Electrolyte Imbalances

Sodium (Na+) is the most abundant electrolyte in the ECF. It's concentration ranges from 135-145 mEq/L. Sodium also has a major role in controlling water distribution throughout the body. Sodium is regulated by: SATA

1. Thirst

2. RAAS

3. SIADH

4. ADH

A. All of the above

B. 2,3,4

C. 1,2,4

D. 1,3,4

C. 1,2,4

SIADH may be associated with sodium imbalance. A nurse knows that one of the causes of SIADH is?

A. Overexcretion of ADH

B. Overstimulation of RAAS

C. Decreased activity of pituitary gland

D. Oversecretion of ADH

D. Oversecretion of ADH

It refers to a sodium serum concentration of less than 130 mEq/L. Cell swells as water is pulled in from ECF; low solute to water ratio.

A. Hypernatremia

B. Hyponatremia

C. Hyperkalemia

D. Hypokalemia

B. Hyponatremia

This type of hyponatremia is seen more frequently found in women and those of small stature wherein it occurs during extreme temperatures, excessive fluid intake before exercise, or prolonged exercise that results in excess loss of sodium by perspiration.

A. Acute HYPONATREMIA

B. exercise-induced hyponatremia

C. Chronic Hyponatremia

D. Isotonic Hyponatremia

B. exercise-induced hyponatremia

High sodium concentration in the urine is associated with? SATA

1. Renal salt wasting/dysfunction

2. Diarrhea

3. Vomiting

4. Diuretics use

A. All except 2 and 3

B. All except 1 and 4

C. All of the above

D. NOTA

A. All except 2 and 3

Deficiency of aldosterone causes decreased reabsorption of H2O and Na into the bloodstream at the nephrons. What medication side effects might predispose a patient into developing hyponatremia? SATA

1. Anticonvulsants

2. SSRIs

3. Desmopressin Acetate

4. Levetiracetam

A. All of the above

B. 1,2,3

C. 1,2,4

D. 2,3,4

A. All of the above

Clinical features of hyponatremia is associated with sodium loss and water gain that includes anorexia, muscle cramps, and exhaustion. The severity of symptoms increases depending on?

A. Cell hydration

B. Degree of hyponatremia and how slowly it develops

C. Serum sodium levels

D. Degree of hyponatremia and speed in which it develops

D. Degree of hyponatremia and speed in which it develops

Although a patient with SIADH retains water abnormally, there is no peripheral edema because fluid accumulates inside the cells. This manifest sometimes as

A. PEDAL Edema

B. Pitting Edema

C. Cerebral Edema

D. Pulmonary EDEMA

B. Pitting Edema

A patient with Hyponatremia was admitted to your hospital and is to received sodium replacement therapy. A nurse knows that serum sodium must not be increased by?

A. More than 8 mEq/L to avoid digitalis toxicity

B. Less than 12 mEq/L to avoid cell swelling

C. More 12 mEq/L in 24 hours to avoid neurologic damage

D. Less than 8 mEq/L to avoid cerebral edema

C. More 12 mEq/L in 24 hours to avoid neurologic damage. (Due to demyelination)

An athlete patient who is a marathon runner has chronic hyponatremia. As a nurse what condiments or minerals can you suggest to help maintain sodium balance and to compensate for Na loss during sweating.

A. Soy sauce riched foods

B. 2 licks of asin tibuok

C. Iodized salt

D. Salt tablets

D. Salt tablets

(However, there is no evidence that this practice works and it is not recommended)

A patient is having abnormal losses of sodium but can consume a general diet. What food will you encourage the patient to take?

A. Cucumber with salt, pepper, and vinegar

B. Broth made with one beef cube

C. Crispy pata with lots of salt

D. Foods high in water and sodium content

B. Broth made with one beef cube (has approx 900mg of Na)

8 oz of tomato juice can also be recommended as it contains approx 70mg of Na

It is a condition in which serum sodium level is higher than 145 mEq/L.

A. Hypernatremia

B. Hyponatremia

C. Hyperkalemia

D. Hypokalemia

A. Hypernatremia

A common cause of hypernatremia is fluid deprivation in patients who do not respond to thirst. These specific affected population are? SATA

1. Cognitively challenged middle age patient

2. 1 month old infant

3. Stroke patient

4. Older adults

A. All of the above

B. All except 3

C. 1,2,3

D. 2,3,4

A. All of the above

Clinical Manifestations of hypernatremia are due to increased plasma osmolality caused by an increase in plasma sodium concentration. What happens to our cell?

A. Water moves out of the cell = extracellular hydration

B. Water moves into the cell = cellular hydration

C. Water moves out of the cell = cellular dehydration

D. Water stays in the cell for homeostasis

C. Water moves out of the cell = cellular dehydration

Which of this human mechanism is a primary characteristic of hypernatremia. It is a strong defender of normal serum sodium levels in healthy people.

A. Frequent urge of urination

B. Increased elimination

C. Hunger

D. Thirst

D. Thirst

Treatment of hypernatremia consists of gradual lowering of serum Na level by infusing what solution?

A. Hypotonic Solution

B. Hypertonic Solution

C. Isotonic Solution

D. Na and H2O oral solution

A. Hypotonic Solution (e.g., 0.45% sodium

chloride) or an isotonic non-saline solution.

An example of isotonic non saline solution is D5W which can be used in patients with hypernatremia when water need to be replaced without sodium. However a hypotonic NaCl solution is thought to be safer than D5W because it allows gradual reduction of serum sodium level. Gradual reduction of serum Na level decreases the risk for?

A. Pulmonary EDEMA

B. Peripheral Edema

C. Cerebral Edema

D. Pitting Edema

C. Cerebral Edema

Hypotonic sodium chloride solution (0.45% NaCl) is also the IV solution of choice in patients with: SATA

1. Hypernatremia

2. Hyperglycemia

3. Hyponatremia

4. Hypoglycemia

A. 2,3

B. 1,4

C. 1,2

D. 1,3

C. 1,2

As a general rule, serum Na level is reduced at a rate no faster than?

0.5-1 mEq/L/h to allow sufficient time for readjustment through diffusion across fluid compartments.

This drug (synthetic ADH) may be prescribed if Hypernatremia is caused by Diabetes Insipidus.

Desmopressin Acetate

The following are nursing management for patients with Hypernatremia: SATA

1. Assess abnormal loss of water and large gains of Na

2. Check for ingestion of OTC high in Na content

3. Obtain medication history

4. Monitor changes in behavior, thirst, and temp

A. All of the above

B. 1,2,3

C. 1,2,4

D. 2,3,4

A. All of the above

If enteral feedings are used, sufficient water should be given to keep serum sodium and BUN within normal limits. (Tap)

The higher the osmolality of the enteral feeding, the greater is the need for water supplementation.

This type of electrolyte is the major intracellular electrolyte. Wherein 98% of this electrolyte is inside the cell. While the remaining 2% is in the ECF for neuromuscular and cardiac function.

A. Na

B. Cl

C. K

D. Mg

C. K

What is the normal serum potassium concentration?

3.5-5 mEq/L

This organ regulates potassium balance by adjusting the amount of potassium excreted in the urine. 80% of potassium is also excreted in ways of this organ while the 20% is lost through bowel and sweat.

Kidneys

A condition wherein serum K is below 3.5 mEq/L that usually indicates a deficit in total K stores.

A. Hypernatremia

B. Hyponatremia

C. Hyperkalemia

D. Hypokalemia

D. Hypokalemia

Hypokalemia may also occur in patients with normal serum potassium stores. This happens when high blood pH is present causing temporary shift of serum K into cells.

A. Acidosis

B. Metabolic Acidosis

C. Alkalosis

D. Respiratory ACIDOSIS

C. Alkalosis

Hyperaldosteronism causes our body to constantly secrete potassium into the nephron tubule leading to renal potassium wasting. This type of hyperaldosteronism is seen in patients with adrenal adenomas (tumors).

A. Primary Hyperaldosteronism

B. Type 1 hyperaldosteronism

C. Malignant hyperaldosteronism

D. Secondary HYPERALDOSTERONISM

A. Primary Hyperaldosteronism

(Secondary Hyperaldosteronism occurs in patient with cirrhosis, nephrotic synd, HF, or malignant Hypertension.)

Patients at risk for hypokalemia: SATA

1. Alcoholism

2. Anorexia

3. Bulimia

4. Overuse of laxatives

A. All of the above

B. 1,2,3

C. 1,2,4

D. 2,3,4

A. All of the above

K deficiency can cause death through cardiac or respiratory arrest. Clinical signs of hypokalemia develops when K decreases to less than?

3 mEq/L

ECG changes in hypokalemic patients include flat T waves, inverted T waves or both, which suggests ischemia, and depressed ST segment and an elevated U wave. Which of these changes in ECG is specific to Hypokalemia?

A. Depressed ST segments

B. Elevated U wave

C. Flat T wave

D. Depressed U wave

B. Elevated U wave

If the cause of K loss is unclear, what diagnostic test can be performed to distinguish between renal and extrarenal loss.

A. BUN & Crea

B. Urnalysis

C. 24 Hour Urinary potassium excretion test

D. Serum K levels

C. 24 Hour Urinary potassium excretion test

What result is anticipated with a patient with renal potassium loss in the said Dx test?

Urinary K excretion exceeding 20 mEq/Day

Dietary intake of potassium in the average adult

50-100 mEq/L

The nurse need to monitor for early presence of patients at risk. (tap to see s/sx)

Fatigue, Anorexia, Muscle weakness, Decreased bowel motility, Paresthesia, and Arrythmias are signs that may indicate hypokalemia.

Hypokalemia potentiates the action of digitalis, therefore a patient who is receiving digitalis and is at risk for K deficiency should closely monitor for signs of digitalis toxicity. As the NOD (nurse on duty), what antidote will you anticipate?

A. N-Acetylcysteine

B. Digibind

C. Naloxone

D. NOTA

B. Digibind

If the cause of hypokalemia is abusive use of diuretics and laxatives, what nursing interventions may help alleviate problems?

A. Encourage increase intake of K

B. Create an Individualized drug study

C. Create an individualized NCP

D. Patient Education

D. Patient Education

Careful monitoring of fluid I & O is necessary. How many mEq of K is lost for every liter of Urine Output?

40 mEq

You are a nurse caring for a patient receiving IV potassium therapeutically. As a nurse, you know that the correct and safest way of administrating IV K is by?

A. IV bolus

B. IV KCl incorporated

C. IV K with infusion pump

D. IV K fast drip

C. IV K with infusion pump

A potassium imbalance characterized by serum K greater than 5 mEq/L.

A. Hypernatremia

B. Hyponatremia

C. Hyperkalemia

D. Hypokalemia

C. Hyperkalemia

Major causes of Hyperkalemia: SATA

1. Decreased renal excretion of K

2. Movement of K from ECF to ICF

3. Rapid admin of K

A. All of the above

B. 1,2

C. 2,3

D. 1,3

D. 1,3

(movement of k from ICF compartment to ECF compartment)

Patients with hypoaldosteronism are at risk for hyperkalemia because lack of aldosterone activity at the nephron causes inadequate sodium and water reabsorption into the bloodstream and inadequate excretion of K in the urine. Which of this disease causes the body to have hypoaldosteronism?

A. CHRON'S Disease

B. Addison Disease

C. Conn's Syndrome

D. H.F.

B. Addison Disease

(deficient adrenal hormones lead to Na loss and K retention)

In acidosis (low blood pH) the K moves out of the cells and into the ECF. Elevated ECF K level should be anticipated when extensive tissue trauma has occurred as in burns, crushing injuries, or severe infections. Similarly, it can occur during lysis of malignant cells after chemo. (Tap for more info. haha)

Any disorder that causes high amounts of cellular lysis or deterioration can cause hyperkalemia.

This type of hyperkalemia has several causes including improper collection or transport of blood samples, traumatic venipuncture, and use of tight torniquet around extremity while drawing a blood sample, producing hemolysis of the sample before analysis. Another cause can be drawing a blood above a site where K is infused and familial causes.

A. Pseudo hyperkalemia

B. False K deficit

C. Pseudomonas Aeruginosa

D. NOTA

A. Pseudo hyperkalemia

The most important consequence of hyperkalemia is its effect on the myocardium. ECG may produce results like peaked narrow T waves; ST segment depression; and a shortened QT Interval. What may happen to the patient? Choose 2 lt

A. Increased BP

B. Cardiac Arrest

C. Ventricular Arrythmias

D. A & B

E. B & C

E. B & C

The management of Hyperkalemia includes VS and ECG monitoring, K restriction, and if mild, diuretics. However in severe cases, Cation-Exchange resin (sodium polystyrene sulfonate) may be used orally or by retention enema. The use of Cation-Exchange resins requires what?

A. Normal liver function for good absorption of medications

B. Normal bowel function

C. Normal bladder function for excretion of K

D. A paralytic ileus to retain medications in retention enema

B. Normal bowel function (Cation E.R. aren't used for patients with paralytic ileus because intestinal perforation can occur)

Which of the following assessment may indicate a paralytic Ileus?

A. N & V

B. Intestinal cramping

C. Hypoactive bowel sounds

D. Black tarry stool

C. Hypoactive bowel sounds

You are caring for a patient with hyperkalemia. The patient asks what healthy drinks can she consume?

A. Avocado Shake

B. Banana Juice

C. Cranberry Juice

D. Tomato Shake

C. Cranberry Juice

T or F

A patient may have total body Ca deficit (osteoporosis) but a normal serum Ca level.

True

Ca serum levels are controlled by PTH and Calcitonin. Therefore, if serum Ca level decreases, parathyroid secretes __________. Whereas if serum Ca increases, thyroid secretes ___________.

Parathyroid secretes PTH

Thyroid secretes Serotonin

Surgeries in thyroid and parathyroid may cause hypocalcemia. In Ca malabsorption, what diseases may cause our body to not effectively absorb Ca?

A. Chron's Disease

B. IBD

C. Paralytic Ileus

D. NOTA

E. A & B

E. A & B

(Hypocalcemia causes paralytic ileus)

Trousseaus sign is done by inflating BP cuff on upper arm above 20 mmHg above systolic pressure; Within 2-5 mins, what manifestation would occur for a patient with hypocalcemia?

A. Tetany

B. Upper arm numbness

C. Paresthesia

D. Carpal spasm

D. Carpal spasm

(because ischemia of the ulnar nerve develops)

When pH increases or becomes alkalotic, what happens to Ca?

More Ca bound to Protein. Therefore, symptoms of hypocalcemia may occur with alkalosis.

High Ca diet is usually the management for Px with hypocalcemia. Which of the following diet has high Ca properties:

A. Chia seeds

B. Bear brand Milk

C. Mega Sardines

D. Cheese

C. Mega Sardines

Normal Magnesium Level

1.3 - 2.3 mg/dL

What Vitamin therapy should we include in treating in hypocalcemic patients?

A. Vitamin A

B. Vitamin B

C. Vitamin C

D. Vitamin D

D. Vitamin D

(to increase calcium absorption from the GI tract)

Hypercalcemia refers to serum Ca greater than 10.4 mg/dL. What is the most common causes of hypercalcemia.

A. Hyperthyroidism

B. Hypothyroidism

C. Hyperparathyroidism

D. Hypoaldosteronism

C. Hyperparathyroidism

(excessive PTH secretion causes increased release of calcium)

Vitamin D and A intoxication as well as chronic lithium and theophylline toxicity can cause calcium excess. This intoxication is also called as?

Hypervitaminosis

A serum Ca of 17 mg/dL or higher or an acute rise indicates?

A. Serum Ca Crisis

B. Hypercalcemic Crisis

C. Code blue

D. Cardiac Arrest

B. Hypercalcemic Crisis

Treatment of hypercalcemia includes fluid administration to dilute serum Ca and promote excretion by kidneys. Calcitonin opposes PTH decreasing serum Ca, bone resorption and increasing deposition of Ca & P in bones while also increasing urinary secretion of Ca & P. In what route do we administer calcitonin?

A. Calcimar IV

B. Calcimar SC

C. Calcimar IM

D. Calcimar by retention enema

C. Calcimar IM

Mithramycin a cytotoxic antibiotic may also be used to prevent bone resorption of Ca thus lowering Ca serum level. As a nurse you know that one of the side effect of this drug is?

A. Nephrotoxicity

B. Hepatotoxic

C. Rebound Hypercalcemia

D. NOTA

E. AOTB

E. AOTB

Increased fluid intake is recommended for patients with hypercalcemia as to prevent kidney stone formation. As a nurse what assessment will you anticipate for a patient with kidney injury and kidney stone formation?

A. Positive rebound tenderness

B. Positive Blumberg's Sign

C. Purpura in right hypochondrium

D. Flank pain

E. NOTA

D. Flank pain

A below normal serum Mg or hypomagnesemia is frequently associated with?

A. Hyperkalemia, Hypocalcemia

B. Hypokalemia, Hypocalcemia

C. Hypercalcemia, Hypokalemia

D. Hyperkalemia, Hypercalcemia

B. Hypokalemia, Hypocalcemia

The following are the causes of Hypomagnesemia except

A. Diarrhea

B. NGT suction

C. Alcohol withdrawal

D. NOTA

D. NOTA

Manifestations of hypomagnesemia include: SATA

1. Cardiac Arrythmias (PVO's, SVT, Torsade's de pointes, V-Fib)

2. Apathy

3. Depressed ST segment

4. Increased susceptibility to Digitalis Toxicity

A. All of the above

B. 1,2,4

C. 1,3,4

D. 1,2,3

A. All of the above

One of the therapy of hypomagnesemia is IV MgSO4 that is administered slowly. Which of the these situations may warrant the nurse to notify M.D.?

A. Hyperactive bowel sound

B. Decreased bowel sound

C. Oliguria urine < 100 mL in 4 hours

D. Polyuria urine > 100 mL in 4 hours

C. Oliguria urine < 100 mL in 4 hours

To treat hypocalcemic tetany or hypermagnesemia, what antidote should be readily available?

Calcium Gluconate

What is the common cause of Hypermagnesemia?

A. Seizures

B. DM

C. DKA

D. Kidney Injury

D. Kidney Injury

Acute elevation of serum Mg level depresses CNS and peripheral neuromuscular junction. These can manifest as: SATA

1. Atrioventricular Block

2. Respiratory center depression

3. Cardiac Arrest

4. Platelet clumping

A. All of the above

B. 1,2,4

C. 1,3,4

D. 1,2,3

A. All of the above

Too much Mg affects cardiovascular and neuromuscular system. What antagonists reverses the effect of Mg?

Calcium gluconate or Ca Cl

One of the nursing mgt in patients with hypermagnesemia is to monitor VS. As a nurse, which of these followings findings should you note? SATA

1. Tachycardia

2. Hypertension

3. Hypotension

4. Shallow breathings

A. All of the above

B. 3,4

C. 2,3

D. 1,3

B. 3,4