thirst, dizziness, inc temp, inc HR, dec BP

ETOH

eat food w/ this cause it can cause hypoglycemia

A. "I need to stop taking my insulin when I am ill because I am not eating."

The nurse is assessing the client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? A. I need to stop taking my insulin when I am ill because I am not eating." B. "I will check my urine for ketones when my blood sugar is over 250." C. I will try and take in Gatorade and water when I am sick." D I will continue all my insulin including my glargine when I am sick."

A. Wear shoes when out of bed. C. Dry between the toes after bathing.

The nurse is providing instructions about foot care for a client with diabetes mellitus. What should the nurse include in the instructions? Select all that apply. A. Wear shoes when out of bed. B. Soak the feet in warm water daily. C. Dry between the toes after bathing. D. Remove corns as soon as they appear. E. Use a heating pad when the feet feel cold.

Microalbumin

Tiny bits of protein that appear in the urine in diabetes

infant

age where hypoglycemia is a higher risk

isotonic soln

btwn 280 and 300. ex NS, LR, D5w

failure

liver__ leads to dec albumin and inc ascites

o2

chng in ph always chngs __ delivery to the brain always causing chng in LOC and blurred vision, dizzy, etc

gestational

type of diabetes in which a woman cant tolerate carbs, 1st seen in pregnancy. use gluc challenge test to dx, risk if BMI above 25 puts you at risk for DKA, preeclampsia, UTI, fetal diuresis (inc amniotic fluid), premature rupt of membranes

glucose

vit d deficit, parenteral nutrition, and meds can put a person at risk for ___ dysregulation

edema

when you have HTN, drop off is inc and pick up is dec. this causes __

osmosis

with dextrose, the --- is chnged after entering the body. the bag toncity is diff compared to tonicity in body

mix

you should not __ Lantus (glargine) and it needs to go in the fridge

Acetazolamide

Which drug does a nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma? A. Chlorothiazide B. Acetazolamide C. Methazolamide D. Aclidinium bromide

C. Misoprostol

Which drug may be used both for cervical ripening during labor and as a stomach protectant? A. Raloxifene B. Clomiphene C. Misoprostol D. Dinoprostone

insensible

_ loss cant be meas (respiration)

older adult

age where hyperglycemia is a higher risk

exciteablility

dec __ in dec ph. Inc __ in inc ph

hypovoleima

low fluid balance

Tx of respiratory alkalosis

• treat underlying cause; in the event of hyperventilation syndrome, patients benefit from reassurance and rebreathing into a paper bag.

kidneys

__ can only excrete K or Na one at a time

alkalosis

caused by HGB, phos, bicarb, panc fluids. manifestations are tiss oxygenation alteration, impaired neuro and musclular funct, tingling twitching and nervousness

diabetes insipidus

caused by dec in ADH of lack of renal respnse to ADH. S+S are polyuria and polydipsia

acidosis

caused by lactic acid, hydrochloric acid, and keto acid. manifestations are altered conractility, dec vascular respnse to catecholamines, dec response to some meds, LOC

hypoglycemia

causes excitation in NS, sweating, irratibility, tremors, anxiety, and hunger also inc cortisol production

respiratory acidosis

causes: emphysema, bronchitis, pneumonia, pulm edema, drug OD (anesthesia and opioids) s+s: headache, restless, conf, dyspnea, resp distress, shallow breath, tachy, dysrhythmia, depression of NS

metabolic alkalosis

causes: vomiting, gi suck, antacids, excessive aldosterone S+S: overexciteability of NS

hypotonic

cells gain fluid

hypertonic

cells lose fluid

5

check gluc at least _ times a day with T2

ASA, DKA

child ate too much ___ causing metabolic acidosis, the 2ndary prob that this can cause is resp alk. ___ is another condition that can cause metabolic acidosis.

Desmopressin (DDAVP)

child w/ DI gets ___

100

child weighing 10kg of less need __mL/kg of h2o

50

child weighing btwn 11-20 kg need 1000 mL + __mL/kg for q kg over 10

20

child weighing over 20 kg need 1500 mL + __mL/kg for q kg over 20 (max 2400)

excitation

dec Ca and Mg causes this ___ while inc Na and K cause the same thing

excretion

dec urine __ lowers osmo

isotonic loss

dehydration due to N/V or bleeding. S+S are wt loss, dry skin and eyes, tenting turgor. tx w/ NS or LR

low

dehydration due to sweating too much causes high HR and __ BP and is tx/ iso soln

metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

blood

dehydration, getting or giving __, narcos and diuretics can mess w/ ph

45

diet in moms w. gestational diabetes carbs: __ to 65% protein: 15 to 20% fat: 20 to 30% fiber fake sugar can still have insulin resistance

Alphaglucosidase inhibitors

does not cause hypoglycemia delays carb absorption acarbose

liver

dont give hypotonic soln w/ burns or __ disease or icp

D. Assessing the IV site for infiltration

Corrective surgery for hypertrophic pyloric stenosis is completed, and the infant is returned to the pediatric unit with an intravenous (IV) infusion in progress. What is the priority nursing action? A. Applying adequate restraints B. Administering a mild sedative C. Removing the nasogastric tube D. Assessing the IV site for infiltration

third spacing

fluid collecting where it should not be. (pleura, pericardia, peritoneal) causes are surgery or dec albumin

alk

generally ____osis causes inc NS stuff (twitch)

slow down

hypokalemia, hyponatremia, hypermagnesia, hypercalcemia, and hypophosphatemia cause a __ __ response, meaning no tetany or HTN

prevents hypoglycemia

Hydrocortisone is a glucocorticoid that -- -- by increasing liver gluconeogenesis and inhibiting peripheral glucose use

NaCl

is the only fluid that can be given w/ blood product

extracellular

isotonics given to inc __ fluid volume, to replace

D. Inhales with the lips tightly sealed around the mouthpiece of the nebulizer

The nurse provides instructions about how to use a nebulizer to a client with chronic obstructive pulmonary disease. The nurse concludes that additional teaching is needed when the client demonstrates which technique? A. Places the tip of the mouthpiece an inch (2.5 centimeters) past the lips B. Holds the inspired breath for at least 3 seconds C. Exhales slowly through the mouth with lips pursed slightly D. Inhales with the lips tightly sealed around the mouthpiece of the nebulizer

B. 70 to 105 mg/dL (3.9 to 5.8 mmol/L) of blood

The primary healthcare provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. What is the goal of treatment with glucose levels for this client? A. 40 to 65 mg/dL (2.2 to 3.6 mmol/L) of blood B. 70 to 105 mg/dL (3.9 to 5.8 mmol/L) of blood C. 110 to 145 mg/dL (6.1 to 8.0 mmol/L) of blood D. 150 to 175 mg/dL (8.3 to 9.7 mmol/L) of blood

D. Identifies the potential for respiratory depression

While a client is being given intravenous magnesium sulfate therapy for preeclampsia, it is essential for the nurse to monitor the client's deep tendon reflexes. What reason does the nurse give to the client to explain why this is done? A. Reveals her level of consciousness B. Reveals the mobility of the extremities C. Reveals the response to painful stimuli D. Identifies the potential for respiratory depression

C. Prepare for insertion of a nasogastric tube.

Two weeks after sustaining a spinal cord injury, a client begins vomiting thick coffee-ground material and appears restless and apprehensive. What is the most important initial nursing action? A. change the client's diet to bland. B. Obtain a stool specimen for occult blood. C. Prepare for insertion of a nasogastric tube. D. Monitor recent laboratory reports for hemoglobin levels.

D. Cortisol

While reviewing the laboratory reports of a client, the nurse finds that the client has low sodium levels. Which hormonal imbalance should the nurse suspect in the client? A. Epinephrine B. Glucagon C. Calcitonin D. Cortisol

D. Large for gestational age, near term (newborns of diabetic mothers may be large for gestational age because hyperglycemia in the mother precipitates hyperinsulinism in the fetus, resulting in excess deposits of fetal fat; these infants are usually born at or before term and are large, not average or small, for gestational age. Diabetic mothers with advanced vascular and renal disease may give birth to infants who are small for gestational age. Because of the risk for fetal death, women with diabetes should give birth before the 40th week of gestation, either by way of induction of labor or, if necessary, by cesarean birth.)

What does the nurse expect the size of a newborn to be if the mother had inadequately controlled type 1 diabetes during her pregnancy? A. Average for gestational age, term B. Small for gestational age, preterm C. Large for gestational age, postterm D. Large for gestational age, near term

B. Applying arm boards to prevent bending at the elbows

What is the priority nursing action when a 3-month-old infant is receiving intravenous (IV) fluids by way of an antecubital vein? A. Monitoring for infiltration behind the infant's elbow B. Applying arm boards to prevent bending at the elbows C. Checking both of the infant's pupils for dilation every hour D. Telling the parents why they cannot hold the infant during IV therapy

type 2

__ _ diabetes risk factors include greater than 45 yrs old, low hdl , ethnicity, fam hx, ovarian disease, you might see fatigue, yeast infections, inc urine and drinking, and acanthosis nigricans

alpha

__ cells in panc make glucagon

mentally

__ impaired are at higher risk for dehydration due to less intake. tx w/ iso soln

intensive

__ insulin - based on carbs eaten

sm

__ vessel damage affects organs, eyes, kidneys, neuropathy

lg

__ vessel damage causes PVD, CAD, and HTN

short acting

__-___ insulin is better for old people

consistent

___ carb - diet for fixed insulin regimen

beta

___ cells in panc make insulin

renal

___ fail causes acidosis, cuz you cant hold onto bicarb also causes inc in lytes

potassium

___ level can either low from excretion or high from acidosis when there is low insulin

dec mg

a ___ in K causes a dec in ___

fat

absence of insulin causes body to break down __ and protein causing ketones to be released leading to metabolic acidosis