Fluid/Elec/Acid Base/Urinary - Test 1
Magnesium - normal range
1.5-2.5
Hemoglobin
11-16 (female) 13-18 (male)
Sodium - normal range
135-145
Platelets
150,000-450,000
WBC range
5,000-10,000
Glucose - normal range
60-100
BUN - normal range
8-23
Calcium - normal range
9-11
Chloride - normal range
98-106
Hypernatremia manifestations
- thirst - elevated temperature - dry, swollen tongue - sticky mucosa - neurologic symptoms - restlessness - weakness
Hypokalemia causes
*GI losses*, medications, alterations of acid-base balance, hyperaldosteronism, poor dietary intake
Hypophosphatemia causes
*alcoholism*, refeeding of patients after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, major burns, low potassium, diarrhea, vitamin D deficiency, *use of diuretic and antacids*
FVE risk factors
*heart failure*, renal failure, cirrhosis of liver
Hypophosphatemia manifestations
*neurologic symptoms*, confusion, muscle weakness, *tissue hypoxia, muscle and bone pain*, increased susceptibility to infection
Hypomagnesemia manifestations
*neuromuscular irritability*, muscle weakness, tremors, athetoid movements, *ECG changes and dysrhythmias*, alterations in mood and level of consciousness
Potassium - normal range
3.5-5.0
Hematocrit
37% (female) 42-52% (male)
Hypocalcemia manifestations
*tetany*, circumoral numbness, paresthesias, *hyperactive DTRs*, *Trousseau's sign*, *Chovstek's sign*, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety
What would most likely indicate respiratory alkalosis?
- decreased PaCO2 <35 mmHg - *hyperventilation* - *anxiety* - brainstem stimulation - head injury - shock - Chvostek's & Trousseau's sign - lightheadedness - increased pH >7.45 - tingling lips/fingers
FVE medical management
- directed at cause - restriction of fluids and sodium (possible 1500mg Na diet) - administration of diuretics (hydrochlorothiazide is gentle) - watch for hyperkalemia
Routes of Loss
- kidney (urine output 30 mL/hr at min) - skin loss (sensible and insensible loss) - lungs - GI tract
Hyponatremia manifestations
- poor skin turgor - dry mucosa - headache - decrease salivation - decreased BP - nausea - abd cramps - neuro changes
FVE nursing management
-I&O and daily weights; assess lung sounds, edema, etc -monitor responses to medications - diuretics -promote adherence to fluid restrictions, pt. teaching related to Na and fluid restriction -monitor, avoid sources of excessive Na including meds -Semi-fowlers position for orthopnea ("position of comfort") -skin care, positioning/turning
Hyperkalemia causes
-treatment related -impaired renal function -hypoaldosteronism -tissue trauma -acidosis
Creatinine - normal range
0.5-1.2 *best indicator of kidney function*
*Things to remember with hyperkalemia*
1. drawing of blood above IV site may result in false lab result *2. salt substitutes and medications can contain potassium* 3. diuretics may elevate potassium levels and shouldn't be used in patients with renal dysfunction
The nurse is caring for a patient with a diagnosis of hyponatremia. What nursing intervention is appropriate to include in the plan of care for this patient. a. assessing for symptoms of nausea and malaise b. encouraging the intake of low-sodium liquids c. monitoring neurological status d. restricting tap water intake e. encouraging the use of salt substitute instead of salt
A, C, D.
The nurse is reviewing a patient's lab results. What findings does the nurse assess that are consistent with acute glomerulonephritis? Select all. a. red blood cells in the urine b. polyuria c. proteinuria d. white cell casts in the urine e. hemoglobin of 12.8 g
A, C, D.
A 24 hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? a. after discarding the 8:00 am specimen b. at 8:00 am with or without a specimen c. 6 hours after the urine is discarded d. with the first specimen voided after 8:00 am
A.
A 76 year old female is admitted due to a recent fall. The patient is confused and agitated. The family members report that this isn't normal behavior for the patient. They explain the patient is very active in the community and cares for herself. Based on the information you have gathered, which order takes priority? a. collect a urinalysis. b. collect a T3 and T4 level. c. insert a foley catheter. d. keep patient NPO.
A.
A nurse is assessing a client with a UTI who takes an antihypertensive drug. The nurse reviews the client's urinalysis results; pH 6.8, color yellow, specific gravity 1.030. The nurse should a. encourage client to increase fluid intake b. without the next dose c. restrict clients sodium intake d. encourage client to eat at least half a banana a day
A.
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes and a positive Chvostek sign. What deficit does the nurse suspect the patient has? a. a calcium deficit b. a magnesium deficit c. a phosphorus deficit d. a sodium deficit
A.
A patient is scheduled for a TURP procedure for BPH and tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur. b. information about penile implants used for ED is available if interested. c. there are many methods of sexual expression that can be alternatives to sexual intercourse. d. sterility will not be a problem after surgery because sperm production will not be affected.
A.
The healthcare provider has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? a. 0.45% sodium chloride b. 0.90% sodium chloride c. 5% dextrose in water d. 5% dextrose in normal saline
A.
The healthcare provider prescribes finasteride (Proscar) for a 56-year-old male patient who has a BPH symptom score of 12 on the AUA Symptom Index. When teaching the patient about the drug, the nurse informs him that a. his interest in sexual activity may decrease while he is taking the medication. b. he should change position from laying to standing slowly to avoid dizziness. c. improvement in the obstructive symptoms should occur within 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.
A.
The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse document that oliguria is present? a. urine output is less than 30 mL/h b. urine output is about 100 mL/h c. urine output is between 300-500 mL/h d. urine output is between 500-1000 mL/h
A.
The nurse should assess the patient for signs of lethargy, increasing intracranial pressure and seizures when the serum sodium reaches what level? a. 115 b. 130 c. 145 d. 160
A.
What foods can the nurse recommend for the patient with hypokalemia? a. fruits - bananas & apricots b. green, leafy vegetables c. milk and yogurt d. nuts and legumes
A.
Hypochloremia causes
Addison's disease, reduced chloride intake, GI loss, diabetic ketoacidosis, excessive sweating, fever, burns, medications, and metabolic alkalosis
Interventions for decreasing UTIs a. insert indwelling catheters b. perform hand hygiene prior to patient care c. assist the patients with frequent toileting d. provide careful perineal care e. encourage patients to wear briefs
B, C, D.
A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line antibacterial agent for UTIs has been found to be significantly effective? a. Trimethoprim-sulfamethoxazole b. ciprofloxacin c. nitrofurantoin d. phenazopyridine
B.
A patient is scheduled for a test with contrast to determine kidney function. What statement needs to be communicated? a. I don't like needles b. I'm allergic to shrimp c. I take medication to sleep at night d. I had had a test similar to this one in the past
B.
A patient with a urinary tract infection is taking Bactrim. The nurse knows it is important for patient to consume 2.5 to 3 L of fluid per day to prevent which complication? a. brown urine b. crystalluria c. renal stenosis d. renal calculi
B.
The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium? a. butter b. citrus fruits c. cooked white rice d. salad oils
B.
The nurse is reviewing the laboratory studies for a patient suspected of acute kidney injury. What test would be the best indicator of the patient's renal function? a. BUN b. serum creatinine c. specific gravity d. urine osmolality
B.
The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate? a. "The bladder irrigation is needed to stop the postoperative bleeding in the bladder." b. "The irrigation is needed to keep the catheter from being occluded by blood clots." c. "Normal production of urine is maintained with the irrigations until healing occurs." d. "Antibiotics are being administered into the bladder with the irrigation solution."
B.
Which electrolyte is found in concentration of 98% within the cell? a. calcium b. potassium c. sodium d. magnesium
B.
Which medication does the nurse anticipate administering to antagonize the effects of potassium on the heart for a patient in severe metabolic acidosis? a. sodium bicarbonate b. magnesium sulfate c. furosemide (Lasix) d. calcium gluconate
B.
Which of the following is the major cation in extracellular fluid? a. calcium b. sodium c. magnesium d. potassium
B.
A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? a. rebound tenderness at McBurney point b. an output of 200 mL with each voiding c. cloudy urine d. urine specific gravity of 1.005 to 1.022
C.
A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing? a. urge incontinence b. functional incontinence c. stress incontinence d. iatrogenic incontinence
C.
A patient is admitted with severe vomiting for 24 hours, weakness and feeling exhausted. The nurse observes flat T waves and ST-segment depression on EKG. Which potassium level does the nurse observe when the laboratory studies are complete? a. 4.0 b. 8.0 c. 2.0 d. 2.6
C.
A patient reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau and Chvostek signs. Which decreased laboratory results does the nurse when the patients lab results comes back? a. potassium b. phosphorus c. calcium d. magnesium
C.
A patient who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue and a body temperature of 99.3. The urine specific gravity is 1.020. What is the most likely serum sodium value for this patient. a. 110 b. 140 c. 155 d. 165
C.
A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms? a. sulfamethoxazole/trimethoprim b. levofloxacin c. phenazopyridine d. amoxicillin
C.
In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours? a. 400 b. 600 c. 800 d. 1200
C.
The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse anticipate the daily urine output will be? a. 1.5 L b. 1.0 L c. less than 400 mL d. less than 50 mL
C.
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis
C.
The nurse is caring for a patient with end stage kidney disease in the hospital and smells a fetid odor from the patient's breath. What major manifestation of uremia will be present? a. a decreased serum phosphorus level b. hyperparathyroidism c. hypocalcemia with bone changes d. increased secretion of parathormone
C.
The nurse is caring for a patient with hypernatremia. What complication of hypernatremia should the nurse continuously monitor for? a. red blood cell crenation b. red blood cell hydrolysis c. cerebral edema d. kidney injury
C.
The physician orders a urine culture on your patient with a UTI. In addition, the patient is ordered to start IV Bactrim. How will you proceed? a. hang antibiotic, then collect urine sample. b. hang antibiotic, once antibiotic is finished collect sample. c. collect urine sample, then hang antibiotic. d. collect urine sample, hold antibiotic until urine culture is read from lab.
C.
To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. the presence of blood in the urine. b. any erectile dysfunction (ED). c. occurrence of a weak urinary stream. d. lower back and hip pain.
C.
Which of the following is a contributing factor of hyponatremia? a. heat stroke b. impaired renal function c. SIADH d. diabetes insipidus
C.
Respiratory Acidosis
CO2 retention *increased intracranial pressure* *aim to improve ventilation*
A female client in an outpatient clinic is being sent home diagnosed with a UTI. Which instruction should the nurse teach to prevent recurrence of a UTI? a. clean the perineum from back to front after a BM b. take warm tub paths instead of hot showers daily c. void immediately preceding sexual intercourse d. avoid coffee, tea, colas and alcoholic beverages
D.
A patient who has been treated with uric acid for stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient? a. low calcium diet b. high protein diet c. low phosphorus diet d. low purine diet
D.
A patient who is having spasms and burning while urinating due to a UTI, is prescribed Pyridium (Phenazopyridine). Which is a normal side effect of this drug? a. hematuria b. crystalluria c. urethra mucous d. orange colored urine
D.
The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate symptoms? a. antispasmodic agents b. urinary analgesics c. antibiotics d. anticholinergic agents
D.
What clinical indication of hypophosphatemia does the nurse assess in a patient? a. bone pain b. paresthesia c. seizures d. tetany
D.
You're assessing your patients during morning rounding. Which patient below is at MOST risk for developing a UTI? a. 25 year old patient who finished a regime of antibiotics for strep throat 10 weeks ago. b. 55 year old female who is post-op day 7 from hip surgery. c. 68 year old male who is experiencing nausea and vomiting. d. 87 year old female with Alzheimer's disease who is experiencing bowel incontinence.
D.
Potassium (Ka)
Heart - given on death row - abnormal rhythms
Hypermagnesemia medical management
IV calcium gluconate, loop diuretics, IV NS of RL, hemodialysis
Hypocalcemia medical management
IV of calcium gluconate, calcium and vitamin D supplements; diet
Calcium (Ca)
Muscle (heart is a muscle!)
Sodium (Na)
Neuro - fluid balance - brain (LOC change)
T/F - is it okay to push potassium via IV?
No - it could stop someone's heart.
Metabolic Acidosis
Renal failure, diarrhea, low bicarbonate *monitor potassium levels*
T/F - The effects of potassium on ECG are peaked T waves?
True
T/F - avocados, broccoli, dairy products, dried fruit, bananas, lean meats, milk, whole grains, citrus fruits, cantaloupe, melon are all foods high in potassium?
True
T/F - during a hypercalcemic crisis fluid overload for a bit to prevent cardiac issues?
True
T/F - dysphagia is common in magnesium-depleted patients - assess ability to swallow with water before administering food/medications.
True
T/F - hypomagnesemia is often accompanied by hypocalcemia?
True
T/F - loss of chloride occurs with loss of other electrolytes like potassium and sodium?
True
T/F - potassium influences both skeletal and cardiac muscle activity?
True
T/F - tetany a condition that is due usually to low blood calcium (hypocalcemia) and is characterized by spasms of the hands and feet, cramps, spasm of the voice box (larynx), and overactive neurological reflexes.
True
Metabolic Alkalosis
Vomiting/gastric suction *hypokalemia will produce alkalosis*
Hypochloremia manifestations
agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma
Hypomagnesemia causes
alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood; contributing causes include diabetic ketoacidosis, sepsis, burns, hypothermia
Hypernatremia nursing management
assessment and prevention, assess for OTC sources of sodium, *offer and encourage fluids to meet patient needs*, provide sufficient water with tube feedings
Hyponatremia nursing management
assessment and prevention, dietary sodium and fluid intake, identify and monitor at-risk patients, effects of medications (diuretics, lithium)
Hypercalcemia nursing management
assessment bc hypercalcemic crisis has high mortality, encourage ambulation, fluids of 3 to 4 L/d, provide fluids containing sodium unless contraindicated, fiber for constipation, ensure safety
Hypocalcemia nursing management
assessment bc severe hypocalcemia is life-threatening, weight-bearing exercises to decrease bone calcium loss, patient teaching related to diet and medications, and nursing care related to IV calcium administration
Hyperkalemia nursing management
assessment of serum potassium levels, mix IVs containing K+ well, monitor medication effects, dietary potassium restriction/dietary teaching for patients at risk
Hypochloremia nursing management
assessment, avoid free water, encourage high-chloride foods, patient teaching related to high-chloride foods
Hypermagnesemia nursing management
assessment, do not administer medications containing magnesium, patient teaching regarding magnesium-containing OTC medications
Hypokalemia nursing management
assessment, severe hypokalemia is life-threatening, monitor ECG and ABGs, dietary potassium, nursing care related to IV potassium administration
FVE causes
due to fluid overload or diminished homeostatic mechanisms
Hyperkalemia manifestations
cardiac changes and dysrhythmias, muscle weakness with potential respiratory impairment, paresthesias, anxiety, GI manifestations
FVE manifestations
edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased BP, pulse pressure, increased weight, increased UO, *SOB, wheezing*
Foods high in calcium
dairy products, canned salmon, sardines, fresh oysters, dark leafy green vegetables
FVD risk factors
diabetes insipidus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, third-space shifts
Hypomagnesemia medical management
diet, oral magnesium, magnesium sulfate IV
Routes of Gains
dietary intake of fluid and food or enteral feeding; parenteral fluids (IV fluids)
Hypernatremia causes
excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions
Hypokalemia manifestations
fatigue, anorexia, nausea, vomiting, *dysrhythmias*, *muscle weakness/changes*, cramps, paresthesias, glucose, intolerance, decreased muscle strength, deep tendon reflexes (DTRs), decreased cardiac output
Hypermagnesemia manifestations
flushing, lowered BP, nausea, vomiting, hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias
Respiratory Alkalosis
hyperventilation
Hypocalcemia causes
hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications
Hypernatremia medical management
hypotonic electrolyte solution or D5W
Hypokalemia medical management
increased dietary potassium, potassium replacement, IV for severe deficit
Normal saline
isotonic - doesn't shift electrolytes
Hypercalcemia causes
malignancy and hyperparathyroidism, bone loss related to immobility
Hyperkalemia medical management
monitor ECG, cation exchange resin (Kayexalate), IV sodium bicarbonate, IV calcium gluconate, regular insulin and hypertonic dextrose IV, limit dietary potassium and perform dialysis
FVD nursing management
monitor I&O, administer oral & parenteral fluids, provide oral care, monitor skin/tongue turgor, mucosa, urinary output, and mental status
Hypercalcemia manifestations
muscle weakness, incoordination, anorexia, constipation, nausea and vomiting, abdominal and bone pain, polyuria, thirst, ECG changes, dysrhythmias
Hypophosphatemia management
oral or IV phosphorus replacement assessment, encourage foods high in phosphorus, gradually introduce calories for malnourished patients receiving parenteral nutrition
FVD medical management
provide fluids to meet body needs (oral fluids/IV solutions)
FVD manifestations
rapid weight loss, decreased skin turgor, oliguria, concentrated urine, *orthostatic hypotension*, rapid weak pulse, increased temperature, cool clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness, cramps
Hypermagnesemia causes
renal failure, diabetic ketoacidosis, excessive administration of magnesium
Hypochloremia medical management
replace chloride-IV NS or 0.45% NS
Hypercalcemia medical management
treat underlying cause, administer fluids, furosemide, phosphates, calcitonin, biphosphonates
FVD causes
vomiting, diarrhea, GI suctioning, sweating, decreased intake, hemorrhaging, GSW, burns, marked ascites, third spacing
Hyponatremia causes
water intoxication, loss by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency
Hyponatremia medical management
water restriction, sodium replacement