Test 5- Alterations In Fluid, Electrolyte And Acid Base Balance

Front 1

____ solutions do not alter osmolality and are primarily used to expand volume in the intravascular compartment.

Back 1

Isotonic

Front 2

____ solutions have a low serum osmolality and are used to hydrate intercellular and interstitial compartments.

Back 2

Hypotonic

Front 3

____ solutions raise serum osmolality by pulling fluids into the vessels thereby expanding the intravascular compartment and increasing blood volume.

Back 3

Hypertonic

Front 4

3 types of isotonic IV fluids are:

Back 4

5% Dextrose in water
0.9% NACl- NS
Lactated Ringers

Front 5

_____ replace water losses in dehydration and provide 20kcal/100mL.

Back 5

Isotonic IV solutions

Front 6

______ should not be administered immediately post-op because it can cause RBC hemolysis.

Back 6

D5W

Front 7

When administered Dextrose is isotonic but quickly becomes _____.

Back 7

hypotonic

Front 8

D5W, an isotonic IV solution, should not be administered to patients with increased

Back 8

cranial pressure.

Front 9

Hypokalemia can occur when administering _____.

Back 9

D5W

Front 10

The 1st line of defense for fluid resuscitation is ____.

Back 10

Normal Saline

Front 11

____ is the only solution compatible with blood.

Back 11

Normal Saline

Front 12

Normal saline can be used for:

Back 12

-hypovolemia
-replace Na losses
-maintain patency of heparin lock
-DKA

Front 13

____ does not provide calories or free water.

Back 13

Normal saline

Front 14

Normal saline is contraindicated in the presence of ____ and ____.

Back 14

edema
heart failure

Front 15

Normal saline can cause ____ because saline promotes excretion of _____.

Back 15

hypokalemia
potassium

Front 16

____ are an isotonic IV solution that most closely represents the contents of plasma.

Back 16

Lactated Ringers

Front 17

Lactated ringers consists of

Back 17

K, Cl, Na, Ca, lactate

Front 18

Lactated ringers can be used for

Back 18

-rehydration
-burns
-mild metabolic acidosis
-salicylate poisoning

Front 19

Considerations when administering lactated ringers are:

Back 19

-edema
-may exacerbate CHf
-renal failure (can't get rid of K)
-contraindicated in liver disease

Front 20

1/2 Normal Saline is a type of _____.

Back 20

hypotonic solution

Front 21

_____ solutions are given for water replacement, hypertonic dehydration, free water for renal elimination, and DKA.

Back 21

Hypotonic

Front 22

Hypotonic solutions should be used cautiously because it could cause

Back 22

cardiovascular collapse

Front 23

Types of hypertonic solutions include

Back 23

Dextrose in Saline solutions
Dextrose and Lactated Ringers
Sodium Chloride 3% and 5%

Front 24

Dextrose in saline solutions can be given for

Back 24

DKA
severe dehydration
water replacement

Front 25

Considerations when administering dextrose in saline solutions are:

Back 25

-shock and circulatory insufficiency
-monitor serum glucose levels
-administer in large arm vein and monitor frequently
-monitor for fluid overload
-contraindicated for clients with renal or cardiac disease

Front 26

Dextrose with Lactated Ringers may be given to

Back 26

-treat mild metabolic acidosis
-provide calories from dextrose
-replace fluid losses from burns

Front 27

Considerations for administering Dextrose with Lactated Ringers are:

Back 27

-monitor for circulatory overload
-contraindicated in lactic acidosis

Front 28

When administering 3% or 5% Sodium Chloride assess for

Back 28

circulatory overload.

Front 29

3% and 5% Sodium Chloride are only administered in

Back 29

critical care areas.

Front 30

When there is severe Na depletion with neurologic symptoms, ____ may be administered.

Back 30

3% or 5% Sodium Chloride

Front 31

Hyponatremia is caused by

Back 31

dilution as a result of excess water of increased sodium loss.

Front 32

Hyponatremia occurs when sodium levels are below _____.

Back 32

135.

Front 33

Causes of Na loss are:

Back 33

-VD
-excess sweating
-gastric suctioning
-burns
-cystic fibrosis
-diuretics
-adrenal insufficiency

Front 34

Causes of water gain that affects Na are:

Back 34

-CHF
-Renal failure
-excessive hypotonic soln
tap water enema
SIADH

Front 35

Hyponatremia means there is low sodium in the ____ as opposed to the interstitial space and the cell therefore water moves into the cell.

Back 35

blood vessel

Front 36

S/Sx of hyponatremia include:

Back 36

muscle cramps and twitching
tremors
weakness, fatigue, lethargy
headache, irritability
confusion, stupor, seizures
coma

Front 37

Treatment of mild hyponatremia is

Back 37

restrict fluids
isotonic IV fluids
increase dietary Na

Front 38

Treatment of severe hyponatremia is

Back 38

hypertonic saline solution
osmotic diuretics

Front 39

Hypernatremia is when the sodium level is greater than ____mEq/L.

Back 39

145

Front 40

Causes of hypernatremia include:

Back 40

water losses and sodium gains

Front 41

Causes of hypernatremia
MODEL

Back 41

Medications and meals
Osmotic diuretics
Diabetes insipidus
Excessive water loss
Low water intake

and excessive parenteral administration of hypertonic saline solution

Front 42

Signs and symptoms of hypernatremia
DRAW MS. C

Back 42

Decreased U/O, dry mouth
Restlessness
Agitation
WEAKNESS
Muscle twitching
Seizures, STUPOR
CONFUSION, COMA

Front 43

Hypokalemia occurs when the serum potassium level is less than ____mEq/L.

Back 43

3.5

Front 44

Causes of hypokalemia are

Back 44

Decreased intake
Increased output

Front 45

Examples of increased output that cause hypokalemia are:

Back 45

vomiting, gastric suction, diarrhea, severe diaphoresis, diuretics, steroids, alkalosis, and hyperaldosteronism

Front 46

_____ is a decrease in deep tendon reflexes.

Back 46

Hyporeflexia

Front 47

S/Sx of hypokalemia are:

Back 47

fatigue, lethargy, muscle weakness, paresthesia, hyporeflexia, weak-irregular pulse,

Front 48

Never administer ____ IV PUSH.

Back 48

potassium

Front 49

Treatments of hypokalemia include

Back 49

high potassium diet
oral supplement
IV replacement

Front 50

The main concern with potassium is it's effects on the ____.

Back 50

heart

Front 51

Potassium is a venous irritant therefore you should monitor for

Back 51

signs of infiltration.

Front 52

Hyperkalemia occurs when the serum potassium level is above ____mEq/L.

Back 52

5

Front 53

Causes of Hyperkalemia are read with a MACHINE

Back 53

Medications (ACE inhibit., NSAIDS)
Acidosis
Cellular destruction (burns, traumatic injury)
Hypoaldosteronism
Intake- excessive
Nephrons- renal failure
Excretion impaired

Front 54

S/Sx of hyperkalemia are:
MR. P AND DIC

Back 54

Muscle weakness
Reflexes
Paralysis, paresthesias
Abdominal cramping
Nausea
Diarrhea
Decreased heart rate
Irregular pulse
Cardiac problems

Front 55

Treatment of mild hyperkalemia is

Back 55

dietary restriction
loop diuretic

Front 56

Treatment of moderate to severe hyperkalemia is

Back 56

kayaxelate and sorbitol

Front 57

Emergency measures for hyperkalemia are:

Back 57

calcium gluconate
10-50% Dextrose and insulin
Sodium Bicarbonate

Front 58

Salt substitutes are also high in _____.

Back 58

potassium

Front 59

Kayaxelate is a cation exchange resin. This means it pulls ____ out of the blood stream and into the intestines where it exchanges with something else.

Back 59

potassium

Front 60

Hypocalcemia occurs when the calcium level is below ____ if ionized or below ____ if serum.

Back 60

4.5mEq/L
8.5mg/dL

Front 61

Calcium ____ neuromuscular excitability.

Back 61

decreases

Front 62

S/Sx of Hypocalcemia make CATS map

Back 62

Confusion, cramps
Arrhythmias, anxiety
Tetany (Trousseaus, Chvosteks)
Seizures, spasms, (hyperreflexia)

muscle twitching
and
paresthesias

Front 63

Hypocalcemia can be caused by

Back 63

-malabsorption
-excess loss
-hyperphosphatemia
-hypomagnesemia
-alkalosis
-citrated blood

Front 64

Tx for Hypocalcemia are

Back 64

-calcium gluconate
-calcium chloride
-dietary calcium
-Vitamin D

Front 65

When giving calcium via IV only give with _____- never ____ because it promotes urinary excretion of calcium.

Back 65

Dextrose
never saline

Front 66

With hypercalcemia, the sedative effect is ______.

Back 66

increased

Front 67

Hypercalcemia occurs when calcium levels are above

Back 67

5.5 mEq/L
10.5mg/dL

Front 68

Causes of hypercalcemia are

Back 68

-hyperparathyroidism
-malignancies
-end stage renal disease
-hypophosphatemia
-thiazide diuretics
-calcium antacids
-excessive Vitamin D
-prolonged immobilization

Front 69

Tx for Hypercalcemia are:

Back 69

-decrease dietary intake
-hydration
-IV normal saline
-loop diuretics
-calcitonin
-biophosphonates

Front 70

S/Sx of Hypercalcemia are:
Fat Little Cats Have money

Back 70

Fatigue
Lethargy
Confusion, coma,
Hypoactive reflexes
Muscle weakness

Front 71

Hypophosphatemia occurs when phosphate levels are below ____mg/dL.

Back 71

2.5

Front 72

Hyperphosphatemia occurs when phosphate levels are above ____mg/dL.

Back 72

4.5

Front 73

Causes of hypophosphatemia are

Back 73

alcoholism
decreased absorption and intake
increased loss thru kidneys
diarrhea and diuretics
hyperparathyroidism
shift from ECF to ICF (alkalosis, insulin)

Front 74

Increased levels of Parathyroid hormone cause increased excretion of ______.

Back 74

phosphate

Front 75

S/Sx of hypophosphatemia are at Camp Irritability

Back 75

confusion
anemia
muscle weakness, malaise
paresthesia
irritability

Front 76

A lack of phosphate interferes with ____ transported by the RBCs and ______.

Back 76

oxygen
energy metabolism

Front 77

Hyperphosphatemia is caused by

Back 77

renal failure
hypoparathyroidism
acidosis
chemo, trauma
excessive intake
blood transfusions

Front 78

When phosphate goes up, calcium goes _____.

Back 78

down

Front 79

S/Sx of hyperphosphatemia include

Back 79

paresthesias
hyperreflexia
tetany

Front 80

Tx for hyperphosphatemia include

Back 80

phosphate binding antacids such as Renagel

Front 81

Hypomagnesemia occurs when magnesium levels are below ____mEq/L.

Back 81

1.5

Front 82

Causes for hypomagnesemia are

Back 82

poor dietary intake
poor absorption or excess loss by GI tract
excessive loss by urinary tract

Front 83

Magnesium has a ____ effect.

Back 83

sedative

Front 84

Hypomagnesemia can cause _____ which can have an affect on the heart.

Back 84

hypokalemia

Front 85

S/Sx of hypomagnesemia are

Back 85

confusion, altered LOC, emotional liability
***tremors, twitching, tetany, hyperactive deep tendon reflexes***

Front 86

Tx of hypomagnesemia include:

Back 86

diet
PO/IM/IV supplements

Front 87

_____ is seen when magnesium is administered.

Back 87

Hypermagnesemia

Front 88

Hypermagnesemia occurs when levels are above ____mEq/L.

Back 88

2.5

Front 89

Causes of hypermagnesemia are:

Back 89

excessive intake- Mg antacids, laxatives, supplements, TPN, IV infusions

impaired excretion- renal failure/insufficiency

Front 90

S/Sx of hypermagnesemia are:

Back 90

-drowsiness, weakness, lethargy
-hypotension, flushed face
-warmth
-generalized weakness
-hypoactive/absent DTRs

Front 91

____ may be given to women to stop preterm labor.

Back 91

Magnesium

Front 92

Tx of hypermagnesemia are:

Back 92

increased fluid intake
diuretics
in emergency- calcium gluconate

Front 93

_____ is an antagonist of magnesium and reverses both neuromuscular and cardiac effects.

Back 93

Calcium gluconate

Front 94

____ occurs when there is an excess of carbon dioxide in the blood.

Back 94

Respiratory acidosis

Front 95

S/Sx of respiratory acidosis are:

Back 95

rapid shallow respirations, dyspnea
restlessness, confusion, lethargy
decreased LOC
headache, warm, flushed skin

Front 96

The ____ are responsible for compensation when respiratory acidosis occurs.

Back 96

kidneys

Front 97

To compensate for respiratory acidosis the kidneys will excrete ____ and retain _____.

Back 97

Hydrogen

bicarbonate

Front 98

Respiratory alkalosis occurs when there is a deficit of ____ in ECF.

Back 98

carbonic acid

Front 99

S/Sx of respiratory alkalosis are:

Back 99

dyspnea, chest tightness
restlessness, confusion, anxiety
lightheadedness, numbness
tingling

Front 100

The kidneys compensate for respiratory alkalosis by excreting ____ and retaining _____.

Back 100

bicarbonate

Hydrogen

Front 101

Metabolic acidosis results from a deficit of ____ in ECF.

Back 101

bicarbonate

Front 102

S/Sx of metabolic acidosis are

Back 102

Kussmaul's respirations
confusion, drowsiness, lethargy
decreased LOC
headache, warm, flushed skin
N/V, anorexia

Front 103

The ___ and ___ must compensate for metabolic acidosis or alkalosis.

Back 103

kidneys and lungs

Front 104

With metabolic acidosis the kidneys excrete ____ and retain ____ while the lungs...

Back 104

hydrogen ions, bicarbonate
increase the rate and depth of respirations.

Front 105

With metabolic alkalosis the kidneys excrete ____ and retain ____ while the lungs...

Back 105

bicarbonate
hydrogen
decrease the respiratory rate.

Front 106

Low pH and low bicarbonate are characteristic of ______.

Back 106

metabolic acidosis

Front 107

High pH and high bicarbonate are characteristic of _____.

Back 107

metabolic alkalosis

Front 108

_____ occurs when there is an excess of bicarbonate in ECF.

Back 108

Metabolic alkalosis

Front 109

Causes of metabolic alkalosis include:

Back 109

vomiting
gastric suctioning
hypokalemia
diuretics
antacids with bicarbonate

Front 110

S/Sx of metabolic alkalosis are

Back 110

*decreased respiratory rate and depth
numbness, tingling, confusion
hyperreflexia, twitching
hypokalemia

Front 111

Respiratory acidosis is characterized by ____pH and ____PaCO2.

Back 111

low pH
high PaCO2

Front 112

Respiratory alkalosis is characterized by ____ pH and ____ PaCO2.

Back 112

high pH

low PaCO2