RegisteredNurse RN Fluid Electrolyte Flashcards
(61 cards)
1
Q
Cushings syndrome causes
Too much cortisol
A
Na Up
Ka Down
Hypernatremia/ Hypokalemia
2
Q
Conns syndrome
Primary Aldosteroneism
A
Hypernatremia
Aldosterone Maintains High BP holding Na & H²O
3
Q
Corticosteroids do this to Na levels and this to K levels
A
Raise Na
Lower K
4
Q
Diabetes Insipidus causes this effect on Na levels.
Why
A
Hypernatremia
Too much urine
5
Q
Burns or cell damage cause this effect on Na
A
Hypernatremia >145
6
Q
S / S Sodium
Fatigue
A
Hypernatremia >145
7
Q
S / S Sodium
Restless / really agitated
A
Hypernatremia >145
8
Q
S / S Sodium
Increases Reflexes (seizure / coma)
A
Hypernatremia >145
9
Q
S / S Sodium
Extreme thirst
A
Hypernatremia >145
10
Q
S / S Sodium
Decreases urine output
Dry mouth
A
Hypernatremia >145
11
Q
Sodium & _____ are very close (electrolyte)
Acid base balance
Balances fluids with Na
A
Chloride 95 - 105
12
Q
Metabolic Alkalosis
High level bicarb
Cystic fibrosis
FVO (Fluid Volume Overload)
HF, SIADH
GI RELATED
BURNS
A
Hypochloremia <95
13
Q
S / S of this electrolyte are the same as hypochloremia
A
Na
14
Q
Cushings syndrome does this to K & Na levels
A
Low K
Increase Na
15
Q
Urine level with hypokalemia
A
Lots of urine
Potassium is lost through urinw
16
Q
Factors for Hyperkalemia
Where is K stored
How is it elimated
A
Potassium is stored Inside Cell
Damage will break cell open and put into blood stream. Ie.
BURNS, TISSUE DAMAGE, RHABDOMYOSIS
How is K Elimated. Urine
RENAL FAILURE causes Hyperkalemia
17
Q
This disease is associated with Hyperkalemia
A
Addisons
Increases K and lowers Na
18
Q
Spironolactone, ACE inhibitors, NSAIDS
Cause this
A
Hyperkalemia > 5
19
Q
Muscle weakness
Decreased cardiac contraction
Rhythm Changws
Early: Muscle twitches
Urine little
Resp failure
A
Hyperkalemia
20
Q
Hypocalcemia can occur from missing this organ.
When ____ levels in the blood drop, the parathyroid glands release parathyroid hormone. PTH acts on the bones, kidneys, and intestines to increase ____ levels in the blood.
A
Thyroid (parathyroid)
calcium / calcium
21
Q
Over active Parathyroid gland will cause
A
Hypercalcemia > 10.5
22
Q
Increased Vitamin D can cause Hypercalcemia
T or F
A
True
23
Q
Thiazide Diuretics, & Lithium
Have this affect on Calcium
A
Hypercalcemia >10.5
24
Q
Mg is found where…
A
Inside cell
25
PPI
Proton Pump Inhibitor (Prilosec) can decrease the absorption of...
Magnesium
Hypomagnesemia
<1.3
26
Hypomagnesemia causes everything to be (Excited / Depressed)
Excited
27
Hypomagnesemia S/S
TWITCH
T= _____ SIGN
W=
I= Increased .....
T =
C = (2) electrolyte levels low
H =
T= Trousseau & Chvostek SIGN
W= weakness
I= Increased tendon reflex
T = Torsades de pointe (Heart Rhytm)
C = Calcium & Potassium Low
H = hypertension
28
Hypermagnesemia causes S /S to be (Faster/ Slower)
Slower
29
patient has a potassium level of 9.0. Which nursing intervention is priority?
A. Prepare the patient for dialysis and place the patient on a cardiac monitor
B. Administer Spironolactone
C. Place patient on a potassium restrictive diet
D. Administer a laxative
The answer is A: Prepare the patient for dialysis and place the patient on a cardiac monitor
30
Which patient is at risk for hyperkalemia?
A. Patient with Parathyroid cancer
B. Patient with Cushing’s Syndrome
C. Patient with Addison’s Disease
D. Patient with breast cancer
The answer is C: Patient with Addison’s Disease
31
Which of the following is not a symptom of hyperkalemia?
A. Positive Chvostek’s sign
B. Decreased blood pressure
C. Muscle twitches/cramps
D. Weak and slow heart rate
The answer is A: Positive Chvostek’s sign
32
patient with nasogastric suctioning is experiencing diarrhea. The patient is ordered a morning dose of Lasix 20mg IV. Patient’s potassium level is 3.0. What is your next nursing intervention?
A. Hold the dose of Lasix and notify the doctor for further orders
B. Administered the Lasix and notify the doctor for further orders
C. Turn off the nasogastric suctioning and administered a laxative
D. No intervention is need the potassium level is within normal range
The answer is A: Hold the dose of Lasix and notify the doctor for further orders
33
patient’s potassium level is 3.0. Which foods would you encourage the patient to consume?
A. Cheese, collard greens, and fish
B. Avocados, strawberries, and potatoes
C. Tofu, oatmeal, and peas
D. Peanuts, bread, and corn
The answer is B: Avocados, strawberries, and potatoes
34
patient is presenting with an orthostatic blood pressure of 80/40 when she stands up, thready and weak pulse of 58, and shallow respirations. In addition, the patient has been having frequent episodes of vomiting and nausea and is taking hydrochlorothiazide. Which of the following findings would explain the patient’s condition?
A. Potassium level of 7.0
B. Potassium level of 3.5
C. Potassium level of 2.4
D. None of the options are correct
The answer is C: Potassium level of 2.4
35
Which patient is at a potential risk for Digoxin toxicity?
A. A patient with Cushing’s syndrome taking Laxis 20 mg IV twice a day
B. A patient with a calcium level of 8.9
C. A patient with a potassium level of 3.8
D. A patient presenting with painful muscle spasms and positive Trousseau’s sign
The answer is A: A patient with Cushing’s syndrome taking Laxis 20 mg IV twice a day
36
patient has a potassium level of 2.0. What would you expect to be ordered for this patient?
A. Potassium 30 meq IV push
B. Infusion of Potassium intravenously
C. An oral supplement of potassium
D. Intramuscular injection of Potassium
The answer is B: Infusion of Potassium intravenously
37
Which of the following is not a cause of hypocalcemia?
A. Low parathyroid hormone
B. Crohn's Disease
C. Acute Pancreatitis
D. Thiazide Diuretics
The answer is D: Thiazide Diuretics
38
patient has a calcium level of 12.5 mg/dL. Which medication will most likely be ordered for this patient?
A. Calcium Chloride
B. 10% Calcium Gluconate
C. Calcitonin
D. Hydrochlorothiazide
C. Calcitonin
39
Lithium is known to affect the parathyroid by increasing ______ levels and decreasing _____ levels?
A. calcium, phosphate
B. phosphate, calcium
C. calcium, sodium
D. sodium, calcium
The answer is A: calcium, phosphate
40
A patient's calcium level is 11.2 mg/dL. Which option below could be the cause?
A. None, 11.2 mg/dL is a normal calcium level
B. Cushing's Syndrome
C. Hydrochlorothiazide
D. Hypoparathyroidism
The answer is C: Hydrochlorothiazide
41
A patient’s lab work shows that they have a high parathyroid hormone level. Which condition is the patient at risk for?
A. Hyperkalemia
B. Hypocalcemia
C. Hypokalemia
D. Hypercalcemia
The answer is D: Hypercalcemia
42
patient's calcium level is 6.9 mg/dL. Which of the following is a nursing priority?
A. Initiate seizure precautions
B. Educate patient about foods rich in calcium
C. Administer Calcitonin
D. Administer Vitamin D supplements as ordered
The answer is A: Initiating seizure precautions are priority because this is a critically low calcium level and the patient is at risk for seizures. Next, you would educate the patient about calcium rich foods and administer vitamin D supplements as ordered. Calcitonin is for HYPERcalcemia.
43
Stimulation of the facial nerve via the masseter muscle causes twitching of the nose/lips in hypocalcemia is known as?
A. Trousseau's Sign
B. Chvostek's Sign
C. Homan's Sign
D. Goodell's Sign
The answer is B: Chvostek's Sign
44
A patient with Celiac disease is at risk for which of the following?
A. Hypokalemia
B. Hypocalcemia
C. Hypomagnesemia
D. Hypercalcemia
The answer is B: Hypocalcemia
Celiac’s and chrones can both cause Hypocalcemia
45
A patient is recovering from parathyroid surgery. Morning labs values are back. Which of the following lab values would correlate as a complication from this type of surgery?
A. Calcium 8.7 mg/dL
B. Calcium 12.5 mg/dL
C. Calcium 6.9 mg/dL
D. Calcium 9.2 mg/dL
The answer is C: Calcium 6.9 mg/dL
Patients who have had any type of neck surgery, especially parathyroid or thyroidectomy is risk for hypocalcemia
46
On morning assessment of your patient in room 2502 who has severe burns. You notice that fluid is starting to accumulate in his abdominal tissue. You note that his weight has not changed and his intake and output is equal. What do you suspect?
A. Third spacing
B. This is normal and expected after a burn and it is benign
C. Document this finding as non-pitting abdominal edema.
D. Intravascular compartment syndrome
The answer is A. You would suspect third spacing. Third-spacing is the accumulation of trapped extracellular fluid in a body space as a result in this case of a burn. Third spacing can occur in body spaces such as the pericardial, pleural, peritoneal, and joint cavities, bowel, and abdomen after a trauma or burn. It is normal not to see a change in weight or abnormal intake or output values.
47
Which patient is at more risk for an electrolyte imbalance?
A. An 8 month old with a fever of 102.3 'F and diarrhea
B. A 55 year old diabetic with nausea and vomiting
C. A 5 year old with RSV
D. A healthy 87 year old with intermittent episodes of gout
The answer is A. The 8 month old with a fever of 102.3 'F and diarrhea is the correct answer. Infants (age 1 and under) and older adults are at a higher risk of fluid-related problems than any other age group. This is because infants have the highest amount of total body fluid (80% of the body is made up of fluid) and if any type of illness especially GI effects the body this increases the chances of an electrolyte imbalance.
48
patient is admitted to the ER with the following findings: heart rate of 110 (thready upon palpation), 80/62 blood pressue, 25 ml/hr urinary output, and Sodium level of 160. What interventions do you expect the medical doctor to order for this patient?
A. Restrict fluid intake and monitor daily weights
B. Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output
C. Administer hypotonic IV fluid and administer sodium tablets.
D. No interventions are expected
The answer is B. The patient must be re-hyrdated and the sodium levels should be decreased at the same time. So a hypertonic solution of 5% dextrose and 0.45% NA will help do this. The solution is hypertonic because of the 5% Dextrose which will rapidly metabolize to the cells. When the dextrose metabolizes to the cells it leaves behind 0.9% NA which acts as a isotonic solution. This allows the 0.45% NA to act as a hypotonic solution to repair the vascular compartment. After these fluids are infused the patient's NA level should decrease, BP increase, HR return to normal etc. It is a complicated physiological process because the Dextrose has unique capabilities when it is metabolized....although the solution is labeled as hypertonic it becomes a hypotonic solution when the Dextrose is metabolized by the cells.
49
Which patient below would have a potassium level of 5.5?
A. A 76 year old who reports taking Lasix four times a day
B. A patient with Addison's disease
C. A 55 year old woman who have been vomiting for 3 days consistently
D. A patient with liver failure
The answer is B. A patient with Addison disease suffers from increased potassium levels due to adrenal insufficiency. Therefore, potassium levels higher than 5.1 may present in patients with Addison's disease.
50
Which patient is at most risk for hypomagnesemia?
A. A 55 year old chronic alcoholic
B. A 57 year old with hyperthyroidism
C. A patient reporting overuse of antacids and laxatives
D. A 25 year old suffering from hypoglycemia
The answer is A. The correct answer is a 55 year old who is a chronic alcoholic. Patients who suffer from alcoholism have an increased secretion of magnesium and usually do not eat a proper diet, therefore, they are at risk for lower magnesium levels.
51
In report from a transferring facility you receive information that your patient's Magnesium level is 1.2. When the patient arrives you are ordered by the doctor to administer Magnesium Sulfate via IV. Which of the following interventions takes priority?
A. Set-up bedside suction
B. Set-up IV Atropine at bedside due to the bradycardia effects of Magnesium Sulfate
C. Monitor the patient's for reduced deep tendon reflexes and initiate seizure precautions
D. None of the above are correct
The answer is C. As the nurse administering Magnesium sulfate IV, you must monitor for reduced deep tendon reflexes because the patient could quickly develop hypermagnesemia. In addition, seizure precautions should be initiated due to the patient's low magnesium level.
52
patient is admitted with exacerbation of congestive heart failure. What would you expect to find during your admission assessment?
A. Flat neck and hand veins
B. Furrowed dry tongue
C. Increased blood pressure and crackles throughout the lungs
D. Bradycardia and pitting edema in lower extremities
The answer is C. The correct answer is increased blood pressure and crackles throughout the lungs. Patients with CHF are in fluid volume overload and the heart can not compensate for the extra fluid volume, therefore, the fluid starts to "backup". You would find an increased blood pressure and crackles in the lungs. You would also see pitting edema in the lower extremities but NOT bradycardia.
53
Which fluid compartment accounts for 2/3 of our body water and is found inside the cell?
A. Transcellular
B. Interstitial
C. Intravascular
D. Intracellular
The answer is D: intracellular. The intracellular compartment accounts for 2/3 of our body water and is found inside the cell.
54
True or False: The extracellular compartment includes the intravascular, interstitial, and transcellular compartments.
True
False
The answer is True.
55
What type of fluid volume overload occurs because water moves from the intracellular to the extracellular compartment due to an increase in osmolarity of extracellular fluid which increases body water?
A. Hypertonic overload
B. Hypotonic overload
C. Isotonic overload
The answer is A: hypertonic overload. Hypertonic overload occurs because water has moved from the intracellular to the extracellular compartment. This is due to an increase in osmolarity of the extracellular fluid.
56
The patient is experiencing a severe case of SIADH (Syndrome of Inappropriate Antidiuretic Hormone). What type of overload is the patient most likely to experience?
A. Hypertonic overload
B. Hypotonic overload
C. Isotonic overload
The answer is B: hypotonic overload. In SIADH, there is too much ADH being released and water is retained. This will increase body water and dilute the extracellular fluid (hence lowering its osmolarity). This will cause water to move from the extracellular to the intracellular compartment and overload both compartments.
57
patient is experiencing hypertonic overload. What could cause this type of overload?
A. Corticosteroids over usage
B. Primary polydipsia
C. SIADH
D. Excessive sodium intake
The answer is D: excessive sodium intake. This will cause an increase of sodium concentration in the blood (plasma), which will increase osmolarity and cause hypertonic overload.
58
Select all the signs and symptoms below that could present with fluid overload:
A. Weight gain
B. >3 seconds capillary refill
C. Orthostatic hypotension
D. Frothy, bloody tinged cough
E. Ascites
F. Jugular venous distention
G. Weak pulse
H. Rales
The answers are A, D, E, F, and H. All of these are possible signs and symptoms of fluid volume overload. Option B, C, and G are signs found in fluid volume deficit.
59
Your patient has a diagnosis of fluid volume overload (isotonic). Select all the interventions you plan to implement for this patient:
A. Encourage patient to limit fluid intake to 4 Liter per day
B. Strict monitoring of intake and output
C. Weigh patient daily at the same time with the same scale
D. Administer diuretics per physician’s order
E. Ensure urinary output is at least 10 mL/hr or greater
F. Restrict foods high in sodium
The answers are B, C, D, and F. Option A is not correct because 4 L/day is a high amount of fluid, and the patient should be on a fluid restriction of about 1-2 L/day. Option E is not correct because the nurse should ensure the urinary output is at least 30 mL/hr (0.5mL/kg/day). A urinary output of >10 mL/hr is too low and not an appropriate goal for the patient.
60
If its HIGH its DRY.
Refers to what?
High values Hemocrit, Hemoglobin, Osmolality, Urine Specific Gravity, Sodium Will be be Higher than normal
61
You assess the lab report for your patient who has isotonic fluid volume overload. Which lab results below are expected with this condition? Select all that apply:
A. Decreased hemoglobin
B. Increased sodium level
C. Decreased urine specific gravity
D. Increased BUN
E. Decreased serum osmolality
The answers are A, C, and E. Remember when fluid volume overload is presenting there is going to be a lot of fluid in the blood and urine. This will make the blood and urine less concentrated (diluted). Therefore, concentration of certain substances in the blood will be decreased. The patient can have: decrease in hemoglobin, hematocrit, decrease in sodium, decreased urine specific gravity and osmolality, and decreased serum osmolality.
