Exam 1

When a client is admitted with dehydartion, which clinical manifestations would the nurse expect to find? Select all that apply A. Oliguria (lowered urinary outpur) B. dyspnea C. hypotension D. pulmonary crackles E. tenting skin turgor

A. C. and D.

Wich signs of hypokalemia would the nurse monitor in the postoperative surgical client with a nasogastric tube to continuos low suction? Select all that apply A. irritability B. Dysrrhythmias C. muscle weakness D. abdominal cramps E. acidosis

B and C

A pt with a history of a thyroidectomy is admitted for a burn that is not healing appropriately. During your assessment you note the pt is confused and complaining of tingling in his fingers. Which of the following might you anticipate A. Bolus of 1 L Lactated Ringers B. fall precautions C. IV phosphate D. switching to H2O irrigations

B. fall precautions

A pt is brought to the ER with seizures, hyperactive deep tendon reflexes, and confusion. A past medical history of alcohol abuse is reported by family members as well as anorexia. The case would relate to an abnormality in which electrolye? A. sodium B.potassium C. Calcium

C. Calcium

After a gastrectomy, a client has a nasogastric tube set to low continuous suction. The client begins to hyperventilate. How would the nurse anticipate that this breathing pattern will alter the client's blood gases? A. increase the PO2 level B. Decrease the pH level C. increase the HCO3 level D. Decrease the pCo2 level

D. Decrease the pCo2 level

Your pt has a PMH of renal disease and heart failure. They present with confusion, seizures, and decreased reflexes what F&E imbalance do you anticipate? and how would you treat

Hyponatremia Treat: fluid management I/O, Labs

A 68 year old Male comes into the hospital with a PMH of renal failure and has been experiencing diarrhea. You also suspect his labs will be indicative of hyperkalemia. What is this pt at risk for and how would you treat?

Metabolic Acidosis treat: hyperkalemia

A pt is administered too much morphine and has a respiratory rate of 6 breaths per minute. What is this pt experiencing or at risk for and how would you treat it?

Respiratory Acidosis Treat: narcan

Pt comes in with hypoventilation and hyperkalemia and decreased LOC, what is this pt at risk for

Respiratory Acidosis treat hyperkalemia

A pt is having a lot of anxiety about her upcoming surgery. SHe starts to hyperventilate and becomes lightheaded and os experiencing tingling in her fingers. What is she experiencing and how would you treat?

Respiratory Alkalosis treat: paper bag

Cues of hypernatremia

SODIUM** skin turgor reduced osmolarity and sodium increased Dry mucous membranes Irritability: Neurological symptoms Urine output decreased Muscle weakness

Your pt is in renal failure and you notice on their EKG cardiac changes, specifically tall peaked T waves and you notice ventricular arrhythmias.. They also report tingling and weakness. What Electrolyte imbalance are they experiencing and how would you treat

hyperkalemia *1st hook them up to EKG then give them insulin and dextrose. other interventions: diuretics, kayexalte, dialysis

Your pt has been having diarrhea, vomitting, and increased urine output. You notice they have shallow breathing, muscle weakness, and cardiovascule changes. What Electrolyte imbalance are they experiencing and how would you treat

hypokalemia assess EKG Administer potassium safety increase dietary intake

Your pt has renal failure and has been on diuretics, while on your shift the pt has a seizure, what could cause this

hyponatremia - seizure from loss of sodium in diuretics

A pt has been taking antacids and complains of muscle cramps, what are they at risk for and how would you treat

metabolic alkalosis

the pt has been vomiting for nearly 4 hours. the nurse recognizes this pt is at high risk for:

metabolic alkalosis

What foods would you adives your hypokalemic pt to increase in their diet?

potatoes, bananas, tomatoes, broccoli, melons, citrus

Your pt has hypernatremia, which food items do you advise them to stay away from?

salt, canned foods, processed foods, condiments

Which clinical manifestations indicate to the nurse that the client has an inadequate fluid volume? Select all that apply A. decreased urine B. hypotension C. dyspnea D. dry mucous membranes E. lung crackles F. poor skin turgor

A. B. D. F

which clinical sign is the most important indication of an accurate degree of dehydration? A. dry skin B. weight loss C. sunken fontanel D. decreased urine output

B. weight loss * ask about this, answer in r/t infants not adults