Pathophysiology chapter 7
A patient with congestive heart failure is given a diuretic to reduce excess fluid volume. The patient has lost 2 pounds. How many liters of fluid have been lost? Insert numeral only.
1
A nurse learns that her patient has central diabetes insipidus and does not produce antidiuretic hormone (ADH). As the nurse scans the laboratory report, which values are expected given the patient's condition? Elevated plasma osmolarity, low urine osmolarity Elevated plasma osmolarity, elevated urine osmolarity Low plasma osmolarity, low urine osmolarity Low plasma osmolarity, elevated urine osmolarity
a
A nursing student is reviewing her note cards for the RAAS. She has renin, angiotensinogen, angiotensin I, and angiotensin II. Which factor should come next? Aldosterone Antidiuretic hormone (ADH) Angiotensin converting enzyme Atrial natriuretic peptide (ANP)
a
A registered nurse is teaching a student nurse how to analyze the electrocardiogram of a hyperkalemic client. Assess the statements made by the student nurse and choose the clinical manifestation that can be observed on the electrocardiogram of a hyperkalemic client. "It will show wide QRS complexes." "It will show a prominent U wave." "It will show a flattened T wave." "It will show a prolonged PR interval."
a
Louise recently had thyroid surgery for a tumor at the acute care clinic where you work as a nurse. She comes into the office today complaining of tingling around her mouth and fingers and small muscle spasms. She is surprised when you ask if you can tap along her cheekbone. When you do this, you note a slight twitch in her facial muscles. Louise wonders if any of this could be related to her surgery. What tissues do you suspect may have been damaged during Louise's surgery? Parathyroid glands Muscles of the jaw Muscles of the eyes Nerves affecting the lips
a
Which of the following responses would you expect to see when fluid volume is too low? Select all that apply. a. Increased renin release b. Increased aldosterone c. Osmoreceptor swelling d. Increased BNP e. Decreased antidiuretic hormone levels
a, b
A laboratory report shows abnormal serum calcium levels. Which of the following tissues will the nurse need to evaluate, as these tissues are affected by abnormal calcium levels? Parathyroid gland Nervous system Skeletal muscles Lungs Cartilage
a, b, c
Had John also had hyponatremia, which of the following signs and symptoms may have been present? Select all that apply. Serum sodium less than 135 mEq/L Confusion Headache Decreased salivation Thirst Check Answer
a, b, c
Which of the following patient presentations may increase the risk for edema? Select all that apply. A patient suffering from protein malnutrition A patient suffering from liver failure A patient suffering from heart failure A patient suffering from dehydration A patient with hyperalbuminemia
a, b, c
Nursing students are learning about the renin-angiotensin-aldosterone system. They are amazed at is complexity, comment on the number of organs involved, and decide to make a list of these organs. Which of the following organs make their list? Liver Kidney Spleen Lungs Pituitary
a, b, d
A patient is given a medication that blocks the effects of angiotensin II. Which of the following may result from the medication? Decreased blood pressure (BP) Increased vessel dilation Increased aldosterone levels Increased vasoconstriction Decreased fluid retention
a, b, e
Your client's lab results show that the client's serum calcium level is very low . What signs and symptoms would the client exhibit? Select all that apply. Chvostek's sign Muscle flaccidity Trousseau's sign Paresthesias around mouth and hands Constipation
a, c, d
Which signs and symptoms that are associated with this electrolyte imbalance? Select all that apply. Leg cramps Dyspnea Prolonged PR interval Flattened T waves Postural hypotension
a, c, d, e
Which of the following are incorrectly matched? Select all that apply. Hypovolemic hypernatremia - edema Hypervolemic hyponatremia - diluted sodium concentration Acidosis - false hyperkalemia Hypokalemia - prolonged PR intervals Hypocalcemia - hypophosphatemia
a, d, e
An isotonic IV solution ______________________. Select all that apply. a. causes no fluid gain or loss by cells. b. is used to counteract cellular swelling. c. has a higher tonicity than the blood. d. causes cell swelling. e. has the same tonicity as the blood.
a, e
A hormone panel was done on a patient with congestive heart failure and fluid volume overload. Which elevated hormone on the patient's chart is indicative of the body's attempt to reduce the fluid overload? Antidiuretic hormone (ADH) Brain natriuretic peptide (BNP) Aldosterone Renin
b
A nurse is providing nutritional advice to a client with hypomagnesemia. Which of the following are risk factors for hypomagnesemia? Select all that apply. Kidney failure Alcoholism Athletic endurance events Obesity Antacid abuse
b
A nursing student want to remember which vital signs may indicate fluid volume depletion. Which of the following would be best to remember? Increased heart rate and decreased respirations Increased heart rate and decreased blood pressure Increased blood pressure and increased respirations Increased respirations and decreased heart rate
b
A patient is prescribed a diuretic and is directed to consume more bananas and orange juice. Which electrolyte condition are the dietary recommendations designed to help manage? Hypocalcemia Hypokalemia Hyponatremia Hypermagnesemia
b
A patient presents with a plasma potassium level of 7.2 mEq/L. Which of the following is the appropriate management strategy? Slow, steady infusion of potassium Rapid infusion of dextrose and insulin Nothing. The potassium level is within the normal range. IV solution with mannitol
b
An athlete competed in a long duration endurance event lasting more than 8 hours. Results from laboratory values obtained in the Emergency Department show that he lost a significant amount of fluid and electrolytes. What phrase may be most applicable to his current status? Hypervolemic hyperkalemia Hypovolemic hyponatremia Hypervolemic hypernatremia Hypovolemic hypernatremia
b
What condition is often associated with hypercalcemia? Hypernatremia Hypophosphatemia Hyponatremia Hyperphosphatemia
b
What condition may result in "false hyperkalemia"? hypernatremia acidosis hypermagnesemia alkalosis hypercalcemia
b
You may also suspect what other electrolyte imbalance? Hypernatremia Hyperphosphatemia Hyperkalemia Hypernatremia
b
A nursing student believes that her patient has hypervolemic hypernatremia. Which of the patient's signs and symptoms would support this diagnosis? Select all that apply. Tachycardia Plasma sodium concentration of 150 mEq/L Edema Hypertension High serum antidiuretic hormone (ADH)
b, c, d
Which of the following statements about sodium imbalances are true? Select all that apply. Hypernatremia causes muscle inflexibility. Hypernatremia may result in increased thirst. Hyponatremia accompanied by fluid excess may result in cell swelling. Hypernatremia may occur with fluid excess or fluid deficit. Hyponatremia only occurs with fluid excess.
b, c, d
A nursing student comments that a fluid output sheet does not account for insensible water loss. Which of the following routes of water loss is the nursing student thinking about? Select all that apply. Voided urine Sweat Emesis Feces Respiration
b, d, e
A laboratory result for parathyroid hormone (PTH) is not available; however, the nurse suspects hyperparathyroidism. Which of the following would support the nurse's conclusion? The patient presents with Chvostek's sign. The patient presents with edema. The patient presents with muscle flaccidity and weakness. The patient presents with paresthesia.
c
A nursing student sees the normal values for plasma sodium and potassium. She asks why the normal values are so different. Which of the following responses by a fellow nursing student is correct? "Potassium is higher in the plasma than sodium due to sodium being actively pumped into cells." "Plasma potassium and plasma sodium levels are normally equal to one another. An error occurred in the reported laboratory normal." "Sodium is high in the extracellular fluid (ECF) while potassium is high in the intracellular fluid (ICF). " "Potassium levels are higher in the plasma than sodium levels because sodium enters cells during depolarization."
c
Recall that Louise complained about tingling around her mouth and in her fingers and muscle spasms. Based on Louise's symptoms, what electrolyte imbalance do you suspect? Hypokalemia Hyperkalemia Hypocalcemia Hyponatremia
c
The accompanying figure is a fluid intake and output sheet for a patient. As the nursing student reviews the sheet, which of the following observations are correct? Fluid output is greater than fluid input. Fluid output was 1000 mL. The chart cannot assess insensible fluid loss, such as sweat. Fluid intake cannot be compared to fluid output because the units are different.
c
Fluid volume excess may cause which of the following signs? Select all that apply. Weight loss Thirst Edema Dark-colored urine Crackles in the lungs
c, e
Which of the following increase the likelihood for edema? Select all that apply. Increased capillary permeability Decreased plasma volume Decreased oncotic pressure Hypoalbuminemia Decreased hydrostatic pressure
c, e
A nurse is reviewing a patient's fluid status, as well as plasma values for electrolytes. The nurse knows which ion most significantly influences plasma volume levels? Calcium Potassium Magnesium Sodium
d
A nurse sees that hypermagnesemia is evident on a patient's chart. Which of the following does the nurse consider as a possible cause for this finding? Alcohol abuse Malnutrition Prolonged diarrhea Renal failure
d
A nurse sees the words "arginine vasopressin" written on a report. What term could she substitute in its place? Renin Brain natriuretic peptide (BNP) Aldosterone Antidiuretic hormone (ADH)
d
A patient is prescribed a medication that causes more rapid opening of sodium channels in electrically active tissue. Which component of cellular signaling is most likely modified by this medication? Polarization Hyperpolarization Resting membrane potential Depolarization
d
If normal plasma volume is 290 mOsm, which of the following patient osmolarity values may indicate dehydration? 270 mOsm 280 mOsm 290 mOsm 300 mOsm
d
John is a 41-year-old sales manager. A routine ECG on John shows a prolonged PR interval and smaller than normal T waves. When he stands up from bed, he complains of dizziness. His medical history indicates that orthostatic hypotension is a concern. John has been in poor health for some time. He has heart failure and is currently taking digitalis and a diuretic to manage his condition. He admits he consumes a poor diet comprised mainly of processed, fast foods. Lately, John states he has been experiencing muscle weakness and feels more tired than usual. He is frequently awakened at night with leg cramps. He also complains of difficulty breathing, especially at night. He states that he needs to prop himself up with two to three pillows. What electrolyte imbalance do you suspect? Hypernatremia Hypocalcemia Hyponatremia Hypokalemia
d
Reduced sodium concentration accompanied by fluid deficit is also known as: hypervolemic hypernatremia hypervolemic hyponatremia hypovolemic hypernatremia hypovolemic hyponatremia hypernatremia
d
To accurately assess calcium levels, which additional laboratory value will the nurse also evaluate? Potassium Sodium pH Albumin
d
What is one sign associated with hypokalemia? Edema Dark-colored urine Weight gain Prolonged PR interval on electrocardiogram
d
What is the term for the twitch noted when you tapped along Louise's jaw? Bell's palsy Kernig sign Trousseau's sign Chvostek's sign
d
Which factor-may increase the risk for developing John's electrolyte imbalance? Being male Sedentary lifestyle Age Diuretic usage
d
Which hormone is released when a fluid volume excess is present? Aldosterone Renin Antidiuretic hormone Natriuretic peptide
d