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107 Cards in this Set

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The pH of blood is an indirect measurement of the ____________ concentration, and is a result of ____________ and __________ compensatory functions.

Arterial pH is an indirect measurement of the HYDROGEN ION concentration, and is a result of RESPIRATORY and RENAL compensatory functions.

Normal Range


pH

7.35 to 7.45

Normal Range


PaCO2

35 to 45

Normal Range


HCO3

22 to 26

In fully compensated acidosis/alkalosis:


pH will be _________


PaCO2 will be _________


HCO3 will be ___________

FULL Compensation:



PH is .... NORMAL


PaCO2 is .... HIGH/LOW


HCO3 is ..... HIGH/LOW


In PARTIALLY compensated acidosis/alkalosis:


pH will be _________


PaCO2 will be _________


HCO3 will be ___________

In PARTIALLY compensated acidosis/alkalosis:


pH, PaCO2, & HCO3


= ALL ABNORMAL

In uncompensated acidosis/alkalosis:


pH will be _________


PaCO2 will be _________


HCO3 will be __________

In uncompensated acidosis/alkalosis:


pH will be HIGH/LOW


AND either PaCO2 OR HCO3


will be HIGH/LOW (while one is normal)

Normal Range


Potassium

3.5 to 5.0

A potassium deficiency is caused by one of three things, what are they?

1) Inadequate intake (*rare)


2.) Increased K+ Loss/excretion (caused by: GI loss, excess renal excretion, loss through skin/wound drainage)


3) Shift into the cells

An deficiency in Potassium [hypokalemia] causes what EKG abnormalities?

HYPOKalemia can result in:


various arrhythmias (PVCs, v-tach)


Altered T wave: flat, shallow, or inverted


ST depression


Prominent U Wave

Low K+ = Low T wave


High K+ = High/Peaked T Waves

What are the most important Nursing Considerations when administering IV potassium replacement therapy?

• NEVER give by IV Bolus


Infusion Rate: 5-10 mEq/hr


• Ensure bag is labeled and mix contents


Concentration should be no more than 1 mEq/10 mL sol


Ensure patient has output


(> 30 mL/hr indicating renal function) prior to admin


Monitor pt for phlebitis, stop infusion immediately if s/s occur


implement the following for


K+ level < 2.5


- monitor for shallow RESP


- cont cardiac monitoring

What are some common causes of hypokalemia?

Hypokalemia Causes:


*vomiting


* NG suction


* prolonged Diarrhea


* overuse of laxatives


*profuse diaphoresis


* potassium wasting diuretics [loop diuretics such as Lasix]

What s/s are associated with Hyperkalemia?

*slow, irregular pulse


*hypotension


*neuromuscular: paresthesias, irritability, extreme weakness


*GI: hyperactive BS, ⬆️ motility, N/V/D, Oliguria


*Cardio: dysrhythmias (V Fib, peaked T waves, wide QRS)


What Medications are Given to Correct HYPERkalemia?

Mild to Moderate HYPER-K+:


* Potassium-Wasting Diuretic


* Kayexelate = binds to K+ and facilitates their excretion.



Severe Elevation:


*Calcium Gluconate >> does NOT actually lower the K+ level, it counteracts K effects on the heart. Works INSTANTLY, but only lasts a few hours.


*IV Regular Insulin


= moves K+ into the cells


* Sodium BiCarb >> given to correct the metabolic acidosis caused by excess Potassium




Normal Range


Sodium

135-145 mEq/L

Normal Range


Calcium

9.0 to 10.5 mg/dL

Normal Range


Phosphorus

3.0 to 4.5 mg/dL

Normal Range


Chloride

98 to 106 mEq/L

Respiratory Acidosis is the result of conditions that ___________________. Some of these are:

Respiratory Acidosis is the result of conditions that affect breathing. Some of these conditions include: asthma, atelectasis, pneumonia, bronchitis, pulmonary edema, pulmonary embolism, CNS Depressants (opioids, sedatives)

This is a picture of __________ sign, it is used to identify what electrolyte imbalance?

Chvostek's Sign


- used to identify HYPOcalcemia

Kernig's sign is a diagnostic test to assess for what condition?

Meningitis.

A normal CSF sample has what characteristics?

CSF is normally Clear (colorless) and transparent. Any discoloration or cloudiness is considered abnormal.

This is a picture of __________ sign, it is used to identify what electrolyte imbalance?

Chvostek's Sign


- used to identify HYPOcalcemia

Kernig's sign is a diagnostic test to assess for what condition?

Meningitis.

A normal CSF sample has what characteristics?

CSF is normally Clear (colorless) and transparent. Any discoloration or cloudiness is considered abnormal.

Prior to obtaining an ABG sample, the above test should be performed. What is it called and why is performed?

Allen's Test


• performed prior to ABG testing in order to ensure that the patient has adequate collateral circulation.

The normal range for total cholesterol is less than ________ mg/dL. The total cholesterol level is composed of both "good" _______ cholesterol and "bad" ________ cholesterol.


The normal range for total cholesterol is less than 200, it is composed of both "good" HDL cholesterol and "bad" LDL cholesterol.

LDL = Loser Cholesterol


HDL = Happy Cholesterol

Following myocardial injury, Troponin levels become elevated within ______ to _______ hours.

3 to 5 hours



Elevations=


Troponin T > 0.2 ng


Troponin I > 0.03 ng

A patient with an Ejection Fraction of less than ______% qualifies for a diagnosis of Heart Failure.

Heart Failure = EF < 40%

The therapeutic drug range for Digoxin is _____ to ______ ng/mL.


Toxicity is indicated by a serum level greater than ______ ng/mL

Digoxin therapeutic range


= 0.8 - 2.0 ng/mL


Toxicity: > 2.4 ng/mL

What are the s/s associated with a Digoxin level > 2.4 ng/dL?

Early Toxicity: N/V, anorexia, fatigue, weakness,


Late: visual disturbances (blurred vision, diplopia, & yellow/green halos)

An induration > than _____ mm is considered a positive Mantoux test and indicates that the individual has been exposed to TB.

10 mm

A nurse is assessing a patient who sustained a head injury for changes in LOC using the Glasgow Coma Scale (GCS). The patient opens his eyes when spoken to, speaks incoherently, and moves extremities when pain is applied. The nurse should document that the patient's current GCS score is:

GCS = 11


Eye Opening = to voice = 3


Motor Response = w/D = 4


Verbal Resp = incoherent = 4


E3 + M4 + V4 = 11

The nurse is caring for a patient with an intracranial pressure monitoring device in place. The nurse reads the above display on the ICP monitor at the patient's bedside. What should the nurse do next?

Nothing. The nurse should chart the patient's ICP (10.4) as (normal range is 10-15 mmHg) WNL and continue to monitor the patient's condition,

Following cataract surgery patient's are instructed not to bend at the waist, cough, sneeze, strain, or other movements that increase the intraocular pressure. A nurse would notify the provider if a patient's IOP was greater than the expected range of ________ to ______ mmHg.

Expected IOP Range


= 10 to 21 mmHg

When obtaining an ABG testing the specimen is collected into a ___________ ___________. It should be capped and immediately placed in a basin with ice and water to preserve ___________.

The specimen is collected into a heparinized syringe. It must placed in a basin with ice and water to preserve pH.

What are the two arteries used to obtain ABG Samples?

Radial and Ulner

The Maternal Alpha Fetoprotein Screening Test is performed between ______ and _____ weeks gestation in order to detect abnormal levels of protein associated with what congenital abnormalities?

The AFP test is done between 16 and 18 weeks gestation in order to detect genetic abnormalities such as neural tube defects, Spina Bifida & Down Syndrome. This is part of the quad screen.


A Non-Stress Test is considered normal or "Reactive" if there are at least two FHR accelerations that increase the baseline FHR by _____ bpm and last a minimum of _____ seconds.

Reactive NST is indicated by:


2 or more FHR accelerations that increase BL by at least 15 bpm and last a minimum of 15 seconds.

What are some of the common indications for performing an Amniocentesis?

• to identify genetic d/o


• to assess for metabolic defect


• to determine fetal lung maturity

Chorionic Villi Sampling can only be performed between _______ and _______ weeks gestation.

CVS is done between 10 and 13 weeks gestation.

A nurse is caring for a patient who is 28 weeks gestation and reports clear fluid leaking from the vagina. In order to determine whether the patient has PROM what 2 tests can be performed?

Nitrazine Test - test strip turns blue indicating AF is present


Fern Test - sample is examined under microscope for "ferning" pattern indicative of AF


Nitrazine Test - test strips are used to detect amniotic fluid which is more alkaline than urine or vaginal secretions.

Pregnant patients who have a negative Rubella Titer during prenatal testing should receive the vaccination when?

In the immediate postpartum period (prior to d/c following delivery) - this is an ideal time because patients are less likely to become pregnant for 1-3 months following vaccine.

All pregnant patients are routinely screened for gestational diabetes by undergoing a glucose tolerance test at _______ to ________ weeks gestation. If patient has an above normal blood glucose level they are then sent for what additional diagnostic?

Oral Glucose Tolerance Test is performed at 24 to 28 weeks gestation. If patient's BG level is > 130-140 they are sent for the 3 hour glucose tolerance test.

When monitoring a patient in preterm labor who is receiving magnesium sulfate what signs and symptoms of magnesium toxicity should the nurse assess for?

Magnesium Sulfate Toxicity:


• decreased urine output


(> 30 mL/hr)


• loss of DTRs


• RR of > 12/min


• pulmonary edema


• chest pain

The fetal heart rate can be heard by Doppler at _______ to _______ weeks gestation. The normal baseline fetal heart rate is between _____and _____ bpm.

FHR is audible via Doppler at 10 to 12 weeks gestation. The normal baseline FHR is 110 to 160 bpm.

During pregnancy maternal blood volume and cardiac output increases by _______ to ________ %.

45-50% increase in cardiac output

When taking a pregnant patient's v/s the nurse knows to expect that the patient's HR, RR, and BP will differ in what way from her normal baseline rate.

HR = Increased (10-15/min)


RR = Increased (2/min)


BP = decreased (5-10 mmHg) *Systolic & Diastolic pressures are initially decreased in pregnancy, but they return to baseline by delivery

A patient with PROM is undergoing an amniocentesis to determine fetal lung maturity. What test is used to determine fetal lung maturity?

Test to determine fetal lung maturity = Lectin/Sphingmyelin Ratio

A Biophysical Profile assess fetal well being by measuring what 5 variables?

5 variables assessed in BPP:


1) Reactivity of FHR


2) Fetal Breathing Movements


3) Body Movements


4) Fetal Tone


5) Amniotic Fluid Volume

A Positive Contraction Stress Test (CST) suggests what about the fetus' well-being?

A Reactive CST is an ABNORMAL finding and is a NON-REASSURING sign of fetal well being. Delivery by cesarean section is indicated.

Annual DRE (Digital Rectal Exam) is recommended for all men over the age of ______. Annual testing should be initiated earlier for those who have a familial history of prostate cancer, and for individuals belonging to what racial group?

Annual DRE's are recommended for all men over the age of 50. African American males should initiate regular screening prior to 50.

Annual DRE (Digital Rectal Exam) is recommended for all men over the age of ______. Annual testing should be initiated earlier for those who have a familial history of prostate cancer, and for individuals belonging to what racial group?

Annual DRE's are recommended for all men over the age of 50. African American males should initiate regular screening prior to 50.

A nurse is reading the results of a patient's Prostate Specific Antigen (PSA) test. The patient has a PSA level of 7.1 ng/mL. Is this level high/low/normal?

A PSA level of 7.1 ng/mL is HIGH - A PSA level > 4 could be caused by prostate cancer, BPH, or prostatitis.


*The patient would likely need additional diagnostics such as TRUS (transrectal U/S) and/or prostate biopsy.

What diagnostic test allows visualization of the esophagus in order to test for esophagitis in patients with GERD?

EGD - is a type of upper endoscopy that is used to determine source of bleeding, to identify gastric ulceration, and also to see if a pt with GERD has esophagitis.

What diagnostic test allows visualization of the esophagus in order to test for esophagitis in patients with GERD?

EGD - is a type of upper endoscopy that is used to determine source of bleeding, to identify gastric ulceration, and also to see if a pt with GERD has esophagitis.

What test is performed in order to definitively diagnose hiatal hernia?

Barium Swallow

What diagnostic test allows visualization of the esophagus in order to test for esophagitis in patients with GERD?

EGD - is a type of upper endoscopy that is used to determine source of bleeding, to identify gastric ulceration, and also to see if a pt with GERD has esophagitis.

What test is performed in order to definitively diagnose hiatal hernia?

Barium Swallow

What diagnostic tests can be used to identify the presence of H.pylori?

• endoscopy: collection of gastric samples to directly test for the bacteria


• stool sample to test for the H.pylori antigen


• serologic (blood test) to screen for the presence of antibody assays


• Urea Breath Testing


What education is required regarding dietary restrictions for a patient who is scheduled to undergo Hemoccult testing?


72 hours prior to testing Pts should abstain from:


- red meat, fish, poultry


- turnips, horseradish


- aspirin, NSAIDS


- vitamin C

Certain foods and meds can cause falsely negative or positive test results

What education is required regarding dietary restrictions for a patient who is scheduled to undergo Hemoccult testing?


72 hours prior to testing Pts should abstain from:


- red meat, fish, poultry


- turnips, horseradish


- aspirin, NSAIDS


- vitamin C

Certain foods and meds can cause falsely negative or positive test results

What is the Osmolarity of normal body fluids?

Approximately 300 mOsm/kg

What education is required regarding dietary restrictions for a patient who is scheduled to undergo Hemoccult testing?


72 hours prior to testing Pts should abstain from:


- red meat, fish, poultry


- turnips, horseradish


- aspirin, NSAIDS


- vitamin C

Certain foods and meds can cause falsely negative or positive test results

What is the Osmolarity of normal body fluids?

Approximately 300 mOsm/kg

Gastric Residual Volumes (GRV) are measured before each intermittent feeding and every _____ hours for patients on continuous feedings.

Q4H

An HIV positive patient with a CD4+ count of 180 would be considered to be in what stage of the disease?

Stage 3 - this patient would no longer be classified as merely being HIV positive, a CD4+


<200 indicates that the patient has AIDS.

What blood test is performed in order to test a patient for HIV?

The initial screening test = ELISA


*Enzyme-Linked Immunosorbent Assay]



If the ELISA test is positive, the sample is then tested by Western Blot to confirm positive result.

A 35 year old patient reports that her mother recently passed away after battling aggressive breast cancer. The patient is worried that she is at an increased risk for developing the same type of cancer. What testing should she undergo to assess her genetic risk?

BRCA 1 & BRCA 2 gene testing

A nurse is analyzing the CBC results for one her clients and notes that her patient has a WBC of 20,000. What would this level be classified as and what condition generally causes it?

WBC count of 20,000 is classified as leukocytosis. An elevated WBC count is typically associated with infection.

Thoracentesis is performed by perforating the chest wall with a large bore needle in order to remove fluid. The amount of fluid removed at any one time is limited to how many mL?

1,000 mL or 1L


* in order to prevent cardiovascular collapse.

What test is used to differentiate between Myasthenic Crisis and Cholinergic Crisis?

Tensilon Testing


- the patient is given Endrophonium (Tensilon) --> Pts in Myasthenic Crisis will have marked improvement in muscle strength. Patients in Cholinergic crisis will have no change.

Thoracentesis is performed by perforating the chest wall with a large bore needle in order to remove fluid. The amount of fluid removed at any one time is limited to how many mL?

1,000 mL or 1L


* in order to prevent cardiovascular collapse.

What test is used to differentiate between Myasthenic Crisis and Cholinergic Crisis?

Tensilon Testing


- the patient is given Endrophonium (Tensilon) --> Pts in Myasthenic Crisis will have marked improvement in muscle strength. Patients in Cholinergic crisis will have no change.

The nurse is analyzing a patient's lab results 8 hours after the patient received 2 units of PRBCs. The nurse would expect to see that the patient's H&H was increased by approx how much?

* Hgb Should be increased by approx 2 mg/dL


*Hct should be 6% higher than it was prior to receiving the infusion.

Each unit of blood raises Hgb by approx 1 mg/dL and Hct by 3%

The Normal Range for Hemoglobin is ?

Women: 12-16


Men: 14-18

The Normal Range for Hemoglobin is ?

Women: 12-16


Men: 14-18

The normal range of Hematocrit is:

Women: 37 to 47


Men: 42 to 52

The expected or desired INR range for a patient on Warfarin therapy is:

2 to 3

INR = PT/average mean PT

The diagnostic test performed in order to assess for clot formation (in patients suspected of having a PE of DVT) is _________________.

D-Dimer


- normal reference ranges are:


0 to 250 ng/mL


Or 0.43 to 2.33 mcg/mL

The diagnostic test performed in order to assess for clot formation (in patients suspected of having a PE of DVT) is _________________.

D-Dimer


- normal reference ranges are:


0 to 250 ng/mL


Or 0.43 to 2.33 mcg/mL

What is normal range for iron?

Female: 60 to 160


Male: 80 to 180


*elevated iron level may indicate liver d/o, Megaloblastic anemia, or excessive intake.


*decreased level is consistent with iron-deficiency anemia or bleeding

What lab levels would be monitored in a patient who is on a heparin drip?

aPTT levels


Normal levels = 1.5 to 2.0 the desired range of 30 to 40 seconds ~ 45-80

A RBC level of 3.8 million/uL is considered ___[HIGH/LOW]__. This level is most likely caused by _______________.

RBC count of 3.8 million/uL is considered LOW. The most likely cause is anemia (which itself may be caused by a variety on abnormalities)

A platelet level of less than _____________ is an indication for a platelet transfusion.

20,000 or less


*if active bleeding is present a count of 80,000 or less may indicate the need for a transfusion.

Serum ferritin is an indicator of what?

The total iron stores in the body

What 5 levels are included in liver function testing?

AST + ALT + ALP + bilirubin + albumin

Patients undergoing a colonoscopy or sigmoidoscopy are given what teaching regard dietary restrictions, bowel preparation, and meds?

Prior to having a lower endoscopy patients are:


- clear liquid or low-residue diet for 24-48 hours prior


- NPO after midnight the day of


- No smoking of chewing gum (increases peristalsis)


- bowel preparation: pt may be ordered to take laxatives, and/or GOLYTELY


A patient who started receiving TPN within the last 24 hours would likely have blood glucose checks ordered how frequently?

Blood Glucose Q4H to Q6H


*more frequently if rate is still being adjusted or if glucose levels have been unstable

A patient with a diagnosis of cirrhosis of the liver is having a Paracentesis to drain the accumulation of fluid in his abdomen. How much fluid will likely be drained by gravity flow?

4L to 6L


*it is drained slowly to prevent complications

Patients with a BMI of _____ or greater may be candidates for bariatric (weight loss) surgery.

Patients with a BMI of 40 or greater


*35 or greater if patient has comorbidities

Urine creatinine clearance 24-hour urine collection and testing is used to determine a patient's _________ and would be ordered for a patient with suspected renal dysfunction.

Used to determine a patient's GFR [Glomerular Filtration Rate]

A nurse is reviewing a clients laboratory findings for urine analysis. The findings indicate the urine is positive for leukoesterase and nitrates. Which of the following is an appropriate nursing action?


A) Repeat the test early in the morning.


B) Start a 24 hour urine collection for creatinine creatinine clearance.


C) obtain a clean catch urine specimen for culture and sensitivity.


D) Insert a urinary catheter to collect a urine specimen.

C) obtain a clean catch urine specimen for culture and sensitivity.


Rationale: a urine analysis that reveals the presence of lukeoesterase & nitrates is considered diagnostic for UTI. The patient requires antibiotics & a C&S will reveal the best choice of medication.

A patient is undergoing urography with contrast, what medication should be withheld due to a risk of lactic acidosis?

Glyucophage (metformin)

A nurse is assessing a client with a diagnosis of acute Glomerulonephritis. Which of the following is an expected finding? Select all that apply.


A) Fever


B) peripheral edema


C) Polyuria


D) dyspnea


E) proteinuria

Answers = A, B, D, E


Rationale: low-grade fever is common in patients with Glomerulonephritis due to infection; peripheral edema is caused by the retention of fluid; dyspnea occurs because of the fluid retention; and protein is lost in the urine as a result of the glomeruli involvement.

A glomerular filtration rate of less than 15 mL/min is considered what stage of kidney disease?

End Stage Kidney Disease


(or Stage 5)

Patients experiencing renal failure are placed on what dietary restrictions?

Protein Restriction


Sodium restriction (1-3 g/day)


Fluid restriction (24 output + 500 to 600 mL)

A patient presenting with signs and symptoms of kidney stones would likely undergo what diagnostic test in order to confirm the presence and location of kidney stones?

IVP (intravenous pyelogram)

Cervical cancer screening tests are every ______ years for women between the ages of 21-29, and every ______ years for women aged 30 to 65.

Cervical Cancer Screening is recommended every 3 years for women between 21-29, and every 5 years for women 30 to 65.

A women with a positive screening mammogram would undergo what diagnostic test?

A Breast Ultrasound


- screening mammograms are done to identify the presence of any abnormal tissue or mass. If positive the next diagnostic test would be a breast U/S in order to identify whether the mass is a fluid filled cyst or a solid mass (possibly cancerous).

A DXA scan is performed in order to assess patients at risk for what condition?

= osteoporosis


• DXA stands for Dual X-ray Absorptiometry - uses two beams of radiation to determine a patient's bone density. The results are determined by assigning a score that compares their bone density to that of others in the same age group.

A Wood's Light Examination is a diagnostic used to determine the presence of what?

= skin infection



- test is performed in a darkened room, using an ultraviolet light and assessing for certain colors indicative of infection.

A nurse is caring for a client who has a suspected viral lesion. Which of the following laboratory findings should the nurse anticipate reviewing to confirm this diagnosis?


A) potassium hydroxide (KOH)


B) culture and sensitivity


C) Tzank smear report


D) biopsy

C) Tzank smear



Rationale: Potassium Hydroxide (KOH) confirms a FUNGAL skin lesion, C&S is used to identify presence and type of bacteria, biopsy is done to identify or R/O malignant cells.

The nurse is caring for a patient who has a new prescription for valproic acid. What lab tests will the patient need to under go in order to monitor for adverse effects?

• baseline LFTs and at least Q2months for first 6 mths


• amylase


•platelets

The therapeutic range for Lithium carbonate maintenance is ____to ____ mEq/L. During an episode of acute mania the therapeutic range is ____to ____ mEq/L.

Maintenance: 0.4 to 1.0 mEq/L


Acute Mania: 0.8 to 1.4 mEq/L

The nurse is reviewing the results of patient who is s/p hysterectomy x 2 days and is receiving prophylactic enoxaparin daily. The lab report reveals the patient has:


WBC 9,000 /uL


RBC 3.5 million/uL


PLT 98,000 mm3


The patient has meds due in 30 minutes, what should she do?

• the nurse should hold the patient's scheduled dose of enoxaparin (Lovenox), she should chart why it was not given. She should then notify the provider.


*Lovenox protocol is to hold med if platelet count is


< 100,000.

Magnesium Sulfate is toxicity is indicated by a blood serum level of greater than ______ mg/dL.

Magnesium Sulfate Toxicity =


Greater than 9 mg/dL