Term
| This is an acid-base balance characterized by an increase in H+ concentration (decreased blood pH). A low arterial pH due to reduced bicarbonate concentration is the metabolic form. A low arterial pH cue to increased PCO2 is the respiratory form. |
|
Definition
|
|
Term
| A physiologic pump that moves fluid from an area of lower concentration to one of higher concentration; requires STP for energy. |
|
Definition
|
|
Term
| How much does 1L of fluid weigh? |
|
Definition
|
|
Term
| What happens when output of ECF exceeds the intake of fluid? |
|
Definition
|
|
Term
| What type of pulse and heart rate would you expect a patient with hypovolemia to have? |
|
Definition
| Fast heartrate, weak pulse. |
|
|
Term
| What type of tonicity does 0.9% NaCl (normal saline) have? |
|
Definition
|
|
Term
| What type of tonicity does D5NS have? |
|
Definition
|
|
Term
| What type of tonicity does Lactated ringers have? |
|
Definition
|
|
Term
| What are some IV fluids that will commonly be used for Hypovolemia? |
|
Definition
| .5% NS, Lactated ringers, and D5W |
|
|
Term
| Why should D5W not be used solely in treatment of fluid volume deficit? |
|
Definition
| Because it dilutes plasma electrolyte concentrations. |
|
|
Term
| Describe the significance of the percentage .9% when describing tonicity of normal saline. |
|
Definition
| .9% is isotonic. Above this is hypertonic. Below this is hypotonic. |
|
|
Term
| What is the tonicity of D5W? |
|
Definition
|
|
Term
| What is the purpose of treatment for hypovolemia? |
|
Definition
|
|
Term
| When should you weigh a patient who is at risk for hypovolemia? |
|
Definition
| At the same time every day. |
|
|
Term
| What will the lab values for specific gravity if a patient is hypovolemic? |
|
Definition
| It will be elevated because the kidneys will be trying to increase the syrum osmolality. |
|
|
Term
| What will lab values look like for sodium when assessing a patient with hypovolemia? |
|
Definition
| It could be either normal or high depending on the process. |
|
|
Term
| If a high BUN is brought down by a fluid bolus, what does this indicate? |
|
Definition
| Indicates that there is no kidney problem, just hypovolemia. |
|
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Term
| If you assess the lungs then give a fluid bolus of normal saline, then come back to check their lung sounds 2 hours later and they are gurgling, what do you do? |
|
Definition
| Shut off the fluids and call the physician. |
|
|
Term
| What is one of the time that older patients are susceptible to hypovolemia and what is one easy way to combat this? |
|
Definition
| Right after surgery. They should be encouraged to drink. |
|
|
Term
| What are some of the main causes of hypervolemia? |
|
Definition
| Heart failure, liver failure, too much sodium |
|
|
Term
| What causes edema in hypervolemia? |
|
Definition
| Hydrostatic pressure pushing fluid into tissues. |
|
|
Term
| With hypervolemia, do you hear wheezes or crackles 1st? |
|
Definition
| You'll probably hear wheezes early, then crackles later when hypervolemia gets worse. |
|
|
Term
| Why can't salt substitute be used when a patient has liver disease? |
|
Definition
| The ammonia content will complicate the liver disease. |
|
|
Term
| Why can't salt substitute be used with a patient taking a diuretic? |
|
Definition
| Because it contains too much potassium and could cause hyperkalemia. |
|
|
Term
| If you drink too much water when trying to pass a drug test, what can this cause? |
|
Definition
| Dilutional hyponatremia-Water intoxication |
|
|
Term
| What are some clinical manifestations of hyponatremia? |
|
Definition
| Brain cell swelling will cause irritability, confusion, and headaches. Also, decreased blood pressure and nausea will result. Incorrect neuro-muscular junction activity is also a concern. Patient will be lethargic. |
|
|
Term
| At which sodium level does ICP get too high? |
|
Definition
| Below 115, neuro problems will be seen. |
|
|
Term
| What are some interventions for Fluid volume excess? |
|
Definition
| Water restriction and sodium replacement. |
|
|
Term
| What are the guidelines for sodium replacement? |
|
Definition
| You don't want to increse more than 12 mEq/L in 24 hours. If brain cells are swollen, you don't want to increse too fast. |
|
|
Term
| For a patient in ICU, how often are sodium levels assessed? |
|
Definition
|
|
Term
| What must the sodium level be to suggest hypernatremia? |
|
Definition
|
|
Term
| What IV solution will be used for Hypernatremia? |
|
Definition
|
|
Term
| What are normal potassium levels? |
|
Definition
|
|
Term
| Where is most potassium lost? |
|
Definition
| In the GI system. With chronic diarrhea, check potassium levels. Laxatives can cause low potassium. |
|
|
Term
| What is one cellular function is potassium used for? |
|
Definition
| Depositing glucose and glycogen in the liver. |
|
|
Term
| When is it okay to give potassium IV push or IM? |
|
Definition
| Never. This is very dangerous. |
|
|
Term
| What is the preferred IV site for giving potassium? |
|
Definition
| It is very damaging to the vein. Therefore, the hand is not preferred. Call the doctor for a PIC or central line. |
|
|
Term
| When monitoring I&O, what notifies you of kidney problems when giving potassium placement to a patient. |
|
Definition
| Less than 20cc of output in 2 consecutive hours. They could develop hyperkalemia if the kidneys aren't secreting potassium. |
|
|
Term
| What level must potassium be above for the nurse to suspect hyperkalemia? |
|
Definition
|
|
Term
| What are some of the main risk factors for hyperkalemia? |
|
Definition
| Tissue trauma (burns), Metabolic or respiratory acidosis (think about hydrogen), PO potassium, ACE inhibitors, and NSAIDs |
|
|
Term
| Where do we see mucle weakness 1st in hyperkalemia? |
|
Definition
|
|
Term
| What GI symptoms will we see in hyperkalemia? |
|
Definition
| Nausea and diarrhea, because potassium causes smooth muscle activity. |
|
|
Term
| What value must calcium level be lower than to suggest hypocalcemia? |
|
Definition
|
|
Term
| Calcium levels are inversly related to what? |
|
Definition
| Phosphate levels. Correct. |
|
|
Term
| How is chvoztek's sign tested? |
|
Definition
| Tapping the zygomatic arch in front of the ear. Muscle spasms in the face are a positive sign. |
|
|
Term
| For hypercalcemia, what level must calcium be above? |
|
Definition
|
|
Term
| If someone is recieving a blood transfusion and the blood is administered too quickly, what is the patient at risk for? |
|
Definition
|
|
Term
| How often should magnesium levels be checked when a patient is going through withdrawals? |
|
Definition
|
|
Term
| In acute respiratory acidosis, what will the finding be for HC03? |
|
Definition
|
|
Term
| For chronic respiratory acidosis, what will be the finding for HCO3. |
|
Definition
|
|
Term
| What is the main treatment for respiratory acidosis? |
|
Definition
| Improve alveolar ventilation. |
|
|
Term
|
Definition
| Chronic levels of CO2 causes a decreased sensitivity to CO2 as stimulant to breathe, leaving hypoxemia as the major stimulus to breathe. When O2 is given, hypoxemia is resolved leaving no drive to breathe. It's very important to monitor O2 administration closely. |
|
|
Term
| Why must you monitor K+ in respiratory alkalosis? |
|
Definition
| Because hydrogen will be pulled out of cells in exchange for potassium, causing serum potassium to fall. |
|
|
Term
| What are the clinical manifestations of respiratory alkalosis? |
|
Definition
| Lethargy, light headedness, confusion, nausea, vomiting, tachycardia, signs of hypocalcemia, numbness, tingling. |
|
|
Term
| In metabolic acidosis, what does hyperventilation do? |
|
Definition
| It decreases CO2 as a compensatory action. |
|
|
Term
| Why might hyperkalemia occur in metabolic acidosis? |
|
Definition
| It may occur as potassium shifts out of the cell, to correct the surplus of hydrogen outside. The potassium switches places with H+. As acidosis is corrected, K+ shifts back into the cell and K+ levels decrease. |
|
|
Term
| What are the clinical manifestations of metabolic acidosis? |
|
Definition
| Increased resp rate and depth, decreased BP, decreased cardiac output, shock, drowsiness, confusion, H/A, coma, hypotension, arrhythmias, N/V/D, abdominal pain |
|
|
Term
| What are the correct nursing management actions when dealing with a patient who has metabolic acidosis? |
|
Definition
| Monitor K+ closely, monitor ABG's and electrolytes. Medication could be bicarbonate and possibly K+ if the potassium level decreases as acidosis resolves. |
|
|
Term
| What are the clinical manifestations of metabolic alkalosis? |
|
Definition
| Dizziness, irritability, nervousness, confusion, tachycardia, N/V, tremors, hypertonic muscles, tetany, tingling, and seizures. |
|
|
Term
| What are the appropriate nursing management actions for a patient with metabolic alkalosis? |
|
Definition
| Monitor I&O, ABG and Electrolytes, VS, IV fluids, medications- K+ ifhypokalemic, H2 receptor antagonist (tagament) to reduce gastric HCL. |
|
|
Term
What am I?:
pH: 7.30
PaCO2: 67
PaO2: 47
HCO3: 37 |
|
Definition
|
|
Term
| What is the normal value for serum pH? |
|
Definition
|
|
Term
| What is the normal value for PaCo2 partial pressure? |
|
Definition
|
|
Term
| What is the normal value for serum HCO3? |
|
Definition
|
|
Term
| In respiratory acidosis, and most cases of metabolic acidosis, what will the kidneys do to correct it? |
|
Definition
| They will excrete H+ ions and conserve bicarbonate ions to help restore balance. |
|
|
Term
| In respiratory and metabolic acidosis, what will the kidneys do to try to correct the problem? |
|
Definition
| They will retain H+ ions and excrete bicarbonate ions to help restore balance. |
|
|
Term
| How will the kidneys compensate for the metabolic acidosis created by renal failure? |
|
Definition
| The kidneys cannot compensate for the metabolic acidosis created by renal failure. |
|
|
Term
| If metabolic acidosis is caused by a lack of bicarbonate, what will the lungs do to compensate? |
|
Definition
| The lungs will increase the rate of breathing, which blows off carbon dioxide and helps to raise the pH to normal. |
|
|
Term
| If metabolic acidosis is caused by a lack of bicarbonate, what will the lungs do to compensate? |
|
Definition
| The lungs will increase the rate of breathing, which blows off carbon dioxide and helps to raise the pH to normal. |
|
|
Term
| If metabolic alkalosis is is caused by an excess of bicarbonate, what will the lungs do to compensate? |
|
Definition
| The lungs will decrease the rate of breathing, which retains carbon dioxide and helps lower pH. |
|
|
Term
| When PaCO2 is high, how will the kidneys react? |
|
Definition
| The kidneys retain bicarbonare and excrete more acid to raise the pH. |
|
|
Term
| How does bicarbonate level move in relation to pH level? |
|
Definition
| It moves in the same direction as pH. |
|
|
Term
| What are the interventions for dilutional hyponatremia? |
|
Definition
| Water restriction and sodium replacement. |
|
|
Term
| What is the 24-hour limit for increasing serum sodium levels in a pt with dilutional hyponatremia? |
|
Definition
| You don't want to increase more than 12mEq/L in 24 hours. The ICP will most likely already be high, and you don't want to decrease the swelling of brain cells too quickly. |
|
|
Term
| How often must sodium levels be assessed in a patient being treated with 3% saline for dilutional hyponatremia? |
|
Definition
|
|
Term
| For a patient with hypernatremia, will you expect to see an increase or a decrease in urine output? |
|
Definition
|
|
Term
| What is the goal of treating hypernatremia? |
|
Definition
| To lower sodium and prevent overcorrection. |
|
|
Term
|
Definition
| In treating hypernatremia. |
|
|
Term
| Where is most potassium lost? |
|
Definition
|
|
Term
| What fluid/elec imbalance are laxatives most likely to cause? |
|
Definition
|
|
Term
| Which electrolyte is used for for the cellular activity of depositing glucose and glycogen in the liver? |
|
Definition
|
|
Term
| When hydrogen moves into a cell, what happens to K+? |
|
Definition
| It gets pushed out of the cell. |
|
|
Term
| Hypervolemia is related to what electrolyte imbalance other than hypernatremia? |
|
Definition
|
|
Term
| How would severe hypokalemia usually cause death? |
|
Definition
| Through cardiac and respiratory arrest. |
|
|
Term
| What electrolyte imbalance are patients with persistent insulin hypersecretion at risk for? |
|
Definition
| Hypokalemia, because inculin promotes entry of potassium into skeletal muscle and hepatic cells. |
|
|
Term
| Why must you look for GI bleeding when giving patients oral potassium? |
|
Definition
| Because oral potassium can cause lesions in the small bowel. |
|
|
Term
| A burn patient is experiencing metabolic respatory acidosis, and taking ACE inhibitors. What electrolyte imbalance would you expect them to experience? |
|
Definition
|
|
Term
| What will the t-wave look like with hyperkalemia? |
|
Definition
| Tall and tinted. It will look like a QRS wave. |
|
|
Term
| What will the QRS wave look like in hyperkalemia? |
|
Definition
|
|
Term
| Where will you see muscle weakness 1st in hyperkalemia? |
|
Definition
|
|
Term
| Why does nausea and diarrhea occur with hyperkalemia? |
|
Definition
| Because of smoothe muscle activity in the GI tract caused by K+. |
|
|
Term
| When would you not want to give kayexelate to a patient with hyperkalemia? |
|
Definition
| You wouldn't want to give kayexalate to a patient with a paralytic ileus because you can perforate their bowel. |
|
|
Term
| When giving IV sodium bicarb to a patient, which shift in electrolyte would you expect? |
|
Definition
| Shift of potassium into cells. It is temporary. |
|
|
Term
| What does a beta-2 agonist cause in terms of potassium levels? |
|
Definition
| A shift of potassium into the cell. |
|
|
Term
| What serum level of calcium denotes hypocalcemia? |
|
Definition
|
|
Term
| A patient is recovering from a thyroidectomy. What elec. imbalance would you monitor for? |
|
Definition
|
|
Term
| How is truseaud's sign checked? |
|
Definition
| Inflate blood pressure cuff 20mmHg above normal for 5 min and if the hand curls, it's positive. |
|
|
Term
| Why don't you use .9% NS when giving calcium replacements to a patient with hypocalcemia? |
|
Definition
| Because it increases renal bicarb loss and can cause toxicity. |
|
|
Term
| Paroxysmal atrial tachycardia is normally associated with what? |
|
Definition
|
|
Term
| What level denotes hypomagnesemia? |
|
Definition
|
|
Term
| Which electrolyte affects enzyme reactions within the cell and carbohydrate metabolism? |
|
Definition
|
|
Term
| I take part in DNA and protein synthesis. I also influence vasodilation, irritability and excitability of cardiac muscles. What electrolyte am I? |
|
Definition
|
|
Term
| Are chvostek and trouseau's sign useful in diagnosing hypermagnesemia? |
|
Definition
| Yes. It will be positive. |
|
|
Term
| What are some foods that are high in magnesium? |
|
Definition
| Green, leafy veggies, grains and peanut butter. |
|
|
Term
| How can Mag sulfate be given on an IV? |
|
Definition
|
|
Term
| A chronic antacid-abusing alcoholic is on diuretics to treat his edema. What is he at risk for? |
|
Definition
|
|
Term
| An anorexic is being refed after nearly starving herself to death. What is one major elec embalance she is at risk for? |
|
Definition
|
|
Term
| A patient is experiencing hypoventilation. What are they at risk of developing? |
|
Definition
|
|
Term
| What are the clinical manifestations of respiratory acidosis? |
|
Definition
| Increased respiration, increased pulse, increased blood pressure; drowsiness, disorientation, dizziness, headache, and seizure. |
|
|
Term
| If a patient is hyperventilating, what are they at risk for developing? |
|
Definition
|
|
Term
| What happens to the cell as serum potassium levels decrease? |
|
Definition
| The hydrogen moves out of the cell. Therefore, the pH of the blood will increase. |
|
|
Term
| What are the signs and symptoms of respiratory alkalosis? |
|
Definition
| Lethargy, light headedness, confusion, tachycardia, numbness, tingling, nausea, vomiting, and maybe some signs of hypocalcemia. |
|
|
Term
| What acid-base imbalance can potassium depletion cause? |
|
Definition
|
|
Term
| What are the clinical manifestations of metabolic alkalosis? |
|
Definition
| Dizziness, irritability, nervousness, confusion, increased heartrate, nausea and vomiting, tremors, tetany, seizures, and hypertonic muscles. |
|
|
Term
| What are some nursing diagnoses that would be given for someone with metabolic alkalosis? |
|
Definition
| Risk for injury due to NM irritability and tetany; altered breathing pattern; risk for irregular cardiac output/arrhythmias. |
|
|
Term
| In metabolic alkalosis, what can you give to reduce hydrochloric acid? |
|
Definition
|
|
Term
A patients ABG reading is:
pH-7.18
paCO2-38
PaO2-70
HcO3-15
What state are they in? |
|
Definition
|
|
Term
| What are two main general rules when selecting an IV site? |
|
Definition
| Avoid bends in arms, and start from the hands and work up. |
|
|
Term
| What is the rule regarding IV site selection in a patient who has had a mastectomy? |
|
Definition
| You don't want to use the arm from the same side as the mastectomy because of the removal of lymph nodes. |
|
|
Term
| What is a unit nurse's first responsibility? |
|
Definition
|
|
Term
| What does most preoperational anxiety arise from? |
|
Definition
|
|
Term
| What is preoperative fear usually regarding? |
|
Definition
| Death or permanent disability. |
|
|
Term
| What system are you assessing when you assess a patient's ability to follow commands? |
|
Definition
|
|
Term
| If you find out a patient has an upper airway infection just before surgery, what would you expect to be the significance of this? |
|
Definition
| The surgery will be rescheduled |
|
|
Term
| How long before surgery are oral medications usually given? |
|
Definition
|
|
Term
| How long before surgery are IM and sub Q meds given? |
|
Definition
|
|
Term
| A patient has just returned from surgery. What is the nurse's first priority? |
|
Definition
|
|
Term
| A patient just had abdominal surgery and is refusing to wear antiembolism stockings. What si the patient at risk for? |
|
Definition
|
|
Term
| The PACU nurse is caring for a patient that is still unconscious. The patient is bluish an ddusty. The patient is not breathing. What is the nurse's initial reaction? |
|
Definition
| Check for laryngeal obstruction and tilt the head back and push the jaw forward. |
|
|
Term
| When signing a consent form the nurse must make sure which of the following is met? |
|
Definition
| Both parents must sign consent form if child is not emancipated. |
|
|
Term
| Which is true of the sterile field in th OR? |
|
Definition
| Only table top is sterile. bacteria can travel on airborne particles, and if a sterile item comes into contact with an unsterile item, it is contaminated. |
|
|
Term
| Patient identification prior to the ER: Select all that apply. |
|
Definition
| Name of the physician performing procedure, have patient state first and last name, compare patient ID with the chart. |
|
|
Term
| A 16 year old pregnant married female is admitted for a C-section. Who should sign the consent from? |
|
Definition
| The patient (not the girl's parents or husband) |
|
|
Term
| A teenage female patient is admitted to the ER for an appendectomy. The nurse notices protruding chest and bones in the ribs. The girl's mother states that she is undergoing treatment for anorexia. What should the nurse do? |
|
Definition
| Notify the surgeon and check electrolyte levels. |
|
|
Term
| A patient admitted for surgery wants to know why he is not allowed to eat for 8hrs prior to his surgery. The nurse's best response is? |
|
Definition
| Pts should be NPO for 8hrs to decrease the risk for aspirtaion. |
|
|
Term
| Select all that apply to the circulating nurse. |
|
Definition
| Documenting, Keep track of all sponges and drains. |
|
|
Term
| A patient in the PACU has not viuded for the past 7hrs. As a nurse, what is the first thang that you need to do? |
|
Definition
|
|
Term
| A 38 yr old pt that is in recovery from surgery is apprehensive, restless, and thirsty. The pt asks if he can have a drink of water. Upon assessment you notice the pt's skin is cool, moist, and pale. What should you be concerned for? |
|
Definition
|
|
Term
| A pt is taking potassium sparing diuretics. What side effects might you expect from hyperkalemia? |
|
Definition
| Fatigue and muscle weaknes. |
|
|
Term
| A patient has been admitted with hyponatremia. What would the nurse frequently assess? |
|
Definition
|
|
Term
| A pt has just received anesthesia and wants to use the restroom. What should you use as the nurse do? |
|
Definition
| Give them a bedpan and don't let them get up |
|
|
Term
| A patient asks why they can't wear their dentures during surgery. Why? |
|
Definition
| It could obstruct their airway. |
|
|
Term
| A pt having a hysterectomy does not need further explanation before signing informed consent when she states? |
|
Definition
| The doctor has explained the risks of hemorrhage. |
|
|
Term
|
Definition
|
|
Term
| A pt has tea (60z), nukd (240cc), an orange, a cup of broth and 200 ml parenteral fluids. What should the nurse put as input? |
|
Definition
|
|
Term
| A pt states that they don't understand what the surgery entails. What should the nurse do? |
|
Definition
|
|
Term
| What is a patient who took several antacid tablets at risk for? |
|
Definition
|
|
Term
| A pt who is NPO the night before surgery has a BP tablet to take. What should the pt do? |
|
Definition
| Take the tablet w/ a sip of water. |
|
|
Term
| What should the nurse expect from a pt with hypomagnesia? |
|
Definition
|
|
Term
| A pt with an abdominal incision is experiencing dehisence with evisceration. What action should the nurse take 1st? |
|
Definition
| Cover the wound with gauze and saline. |
|
|
Term
| A pt states his grandmother spiked a fever of 104 for no reason during surgery. Why is this information important to the surgical team? |
|
Definition
|
|
Term
| What is the best way to measure a pt for fluid imbalance? |
|
Definition
|
|
Term
| If a pt who weighed 178 lbs 2 days ago now weighs 170 lbs, how much water did they lose? |
|
Definition
8-lbs/2.2=3.6kg
1kg=1L
3.6kg=1L=4L |
|
|
Term
| A patient's labs come back with a diagnosis of respiratory alkalosis. The patient's vitals are normal except for a respiration rate of 24. The patient complains of pain at the incision site. What should the nurse do 1st? |
|
Definition
|
|
Term
| A pt recently in for heart failure is currently takin digitalis. The pt complains to the home health nurse about weakness and heart flutters. What should the nurse do? |
|
Definition
| Tell the pt to stop taking digitalis and call physician |
|
|
Term
| A pt with COPD is most at risk for developing which one of the following? |
|
Definition
|
|
Term
| Which labs indicate respiratory acidosis? |
|
Definition
|
|
Term
| For a dx of hyperkalemia and met acidosis, which do you correct 1st? |
|
Definition
| correct metabolic acidosis 1st. |
|
|
Term
| What does the ECG look like with hyperkalemia? |
|
Definition
| peaked narrowed T waves and widened QRS |
|
|
Term
| A pt doesn't want to take their pain meds because they fear it will slow down the healing process. What should you tell them? |
|
Definition
| Pain medicines help you heal faster because you're able to get up sooner and only prolonged use can cause addiction. |
|
|
