Electrolytes
3.5-5
What is the only IV fluid that can be given with blood products?
A. Hypotonic
B. Hypertonic
C. Isotonic
What is the first line of medication for osteoarthritis?
acetaminophen
What is the reversal agent for opioids?
Naloxone (Narcan)
You have a CO2 of 59. What imbalance is this?
acidic
You have a patient with calcium of 7.9. What clinical manifestations (signs and symptoms) would you expect for this patient?
Trousseau → muscle spasm when BP cuff is inflated; Chvostek Sign → facial twitching when they tap on the fact;Paresthesia → tingling around lips
HR & ECG changes, Hyperactive BS, anxiety
What are some clinical manifestations for hypovolemia, or FVD?
Weight loss, decreased BP & urine output, tachycardia, cool clammy skin
Increased BUN & creatinine, electrolyte imbalances
What are 3 side effects of opioids?
hypotension, respiratory depression, sedation, constipation
Name 4 nonpharmacologic methods for pain control
Ice, heat, distraction, massage, repositioning, quiet environment, etc.
You have an ABG come back with the following numbers. What imbalance do you expect?
pH: 7.32
PaCO₂: 55 mm Hg
HCO₃⁻: 28 mEq/L
respiratory acidosis
You have a patient who has a potassium of 5.6. Name 2 nursing interventions you would do at this time?
Kayexalate, IV calcium gluconate, IV Sodium bicarbonate, IV regular insulin and dextrose, ECG
You have a patient who has had severe diarrhea, vomiting, and hasn't been able to keep any fluids down for 24 hours. What fluid imbalance might you expect?
fluid volume deficit; hypovolemia
A post-op client received IV fentanyl 20 minutes ago. The nurse goes in to reassess and notices pinpoint pupils, a respiratory rate of 4/min, and the patient does not wake upon stimuli. What is the nurse’s priority action?
A. Administer naloxone per protocol.
B. Notify the healthcare provider immediately.
C. Apply oxygen at 2 L/min via nasal cannula.
D. Continue to monitor for changes in vital signs.
A; you expect that this patient is experiencing an overdose
Who can press the button if a patient has a PCA pump?
ONLY THE PATIENT CAN PUSH IT
You have a patient who has Kussmaul's respirations, and presents as confused and drowsy. They have a BP of 98/60. What acid-base imbalance might you expect?
Metabolic acidosis; the Kussmaul's respirations are trying to compensate for the state the body is in. Kussmauls respirations will not go away until the acidosis is corrected.
You have a patient presenting with severe thirst, is agitated and lethargic, and has skeletal muscle twitching. What electrolyte imbalance might you expect?
hypernatremia
You have a patient with weight gain, crackles in the lungs, and HTN with a bounding pulse. What interventions would you expect?
Daily weights, fluid restriction, diuretic, decrease sodium intake
You have a patient with a potassium of 3.0 who needs a diuretic. Which diuretic would you expect to give?
spironolactone
What are consequences of untreated pain?
Unnecessary suffering; Physical and psychosocial dysfunction; Immunosuppression; Sleep disturbances
A client who has been having diarrhea is admitted to the ED. What kind of acid-base imbalance might you expect?
metabolic acidosis; diarrhea is basic, so you are getting ride of a base causing you to go into an acidic state
DROP THE BASE
You have a patient with these labs:
sodium: 129
potassium: 5.5
calcium: 10
a) What electrolytes are out of balance?
b) What would be priorities at this time?
a) hyponatremia
b) hyperkalemia
For potassium: decrease potassium levels by giving diuretic or Kayexalate, IV calcium gluconate put on ECG monitoring,
For sodium: seizure precautions, monitor LOC, sodium if in deficit or diuretic if in water gain
You have a patient on IV fluids who starts developing SOB, chest pain, and upon auscultation you hear crackles in the lungs. What are some interventions you may do at this time?
Here you would expect fluid overload; raise HOB, , stop or lower fluid rate, administer prescribed diuretic, notify health care provider, reassess, assess O2 sats, potentially put on oxygen
You have a patient with a potassium of 5.8. What medication order would you question?
a) spironolactone
b) furosemide
c) oxycodone
d) torsemide
a) spironolactone; this is potassium sparing and they already have hyperkalemia
You have a patient who is on oxycodone for pain control. What acid base imbalance could you potentially expect for this drug?
respiratory acidosis --> patient is unable to get out the CO2 due to potential respiratory depression
You have a patient with an ABG of:
pH: 7.50
PaCO₂: 30 mm Hg
HCO₃⁻: 24 mEq/L
What signs and symptoms of this imbalance would you expect?
This patient is in respiratory alkalosis: you might see lightheadedness, inability to concentrate, numbness and tingling, LOC