Quizes Flashcards
A patient with a head injury is admitted to the emergency unit. The laboratory test reports reveal the patient’s sodium level as 109 mEq/L. Which condition does the patient have?
Diabetes insipidus
Fatal cardiac dysrhythmias
Type B chronic obstructive pulmonary disease
Syndrome of inappropriate antidiuretic hormone
Syndrome of inappropriate antidiuretic hormone
The normal range for the sodium level is from 136 to 145 mEq/L. A patient with a head injury may have syndrome of inappropriate antidiuretic hormone, which may result in excessive secretion of antidiuretic hormone, which causes hyponatremia by causing water retention. A head injury may also cause diabetes insipidus, which leads to hypernatremia due to dilution of the urine. Fatal cardiac dysrhythmias occur due to hyperkalemia. Type B chronic obstructive pulmonary disease leads to fluid, electrolyte, and acid-base imbalances.
A patient with blood type O needs platelets. What should the nurse consider when choosing a donor for platelet transfusion?
Rh compatibility is excluded.
Donor can be of any blood group.
Donor should be of blood group O.
Donor can be exempted from screening for infections.
Donor should be of blood group O.
Donor can be exempted from screening for infections.
For platelet transfusion to a patient with blood group O, the donor must be of blood group O only. Any other blood type may cause a mismatch and lead to a transfusion reaction. Rh compatibility should be checked before transfusion, because it can also lead to a transfusion reaction. Donor specifications exist for platelet transfusions; not just any blood group is acceptable. The donor must be screened for all communicable diseases, including human immunodeficiency virus (HIV).
Why are older adults prone to dehydration?
They sweat more in hot weather.
Their lungs evaporate more water during respiration.
The ability of their kidneys to concentrate urine decreases.
Water absorption from their gastrointestinal (GI) tract decreases.
The ability of their kidneys to concentrate urine decreases.
The very old and the very young may be most at risk for dehydration. In older adults, risk increases because of the kidneys’ ability to concentrate urine, limited movement, drug interactions, and malfunctioning thirst sensation. Limited ability to move and nocturia may increase fears of incontinence, leading to decreased liquid intake, which leads to dehydration. The secretion from sweat glands decreases as one ages, putting older adults at high risk for heat exhaustion. The lungs evaporate less water during respiration. Water absorption from the gastrointestinal (GI) tract decreases, leading to constipation.
While caring for a patient with gastroenteritis, the nurse finds a supine blood pressure of 90/58 mm Hg and a heart rate of 102 bpm. What condition does the nurse suspect?
Risk for impaired skin integrity
Nausea related to gastric irritation
Deficient fluid volume related to vomiting
Diarrhea related to intestinal inflammation
Deficient fluid volume related to vomiting
A supine blood pressure of 90/58 mm Hg and a heart rate of 102 bp in a patient with gastroenteritis indicate deficient fluid volume related to vomiting. The symptoms of impaired skin integrity in a patient with gastroenteritis are intact skin, redness, and decreased skin turgor. Little interest in eating and increased salivation are symptoms of nausea related to gastric irritation. Abdominal cramping and hyperactive bowel sounds are symptoms of diarrhea related to intestinal inflammation.
A patient is receiving treatment for chronic diarrhea. The nurse advises the patient to eat food items rich in potassium. What is the reason behind promoting a potassium-rich diet?
Potassium improves smooth, skeletal, and cardiac muscle function.
Potassium is necessary for production of adenosine triphosphate (ATP).
Potassium decreases muscle wasting.
Potassium acts as a cofactor for various enzymes.
Potassium improves smooth, skeletal, and cardiac muscle function.
Potassium is required for normal functioning of smooth, skeletal, and cardiac muscles, because it helps to maintain resting membrane potential. Phosphate, not potassium, is required for production of adenosine triphosphate (ATP). Potassium does not decrease muscle wasting. Magnesium acts as a cofactor for various enzymes.
The nurse works in an acute care facility. Which patients should the nurse monitor for development of hypokalemia? Select all that apply.
Patients with adrenal insufficiency
Patients with end-stage renal disease
Patients with diarrhea
Patients with vomiting
Patients using potassium-wasting diuretics
Patients with diarrhea
Patients with vomiting
Patients using potassium-wasting diuretics
Hypokalemia is common when potassium output is increased. Diarrhea and vomiting can increase potassium loss through the gastrointestinal tract. Potassium-wasting diuretics may increase potassium loss in urine. Adrenal insufficiency leads to hyperkalemia by decreasing excretion of potassium. Oliguria in end-stage renal disease may cause decreased excretion of potassium in the urine, leading to hyperkalemia.
A patient is experiencing a malignancy in which the malignant cells secrete chemicals similar to parathyroid hormone. Which condition does the patient most likely have? Hyperkalemia Hypernatremia Hypercalcemia Hypermagnesemia
Hypercalcemia
Increased levels of parathyroid hormone may cause shifting of the calcium from the bones to the extracellular space, leading to hypercalcemia. Hyperkalemia (reduced potassium levels) and hypernatremia (reduced sodium levels) occur during cancer chemotherapy and not before initiating therapy. Hypermagnesemia is seen either due to excess intake of magnesium-rich food or during renal insufficiency due to reduced renal excretion.
A patient’s laboratory reports indicate a sodium level of 120 mEq/L in the blood. Which drug is most likely responsible for this condition? Ibuprofen Carbenicillin Spironolactone Magnesium hydroxide
Ibuprofen
The normal level of sodium in the blood ranges from136 to 145 mEq/L. A level of 120 mEq/L indicates hyponatremia. This condition is caused by nonsteroidal antiinflammatory drugs such as ibuprofen. Carbenicillin will cause hypokalemia if large doses are administered. Spironolactone is a potassium-sparing diuretic that causes hyperkalemia. Magnesium hydroxide may cause hypermagnesemia.
A patient is dehydrated and needs an infusion of isotonic fluids to correct dehydration. Which intravenous fluid is appropriate for this patient?
Dextrose 5% in water (D5W)
Dextrose 10% in water (D10W)
Dextrose 5% in lactated Ringer’s (D5LR)
Dextrose 5% in 0.9% sodium chloride (D5NS; D50.9% NaCl)
Dextrose 5% in water (D5W)
Dextrose 5% in water (D5W) is an isotonic fluid. It enters cells rapidly, leaving free water, which dilutes extracellular fluid; most of the water then enters cells by osmosis. This mechanism helps correct dehydration. Dextrose 10% in water (D10W), dextrose 5% in lactated Ringer’s (D5LR), and dextrose 5% in 0.9% sodium chloride (D5NS; D50.9% NaCl) are hypertonic solutions; hence, these are not suitable for this patient. Hypertonic solutions have an osmolality that is greater than that of body fluids and tend to extract water from cells.
After assessing a patient with gastroenteritis, the nurse suspects deficient fluid volume related to vomiting and diarrhea. Which symptoms support the nurse’s suspicion? Select all that apply. Dark yellow urine Increased salivation Abdominal cramping Little interest in eating Heart rate of 102 bpm
Dark yellow urine
Heart rate of 102 bpm
In a patient with gastroenteritis, dark yellow urine and an elevated heart rate of 102 bpm indicates deficient fluid volume related to vomiting and diarrhea. Increased salivation and little interest in eating indicate nausea related to gastric irritation. Abdominal cramping indicates diarrhea related to intestinal inflammation.
Which laboratory findings can be seen in a patient with clinical dehydration? Select all that apply. Blood urea nitrogen (BUN) of 28 mg/dL Urine specific gravity of 1.150 Serum sodium level of 160 mEq/L Serum osmolality of 270 mOsm/kg Blood urea nitrogen (BUN) of 9 mg/dL
Blood urea nitrogen (BUN) of 28 mg/dL
Urine specific gravity of 1.150
Serum sodium level of 160 mEq/L
An extracellular fluid volume (ECV) deficit and hypernatremia that occurs at the same time is known as clinical dehydration. A blood urea nitrogen (BUN) level of 28 mg/dL indicates hypernatremia, so this can be a laboratory finding in a patient with clinical dehydration. A urine specific gravity above 1.030 indicates an ECV deficit. A serum sodium level greater than 145 mEq/L indicates hypernatremia. Serum osmolality of 270 mOsm/kg is a laboratory finding of hyponatremia, which is not associated with clinical dehydration. A BUN level of 9 mg/dL (or any level below 10) is a finding of ECV excess, which is not associated with clinical dehydration.
A patient on antidepressant therapy has developed hyponatremia. Which drug might have led to this condition? Losartan Captopril Fluoxetine Furosemide
Fluoxetine
Fluoxetine is an antidepressant that leads to hyponatremia. Losartan is an angiotensin II receptor blocker that causes hyperkalemia. Captopril is an angiotensin-converting enzyme inhibitor that also causes hyperkalemia. Furosemide is a diuretic that causes hypokalemia and hypomagnesemia.
