Exam 1: Education, Fluids, Electroytes, Renal Failure, Acid Base Imbalances

Question 1

What are some risk factors for a fluid volume excess?

Answer 1

Excessive fluid replacement, kidney failure, heart failure, long term corticosteroid use, SIADH, psychiatric disorders with polydipsia, and water intoxication.

Question 2

What are some risk factors for a fluid volume deficit?

Answer 2

Hemorrhage, vomiting, diarrhea, profuse salivation, fistulas, ileostomy, profuse sweating, burns, severe wounds, long term NPO status, diuretic therapy, GI suction, hyperventilation, diabetes insipidus, fever, coma, impaired motor func

Question 3

What are some complications of a fluid volume excess?

Answer 3

CHF, pulmonary edema, skin breakdown, poor perfusion, coma, potential for injury, possibly seizures and multi organ system failure.

Question 4

What are some complications of a fluid volume deficit?

Answer 4

Potential for injury, poor perfusion, seizures, coma, hypovolemic shock, multi system organ failure

Question 5

What are some things a nurse should assess for a pt with a fluid imbalance?

Answer 5

Input and output, daily weight, medications, hx of renal or endocrine issues, LOC, vitals, muscle weakness or spasms, visual changes, headaches, skin, extremities, edema, pulses, cap refill, skin color and temp

Question 6

What labs are a priority to look at for a fluid volume excess and what are the anticipated results?

Answer 6

Serum osmolality: decreased
CBC: decreased
BUN: decreased
Serum sodium: decreased
Urine specific gravity: decreased
REMEMBER: it’s decreased because it’s very diluted!

Question 7

What labs are a priority for a fluid volume deficit and what are the anticipated results?

Answer 7

Serum osmolality: increased
CBC: increased
BUN: increased
Serum sodium: increased
Urine specific gravity: increased
REMEMBER: it’s increased because it’s very concentrated!

Question 8

What are some potential assessment findings for a fluid volume excess?

Answer 8

Tachycardia, bounding pulse, hypertension, distended neck veins, weight gain, tachypnea, shallow respirations, shortness of breath, moist crackles in lungs, pitting edema, cool and clammy skin, altered LOC, headache, weakness

Question 9

What are some potential assessment findings for a fluid volume deficit?

Answer 9

Weight loss, skin tenting, dry mucous membranes, weak thready pulse, orthostatic hypotension, lightheadedness, flat neck veins, oliguria, syncope, hypovolemic shock

Question 10

What are some interventions that may be implemented for a fluid volume deficit?

Answer 10

Oral rehydration, isotonic IV solution (0.9% NaCl or LR), O2 for confusion, monitor I&Os, daily wt, monitor vitals and peripheral pulses, monitor LOC and mental status, and safety precautions.
If SEVERE: hypotonic IV solution (0.45% NaCl)

Question 11

What are some interventions that may be implemented for a fluid volume excess?

Answer 11

Monitor vitals, pulses, edema, lung sounds, and I&Os, daily wt, Fowlers position, treat cause first then may use diuretics (furosemide and mannitol) restrict intake of water and sodium.
If SEVERE: hypertonic IV solution (D5W NaCl or D5W in LR)

Question 12

What are some causes of hypercalcemia?

Answer 12

Bone destruction, bone disorders, hyperparathyroidism, decreased excretion from kidney disease, glucocorticoids, dehydration, immobilization, calcium or vitamin D overdose from supplements, acidosis, thiazide diuretics, and increased intake of calcium antacids.

Question 13

What may be some causes of hypocalcemia?

Answer 13

Low intake, lactose intolerance, parathyroidism, pancreatitis, multiple blood transfusions, alkalosis, laxative abuse, malabsorption syndromes, kidney disease, vitamin D deficiency, low magnesium, alcoholism, diarrhea, loop diuretics, wound drainage, and immobility

Question 14

What are some assessment findings a nurse might find with hypercalcemia?

Answer 14

Tachycardia, hypertension, bounding pulse, lethargy, weakness, confusion, decreased reflexes, n/v, bone pain, bone fractures, polyuria, and kidney stones.

Question 15

What are some assessment findings a nurse may find with hypocalcemia?

Answer 15

Bradycardia, hypotension, weak peripheral pulses, tetany, positive chvoteks and trousseaus signs, dysphasia, fatigue, anxiety, depression, hyperreflexia, muscle spasms, and numbness and tingling of extremities and around mouth.

Question 16

What are some priority nursing intervention and medications for hypercalcemia?

Answer 16

Find and treat underlying cause, hydrate with fluids, low calcium diet, increase wt bearing exercises, strain urine for kidney stones, assess, for flank pain, give furosemide to excrete through kidneys, give calcitonin to lower serum levels, give pamidronate to lower levels

Question 17

What are some priority nursing interventions for hypocalcemia?

Answer 17

Find and treat underlying cause, increase intake of calcium and vitamin D, administer IV calcium gluconate, monitor ECG.

Question 18

What are some foods that are rich in calcium?

Answer 18

Milk, yogurt, mozzarella, cheddar, collard greens, broccoli, kale, sardines, salmon, shrimp, beans, food fortified with calcium

Question 19

What are some causes of hyperkalemia?

Answer 19

Acidosis, burns, injuries, infections, potassium sparing medications, high intake, medications high in K, renal failure, adrenal insufficiency, overuse of K salt substitute

Question 20

What are some causes of hypokalemia?

Answer 20

Diarrhea, vomiting, inadequate intake, overuse of laxatives, low magnesium levels, excessive sweating, hydration with fluids w/o K, stress, alkalosis, wound drainage, potassium wasting diuretics, kidney disease, water intoxication, GI suction

Question 21

What are some assessment findings a nurse may find with hyperkalemia?

Answer 21

Irregular pulse, bradycardia, irritability, anxiety, leg cramping and pain, weakness, abdominal cramps, diarrhea, dysrhythmias, and paresthesias.

Question 22

What are some assessment findings with hypokalemia?

Answer 22

Weak, irregular pulse, shallow respirations, orthostatic hypotension, muscle weakness, paralytic ileum, hyperglycemia ,paralysis, anxiety, confusion, lethargy, depressed deep tendon reflexes.

Question 23

What are some priority nursing interventions for hyperkalemia?

Answer 23

Administer potassium wasting diuretics (furosemide), give potassium binding medications, monitor ECG, safety precautions

Question 24

What are some priority nursing interventions for hypokalemia?

Answer 24

Administer potassium supplements, encourage oral intake of K, administer K slowly, monitor EKG,

Question 25

What are some causes of hypernatremia?

Answer 25

Diabetes insipidus, hyperglycemia, excessive sweating, sodium intake w/o water, excessive hypertonic saline IV solution, lack of water with tube feedings, osmotic diuretics, diarrhea

Question 26

What are some causes of hyponatremia?

Answer 26

Sweating, diarrhea, draining wounds, vomiting, trauma with blood loss, intake of fluids w/o sodium, excessive water intake, SIADH

Question 27

What are some assessment findings for hypernatremia?

Answer 27

Hypotension, orthostatic hypotension, poor skin turgor, dry swollen tongue, agitation, lethargy, weakness, thirstyness

Question 28

What are some assessment findings for hyponatremia?

Answer 28

Changes in LOC, headache, confusion, irritability, muscle weakness, seizures, orthostatic hypotension, weak thready pulse, diminished DTR, diminished peripheral pulses, hyperactive bowels

Question 29

What are some priority nursing interventions for hypernatremia?

Answer 29

Administer hypotonic or isotonic fluids, limit sodium intake, give diuretics that waste sodium (hydrochlorothiazide diuretics), monitor LOC

Question 30

What are some priority nursing interventions for hyponatremia?

Answer 30

Restrict fluids, give sodium containing fluids, monitor LOC

Question 31

What are some foods that are rich in potassium?

Answer 31

Potatoes, legumes, juices (carrot, prune, orange, pomegranate), seafood, leafy greens, dairy, tomatoes, bananas, avocados

Question 32

what are some foods rich in sodium?

Answer 32

Table salt, processed foods, canned foods

Question 33

What are some of the diagnostic tests a nurse may look at for a patient with kidney damage?

Answer 33

Urine analysis, creatinine, BUN, electrolytes, ABGs, CBC, renal ultrasound, CT, and a perfusion study

Question 34

What are some pharmacological interventions a nurse may administer for a patient with kidney damage?

Answer 34

Loop diuretics(furosemide, bumetanide), osmotic diuretics(mannitol),
To treat anemia:folic acid, iron, erythropoietin
To treat hyperkalemia: calcium gluconate, sodium bicarbonate, kayexalate, insulin, glucose
Calcium acetate: lowers phosphate
Calcitonin: lowers calcium

Question 35

What are some non-pharmacological interventions a nurse may implement for a patient who has kidney damage?

Answer 35

Fluid restrictions, increase calories with carbs and fats, decrease protein, hemodialysis, and peritoneal dialysis

Question 36

What are some risk factors for chronic renal failure?

Answer 36

Diabetes, hypertension, chronic kidney infections, lupus, acute renal failure, African Americans

Question 37

What are some things a patient can do to help prevent chronic renal failure that a nurse may educate about?

Answer 37

Control hypertension and diabetes, drink fluids, stop smoking, eat a healthy diet, exercise, increase healthy cholesterol, take meds as prescribed, prevent UTIs

Question 38

What are some focused assessments a nurse should make for a patient with chronic renal failure and what might they find?

Answer 38

Fluid and electrolytes may be imbalanced
Cardio: may have poor perfusion or dysrhythmias
Immunity may be compromised
GI: may be in metabolic acidosis
Neuro: altered LOC from electrolyte imbalances
Musculoskeletal: may be weak
Endocrine/metabolic: ABGs off, poor glucose regulation
Dermatological: edema, skin breakdown
Hematological: may be anemic

Question 39

What are some possible complications of a kidney transplant that the nurse should educate their patient about?

Answer 39

Cardiovascular, dyslipidemia, bone disease, long term need for dialysis, organ rejection, infections, sepsis, hyperkalemia

Question 40

What are some goals a nurse may set for her patient with acute kidney damage?

Answer 40

Thorough med reconciliation, find cause and treat, get kidney back to normal function, prevent anemia, prevent further damage

Question 41

what are some patient goals a nurse may set for her patient with chronic renal failure?

Answer 41

Slow the progression, manage symptoms, be comfortable, eat a good diet, lifestyle changes, adjust to new normal, find support, education

Question 42

How do the lungs compensate for both acidosis and alkalosis?

Answer 42

Acidosis: RR increase to exhale acids
Alkalosis: RR decrease to retain acids to neutralize

Question 43

How do the kidneys compensate for both acidosis and alkalosis?

Answer 43

Acidosis: hydrogen ions are excreted in urine
Alkalosis: bicarbonate ions are excreted in urine

Question 44

What are some risk factors for developing metabolic acidosis?

Answer 44

Diabetic ketoacidosis, diarrhea, renal failure, trauma, aspirin overdose, sepsis, malnutrition, GI fistulas, lactic acidosis, thyroid storm

Question 45

What are some assessment findings a nurse might expect for a patient with metabolic acidosis?

Answer 45

Hypotension, tachypnea, dysrhythmias, drowsiness, confusion, headache, warm flushed skin, n/v, diarrhea, abdominal pain, pH decreased, HCO3 low, hyperkalemia, weak pulses, decreased LOC, hyporeflexia, kussumal respirations (fast and deep)

Question 46

What are some risk factors for developing metabolic alkalosis?

Answer 46

Loss of gastric secretions, excessive vomiting, GI suctioning, overuse of antacids, potassium wasting diuretics

Question 47

What are some assessment findings that a nurse may expect to find with a patient who has metabolic alkalosis?

Answer 47

Tachycardia, bradypnea, dysrhythmias, dizziness, confusion, headache, n/v, tetany, muscle cramps, tremors, hypotonicity, pH increased, HCO3 increased, hyperreflexia, hypocalcemia, hypokalemia

Question 48

What are some risk factors for developing respiratory acidosis?

Answer 48

Hypoventilation, COPD, airway obstruction, drug overdose, chest trauma, pulmonary edema, pneumonia, asthma, hyperoxygenation, PE

Question 49

What are some assessment findings that a nurse my expect to see for a patient with respiratory acidosis?

Answer 49

Respiratory depression, hypotension, bradypnea, hypoxia, dizziness, confusion, headache, warm flushed skin, pH low, CO2 up, weak pulses, decreased LOC, hyporeflexia, kussmual respirations

Question 50

What are some nursing interventions that may be implemented for respiratory acidosis?

Answer 50

Treat underlying cause, provide O2, semi fowlers position, turn cough and deep breathe, fluid therapy, mucolytics to loosen secretions, suction as needed, avoid meds that cause respiratory depression, breathing treatments, monitor for rising CO2 and need for mechanical ventilation

Question 51

What are some risk factors that can cause respiratory alkalosis?

Answer 51

Hyperventilation, hypoxia, PE, fear, anxiety, high altitude, pregnancy, fever, mechanical over ventilation, brain injury, sepsis, aspirin overdose

Question 52

What are some assessment findings that the nurse may expect to find for a patient with respiratory alkalosis?

Answer 52

Tachycardia, tachypnea, dysrhythmias, confusion, lethargy, headache, n/v, tetany, numbness, tingling, hyperreflexia, pH up, CO2 down, hypocalcemia, irritability,

Question 53

What are some nursing interventions that may be implemented for a patient with respiratory alkalosis?

Answer 53

Treat underlying cause, encourage normal/deep breathing exercises, alleviate hypoxemia, administer calcium carbonate to treat hypocalcemia