Lytes
A patient is being discharged after being hospitalized with a hypomagnesemia. What type of foods will you encourage the patient to consume in your diet teaching?
a. liver and steak
b. cereal and nuts
c. ice cream and yogurt
d. turnips and cauliflower
b
Good food sources for Magnesium - green vegetables, whole grain cereals, nuts
A patient has the following labs:
Sodium-155 mEq/L Potassium-3.5
Calcium-10 Magnesium-2
Which would be most concerning to the nurse?
Sodium 155 (135-145)
Which of the following solutions has a greater concentration of solutes than blood has?
a) Isotonic
b) Hypotonic
c) Hypertonic
d) Hyposmolar
c) Hypertonic
Rationale: Normal plasma is isotonic. Hypertonic solutions have a greater concentration of solutes than plasma does.
The client is ordered to received 30 mEq of potassium via IV. The medication label reads 40 mEq per 20 mL. How many milliliters of potassium chloride do you need to add to a bag of normal saline to get the correct dose?
Answer: B - The nurse would prepare 15 ml of potassium chloride.
desired dose: 30 mEq
available concentration: 40 mEq (units) per 20 mL (volume)
(desired dose ÷ available concentration (units)) × available concentration (volume) = mL per desired dose
(30 mEq ÷ 40 mEq) × 20 mL = 0.75 × 20 mL = 15 mL
On admission, a patient blood alcohol limit is greater than 400 mg/dL. The patient reports drinking a 12 pack of beer on a daily basis. Which of the following conditions is this patient MOST at risk for?
A
pH 7.32
CO2 35
HCO3 15
metabolic acidosis
The RN is admitting a new client. What should the nurse ask first about spirituality?
1 Where do you go to church?
2. Do you attend church often?
3. Did you grow up going to church?
4. What are your beliefs about spirituality?
4
The nurse first needs to assess what the patient believes. This will lead the nurse to other questions about spirituality and how the nurse can assist the patient.
A patient with a magnesium level of 5 would exhibit which of the signs and symptoms EXCEPT?
D
Hypermagnesemia (<2.5) s/s -
Flushing, decreased Deep tendon reflexes (hyporeflexia), muscle weakness, lethargy, decreased respirations, bradycardia, hypotension
The nurse is aware that a patient that has been immobilized for a long period of time will most likely have a calcium level of:
a. 5
b. 15
B
Which of the following solutions would be administered intravenously to manage a client with a serum sodium level of 130 mEq/L?
a) D5W
b) Lactated Ringer's
c) D5W with Potassium added
d) 0.9% NaCl
d) 0.9% NaCl
Rationale: Hyponatremia is defined as serum sodium levels < 135 mEq/L. Mild hyponatremia usually is treated with intravenous infusions of NaCl.
Doctor’s Order: Synthroid 75 mcg po daily; Available: Synthroid 0.15 mg tab (scored). How many tab will you administer?
0.5 tab
When assessing a patient for electrolyte balance, the nurse is aware that etiologies for hyponatremia include:
4
pH 7.3, PaCO2 50 mmHg, HCO3- 22 mEq/L, and PaO2 72.
Imbalance?
Compensation?
Respiratory acidosis, uncompensated
–No compensation – pH abnormal, acid or base abnormal
–Partial compensation – pH & acid & base abnormal
–Full compensation – pH returns to normal & both other ABG components are abnormal
The nurse is caring for a patient that is on hospice care. The patient's respirations have been increasingly getting slower, but increases when the patient moans. The family asks if the patient can have more pain medicine. The nurse's best response is?
1 Educate the family that more pain medicine cannot be given r/t the decreasing respirations
2 Assess the patient for s/s of pain
3 Inform the provider of the decreasing respirations
2
The client complains of muscle cramps, anxiety, and the sensation of the heart skipping a beat. These symptoms can be symptoms of which of the following imbalances?
a) hyperkalemia
b) hypernatremia
c) hypercalcemia
d) hypoglycemia
a) hyperkalemia
Rationale: Hyperkalemia, serum potassium level > 5.5 mEq/L, predisposes the client to cardiac and muscle irregularities. (muscle twitches, cramps, paresthesia, irritability & anxiety, hypotension, EKG changes, dysrhthmias)
Which patient below is at risk for experiencing Hypovolemic Hyponatremia?
D
What type of diuretic is:
1. metolazone
2. furosemide
3. hydrochlorothiazide
4. spironolactone
1 & 3 thiazide
2 loop acting
4 potassium sparing
Doctor’s Order: Diuril 1.8 mg/kg po tid; Available: Diuril 12.5 mg caps. How many cap will you administer for each dose to a 31 lb child?
2 caps
31 / 2.2 = 14.0909091
1.8mg x 14.0909091kg = 25.3636364
25.3636364 / 12.5 x 1 = 2.02909091
Which of the following findings would the nurse expect to assess in a patient with hypokalemia?
4
Hypokalemia s/s alkalosis, shallow respirations, irritability, confusion/drowsiness, weakness/fatigue, arrhythmias, thready pulse, lethargy, decreased intestinal motility, N/V, hyperglycemia
pH of 7.44, PCO2 of 48, HCO3 of 34
Imbalance?
Compensation?
compensated, metabolic alkalosis
pH-normal, (closer to alkalosis)
CO2- high
HCO3-high
No compensation – pH abnormal, acid or base abnormal
–Partial compensation – pH & acid & base abnormal
–Full compensation – pH returns to normal & both other ABG components are abnormal
Fill in the blank
1 Non-curative care provided for patients that are at end of life _____________________
2 Non-curative care provided for patients with a chronic illness _______________________
1 Hospice
2 Palliative
You have completed diet teaching with a patient who has hypernatremia. Which statement by the patient causes concern?
C
The nurse checks the laboratory result for a serum potassium level that was prescribed for a client earlier in the day and notes that the result is 6 mg/mL. The nurse should take which immediate action?
a. call the provider
b. administer spironolactone
c. administer potassium IV push
d. chart the level
A pt recovering from surgery has an indwelling urinary catheter. The nurse would contact the pt's primary healthcare provider with which of the following 24-hour urine output volumes?
1. 600 mL
2. 750 mL
3. 1000 mL
4. 2800 mL
Answer: 1
Rationale 1: A urine output of less than 30 mL per hour must be reported to the primary healthcare provider. This indicates inadequate renal perfusion, placing the pt at increased risk for acute renal failure & inadequate tissue perfusion. A minimum of 720 mL over a 24-hour period is desired (30 mL multiplied by 24 hours equals 720 mL per 24 hours).
Doctor’s Order: Kanamycin 7.5 mg/kg IM q 12 hr; Available: Kanamycin 0.35 Gm/mL. How many mL will you administer for each dose to a 157 lb patient? (round to the tenth)
1.5 ml
157 / 2.2 = 71.3636364
7.5mg x 71.3636364kg = 535.227273 mg
535.227273 / 1,000 = 0.53522727 mg
0.53522727 / 0.35 x1 = 1.52922078
Place your bets!!!
In the extracellular fluid, chloride is a major:
3
Daily Double
The following arterial blood gases were obtained: pH 7.50, PaO2 91, PaCO2 28 mmHg, HCO3- 26 mEq/L. The client is experiencing ____________________ ______________________.
Respiratory Alkalosis
the pH is elevated above normal parameters indicating an alkalotic state. The PaCO2 is low--below normal parameters. The HCO3 reveals it is within normal parameters. Therefore with the pH elevated and the CO2 low, the client is experiencing a respiratory alkalosis. Treatment.
T or F
A dying patient suddenly has a period of alertness. The nurse is aware that death is moments away.
F
Hyperphosphatemia is tolerated well by the body. However, what condition should you be worried about?
a Hypophosphatemia b Hypermagnesemia
c Hypocalcemia d Hypercalcemia
C
Calcium & phosphorus are inversely proportional
The nurse would be most concerned about which lab values obtained from a client receiving furosemide therapy?
a. BUN 20
b. K 2.6
c. Creatinine 1.1
d. Na 145
B
A patient has just arrived to the med-surg floor after an emergency surgery to remove the patient's spleen. The pt's BP-78/54, pulse-119 weak and thready, respirations-29, temp.- 100.2 F, and pulse o2-91%. What intravenous fluids would the nurse expect to be ordered immediately?
1. 0.9% NaCl
2. 0.45% NaCl
3. 3% NaCl
4. D5W
1.
The client is experiencing hypovolemia most probably from a hemorrhage. The expected solution to administer would be 0.9% NaCl (Normal Saline). Normal saline is an isotonic fluid that remains inside the intravascular space, thus increasing volume.
Doctor’s Order: Heparin 7,855 units Sub Q bid; Available: Heparin 10,000 units per ml. How many mL will you administer? (round to the hundredth)
0.79 ml
7,855 / 10,000 x 1 = 0.7855
What is the priority assessment for a patient with a Mag level of 5.5 mEq/L.
1. deep tendon reflexes
2. mood changes
3. lethargy
4. tetany
1
pH 7.1
CO2 40
HCO3 15
PaO2 90
Metabolic acidosis
A. Agnostic
B. Athesist
C. Theist
D. Non-conformist
C.
Atheist- Believes that God or a higher power does not exist
Theist - one who believes in God, gods, or a higher power.
Agnostic - Believes that the nature or existence of God is unknowable
Non-conformist - One who does not conform to a generally accepted practice