112 1st test

Red blood cells should measure

0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field.

1. Active transport: 2. Osmosis: 3. Passive diffusion: 4. Facilitated diffusion:

1. requires the use of the body's energy molecule (ATP) to meet body needs for fluid and particle transport. 2. is the movement of body fluids through a semipermeable membrane that allows not all substances to pass through. 3. allows the movement of substances from an area of higher concentration to lower concentration. 4. has certain dissolved substances that require the assistance from a carrier module to pass through the semipermeable membrane.

Urine specific gravity normally ranges from

1.010 to 1.025

Hyponatremia exists when the serum concentration decreases below________.

135 mEq/L (135 mmol/L)

Normal sodium serum concentration ranges from

135 to 145 mEq/L (135-145 mmol/L).

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 how many lbs?

2 lbs (160 - 2 = 158 lbs).

In healthy adults, normal serum osmolality is

270 to 300 mOsm/kg

Normal urine pH is

4.5 to 8

Normal potassium level is 3.5 to

5.5 mEq/L. Elevated potassium levels can lead to muscle weakness, paresthesias, and cardiac dysrhythmias.

Normal Calcium range

9-11 mg/dl

A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be

Above 7.45

The nurse has been assigned to care for various clients. Which client is at the highest risk for a fluid and electrolyte imbalance?.

An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide

A volume-depleted patient would present with which of the following diagnostic lab results?

BUN-to-creatinine ratio of 24:1

Potassium is a major (a. cation b. anion) that affects cardiac muscle functioning.

Cation

The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the medication orders?

Cimetidine

A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How should these nurses be encouraged to deal with excess hair at the intended site?

Clip the hair in the area.

A patient is responding poorly to interventions aimed at treating shock and appears to be transitioning to the irreversible stage of shock. What action should the intensive care nurse include during this phase of the patient's care?

Communicate clearly and frequently with the patient's family.

The acute care nurse is providing care for an adult patient who is in hypovolemic shock. The nurse recognizes that antidiuretic hormone (ADH) plays a significant role in this health problem. What assessment finding will the nurse likely observe related to the role of the ADH during hypovolemic shock?

Decreased urinary output

A critical care nurse is planning assessments in the knowledge that patients in shock are vulnerable to developing fluid replacement complications. For what signs and symptoms should the nurse monitor the patient?

Difficulty breathing Cardiovascular overload Pulmonary edema

When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur?

Hydrostatic pressure resulting from the pumping action of the heart

You are the nurse caring for a patient who is to receive IV daunorubicin, a chemotherapeutic agent. You start the infusion and check the insertion site as per protocol. During your most recent check, you note that the IV has infiltrated so you stop the infusion. What is your main concern with this infiltration?

Extravasation of the medication

Hypokalemia occurs with Hyperkalemia occurs with

GI and renal losses. adrenal insufficiency.

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing?

Hyperkalemia

A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. Laboratory values are as follows: Na + 147 mEq/L K + 3.0 mEq/L Cl - 112 mEq/L Mg ++ 2.3 mg/dL Ca ++ 1.5 mg/dL Which of the following is consistent with the client's findings?

Hypokalemia

A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for

Hyponatremia

You are the nurse evaluating a newly admitted patient's laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone (ADH)?

Increased serum sodium

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?

Increases arterial pH

You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patient's skin turgor?

Inelastic skin turgor is a normal part of aging

You are making initial shift assessments on your patients. While assessing one patient's peripheral IV site, you note edema around the insertion site. How should you document this complication related to IV therapy?

Infiltration

In all types of shock, nutritional demands increase rapidly as the body depletes its stores of glycogen. Enteral nutrition is the preferred method of meeting these increasing energy demands. What is the basis for enteral nutrition being the preferred method of meeting the body's needs?

It promotes GI function through direct exposure to nutrients.

With which condition should the nurse expect that a decrease in serum osmolality will occur?

Kidney failure

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance?

Metabolic acidosis

Calcium deficit is associated with the following symptoms.....

Numbness and tingling of the fingers, toes, and circumoral region; positive Trousseau's sign and Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, decreased prothrombin, diarrhea, and hypotension. Electrocardiogram findings associated with hypocalcemia include prolonged QT interval and lengthened ST.

A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following?

Osmosis and osmolality

What does the nurse recognize as one of the indicators of the patient's renal function?

Serum creatinine

A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:

Serum osmolality can be estimated by doubling the serum sodium or using the formula: Na × 2 = glucose/18 + BUN/3. Therefore, the nurse could estimate a serum osmolality of 280 mOsm/kg by doubling the serum sodium value of 140 mEq/L.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result?

Serum sodium level of 124 mEq/L

A medical nurse educator is reviewing a patient's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?

The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the rise in pH?

The lungs are not able to blow off carbon dioxide.

It is important for a nurse to know how to calculate the corrected serum calcium level for a patient when hypocalcemia is seen along with low serum albumin levels. Calculate the corrected serum calcium when the serum calcium is 9 mg/dL and the serum albumin is 3 g/dL.

To calculate corrected serum calcium, subtract the normal serum albumin level of 4 g/dL from the reported albumin level of 3 g/dL, multiply that value (1) by 0.8 (constant factor) and then add that result (0.8 mg) to the reported serum level of 9 mg/dL. Therefore, 9 + 0.8 = 9.8 mg/dL (corrected value). Note: a constant factor of 0.8 is used because, for every decrease in serum albumin of 1 g/dL below 4 g/dL, the total serum calcium level is underestimated by 0.8 mg/dL.

A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurse's preceptor is going over the patient's past lab reports with the new nurse. The nurse takes note that the patient's PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurse's best response?

Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.

Indicative of hypervolemia is

a bounding pulse and elevated blood pressure due to the excess volume in the system.

Respiratory alkalosis is always caused by hyperventilation, which is

a decrease in plasma carbonic acid concentration. The pH is elevated above normal as a result of a low PaCO2.

Chloride, bicarbonate, and phosphate are ______

anions.

Chloride, bicarbonate, and phosphate... cations or anions?

anions.

Hypocalcemia or low serum calcium levels can affect clotting. Therefore, in this condition, the nurse should take extra care to check for

bruising or bleeding.

Potassium is a major______ that affects cardiac muscle functioning.

cation

The major anions are

chloride, bicarbonate, phosphate, sulfate, and proteinate ions.

Urine should be

clear, with color ranging from pale yellow to deep amber.

Classic signs of water intoxication include

confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur.

Decreased serum sodium is a factor associated with

decreased serum osmolality.

The most common fluid imbalance in older adults is

dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances.

Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is associated with disorders such as

emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis.

Prevention measures for hypokalmia may involve

encouraging the client at risk to eat foods rich in potassium (when the diet allows), including fruit juices and bananas, melon, citrus fruits, fresh and frozen vegetables, lean meats, milk, and whole grains. If the hypokalemia is caused by abuse of laxatives or diuretics, client education may help alleviate the problem.

Symptoms of hypokalemia (<3.0 mEq/L) include.....

fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, paresthesias, leg cramps, hypotension, ileus, abdominal distention, and hypoactive reflexes. Electrocardiogram findings associated with hypokalemia include flattened T waves, prominent U waves, ST depression, and prolonged PR interval.

Sunken eyeballs, thirst, and increased BUN levels indicate

fluid volume deficit.

A solution of D5W is an isotonic IV solution that is contraindicated in

head injury because it may increase intracranial pressure.

When hemoconcentration occurs due to a hypovolemic state, a high ratio of blood components in relation to watery plasma occurs, thus causing an elevated _____level.

hematocrit level. A high white blood cell count and urine specific gravity is also noted.

Tetany is the most characteristic manifestation that occurs when the _______ level is less than 4.4 mg/dL.

hypocalcemia

A client with a calcium level of 4.0 mg/dL has The nurse closely monitors the client for

hypocalcemia. neurological manifestations such as tetany, seizures, and spasms. If the calcium level continues to decrease, seizure precautions are necessary. Cardiac dysrhythmias and airway obstruction may also occur.

Dehydration and hyperglycemia are associated with

increased serum osmolality

Hyponatremia occurs with Hypernatremia results from

increased thirst and ADH release. increased insensible losses and diabetes insipidus.

Acidosis is associated with

increased urine osmolality.

When the serum sodium concentration decreases to <115 mEq/L (<115 mmol/L), signs of..... General manifestations of hyponatremia include.....

increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur. poor skin turgor, dry mucosa, headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic changes, including altered mental status, status epilepticus, and coma, are probably related to cellular swelling and cerebral edema associated with hyponatremia. Hallucinations are associated with increased serum sodium concentrations.

The most common causes of hypercalcemia are

malignancies and hyperparathyroidism.

Normal serum concentration level ranges from 135 to 145 mEq/L (135-145 mmol/L). When the level dips below 135 mEq/L (135 mmol/L), hyponatremia occurs. Manifestations of hyponatremia include

mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the deficit is severe. Values of 140, 142, and 145 mEq/L (mmol/L) are within the normal range.

A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance?

metabolic alkalosis

Respiratory acidosis is always from inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations. Respiratory acidosis can occur in diseases that impair respiratory muscles such as

myasthenia gravis.

One of the earliest symptoms of *hypo*volemia is

thirst.

Metabolic alkalosis is a clinical disturbance characterized by a high

pH and high plasma bicarbonate concentration

Normally, urine contains no

protein, glucose, ketones, bilirubin, bacteria, casts, or crystals.

Clients diagnosed with bulimia frequently suffer increased potassium loss through

self-induced vomiting and misuse of laxatives, diuretics, and enemas.

Complications associated with respiratory acidosis are

shock and cardiac arrest

The major cations in body fluid are

sodium, potassium, calcium, magnesium, and hydrogen ions.

The major chemical regulator of plasma pH is

the bicarbonate-carbonic acid buffer system.

Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore,

the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.

Hypernatremia is a serum sodium concentration >145 mEq/L (>145 mmol/L). A cause of hypernatremia is near drowning in seawater (which contains a sodium concentration of approximately 500 mEq/L). S/S of hypernatremia include......

thirst, elevated body temperature, swollen and dry tongue and sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, simple partial or tonic-clonic seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia, elevated pulse, and elevated blood pressure.

Early signs of hypervolemia are

weight gain, elevated blood pressure, and increased breathing effort. Eventually, fluid congestion in the lungs leads to moist breath sounds.

Fluid volume deficit (FVD) occurs

when the loss extracellular fluid (ECF) volume exceeds the intake of fluid. FVD results from loss of body fluids and occurs more rapidly when coupled with decreased fluid intake. A cause of this loss is hemorrhage.

Hypercalcemia is defined as a calcium concentration of.......

>10.2 mg/dL (>2.6 mmol/L).

A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance?

Respiratory alkalosis