quiz 3
A patient with COPD has the following blood gases: PCO2 59, pH 7.26, HCO3 42. Which of the following conditions is presenting?
B. Respiratory acidosis
A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition?
B. Tachypnea
A patient with a sodium level of 178 is ordered to be started on 0.45% Saline. What is the most IMPORTANT nursing intervention for this patient?
The answer is D: Give slowly and watch for signs and symptoms of cerebral edema.
Which patient below is at risk for experiencing Hypovolemic Hyponatremia?
The answer is D: Patient with nasogastric tube suction experiencing diarrhea
When assessing a pregnant patient with eclampsia who is receiving IV magnesium sulfate, which finding should the nurse report to the health care provider immediately?
The patellar and triceps reflexes are absent.
A patient is being discharged home after hospitalization with hypocalcemia. Which statement by the patient indicates she understood the dietary instructions?
"I will be sure to eat lots of cheese, tofu and spinach."
Hypokalemia Clinical Manifestations:
- Fatigue - Muscle weakness, leg cramps- Nausea, vomiting, paralytic ileus- Soft, flabby muscles - Paresthesias, decreased reflexes- Weak, irregular pulse- Polyuria- Hyperglycemia
Hyponatremia Clinical Manifestations:
- Irritability, apprehension, confusion, dizziness, personality changes, tremors, seizures, coma- Dry mucous membranes- Postural hypotension, decreased CVP, decreased jugular venous filling, increased pulse, thready pulse- Cold and clammy skin
Hyperkalemia Clinical Manifestations:
- Irritability- diarrhea- Weakness of lower extremities- Paresthesias- Irregular pulse- Cardiac arrest if hyperkalemia sudden or severe
Hyperkalemia EKG Changes:
- Tall, peaked T wave - Prolonged PR interval - ST segment depression- - Loss of P wave - Widening QRS - Ventricular fibrillation - Ventricular standstill
A patient's potassium level is 3.0. Which foods would you encourage the patient to consume?
. Avocados, strawberries, and potatoes
Which patient is likely to present with a phosphate level of 6.0?
A patient in end-stage renal failure who is scheduled for dialysis tomorrow.
Which patient is at a potential risk for Digoxin toxicity?
A. A patient with Cushing's syndrome taking Laxis 20 mg IV twice a day
Magnesium is absorbed by what system of the body?
A. Gastrointestinal
A patient with nasogastric suctioning is experiencing diarrhea. The patient is ordered a morning dose of Lasix 20mg IV. Patient's potassium level is 3.0. What is your next nursing intervention?
A. Hold the dose of Lasix and notify the doctor for further orders
On admission, a patient blood alcohol limit is greater than 400 mg/dL. The patient reports drinking a 12 pack of beer on a daily basis. Which of the following conditions is this patient MOST at risk for?
A. Hypomagnesemia
A patient's calcium level is 6.9. Which of the following is a nursing priority?
A. Initiate seizure precautions Initiating seizure precautions are priority because this is a critically low calcium level and the patient is at risk for seizures. Next, you would educate the patient about calcium rich foods and administer vitamin D supplements as ordered. Calcitonin is for HYPERcalcemia.
A patient is in high anion gap metabolic acidosis due to diabetic ketoacidosis. Which of the following signs and symptoms would you expect to see in this patient?
A. Kussmaul's respirations
PH 7.21, PaC02 39, HCO3 19
A. Metabolic Acidosis Uncompensated
Please interpret: Lab Value: 7.52, paC02 48, HCO3 28
A. Metabolic Alkolosis Partially Compensated
ph 7.31, pa CO2 34, HcO3 21
A. Metabolic Alkolosis Partially Compensated
A patient is being discharged after being hospitalized with a phosphate level of 1.8. What type of foods will you encourage the patient to consume in your diet teaching?
A. Organs meats and beef
Which of the following is not a symptom of hyperkalemia?
A. Positive Chvostek's sign
A patient is experiencing respiratory acidosis due to brain trauma. Which of the following lab values correlates with this acid imbalance?
A. Potassium level of 6.0
A patient has a potassium level of 9.0. Which nursing intervention is priority?
A. Prepare the patient for dialysis and place the patient on a cardiac monitor
patient is post-opt from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?
A. Respiratory acidosis
A patient on mechanical ventilation has the following blood gases: PaCO2 29, pH 7.56, HCO3 23. Which of the following conditions is the patient experiencing?
A. Respiratory alkalosis not compensated
A patient has a phosphate level of 5.6. The doctor orders the patient to take Phoslo. What education will you provide to this patient regarding this medication?
A. Take the medication with a meal or right after
You are caring for a patient admitted with an exacerbation of asthma. After several treatments, the ABG results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, O2 saturation 99%. You interpret these results as which of the following?
A. Within normal limits
A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the patient is receiving this infusion?
A. lung sounds
A patient is on continuous BiPap and has arterial blood gases (ABGs) drawn. Select ALL the abnormal results:
A. pH 7.20B. PCO2 48
A patient with new-onset confusion and hyponatremia is being admitted. When making room assignments, the charge nurse should take which action?
Assign the patient to a room near the nurse's station.
A patient has a potassium level of 2.0. What would you expect to be ordered for this patient?
B. Infusion of Potassium intravenously
What of the following is not an expected treatment for a phosphate level of 2.2?
B. Administering Phoslo by mouth with meals
A patient has the following blood gases: PaCO2 25, pH 7.50, HCO3 19. Which of the following could NOT be the cause of this condition?
B. Chronic obstructive pulmonary disease (COPD)
A patient's magnesium level is 0.9. The doctor orders Magnesium Sulfate IV. Which nursing intervention takes PRIORITY?
B. Monitoring deep tendon reflexes
Which patient is experiencing partially compensated respiratory acidosis?
B. PaCO2 53, pH 7.23, HCO3 28
A patient is experiencing hypercalcemia and has developed renal calculi. What is the effect on the phosphate level in hypercalcemia?
B. Phosphate level decrease
A patient is being discharged after being hospitalized with a Magnesium level of 0.7. After diet teaching with this patient, which statement by the patient warrants you to re-educate the patient?
C. "I can't believe I have to give up dark chocolate".
A patient's magnesium level is 3.0. The cater associate brings the patient a dinner tray. Which item on the tray would you remove to ensure the patient does not eat?
C. Kale
A patient is admitted to the ER. The patient receives dialysis on Tuesdays and Thursdays of every week, and presents with a palpable AV shunt (thrill present) in the left upper arm. The patient is extremely lethargic and family members are present to help answer questions. While collecting the patient's medication history the daughter states her mother has been taking "a lot" of Maalox lately due to upset stomach. You note this to be a significant finding. Which of the following lab values correlates with this finding?
C. Magnesium level of 3.6
Which patient is at risk for hyperkalemia?
C. Patient with Addison's Disease
. A patient attempted to commit suicide by ingesting a bottle of Aspirin. Which of the following conditions is this patient at risk for?
C. Respiratory alkalosis
Which arrhythmia is a patient who has a Mg+ level of 0.8 most likely to experience?
C. Torsades de pointes
A patient has a calcium level of 12.5. Which medication will most likely be ordered for this patient?
Calcitonin
A patient is recovering from parathyroid surgery. Morning labs values are back. Which of the following lab values would correlate as a complication from this type of surgery?
Calcium 6.9
Respiratory alkalosis can affect other electrolyte levels in the body. Which of the following electrolyte levels can also be affected in this condition?
Calcium and potassium levels
Stimulation of the facial nerve via the masseter muscle causes twitching of the nose/lips in hypocalcemia is known as?
Chvostek's Sign
Which of the following patients is MOST at risk for hypermagnesemia?
D. A patient with a magnesium level of 0.6 receiving IV magnesium sulfate
. A patient has a Magnesium level of 1.3. Which of the following is NOT a sign or symptom of this condition?
D. Absent deep tendon reflexes
Tall peaked T-waves, flat P-waves, prolonged PR intervals and widened QRS complexes can present in which of the following conditions?
D. Hyperkalemia
. Which of the following is not a cause of respiratory acidosis?
D. Hyperventilation
A patient has the following arterial blood gases (ABGs). How do you interpret these results: pH 7.38, HCO3 24, and PCO2 38:
D. Normal
Which of the following would you NOT expect to see with a phosphate level of 1.2?
D. Positive Trousseau's Sign
Which of the following is indicative of an EKG change in a case of hypokalemia?
D. ST depression and inverted T-wave
ph 7.20, paC02 49, HCO3 25
D. Uncompensated Respiratory Acidosis
he nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan?
Encourage fluid intake up to 4000 mL every day. To decrease the risk for renal calculi, the patient should have a fluid intake of 3000 to 4000 mLdaily. Ambulation helps decrease the loss of calcium from bone and is encouraged in patients with hypercalcemia. Trousseau's and Chvostek's signs are monitored when there is a possibility of hypocalcemia. There is no indication that the patient needs frequent assessment of lung sounds,although these would be assessed every shift.
A patient's calcium level is 11.2. Which option below could be the cause?
Hydrochlorothiazide
A patient's lab work shows that they have a high parathyroid hormone level. Which condition is the patient at risk for?
Hypercalcemia
A patient with a magnesium level of 3.6 would exhibit which of the signs and symptoms EXCEPT?*
Hyperreflexia of the deep tendons
A patient with Celiac disease is at risk for which of the following?
Hypocalcemia
Lab 7.55 , 47HCO3 30
Metabolic Alkalosis, Partially Compensated
After receiving change-of-shift report, which patient should the nurse assessfirst?
Patient with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive
A patient is presenting with an orthostatic blood pressure of 80/40 when she stands up, thready and weak pulse of 58, and shallow respirations. In addition, the patient has been having frequent episodes of vomiting and nausea and is taking hydrochlorothiazide. Which of the following findings would explain the patient's condition?
Potassium level of 2.4
A patient has a calcium level of 7.2. What sign below is indicative of this lab value?
Prolonged QT interval on the EKG
Hypernatremia clinical manifestations
Restlessness, agitation, twitching, seizures, coma- Intense thirst. Dry, swollen, tongue. Sticky mucous membranes- Postural hypotenstion, increase pulse- Weakness, lethargy
A patient with Cushing's Syndrome has been experiencing an infection and has a fever of 102'F. On assessment, you find the patient to be confused, restless, has dry mucous membranes, and flushed skin. Which finding below correlates with the presentation of this patient?
The answer is C: Sodium level of 170
A patient who is taking a potassium-wasting diuretic for treatment of hypertension complains of generalized weakness. Which action is appropriate for the nurse to take?
Suggest that the health care provider order a basic metabolic panel.
Which patient below is considered hypernatremic?
The answer is A: A patient with a sodium level of 155
A patient reports taking Diamox and has been reporting confusion, fatigue, and headaches. On assessment, you note the patient is exhibiting deep and rapid respirations. Which arterial blood gas finding below confirms the acid-base imbalance for this patient given their symptoms and medication usage?
The answer is A: HCO3 12, pH 7.19, PaCO2 29 This patient is at risk for metabolic acidosis,
Diabetic ketoacidosis, aspirin toxicity, and renal failure are examples of the causes of
The answer is A: High anion gap metabolic acidosis
A patient states they have been vomiting for the last 4 days. The patient is irritable, weak, and reporting muscle cramping and weakness. On assessment, the patient is experiencing bradypnea with a respiratory rate of 10. The patient has the following ABGs result: HCO3 36, pH 7.52, PaCO2 48. Which condition below is presenting?
The answer is A: Metabolic alkalosis partially compensated
In metabolic alkalosis, the blood pH level:
The answer is A: increases
A patient with hypovolemic hyponatremia is started on IV fluids. Which of the following fluids do you expect the patient to be started on?
The answer is B: 3% Saline Patients with hypovolemic hyponatremia are started on a hypertonic solution (the circulatory system is dehydrated & and the cells are swollen...so a hypertonic solution will shrink the cells and increase fluid volume) and 3% Saline is the only hypertonic solutions. The other options are either hypotonic or isotonic.
A patient has a sodium level of 123 and presents with confusion. The doctor diagnoses the patient with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Which type of hyponatremia is this?
The answer is B: Euvolemic
A patient has the following arterial blood gases: HCO3 38, pH 7.50, PaCO2 50. Which of the following signs may this patient exhibit as a compensatory mechanism?
The answer is B: Hypoventilation (bradypnea)
A patient has the following arterial blood gases: PaCO2 33, HCO3 15, pH 7.23. Which condition below is presenting?
The answer is B: Metabolic acidosis partially compensated
A patient with a sodium level of 112 is taking Lithium. Which of the following is a nursing priority?
The answer is B: Monitor Lithium drug level due to risk of toxicity
What of the following is NOT a cause of metabolic alkalosis?
The answer is B: Usage of Diamox
You have completed diet teaching with a patient who has hypernatremia. Which statement by the patient causes concern?
The answer is C: "I'm glad I can still eat sandwiches with bologna."
A patient has a sodium level of 119. Which of the following is NOT related to this finding?
The answer is C: Inadequate water intake
A patient is in metabolic alkalosis due to diuretic therapy. How do you expect the potassium level and bicarbonate level to be affected?
The answer is D: Decreased potassium level and increase bicarb level
A patient is receiving a 3% saline continuous IV infusion for hyponatremia.Which assessment data will require the most rapid response by the nurse?
There are crackles throughout both lung fields.
Which of the following is not a cause of hypocalcemia?
Thiazide Diuretics
A patient has a magnesium level of 1.3 mg/dL. Which assessment would help the nurse identify a likely cause of this value?
a. Daily alcohol intake
A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.0 mEq/L. The nurse should alert the healthcare provider immediately that the patient is on which medication?
a. Digoxin (Lanoxin) 0.25 mg/day
A patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG) results: pH 7.32 PaCO2 37 mm Hg HCO316 mEq/L. How should the nurse interpret these results?
a. Metabolic acidosis
The nurse notes a serum calcium level of 7.9 mg/dL for a patient who haschronic malnutrition. Which action should the nurse take next?
a. Monitor ionized calcium level.
Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." Which assessment should the nurse complete?
a. Presence of the Chvostek's sign
When caring for a patient with renal failure on a low phosphate diet, the nurse will inform unlicensed assistive personnel (UAP) to remove which food from the patient's food tray?
a. Skim milk
A patient has a serum calcium level of 7.0 mEq/L. Which assessment finding is most important for the nurse to report to the health care provider?
a. The patient is experiencing laryngeal stridor. Hypocalcemia can cause laryngeal stridor, which may lead to respiratory arrest. Rapid action isrequired to correct the patient's calcium level. The other data are also consistent with hypocalcemia, but do not indicate a need for as immediate action as laryngospasm. --fatigue, tingling, constipation, numbness
A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction. The patient complains of anxiety and incisional pain. The patient's respiratory rate is 32 breaths/min, and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first?
b. Give the patient the PRN IV morphine sulfate 4 mg.
A patient is admitted to the emergency department with severe fatigue and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse?
b. Serum calcium is 18 mg/dL.
A patient who has a small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the health care provider about which assessment finding?
b. Serum sodium level of 120 mg/dL Hyponatremia is the most important finding to report. SIADH causes water retention and adecrease in serum sodium level. Hyponatremia can cause confusion and other central nervoussystem effects
An older patient receiving iso-osmolar continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory result should the nurse report to the health care provider immediately?
c. Na+154 mEq/L (154 mmol/L) The elevated serum sodium level is consistent with the patient's neurologic symptoms andindicates a need for immediate action to prevent further serious complications such as seizures.
Lithium is known to affect the parathyroid by increasing ______ levels and decreasing _____ levels?
calcium and phosphate
A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO285 mm Hg, PaCO232 mm Hg, and HCO325 mEq/L?
d. Respiratory alkalosis
A patient has a sodium level of 130. What is this condition called?
hyponatremia
