NURS 241- Exam 1 Psychosis, electrolytes, fluid balance, & HF
What are signs & symptoms of hypokalemia <3.5 vs hypoerkalemia >5?
Hypokalemia: -weakness -tirednress -cramping -lot of muscle involvement Hyperkalemia: -numbness, tingling Both: -palpitations, arrythmia -N/V
What term describes a medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts, or other pathological processes
Fluid replacement/resuscitation *hypotonic, hypertonic, isotonic
Psychosis is the dysregulation of which NT transport systems between the limbic system and prefrontal cortex?
Dopamine
Match the following with either a) LSHF or b) RSHF 1) paroxysmal nocturnal dyspnea 2) anorexia & complaints of GI distress 3) cough 4) crackles 5) wheezes 6) blood tinged sputum 7) JVD 8) confusion 9) restlessness 10) hear S3/extra heart sounds 11) ascites 12) enlarged liver or spleen 13) cyanosis 14) orthopnea 15) dependent edema 16) swelling in hands, fingers, + feet 17) exertional dyspnea 18) fatigue
*Left sided HF:* 1) paroxysmal nocturnal dyspnea 3) cough 4) crackles 5) wheezes 6) blood tinged sputum 8) confusion 9) restlessness 10) hear S3/extra heart sounds 13) cyanosis 14) orthopnea 17) exertional dyspnea *Right sided HF:* 2) anorexia & complaints of GI distress 7) JVD 11) ascites 12) enlarged liver or spleen 15) dependent edema 16) swelling in hands, fingers, + feet 18) fatigue
What symptoms would indicate extreme version of HF aka pulmonary edema? What is the treatment?
*Symptoms*: -confusion or restlessness -fast worsening crackles from bottom to top -wheezes in lung sounds -pink, frothy sputum -cough, SOB *Treatment*: -HOB upright -O2 therapy ex: 50% venturi mask or nonrebreather -give nitro to reduce preload -give IV diuretic like furosemide (NOT PO)
What are nursing implication & adverse effects of SA node modulators like Ivabradine?
-don't use with arrhythmia -might be used with beta blockers -used in NYHA class 2 or 3
What acronym is used for self management teaching of HF? *refer to Table 35-4
-*(M)edications*: take as prescribed, know purpose & side effect, avoid NSAIDS to prevent Na+ & fluid retention -*(A)ctivity*: stay as active as possible, don't overdo it, know your limits, be able to carry convo while exercising -*(W)eight*: weight each day at same time on same scale -*(D)iet*: limit daily Na+ intake 2-3g, limit daily fluid intake 2L -*(S)ymptoms*: note any new or worsening symptoms & notify HC provider
What are the stages of AHA CHF sages?
-*Stage A*: at risk for developing HF; need lifestyle modifications (diet, weight loss, exercise); treat comorbidities (HTN, DM, hyperlipidemia, & afib) -*Stage B*: asymptomatic with structural heart defects; continue treating comorbidities; add treatment for reduced EF pts only (beta blockers, ACEI, ARBS, ICD) -*Stage C*: symptomatic; prior of current symptoms of HF; continue treating comorbidities; educate on self care (restrict salt & HF symptoms) -*Stage D*: refractory or advanced HR; advanced therapies like LVAD, heart transplant; end of life treatment goals
What are the causes of initial irritation and changes in blood vessels, leading to the development of HF?
-*chronic HTN* (r/t changes in structure & flexibility of vessels & tissue) -valve problems (ex: mitral regurgitation; r/t increased afterloud) -MI -fluid overload -kidney failure (r/t increased preload) -CAD; atherosclerosis; arteriosclerosis -advancing age -DM -smoking/tobacco use -obesity -hyperlipidemia -blacks
What assessment findings indicate possible HF?
-*dyspnea on exertion* -*initial increase in HR* (w/ new diagnosis from compensation) -*orthopnea* or dyspnea at night -*change in ability to perform ADL's*, exercise intolerance, shortness in breath -*generalized edema of feet AND hands*, sock marks, shoes don't fit -*confusion* w worsening HF/pulmonary edema -*Rales* in lungs w LSHF -*JVD* w RSHF
What labs & test will the nurse assess for pt with suspected HF?
-*xray* to rule out structural stuff like pneumonia -*echo* for EF, how well valves open & close -*ECG* to look for palpitations, irregularities, or rhythm changes -*stress test* to look at heart function under stress -*BNP* -*Tumor Necrosis Factor* newer screening marker where sells release this checmical under changes from stress
Commonly used drug classifications for pts with systolic HF? *refer table 35-3
-ACE inhibitors -ARBs -diuretics -human BNP -nitrates -inotropics ex: digoxin -beta blockers -phosphodiesterase inhibitors -ARNI ex: sacubiril/valsartan -aldosterone antagonist ex: spiranolactone -SA node modulator ex: ivabradine
What should the nurse do if they suspect that the pt is having a delusion/ *ex: I am being followed by the government
-Assess for safety concerns r/t the delusion (ex: pt believes staff is attempting to harm them) -distract the pt w reality-based activities -don't argue bc strengthens their beliefs
What are the 4 classess of NYHA HF? *must know!
-Class 1: no limitation of physical activity; ordinary activity doesn't cause fatigue, SOB, etc -Class 2: slight limitation of physical activity; comfortable at rest; ordinary activity results in fatigue, palpitation, SOB -Class 3: marked limitation of physical activity; comfortable at rest; less than ordinary activity causes fatigue, palpitation, or SOB -Class 4: unable to carry out any physical activity w/out discomfort; symptoms of fatigue, palpitation, & SOB at rest
What is another term for diastolic HF where the ventricles do not relax as they should during ventricular filling? What about systolic heart failure where the heart muscle does not contract effectively & less oxygen rich blood is pumped out of the body?
-Diastolic heart failure= Preserved ejection fraction (HFpEF) -Sytolic heart failure= Reduced ejection fraction (HFrEF)
What education should be provided for care of pt with HF?
-HF med education, language, & education barriers -lots of teach back time -enlist other family members, friends, & support people -daily weight at home -daily HR at home -diet recall & teaching -home care checks -wellness phone calls/follow up -classes including exercise classes -helpful apps ex: HR checker w apple watch; reminder on phone to take daily weight; app to enter food to track Na+, calories, & nutrients
What are common causes & risk factors of HF? *table 35-1
-HTN -CAD -cardiomyopathy -substance abuse (alcohol & illicit/prescribed meds) -valvular disease -congenital defects -cardiac infections & inflammations -dysrhthmias -DM -smoking/tobacco use -family hx -obesity -severe lung disease -sleep apnea -hyperkinetic conditions ex: hyperthyroidism
Why does RSHF usally occur from LSHF?
-LSHF causes increased fluid pressure that is transferred back through the lungs, ultimately damaging the heart's right side -when right side loses pumping power, blood backs up in the body's veins -causes swellling in the legs & ankles
Why is MI a risk factor for developing HF?
-MI causes death of tissue, causing cells to change known as heart remodeling -ex: ventricular remodeling in diastolic & systolic HF, the heart tries to overcome that stress & walls get thicker; these new cells go through apoptosis & end up with hypertrophied heart with less room to fill
What are the 3 ranges for Ejection Fraction (EF)?
-Normal 50-70% -Borderline 41-49% (symptoms include SOB possibly during rest) -reduced <40% (symptoms noticeable at rest)
What are the inpatient nursing interventions of HF?
-O2 -ECG rhythm -VS: HR, BP, RR -urine output; daily weight; I&O -track electrolytes: Na+ & K+ -plan activity; provide rest -IV morphine -anticipate diuretics -anticipate inotropes like dig -anticipate vasodilators -anticipate nitrates -pt ed on meds, weights, diet & exercise -follow up
What is a way to remember meds that are typical antipsychotics (1st gen) vs atypical antipsychotics (2nd gen)?
-Typical: haloperidol and end in suffix "azine" -Atypical: end in suffix "apine" or "idone" ex: olanzapine, quetiapine, risperidone, & ziprasidone
What are the biggest downfalls of using a typical antipsychotic vs atypical?
-Typical: more likely EPS -Atypical: more likely gain weight, metabolic syndrome (HTN, elevating fasting BG, increased abd girth, dyslipidemia)
What are examples of colloid solutions?
-albumin (plasma protein) -dextran (synthetic) -hetastarch (synthetic) -mannitol (use for changes in ICP) *moves fluids back into vasculature such as shock, hemorrhage, or trauma pts
What should be done before diagnosing a pt w schizophrenia?
-assess & lof accumulation of symptoms for >1 mos to 6 mos -rule out changes or trauma w CT or MRI -rule out delirium or dementia -rule out infection or autoimmune disorder -rule out electrolyte imbalance or vitamin deficiency -look at meds & rule out toxicity -*look for stress markers in blood - 'oxidative' stress*
What are nursing implication & adverse effects of diuretics like furosemide or hydrochlorothiazide?
-can lower BP -do not double dose if missed -monitor electrolytes -weight daily
What are nursing implication & adverse effects of aldosterone antagonist like spiranolactone?
-can raise K+; monitor & teach diet -used with myasthenia gravis -monitor renal pts
What are nursing implication & adverse effects of ACE inhibitor like captopril or lisinopril ?
-caution with renal failure -use with other CHF meds -causes cough and dizziness -space out from beta blockers -watch extra K+ intake
What are the pt & family education about what they have to cope with?
-chronic disease -occurs over time & gets worse -financial burden -depression -can affect work, travel, & quality of life -support whole family -pt needs to check in on symptoms frequently -daily plans for self care -needs follow up from Drs, nurses, pharmacists, dietitians, exercise, physiologists, & psychological support for coping -foal is to reduce re-admissions (recidivism)
What assessments should the nurse provide to evaluate fluid & electrolyte status?
-cognition & neuro status (ex: A&O) -neuro responses & cellular regulation -muscle assessment & mobility (ex: twitches, tremors, weakness, hyperactive reflexes) -elimination (ex: stool changes, wound drainage, vomiting) -ciruclation & perfusion (ex: VS like HR & BP)
What key features of pulmonary edema? *refer chart 35-3
-crackles -dyspnea at rest -disorientation or acute confusion -tachycardia -HTN -hypotension -reduced urinary output -cough with frothy, pink-tinged sputum -PVC & other dysrhythmias -anxiety -restlessness -lethargy
What are s/s of dig toxicity? *can occur with too much drug, tolerance to drug over time, or as a complication of regular doses of drug (think renal failure when electrolytes get screwed up)
-decreased HR -confusion -irregular pulse or rhythm -decreased LOC *treat dig toxicity with activated charcoal stomach lavage or IV dig binders like digibind
What underlying medical illnesses can manifest in symptoms of psychosis?
-deficiencies -vitamin A & D deficiency -magnesium deficiency -infection -autoimmune disorders -toxins -CVA/stroke -MS -lyme disease -encephalitis -sarcoidosis *when assessing pt for psychosis, rule out these other explainable & fixable causes first
What may cause toxic psychosis in an pt?
-deficiencies -infections -autoimmune disorders -toxins
What are overall symptoms for pt with schizophrenia?
-delusions -disorganized thinking -hallucinations -agitation -disturbed sleep -anxiety -poor memory -anger -disorganized speech -catatonic behavior (withdrawal of emotional response) -inappropriate behavior (ex: childlike, laughing for no reason) -social withdrawal -apathy -lack of initiative or drive'-lack of emotional response -depression
What are examples of negative symptoms of schizophrenia? *too little dopamine is present
-disturbances in affect: inappropriate, bland, or flat -affective flattening -anhedonia (lack of interest) -alogia -apathy -avolition -lack of interest or skill in interpersonal interaction -anosognosia (lack of insight) -anergia -concrete thinking (lack of abstract thinking) -dysphoria -suicidality -helplessness -waxy flexibility -posturing -pacing & rocking regression -eye movement abnormalities
What meds are available for treatment of HF?
-diuretics ex: furosemide, hydrochlorothiazide -ARBS ex: valsartan, candesartan -vasodilators ex: nitro -ACE inhibitors ex: captopril; lisinopril -inotropes ex: digoxin -beta blockers ex: meteprolol, carvedilol -ARNI ex: valsartan/sacubritril -SA node ex: Ivabradine
What pharmocological treatment can impact electrolytes? (positive or negative effects)?
-diuretics ex: loop, thiazide, potassium sparing -K+ replacement ex: K-Dur -K+ correction ex; Kayexalate -Mg replacement (PO or IV) -Ca+ replacement ex: calcium gluconate and calcitriol -ATB -corticosteroids -hormones -chemotherapy
What are nursing implication & adverse effects of ARNI's like valsartan/sacubitril?
-do not give with angioedema -decreases hospitalizations -do not give with other CHF meds -used in NYHA class 2 or 3
What are nursing implication & adverse effects of Inotropes like digoxin?
-increases renal BF :) watch with renal failure :( -mild diuretic :) monitor K+ :( -monitor rhythm for heart blocks -have parameters to hold; teach them! ex: HOLD <60 bpm -slow rapid ventricular rate so heart pump easier; keep HR around 60 -DO NOT USE w ventricular rhythms, kidney impairment, or electrolyte imbalance -low K+ increases risk of dig toxicity -can interact with calcium channel blocker like verapamil or antiarrhythmics like amiodarone -if dig toxicity is suspected, assess lab level, check and give K+, correct fluids, check kidney function -if dig toxicity; treat with activated charcoal stomach lavage or IV digoxin binders like digibind
What are examples of psychiatric treatment that can be recommended for pt with schizophrenia?
-individual therapy -group therapy -social skills training -family therapy -support group
How does the body compendate in CHF?
-initial HR increase -SNS activated -sustained higher HR doesn't allow time for heart to fill -cells will change in response to stress & stretching (apoptosis) -too much stretching over time decreases force of contraction -vessels constrict to help perfusion, but this increases afterload :( -further remodeling of cells and tissues occurs over time :( can be irreversible
What are some general causes/people at an increased risk of electrolyte imbalances?
-kidney disease -not replenishing electrolytes or staying hydrated adfter exercise -prolonged periods of vomiting or diarrhea -poor diet -severe dehydration -acid base imbalance -CHF -cancer treatment -medications ex: diuretics -bulimia -older adults
What BNP level indicates: 1) NO HF 2) suggests HF present 3) mild HF 4) moderate HF 5) severe HF
-level below 100= NO HF -levels of 100-300= suggests HF present -levels above 300= mild HF -levels above 600= moderate HF -levels above 900= severe HF
What are the goals/outcomes for CHF?
-manage symptoms & allow for ADLs -meds & treatment maximize heart function (not reversible or cure) -underlying cause will be treated & minimized (ex: HTN, smoking, vessel problems) -interdisciplinary team will monitor pt status closely -maintain self care in diet, meds, activity, & reducing risk (ex: taking HTN meds, lose 20 lbs) -avoid re-admittance -avoid home exacerbation
What is the nursing assessment for pt with suspected schizophrenia? (hx & PA)
-medical, mental health, substance abuse, family/genetic, & birth hx -coping strategies & support systems -CN assessment -apperance -behavior -mood -speech -thought process -cognition -judgment & daily tasks *rule out underlying causes
What are nursing implication & adverse effects of ARBS like valsartan & candesartan?
-not as many side effects as ACEI -can chave dizziness -avoid extra K+ -don't double up if missed dose -can be used if intolerant to other CHF meds
What are the guidelines to control pts with schizoprenia's behavior & prevent injury to themself, staff, & others? *refer to nursing procedures & skills: schizophrenia pt care
-remove potentially dangerous objects (1st thing to do) -be honest & genuine -be straightforward, nonthreatening -use simple, concrete subjects -never argue -don't support their miscperceptions -reassurance only if you've done this before and know that it's safe! :)
What are the guidelines for peripheral IV potassium treatment?
-replace 20-60 mEq gradually in 24 hrs -Max IV rate is 20 mEq per hour -do not administer too fast or can have arrythmias -IV K+ burns veins so dilute with a mainline IV & run slowly
What physcial assessments techniques will the nurse use for assessment of pt HF?
-resp sounds, lung sounds -O2 status -presence of edema -activity intolerance/ADL's -daily weight & fluid status -I&O -peripheral circulation/pulses -assess for JVD
What is the home care assessment for pt with HF? *refer to Chart 35-4
-s/s of changes in VS (HR >100, new afib, BP <90 or >150 systolic) -indications of poor tissue perfusion: fatigue, angina, activity intolerance, changes in mental status, pallor or cyanosis, cool extremities -indications of congestion: presence of cough or dyspnea, weight gain, JVD, & peripheral edema -assess functional ability like performance of ADL, mobility & ambulation, & cognitive ability -assess nutritional status like food & fluid intake, intake of Na+ rich foods, alcohol consumption, skin turgor -assess home environment like safety hazards, esp. r/t O2 therapy, structural barriers, affecting functional ability, social support -assess pts adherence like s/s to report to HC provider, dosages, effects, & side or toxic effects of meds; use of home oxygen; presence of advance directive; accurately weigh self; when to report for labs -assess pt & caregiver coping skill
What interventions should be provided for pt with schizophrenia?
-safety ex: assess for suicidal ideation, protect from self harm -add therapeutic meds ex: 1st or 2nd antipsychotics -remove nontherapeuric meds ex: help treat substance abuse -psychiatric treatment ex: individual therapy, group therapy, social skills training, family therapy, support group -home support ex: home health aide
What are potential side effects of Atypical Antipsychotics (2nd gen) like meds ending in "-apine" or "-idone"?
-sedation -orthostatic hypotension -anticholinergic ex: dry mouth, urinary retention, constipation -*lower risk of EPS* -*weight gain r/t insulin resistance & carb craving* -*metabolic syndrome: increased abd girth, dyslipidemia, HTN, elevated fasting glucose* *fall precautions; timing of med r/t sedation, anticholinergic effects; teach importance of diet, exercise, BP monitoring; request lipid panel
What are potential side effects of Typical Antipsychotics (1st gen) like haloperidol (Haldol) and meds ending in "-azine"?
-sedation -orthostatic hypotension -anticholinergic ex: dry mouth, urinary retention, constipation -elevated prolactin ex: gynecomastia or galactorrhea -EPS ex: involuntary muscle spasms (dystonia) of the neck (torticollis), eyes (oculogyric crisis), & airway *pt should be monitored for falls, time med if pt has sedation, give anticholingergics if EPS, and help w anticholinergic effects like dry mouth, urinary retention, or constipation
Assessment of fluid status done through the assessment of what? *include labs
-skin -daily weight -stool -urine -presence of edema -heart sounds -lung sounds -pulses -BUN & creat -H&H -Na+ -GFR -SpecGravity -serum & urine osmolality *remember for labs high & dry: pt who is FVD will have increased labs
What are nursing implication & adverse effects of beta blockers like carvediolol or meteprolol?
-take with food -can cause dizziness -space away from other meds -don't double up if dose missed
What are risk factors for schizophrenia?
-winter or spring birth -urban environment -pschological factors -sociocultural factors ex: downward drift hypothesis -stressful life events -cannbis use -family hx ex: siblings risk, parent risk -Pregnancy or birth complications ex: hypoxia, greater paternal age -viral infection -malnutrition -maternal DM
What type of people are more likely to have schizophrenia?
-younger adults -white caucasians -less educated; or college population -low income <$25,000 -unemployed
What IV solution is a hypotonic crystalloid solution of sodium chlorids dissolved in sterile water, administered to treat hypernatremia or DKA?
0.45% Normal Saline (NS)
What is one of the most ocmmon IV flujids, administered for most hydration needs like: -hemorrhage -vomiting -diarrhea -drainage from GI suction -metabolic acidosis -shock
0.9% Normal Saline (NS)
How does the nurse calculate dehydration fluid losses and need for that replacement?
1% or more of body mass of lost fluid ex: 200 lbs - 1%= 198 lb so 2 lbs were lost & 2.2lbs= 1 L= 1,000 ml needs to be replaced over 24 hrs or 42 mls/hr
What are the 2 types of meds used to treat schizophrenia? *may consider ECT
1) 1st gen antipsychotic -dopamine receptor blocker -"conventional" -many side effects -cause cause EPS like parkinsonism, acute dystonia, akathisia, and Tardive Dyskiensia -ex: haloperidol (halidol) & clozapine -haloperidol dose NOT aid cognitive dysfunction 2) 2nd gen antupsychotics "atypical" -less likely to cause EPS and TD -higher risk for metabolic effects ex: weight gain, DM, dyslipidemia, cardiac changes -increased risk of death when used to treat dementia -ex: riperidone, olanzipine, ziprazedone, apriprazole
Match the following MOA with HF med: 1) blocks constriction of vessels; lowers BP; decreases cardiac workload; can be used if intolerant to to other CHF meds 2) reduces Na+ and fluid in body; increases urine outputl lowers K+ 3) inhibits Na+; more Ca+ available; reduced conduction velocity; slows HR; improves pumping (contractility) 4) can replace other CHF meds; used in NYHA class 2 or 3 CHF; helps breakdown cycle of BNP 5) helps body metabolize salt & water; dilates vessels to help blood flow; decreases mortality; use cautiously with renal failure; used with other CHF meds 6) reduces HR by slowing conduction; used in NYHA class 2 or 3 7) blocks Na+; lowers BP; can have cardiac protective effect; used in severe HR; K+ sparing diuretic
1) ARBs ex: valsartan or candesartan 2) Diuretic ex: furosemide or hydrochlorothiazide 3) Inotropes ex: digoxin 4) ARNI ex: valsartan/sacubitril 5) ACEI ex: captopril or lisinopril 6) SA node modulator ex: Ivabradine 7) aldosterone antagonist ex: spiranolactone 8) beta blocker ex: carvediolol or metoprolol
Answer the following questions regarding calcium treatment: 1) What is the med used for oral replacement? 2) What med can interfere with calcium? *space them out!* 3) What is the med used for IV replacement
1) Calcium carbonate 2) Beta blockers ex: propranolol (atenolol) 3) calcium chloride (best in shock) or calcium gluconate (less corrosive to veins) *Give carefully! Have pt on cardiac monitor! Check VS!
What are the normal values for the following labs: 1) Sodium 2) Potassium 3) Serum Calcium 4) Ionized Calcium 5) Magnesium 6) serum osmolality 7) urine specific gravity 8) BUN 9) Creatinine 10) Hgb 11) Hct
1) Na+ 135-145 2) K+ 3.5-5 3) Ca+ 9-10.5 4) IonCa 4.64-5.28 5) Mg 1.2-2.1 6) serum osmolality 280-300 7) SpecGravity 1.003-1.030 8) BUN 6-25 9) Creat 0.5-1.2 10) hgb men 13.5-17.5 /or/ women 12.5-15.5 11) hct men 38.8-50 /or/ women 34.9-44.5
Antipsychotics meds can cause adverse effects like EPS (esp 1st gen). Match the following examples of EPS symptoms 1) abnormal, involuntary muscle movements like writhing wormlike movements of tongue & face, lip smacking, tongue thrusts 2) bradykinesia, mask-like faces, drooling, tremors, rigidity, shuffling gair, cog-wheeling 3) involuntary, sustained muscle spasms. develops in 1st few days, severe spasm of facial/neck/back muscle causing joint dislocation 4) restlessness, pacing, squirming 5) rare but serious, "lead pipe" rigidity, sudden high fever, sweating, autonomic instability, dysrhythmias, seizures, coma
1) Tadive Dyskiensia (can be permanent so prevent w lowest dose or switch to SGA) 2) Parkinsonism (treat w benztropine or diphenhydramine; switch to SGA) 3) Acute dystonia (laryngeal dystonia can cause resp distress; treat w benztropine, diphenhydramine IM or IV) 4)Akathisia (treat w beta blocker, benzodiazepine, anticholinergic) 5) neuroleptic malignant syndrome
What 3 things change for a person with psychosis?
1) affectice response 2) communication 3) relationships with others
1) What disorder causes narrowed arteries in the heart from plaques? 2) What disorder causes stiff, unresponsive vessels? *both gradually leave the heart too weak or stiff to fill & pump effieciently
1) atheroscelorisis 2) arteriosclerosis *heart muscle can change thickness as a response to chronic disease/inflammation & that can impact filling and squeezing
Match the following HF meds to their usual doses: 1) 4mg start; 32mg 2) 2.5-5mg start; 20-35mg 3) 40 mg start; 160mg BID 4) 100-200 mg BID 5) 3.125-20mg BID 6) 0.25-1.5mg 7) 10-40mg BID 8) 25-100mg 1-3x/day 9) 6.25-12.5mg TID start; 25-50mg TID 10) 5mg BID 11) 50-100mg 12) 25-200mg
1) candesartan: 4mg start; 32mg 2) lisinopril: 2.5-5mg start; 20-35mg 3) valsartan: 40 mg start; 160mg BID 4)valsartan/sacubitril: 100-200 mg BID 5) carvediolol: 3.125-20mg BID 6) digoxin: 0.25-1.5mg 7) furosemide: 10-40mg BID 8) hydrochlorothiazide: 25-100mg 1-3x/day 9) captopril: 6.25-12.5mg TID start; 25-50mg TID 10) Ivabradine: 5mg BID 11) metoprolol: 50-100mg 12) spironolactone: 25-200mg
What are the following HF meds usual doses: 1) capto*pril* {ACEI} 2) lisino*pril* {ACEI} 3) val*sartan* {ARBS} 4) cande*sartan* {ARBS} 5) carvedi*lol* {beta blocker} 6) metopro*lol* {beta blocker} 7) furosemide {diuretic} 8) hydrochlorothiazide {diuretic} 9) valsartan/sacubitril {ARNI} 10) Ivabradine {SA node modulator} 11) digoxin {inotropes} 12) spironolactone {aldosterone antagonist}
1) captopril: 6.25-12.5mg TID start; 25-50mg TID 2) lisinopril: 2.5-5mg start; 20-35mg 3) valsartan: 40 mg start; 160mg BID 4) candesartan: 4mg start; 32mg 5) carvediolol: 3.125-20mg BID 6) metoprolol: 50-100mg 7) furosemide: 10-40mg BID 8) hydrochlorothiazide: 25-100mg 1-3x/day 9) valsartan/sacubitril: 100-200 mg BID 10) Ivabradine: 5mg BID 11) digoxin: 0.25-1.5mg 12) spironolactone: 25-200mg
Fill in the blanks: When a person is dehydrated & electrolytes are imbalanced. The body is stressed & cognitive function is impaired. The blood becomes (1)_____ signaling for the kidneys to (2)______ which causes urine output to (3) ______. The blood becomes (4) ____ causing the heart to work (5)____ and the pulse to (6)____ to maintain (7)____
1) concentrated 2) retain water 3) decrease 4) thicker 5) harder 6) increase 7) BP *replacing fluids IV resolves imbalance
What are the 5 domains of schizophrenia?
1) delusions 2) hallucinations 3) disorganized thiking 4) disorganized or abnormal motor behavior including catatonia 5) negative symptoms
Match the following with either a) systolic failure or b) diastolic failure 1) left ventricle can't relax & fill normally; can be from muscle being enlarged, stiff, or overgrown/hypertrophied 2) left ventricle can't contract normally; can't pump w enough force to push enough blood into circulation
1) diastolic failure/dysfunction "filling problem" 2) systolic failure/dysfunction "pump problem" *both are types of LSHF
What HF med: 1) removes water 2) aldosterone antagonisis; reverses vasocontstriction 3) for CHF with dyspnea; reduced preload 4) reduces afterload; dilates vessels 5) enhances contractility; helps heart pump more efficiently 6) reverses SNS response; for chronic CHF only! 7) helps break down BNP 8) helps slow HR
1) diuretics 2) ARBs 3) vasodilators 4) ACE inhibitors 5) inotropes 6) beta blockers 7) ARNI's 8) SA node modulators
How often should the nurse... 1) monitor labs? 2) assess pt for + or - signs of electrolyte imbalance? 3) assess pt for + or signs of FVE or FVD? 4) able to identify & apply electrolyte intervention including replacement for each pt?
1) each shift 2) q 4-8 hrs 3) 4-8 hrs 4) each shift
Match the following antipsychotic meds to their usual doses: 1) 0.5-5mg (2-3x/day) 2) 30-300mg (1-3x/day) 3) 2-3mg
1) haloperidol 2) chlorpromazine 3) risperidone
Match the following antipsychotic meds to their usual doses: 1) 0.5-5mg (2-3x/day) 2) 30-300mg (1-3x/day) 3) 2-3mg
1) haloperidol: 0.5-5mg (2-3x/day) 2) chlorpromazine: 30-300mg (1-3x/day) 3) risperidone: 2-3mg
What are the following antipsychotic meds usual doses: 1) haloperidol 2) chlorpromazine 3) risperidone
1) haloperidol: 0.5-5mg (2-3x/day) 2) chlorpromazine: 30-300mg (1-3x/day) 3) risperidone: 2-3mg
Match the following with either a) infiltration, b) local infection (abscess), c) phlebitis, or d) hypothermia 1) ___ when the catheter unintentionally enters the tissue surrounding the blood vessel & IV fluid goes into the tissues 2) ___ inflammation of a blood vessel 3) ___ when large amounts of cold fluids are infused rapidly 4) ___ microscopic organism may use the tiny hole in the skin creased but the IV catheter
1) infiltration (A) 2) phlebitis (C) 3) hypothermia (D) 4) local infection (B) *check IV q 4hrs
Answer the following questions for the values of: 1) normal intake per day? 2) normal output per day? 3) normal insensible loss per day? 4) what urine output per day is considered oliguria? 5) 100 mL of ice is how much fluid? 6) % of body mass lost as fluid with dehydration?
1) intake 2,000 ml/day 2) output 800-2,000 ml/day 3) insensible loss 1,100 ml/day 4) oliguria <500 ml/day 5) 100 mL ice=50 mL fluid 6) 1% or more of body mass ex: 200 lbs - 1%= 198 lb so 2 lbs were lost & 2.2lbs= 1 L= 1,000 ml needs to be replaced over 24 hrs or 42 mls/hr
Match the following sources of food with the proper electrolyte 1) dill pickles, tomato juices/sauces/soups, & table salt 2) potatoes with skin, plain yogurt, & banana 3) halibut, pumpkin seeds, & spinach 4) yogurt, milk, ricotta, collard greens, spinach, sardines, & kale
1) sodium (1,500 mg) 2) potassium (4,700 mg) 3) magnesium (320-420 mg) 4) calcium (1,000 mg)
What are the 2 types of LSHF?
1) systolic failure/dysfunction (left can't contract normally) 2) diastolic failure/dysfunction (left can't relax & fill)
Answer the following with either a) true or b) false about schizophrenia 1) is a collection of symptoms that distances society from the pt & society from pt 2) is the inability to tell what is real & what is not 3) is combination of cognitive/thought and affective/emotional symptoms 4) is a split personality 5) there are both positive & negative symptoms
1) true 2) true 3) true 4) false! 5) true
What is the normal insensible loss each day without illness or injury? *ex: breathing or sweating
1,100 mL per day *remember 1,000 mL = 1 L = 1 kg = 2.2 lbs
Sodium level should not be raised more than what level in 24 hours? Why?
10 mEq/L bc risk for cerebral edema or paralysis from osmotic demyelination synrome *monitor labs, HR, BP, and mental status
What IV solution is a crystalloid that is both hypotonic then isotonic, administered for hypernatremia & to provide free water for the kindeys?
5% Dextrose in water
The nurse is caring for a client who is receiving intravenous (IV) magnesium sulfate. Which assessment parameter is critical? A) Assessing the blood pressure hourly B) Monitoring 24-hour urine output C) Asking the client about feeling depressed D) Monitoring the serum calcium levels
A) Assessing the blood pressure hourly *Assessing hourly blood pressures is critical when caring for a client receiving IV magnesium sulfate. Hypotension is a sign/symptom of hypermagnesemia during magnesium infusion. Most clients who have fluid and electrolyte problems will be monitored for intake and output, and will not immediately indicate problems with magnesium overdose. Low magnesium levels can cause psychological depression, but assessing this parameter as the levels are restored would not safely assess a safe dose or an overdose. Although administration of magnesium sulfate can cause a drop in calcium levels, this occurs over a period of time and would not be the best way to assess magnesium toxicity.
A 25-year-old man is admitted to the psychiatric unit after being found by the police walking naked down the middle of the street at 3:00 AM. He insists that he is the real Santa Claus. Which of the following nursing interventions should the nurse implement when working with this patient? A) Consistently use the patient's name. B) Point out to the patient why he cannot be Santa Claus. C) Agree that he is Santa Claus so as not to upset him further. D)Provide medication as needed (PRN). *The patient needs continuous reality-based orientation, so his name should be used in all interactions with the nurse and other staff. The nurse should not reinforce the delusion by agreeing with the patient. Logical arguments and PRN medication are not likely to change his thinking.
A) Consistently use the patient's name. *The patient needs continuous reality-based orientation, so his name should be used in all interactions with the nurse and other staff. The nurse should not reinforce the delusion by agreeing with the patient. Logical arguments and PRN medication are not likely to change his thinking.
The nurse is assessing a client with a sodium level of 118 mEq/L (118 mmol/L). Which activity takes priority? A) instructing the client not to ambulate without assistance B) Monitoring urine output C) assessing deep tendon reflexes D) encouraging sodium rich fluids and foods throughout the day
A) instructing the client not to ambulate without assistance *Safety is the priority in this instance. Instructing the client not to ambulate without assistance is the priority for a client with a sodium level of 118 mEq/L (118 mmol/L). This sodium level denotes severe hyponatremia which makes depolarization slower and cell membranes less excitable. This is manifested as general muscle weakness which is worse in the legs and arms. Additionally, this client may have developed confusion from cerebral edema. Monitoring urine output needs to be done but is not the priority action in this situation. Generally, fluid is restricted, rather than sodium rich foods offered, to minimize the hyponatremia. While the nurse may assess muscle strength and deep tendon reflex responses, safety is the priority.
What HF med helps the body metabolize salt & water, dilates vessels to help blood flow, and decreases mortality?
ACE inhibitor like captopril or lisinopril *caution with renal failure; use with other CHF meds; causes cough and dizziness; space out from beta blockers -watch extra K+ intake,
What med can replace other CHF meds & is used in NYHA class 2 or 3 CHF bc it helps in breakdodwn cycle of BNP
ARNI like valsartan/sacubitril *SA node modulators like ivabradine also used NYHA class 2 or 3, but its MOA is reducing HR by slowing conduction
What term describes a negative symptom of psychosis characterized by difficulty in speaking?
Alogia
What term describes a negative symptom of psychosis characterized as a lack of interest and absence of caring or thought;
Anhedonia *negative symptom
True or false: BNP of 550 is not concerning ,bc level does not induicate HF
False! Above 100 suggests HF and so pt has mild HF bc level between 300-600
EPS is more likely with the use of typical antipsychotics (1st gen) like haloperidol (haldol) or meds ending in "-azine". What may be ordered to treat these symptoms?
Anticholinergic agents like benztropine (Cogentin) or diphenhydramine (Benadryl) *use IM if emergency or PO if know pt is susceptible
What should the nurse do if they suspect that the pt is having a hallucination? *ex: tilting head to one side, laughing, or talking to oneself
Attempt to discern content of the hallucinations before providing reassurance to the patient that the hallucinations are not real *ex: "I understand you are hearing voices, but I am not hearing any voices"
What lab test: -secreted from heart in response to changes in pressure & cells with HF -levels increase when HF worsens & decrease when HF stabilized -level is higher in stable HF than person with normal heart function -level below 100= NO HF -levels of 100-300=suggest HF present -levels above 300= mild HF -levels above 600=moderate HF -levels above 900=severe HF
BNP
While watching television, a 28-year-old male patient appears to be hallucinating. He is swearing loudly at the television and is becoming increasingly agitated. Which of the following nursing interventions would be appropriate in dealing with this patient? (select all that apply) A) In a firm voice, tell the patient to stop this behavior. B) Acknowledge the presence of the hallucinations. C) Instruct other team members to ignore the patient's behavior. D) Reassure the patient that he is not in any danger. E) Give simple commands in a calm voice.
B) Acknowledge the presence of the hallucinations. D) Reassure the patient that he is not in any danger. E) Give simple commands in a calm voice. *Using a calm voice and giving simple commands, the nurse should reassure the patient that he is not in any danger. It is not appropriate to tell the patient to stop the behavior, and ignoring the behavior will not reduce his agitation.
A patient injured in an earthquake today when a wall fell on his legs received 9 units of blood an hour ago because he was hemorrhaging. Which laboratory value should the nurse check first when the report returns? A) Serum sodium B) Serum potassium C) Serum total calcium D) Serum magnesium
B) Serum potassium *The patient has two major risk factors for hyperkalemia: massive sudden cell death from a crushing injury (potassium shift from cells into the extracellular fluid) and massive blood transfusion (rapid potassium intake). Although massive blood transfusion may cause calcium and magnesium ions to bind to citrate in the blood, thereby decreasing the physiological availability of those ions, it does not decrease the total calcium or magnesium laboratory measurements. Clinically significant changes in serum sodium are the least likely in this patient.
A 20-year-old male patient diagnosed with chronic schizophrenia is placed on an antipsychotic, 20 mg twice a day. At the evening medication time, he expresses that he is not feeling well. The nurse assesses the patient and finds the following symptoms: oral temperature 103° F (39.4° C), pulse 110 beats/min, and respirations 24 breaths/min. The patient is diaphoretic and appears rigid. This patient is most likely suffering from which of the following? A) Tardive dyskinesia B) Pneumonia C)Neuroleptic malignant syndrome D) Pseudoparkinsonism
C)Neuroleptic malignant syndrome *The symptoms are consistent with neuroleptic malignant syndrome, which is an adverse reaction to antipsychotic medication. While the other conditions listed in answers A and D may also be side effects of antipsychotic medication, the symptoms presented are not indicative of these conditions. Pneumonia may present with these vital signs; however, the diaphoresis and muscular rigidity are not.
If a pt had surgery to remove their thyroid, what electrolyte level should be checked?
Calcium *levels decrease with hypothroid/hypoparathyroidWh
What electrolyte works with phosphorus and magnesium, maintains bone mass & strength, & also binds with albumin?
Calcium *normal total Ca+ 9-10.5 and ionized range 4.64-5.28 (ionized calcium more accurate)
What's the difference between total calcium and ionized calcium?
Calcium: -bound to albumin -low levels by kindey failure or malnutrition -high levels from cancers, bone fractures, too much calcium, or vitamin D Ionized calcium -free or not bound to albumin -more specific -use to check & track calcium replacement more closely if levels can be or are low -low levels caused by vit D deficiency or hypoparathyroidism -high levels by hyperparathyroidism or too much calcium carbonate
What term describes a positive symptom of psychosis characterized as disorganized and abnormal motor behavior?
Catatonioa *positive symptom
What is a red flag bc the pt is much more likely to predisposed and develop HF
Chronic HTN *r/t cahnges in structure & flexibility of vessels and tissue
What type of IV solution contains large particles that remain in the blood vessels, drawing fluid from interstitial space back into the blood vessels with oncotic pressure. The are used less frequently but are for patients unable to tolerate large fluid volumes or are malnourished. *ex: shock, external burns, pancreatitis, peritonitis, post-op albumin loss
Colloids *ex: Albumin, Hespan
What is the red flag that pt with CHF has worsening HF & is developing pulmonary edema?
Confusion!
What is a cristical moment vs worst case scenario for pt with schizophrenia?
Critical moment: -suicidal -non interactive w society -unable to perform ADL's Worst case scenario: -increased symptoms & untreated schizophrenia -delayed treatment makes disease process worse
What type of IV solution contains small particles that pass easily from bloodstream to cells and tissues. According to their tonicity, they make water move into or out of cells by osmosis *ex: hypotonic, hypoertonic, & isotonic solutions
Crystalloids
A patient has acute gastroenteritis with watery diarrhea. Which statement by this patient would indicate that the nurse's teaching has been effective? A) "I should drink a lot of tap water today." B) "I need to take more calcium tablets today." C) "I should avoid fruits with potassium in them." D) "I need to drink liquids with some sodium in them."
D) "I need to drink liquids with some sodium in them." *Sodium-containing fluids are removed from the body by acute diarrhea and must be replaced to prevent an extracellular fluid volume (ECV) deficit. Drinking tap water will not prevent ECV deficit from diarrhea, because tap water does not contain enough sodium to hold the water in the extracellular compartment. Taking calcium tablets is an incorrect answer because hypocalcemia is characteristic of chronic diarrhea rather than acute diarrhea. Restricting fruits is an incorrect answer because diarrhea increases the potassium output and the potassium intake should be increased to balance it.
Indicate whether you should a) DO or b) DON't regarding good communication techniques for pt with psychosis: 1) asking personal questions 2) "you'll get better" 3) share empathy 4)"that was a bad decision" 5) false hope or reassurance 6) being fully present 7) supportive silence 8) approve or disapprove pts statement 9) "it'll be okay" 10) arguing 11) connect with patient 12) paraphrase & validate what they're saying 13) "I understand you see bats, but I'm not seeing bats" 14) share observations 15) "that's not right" 16) changing the subject
DO: 3) share empathy 6) being fully present 7) supportive silence (esp w disorganized thoughts & feelings) 11) connect with patient 12) paraphrase & validate what they're saying 13) "I understand you see bugs, but I'm not seeing bugs" 14) share observations DON'T: 1) asking personal questions 2) "you'll get better" 4)"that was a bad decision" 5) false hope or reassurance 8) approve or disapprove pts statement 9) "it'll be okay" 10) arguing 15) "that's not right" 16) changing the subject
What are examples of positive symptoms of schizophrenia? *too much dopamine is present
Disturbances in thought: -delusions -paranoia -magical thinking Disturbances in perception: -hallucinations -illusions -echopraxia Disturbances in thought manifested in speech: -disorganized speech -loose associations -clang associations -neologisms -word salad -circumstantiality -tangentiality -perseverations -echolalia Disorganized/abnormal motor behavior: -catatonia (abnormal movement)
The diagnosis of HF can be made by using what diagnostic test? What does it look for?
Echocardiogram; it is an external ultrasound to look at the overall structures and valves of the heart to look for akinesia, dyskinesia, hypokienesia, & EF
The diagnosis of HF can be made by using echocardiogram, which is an external ultrasounds to look at the overall structures and valves of the heart. What is it used to measure?
Ejection fraction (EF) to measure heart's pumping effectiveness with a %: -Normal 50-70% -Borderline 41-49% (symptoms include SOB possibly during rest) -reduced <40% (symptoms noticeable at rest)
What term describes minerals that carry a small electric charge ina fluid environment that the body needs to function? What are some examples of the most important?
Electrolytes like sodium, potassium, calcium, & magnesium *keeps cells, tissues, & fluids active & able to communicate w/in our bodies
What term refers to the inherited characteristics passed on from parents to children that make them more likely that they will develop psychosis?
Genomic vulnerability
What are the pts expected outcomes/hope to see for pt with schizophrenia?
Healthy: -normal mood fluctuations, calm & takes things in stride, good sense of humor, performing well -in control mentally, physically & socially active -normal sleep patterns, few sleep difficulties -physically well, good energy level -no or limited alcohol use/gambling Reacting: -irritable, impatient, nervous, sadness, overwhelmed -displaced sarcasm, decreased activity, socializing -procrastination, forgetfulness -trouble sleeping, intrusive thoughts, nightmares, low energy -muscle tension, headaches -regular but controlled alcohol use & gambling Injured: -anger, anxiety, pervasively sad, hopeless -negative attitude, avoidance, withdrawal -poor performance, workaholic, poor concentration/decisions -restless disturbed sleep, recurrent images, nightmares, increased fatigue -increased aches, pains, & fatigue -increased alcohol use/gambling Ill: -abgrey outbutsts, aggression, excessive anxiety, panic attacks, depressed, suicidal thoughts, over insubordination -can't perform duties, control behavior, or concentrate -can't fall asleep or stay asleep, sleeping too much or too little, constant fatigue -physical illness -not going out or answering phone -alcohol, gambling, or other addictions
What type of IV solution is used for hypovolemia, vascular expansion, increased urine output (post op), 3rd spacing, & DKA? It is NOT used for renal or cardiac pts, pulmonary edema, or dehydration
Hypertonic solution *watch for hypervolemia, increase NaCl, extravasian, cellular dehydration, hyperglycemia
What type of Crystalloid IV solution will the extracellular fluid have more solutes than the fluid in the cells? Will water move into or out of cells?
Hypertonic solution *water moves OUT of the cells to the extracellular space
Is the patient hypotonic, hypertonic, or isotonic if they have symptoms like: -thirst -dry mucous memebranes -decreased skin elasticitiy -pale skin color -tachycardia -deceased urine output -postural hypotension -increased hematocrit -elevated BUN and creatinine -N/V -decreased tearing -dry eyes -dry skin w tenting -clear but rapid & shallow respirations, & weak pulses
Hypertonic state *think FVD
What are signs & symptoms of hypocalcemia <9 vs hypercalcemia >10.5?
Hypocalcemia: -impacts muscles, nerves, & heart -hyperreflexia -hyperactive bowel sounds -confusion Hypercalcemia: -tiredness -weakness -lethargy -cardiac rhythm changes -low phosphorus
What is the treatment of hypocalcemia <9 vs hypercalcemia >10.5?
Hypocalcemia: -monitor heart rhythm; tele -monitor VS, esp HR & BP -increase diet with yogurt, cheese, canned fish, nuts & seeds -oral calcium carbonate with vitamin D -replace IV calcium gluconate if very low Hypercalcemia: -monitor reflexes & neuro status -diuretics and saline solution -IV calcitonin -IV hydration; esp if hypovolemic -watch & treat for constipation from high Ca+ Both: -recheck several hrs to overnight
Match the following causes with hypocalcemia vs hypercalcemia? 1) low total calcium w/ low protein 2) hyperparathyroid 3) malnutrition 4) hypothyroid 5) cancer; esp bone cancer or mets 6) fractures or trauma 7) hypoparathyroid 8) total care pts that don't move 9) decreased vitamin D 10) decreased Mg
Hypocalcemia: 1) low total calcium w/ low protein 3) malnutrition 4) hypothyroid 7) hypoparathyroid 9) decreased vitamin D 10) decreased Mg Hypercalcemia: 2) hyperparathyroid 5) cancer; esp bone cancer or mets 6) fractures or trauma 8) total care pts that don't move
What is the treatment for pts with hypokalemia <3.5 vs hyperkalemia >5
Hypokalemia: -add K+ to diet (ex: melon, bananas, green leafy veggies) -replace orally with K-DUR or IV with potassium chloride bolus Hyperkalemia: -give diuretics (PO or IV), kayexelate (PO or rectal) -for critical values give insulin & glucose IV, or dialyze, or bicarb IV Both: -monitor heart rhythm -monitor VS, esp HR & BP -monitor I&O & daily weight -recheck K+ levels w 12 hrs or next morning; q 4-6 hrs if more critical or symptomatic
What are potential causes of hypokalemia <3.5 vs hyperkalemia >5? (can have some that causes both) 1) alkalosis 2) acidosis 3) CKD 4) type 1 DM 5) diarrhea 6) excessive laxative use 7) burns &trauma 8) excessive vomiting 9) ACE inhibitors 10) diuretics 11) bariatric surgery 12) overuse of supplements 13) alcoholism
Hypokalemia: 1) alkalosis (think "low k") 3) CKD 5) diarrhea 6) excessive laxative use 8) excessive vomiting 10) diuretics 11) bariatric surgery 13) alcoholism Hyperkalemia 2) acidosis 3) CKD 4) type 1 DM 7) burns &trauma 9) ACE inhibitors (ex: captopril, enalapril) 12) overuse of supplements
What are potential causes of hypomagnesemia vs hypermagnesemia? 1) high antacid use 2) alcoholism 3) high laxative use 4) DKA 5) malabsorption w bowel surgery 6) meds that harm kindeys ex: ATB
Hypomagnesemia 2) alcoholism 5) malabsorption w bowel surgery 6) meds that harm kindeys ex: ATB Hypermagnesemia: 1) high antacid use 3) high laxative use 4) DKA
What is the treatment for hypomagnesemia vs hypermagnesemia?
Hypomagnesemia: -add Mg to diet (nuts, avocado, whole grains) -replace orally with Mag-Ox or IV magnesium sulfate -monitor renal function & labs Hypermagnesemia: -Give calcium -discontinue Mg containing meds ex: Maalox -monitor muscle involvement Both: -monitor heart rhythm; tele -monitor VS, esp HR & BP -recheck levels in couple hrs
What are the signs & symptoms of hypomagnesemia <1.2 vs hypermagnesemia >2.2?
Hypomagnesemia: -severe cardiac rhythms disturbances ex: Torsades -may not have symptoms -twitches -tremors -muscle cramps -hyperrreflexia Hypermagnesemia: -severe cardiac rhythm disturbances ex: heart blocks and long QT interval -low muscle & nerve function -muscle weakness -diminished reflexes
What are signs & symptoms of hyponatremia <135 hypernatremia >145? *MORE common & problematic with hyponatremia
Hyponatremia: -CNS changes -neuromuscular changes -confusion -leg cramps -twitching -*seizures!* Hypernatremia: -high serum osmolality -nausea, difficulty swallowing
What is the treatment for hyponatremia <135 vs hypernatremia >145
Hyponatremia: -add Na+ to diet -restrict fluids -give isotonic or hypertonic solution slowly! -seizure precautions Hypernatremia: -monitor VS esp HR & BP -check for edema -give isotonic fluids slowly! (ex: NS, D5W, LR) Both: -monitor I&O & daily weight -monitor neuro for changes or confusion -recheck sodium
Match the following potential causes of either hyponatremia <135 vs hypernatremia >145? 1) low salt diet 2) CHF 3) diuretics 4) high sodium diet 5) hypotonic IV 6) wound drainage 7) hypotonic fluid deficit 8) dehydration 9) diaphoresis 10) cushings syndrome 11) hypotonic fluid deficit 12) diabetes insipidus 13) high protein and low fluid diet
Hyponatremia: 1) low salt diet 11) hypotonic fluid deficit 9) diaphoresis 2) CHF 6) wound drainage Hypernatremia: 5) hypotonic IV 12) diabetes insipidus 13) high protein and low fluid diet 10) cushings syndrome 8) dehydration 3) diuretics 4) high sodium diet (ex: fast food, cured meats, preserved boxed/frozen foods)
Is the patient hypotonic, hypertonic, or isotonic if they have symptoms like: -headache -confusion -twitching -irritability -HTN -bounding pulses -increased central venous pressure -JVD
Hypotonic patient *think FVO
What type of IV solution is used for cellular hydration? It is NOT used for low BP, increased ICP, stroke, neuro pt, liver, trauma, surgery, or burns?
Hypotonic solution *watch for decreased BP and decreased BV
What type of Crystalloid IV solution will the extracellular fluid have fewer solutes than the fluid in the cells? Will water move into or out of cells?
Hypotonic solution *water moves from extracellular space INTO the cells
Match the following with either a) hypotonic, b) isotonic, or c) hypertonic 1) D5W in body 2) D5 .25%NS 3) D5 .45NS 4) 0.45%NS 5) D10W 6) Normosol 7) 0.33%NS 8) 3%NS 9) D5W in bag 10) D5NS 11) 0.225%NS 12) 0.9%NS 13) LR 14) D5LR
Hypotonic: 1) D5W in body 4) 0.45%NS 7) 0.33%NS 11) 0.225%NS Isotonic: 2) D5 .25%NS 6) Normosol 9) D5W in bag 12) 0.9%NS 13) LR Hypertonic: 3) D5 .45NS 5) D10W 8) 3%NS 10) D5NS 14) D5LR
Match the following with either a) hypotonic, b) isotonic, or c) hypertonic solution in the bag? 1) NS 2) D5NS 3) 2.5D5W 4) D5LR 5) .45NS 6) D5 1/2 7) D5W 8) .33NS 9) LR
Hypotonic: 3) 2.5D5W 5) .45NS 8) .33NS Isotonic: 1) NS 7) D5W 9) LR Hypertonic: 2) D5NS 4) D5LR 6) D5 1/2
Match the following pts symptoms of HF to AHA CHF stages (A-D): I) symptomatic; prior or current symptoms of HF; continue treating comorbidities; educate on self care (restrict salt & HF symptoms) II) at risk for developing HF; need lifestyle modifications (diet, weight loss, exercise); treat comorbidities (HTN, DM, hyperlipidemia, & afib) III) refractory or advanced HR; advanced therapies like LVAD, heart transplant; end of life treatment goals IV) asymptomatic with structural heart defects; continue treating comorbidities; add treatment for reduced EF pts only (beta blockers, ACEI, ARBS, ICD)
I) *Stage C*: symptomatic II) *Stage A*: at risk for developing HF III) *Stage D*: refractory or advanced HR IV)*Stage B*: asymptomatic with structural heart defects/HF
Match the following pts symptoms of HF to NYHA classes (1-4): I) unable to carry out any physical activity w/out discomfort; symptoms of fatigue, palpitation, & SOB at rest II) slight limitation of physical activity; comfortable at rest; ordinary activity results in fatigue, palipitation, SOB III) no limitation of physical activity; ordinary activity doesn't cause fatigue, SOB, etc IV) marked limitation of physical activity; comfortable at rest; less than ordicnary activity causes fatigue, palpitation, or SOB
I) class 4 II) class 2 III) class 1 IV) class 3 *must know
When would the nurse check K+ levels on a pt that getting avtive K+ replacement ex: K-DUR (PO) or potassium chloride bolus (IV)
If actively replacing then in 12 hrs or next morning *if pt is more critical then check q 4-6 hrs
What are other sources of fluid intake vs output that need to added to I&O?
Intake: -food -meds -ice chips (100mL of ice =50mL of fluid) -jello -peg tube feeding -K+ replacement in IV solution Output: -chest tube drainage -liquid stool -vomit -drainage -suction ex: bulb suction -blood loss ex: surgery -fluid removal ex: paracentesis or thoracentesis -insensible loss from breathing or skin
What type of Crystalloid IV solution will the extracellular and intracellular fluids have same osmolarity? Will water move into or out of cells?
Isotonic *no movement of water between them
What type of IV solution is used for fluid & lyte replacement? It is NOT used for FVE pts?
Isotonic solution *watch for FVE, edema, & diluted labs
Is the patient hypotonic, hypertonic, or isotonic if they have symptoms like: -hypotension -dizziness -syncope -tachycardia -thready pulses -weak peripheral pulses -sunken eyeballs -poor skin turgor -oliguria/decreased urine output -hemoconcentration
Isotonic state *can be caused by hemorrhage, GI losses, fever, environmental heat, diaphoresis, burned pts, & overuse of diuretics
What can occur if pt is taking diuretic & dig at same time?
K+ loss which low levels of K+ increase risk of dig toxicity; dig can look falsely HIGH in blood when K+ LOW *watch for signs of decreased HR, confusion, irregular pulse or rhythm, & decreased LOC
What labs, diagnostics, & meds should the nurse look at for pt with suscpected schizophrenia? *used to rule out other causes of psychosis like trauma or tumor
Labs & diagnostics: -MRI -CT -electrolytes (Na, K, Mg, Ca) -BUN/Creat Meds (top psychosis inducing drugs): -methamphetamine -cannabis -cocaine -LSD, PCP, ecstasy -alcohol -opioids -corticosteroids -ATB -organophosphates (pesticides)
What IV solution is most similar to blood plasma concentration and is fluid of choice for burn & trauma patients?
Lactated Ringers (LR)
What type of HF: -largest & supplies most of heart's pumping power -this side of heart must work harder to pump the same amount of blood -usually occurs 1st before other HF -2 types of this HF ex: systolic failure & diastolic failure
Left sided hf
What treatment for HF takes over the workload of the left ventricle mechanically? *gives heart reat by putting in artificial LV
Left ventricular assist device (LVAD) *can get LVAD while waiting for heart transport; temporary to buy time to fix underlying problem
Where do problems occur for pt w LSHF vs RSHF?
Left= Lungs Right= Remote (swelling in legs)
What is the nurse concerned could happen if pt has hight K+ that keeps increasing?
Lethal arrythmia
What is important for the nurse to know for post surgical pts ex: post mastectomy r/t electrolyte balance?
Magnesium treatment may lower neuropathic pain 7 can also improve sleep & cognition *give Mg to pts to help control their pain & improve memory
What nursing implications is used regarding the use of beta blockers and calcium replacement?
Must be spaced out by 3 hrs
List pt outcomes & prognosis for the pt with schizophrenia when re-evaluating
Patient will.... -participate in treatment during hospitalization -take meds daily (taken long term; don't give med for 3 days then withdrawawl) -be free from harm (r/t suicidal ideation; continue after discharge w resources & schedule home visit) -have reduction of (+) & (-) symptoms w/in 2 day of starting meds (if don't, consider switching meds) -have shorter duration of psychotic episodes over next 6 mos -be able to bathe, eat, & get dressed independently by discharge -report feelings of hopelessness or psychosis to HC provider immediately -maintain relationships over the next 6-12 mos
What is the treatment of dig toxicity? *normal value is 0.25-1.5 mg
activated charcoal stomach lavage or IV digoxin binders like digibind
What term describes adding a behavior, thought or feeling for a pt with schizophrenia?
Positive symptoms *ex: loose associations, neologisms, clang associations, word salad, circumstantiality, tangentiality, perseveration, echolalia, illusions, echopraxia, magical thinking, delusions, hallucinations, disorganized speech, catatonia (withdrawal or absence of interaction)
Match the following as either: *Positive* or *Negative* symptoms of schizophrenia 1) ____ apathy 2) ____ delusions 3) ____avolition 4) ____ anosognosia (lack of insight) 5) ____ anergia 6) ____ hallucination 7) ____ magical thinking 8) ____ concrete thinking 9)____ illusioins 10) ____ paranoia 11) ____ echopraxia 12) ____ lack of interest or skill in interpersonal interaction 13) ____ catonia 14) ____ affective flattening ex: inappropriate, bland, or flat 15) ____ mood symptoms ex: dysphoria, suicidailty, helplesseness 16) ____ alogia 17) ____ anhendonia 18) ____ disorganized speech ex: word salad, loose associations, neologisms, clang associations, circumstatiality, tangentiality, perseveration, echolalia 19) waxy flexibility 20) regression 21) posturing 22) eye movement abnormalities 23) pacing & rocking
Positives: 2) delusions 6) hallucinations 7) magical thinking 9) illusioins 10) paranoia 11) echopraxia 13) catonia 18) disorganized speech ex: word salad, loose associations, neologisms, clang associations, circumstatiality, tangentiality, perseveration, echolalia Negatives: 1) apathy 3) avolition 4) anosognosia (lack of insight) 5) anergia 8) concrete thinking 12) lack of interest or skill in interpersonal interaction 14) affective flattening ex: inappropriate, bland, or flat 16) alogia 17) anhendonia 15) mood symptoms ex: dysphoria, suicidailty, helplesseness 19) waxy flexibility 20) regression 21) posturing 22) eye movement abnormalities 23) pacing & rocking
What electrolyte is responsible for maintenance of ICF and is essential for muscle contraction?
Potassium (K+) *normal range is 3.5-5
What term describes a specific group of symptoms that may precede the onset of mental illness?
Prodromal
What term describes a disorder characterized by delusions, hallucinations, disorganized thought, disorganized motor behavior, and "negative" symptoms
Psychosis *related to dysregulation og dopamine transport systems
What type of HR: -usually occurs as a result of the other type of HF from increased fluid pressure transferred back through the lungs, ultimately damaging the heart's right side -when right side loses pumping pwer, blood backs up in the body's veins usually causing swelling in the legs & ankles
Right sided HF
What med is used in NYHA class 2 or 3 CHF bc it reduced HR by slowing conduction
SA node modulator like ivabradine
What term describes a type of primary psychosis, meaning from a psychiatric origin?
Schizoaffective disorder
What electrolyte is responsible for maintenance of ECF & is essential for neuro function?
Sodium (Na+) *normal range 135-145
An emergency room nurse obtains the health history of a client. Which statement by the client should alert the nurse to the occurrence of heart failure? a. I get short of breath when I climb stairs. b. I see halos floating around my head. c. I have trouble remembering things. d. I have lost weight over the past month.
a. I get short of breath when I climb stairs. *Dyspnea on exertion is an early manifestation of heart failure and is associated with an activity such as stair climbing. The other findings are not specific to early occurrence of heart failure.
True or false: supportive silence is helpful communication technique for pt with schizophrenia displaying disorganized thoughts & feelings
True!
True or false: a significant proportion of pts with HF have a normal ventricular EF?
True; it's a tool to track & measure HF overtime (%) can have normal EF with HF so not always accurate
What types of medications may be prescribed for pt w schizophrenia? What are common side effects between these types?
Typical Antipsychotics (1st gen) & Atypical Antipsychotics (2nd gen) *sedation; orthostatic hypotension; & anticholinergic like dry mouth, urinary retention, constipation
Match the following diseases/illnesses with either a) useful for or b) cautious in when administering hypotonic solution like 0.45%NS, D5W, D5 .45%NS 1) dehydration 2) SIADH 3) hyponatremia 4) CHF 5) renal disorders 6) burns 7) surgery 8) excessive diuretic use 10) trauma 11) hypernatremia 12) hypotension 13) cellular hydration 14) increased ICP 15) stroke 16) neuro pt
Useful for: 1) dehydration 5) renal disorders 8) excessive diuretic use 11) hypernatremia 13) cellular hydration Cautious in: 2) SIADH 3) hyponatremia 4) CHF NO: 6) burns 7) surgery 10) trauma 12) hypotension 14) increased ICP 15) stroke 16) neuro pt
Match the following diseases/illnesses with either a) useful for or b) cautious in when administering Colloids solution like Albumin, blood, plasma, Dextran 1) edema 2) CHF 3) severe anemia 4) hypervolemia 5) hemoconcentration 6) expand intravascular space 7) prevent vasospasm
Useful for: 1) edema 3) severe anemia 6) expand intravascular space 7) prevent vasospasm Cautious in: 2) CHF 4) hypervolemia 5) hemoconcentration
Match the following diseases/illnesses with either a) useful for or b) cautious in or c) NO when administering isotonic solution like NS or LR 1) CHF 2) shock 3) hypotension 4) dehyrdatin 5) hemorrhage 6) hypovolemia 7) HTN 8) FVE
Useful for: 2) shock 3) hypotension 4) dehyrdatin 5) hemorrhage 6) hypovolemia Cautious in: 1) CHF 7) HTN NO: 8) FVE
Match the following diseases/illnesses with either a) useful for or b) cautious in or c) NO when administering hypertonic solution like 3%NS, D5NS, D10 1) hypervolemia 2) cardiac pt 3) hemoconcentration 4) increased ICP 5) head trauma 6) hyponatremia 7) dehydration 8) acid base imbalance 9) DKA 10) hypernatremia 11) edema 12) renal pt 13) JVD
Useful for: 4) increased ICP 5) head trauma 6) hyponatremia 8) acid base imbalance 9) DKA 11) edema Cautious in: 1) hypervolemia 3) hemoconcentration 10) hypernatremia 13) JVD NO: 2) cardiac pt 12) renal pt 7) dehydration
Match each medication drug class with how they work in heart failure. 1. ACE inhibitor 2. Beta blocker 3. ARBs 4. ARNIs 5. Inotropes ____ Dilates blood vessels, helps manage salt and water ____ Decreases cardiac workload, keeps vessels from constricting, can lower BP ____ Slows heart rate; helps heart work more efficiently, improves pumping. ____ Helps block renin-angiotensin system. Helps prevent cardiac death. Helps prevent readmissions! Masks BNP measurement - will need NT-proBNP measurement instead of BNP lab when using this drug. ____ Dilates vessels, slows heart rate, can lower BP
__1__ Dilates blood vessels, helps manage salt and water __3__ Decreases cardiac workload, keeps vessels from constricting, can lower BP __5__ Slows heart rate; helps heart work more efficiently, improves pumping. __4__ Helps block renin-angiotensin system. Helps prevent cardiac death. Helps prevent readmissions! Masks BNP measurement - will need NT-proBNP measurement instead of BNP lab when using this drug. __2__ Dilates vessels, slows heart rate, can lower BP
The nurse is taking care of a new admission patient with known schizophrenia who has been having diarrhea for 3 days from a new medication regimen. The patient is restless and agitated, and has twitching in their face and hands. The patient states they "can't go on like this." Put the following nursing interventions in order of prioritization. ____ Assess patient vital signs, intake and output and basic neurological orientation ____ Start IV fluids of 0.9 NS with 20 meq potassium ____ Notify provider of findings ____ Assess lab values including magnesium and sodium ____ Assess that the patient is safe and free from imminent danger including suicidal ideation
__2__ Assess patient vital signs, intake and output and basic neurological orientation __5__ Start IV fluids of 0.9 NS with 20 meq potassium __4__ Notify provider of findings __3__ Assess lab values including magnesium and sodium __1__ Assess that the patient is safe and free from imminent danger including suicidal ideation *This is the second most accurate assessment. These are baseline informational pieces needed to critically think and plan. For a new admission (with no orders) labs, vitals and patient status should be assessed before an intervention. This cannot be initiated without an order, and the provider would have to be notified to obtain this IV solution with medication. This is the last priority action. The provider should be notified only after pertinent information has been gathered and analyzed. This is the third most priority action to address the diarrhea and twitching. This is the priority statement. Safety assessment is a reality with this diagnosis, especially suicidal ideation.
Match the lab profile with the most likely fluid imbalance. 1) Fluid Volume Deficit 2) Fluid Volume Excess ____ Hgb 13.2 yesterday, 10.1 today; Urine specific gravity 1.001 ____ BUN 45; Cr 0.7 ____ Na 148; Hct 40% yesterday, 49% today; serum osmolality 308
__2__ Hgb 13.2 yesterday, 10.1 today; Urine specific gravity 1.001 __1__ BUN 45; Cr 0.7 __1__ Na 148; Hct 40% yesterday, 49% today; serum osmolality 308
Match the New York Heart Association (NYHA) Stage with its best definition / patient symptoms. Class 1; Class 2; Class 3; Class 4 ____ Mostly comfortable and symptom-free, but ADLs makes the patient tired and/ or short of breath ____ Able to perform ADLs and normal activity with no CHF symptoms such as shortness of breath. ____ The patient has trouble with any activity. Symptoms may be present even when resting and get worse with any activity. ____ Ok when resting, but even minimal activity causes symptoms such as heart rhythm changes.
__2__ Mostly comfortable and symptom-free, but ADLs makes the patient tired and/ or short of breath __1__ Able to perform ADLs and normal activity with no CHF symptoms such as shortness of breath. __4__ The patient has trouble with any activity. Symptoms may be present even when resting and get worse with any activity. __3__ Ok when resting, but even minimal activity causes symptoms such as heart rhythm changes. *Take a look at the wording: get used to explaining each category in your own words!
What is the most appropriate order for discharge activities as listed. Put the following in the most appropriate order of occurence. ____ Discharge patient ____ Teach patient and family about discharge medications, diet, activity, and reasons to call the doctor ____ Have patient verbalize teaching back to nurse ____ Clarify specific discharge orders with physician ____ Call patient at home to check on progress or questions
__4__ Discharge patient __2__ Teach patient and family about discharge medications, diet, activity, and reasons to call the doctor __3__ Have patient verbalize teaching back to nurse __1__ Clarify specific discharge orders with physician __5__ Call patient at home to check on progress or questions *This is first. Make sure you have the latest treatment plan before teaching your patient.
Match each CHF medication class with its best exemplar medication. 1. ACE inhibitor 2. ARBs 3. Beta blocker 4. Diuretics 5. ARNI 6. Sinoatrial node modulators (SNMs) ____ Hydrochlorothiazide ____ Ivabradine ____ Carvedilol ____ Lisinopril ____ Valsartan/sacubitril ____ Candesartan
__4__ Hydrochlorothiazide __6__ Ivabradine __3__ Carvedilol __1__ Lisinopril __5__ Valsartan/sacubitril __2__ Candesartan
The nurse is providing discharge teaching to a client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates a correct understanding of the teaching? a) "I will call the provider if I have a cough lasting 3 or more days." b) "I will try walking for 1 hour each day." c) "I should expect occasional chest pain." d) "I should call the provider if I gain 1 pound in a week"
a) "I will call the provider if I have a cough lasting 3 or more days." *The client understands the discharge teaching about when to seek medical attention when the client says: "I will call the provider if I have a cough lasting 3 or more days." Cough, a symptom of heart failure, is indicative of intra-alveolar edema; it is important to notify the provider if this occurs.The client would call the provider for weight gain of 3 pounds (1.4 kg) in a week or 1-2 pounds (0.45 to 0.9 kg) overnight. The client would begin by walking 200 to 400 feet (61 to 123 meters) per day. Chest pain is indicative of myocardial ischemia and worsening of heart failure. The provider must be notified if this occurs.
Which intravenous solution should you anticipate for a patient with isotonic dehydration? a) 0.9% saline b) Dextrose 10% in water c) Dextrose 5% in water d) 0.45% saline
a) 0.9% saline -0.9% normal saline is the only isotonic solution that remains isotonic after administration. -A is isotonic in solution but hypotonic once administered, B is hypertonic and C is hypotonic.
The patient with a NYHA Association classification of Class 4 would most likely have a BNP value of: a) 1020 b) 100 c) 600 d) 400
a) 1020 *Correct! This lab value is indicating severe heart failure, and so does NYHA Class IV.
What IV K+ order does the nurse know to MOST question? a) 150 meq over 30 mins b) 20 meq over 1 hr c) 150 meq over 3 hrs d) 20 meq over 90 mins
a) 150 meq over 30 mins *no more than 20 meq/hr
Which of the following nursing interventions would the nurse perform for the client with psychosis/schizophrenia? (Select all that apply) a) Assess home medications and current doses, and verify proper administration/dosing with patient b) Look for signs and symptoms of suicidal ideation, thoughts, or plans. c) Assess any available MRI or CT scans to rule out injury d) Assess labs including electrolytes and any substance abuse toxicology reports
a) Assess home medications and current doses, and verify proper administration/dosing with patient b) Look for signs and symptoms of suicidal ideation, thoughts, or plans. c) Assess any available MRI or CT scans to rule out injury d) Assess labs including electrolytes and any substance abuse toxicology reports -This is an accurate statement. the nurse should assess not only the medications, but should recognize usual doses and if the patient is following the treatment plan. in addition, many psychiatric medications can have significant side effects that impacts patient use and compliance. -Suicide risk is real for clients living with psychosis/schizophrenia. The nurse should assess for risk of suicide. Suicide can be considered a true 'extreme version' critical scenario with psychosis/schizophrenia.
Which test is most useful for pt with HF? a) BNP b) CRP c) ABG d) sed rate
a) BNP (brain natriuretic peptide)
The nurse caring for a client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? (select all that apply) a) Blurred vision b) Tachycardia c) Fatigue d) Serum digoxin level of 1.5 ng/ml (1.92 nmol/L) e) Anorexia
a) Blurred vision c) Fatigue e) Anorexia *The signs and symptoms of digoxin toxicity that the nurse notifies the provider include: blurred vision, fatigue, and anorexia. Changes in mental status, especially in older adults, may also occur.Sinus bradycardia and not tachycardia is a sign of digoxin toxicity. A serum digoxin level between 0.8 and 2.0 (1.02 and 2.56 nmol/L) is considered normal and is not a symptom.
The nurse is caring for a client with heart failure. For which symptoms does the nurse assess? (select all that apply) a) Chest discomfort or pain b) Tachycardia c) Expectorating thick, yellow sputum d) Sleeping on back without a pillow e) Fatigue
a) Chest discomfort or pain b) Tachycardia e) Fatigue *When caring for a client with heart failure, the nurse needs to assess for chest discomfort or pain, tachycardia, and fatigue. Decreased tissue perfusion with heart failure may cause chest pain or angina. Tachycardia may occur as compensation for or as a result of decreased cardiac output. Fatigue is a symptom of poor tissue perfusion in clients with heart failure.Presence of a cough or dyspnea results as pulmonary venous congestion ensues. Clients with acute heart failure have dry cough and, when severe, pink, frothy sputum. Thick, yellow sputum is indicative of infection. Position for sleeping isn't a symptom. Clients usually find it difficult to lie flat because of dyspnea symptoms
Which of the following does the nurse anticipate as part of initial heart failure orders? Select all that apply. a) Daily weight b) Morphine 2 mg prn c) Beta blocker d) House diet e) Daily electrolytes
a) Daily weight b) Morphine 2 mg prn c) Beta blocker e) Daily electrolytes -Yes, great measure of fluid status (and more accurate than I & O) -Yes. This is a low dose of morphine, and morphine is a great cardiac drug. It reduces preload, oxygen consumption, anxiety, and pain. -Yes. Beta blockers can help both heart rate and blood pressure -Yes, probably. Following especially sodium and potassium are very pertinent with diuresis, sodium diet restriction, and many of the heart failure medications. If there are issues, you may be drawing labs several times a day, especially to check the effectiveness of sodium or potassium replacements.
A client with diarrhea for 3 days and inability to eat or drink well is brought to the emergency department (ED) by her family. She states she has been taking her diuretics for congestive heart failure (CHF). What nursing actions are indicated at this time? (Select all that apply.) a) Evaluate the electrolyte levels. b) Administer the ordered diuretic. c) assess for orthostatic hypotension. d) initiate cardiac monitoring e) Place the client on bed rest.
a) Evaluate the electrolyte levels. c) assess for orthostatic hypotension. d) initiate cardiac monitoring e) Place the client on bed rest. *Nursing actions indicated at this time include: placing the client on bedrest and assisting the client out of bed, evaluating electrolyte levels, assessing for orthostatic hypotension, and applying a cardiac monitor. Safety is required to prevent falls due to weakness from a likely fluid volume deficit and electrolyte imbalance. The nurse should review the laboratory and diagnostic results to detect likely loss of sodium, potassium, and magnesium secondary to diarrhea and diuretic us. Fluid volume deficit is likely with diarrhea and diuretic use and leads to fluid and electrolyte imbalances, especially hypokalemia. Assessing for orthostatic changes will confirm presence of volume deficit. Monitoring for inverted T wave or presence of U wave on the ECG as well as dysrhythmias is indicated when hypokalemia is anticipated. Diuretics increase loss of fluids and electrolytes. The nurse would question this order in the presence of assessment data indicating fluid loss from the diuretics and diarrhea.
What are the most likely reasons that heart failure patients get readmitted to the acute care setting? Select all that apply. a) Family can't manage complex care b) Patient can't take medications correctly due to cost, misunderstanding, lack of ability to understand med schedule, etc. c) Patient misses nursing staff d) Heart failure can get worse over time e) Post discharge care such as cardiac rehab classes are hard to maintain f) Too many cats at home: have to get away
a) Family can't manage complex care b) Patient can't take medications correctly due to cost, misunderstanding, lack of ability to understand med schedule, etc. d) Heart failure can get worse over time e) Post discharge care such as cardiac rehab classes are hard to maintain *Yes, unfortunately, this chronic disease can get worse over time, especially without good exercise and diet Yes, this is a reality due to finances, having to travel, lack of insurance coverage - or insurance only pays for a few visits, etc.
What would you most likely assess in RSHF? a) JVD b) oliguria c) orthopnea d) distended foot veins
a) JVD
A client with hypermagnesemia is seen in the emergency department (ED). Which of these interventions is most appropriate? a) Place the client on a cardiac monitor b) Institute teaching on avoiding magnesium rich foods c) prepare for endotracheal intubation d) Monitor for hyperactive reflexes
a) Place the client on a cardiac monitor *Hypermagnesemia causes changes in cardiac rhythm and may result in cardiac arrest, therefore instituting cardiac monitoring is most appropriate. Reflexes are typically reduced in the presence of hypermagnesemia. There is no indication that the client has signs and symptoms of respiratory distress at this time, however the nurse would monitor the client for respiratory weakness and respiratory failure. The nurse will institute teaching after the emergency passes and the cause of the magnesium excess is determined.
Which of the following is true about heart failure with preserved ejection fraction (HFpEF)? (Select all that apply) a) The heart pumps normally but is too stiff to fill properly b) The heart muscle is too weak to squeeze properly c) It is caused by hypertension, obesity, and/or diabetes d) It is caused by acute kidney injury, ventricular tachycardia, and diabetes insipidus. e) The ejection fraction is preserved because the ventricle can pump effectively in HFpEF, but it can't fill with enough blood, so there is less blood is available to be ejected. f) The ejection fraction is reduced because there is not enough squeezing force to move the blood out of the heart.
a) The heart pumps normally but is too stiff to fill properly c) It is caused by hypertension, obesity, and/or diabetes e) The ejection fraction is preserved because the ventricle can pump effectively in HFpEF, but it can't fill with enough blood, so there is less blood is available to be ejected. *Make sure you understand systolic versus diastolic, and HFrEF and HFpEF! YES. This filling should make you think of diastolic function, and diastolic heart failure is the same as heart failure with preserved ejection fraction (HFpEF) YES. These are all conditions that cause heart failure in general. YES. This is the definition of diastolic heart failure, or HFpEF. HFpEF is the most common form of heart failure.
The nurse is caring for a client receiving lactated Ringer's solution IV for rehydration. Which assessments will the nurse monitor during intravenous therapy? (Select all that apply.) a) Urinary output b) Urine specific gravity c) Pulse rate and quality d) Blood pressure e) Blood serum glucose
a) Urinary output b) Urine specific gravity c) Pulse rate and quality d) Blood pressure *The two most important areas to monitor during rehydration are pulse rate and quality and urine output. In addition, decreasing specific gravity of urine is also an indication of rehydration. Blood pressure is another important vital sign to monitor during rehydration. *Blood glucose changes do not have a direct relation to a client's hydration status; lactated ringers are free from glucose.
What are risk factors for schizophrenia? (select all that apply) a) family members with mood disorder b) lower education c) cousin who is poor d) early vs later adult age
a) family members with mood disorder b) lower education d) early vs later adult age -other ex: early 20's young adult, Caucasian, less educated (high school or less), fair amount of college students, low incomes ($<24,000) -NOT geographical or gender specific -older adults around 85 yrs who are psychotic is usually med related or hypoxic
When evaluating the hydration status of a new 84-year-old nursing home client, the nurse observes tenting of the skin on the back of the client's hand. What is the nurse's best action? a. Assess the skin turgor on the client's forehead. b. Ask the client when he or she last had anything to drink. c. Examine the client's dependent body areas, especially the ankles. d. Document this observation in the client's record as the only action.
a. Assess the skin turgor on the client's forehead. *Skin turgor and hydration status cannot be accurately assessed on an older adult's hands because of age-related loss of elastic tissue in this area. Areas that more accurately show turgor and hydration status on an older adult are the skin of the forehead and the chest.
A nurse assesses a client who is prescribed a medication that inhibits angiotensin I from converting into angiotensin II (angiotensin-converting enzyme [ACE] inhibitor). For which expected therapeutic effect should the nurse assess? a. Blood pressure decrease from 180/72 mm Hg to 144/50 mm Hg b. Daily weight increase from 55 kg to 57 kg c. Heart rate decrease from 100 beats/min to 82 beats/min d. Respiratory rate increase from 12 breaths/min to 15 breaths/min
a. Blood pressure decrease from 180/72 mm Hg to 144/50 mm Hg *ACE inhibitors will disrupt the reninangiotensin II pathway and prevent the kidneys from reabsorbing water and sodium. The kidneys will excrete more water and sodium, decreasing the clients blood pressure.
An 84-year-old client with heart failure presents to the emergency department with confusion, blurry vision, and an upset stomach. Which assessment data is most concerning to the nurse? a. Digoxin (Lanoxin) therapy daily. b. Daily metoprolol (Lopressor). c. Furosemide (Lasix) twice daily. d. Currently taking an antacid for upset stomach.
a. Digoxin (Lanoxin) therapy daily. *Confusion, blurry vision, and upset stomach are symptoms of Digoxin toxicity, which is common in older adults and requires immediate treatment. The other answers are important assessment data but do not indicate immediate connection to the client's presentation.
A nurse assesses a client who is admitted for treatment of fluid overload. Which manifestations should the nurse expect to find? (Select all that apply.) a. Increased pulse rate b. Distended neck veins c. Decreased blood pressure d. Warm and pink skin e. Skeletal muscle weakness *Manifestations of fluid overload include increased pulse rate, distended neck veins, increased blood pressure, pale and cool skin, and skeletal muscle weakness.
a. Increased pulse rate b. Distended neck veins e. Skeletal muscle weakness *Manifestations of fluid overload include increased pulse rate, distended neck veins, increased blood pressure, pale and cool skin, and skeletal muscle weakness.
A client is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have? (Select all that apply.) a. Peripheral edema b. Crackles in both lungs c. Increased abdominal girth d. Ascites e. Tachypnea *Peripheral edema, increased abdominal girth, ascites, and tachypnea are all symptoms associated with right-sided heart failure due to the back up into the peripheral system. Crackles in the lungs are associated with left-sided heart failure.
a. Peripheral edema c. Increased abdominal girth d. Ascites e. Tachypnea *Peripheral edema, increased abdominal girth, ascites, and tachypnea are all symptoms associated with right-sided heart failure due to the back up into the peripheral system. Crackles in the lungs are associated with left-sided heart failure.
The nurse is taking care of the client with schizophrenia who has current visual hallucinations of seeing bats in the activity room. Which of the following statements indicate that nurse understands therapeutic communication techniques for the client? (Select all that apply.) a) "I'm sure it will get better when your meds kick in" b) "I will just sit here quietly with you. If you want to talk about it, that's ok" c) "So what you are saying is that you are seeing small flying animals" d) " Let's see what's on TV" e) "I am not seeing bats in the activity room"
b) "I will just sit here quietly with you. If you want to talk about it, that's ok" c) "So what you are saying is that you are seeing small flying animals" e) "I am not seeing bats in the activity room" *This is a correct answer and demonstrates therapeutic listening and/or silence. This shows clarification and reinforcing reality.
Which of the following potassium levels is most concerning for the nurse regarding the patient taking regular doses of digoxin? a) 5.1 b) 3.0 c) 4.0 d) 3.5 e) 3.3
b) 3.0 -Can you name some warning signs of digoxin toxicity? -This is a low potassium level, and the lowest in these choices. Therefore, this is the most concerning for digoxin toxicity even with regular, normal doses of digoxin.
What is correct med dose of haldolol for active psychosis? a) 0.25 mg PO b) 5 mg PO c) 50 mg PO d) 500 mg PO
b) 5 mg PO -Usual dose is 0.5-5mg; crisis dose is 5-7.5mg -Option A, 0.25mg is too low, C & D are too large.
After receiving change-of-shift report, which client does the RN assess first? a) A client with a nasogastric (NG) tube who has dry oral mucosa and is complaining of thirst b) A client receiving intravenous (IV) diuretics whose blood pressure is 88/52 mm Hg c) A client with nausea and vomiting who complains of abdominal cramps d) A client with normal saline infusing at 150 mL/hr whose hourly urine output has been averaging 75 mL
b) A client receiving intravenous (IV) diuretics whose blood pressure is 88/52 mm Hg *The nurse must first assess the client receiving IV diuretics whose blood pressure is 88/52 mm Hg. This client with hypotension may have developed hypoperfusion caused by hypovolemia. Immediate interventions are needed. The client with nausea and vomiting, the client with an NG tube complaining of thirst, and the client receiving normal saline with an hourly urine output of 75 mL/hr have problems which are not urgent at this time.
The nurse is teaching a client who is taking a potassium-sparing diuretic about precautions while taking this medication. Which of these does the nurse teach the client to avoid or use cautiously? (Select all that apply.) a) Grapes b) ACE inhibitors c) Salt substitute d) Apples e) Bananas
b) ACE inhibitors c) Salt substitute e) Bananas *While taking a potassium-sparing diuretic, the nurse teaches the client to avoid bananas, ACE inhibitors, and salt substitutes. Other foods high in potassium include cantaloupe, kiwi, oranges, avocados, broccoli, dried beans, lima beans, mushrooms, potatoes, seaweed, soybeans, and spinach. Salt substitutes contain potassium and may predispose the client to hyperkalemia. Apples and grapes are considered lower potassium-containing foods.
The nurse is caring for a client who is receiving a loop diuretic for treatment of heart failure. Which of these actions will be included in the plan of care? (Select all that apply.) a) Weigh the client weekly. b) Assess daily weights. c) Discourage intake of spinach. d) Encourage consumption of citrus fruits. e) Monitor serum potassium. f) Monitor for bradycardia.
b) Assess daily weights. d) Encourage consumption of citrus fruits. e) Monitor serum potassium. *Actions for the nurse to include when caring for a client taking a loop diuretic for heart failure include: assessing daily weights, encouraging consumption of citrus fruits, and monitoring the client's serum potassium. High-ceiling (loop) diuretics remove excess fluid and are potassium-depleting drugs. Consuming citrus fruit, green leafy vegetables, cantaloupe, tomato, and other food with potassium is indicated while receiving this type of diuretic to compensate for urinary loss of potassium. The client must be weighed at the same time each day, using the same scale and wearing approximately the same amount of clothes. Green leafy vegetables such as spinach contain potassium and are encouraged. The diuretic itself has no effect on the heart rate, however potassium depletion caused by the diuretic may cause cardiac irritability with a weak and thready pulse.
The home health nurse visits a client with heart failure who has gained 5 pounds (2.3 kg) in the past 3 days. The client states, "I feel so tired and short of breath." Which action does the nurse take first? a) Assess the client for peripheral edema. b) Auscultate the client's posterior breath sounds. c) Notify the health care provider about the client's weight gain. d) Remind the client about dietary sodium restrictions.
b) Auscultate the client's posterior breath sounds. *The action the home care nurse takes first is to auscultate the heart failure client's posterior breath sounds. Because the client is at risk for pulmonary edema and hypoxemia, the breath sounds must be assessed.Assessment of edema may be delayed until after breath sounds are assessed. After a full assessment, the nurse must notify the health care provider. After physiologic stability is attained, then ask the client about behaviors that may have caused the weight gain, such as increased sodium intake or changes in medications.
Which medication, when given in heart failure, may improve morbidity and mortality? a) Dobutamine (Dobutrex) b) Carvedilol (Coreg) c) Digoxin (Lanoxin) d) Bumetanide (Bumex)
b) Carvedilol (Coreg) *Carvedilol when given to clients in heart failure may improve morbidity and mortality. Beta-adrenergic blocking agents such as carvedilol reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure. This category of pharmacologic agents improves morbidity, mortality, and quality of life.Dobutamine and digoxin are inotropic agents used to improve myocardial contractility but have not been directly associated with improving morbidity and mortality. Bumetanide is a high-ceiling diuretic that promotes fluid excretion, and does not improve morbidity and mortality.
The RN is assessing a 70 yr old pt admitted to the unit with severe dehydration. Which finding requires immediate intervention by the nurse? a) Urine output of 950 mL for the past 24 hours b) Client behavior that changes from anxious to lethargic c) Deep furrows on the surface of the tongue d) Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched
b) Client behavior that changes from anxious to lethargic *This change in mental status suggests poor cerebral blood flow and fluid shifts within the brain cells. Immediate intervention is needed to prevent further cerebral dysfunction. Deep furrows on the surface of the tongue, poor skin turgor, and low urine output are all caused by the fluid volume deficit, but do not indicate complications of dehydration that are immediately life-threatening.
Which of the following predisposing factors are most prevalent in the development of psychosis? (Select all that apply) a) Age 65+ b) Encephalitis and/or other infections c) Substance abuse d) High income e) White / caucasian ethnicity
b) Encephalitis and/or other infections c) Substance abuse e) White / caucasian ethnicity *You're a winner! Infections can cause symptoms of psychosis and should be ruled out as a part of the diagnosis process. Yes! There are higher rates of psychosis/schizophrenia with substance abuse, particularly methamphetamine (and others) Yes! Psychosis/schizophrenia is more prevalent in white/Caucasian ethnicity than Hispanic/Latinx, Asian, or Native American ethnicity.
The nurse is caring for an older adult with hypernatremia. Which of these interventions does the nurse perform first? a) Monitor the serum osmolarity b) Encourage fluid intake c) Administer a diuretic d) Restrict the client's intake of sodium
b) Encourage fluid intake *When caring for an older adult with hypernatremia, the nurse first encourages the client to take more fluid. Encouraging fluids in the older adult is important to prevent dehydration with resulting concentrated sodium levels. Hypernatremia and fluid loss typically occur in tandem in the older adult. Restricting sodium does not replace fluids needed by many elderly clients. A diuretic will worsen the fluid volume deficit the client is experiencing. Monitoring the osmolarity will detect an abnormality, but not resolve the problem.
Which assessment finding best indicates that fluid resuscitation therapy for the patient with hypertonic dehydration has acheived the desired effect? a) Peripheral pulses changed from 1+ to 3+ b) Serum osmolality has changed from 375 to 300 c) Pulse oximetry shows oxygen saturation of 95% d) Neck veins slightly distended @ 30 degrees e) Serum osmolality has changed from 375 to 400
b) Serum osmolality has changed from 375 to 300
Furosemide (Lasix) has been ordered for a client with heart failure, shortness of breath, and 3+ pitting edema of the lower extremities. Which assessment finding indicates to the nurse that the medication has been effective? a) The client has experienced a weight gain of 1 pound (0.5 kg). b) The client is free from adventitious breath sounds. c) The client's heart rate is 101 beats per minute. d) The client's potassium level is 5.1 mEq/L (5.1 mmol/L).
b) The client is free from adventitious breath sounds. *The nurse recognizes that Furosemide is effective when the client is free from adventitious breath sounds such as crackles. Other positive outcomes to the diuretic include normal heart rate, weight loss with resolution of edema, and increased urine output. A potassium value of 5.1 mEq/L or (5.1 mmol/L) is normal. Changes in potassium levels such as hypokalemia are side effects of furosemide, not therapeutic effects. Although a fall in the client's BP may occur with the decrease in body fluid, this is not the priority. Tachycardia may occur during episodes of fluid volume excess or deficit and does not directly indicate the medication has been effective. Weight loss, rather than weight gain, is often the effect of Furosemide, caused by the diuresis.
A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication? a) The client's ability to understand medication teaching b) The risk for hypotension c) The potential for bradycardia d) Liver function tests
b) The risk for hypotension *At the start of therapy with lisinopril, the nurse needs to consider the risk for hypotension. Angiotensin-converting enzyme (ACE) inhibitors like lisinopril are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years.Although desirable, ability to understand teaching is not essential. ACE inhibitors are vasodilators and do not affect heart rate. Renal function, not liver function, may be altered by ACE inhibitors.
The patient with CHF has vital signs of T 98.7, HR 89, BP 120/70, and Sa02 on room air of 98%. She develops pulmonary edema with a sudden oxygen saturation on room air of 85%. What is your most correct oxygen intervention? a) Nasal cannula at 3 liters b) Venturi mask c) Nasal cannula at 8 liters d) Bag-valve-mask at 100% oxygen.
b) Venturi mask *Correct. This is the best choice, given the severity of pulmonary edema. The nurse also has choices within the Venturi mask to titrate or change the O2 delivery by changing the colored piece in the equipment set up.
which of the following pts is more likely to have schizophrenia? (select all that apply) a) 65 yr old adult b) college student c) native america d) didn't graduate high school e) income of $20,000
b) college student d) didn't graduate high school e) income of $20,000 *more likely with white, young, low income, unemployed, & less educated but fair share of college students too
Your patient is a 67 year old unconscious patient with a fever, saline lock IV site, and orders for 1000 mL tube feeding q 24 hours. Does the data in this case point to FVD or FVE? a) fluid volume excess b) fluid volume deficit c) neither fluid volume deficit or excess.
b) fluid volume deficit *Right!! Fever can cause dehydration but can also be the result of dehydration. 1200 mls/24 hours is likely not enough daily fluid. The unconsious patient is likely not taking anything by mouth. The patient is not extremely elderly, but likely has an increased risk for dehydration versus a younger patient. The IV site is capped, and the patient would likely benefit from IV solution to add to the tube feeding volume.
Which of the following is most correct for diastolic heart failure? a) heart failure with reduced ejection fraction (HFrEF) b) heart failure with preserved ejection fraction (HFpEF) c) correct answer not shown
b) heart failure with preserved ejection fraction (HFpEF)
Which of the following actions would the nurse question for treatment of pt with pulmonary edema a) 50% O2 through venturi mask b) position HOB flat c) aminister sublingual nitro d) start IV furosemide (lasix)
b) position HOB flat *HOB should be upright
What patient would cause the nurse to question the order for 0.45% NS? (select all that apply) a) pt that overused diuretics b) pt with head trauma c) pt who is dehydrated d) pt with a CHF e) pt with syndrome of inappropriate antidiuretic hormone (SIADH) f) pt that's hypernatremic with Na+ of 150
b) pt with head trauma d) pt with a CHF e) pt with syndrome of inappropriate antidiuretic hormone (SIADH) *FOR pts who are dehydrated, hypernatremic, using diuretics, renal disorders, DM, & dialysis *NOT for pts who are FVE, SIADH, hyponatremic, head trauma, water intoxication, HF
Which of the following indicates that the nurse needs more education on therapeutic communication? a) do you have thoughts of harming yourself? b) that's just crazy talk c) tell me more about that d) I understand that you see bats, but I do not
b) that's just crazy talk
What is the best answer for when you want a hypertonic IV solution? a) to move fluids into tissues b) to move fluids into vasculature c) to move fluids into cells d) to expand intravasculature spaces
b) to move fluids into vasculature *refer to mcullen article
What is the MOST realistic goal for HF? a) to regain full pumping b) to optimize their quality of living c) to improve achievement of ADL's d) to reduce NYHA stage score
b) to optimize their quality of living -can't cure HF, only maintain/optimize/make them as good as they can be for the stage their at/best of what you have -can't "improve"
For which clients is it most important for the nurse to check frequently for dehydration? (Select all that apply.) a. 24-year-old athlete who is NPO for 4 hours awaiting an appendectomy b. 42-year-old client who has diabetes insipidus c. 56-year-old client recently diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) d. 68-year-old client with poorly controlled type 2 diabetes mellitus e. 72-year-old client taking 80 mg of furosemide orally every day f. 74-year-old undergoing a bowel preparation with multiple enemas before colon surgery
b. 42-year-old client who has diabetes insipidus d. 68-year-old client with poorly controlled type 2 diabetes mellitus e. 72-year-old client taking 80 mg of furosemide orally every day f. 74-year-old undergoing a bowel preparation with multiple enemas before colon surgery *24 yr old athlete is highly unlikely to become dehydrated *pt with SIADH retains water and is at greater risk for fluid overload rather than dehydration. *pt with diabetes insipidus is at great risk for dehydration because the kidneys do not respond to ADH or to high blood osmolarity. Urine output is huge and the adult can dehydrate quickly. *Any adult with type 2 diabetes mellitus that is poorly controlled is at high risk for dehydration because the body's response to high BG levels is to pull fluid from the interstitial and intracellular spaces and increase urine output. *Furosemide is a very effective loop diuretic that greatly increases urine output. 80 mg is a higher than average dose. *Multiple enemas can greatly increase fluid lose from the GI tract and cause dehydration.
A nurse is assessing clients on a medical-surgical unit. Which adult client should the nurse identify as being at greatest risk for insensible water loss? a. Client taking furosemide (Lasix) b. Anxious client who has tachypnea c. Client who is on fluid restrictions d. Client who is constipated with abdominal pain
b. Anxious client who has tachypnea *Insensible water loss is water loss through the skin, lungs, and stool. Clients at risk for insensible water loss include those being mechanically ventilated, those with rapid respirations, and those undergoing continuous GI suctioning. Clients who have thyroid crisis, trauma, burns, states of extreme stress, and fever are also at increased risk. The client taking furosemide will have increased fluid loss, but not insensible water loss. The other two clients on a fluid restriction and with constipation are not at risk for fluid loss.
The nurse at a long-term care facility is teaching a group of unlicensed assistive personnel (UAP) about fluid intake principles for older adults. Which of these should be included in the education session? a) "Be careful not to overload them with too many oral fluids." b) "Wake them every 2 hours during the night with a drink." c) "Offer fluids that they prefer frequently and on a regular schedule." d) "Restrict their fluids if they are incontinent."
c) "Offer fluids that they prefer frequently and on a regular schedule." *The long-term care nurse teaches the UAPs to frequently offer older adults fluids that they prefer and on a regular basis. Because of the decreased thirst mechanism, older adults can become dehydrated and must be offered oral fluids every 2 hours. The likelihood of their accepting the fluid increases if it is one they prefer. Risk of overhydration, especially with oral fluids, is minimal. Fluids would never be restricted even if the client is incontinent. Restricting fluids to incontinent clients is a common mistake made by UAP in long-term care environments. It is not necessary to disturb older adults during their sleep to offer fluids. However, they should be offered a drink during waking hours at frequent intervals (e.g., every 2 hours).
Which of the following fluids would NOT be indicated for pt with BP of 80/60? a) 0.9% NS b) LR c) 0.45% NS
c) 0.45% NS *hypotonic solution is not good for keeping intravascular stability bc water will move out of the vasculature into the cels
What is the most expected range for magnesium? a) 0.5-1.5 b) 2.5-5 c) 1.2-2.2 d) 1.7-2.2
c) 1.2-2.2 -obvious abnormal values include 0.5 or 18
Which of the following best represents accurate, prioritized, initial nursing assessment of the client with psychosis who has fasciculations (muscle twitching) of the arms and legs? a) Assess mental health history, electrolytes, and heart tones b) Assess mental health history, BUN/creat, general appearance c) Assess medication history, electrolytes, cranial nerves d) Assess medication history, intake and output, and birth history
c) Assess medication history, electrolytes, cranial nerves
Which diagnostic test result is consistent with a diagnosis of heart failure (HF)? a) Serum potassium level of 3.2 mEq/L (3.2 mmol/L) b) Ejection fraction of 60% c) B-type natriuretic peptide (BNP) of 760 pg/mL (760 ng/dL) d) Chest x-ray report showing right middle lobe consolidation
c) B-type natriuretic peptide (BNP) of 760 pg/mL (760 ng/dL) *A BNP of 760 pg/ml (760 ng/dL) is consistent with a diagnosis of heart failure. BNP is produced and released by the ventricles when the client has fluid overload as a result of HF. A normal BNP value is less than 0-99 picograms per milliliter (pg/mL) or 0-99 nanograms per liter (ng/L).Hypokalemia (serum potassium level of 3.2 mEq/L [3.2 mmol/L]) may occur in response to diuretic therapy for HF, but may also occur with other conditions. It is not specific to HF. Ejection fraction of 60% represents a normal value of 50% to 70%. Consolidation on chest x-ray may indicate pneumonia.
What pt should the nurse MOST question for receiving IV 0.9%NS at 150 ml/hr? a) adult that's NPO b) schizophrenia c) CHF d) Na+ 136
c) CHF *pt that is NPO will need fluid replacement
What patient would cause the nurse to question the order for 0.9% NS? (select all that apply) a) pt that overused diuretics b) pt with GI losses c) pt with CHF d) pt with a fever of 104 degrees e) pt with HTN whose BP was 160/80 f) pt with left ventricular dysfunction
c) CHF e) pt with HTN whose BP was 160/80 f) pt with left ventricular dysfunction *must use cautiously bc risk of FVE
A client develops fluid overload while in the intensive care unit. Which nursing intervention does the nurse perform first? a) Places the extremities in a dependent position b) Puts the client in a side-lying position c) Elevates the head of the bed d) Draws blood for laboratory tests
c) Elevates the head of the bed *The nurse first needs to elevate the client's head of bed when caring for a client with fluid overload. Remember to follow the ABC's and perform interventions that promote lung expansion and oxygenation to relieve symptoms of fluid overload. Drawing blood for laboratory tests may be indicated, but would not be performed first. Placing the extremities in a dependent position increases peripheral edema, and positioning the client in a side-lying position increases the work of breathing.
The nurse is taking care of the patient with acute paranoid schizophrenia. Which of the following medication orders is the most correct? a) Haldol decanoate (haloperidol) 15 mg IV x 1 for acute psychosis b) Haldol decanoate (haloperidol) 150 mg orally every 12 hours c) Haldol decanoate (haloperidol) 1.5 mg orally every 12 hours d) Haldol decanoate (haloperidol) 0.15 mg IM x 1 for acute psychosis
c) Haldol decanoate (haloperidol) 1.5 mg orally every 12 hours *This is 3 mg daily which falls within the correct range for this medication.
Which intervention best assists the client with acute pulmonary edema in reducing anxiety and dyspnea? a) Monitor pulse oximetry and cardiac rate and rhythm. b) Reassure the client that his distress can be relieved with proper intervention. c) Place the client in high-Fowler's position with the legs down. d) Ask a family member to remain with the client.
c) Place the client in high-Fowler's position with the legs down. *The best intervention to help the client with acute pulmonary edema to reduce anxiety and dyspnea is to place the client in high-Fowler's position with the legs down. High-Fowler's position and placing the legs in a dependent position will decrease venous return to the heart, thus decreasing pulmonary venous congestion.Monitoring of vital signs will detect abnormalities, but will not prevent them. Reassuring the client and a family member's presence may help alleviate anxiety, but dyspnea and anxiety resulting from hypoxemia secondary to intra-alveolar edema must be relieved.
The nurse is caring for a group of clients with electrolytes and blood chemistry abnormalities. Which client will the nurse see first? a) The client with a random glucose reading of 123 mg/dL (6.8 mmol/L) b) The client with a sodium level of 143 mEq/L (143 mmol/L) c) The client whose potassium is 6.2 mEq/L (6.2 mmol/L) d) The client who has a magnesium level of 2.1 mEq/L (1.0 mmol/L)
c) The client whose potassium is 6.2 mEq/L (6.2 mmol/L) *The first client the nurse sees with electrolyte and blood chemistry abnormalities is the client whose potassium is 6.2 mEq/L (6.2 mmol/L). A potassium value of 6.2 mEq/L (6.2 mmol/L) is elevated and the client has potential for cardiac dysrhythmias. A random or casual glucose, taken at any time of day, is elevated if ≥200 mg/dL(>11.1 mmol/L); a random value of 123 mg/dL (6.9 mmol/L) does not require intervention. The other clients with a magnesium value of 2.1 mEq/L (1.0 mmol/L) and a sodium value of 143 mEq/L (143 mmol/L) demonstrate normal laboratory values and do not require intervention.
Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy? a) The client ambulates around the nursing unit with a walker. b) The nurse monitors the client's pulse and blood pressure frequently. c) The nurse obtains a bedside commode before administering furosemide. d) The nurse returns the client to bed when the client becomes tachycardic.
c) The nurse obtains a bedside commode before administering furosemide. *The nursing intervention that can help the client admitted today with heart failure is to have a bedside commode available to the client before administering furosemide. Limiting the need for ambulation on the first day of admission to sitting in a chair or performing basic leg exercises promotes physical rest and reduced oxygen demand.Monitoring of vital signs will alert the nurse to increased energy expenditures but will not prevent them. Waiting until tachycardia occurs permits increased oxygen demand. The nurse must prevent this situation.
Positive symptoms of schizophrenia include (select all that apply) a) agnosia b) anergia c) hearing voices d) thinking you are king of England
c) hearing voices d) thinking you are king of England -other (+) ex: delusions, hallucinations, paranoia, magical thinking, illusions, echopraxia, disorganized speech, catatonia (withdrawal or absence of interaction) -some (-) ex: affective flattening, alogia, avolition, anhedonia, apathy, lack of interest, anergia, concrete thinking, & mood symptoms (helpnessness, suicdality, & dysphoria)
Which of the following is not a potential complication of HF? a) HTN b) tachycardia c) urticaria d) pulmonary edema
c) urticaria -urticaria is hives and is unrelated -HTN is a complication bc more fluid trying to "push around" affecting preload and afterload
A nurse teaches clients at a community center about risks for dehydration. Which client is at greatest risk for dehydration? a. A 36-year-old who is prescribed long-term steroid therapy b. A 55-year-old receiving hypertonic intravenous fluids c. A 76-year-old who is cognitively impaired d. An 83-year-old with congestive heart failure
c. A 76-year-old who is cognitively impaired *Older adults, because they have less total body water than younger adults, are at greater risk for development of dehydration. Anyone who is cognitively impaired and cannot obtain fluids independently or cannot make his or her need for fluids known is at high risk for dehydration.
What immediate response does the nurse expect as a result of infusing 1 liter of an isotonic intravenous solution into a client over a 3-hour time period if urine output remains at 100 mL per hour? a. Extracellular fluid (ECF) osmolarity increases; body weight increases. b. Extracellular fluid (ECF) osmolarity decreases; body weight decreases. c. Extracellular fluid (ECF) osmolarity is unchanged; body weight increases. d. Extracellular fluid (ECF) osmolarity is unchanged; body weight decreases.
c. Extracellular fluid (ECF) osmolarity is unchanged; body weight increases. *Isotonic solutions have the same tonicity as plasma and other extracellular fluids. Therefore, the intravenous fluid would not change the ECF osmolarity. When 1000 mL are infused within 3 hours and the client only urinates 300 mL, the extra fluid would increase the client's weight. Remember that 1 liter of fluid is equal to 2.2 lb.
A nurse teaches a client who is at risk for mild hypernatremia. Which statement should the nurse include in this clients teaching? a. Weigh yourself every morning and every night. b. Check your radial pulse twice a day. c. Read food labels to determine sodium content. d. Bake or grill the meat rather than frying it.
c. Read food labels to determine sodium content. *Most prepackaged foods have a high sodium content. Teaching clients how to read labels and calculate the sodium content of food can help them adhere to prescribed sodium restrictions and can prevent hypernatremia. Daily self-weighing and pulse checking are methods of identifying manifestations of hypernatremia, but they do not prevent it. The addition of substances during cooking, not the method of cooking, increases the sodium content of a meal
The nurse is preparing a client a diagnosis of congestive heart failure (CHF) for discharge. Which statement by the client indicates a correct understanding of self-management of CHF? a) "Weighing myself daily can determine if my caloric intake is adequate." b) "I can gain 2 pounds (1 kg) of water a day without risk." c) "I should call my provider if I gain more than 1 pound (0.5 kg) a week." d) "Weighing myself daily can reveal increased fluid retention."
d) "Weighing myself daily can reveal increased fluid retention." *The client with CHF should weigh himself daily to observe for increasing fluid retention, which may not be visible. Rapid weight gain is the best indicator of fluid retention and overload. Each pound (0.5 kg) of weight gained (after the first half-pound [0.2 kg]) equates to 500 mL of retained water. The client must be weighed at the same time every day (before breakfast), and on the same scale. The client would call the primary care provider if more than 1 or 2 pounds (0.5 or 1 kg) are gained in a 24-hour period or if more than 3 pounds (1.4 kg) are gained in 1 week. Daily weights are not an indication of effective dieting for purposes of weight loss or gain. They will show fluid retention after an especially high sodium intake (in a client with fluid retention problems), but caloric intake is related to food intake rather than fluid retention problems.
An older adult is admitted to the medical surgical unit with dehydration. The nurse performs which of these assessments to determine whether the client is safe for independent ambulation? a) Assesses for dry oral mucous membranes b) Evaluates that the serum potassium level is 4.0 mEq/L (4.0 mmol/L) c) Notes pulse rate is 72 beats/min and bounding d) Checks for orthostatic blood pressure changes
d) Checks for orthostatic blood pressure changes *When caring an older adult admitted for dehydration, the nurse determines if the client is safe for independent ambulation by assessing for orthostatic blood pressure. Blood pressure measured with the client lying, then sitting, and finally standing is done to detect orthostatic or postural changes. During low blood volume states, especially when standing, insufficient blood flow to the brain may cause hypotension and tachycardia upon arising. This may cause light-headedness and dizziness, which increases the risk for falls, especially in older adults. Assessment of oral mucous membranes and the pulse rate can detect symptoms of dehydration, but these are not the best ways to assess for a fall risk. Checking serum potassium does ensure safety for ambulation nor assess for fall risk.
The nurse is caring for a client who takes furosemide (Lasix) and digoxin (Lanoxin). The client's potassium (K+) level is 2.5 mEq/L (2.5 mmol/L). Which additional assessment will the nurse make? a) Increases in edema b) Sodium level c) Blood pressure (BP) d) Heart rate
d) Heart rate The nurse must assess the heart rate for bradycardia related to digoxin and irritability or irregularity related to hypokalemia. Hypokalemia increases the sensitivity of cardiac muscle to digoxin and may result in digoxin toxicity, even when the digoxin level is within the therapeutic range. The nurse also assesses for GI symptoms such as diarrhea, and other symptoms of toxicity to digoxin. The BP may decrease with low potassium level but monitoring the pulse is essential. The diuretic would reduce edema, therefore assessing the heart rate is the priority. High serum sodium levels would not be expected in this scenario unless fluid volume deficit is present. The nurse must assess the heart rate for bradycardia related to digoxin and irritability or irregularity related to hypokalemia. Hypokalemia increases the sensitivity of cardiac muscle to digoxin and may result in digoxin toxicity, even when the digoxin level is within the therapeutic range. The nurse also assesses for GI symptoms such as diarrhea, and other symptoms of toxicity to digoxin. The BP may decrease with low potassium level but monitoring the pulse is essential. The diuretic would reduce edema, therefore assessing the heart rate is the priority. High serum sodium levels would not be expected in this scenario unless fluid volume deficit is present.
The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8°F (37.7°C), Pulse: 48 beats/min and irregular, Respirations: 20 breaths/min, Potassium level: 3.2 mEq/L (3.2 mmol/L). What action does the nurse take? a) Give the digoxin; reassess the heart rate in 30 minutes. b) Give the digoxin; document assessment findings in the medical record. c) Hold the digoxin, and obtain a prescription for an additional dose of furosemide. d) Hold the digoxin, and obtain a prescription for a potassium supplement.
d) Hold the digoxin, and obtain a prescription for a potassium supplement. *The nurse needs to hold the digoxin and get a prescription for a potassium supplement. Digoxin causes bradycardia and hypokalemia potentiates digoxin toxicity.Furosemide decreases circulating blood volume and depletes potassium. There is no indication suggesting that the client has fluid volume excess at this time.
The rapid response team (RRT) is called to the bedside of a client with heart rate of 38 beats per minute and a potassium level of 7.0 mEq/L (7.0 mmol/L). For which medication will the nurse anticipate a prescription? a) atropine b) potassium phosphate c) Sodium polystyrene sulfonate (Kayexalate) d) Insulin
d) Insulin *The rapid response nurse expects to administer a combination of 20 units of regular insulin in 100 mL of 20% dextrose in water. This may be prescribed to promote movement of potassium from the blood into the intracellular fluid. While atropine will treat bradycardia, it does not address the underlying cause of bradycardia which is likely hyperkalemia. Sodium polystyrene sulfonate (Kayexalate)may be used for hyperkalemia, but it will not act quickly enough in an emergency. Additional potassium such as contained in potassium phosphate will make the client's condition more critical.
A client admitted for heart failure has a priority problem of hypervolemia related to compromised regulatory mechanisms. Which assessment result obtained the day after admission is the best indicator that the treatment has been effective? a) The client has diuresis of 400 mL in 24 hours. b) The client's blood pressure is 122/84 mm Hg. c) The client has an apical pulse of 82 beats/min. d) The client's weight decreases by 2.5 kg.
d) The client's weight decreases by 2.5 kg. *The best indicator that treatment is effective on a client with heart failure and problems of hypervolemia is the client's weight decreased by 5.5 pounds (2.5 kg) in one day. The best indicator of fluid volume gain or loss is daily weight. Because each kilogram represents approximately 1 liter, this client has lost approximately 2500 mL of fluid.Diuresis of 400 mL in 24 hours represents oliguria. Although a blood pressure of 122/84 mm Hg is a normal finding, alone it is not significant for relief of hypervolemia. Although an apical pulse of 82 beats/min is a normal finding, alone it is not significant to determine whether hypervolemia is relieved.
A pt is admitted to the hospital w dehydration secondary to influenza and vomiting. The provider orders an IV potassium replacement for K+ level of 2.7 Which of these best practice techniques does the nurse include when administering this medication? (Select all that apply.) A) Check IV access for blood return after the infusion b) Use a vein in the hand for better flow c) Push the medication over 5 minutes d) Use an IV pump to deliver the medication e) Ensuring that the rate is no greater than 20 mEq/hr
d) Use an IV pump to deliver the medication e) Ensuring that the rate is no greater than 20 mEq/hr *Best practice technique for administering IV potassium replacement is to ensure that the concentration is no greater than 1 mEq/10 mL of solution. A pump or controller device must be used to deliver the medication to prevent rapid infusion and complications of hyperkalemia, including cardiac arrest. Potassium must be infused via a large vein with a high volume of flow, avoiding the hand. The maximum recommended infusion rate of potassium is 5 to 10 mEq/hr. This rate is never to exceed 20 mEq/hr. Potassium would never be administered via IV push. Assess the IV access for placement and an adequate blood return beforeadministering potassium-containing solutions.
The nurse is assessing fluid balance in the client with heart failure. Which of these strategies will the nurse employ? a) Place an indwelling catheter to measure urine output. b) Auscultate the lungs for adventitious sounds. c) Ask the client how much fluid was consumed yesterday. d) Weigh the client daily, at the same time.
d) Weigh the client daily, at the same time. *When assessing fluid balance on a client with heart failure the nurse must weigh the client at the same time every day. Changes in daily weights are the best indicators of fluid losses or gains. A weight change of 1 pound (0.5 kg) corresponds to a fluid volume change of about 500 mL therefore the weight must be compared to intake and output. The nurse must weigh the client rather than rely on client estimate or memory. An indwelling catheter poses a risk for catheter associated urinary tract infection, and is reserved for specific reasons. Auscultating for adventitious lung sounds or crackles will demonstrate fluid overload, but may not immediately show up.
What is likely for pt w EF of 65% a) expect symptoms of HF b) expect to have peripheral edema c) expect to have cardiac stress test d) expect to be discharged
d) expect to be discharged *normal EF is 50-70%; borderline EF 42-49% (symptoms of SOB potentially during rest); reduced EF <40% (symptoms are noticeable at rest)
What patient would cause the nurse to question the order for hypertonic solution like D5NS or 3%NS? (select all that apply) a) pt that's hyponatremic with Na+ 130 b) pts with elevated ICP c) trauma pts d) pt that's hypernatremic with Na+150 e) pt with 3+ pitting edema f) pt with JVD
d) pt that's hypernatremic with Na+150 f) pt with JVD
What is the definition of the extrapyramidal symptom akathasia? a) tongue protrusion b) tremoring c) rigidity d) restlessness
d) restlessness *other symptoms include trouble standing still,paces the floor, feet in constant motion, rocking back & forth
A client is receiving 250 mL of a 3% sodium chloride solution intravenously for severe hyponatremia. Which signs and symptoms indicate to the nurse that this therapy is effective? a. The client reports hand swelling. b. Bowel sounds are present in all four abdominal quadrants. c. Serum potassium level has decreased from 4.4 mEq/L (mmol/L) to 4.2 mEq/L (mmol/L). d. Blood pressure has increased from 100/50 mm Hg to 112/70 mm Hg.
d. Blood pressure has increased from 100/50 mm Hg to 112/70 mm Hg. *Where sodium goes, water follows. Clients with severe hyponatremia are most often hypovolemic and hypotensive because fluid does not stay in the plasma volume when sodium levels are low. The plasma volume leaks into the interstitial space, which leads to edema formation. Having the blood pressure increase is the best nonlaboratory indicator that the treatment is effective.
A nurse is caring for an older adult client who is admitted with moderate dehydration. Which intervention should the nurse implement to prevent injury while in the hospital? a. Ask family members to speak quietly to keep the client calm. b. Assess urine color, amount, and specific gravity each day. c. Encourage the client to drink at least 1 liter of fluids each shift. d. Dangle the client on the bedside before ambulating.
d. Dangle the client on the bedside before ambulating. *An older adult with moderate dehydration may experience orthostatic hypotension. The client should dangle on the bedside before ambulating. Although dehydration in an older adult may cause confusion, speaking quietly will not help the client remain calm or decrease confusion. Assessing the clients urine may assist with the diagnosis of dehydration but would not prevent injury. Clients are encouraged to drink fluids, but 1 liter of fluid each shift for an older adult may cause respiratory distress and symptoms of fluid overload, especially ifthe client has heart failure or renal insufficiency.
A client with chronic heart failure presents to the ED with a new onset of atrial fibrillation. Which of the following medications would the nurse question? a. furosemide (Lasix) b. metoprolol succinate (Toprol XL) c. diltiazem (Cardizem) d. ivabradine (Corlanor)
d. ivabradine (Corlanor) *Ivabradine is contraindicated in the presence of atrial fibrillation and should be stopped
What is the inability of the heart to keep up with the demands on it, so that the heart fauks ti opump blood with normal efficiency?
heart failure
Why term describes psychosis organic in origin associated with substance abuse, delirium, or dementia
secondary psychosis
What is the nurse concerned could happen if pt has low Na+ that keeps decreasing?
seizures *avoid this by replacing Na+ in body w diet or meds
Match the following with either a) systolic failure/dysfunction or b) diastolic failure/dysfunction 1) dilated heart 2) failure to squeeze 3) failure to pump 4) muscles too dilated so there's to much room to fill, can't squeeze tightly enough 5) muscle too thick so there's no room to fill 6) enlarged ventricles fill with blood & can't squeeze efficiently 7) thickened walls 8) stiff ventricles fill with less blood than normal bc space is narrowed from stiff or overgrown ventricles
systolic failure/dysfunction: 1) dilated heart 2) failure to squeeze 4) muscles too dilated so there's to much room to fill, can't squeeze tightly enough 6) enlarged ventricles fill with blood & can't squeeze efficiently diastolic failure/dysfunction: 3) failure to pump 5) muscle too thick so there's no room to fill 7) thickened walls 8) stiff ventricles fill with less blood than normal bc space is narrowed from stiff or overgrown ventricles
What term describes many medical illnesses that can manifest in symptoms of psychosis, such as deficiencies, infections, autoimmune disorders, or toxins
toxic psychosis
