Fluid, electrolyte, and acid-base balance

Question 1

Intracellular:

Answer 1

2/3 of total body water (majority)

Question 2

Extracellular:

Answer 2

1/3 of total body water

Question 3

Human body composed of ___% water:

Answer 3

60%

Question 4

2 major divisions of extracellular component:

Answer 4

Intravascular

Interstitial

Question 5

1 minor division of extracellular component:

Answer 5

Transcellular

Question 6

Intravascular:

Answer 6

Liquid part of the blood (plasma)

Question 7

Interstitial fluid:

Answer 7

Between cells and outside blood the vessels

Question 8

Transcellular fluid:

Answer 8

• Secreted by epithelial cells

- cerebrospinal , placental, peritoneal, synovial

Question 9

Osmosis:

Answer 9

Passive movement of water from low to high conc. across a membrane

Question 10

Filtration:

Answer 10

Mediated by fluid pressure from high to low pressure

Question 11

Diffusion:

Answer 11

Passive movement of electrolytes down a conc. gradient from high to low conc.

Question 12

Active transport:

Answer 12

Requires energy in the form of ATP to move electrolytes against conc. gradient (low to high)

Question 13

Steps to start peripheral IV therapy:

Answer 13

3. Apply tourniquet.
4. Select vein.
5. Release tourniquet.
6. Clean site.
7. Reapply tourniquet.
8. Insert vascular access device.
9. Advance and secure.

Question 14

Most abundant cation in blood:

Answer 14

Sodium

Question 15

Cations:

Answer 15

Positively charged ions

-Sodium, potassium, calcium, magnesium

Question 16

Anion:

Answer 16

Negatively charged ions

-Chloride, bicarbonate

Question 17

Normal value for sodium:

Answer 17

135-145

Question 18

Normal value for potassium:

Answer 18

3.5-5.0

Question 19

Normal value for calcium:

Answer 19

8.4-10.5

Question 20

Normal value for magnesium:

Answer 20

1.3-2.5

Question 21

Calcium is elevated. When checking phosphate level, nurse expects to see?

Answer 21

Phosphate decreased due to their inverse relationship

Question 22

The patient has an intravenous (IV) line and the nurse needs to remove the gown. In which order will the nurse perform the steps, starting with the first one?

Answer 22

1. Remove the sleeve of the gown from the arm without the IV.
2. Remove the sleeve of the gown from the arm with the IV.
3. Remove the IV solution container from its stand.
4. Pass the IV bag and tubing through the sleeve.

Question 23

Positive Chvotek sign represents:

Answer 23

Hypocalcemia or hypomagnesemia

Question 24

Tasks the RN can delegate to an NAP when caring for a pt with a peripheral IV therapy:

Can’t do?

Answer 24

Recording intake and output

Regulate flow rate, start IV, or change an IV

Question 25

ADH:

Answer 25

- Produced by hypothalamus - Stored in pituitary - Restores blood volume by increasing or decreasing excretion of water

Question 26

RAAS:

Answer 26

- Secreted in kidneys - Regulates ECV by influencing how much sodium and water are excreted into urine - Regulates BP

Question 27

ANP (atrial natriuretic peptide):

Answer 27

Regulates ECV by influencing how much sodium and water are excreted into urine

Question 28

Sxs of hypokalemia:

Answer 28

- Muscle weakness that may ascend to resp. muscles - abd distention - decreased bowel sounds/constipation

Question 29

Sxs of hyperkalemia:

Answer 29

- Muscle weakness - abd cramps - diarrhea - cardiac arrest

Question 30

Sxs of hypocalcemia:

Answer 30

``` -Numbness/tingling fingers/toes/mouth + Chvosteks sign -hyperactive reflexes -muscle twitching/cramping -spasm, tetany, seizure ```

Question 31

Sxs of hypercalcemia:

Answer 31

- Anorexia - Nausea and vomiting - Constipation - fatigue - diminished reflexes - lethargy - decreased level of consciousness

Question 32

Sxs of hyponatremia:

Answer 32

- Decreased level of consciousness | - seizures

Question 33

Sxs of hypernatremia/ ECV deficit:

Answer 33

- Rapid weight loss - Postural hypotension - tachy - dry mucous membranes - thready pulse - poor skin turgor

Question 34

Sxs of hypermagnesemia:

Answer 34

- Lethargy - hypoactive DTR - hypotension/brady

Question 35

Clinical dehydration:

Answer 35

ECV deficit plus hypernatremia

Question 36

What IV fluid is administered w blood transfusion?

Answer 36

Normal saline

Question 37

Max transfusion time:

Answer 37

4 hrs

Question 38

Complications of IV therapy:

Answer 38

- Infiltration - Phlebitis - Infection - Adverse effects- fluid overload - Bleeding

Question 39

Hypotonic IV soln:

Answer 39

0. 45% saline (1/2 NaCI) | 0. 225% saline (1/4 NaCI)

Question 40

TPN:

Answer 40

IV composed of nutrients and electrolytes

Question 41

Isotonic IV soln:

Answer 41

0.9% sodium chloride (NS)

Question 42

Hypernatremia dx'd by:

Answer 42

Elevated serum sodium conc.

Question 43

Patients with NG suctioning are at risk for:

Answer 43

Potassium deficit

Question 44

Infiltration:

Answer 44

IV fluid enters subQ tissue around puncture site and causes edema

Question 45

Phlebitis:

Answer 45

Inflammation of inner layer of vein

Question 46

Recommended bundle insertion of central line protocol (CLABSI):

Answer 46

- hand hygiene - max sterile precautions - chlorhexidine skin asepsis - avoid femoral vein - daily evaluation

Question 47

When preparing to administer blood...

Answer 47

Prime the tubing with 0.9% sodium chloride (nml saline) to prevent hemolysis of RBC

Question 48

Pts with diabetes insipidus are at risk for?

Answer 48

Dehydration and hypernatremia

Question 49

Actions by the nurse when selecting a site to insert IV: (6)

Answer 49

- Check for contraindications to the extremity (mastectomy, AV fistula, central line) - Choose vein with minimal curvature - Avoid areas of flexion - Choose nondominant arm - Start distally and move proximally - Good vein should feel spongy- never rigid

Question 50

Sxs of infiltration:

Answer 50

Edema Pale skin Cool skin

Question 51

Sxs of phlebitis:

Answer 51

``` Pain Warmth Erythema Red streak Palpable venous cord ```

Question 52

A nurse is discontinuing a patient’s peripheral IV access. Which actions should the nurse take? (3)

Answer 52

- Stop infusion before removing IV - Keep cath parallel to skin while removing it - Apply light pressure to site for 2-3 min after removal

Question 53

Reduces excretion of water:

Answer 53

ADH

Question 54

Increases excretion of sodium and water

Answer 54

ANP

Question 55

Reduces excretion of sodium and water

Answer 55

Aldosterone

Question 56

Major buffer in the extracellular fluid

Answer 56

Bicarbonate

Question 57

Vasoconstricts and stimulates aldosterone release

Answer 57

Angiotensin II

Question 58

Isotonic solns used to:

Answer 58

Increase extracellular fluid volume

Question 59

Hypertonic soln: Used to treat?

Answer 59

3% saline (NaCI) D5LR (dextrose 5% lactated ringers) Severe hyponatrermia

Question 60

Sensible losses:

Answer 60

Urination Defecation Wound drainage

Question 61

Insensible losses:

Answer 61

Evaporation from skin | Respiration loss from lungs