ch 16
A nurse in the medical ICU has orders to infuse a hypertonic solution into her patient with low blood pressure. Which IV fluid is considered to be hypertonic? A. Lactated Ringers solution B. 0.9% Normal Saline C. D5.45 Normal Saline D. 0.45% Normal Saline
0.9Normal Saline and LR are both isotonic solutions where 0.45Normal Saline is a hypotonic solution. D5.45 Normal Saline is the only hypertonic solution listed as the osmolarity is exceeds the ECF osmolarity making it a hypertonic solution. C. D5.45 Normal Saline
You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: PH 7.26, PaCO2 33, HCO3 11 mEq/L. How would you interpret these results? A. Metabolic alkalosis with a compensatory alkalosis B. Respiratory acidosis with no compensation C. Metabolic acidosis with no compensation D. Metabolic acidosis with partial compensation
A low pH indicates acidosis (normal pH is 7.35 to 7.45.. The PaCO3 is also low, which causes alkalosis. The bicarb is low, which causes acidosis. The pH bicarb more closely corresponds with a decrease in pH, making the metabolic component the primary problem. These facts make options A, B, and C incorrect. D. Metabolic acidosis with partial compensation
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? A) The patient reports feeling sick to my stomach. B) The patellar and triceps deep tendon reflexes are absent and B/P 80/50. C) The bibasilar breath sounds are decreased D) The patient has been sleeping most of the day.
B) The patellar and triceps deep tendon reflexes are absent and B/P 80/50 The loss of the deep tendon reflexes indicates that the patient magnesium level may be reaching toxic levels. Nausea and lethargy are also side effects associated with magnesium elevation and should be reported, but they are not as significant as the loss of deep tendon reflexes. The decreased breath sounds suggest that the patient needs to cough and deep breathe to prevent atelectasis
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 complains of generalized fatigue. B) The patient is experiencing laryngeal stridor or larngealspasm with difficulty breathing. C) The patient complains of anxiety. D) The patient has numbness and tingling of the lips
B) The patient is experiencing laryngeal stridor or larngealspasm with difficulty breathing. Hypocalcemia can cause laryngeal stridor, which may lead to respiratory arrest. Rapid action is required 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
You are doing an admission assessment on an elderly patient newly admitted for diarrhea and vomiting. What would you expect to find in this patient? Choose all that apply. The patient's skin is edematous and spongy. A. BUN is 12. B. Creatinine is 0.8 C. HCT is 60. D. The patient's skin turgor is inelastic and tents.
C. HCT is 60. D. The patient's skin turgor is inelastic and tents. Feedback: Inelastic skin turgor is a normal part of aging. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy. Normal skin turgor is dry and firm. Increased HCT indicates dehydration.
You are the nurse caring for a 65-year-old female patient who is in renal failure. During your shift assessment, the patient complains of tingling around her lips and fingers. She also tells you she is experiencing facial muscle spasms and pain especially if she taps the side of her face. What lab value would you suspect in this disorder? A. Calcium 11.0 mg/dL B. Phosphate 2.0mg/dL C. Magnesium 2.5 mg/dL D. Calcium 6.5 mg/dL
Calcium 6.5 mg/dL Hide Feedback Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Normal Calcium is 8.5-10.5. Sensations of tingling may occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Taking a normal blood pressure could illicit a carpal spasm if it creates slight ischemia of the ulnar nerve. Option A is incorrect; hypophosphatemia creates central nervous dysfunction, resulting in seizures and coma. Option C is incorrect; hypermagnesemia creates hypoactive reflexes and somnolence. Option D is incorrect; hyperkalemia creates paresthesias and anxiety.
As the nurse caring for a patient with renal failure, labs are drawn and the phosphorus level is 6.0mg/dL. What other lab value would you expect to see? 1. Calcium 12.9 2. Potassium 4.0 mg/dL 3. Calcium 6.3 mg/dL 4. Creatinine 0.3 mg/dL Calcium and Phosphorus have a reciprical relationship. When one is up the other is down. In this case, the phosphorus level is high so you would expect a low calcium level.
Calcium and Phosphorus have a reciprical relationship. When one is up the other is down. In this case, the phosphorus level is high so you would expect a low calcium level. 3. Calcium 6.3 mg/dL
You are doing an admission assessment on an elderly patient newly admitted for diarrhea and vomiting. What would you expect to find in this patient? Choose all that apply. a.The patient's skin is edematous and spongy. b. BUN is 12. c. Creatinine is 0.8 d. HCT is 60. e.The patient's skin turgor is inelastic and tents.
Feedback: Inelastic skin turgor is a normal part of aging. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy. Normal skin turgor is dry and firm. Increased HCT indicates dehydration. HCT is 60. The patient's skin turgor is inelastic and tents.
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 complains of generalized fatigue. B) The patient is experiencing laryngeal stridor or larngealspasm with difficulty breathing. C) The patient complains of anxiety. D) The patient has numbness and tingling of the lips.
Hypocalcemia can cause laryngeal stridor, which may lead to respiratory arrest. Rapid action is required 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 B) The patient is experiencing laryngeal stridor or larngealspasm with difficulty breathing
Patient comes into the emergency room after taking an overdose of narcotics. Upon arrival, respiratory rate is 9 breaths a minute, and the patient is unresponsive. Which ABG result would you expect to see? ph 7.25 PaCO2 66 HCO3 26 pH 7.47; PaCO2 45 HCO3 33 pH 7.38 PaCO2 45 HCO3 26 pH 7.33 PaCO2 40 HCO3 18
Hypoventilation there is an accumulation of carbon dioxide, which cause a drop in pH. resulting in respiratory acidosis. ph 7.25 PaCO2 66 HCO3 26
A nurse is caring for a patient who has a Sodium level of 128mEq/L. As part of the care, the nurse knows to restrict which item for this patient? 1.Water 2. Sports drinks, such as Gatorade 3. Eggs and cheese products 4. Salt on the diet tray
In hyponatremia, one or more factors — ranging from an underlying medical condition to drinking too much water — cause the sodium in the body to become diluted. When this happens, the body's water levels increase and can cause cells to swell. This swelling can cause many health problems, from mild to life-threatening. Depending on the cause of hyponatremia, patients need to decrease their fluid intake and may need IV fluids with normal saline 1. Water
The nurse caring for a patient post colon resection is assessing the patient on the 5th postoperative day. The nasogastric tube (NG. remains patent and continues at low intermittent wall suction.) The IV is patent and infusing at 125 mL per hour. The patient reports pain at the incision site rated at a three on a zero-to-ten rating scale. During your initial shift assessment, the patient complains of cramps in her calves mainly at night, skeletal muscle weakness, constipation, abdominal distention, numbness and tingling, decreased deep tendon reflexes for the last 3 days. What other signs or symptoms would you expect this patient to exhibit? 1. Polyuria 2. Dimished thirst 3. Increased muscle strength 4. Increased bowel motility
Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias (numbness and tingling., and dysrhythmias. If prolonged, hypokalemia can lead to an inability of the kidneys to concentrate urine, causing dilute urine (resulting in polyuria, nocturia. and excessive thirst. Potassium depletion suppresses the release of insulin and results in glucose intolerance. Decreased muscle strength and DTRs can be found on physical assessment. Options A and D are incorrect because at this point post-op bowel motility cannot be accurately assessed and a patient with an IV running at 125 mL per hour should not exhibit signs of thirst. You would expect decreased, not increased, muscle strength with hypokalemia. 1. polyuria
You are caring for a 65-year-old male patient admitted to your unit 72 hours ago with pyloric stenosis. A nasogastric tube was placed upon admission has been on low intermittent suction ever since and the patient as been having large amounts of GI fluid out via the NG tube. What would you be concerned that the patient may be at risk for? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Hypercalcemia
Metabolic alkalosis Hide Feedback Probably the most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric fluid is lost. Vomiting, gastric suction, and pyloric stenosis all remove potassium and can cause hypokalemia. Option A is incorrect; this patient would not be at risk for hypercalcemia; hyperparathyroidism and cancer account for almost all cases of hypercalcemia. Option B is incorrect; the nasogastric tube is removing stomach acid and will likely raise pH. Option D is incorrect; respiratory acidosis is unlikely since there was no change reported in the patient's respiratory status.
An adult male client was involved in a single-vehicle car accident. He is reporting chest pain and difficulty breathing. A chest x-ray reveals a pneumothorax. Blood gas analysis is obtained. Which of the following results should the nurse expect? A. pH 7.29, PaCO2 50, HCO3 24 mEq/L B. pH 7.42, PaCO2 38 mm Hg, HCO3 23 mEq/L C. pH 6.98, PaCO2 30 mm Hg, HCO3 18 mEq/L D. pH 7.58, PaCO2 38 mm Hg, HCO3 29 mEq/
Pneumothorax can cause alveolar hypoventilation and increased CO2 levels, resulting in a respiratory acidosis. Answer: pH 7.29, PaCO2 50, HCO3 24 mEq/L
An adult male client was involved in a single-vehicle car accident. He is reporting chest pain and difficulty breathing. A chest x-ray reveals a pneumothorax. Blood gas analysis is obtained. Which of the following results should the nurse expect? a. pH 7.29, PaCO2 50, HCO3 24 mEq/L b. pH 7.42, PaCO2 38 mm Hg, HCO3 23 mEq/L c. pH 6.98, PaCO2 30 mm Hg, HCO3 18 mEq/L d. pH 7.58, PaCO2 38 mm Hg, HCO3 29 mEq/L Pneumothorax can cause alveolar hypoventilation and increased CO2 levels, resulting in a respiratory acidosis.
Pneumothorax can cause alveolar hypoventilation and increased CO2 levels, resulting in a respiratory acidosis. pH 7.29, PaCO2 50, HCO3 24 mEq/L
A patient is admitted to the hospital and has had an NG tube in due to a bowel obstruction and has been having large amounts of GI fluid being drained out. What acid base disorder would you expect? A.pH 7.29 PaCO2 40 HCO3 26 B. pH 7.36 PaCO2 42 HCO3 25 c. pH 7. 54 PaCO2 45 HCO3 28 D. pH 7.35 PaCO2 45 HCO3 24
Pt has lost a lot of GI fluids which has acid so has metabolic alkalosis. c. pH 7. 54 PaCO2 45 HCO3 28
The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequate ventilation. What diagnosis could the patient have that could cause inadequate ventilation? 1. Multiple myloma 2. Insomnia 3. Overdose of sedatives 4. Overdose of amphetamines Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations and, consequently, increased levels of carbonic acid. Acute respiratory acidosis occurs in emergency situations, such as acute pulmonary edema, aspiration of a foreign object, atelectasis, pneumothorax, overdose of sedatives, sleep apnea, administration of oxygen to a patient with chronic hypercapnia (excessive CO2 in the blood., severe pneumonia, and acute respiratory distress syndrome. Respiratory acidosis can also occur in diseases that impair respiratory muscles, such as muscular dystrophy, myasthenia gravis, and Guillain-Barré syndrome. This makes options A, B, and D incorrect.
Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations and, consequently, increased levels of carbonic acid. Acute respiratory acidosis occurs in emergency situations, such as acute pulmonary edema, aspiration of a foreign object, atelectasis, pneumothorax, overdose of sedatives, sleep apnea, administration of oxygen to a patient with chronic hypercapnia (excessive CO2 in the blood., severe pneumonia, and acute respiratory distress syndrome. Respiratory acidosis can also occur in diseases that impair respiratory muscles, such as muscular dystrophy, myasthenia gravis, and Guillain-Barré syndrome. This makes options A, B, and D incorrect. 3. Overdose of sedatives
You are caring for a patient on the oncology unit with metastatic brain cancer. Upon your assessment you find decreased reflexes and the patient is complaining of increase in thirst, increase in urination, abdominal pain, and deep bone pain. What might you believe is occurring with your patient? A. Hypophosphatemia B. Hypomagnesia C. Hypercalcemia D. Hypocalcemia
The correct answer is C. ,hypercalcemia. The most common causes of this are malignancies and hyperparathyroidism. Bone pain is prsent as bones are breaking down or resportion is taking place and calcium is released from the bone. Also present thirst, depressed reflexes, abd. distention, ileus, and confusion can all occur with hypercalcemia.
You are caring for a patient on the oncology unit with metastatic brain cancer. Upon your assessment you find decreased reflexes and the patient is complaining of increase in thirst, increase in urination, abdominal pain, and deep bone pain. What might you believe is occurring with your patient? Hypophosphatemia Hypomagnesia Hypercalcemia Hypocalcemia Hide Feedback The correct answer is D,hypercalcemia. The most common causes of this are malignancies and hyperparathyroidism. Bone pain is prsent as bones are breaking down or resportion is taking place and calcium is released from the bone. Also present thirst, depressed reflexes, abd. distention, ileus, and confusion can all occur with hypercalcemia.
The correct answer is D,hypercalcemia. The most common causes of this are malignancies and hyperparathyroidism. Bone pain is prsent as bones are breaking down or resportion is taking place and calcium is released from the bone. Also present thirst, depressed reflexes, abd. distention, ileus, and confusion can all occur with hypercalcemia.
A nurse is caring for four hospitalized patients. Which of the following clients is at greatest risk for fluid volume deficit? 1. The patient with congestive heart failure and is on diuretic therapy. 2. The patient with end stage renal failure and is scheduled for dialysis today. 3. An older patient of 75 years has been admitted with vomiting and diarrhea for the last week and has a temperature of 101 degrees. 4. The patient who has been NPO since midnight.
The elderly are at increased risk for dehydration and can dehydrate quickly with vomiting and diarrhea especially with a temperature. Therefore, options A, C, and D are incorrect
A patient with anxiety presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. What blood gas value would you expect to find on this patient? A. pH 7.56, PaCo2- 40, HCO3 30 B. pH 7.35, PaCo2- 38, HCO3- 26 C. pH 7.50, PaCo2- 25, HCO3 24 D. pH 7.24, PaCo2- 56, HCO3 30
The most common cause of acute respiratory alkalosis is hyperventilation. Extreme anxiety can lead to hyperventilation. Acute respiratory acidosis occurs in emergency situations such as pulmonary edema and is exhibited by hypoventilation and decreased PaCO2. CNS disturbances are found in extreme hyponatremia and fluid overload. C. pH 7.50, PaCo2- 25, HCO3 24
A patient in the ICU starts complaining of being "short of breath." An arterial blood gas (ABG.) is drawn. The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect? A. Metabolic alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Respiratory alkalosis The pH below 7.40, PaCO2 greater than 40, and the HCO3 is normal; therefore, it is a respiratory acidosis, and compensation by the kidneys has not begun, which indicates this was probably an acute event. Option B is incorrect; the HCO3 of 24 is within the normal range so it is not metabolic alkalosis. Option C is incorrect; the pH of 7.21 indicates an acidosis, not alkalosis. Option D is incorrect; the pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is within the normal range so it is not a metabolic acidosis.
The pH below 7.40, PaCO2 greater than 40, and the HCO3 is normal; therefore, it is a respiratory acidosis, and compensation by the kidneys has not begun, which indicates this was probably an acute event. Option B is incorrect; the HCO3 of 24 is within the normal range so it is not metabolic alkalosis. Option C is incorrect; the pH of 7.21 indicates an acidosis, not alkalosis. Option D is incorrect; the pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is within the normal range so it is not a metabolic acidosis B. Respiratory acidosis
A 36 year female is admitted with vomiting and dehydration due to the flu for 3 days. ABG's are pH 7.47, PaCO2 45, and HCO3 33. What do these values indicate to the nurse? 1.Metabolic Acidosis 2. Respiratory alkalosis 3.Metabolic alkalosis 4.Respiratory acidosis
The pH indicates alkalosis and the HCO3 is elevated, indicating a metabolic basis. The PaCO2 is slightly elevated, indicating that compensation is occurring. Options A and B are incorrect due to it being alkalosis. D is incorrect because compensation is occurring due to the increased CO2 level. 3.Metabolic alkalosis
A patient is admitted to the emergency department with severe fatigue, deep bone pain, and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse? A) Arterial oxygen saturation is 92%. B) Serum calcium is 18 mg/dL. C) Arterial blood pH is 7.35 D) Serum potassium is 4.9 mEq/L.
The serum calcium is well above the normal level and puts the patient at risk for cardiac dysrhythmias. The nurse should initiate cardiac monitoring and notify the health care provider. The potassium, oxygen saturation, and pH are also abnormal, and the nurse should notify the health care provider about these values as well, but they are not immediately life threatening. B) Serum calcium is 18 mg/dL.
A patient presents to the emergency department and is short of breath and patient reports he has COPD with chronic bronchitis. He thinks he is having an exacerbation of his COPD as he has been feeling worse over the past week. Which blood gas value would you expect to see? A) pH 7.54 PaCO2 45 HCO3 28 B) pH 7.33 PaCO2 25 HCO3 12 C) pH 7.46 PaCO2 28 HCO3 24 D) pH 7.30 PaCO2 50 HCO3 25
This is respiratory acidosis, patient having a hard time breathing D) pH 7.30 PaCO2 50 HCO3 25
You are caring for a patient admitted with a diagnosis of renal failure. When you review your patient's laboratory reports, you note that the patient's magnesium level is 3.0 What might you find on your assessment? A. Diminished deep tendon reflexes, hypotension, drowsiness, and diaphoresis B. Increased serum Sodium and insomnia C. Increased B/P and ileus D. Cool, clammy skin
To gauge a patient's magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia and cool, clammy skin are not assessments for hypermagnesemia. A. Diminished deep tendon reflexes, hypotension, drowsiness, and diaphoresis
The nurse is administering an IV potassium chloride supplement to a patient who has heart failure. When developing a plan of care for this patient, the nurse should consider that: A) The administration of the IV potassium chloride should not exceed 10 mEq/h. B) The patient's potassium levels will be unaffected by a potassium sparing diuretic. C) Hyperkalemia will intensify the action of the patient's digoxin preparation. D) Metabolic alkalosis will increase the patient's serum potassium levels.
When administering IV potassium chloride, the administration should not exceed 10 or a concentration of 40 via a peripheral line. These limits are extremely important to prevent the development of dysrhythmias. In some situations, with dangerously low serum potassium levels, the patient may need cardiac monitoring and more than 10 mEq of potassium per hour. Potassium sparing diuretics may lead to hyperkalemia as they affect the kidney's ability to excrete excess potassium. Metabolic alkalosis can cause potassium to shift into the cells, thus decreasing the patient's serum potassium levels. Hypokalemia can lead to digoxin toxicity A) The administration of the IV potassium chloride should not exceed 10 mEq/h.
The nurse is administering an IV potassium chloride supplement to a patient who has heart failure. When developing a plan of care for this patient, the nurse should consider that: A) The administration of the IV potassium chloride should not exceed 10 mEq/h. B) The patient's potassium levels will be unaffected by a potassium sparing diuretic. C) Hyperkalemia will intensify the action of the patient's digoxin preparation. D) Metabolic alkalosis will increase the patient's serum potassium levels. When administering IV potassium chloride, the administration should not exceed 10 or a concentration of 40 via a peripheral line. These limits are extremely important to prevent the development of dysrhythmias. In some situations, with dangerously low serum potassium levels, the patient may need cardiac monitoring and more than 10 mEq of potassium per hour. Potassium sparing diuretics may lead to hyperkalemia as they affect the kidney's ability to excrete excess potassium. Metabolic alkalosis can cause potassium to shift into the cells, thus decreasing the patient's serum potassium levels. Hypokalemia can lead to digoxin toxicity.
When administering IV potassium chloride, the administration should not exceed 10 or a concentration of 40 via a peripheral line. These limits are extremely important to prevent the development of dysrhythmias. In some situations, with dangerously low serum potassium levels, the patient may need cardiac monitoring and more than 10 mEq of potassium per hour. Potassium sparing diuretics may lead to hyperkalemia as they affect the kidney's ability to excrete excess potassium. Metabolic alkalosis can cause potassium to shift into the cells, thus decreasing the patient's serum potassium levels. Hypokalemia can lead to digoxin toxicity. A) The administration of the IV potassium chloride should not exceed 10 mEq/h
Your patient just had a blood gas drawn, what does the blood gas show? pH 7.25 PaCO2 60 HCO3 28 1. Respiratory Acidosis with partial compensation 2. Metabolic Acidosis with partial compensation 3. Metabolic Alkalosis 4. respiratory alkalosis This is respiratory acidosis with partial compensation
his is respiratory acidosis with partial compensation 1. Respiratory Acidosis with partial compensation
You are an ICU nurse caring for a trauma patient. The patient is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3- 25 mEq/L. What would you know is happening with this patient? Respiratory acidosis Metabolic alkalosis Mixed acid-base disorder Respiratory alkalosis pH is low indicating acidosis and the PaCo2 is high indicating respiratory acidosis and bicarb is within normal range.
pH is low indicating acidosis and the PaCo2 is high indicating respiratory acidosis and bicarb is within normal range. Respiratory acidosis
