Chapter 36 - Fluid & Electrolytes (Week 6 Quiz) Flashcards
(110 cards)
1
Q
A ______ is a solid substance dissolved in body fluids. It can be crystalloid (readily dissolves) or colloid (larger molecule that does not dissolve as easy)
A
solute
2
Q
Define solute
A
● A solute is a solid substance dissolved in body fluids.
3
Q
An ______ is a substance that develops an electrical charge when dissolved in water.
●
A
electrolyte
4
Q
_______fluid is fluid contained within the cells.
______ fluid is fluid outside the cells. It consists of three types of fluid: interstitial, intravascular, and transcellular fluid.
A
Intracellular
Extracellular
5
Q
A ______ is an electrolyte that carries a positive charge. They include sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+).
An ______ is an electrolyte that carries a negative charge. Examples are chloride (Cl−), bicarbonate (HCO3−), phosphate (HPO42−), and sulfate (SO42−).
A
cation
anion
6
Q
An ______ is a substance that develops an electrical charge when dissolved in water.
A
electrolyte
7
Q
Identify the major electrolytes in the ICF and ECF.
A
These cellular fluids contain the following major electrolytes:
● In intracellular fluid (ICF), the major cations are potassium (K+) and magnesium (Mg2+), and the major anion is phosphate (HPO42−) .
● In extracellular fluid (ECF), the major cation is sodium (Na+), and the major anions are chloride (Cl−) and bicarbonate (HCO3−).
8
Q
What are the functions of body fluids?
A
- maintain blood volume
- regulate body temp
- transport material to and from cells
- serve as medium for cellular metabolism
- Assist with digestion of food
- Serve as medium for excreting waste
9
Q
T or F: Water content varies with age, sex, adipose tissue. The more fat you have the less water you have compared to a person of a lean build.
A
true.
p.914
10
Q
Most body fluid is contained withing two compartments:
_______fluid is fluid contained within the cells. It is essential for cell function and metabolism.
______ fluid is fluid outside the cells. It carries water, electrolytes, nutrients, and oxygen to cells and removes waste products. It consists of three types of fluid: interstitial, intravascular, and transcellular fluid.
A
Intracellular
Extracellular
11
Q
Most body fluid is contained withing two compartments:
_______fluid is fluid contained within the cells. It is essential for cell function and metabolism.
______ fluid is fluid outside the cells. It carries water, electrolytes, nutrients, and oxygen to cells and removes waste products. It consists of three types of fluid: interstitial, intravascular, and transcellular fluid.
A
Intracellular
Extracellular
12
Q
_____ fluid lies between the body cells. excess of this fluid is called edema.
____ fluid is the plasma within the blood. It transports blood cells.
______ fluid includes specializes fluids such as cerebrospinal, pleural, peritoneal, synovial, and digestive juices.
A
interstitial, intravascular, and transcellular fluid.
13
Q
______ is the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
A
ascites
14
Q
A ______ is an electrolyte that carries a positive charge. They include sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+).
An ______ is an electrolyte that carries a negative charge. Examples are chloride (Cl−), bicarbonate (HCO3−), phosphate (HPO42−), and sulfate (SO42−).
A
cation
CaNaK Mg
anion
15
Q
Identify the major electrolytes in the ICF and ECF.
A
These cellular fluids contain the following major electrolytes:
● In intracellular fluid (ICF), the major cations are potassium (K+) and magnesium (Mg2+), and the major anion is phosphate (HPO42−) .
● In extracellular fluid (ECF), the major cation is sodium (Na+), and the major anions are chloride (Cl−) and bicarbonate (HCO3−).
16
Q
_______: movement of water across a membrane from one area of less concentrated solution to greater concentrated solution
_______: movement of molecules of solute from Higher to lower concentration
A
Osmosis
Diffusion
17
Q
________: movement water & smaller particles from area of high pressure to one of low pressure
____ ______: movement of molecules (electrolytes) from area of low concentration to high concentration
A
Filtration
Active transport
18
Q
_______: movement of water across a membrane from one area of less concentrated solution to greater concentrated solution
________: movement water & smaller particles from area of high pressure to one of low pressure
A
Osmosis (concentration)
Filtration (pressure)
19
Q
____ ______: movement of molecules (electrolytes) from area of low concentration to high concentration
_______: movement of molecules of solute from Higher to lower concentration
A
Active transport (low to high uses energy, like climbing stairs to get to the top of a slide)
Diffusion (going down a slide)
20
Q
_______: movement of water across a membrane from one area of less concentrated solution to greater concentrated solution
________: movement water & smaller particles from area of high pressure to one of low pressure
A
Osmosis (concentration related - not pressure)…goes toward concentrated area to dilute it.
Filtration (pressure related)
21
Q
What are the three passive transport systems?
A
osmosis, diffusion, filtration
22
Q
The concentration of solutes providing pressure in body fluid is called….
____ refers to the # of particles of solute per kg of water.
A
osmolality
osmols
23
Q
The concentration of solutes providing pressure in body fluid is called….
____ refers to the # of particles of solute per kg of water.
A
osmolality (also called tonicity)
osmols
24
Q
______ pressure is the force created by fluid within a closed system and is responsible for normal circulation of blood. Blood flows from the high pressure arterial system to the low pressure capillaries and veins.
A
hydrostatic
25
______ pressure is the FORCE created by fluid within a closed system and is responsible for normal circulation of blood. Blood flows from the high pressure arterial system to the low pressure capillaries and veins.
hydrostatic
26
____ pressure is the power of a solution to DRAW water.
osmotic pressure
27
____ pressure is the power of a solution to DRAW water.
osmotic pressure
Plasma proteins in the blood exert osmotic pressure.
28
Identify the appropriate mechanism: osmosis, diffusion, filtration, or active transport.
● Molecules move across a membrane to equalize concentration.
● Fluid moves across a membrane to equalize concentration.
● Molecules move against a concentration gradient.
● Molecules move to equalize pressure.
Answer:
Diffusion
Answer:
Osmosis
Answer:
Active transport
Answer:
Filtration
29
Identify the appropriate mechanism: osmosis, diffusion, filtration, or active transport.
● Molecules move across a membrane to equalize concentration.
● Fluid moves across a membrane to equalize concentration.
● Molecules move against a concentration gradient.
● Molecules move to equalize pressure.
Answer:
Diffusion
Answer:
Osmosis
Answer:
Active transport
Answer:
Filtration
30
T or F: IOM recommends 2700 mL/day women, 3500 mL/day men.
True. And this is much higher than the 6-8 8-ounce glasses...
31
Situations that increase plasma osmalality and promote thirtst include
excessive fluid loss
excessive sodium intae
decreased fluid intake
32
Situations that increase plasma osmalality and promote thirtst include
excessive fluid loss
excessive sodium intake
decreased fluid intake
33
What is the difference between sensible and insensible fluid loss?
Sensible can be perceived and easily measured.
Insensible cannot... it is evaporation through skin, lungs and accounts for about 900mL/day
34
What are ways fluid leaves the body (output)
Urine: 1500 mL/day
Skin: perspiration
Lungs: exhalation
Feces: 100–200 mL/day
35
_____ are the principal regulator of fluid and electrolyte balance.
Kidneys
36
The pituitary gland releases _____ if the fluid volume/pressure is low. It causes the kidney to retain fluid.
ADH
AntiDiuretic Hormone
Anti diuretic..against diuretic....against water loss.
37
The pituitary gland releases _____ if the fluid volume/pressure in the body is low. It causes the kidney to retain fluid.
ADH
AntiDiuretic Hormone
Anti diuretic..against diuretic....against water loss.
38
When extracellular fluid volume is decreased, the kidney release renin. Renin converts angiotensin I into II. What does angiotensin II do?
acts on the nephrons to retain sodium and water.
It also directs adrenal cortex to release aldosterone.
39
When aldosterone is released it stimulates the kidneys to reabsorb _____ and excrete _____.
Sodium; potassium
40
When aldosterone is released it stimulates the kidneys to reabsorb _____ and excrete _____.
Sodium; potassium
| aldostee salty
41
______ is the discharge of sodium through urine.
Natriuresis.
NAtriuresis
Na=Sodium
uresis=excretion of urine
42
T or F: Moderate potassium deficiency is associated with increased blood pressure.
True
43
____ can donate hydrogen ions
____ can accept hydrogen ions
acid
base (alkali)
44
Remember: for every 1 number on the pH scale, it is TEN TIMEs more or less acidic or basic
Example:
An acid that is 4 on pH is ten times more acidic than a pH of 5.
45
Three complex mechanisms maintain acid-base balance. They are :
1. Buffers
2. Respiratory control of CO2 (carbon dioxide)
3. renal regulation of HCO3 (bicarbonate)
46
How do buffer systems work?
Weak acid and weak base either absorb or release hydrogen ions.
47
Carbonic Acid-SOdium bicarbonate systems balance between carbonic acid (H2CO3) and sodium bicarbonate (NaHCO3). As long as they stay in balance (20:1 NaHCO3:H2CO3), the body's pH remains the same.
If bicarbonate, used to neutralize acid, becomes depleted, the pH will drop and become more acidic. This is called...
acidosis
remember the lower the number the more acidic.
48
The lungs are the second line of defense to restore normal pH. They control the body's carbonic acid supply by carbond dioxide _____ or _____.
retention or removal
49
T or F: When the body is too acidic, the body will rapid/deep breathe.
True. Does this to remove carbon dioxide which will raise the pH to a more neutral number.
50
T or F: When the body is too acidic, the body will rapid/deep breathe.
True. Does this to remove carbon dioxide which will raise the pH to a more neutral number.
Breathe it OUT
51
T or F: If the pH is too high (too alkaline), the lungs will try to conserve carbon dioxide through shallow respiration.
True!
This is how the carbonic acid-sodium bicarbonate buffer system works.
52
The last line of defense is the kidneys, which regulate the concentration of plasma _____.
bicarbonate
53
Briefly describe the three mechanisms used to maintain pH.
Answer:
The three mechanisms that maintain pH (acid–base balance) are buffers, respiratory mechanisms, and renal mechanisms:
● Buffers. Buffer systems respond to electrolyte imbalances to prevent wide swings in pH. A buffer system consists of a weak acid and a weak base. These molecules react with strong acids or bases to keep them from altering the pH by either absorbing free hydrogen ions or releasing free hydrogen ions (H+).
● Respiratory. When the serum pH is too acidic (pH is low), the lungs remove carbon dioxide (CO2) through rapid, deep breathing. This reduces the amount of carbon dioxide available to make carbonic acid (H2CO3)in the body. If the serum pH is too alkaline (pH is high), the lungs try to conserve carbon dioxide through shallow respirations.
● Renal. The kidneys affect pH by regulating the amount of bicarbonate (a base, HCO3−) that is kept in the body. If the serum pH is too acidic, the kidneys reabsorb additional bicarbonate to neutralize the acid. If the serum pH is too alkaline, the kidneys excrete additional bicarbonate to lower the amount of base and thereby decrease the pH. The kidneys also buffer pH by forming acids and ammonium (a base).
54
Rank order the acid–base balance mechanisms from most rapidly acting to the most slowly acting.
Answer:
The three acid–base balance mechanisms are ranked as follows:
● Buffers act the most rapidly.
● Respiratory mechanisms are intermediate.
● Renal mechanisms act the slowest.
55
The last line of defense is the kidneys, which regulate the concentration of plasma _____.
bicarbonate
The kidneys are slow at doing it, but they can neutralize a larger amount of acid or base than the other methods.
56
_____ _____ _____ occurs when there is a proportional loss of fluid and electrolytes from the ECF.
deficient fluid volume
Two examples:
Hypovolemia - loss of blood volume
Dehydration - negative fluid balance with loss of water.
57
Three causes of dehydration?
1. insufficient intake
2. excessive fluid loss (bleeding, vomiting, diarrhea); electrolytes will be lost
3. Fluid shifts (from Intravascular to body tissue).
58
____ _____ is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
Hypovolemic shock
59
____ _____ is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. Dizzy upon standing.
Orthostatic hypotension
60
Symptoms of dehydration?
```
Dry skin and mucous membranes
Nonelastic skin and tongue turgor
Decreased urine output
rise in temperature
Muscle weakness
```
61
T or F: A patient with fluid volume deficit usually has elevated BUN to creatinine ratio and elevated hematocrit.
True.
Same amount of solid substances in less water = more concentration.
62
T or F: Specific gravity of the urine increases as the kidneys attempt to conserve water, resulting in more concentrated urine.
True.
Instead of a lot of pee, you get less pee but dark and cloudy.
63
_____, or fluid overload, is the medical condition where there is too much fluid in the blood. The opposite condition is hypovolemia, which is too little fluid volume in the blood.
Hypervolemia
64
What are some causes of excess fluid volume?
1. excessive salt intake
2. disease affecting kidney or liver function.
3. poor pumping action of the heart
65
What are some causes of excess fluid volume? What are some signs?
1. excessive salt intake
2. disease affecting kidney or liver function.
3. poor pumping action of the heart
Opposite of hypo... full of water like a balloon so:
1. BP elevated
2. pulse bounding
3. respiration increase and are shallow
4. neck veins distended
66
What are some causes of excess fluid volume? What are some signs?
1. excessive salt intake
2. disease affecting kidney or liver function.
3. poor pumping action of the heart
Opposite of hypo... full of water like a balloon so:
1. BP elevated
2. pulse bounding
3. respiration increase and are shallow
4. neck veins distended
5. edema
6. Lots of pee
7. cool skin (sweating/cooling)
67
T or F: In sever fluid overload you may encounter crackles in the lungs, dyspnea, and ascites.
True
68
Define deficient fluid volume and excess fluid volume.
Answer:
These terms have the following definitions:
● Deficient fluid volume occurs when there is a proportional loss of water and electrolytes from the ECF. It may occur as a result of insufficient intake of isotonic fluid; bleeding; excessive loss through urine, skin, insensible losses, or the gastrointestinal tract; or loss of fluid into a third space.
● Excess fluid volume involves excessive retention of sodium and water in the ECF. A synonym is hypervolemia. Fluid volume excess occurs as a result of excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart.
69
Identify the signs and symptoms of deficient fluid volume and excess fluid volume.
Answer:
The following are signs and symptoms related to fluid volume:
● Deficient fluid volume (hypovolemia):
● The first symptom of hypovolemia is thirst. If the patient is able to recognize and respond to this symptom by drinking liquid, no further treatment may be required. If fluid is not available or the patient is unable to consume the liquid, the syndrome progresses. As fluid volume decreases, the heart pumps the remaining blood faster but not as powerfully, resulting in a rapid, weak pulse and a low blood pressure, although, initially as fluid is lost and the heart beats faster, the blood pressure rises through vasoconstriction in an attempt to keep blood flow and oxygenation going. Eventually, compensatory mechanisms wear out and blood pressure falls.
● Water is pulled from the interstitial spaces and the intracellular fluid into the vascular system, resulting in dry skin and mucous membranes, decreased skin turgor, and decreased urine output.
● Patients complain of muscle weakness, fatigue, and feeling warm. Temperature increases because the body is less able to cool itself through perspiration. In an older adult, temperature will rise but may not be elevated above normal body temperature.
● Weight is a sensitive measure of fluid loss. A sudden 5% loss of body weight is considered clinically significant. When loss approaches 8%, fluid loss is severe. A loss of 15% of body weight due to fluid loss is usually fatal.
● The patient with fluid volume deficit usually has an elevated blood urea nitrogen (BUN) level and elevated hematocrit. Both values increase because there is less water in proportion to the solid substances being measured. Specific gravity of the urine increases.
● Excess fluid volume (hypervolemia):
● The blood pressure is elevated, pulse is bounding, and respirations are increased and shallow.
● The neck veins may become distended, and edema develops in dependent areas.
● The skin is pale and cool.
● Urine output becomes dilute, and volume increases.
● The patient rapidly gains weight. In severe fluid overload, the patient develops moist crackles in the lungs, dyspnea, and ascites (excess peritoneal fluid).
● Hemodilution causes BUN, hematocrit, and the specific gravity of urine to decrease.
70
Describe dehydration and hypervolemia.
Answer:
● Dehydration implies the loss of water only.
● Hypervolemia implies excess water.
Neither involves changes in electrolyte levels
71
The last line of defense is the kidneys, which regulate the concentration of plasma _____.
bicarbonate
The kidneys are slow at doing it, but they can neutralize a larger amount of acid or base than the other methods.
72
______ is a mechanism by which the kidneys can regulate the plasma pH. It is slower than respiratory compensation, but has a greater ability to restore normal values.
Renal compensation
73
What is hyponatremia?
condition that occurs when the level of sodium in your blood is abnormally low
74
What is hyponatremia?
condition that occurs when the level of sodium in your blood is abnormally low
75
What is hypernatremia?
an elevated sodium level in the blood
76
____ occurs when pH falls below 7.35
_____ occurs hen pH increases above 7.45
ABG is used to monitor this balance.
acidosis
alkalosis
77
Difference between metabolic and respiratory acidosis/alkalosis?
resp disturbance vs metabolic disturbance causing the issue.
78
REMEMBER:
pH = 7.35-7.45
CO2 = 35-45 mmHg
HCO3 = 22-26 mEq/L
pH = 7.35-7.45
CO2 = 35-45
HCO3 = 22-26
79
What are the steps to interpret Acid Base balance?
1. Examine the pH
| 2. Examine Pco2 amd HCO3
80
What are the steps to interpret Acid Base balance?
1. Examine the pH - acidic?alkalotic?normal?
2. Examine Pco2 and HCO3:
* *which one at fault? you can tell by which one has abnormal number
* *high or low? (acid or basic)?
3. Compensation? (takes 3 days for kidneys to compensate)
* **If pH abnormal and only one ABG are abnormal = no comp
* **If pH abnormal and one ABG are abnormal PLUS a the other is beginning to change (or changed) = partial compensation
***pH is normal BUT ABG's are both abnormal = Full compensation
81
Interpret the following ABG results.
pH = 7.53 PCO2 = 26 mm Hg HCO3− = 22 mEq/L
pH = 7.40 PCO2 = 39 mm Hg HCO3− = 25 mEq/L
pH = 7.30 PCO2 = 70 mm Hg HCO3− = 30 mEq/L
pH = 7.48 PCO2 = 46 mm Hg HCO3− = 30 mEq/L
Answer:
Respiratory alkalosis uncompensated
Answer:
Normal ABG results
Answer:
Respiratory acidosis, partially compensated
Answer:
Metabolic alkalosis, partially compensated
82
Difference between metabolic and respiratory acidosis/alkalosis?
resp disturbance vs metabolic disturbance causing the issue.
```
Metabolic = HCO3
Respiratory = CO2
```
When one system is compromised or having trouble the other will attempt to balance out. Kidneys take 3 days to compensate for imbalance.
83
Identify the signs and symptoms of deficient fluid volume and excess fluid volume.
Answer:
The following are signs and symptoms related to fluid volume:
● Deficient fluid volume (hypovolemia):
● The first symptom of hypovolemia is thirst. If the patient is able to recognize and respond to this symptom by drinking liquid, no further treatment may be required. If fluid is not available or the patient is unable to consume the liquid, the syndrome progresses. As fluid volume decreases, the heart pumps the remaining blood faster but not as powerfully, resulting in a rapid, weak pulse and a low blood pressure, although, initially as fluid is lost and the heart beats faster, the blood pressure rises through vasoconstriction in an attempt to keep blood flow and oxygenation going. Eventually, compensatory mechanisms wear out and blood pressure falls.
● Water is pulled from the interstitial spaces and the intracellular fluid into the vascular system, resulting in dry skin and mucous membranes, decreased skin turgor, and decreased urine output.
● Patients complain of muscle weakness, fatigue, and feeling warm. Temperature increases because the body is less able to cool itself through perspiration. In an older adult, temperature will rise but may not be elevated above normal body temperature.
● Weight is a sensitive measure of fluid loss. A sudden 5% loss of body weight is considered clinically significant. When loss approaches 8%, fluid loss is severe. A loss of 15% of body weight due to fluid loss is usually fatal.
● The patient with fluid volume deficit usually has an elevated blood urea nitrogen (BUN) level and elevated hematocrit. Both values increase because there is less water in proportion to the solid substances being measured. Specific gravity of the urine increases.
● Excess fluid volume (hypervolemia):
● The blood pressure is elevated, pulse is bounding, and respirations are increased and shallow.
● The neck veins may become distended, and edema develops in dependent areas.
● The skin is pale and cool.
● Urine output becomes dilute, and volume increases.
● The patient rapidly gains weight. In severe fluid overload, the patient develops moist crackles in the lungs, dyspnea, and ascites (excess peritoneal fluid).
● Hemodilution causes BUN, hematocrit, and the specific gravity of urine to decrease.
84
Nursing interventions include:
Dietary teaching
Oral electrolyte supplements
Limiting or facilitating oral fluid intake
Parenteral replacement of fluids and/or electrolytes
POTASSIUM CAN KILL!
85
Why is daily weight an accurate way of measuring fluid loss?
Each kg of body weight is equivalent to 1 liter of fluid.
loss of 5 pounds post diarrhea = 2300 mL
86
Identify ten physical assessment components that can be used to monitor fluid, electrolyte, and acid–base balance.
Answer:
The following physical assessment components can be used to monitor fluid, electrolyte, and acid–base balance:
● Skin is evaluated for six components: color, temperature, moisture content, continuity, turgor, and edema.
● The status of the mucous membranes provides information about fluid and electrolyte balance.
● All of the vital signs reflect information about fluid, electrolyte, and acid–base balance.
● If you suspect fluid volume deficit, be sure to assess the patient for orthostatic hypotension.
● Capillary refill and venous filling also offer information about fluid status.
● Respiratory rate and pattern, as well as breath sounds, offer clues about fluid, electrolyte, and acid–base status.
● Assess orientation, level of consciousness, reflexes, and fatigue.
● Monitoring daily change in weight is an accurate method of assessing fluid status.
● Measure all fluids consumed or excreted in a 24-hour period.
87
What aspects should be evaluated in a nursing history focused on fluid, electrolyte, and acid–base balance?
```
Answer:
The nursing history related to fluids, electrolytes, and acid–base balance includes questions about intake and output, underlying medical conditions, and current health problems. The following topics need to be assessed:
● Demographic data
● Past medical history
● Current health concerns
● Food and fluid intakes
● Fluid elimination
● Medications
● Lifestyle
```
88
What is a CBC test?
complete blood count (rbc wbc platelets)
89
What is being tested during urinalysis?
```
urine pH (5-9)
specific gravity
```
90
How do hypertonic fluids work?
When administered, they pull fluids and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. This stabilizes blood pressure, increases uring output, reduces edema.
Imagine someone is swollen with edema.... you put salt into the arteries....water is drawn away from the parts with edema and into the blood... it run through the kidneys and the kidneys say bye felicia and the volume if water in the body decreases.
91
What is infiltration?
damage to the vein that allows fluid to leak into the interstitial space.
92
Identify laboratory tests that monitor fluid, electrolyte, and acid–base balance.
Answer:
The following lab tests monitor fluid, electrolyte, and acid–base balance:
● Serum electrolytes measures sodium, potassium, chloride, and bicarbonate levels. Test often includes blood urea nitrogen (BUN), creatinine, and glucose.
● Serum osmolality is a measure of the solute concentration of the blood.
● Urine osmolality is the solute concentration of urine.
● Hematocrit is a measure of the percent of RBCs in whole blood.
● Specific gravity measures the kidney’s ability to concentrate or dilute urine in relation to the plasma.
● ABGs measure acid–base balance and oxygen status.
93
Give at least five strategies to prevent fluid and electrolyte imbalance.
Answer:
Answers may include any five of the following strategies to prevent fluid and electrolyte imbalance:
● Drink at least eight to ten 8-ounce glasses of water per day. Educate the client about usual fluid needs and circumstances that increase fluid needs, such as high environmental temperature, fever, gastrointestinal fluid loss, or draining wounds. Base your teaching on the client’s current intake and the changes required to meet fluid goals.
● Instruct clients to use thirst as guide. When the client is physically able to access liquid, this is a useful tool.
● Limit consumption of fluids high in salt, sugar, caffeine, or alcohol.
● Teach the client to contact a healthcare provider if he experiences prolonged vomiting, diarrhea, or inability to tolerate liquids or food.
● Encourage clients to drink water before, during, and after strenuous exercise.
● Identify medications or conditions that place the client at risk for imbalances. For example, if the client is receiving a potassium-wasting diuretic, she will need to increase her potassium intake, either by taking a supplement or by altering her diet.
● Caution clients to avoid routine use of laxatives, antacids, weight-loss products, or enemas. All of these products may cause imbalances.
● Instruct the client to weigh himself daily if fluid balance is critical or if the client is experiencing excessive loss.
● Instruct the client to contact a health professional if there is a sudden change of weight, decreased urine output, swelling in dependent areas, shortness of breath, or dizziness.
● Encourage clients to eat a well-balanced diet, including dairy products rich in calcium.
94
What is the purpose of IV fluids?
Answer:
IV fluids are used for the following reasons:
● To expand intravascular volume
● To correct an underlying imbalance in fluids or electrolytes
● To compensate for an ongoing problem that is affecting either fluids or electrolytes
95
Under what conditions would a central venous access device be preferable to a peripheral device?
Answer:
A central venous access device would be preferable to a peripheral device in these situations:
● When highly irritating or hyperosmolar solutions are administered
● When the client is severely fluid depleted and a peripheral line cannot be started
● When central venous pressure monitoring is prescribed
● For parenteral nutrition
● For long-term IV therapy
96
Put in order of use for shortest to longest therapy...
midline peripheral catheter
central venous access device
butterfly
Shortest = butterfly
middle range = midline peripheral catheter (longer than butterfly)
Longest = central venous access device
97
Put in order of use for shortest to longest therapy...
midline peripheral catheter
central venous access device (PICC is an example)
butterfly
Shortest = butterfly
middle range = midline peripheral catheter (longer than butterfly)
Longest = central venous access device
98
What factors should be considered when selecting an insertion site for a peripheral IV line?
```
Answer:
When selecting an insertion site for a peripheral IV line, the following client factors should be considered:
● Age
● Body size
● Clinical status
● Skin condition
● Impairments
● Type of fluid
● Duration expectation of IV therapy
```
99
What is phlebitis?
inflammation of the vein; vein is irritated; redness, pain, swelling, palpable cord along vein. Sluggish infusion rate, elevated temp.
If this happens, discontinue immediately.
100
Describe the difference between infiltration and extravasation as a complication of IV therapy.
Answer:
These complications of IV therapy have the following difference:
● Infiltration involves a nonvesicant solution. May cause burning sensation.
● Extravasation involves a vesicant (solution that causes the formation of blisters and subsequent tissue sloughing and necrosis).
101
What is phlebitis?
inflammation of the vein
102
Describe the difference between infiltration and extravasation as a complication of IV therapy.
Answer:
These complications of IV therapy have the following difference:
● Infiltration involves a nonvesicant solution.
● Extravasation involves a vesicant (solution that causes the formation of blisters and subsequent tissue sloughing and necrosis).
103
A patient was brought to the emergency department with complaints of extreme fatigue, nausea, vomiting, and muscle weakness. Lab results reveal the following: Na+ = 140 mEq/L; K+ = 2.0 mEq/L; Ca2+ = 8.6 mg/dl; Mg2+ = 1.6 mg/dL; and Cl– = 96 mEq/L. The electrocardiogram (ECG) tracing has a flat T wave and frequent PVCs (premature ventricular contractions). The patient's prescribed daily oral medications include furosemide 20 mg, digoxin 0.25 mg, and aspirin 81 mg. The nurse recognizes that these symptoms and diagnostic information are consistent with which of the following?
1) Hypocalcemia
2) Hypernatremia
3) Hypokalemia
4) Hypermagnesemia
Answer:
3) Hypokalemia
Rationale:
The serum potassium level is low (norm = 3.5 to 5.0 mEq/L). PVCs related to cardiac irritability and a flat T wave on an ECG are also indicative of hypokalemia. The patient takes furosemide (Lasix), a diuretic that can induce hypokalemia.
104
A patient was brought to the emergency department with complaints of extreme fatigue, nausea, vomiting, and muscle weakness. Lab results reveal the following: Na+ = 140 mEq/L; K+ = 2.0 mEq/L; Ca2+ = 8.6 mg/dL; Mg2+ = 1.4 mg/dL; and Cl– = 96 mEq/L. The electrocardiogram (ECG) tracing has a flat T wave and frequent PVCs (premature ventricular contractions). The patient's prescribed daily oral medications include furosemide 20 mg, digoxin 0.25 mg, and aspirin 81 mg. Why might the nurse question the order for digoxin 0.25 mg orally daily?
1) Based on the digoxin level, the dose may need to be increased.
2) The patient is at risk for an elevated digoxin level at this time.
3) Digoxin and furosemide should never be taken together.
4) The nurse should not be concerned about the order as written.
2) The patient is at risk for an elevated digoxin level at this time.
Rationale:
The hypokalemic patient on digoxin is at high risk for digoxin toxicity. The patient's serum digoxin level will need to be assessed as she receives potassium supplementation. Digoxin and furosemide can be taken together.
105
Which of the following is considered a first-line intravenous solution for a patient with hypovolemia?
1) 0.9% NaCl (normal saline)
2) 0.45% NaCl (1/2 normal saline)
3) Dextran (a plasma expander)
4) D5W (5% dextrose in water)
Answer:
1) 0.9% NaCl (normal saline)
Rationale:
Hypovolemia occurs when there is a proportional loss of water and electrolytes from the extracellular fluid.
Normal saline is an isotonic fluid that remains inside the intravascular space, thus increasing volume.
Solutions of 0.45% NaCl and D5W are hypotonic fluids and therefore would pull body water from the intravascular compartment into the interstitial fluid compartment, leading to cellular death.
Dextran is a hypertonic fluid that pulls fluid and electrolytes from the intercellular and interstitial compartments into the intravascular compartment and can be used in cases of hypovolemia but is not considered as a first choice.
106
A patient has been admitted to the hospital with medical diagnoses of hypervolemia, acute renal failure, and cardiac dysrhythmias. The patient's vital signs are the following: T = 98.4°F (36.9°C); P = 110; R = 32; BP = 162/102. On physical examination the nurse notes distended neck veins and 3+ pitting edema in both lower extremities. The patient reports he has been drinking and eating as usual but has been unable to urinate. Which is the most appropriate nursing diagnosis for this patient?
1) Excess Fluid Volume related to excessive food and fluid intake
2) Deficient Fluid Volume related to increased metabolic demands
3) Imbalanced Electrolytes secondary to fluid shifts
4) Excess Fluid Volume secondary to acute renal failure
Answer:
4) Excess Fluid Volume secondary to acute renal failure
Rationale:
This patient is experiencing Excess Fluid Volume secondary to acute renal failure.
There is no indication that he has engaged in excessive food or fluid intake.
There is no laboratory result to indicate an electrolyte imbalance, although his test results will most likely demonstrate abnormalities because of the acute renal failure.
107
A patient is in respiratory distress. The physician has ordered arterial blood gases (ABGs). The results are the following: pH = 7.50; PCO2 = 26; HCO3 = 24 mEq/L. How should the nurse interpret the ABGs?
1) Respiratory acidosis
2) Respiratory alkalosis
3) Metabolic acidosis
4) Metabolic alkalosis
Answer:
2) Respiratory alkalosis
Rationale:
The ABGs are consistent with respiratory alkalosis. The pH is elevated, indicating alkalosis. The PCO2 is decreased, which is also consistent with alkalosis. The HCO3 is within normal range.
108
A patient is in respiratory distress. The physician has ordered arterial blood gases (ABGs). The results are the following: pH = 7.50; PCO2 = 26; HCO3 = 24 mEq/L. How should the nurse interpret the ABGs?
1) Respiratory acidosis
2) Respiratory alkalosis
3) Metabolic acidosis
4) Metabolic alkalosis
Answer:
2) Respiratory alkalosis
Rationale:
The ABGs are consistent with respiratory alkalosis. The pH is elevated, indicating alkalosis. The PCO2 is decreased, which is also consistent with alkalosis (PCO2 is related to respiratory). The HCO3 is within normal range.
109
For a patient in respiratory distress, the first arterial blood gases (ABGs) were the following: pH = 7.50; PCO2 = 26; HCO3 = 24 mEq/L. The ABGs were repeated the next morning. The new results are the following: pH = 7.47; PCO2 = 26 mmol/L; HCO3 = 28 mEq/L. The nurse recognizes that the values have changed and that the patient is now experiencing
1) respiratory acidosis.
2) metabolic alkalosis.
3) partial compensation.
4) complete compensation.
Answer:
3) partial compensation.
Rationale:
Although the pH remains alkalotic, the bicarbonate level has begun to rise to compensate for the low PCO2. Complete compensation occurs when the pH returns to normal.
110
The student nurse is reviewing a patient's laboratory reports. Which of the following results should be reported to the primary care provider?
1) Na+ = 126 mEq/L
2) K+ = 3.8 mEq/L
3) Ca2+ = 9.2 mg/dL
4) Mg2+ = 1.8 mg/dL
Answer:
1) Na+ = 126 mEq/L
Rationale:
Serum sodium of 126 mEq/L indicates significant hyponatremia. The student nurse should report the findings to the nurse with whom she is working (or the primary care provider, depending on agency policy) who will report the findings to the primary care provider. The other laboratory results are all within normal limits.
