IVF
Which of these is NOT isotonic:
a) Normal Saline (NS)
b) D5 1/4 Normal Saline
c) 1/2 Normal Saline
d) Lactated Ringers
IV potassium is safe to push over 2-3 minutes as long as the nurse remains in the patient's room and the patient is on a cardiac monitor.
a) True
b) False
FALSE
We never IV push potassium
Maximum rate is 10mEq/hr - SLOW
True or False. Hydrochlorothiazide and potassium chloride should never be given together:
False
Hydrochlorothiazide is Potassium-wasting. Patient's should be replacing potassium.
Mrs. Cole, a 76 year old patient states: "I just cant swallow that huge potassium pill. I won't take it!". What response from the nurse is most appropriate?
a) "That's ok, as long as you eat foods high in potassium, you don't have to take the pill"
b) "You must take this pill, Mrs. Cole. We can crush it up and put it in applesauce if you need."
c) "It is important to take your potassium medication. Let's talk with pharmacy and see if there is another form of the medication you can take"
d) "Potassium only comes in pill form, Mrs. Cole. We cannot crush this pill, you must take it as-is"
c) Potassium chloride also comes in PO liquid. Potassium-rich foods should never be relied on alone to replace potassium in patients with hypokalemia as food sources have inconsistent potassium content.
The nurse should anticipate drawing what lab before initiating Furosemide (Lasix) treatment?
CMP or BMP
What kind of patient would not be a great candidate for an IV fluid containing Dextrose?
Diabetic Patients
Potassium Chloride would be contraindicated (DO NOT GIVE) in what kind of patients?
Patients with high potassium or kidney failure (severe CKD or AKI)
Patients with hyperkalemia (and pregnant patients)
Mr. Jones has the following lab results:
Sodium: 140
Potassium: 5.2
Calcium: 10.4
BUN: 7
Which medication from Mr. Jones' med list is most concerning?
a) Spironolactone (Aldactone)
b) Calcium Carbonate (Tums)
c) Ibuprofen
d) Digoxin (Lanoxin)
a) Spironolactone (Aldactone)
Which medication in the patient's medication list is most concerning if the patient has a potassium level of 3.0?
a) Spironolactone
b) Calcium gluconate
c) Digoxin
d) Calcium carbonate
c) Digoxin - Toxicity likely if low potassium
What kind of fluids are most appropriate for patient's experiencing fluid volume deficit due to dehydration?
a) hypotonic
b) isotonic
c) hypertonic
b) isotonic
Calcium Carbonate (Tums) would be contraindicated (DO NOT GIVE) for patients with what serum lab imbalances? Give 2
Hypercalcemia
Hypophosphatemia
A patient with blood pressure of 82/45 and potassium of 6.7 is NOT a candidate for Furosemide. Why?
Patients with hypovolemia should not use ANY diuretics, as diuretics cause further fluid volume loss.
Leslie is going home on Furosemide (Lasix) for fluid volume overload should be given what additional teaching by the nurse? Select all that apply
a) Be sure to weigh yourself DAILY and report weight gain of over 1kg per day to your doctor
b) Avoid foods high in salt such as lunch meats and processed foods
c) Be sure to take your potassium supplement daily
d) Increase your water intake to 3 Liters daily
a, b, and c
Which medications in the patient's medication list are most concerning if the patient's GFR is 15, BUN is 35, and patient is on hemodialysis. Select all that apply
a) Naproxen (Aleve)
b) Ibuprofen
c) Furosemide (Lasix)
d) Potassium Chloride
ALL
Naproxen and Ibuprofen are nephrotoxic and encourage the kidneys to retain potassium
Diuretics should NEVER be used in patients who are anuric (do not urinate)
Potassium should not be used in patient's with severe kidney disease who cannot eliminate it
The nurse has orders for an IV antibiotic, ciprofloxacin, to be run via IV secondary infusion (IV piggy back). The patient has IV Lactated Ringers running as a primary maintenance infusion. What should the nurse FIRST do before running the antibiotic with the lactated ringers?
Check compatibility of EVERY drug that runs through the maintenance line.
Ciprofloxacin IS NOT COMPATIBLE with LR
Which lab values would encourage the use of Calcium Gluconate?
a) Calcium of 10.2
b) Phosphorus of 2.7
c) Potassium of 7.8
d) Magnesium of 1.2
c) Potassium of 7.8 - Emergent prevention of life-threatening arrhythmias due to high potassium
How would the nurse know the patient's Furosemide (Lasix) is working? Name 2 ways.
Potassium within normal range on labs (CMP)
No symptoms of fluid volume overload - no adventitious breath sounds, blood pressure within normal range, no edema, etc.
Mr. Hinley has the following labs prior to his hemodialysis appointment:
Potassium: 7.9
Calcium: 10.5
Magnesium: 1.3
Which medication can the nurse anticipate giving to Mr. Hinley prior to dialysis?
a) Furosemide
b) Calcium carbonate
c) Calcium gluconate
d) Spironolactone
c) Calcium gluconate
A patient has been taking a medication off the shelves for indigestion multiple times a day for the last 3 weeks. The nurse notes the medication to be aluminum hydroxide/magnesium hydroxide suspension (Maalox).
Which lab should the nurse request?
CMP/BMP - Check magnesium level
A patient has lower extremity edema, adventitious breath sounds (crackles), weight gain of 2kg in one day, and blood pressure of 165/101.
What kind of IVF would the nurse anticipate giving to this patient?
NONE
Fluid volume excess
What tools should the nurse use when assessing a patient receiving IV Magnesium Sulfate?
a) Reflex Hammer
b) Pen Light
c) Blood pressure cuff
d) A and C
e) A and B
d) A and C
Reflex hammer to check for decreased DTRs
Blood pressure cuff to check for Hypotension
A patient taking Bumetanide (Bumex) should beware of which safety concern:
a) dizziness and falling due to orthostatic hypotension from fluid volume deficit
b) tetany and seizures due to hypocalcemia
c) Confusion and seizures due to hypernatremia
a) dizziness and falling due to orthostatic hypotension from fluid volume deficit
How should we encourage safety for this patient?
Penelope is an 11 year old patient in the hospital for dehydration. Which IVF can the nurse anticipate giving?
a) 1/2 normal saline
b) Multi-vitamin bag
c) Normal Saline with 20mEq Potassium Chloride
d) Dextrose 5% in 1/4 normal saline
d) Dextrose 5% in 1/4 Normal saline - an isotonic solution
A patient has been taking Hydrochlorothiazide and Laxatives daily for the last 6 weeks. Which TWO labs should the nurse anticipate being ordered for this patient?
CMP/BMP and CBC - to check fluid volume status and electrolyte status