Hormone Regulation
Tachycardia, headache, diaphoresis, pallor, dizziness, and mood changes are all symptoms of this chemical imbalance in the body.
Hypoglycemia
Describe this acid-base balance:
pH 7.40, PaCO2 37, HCO3 23, PaO2 88
Normal pH
Hypoxia or hypoxemia
Which of the following fluids are isotonic when they enter the bloodstream? Select all that apply. 0.9% sodium chloride in water, 0.45% sodium chloride in water, 5% dextrose in water, lactated Ringer's solution, 3% sodium chloride in water
0.9% sodium chloride in water, 5% dextrose in water, lactated Ringer's solution. The 5% dextrose in water becomes hypotonic once the dextrose is absorbed by the body's cells.
Which organ systems are involved in the elimination of ammonia wastes from the body?
An oral antidiabetic medication class that should be taken with food to mitigate the risk of hypoglycemia
Sulfonylureas
Which of the following groups is typically the most vulnerable to acid/ base imbalance, and why?
Infants
Adolescents
Pregnant adults
Infants, because of small lungs, poor respiratory reserve, soft ribcages, small airways, higher basal metabolic rate
Patients with chronic obstructive pulmonary disease are often advised to drink plenty of fluids. What is the therapeutic benefit of hydration in COPD? Name at least two other nursing interventions that accomplish the same thing.
Thin and mobilize secretions. Other interventions could include turn/ cough/ deep breathe, mobilization/ ambulation, positioning for postural drainage, flutter valve device, chest physiotherapy.
The bloodstream and lymphatic vessels together are part of which fluid space (first, second, or third)?
First space
Jaundice is caused by a buildup of which waste product in the body?
Bilirubin
A drug class used to treat Addison's disease that can cause weight gain, hyperglycemia, osteoporosis, and infection risk when used chronically
Corticosteroids
A 10-year old client sustained a head injury 6 hours ago. Their Blood pressure is 132/91 mm Hg; pulse rate is 63 beats per minute; respiratory rate is 36 breaths per minute; oxygen saturation is 94%. pH is 7.49, PaCO2 is 27 mm Hg, HCO3 is 24 mEq/L. What type of acid/base situation is this?
Uncompensated respiratory alkalosis
A patient in respiratory distress has a RR of 34, oxygen saturation of 96% on room air, and wheezes throughout the bases of both lungs. Which of the following is the likely treatment of choice: Inhaled corticosteroid, supplemental oxygen, sodium bicarbonate, or inhaled short-acting beta agonist?
Inhaled short-acting beta agonist
A patient has a buildup of fluid in the pleural space surrounding the lungs. What fluid space is this (first, second, third)? What might need to be done to relieve this fluid buildup and why?
Third space. It is categorized this way because the fluid accumulation cannot diffuse easily and directly back into the bloodstream. If this compromises breathing, the patient may need to have this surgically drained.
Which class of laxatives is usually considered to be unsafe in patients with renal failure? Stimulants, osmotics, bulk-forming laxatives, or stool softeners? Why?
Osmotics, which frequently contain high amounts of magnesium or phosphate
Which of the following are symptoms of hyperthyroidism? Select all that apply: Weight gain, constipation, heat intolerance, fatigue, tachycardia, increased hair growth
Heat intolerance, tachycardia, and increased hair growth
A client has overdosed on heroin and has respiratory suppression. What is their most likely acid/ base imbalance? What do they immediately need to stabilize them? What medications would we treat them with?
Respiratory acidosis due to hypoventilation and CO2 retention. Rescue therapy will include rescue breathing, and the medications will most likely be oxygen and naloxone.
A client with COPD exhibits the following vital signs. Please explain what likely happened:
At 5 pm: HR 96, BP 136/78, RR 22, SpO2 92% on 2LNC
At 7 pm: HR 106, BP 112/68, RR 10, SpO2 100% on 6LNC
Since the client has COPD, they likely rely on hypoxic respiratory drive, and the sudden flood of oxygen has decreased that drive significantly.
Spironolactone. Peaked T-waves and palpitations are characteristic of hyperglycemia, and spironolactone, as a potassium-sparing diuretic, could potentially increase serum potassium. This should be held until the nurse has a conversation with the provider, who will likely order a serum electrolyte test.
A patient is suffering from acute kidney injury following the ingestion of a substance that is toxic to the kidneys. Which of the following should the patient be cautioned not to consume in excess? Potassium, sugar, sodium, phosphate
Potassium, sodium, and phosphate. All of these are eliminated by the kidneys and diseased kidneys could cause toxic buildup.
You are attending a youth soccer game when one player, known to have type 1 diabetes, becomes dizzy and lightheaded. A concerned parent says they need their NPH insulin. What is your response and why?
A patient with diabetes has fruity-smelling breath and tachypnea. A blood sugar check reveals their blood glucose level to be 800. What is the likely acid-base imbalance? What is this clinical situation called?
Likely metabolic acidosis due to overproduction of ketoacids; this is likely diabetic ketoacidosis. The clues are the history, the fruity (ketone) smelling breath, the tachypnea, and the high blood sugar.
A patient with a pulmonary embolism in an emergency department is breathing 100% oxygen via a non-rebreather mask. An inexperienced nurse says that this therapy is inappropriate because their airway is fine. Are they correct? Why or why not?
Incorrect. Pulmonary embolus cuts off blood supply to part of the lung. While it is true that the airways might be clear, adding oxygen allows for improved O2 absorption by the alveoli that are still perfused; oxygen is an appropriate therapy here.
Patients who receive red blood cell transfusions frequently have increased urine production for the following few hours. Explain why this is the case.
Name at least four things a patient with kidney failure should consider when deciding whether to undergo peritoneal dialysis, hemodialysis, or no dialysis?
Whether they want to travel, availability of helpers, willingness and ability to self-manage their dialysis, whether they can tolerate fluid and dietary restrictions, desire for independence and control, quality of life, lots of others!