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147 Cards in this Set
- Front
- Back
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Which of the following short or long term venous access devices is usually introduced into the subclavian or vena cava just above the right atrium?
a. Peripherally inserted central catheter b. Implanted port c. Central venous catheter d. Electronic infusion device |
c
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When teaching a patient about foods that affect his fluid balance, the nurse will keep in mind that the electrolyte that primarily controls water distribution throughout the body is which of the following?
a. Na + b. K+ c. Ca ++ d. Mg++ |
a
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A healthy patient eats a regular, balanced diet and drinks 3,000 mL of liquids during a 24hr period. In evaluation this patients urine output for the same 24hr period the nurse realizes that it should total approximately how many mL?
a. 3750 b. 3000 c. 1000 d. 500 |
b
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For the patient with hyperkalemia related to decreased renal excretion secondary to potassium conserving diuretic therapy, and appropriate expected outcome would be which of the following?
a. Bowel motility will be restored within 24 hrs after beginning supplemental K+ b. ECG will show no cardiac arrhythmias within 48hrs after removing salt substitutes, coffee, tea, and other K+ rich foods from diet. c. ECG will show no cardiac arrhythmias within 24hr after beginning supplemental K+. d. Bowel motility will be restored within 24hrs after eliminating salts substitutes, coffee, tea, and other K+ - rich foods from the diet. |
b
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Which of the following nursing diagnoses would you expect to be based on the effects of fluid and electrolyte imbalance on human functioning?
a. Constipation related to immobility b. Pain related to surgical incision c. Altered Thought Processes related to cerebral edema, including metal confusion and disorientation. d. Health Risk for infection related to inadequate personal hygiene. |
c
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Which of the following is the liquid constituent of blood?
a. Intracellular fluid b. Extracellular fluid c. Interstitial Fluid d. Intravascular Fluid |
d
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The body eliminates excess sodium through which of the following organs?
a. Kidneys b. Bowels c. Skin d. Heart |
a
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Which of the following food items is a leading source of potassium?
a. Canned vegetables b. Cheese c. Bread d. Bananas |
d
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Which of the following is the most abundant electrolyte in the body?
a. Sodium b. Calcium c. Potassium d. Magnesium |
c
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"Pumping uphill" would describe which of the following means of transporting materials to and from intracellular compartments?
a. Osmosis d. Diffusion c. Filtration d. Active transport |
d
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When Determining a site for an IV infusion the nurse should consider which of the following guidelines?
a. Scalp veins should be selected for infants because of their accessibility. b. Antecubital veins should be used for long term infusions. c. Veins in the leg should be used to keep the arms free for the patients use. d. Veins in surgical areas should be used to increase the potency of medication. |
a
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Individuals with which of the following blood types are often called universal donors?
a. Type A b. Type O c. Type B d. Type AB |
b
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A nurse who has diagnosed a patient as having "fluid volume excess" related to compromised regulatory mechanism (Kidneys) may have been alerted by which of the following symptoms?
a. Muscle twitching b. Distended neck veins c. Fingerprinting over sternum d. Nausea and vomiting |
b
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Which of the following accurately reflects the role of water in the human body? (select all that apply)
a. A person can live for many days without water. b. Water provides a medium of transporting wastes to cells for elimination. c. Water Facilitates cellular metabolism and proper chemical functioning. d. Water acts as solvent for electrolytes and non electrolytes. e. The disirable amount of fluid intake and loss in the normal adult averages about 1000 mL per day. f. Water helps maintain normal body temperature. |
c, d, f
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Which of the following are proper actions for preparing an IV solution and tubing when starting an IV infusion? (select all that apply)
a. Maintain aseptic technique when opening sterile packages and IV solution. b. Clamp tubing, uncap spike, and insert into entry site on bag as manufacturer directs. c. Squeeze drip chamber and allow it to fill one fourth full. d. remove cap at end of tubing, release clamp, and allow fluid to move through tubing. e. Allow fluid to flow and cap at end of tubing before all air bubbles have disappeared. f. Apply label if medication was added to the container, if not done by the pharmacy. |
a, b, d, f
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Following preparation of the IV solution and tubing, which of the following actions would be performed by the nurse when selection a site and palpating a vein to start an IV infusion? (select all that apply)
a. place the patient in high Fowlers position in bed. b. Select an appropriate site and palate accessible veins. c. Apply a tourniquet 2 to 3 inches above the vein puncture site to obstruct venous flow and distend the vein. d. Direct the ends of the tourniquet away from the site and check that the radial pulse is still present. e. Ask the patient to keep a tightly closed fist while observing and palpating for a suitable vein. f. If a vein cannot be felt, release the tourniquet and have the patient lower the arm blow the level of the heart to fill the veins. |
b, d, f
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Which of the following are signs of complication and their probable causes that may occur when administering an IV solution to a patient? (select all that apply)
a. Swelling, pain, coolness, or pallor at the insertion site many indicate infiltration of the IV. b. Redness, swelling, heat, and pain at the site may indicate phlebitis. c. Local or systemic manifestations may indicate an infection is present at the site. d. A pounding headache, fainting, rapid pulse rate, increased blood pressure, chills, back pains, and dyspnea occur when an air embolus is present. e. Bleeding at the site when the IV is discontinued indicates and infection is present. f. Engorged neck veins, increased blood pressure and dyspnea occur when a thrombus is present. |
a, b, c
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Which of the following statements accurately describe the function of regulation of potassium in the body? (select all that apply)
a. Potassium is the major cation of ICF and works reciprocally with sodium. b. Potassium is the chief regulator of cellular enzyme activity and cellular water content. c. Potassium is needed for vitamin B12 absorption and for its use of body cells. d. Potassium determines the thickness and strength of cell membranes. e. The kidneys conserve potassium when cellular potassium is decreased. f. The normal range for serum potassium is 6.5 to 8.0mEq/L. |
a, b, e
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Which of the following statements accurately describe fluid and electrolyte movement? (Select all that apply)
a. Cell membranes are impermeable, making it impossible for water to be transported through cell walls. b. Active transport is the major method of transporting body fluids. c. Through the process of osmosis the solvent water passes from an area of lesser solute concentration to an area of greater solute concentration until equilibrium is established. d. A hypertonic solution has a greater concentration of particles in solution causing water to move out of the cells and into the intravascular compartment in which the fluid is hypertonic causing the cells to shrink. e. In the process of diffusion the solute moves from an area of higher concentration to an area of lower concentration until equilibrium is established. f. Active transport is the passage of fluid through a permeable membrane from an area of high pressure to one of lower pressure. |
c, d, e
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Which of the following statements accurately describe the function of the organs to maintain fluid homeostasis? (Select all that apply)
a. The kidneys normally filter 210L of plasma daily in the adult while excreting only 1.5L of urine. b. The cardiovascular system is responsible for pumping and carrying nutrients and water throughout the body. c. The regulation of the carbon dioxide level by the lungs is crucial in maintaining acid base balance. d. the thyroid gland secretes aldosterone a hormone that helps the body conserve sodium, saves chloride and water, and causes potassium to be excreted. e. Thyroxine, released by the thyroid gland, increases blood flow in the body leading to increased renal circulation and resulting in increased glomerular filtration and urinary output. f. The adrenal glands secrete parathyroid hormone, which regulates the level of calcium in ECF. |
b, c, e
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Refer to the rules of ABG Interpretation table on pg 335
Mr. W is a 90yr old who had a successful cardiopulmonary resuscitation a few hrs ago. ABS's: pH = 7.55; PaCO2 = 43; HCO3 = 36 a. Respiratory acidosis b. Metabolic acidosis c. Metabolic alkalosis d. Respiratory alkalosis |
c
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Refer to the rules of ABG Interpretation table on pg 1696
Mr. W is a 90 yr old man who had a successful cardiopulmonary resuscitation a few hrs ago. He recieved bicarbonate during that resuscitation. ABG's: pH = 7.55 PaCO2 = 43; HCO3 = 36 a. Respiratory acidosis b. Metabolic acidosis c. Metabolic akalosis d. Respiratory alkalosis |
c
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Refer to the rules of ABG Interpretation table on pg 1696
Mr. E is a 56 yr old man with a history of COPD. ABGs: pH = 7.36; PaCO2 = 60; HCO3 = 35 a. Respiratory acidosis with renal compensation. b. Metabolic acidosis with partial respiratory compensation. c. Respiratory alkalosis d. Respiratory acidosis |
a.
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Refer to the rules of ABG Interpretation table on pg 1696
A 55yr old woman is admitted with chronic renal failure. She is weak and tired. ABGs: pH = 7.24; PaCO2 = 30; HCO3 = 12 a. Respiratory acidosis b. respiratory alkalosis c. Metabolic alkalosis with partial respiratory compensation d. Metabolic acidosis With partial respiratory compensation. |
d
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Refer to the rules of ABG Interpretation table on pg 1696
Mrs. S is a 55yrs old woman with heart failure and dyspnea. She complains of pleuritic pain. ABGs: pH = 7.56 PaCO2 = 22; HCO3 = 24 a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic acidosis d. Metabolic alkalosis |
a
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Refer to the rules of ABG Interpretation table on pg 1696
Ms. S is a 21yr old woman who was found by her friends in the floor of her room. She is "out of it" ABGs: pH = 7.18; PaCO2 = 79; HCO3 = 26 a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis with partial respiratory compensation d. Metabolic acidosis with partial respiratory compensation |
b
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True or false
The body usually does the smart thing to compensate: Metabolic disorders compensated by the lungs; Respiratory disorders compensated by the kidney |
True
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Any pH below _______ is a state of acidosis
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7.35
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Any pH greater than ______ is a states of alkalosis
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7.45
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CO2 is a _____
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acid
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HCO3 is a _______
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Base
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Any changes in CO2 reflects a ___________ change.
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respiratory
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Any changes in HCO3 reflects a ________ change
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metabolic
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True or false
If the pH returns to normal compensation has taken place. |
true
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True or false
If the primary event is a fall in pH whether respiratory or metabolic in origin the arterial pH stays on the acid side after compensation. |
True
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True or false
If the primary event is an increase in pH whether respiratory or metabolic in origin the arterial pH stays on the base side after compensation. |
True
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PaCO2 is > 45 mm Hg = ?
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Respiratory acidosis
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PaCO2 is < 35 mm Hg = ?
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Respiratory alkalosis
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HCO3 is < 22 mEq/L = ?
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Metabolic acidosis
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HCO3 is > 26 mEq/l = ?
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Metabolic alkalosis
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It is the chief regulator of cellular enzyme activity and cellular water content
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Potassium
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It is necessary for nerve impulse transmissions and blood clotting.
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Calcium
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It controls and regulates the volume of body fluids.
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Sodium
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It is the primary regulator of ECF volume
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Sodium
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It is important for the metabolism of carbohydrates and proteins.
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Magnesium
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It is the catalyst for muscle contraction
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Calcium
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It assists in the regulation of acid base balance by cellular exchange with H+.
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potassium
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It is necessary for the protein and DNA synthesis, DNA and RNA transcription, and translation of RNA.
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Magnesium
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It acts with sodium to maintain the osmotic pressure of the blood.
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Chloride
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It is important for cell division and for the transmission of hereditary traits.
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Phosphate
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It is important in the buffering system that is activated by the exchange of oxygen and carbon dioxide between body tissues and red blood cells.
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Chloride
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It is found primarily within cells and is associated with intracellular protein.
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Sulfate
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It is essential for acid base balance and in combination with carbonic acid constitutes the body's primary buffer system.
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Bicarbonate
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It participates in many important chemical reactions in the body; for example it is necessary for many B vitamins to be effective and plays a role in carbohydrate metabolism.
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Phosphate
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It is essential for the production of hydrochloric acid in gastric cells
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Chloride
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Ions that develop a positive charge
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Cation
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Substances that are dissolved in a solution
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Solutes
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Fluid that surrounds tissue cells
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Interstitial fluid
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Measured in terms of their chemical combining power or chemical activity
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Electrolyte
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The liquid constituent of blood
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Solvents
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process that requires engergy for the movement of substances through a cell membrane form an area of lesser concentration to an area of higher concentration.
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Active transport
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The passage of a fluid through a permeable membrane
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Filtration
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An atom or molecule carrying an electric charge
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Ion
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An ion with a negative charge
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Anion
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Liquids that hold a substance in solution
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Solvents
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A force exerted by a fluid against the container wall
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Hydrostatic pressure
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The difference between colloid osmotic pressure and blood hydrostatic pressure.
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Filtration pressure
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A substance that prevents body fluids from becoming overly acidic or alkaline
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Buffer
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The concentration of particles in solution or its pulling power
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Osmolarity
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The tendency of solutes to move freely through out a solvent
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Hydrostatic pressure
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The human body is composed of ___________ water by weight
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50 to 60%
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Substances capable of breaking into electrically charged ions when dissolved in a solution are called _______________
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electrolytes
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A ____________ has less osmolarity than plasma.
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Hypotonic solution
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____________ make up the largest amount of water normally taken into the body.
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Ingested liquids
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The acidity or alkalinity of a solution is determined by its concentration of _______________ ions.
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Hydrogen
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An _______ is a substance that can accept or trap hydrogen ions.
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Alkaline
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Normal body plasma is slightly ____________ and has a normal pH of 7.35 to 7.45
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Alkaline
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The ___________ are the primary controller of the body's carbonic acid supply.
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Lungs
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Excessive retention of water and sodium in ECF results in a condition termed fluid volume excess or _____________
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Hypervolemia
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________________ refers to a surplus of sodium in ECF that an result from excess water loss or an overall excess of sodium.
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Hypernatremia
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____________ are most commonly used to assess and treat acid base imbalances
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Arterial blood gases
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The solvent water passes from an area of lesser solute concentration to an area of greater solute concentration until an equilibrium is established. What is this process known as?
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Osmosis
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The tendency of solutes to move freely through a solvent. The solute moves an area of lower concentration until an equilibrium is established.
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Diffusion
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A process that requires energy for the movement of sustances through a cell membrane from an area of lesser concentration to an area of higher concentration.
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Active transport
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How is water derived from the following sources? Fluid intake
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Ingested liquids are regulated by the thirst mechanism and is stimulated by intracellular dehydration and decreased blood volume.
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How is water derived from the following sources? Food
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The amount of water depends on the food (ex. melons have a higher water content than bread)
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How is water derived from the following sources? Metabolic oxidation
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Water is and end product of oxidation that occurs during the metabolism of food.
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List three mechanisms for water loss in the body.
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1. Through the kidneys as urine
2. Through the skin as perspiration 3. Through insensible water loss |
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Explain how this organ or organ system of the body maintain fluid homeostasis. Kidneys
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Approximately 170L of plasma is filtered daily in an adult while only 1.5L of urine is excreted. They selectively retain electrolytes and water and excrete wastes
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Explain how this organ or organ system of the body maintain fluid homeostasis. Cardiovascular system
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The heart and blood vessels are responsible for pumping and carrying nutrients and water throughout the body.
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Explain how this organ or organ system of the body maintain fluid homeostasis. Lungs
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The lungs regulate oxygen and carbon dioxide levels of the blood.
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Explain how this organ or organ system of the body maintain fluid homeostasis. Thyroid
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Thyroxine released by the thyroid gland increases blood flow in the body. This in turn increases renal circulation which results in increased glomerular filtration and urinary output.
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Explain how this organ or organ system of the body maintain fluid homeostasis. Parathyroid Glands
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The parathyroid glands secrete parathyroid hormone which regulates the level of calcium in the ECF
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Explain how this organ or organ system of the body maintain fluid homeostasis. Gastrointestinal Tract
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The GI tract absorbs water and nutrients that enter the body through this route.
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Explain how this organ or organ system of the body maintain fluid homeostasis. Nervous system
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The nervous system acts as a switchboard and inhibits and stimulates mechanisms that influence fluid balance.
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Give a brief description of the following condition: Acidosis
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Characterized by a high concentration of hydrogen ions in ECF which causes the pH to fall below 7.35
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Give a brief description of the following condition: Alkalosis
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Characterized by a low concentration of hydrogen ions in ECF which causes the pH to exceed 7./45
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Describe the this acid base imbalance and its effect on the body: Respiratory acidosis
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An excess of carbonic acid in ECF caused by decreased alveolar ventilation and resulting in the retention of carbon dioxide. The lungs cannot compensate for the rise in carbonic acid levels. As the carbonic acid concentration increases the kidneys retain more bicarbonate and increase their excretion of hydrogen.
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Describe the this acid base imbalance and its effect on the body: Respiratory alkalosis
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A deficit of carbonic acid in ECF caused by a decrease in carbon dioxide. Respiratory rate and depth increase because carbon dioxide is being excreted faster than normal; depression or cessation of respiration can occur. The kidneys attempt to alleviate this imbalance by increasing bicarbonate excretion and hydrogen retention.
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Describe the this acid base imbalance and its effect on the body: Metabolic acidosis
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A deficit of bicarbonate in ECF resulting from an increase in acidic components or an excessive loss of bicarbonate. The lungs attempt to increase the rate of carbon dioxide excretion by increasing the rate and depth of respiration; the kidneys attempt to compenstate by retaining bicarbonate and excreting more hydrogen. Many result in loss of consciousness and death.
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Describe the this acid base imbalance and its effect on the body: Metabolic alkalosis
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An excess of bicarbonate in the ECF resulting from loss of acid or ingestion or retention of base. THe body attempts to compensate by retaining carbon dioxide. Respiration become slow and shallow and periods off apnea may occur. The kidneys excrete potassium and sodium along with excess bicarbonate and retain hydrogen within carbonic acid.
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An increased hematocrit can lead to?
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Severe dehydration and shock when hemoconcentration rises considerably
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A decreased hematocrit can lead to?
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Acute massive blood loss hemolytic reaction following transfusion of incompatible blood.
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An increased hemoglobin can lead to?
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Hemoconcentration of the blood
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A decreased hemoglobin can lead to?
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Anemia severe hemorhage and following a hemolytic reaction.
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Briefly describe the following screening tests: Urine and specific gravity
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It is a measure of the kidneys ability to concentrate urine. Normal range is 1.003 to 1.035. Specimen may be obtained by dipstick measurement on a fresh voided specimen through lab analysis.
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Briefly describe the following screening test: Serum electrolytes
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Indicates plasma levels of select electrolytes.
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Briefly describe the following screening test: Arterial blood gases
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Indicate the adequacy of oxygenation and ventilation and acid base status
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You are the visiting nurse for an elderly patient with diabetes. List four factors you should consider to prevent fluid imbalance for this patient.
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1. Note patients fluid intake and learn what the patients previous eating and drinking patterns have been.
2.Note whether thirst is excessive or whether patient experiences little to no thirst. 3. Note excessive losses of fluid from the body and attempt to prevent losses when possible. 4. Physiologic changes that accompany the aging process may affect the patients ability to maintain fluid balance. |
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List four guidelines for selecting a vein for an IV.
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1. Select a vein large enough to accommodate the needle.
2. Select a site that is naturally splinted by bone such as the back of the hand or the forearm. 3. Select a site distal to the hear and move proximately as necessary to find the appropriate injection site. 4. Select a site while moving toward the heart and away from the damaged vein. |
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List important points a home healthcare nurse should address when caring for a patient on home infusion therapy.
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Handling all equipment performing dressing changes assessing patient for evidence of infection or other complications, and maintaining the supplies necessary to continue home infusion.
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What is normal pH?
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7.35 to 7.45
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What is normal PaCO2?
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35-44 mmHg
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What is normal PaO2?
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75-100 mmHg
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What is normal SaO2?
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92- 98%
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What is normal HCO3?
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22-26 meq
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What is normal BE?
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0-2
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This is an acid b ase imbalance characteried by an increase in H+ concentration (decreased blood pH). A low arterial pH due to increased PCO2 is respiratory acidosis
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Acidosis
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This is an acid base imbalance characterized by a reduction of H+ concentration (increased blood pH). A high arterial pH with increased bicarbonate concentration is called metabolic alkalosis; a high arterial pH due to reduced PCO2 is respiratory alkalosis
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Alkalosis
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This major electrolyte has a mEq/L of 142 in the ECF.
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Sodium (Na+)
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This major electrolyte has a mEq/L of 5 in the ECF.
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Potassium (K+) or Calcium (Ca+) Organic acids
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This major electrolyte has a mEq/L of 2 in the ECF.
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Magnesium (Mg+) Cation or Phosphate (HPO4-) anions
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How many total cations are in the ECF?
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around 154
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This major electrolyte has a mEq/L of 103 in the ECF.
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Chloride (Cl-)
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This major electrolyte has a mEq/L of 26 in the ECF.
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Bicarbonate (HCO3-)
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This major electrolyte has a mEq/L of 1 in the ECF.
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Sulfate (SO4-)
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This major electrolyte has a mEq/L 17of in the ECF.
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Proteinate
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What are the total anions in the ECF?
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about 154
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This major electrolyte has a mEq/L of 150 in the ICF.
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Potassium (K+) Cations; Phosphates and Sulfates Anions
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This major electrolyte has a mEq/L of 40 in the ICF.
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Magnesium (Mg+) Cations; Proteinate anions
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This major electrolyte has a mEq/L of 10 in the ICF.
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Sodium (Na+) cations; Bicarbonate (HCO3-) anions
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How many fluid compartments does the body have?
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2 ICF and the ECF
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In 6L of blood how many Liters will be plasma?
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3L
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What are the major cations in body fluid?
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Sodium, Potassium, Calcium, Magnesium and hydrogen ions.
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What are the major anions in body fluid?
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Chloride, Bicarbonate, phosphate, sulfate and proteinate ions
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What is a normal BUN level?
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10mg/dL to 20mg/dL or 3.6 to 7.2 mmol/L
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If you BUN is increased what could be going on with your patient?
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Decreased renal function, GI bleeding, dehydration, increased protein intake, fever, and sepsis.
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If you BUN is decreased what could be going on with your patient?
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End stage liver disease, low protein diet, starvation, and any condition that results in expanded fluid volume.
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What is a normal BUN level?
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10 to 20 mg/dL or 3.6 to 7.2 mmol/L
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What is a normal serum creatinine level?
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0.7 to 1.4 mg/dL or 62 to 124 mmol/L
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What is normal Serum ANP levels?
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20 to 77 pg/mL or ng/L
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__________ or ____________ occurs when loss of ECF volume exceeds the intake of fluid.
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FVD (FLuid Volume Deficit) or Hypovolemia
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What are the clinical manifestation of FVD?
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Acute weight loss decreased skin turgor, oligruia, concentrated urine, orthostatic hyoptention due to volume decreased, weak heart rate flattened neck veins increased Temp, thirst, decreased or delayed capillary refill, decreased central venous pressure cool clammy pale skin, r/t peripheral vasoconstriction, anorexia, nausea, lassistued, muscle weakness and cramps.
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What how many mEq/L of sodium is in the EFC?
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135-145mEq/L
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How many mEq/L of sodium is in the IFC?
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10-14 mEq/L
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How many mEq/L of Potassium is in the EFC?
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3.5 - 5 mEq/L
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How many mEq/L of Potassium is in the IFC?
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140 -150 mEq/L
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