NURS 271 Exam 1

Normal Range of pH

7.35-7.45

Normal range of PaCO2

35-45 mmHg

Normal range:

HCO3- bicarbonate

22-26 mEq/L

Normal range of PaO2

80-100 mmHg

Normal range of SaO2

95-100%

PaCO2 is the measure of partial pressure of CO2 which indicates __________, it moves in the opposite direction of _____ levels

respiratory function, pH levels

HCO3 or ____________ is chemical buffer that works with respiratory and renal systems to decrease strength of damaging acids or bases- it indicates _______ function.

bicarbonate, metabolic

In the clinical setting, how should arterial blood gases be assessed?

By collecting blood drawn from the radial artery

Chemical Buffers are the ______ line of defense when it comes to correcting acid base imbalances

1st

Chemical Buffers include

1. _____________- buffers blood and interstitial fluid & decreases strength of damaging acid or base while working with respiratory and renal systems

2. _________ binds with excess bases and acids (ie: albumin and plasma proteins)

3. _________ is very effective in renal tubules (where they exist)

1. bicarbonate

2. proteins

3. phosphate

3 multiple choice options

______ are the 2nd line of defense when it comes to correcting acid base imbalances and this system specializes in ______ term management

lungs, short

Kidneys are the _____ line of defense when it comes to correcting acid base imbalances and this system specializes in _____ term management (taking hours or days to see results)

3rd, long

Which patient would most benefit from a bronchodilator (albuterol/proventil) treatment?

One with....

a. respiratory acidosis

b. respiratory alkalosis

c. metabolic alkalosis

d. metabolic acidosis

a

3 multiple choice options

Mr. Sushi presents with a headache (6/10 pain), he is confused and restless, unable to sit still. He has shallow breaths (tachypnea and dyspnea) and he is sweating profusely (diaphoresis). In his chart you see a history of a recent chest trauma to his lung as well as us of a CPAP machine while he sleeps, and a past overdose on opiates.

What would you expect this patient's PaCO2 results to be?

a. PaCo2 35 mmHG

b. PaCO2 57 mmHg

c. PaCO2 32 mmHg

d. PaCO2 45 mmHg

b

The max amount of liters that can be administered via Nasal Cannula is ____, otherwise additional moisture is needed

6L

Respiratory Acidosis is characterized by the inability to eliminate _______ made by peripheral tissues which will then accumulate in the ECF leading to hypercapnia (retention) and the increase of PaCO2

* alveolar HYPOventilation

CO2

_________ is how the body works to correct blood pH by using a different organ/system/method than the affected one

Compensation

Full or partial compensation?

______ blood pH is still imbalanced but respiratory/renal has left normal state

partial

3 multiple choice options

Full or partial compensation

_____ blood pH is within normal range

full

Alveolar hyperventilation causes hypocapnia (the decrease of ____) which can lead to ____

CO2, Respiratory Alkalosis

Ms. Paytas presents with tachycardia, heart palpitations, and a temperature above 38C/100.4F. She reports having multiple panic or anxiety attacks within the last day. When using the ECG you find that her PR interval is prolonged (greater than .20 seconds). What do you expect her PaCO2 results to be?

a. PaCO2 35

b. PaCO2 45

c. PaCO2 29

d. PaCO2 38

c

A PaCO2 result that is BASIC is one that is

a. less than 35

b. more than 35

c. more than 45

d. equal to 45

a

A patient experiencing respiratory alkalosis would benefit from which treatment the LEAST?

a. mucolytic acetylcysteine (mucomyst)

b. administration. of antipyretics (acetaminophen/tylenol)

c. administration of broad spectrum antibiotics

d. administration of sedatives/benzodiazepines

a

If left untreated, metabolic acidosis can lead to cardiac _______ due to potassium abnormalities

arrythmias

Mr. Llama presents with Kussmaul respirations (deep and fast breaths) with a fruity odor coming from his breath. His LOCs are depressed and he reports having a dull headache. In his chart you find that he is a chronic drinker and has damaged kidneys. He also reports having to void like "a dozen times" a day. His BP is 90/60.

What do you suspect Mr. Llama's HCO3 result to be?

a. 26

b. 22

c. 19

d. 24

c

Renal threshold is the point at which the body can NO longer _______ excess glucose which is then excreted into the urine. (_____mg/dL)

reabsorb, 180

Causes of Metabolic Acidosis include:

1. DKA

2. Chronic alcoholism

3. kidney failure

4. Diarrhea

5. All of the above

5

________ is a complication of Type I diabetes where blood glucose rises above 180mg/dL or ____ leading to osmotic diuresis and a significant loss of electrolytes like ______. The lack of INSULIN prevents glucose from being pushed into the cell and the body burns ______ as back up energy storage.

Diabetic Ketoacidosis, renal threshold, K, fat

How would you expect this patient's myocardial function to be affected when viewing these ABG results?

pH 7.1

PaCO2 40

HCO3 20

a. Blood pressure will increase

b. Blood pressure will decrease

c. Cardiac output will decrease

d. both b and c

d

Relative hyperkalemia is commonly experienced by patients with ______, yet in reality potassium levels are low

DKA

What is the best treatment plan for a diabetic patient with metabolic acidosis if their pH is less than 7.1

a. administer bicarbonate

b. administer fast acting insulin

c. administer bronchodilator

d. a and b

d

Mr. Bus complains of having extreme bouts of vomiting in the last couple of hours. On his medication list you find Lasix/furosemide prescribed for his hypertension. In his serum electrolyte test you find low values for potassium and calcium. He also reports having painful spasms and tremors (possible tetany)

What do you expect his HCO3 results to be?

a. 28

b. 24

c. 21

d. 25

a

For patients with metabolic alkalosis, which treatment plan is the best?

a. mucomyst

b. administer a K sparing diuretic

c. administer insulin

d. intubation

b

What is the ABG imbalance?

pH: 7.11, CO2: 43, HCO3: 18

Uncompensated Metabolic Acidosis

What is the ABG imbalance?

pH: 7.73, CO2: 36, HCO3: 29

Uncompensated Metabolic Alkalosis

Interpret these ABG results

pH: 7.4, CO2: 42, HCO3 25

Normal

what is the ABG imbalance?

pH: 7.52, CO2: 50, HCO3: 35

Partially Compensated Metabolic Alkalosis

What is the ABG Imbalance?

pH: 7.41, CO2: 29, HCO3: 18

Fully Compensated Respiratory Alkalosis

What is the ABG imbalance?

pH: 7.14, CO2: 52, HCO3: 23

Uncompensated Respiratory Acidosis

What is the ABG imbalance?

pH: 7.18, CO2: 25, HCO3: 21

Partially Compensated Metabolic Acidosis

Intracellular to extracellular fluid ration

75:25

Fluid loss than can be measured like urine excretion (about 1500ml/day) is considered a ______ loss

sensible

Fluid loss that canNOT be measured like skin (about 600/day) and lungs (around 400/day) are considered a _____ loss

insensible

Anti-diuretic hormone or Vasopresin is a ___________ hormone

water retaining

ADH is produced by the _______ which regulates many things like hunger, thirst, circadian, etc. ADH is stored and released by the _____

hypothalamus, posterior pituitary

ADH is activated by an increase level of _______ secondary to decrease in _______/increased serum concentration

Na, blood volume

How does ADH retain water?

Signaling renal tubules to become more permeable to water- reabsorbed into blood

Does urinary output decrease or increase after ADH is activated

decrease- water is reabsorbed

Vasopresin causes both vasoconstriction and fluid reabsorption which leads to Increase _____

arterial pressure

Why is diarrhea a big concern for neonates?

80% of neonate body mass is water

Which IV solution is isotonic?

.9NS/ LR

2 multiple choice options

When the body is dry, the labs are _______

high

Which IV solution is hypotonic?

.45 NS

3 multiple choice options

Which IV solution is hypertonic (used for hyponatremia)

3%NS

Which of the IV solutions have dual tonicity?

D5W and D5.45NS

After metabolism, in IV solutions D5W and D5.45NS becomes

hypotonic

Isotonic

equal concentration

Hypotonic

lower concentration- water moves in SWELL

Hypertonic

higher concentration- water moves out- SHRINK

The main goal of the Renin Angiotensin Aldosterone System RAAS is to regulate _______ and fluid balance

BP

RAAS When blood pressure decreases (renal perfusion decreases) and the juxtaglomerular cells secrete ___________ which converts angiotensinogen into angiotensin 1

Renin

RAAS

Angiotensin 1 is converted into Angiotensin 2 by ________ in the ____

ACE (angiotensin converting enzyme) lungs

When angiotensin 2 enters the adrenal cortex vasoconstriction occurs and ________ is secreted which causes reabsorption of Na and water into blood

Aldosterone

the end result of RAAS

- blood pressure ______

- blood volume ______

- ECF _____

increase 3x

Normal level of Na

135-145 mEq/L

Sodium is a very important _______

impulse transmitter

Hyponatremia is a Na deficiency related to amount of water in body causing a shift from the _____ to the ICF causing cells to _____

ECF, swell

Causes of Hyponatremia may include all of the following EXCEPT

a. diuretics

b. hyperglycemia (increased voiding)

c. wound drainage

d. excessive Na intake

d

for CNS status it is important to know your patient's

baseline

Hyperactive BS is common in patients with

hyponatremia

For severe hyponatremia (less than 120) what intervention should be delivered?

a. giving 3% NS immediately and as quickly as possible

b. administering loop diuretics

c. administer Tolvaptan Samsca

d. giving 3% NS in small increments to prevent respiratory acidosis r/t pulmonary edema

d

Tolvaptan (Samsca) would benefit patients with _____ as it is a vasopresin ADH antagonist that enhances H2O while retaining Na

hyponatremia

Hypernatremia is most common in what comorbidity?

Renal failure

Hypernatremia occurs when Na concentration is elevated due to insufficient amount of ______ in body

water

Which medication is most likely to cause hypernatremia?

a. Prednisone

b. Albuterol

c. Lasix

d. Furosemid

a

If hypernatremia is caused by fluid loss, _____ should be administered

If caused by poor renal excretion, ____ should be administered

If a more aggressive approach is needed, ____ should be considered

.9NS, diuretics, hemodialysis

Normal range for K

3.5-5 mEq/L

CASE STUDY

Mr. Skywalker has recently received copious amounts of NG suctioning and has been taking loop diuretics for his edema for the past 3 days. When doing a head to toe on Skywalker you find that his diaphragm is weakened and he is taking shallow respirations. He has excessive diaphoresis and weak hand grasps, reflexes are poor. Along with hypoactive bowel sounds he also has a weak pulse. After viewing his labs you find that he has a K level of 2.0. .

What is the HIGHEST concern?

a. Possible pre-mature death from cardiac arrthymias

b. Tetany of limbs

c. Fluid overload

d. Decreased peristalsis

A

CASE STUDY

Mr. Skywalker has recently received copious amounts of NG suctioning and has been taking loop diuretics for his edema for the past 3 days. When doing a head to toe on Skywalker you find that his diaphragm is weakened and he is taking shallow respirations. He has excessive diaphoresis and weak hand grasps, reflexes are poor. Along with hypoactive bowel sounds he also has a weak pulse. After viewing his labs you find that he has a K level of 2.0.

How will you administer K replacements?

a. IM route

b. Feed pt spinach banana smoothe

c. If oral is not possible IV Piggy back or central line at 1mEq/10 mL

d. SQ route

c

CASE STUDY

Mr. Skywalker has recently received copious amounts of NG suctioning and has been taking loop diuretics for his edema for the past 3 days. When doing a head to toe on Skywalker you find that his diaphragm is weakened and he is taking shallow respirations. He has excessive diaphoresis and weak hand grasps, reflexes are poor. Along with hypoactive bowel sounds he also has a weak pulse. After viewing his labs you find that he has a K level of 2.0.

Which diuretic will benefit Skywalker?

a. Bumex/ Bumetanide

b. Spironolactone/ Aldactone

c. Furosemide/Lasix

d. Tolvaptan/ Samsca

B

Sources of potassium via nutrition include

Spinach, bananas, halibut, ______, cantaloupe, and ______

halibut, papaya

CASE STUDY

Ms. Hazel Grace Lancaster has recently received whole blood/packed RBC blood transfusion (10mEq of K per unit) and on the ECG it appears that she has a prolonged PR interval. When performing your head to toe assessment you find that she has hyperactive bowel sounds and that she feels extremely dehydrated. She also reports having diarrhea and you notice she has had an IV of K for far too long.

What is the HIGHEST concern?

a. Muscle weakness

b. Transfusion rejection

c. Dehydration

d. Possible heart block - cardiac monitoring NEEDED

d

CASE STUDY

Ms. Hazel Grace Lancaster has recently received whole blood/packed RBC blood transfusion (10mEq of K per unit) and on the ECG it appears that she has a prolonged PR interval. When performing your head to toe assessment you find that she has hyperactive bowel sounds and that she feels extremely dehydrated. She also reports having diarrhea and you notice she has had an IV of K for far too long.

What medication should you recommend the doctor prescribe?

a. Kayexalate

b. Spironolactone/Aldactone

c. Tolvaptan/Samsca

d. Albuterol

a

In which scenario would a non-diabetic patient benefit from receiving insulin or 50%Dextrose+Insulin?

a. One with Hyperkalemia

b. One with Albuminemia

c. A burn victim

d. A sleepy poo

a

Calcium normal range

8.5-10.5 mg/dL

Which hormone increases serum Ca levels?

A. Aldosterone

B. Renin

C. PTH

D. Insulin

c

CASE STUDY

Ms. Spice (Ice Spice) is a 75 year old woman presenting with numbness in her muscles and decreased myocardial contractility. In her history you find that she has suffered from alcohol abuse for decades and that her estrogen levels are decreased. You find that her Albumin levels are significant lowly and that she suffered third degree burns a couple of weeks ago.

What medication might be prescribed to her?

a. Calcium gluconate

b. Aluminum hydroxide + Vit D

c. Calcium chloride

d. all of the above

d

What signs might indicate hypocalcemia

1. upper facial contraction after tapping on facial nerve ____

2. increases SYS to 20 mmHg above normal- leave for 1-4 mins and hand raises

Chvostek's, Trousseau's

CASE STUDY

Mr. Tickle Me Elmo is a cancer patient with hyperparathyroidism on thiazide diuretics. He has been experiencing persistent tachycardia and hypertension with muscle weakness/lethargy/ and increased abdominal girth. You conclude that he has decreased gastric motility and that he will require possible hemodialysis.

What is the BIGGEST concern?

a. Confusion and lethargy

b. decreased gastric motility related malnutrition

c. HTN

d. Risk for CVA or PE

d

CASE STUDY

Mr. Tickle Me Elmo is a cancer patient with hyperparathyroidism on thiazide diuretics. He has been experiencing persistent tachycardia and hypertension with muscle weakness/lethargy/ and increased abdominal girth. You conclude that he has decreased gastric motility and that he will require possible hemodialysis.

What medication should he receive?

a. Vasopresin

b. Insulin

c. Furosemide/Lasix

d. Silly goofy boy meds

c

Determine the degree of this burn:

Outermost layer of the epidermis has been destroyed. There is local discomfort and a slight erythema due to inflammation.

a. first degree

b. second degree

c. third degree

d. fourth degree

A

Determine the degree of this burn:

Involves the epidermis and dermis slightly. Red with blisters, extremely painful

a. first

b. superficial partial thickness 2nd

c. deep partial thickness 2nd

d. third

b

Determine the degree of this burn

Extends to deeper layers of the dermis, no blisters, dead tissue sticks to underlying tissue, less pain as nerve endings have been destroyed.

a. first

b. superficial partial thickness 2nd

c. deep partial thickness 2nd

d. third

c.

Healing 2nd degree burn can take 1-3 weeks but it may take longer in what kind of patients?

1. Black patients

2. Patients with red hair

3. Patients with co-morbidities

4. Patients with altered LOCs

3

Scarring is genetically determined. What populations are more likely to scar?

1. Black people

2. Gingers

3. Doctors

4. Blondes

1 and 2

Which nurse needs more education on caring for patients with burns.

a. One who knows that burn victims are likely to experience clinical dehydration

b. The nurse who administers NSAIDs for pain relief

c. A nurse who chooses to pop the blister on a 2nd degree burn

d. A nurse who refers the patient to a psychologist for impacted body image

c

Determine the degree of this burn:

Involves the dermines, epidermis, and subcutaneous layer with a full thickness burn. Eschar develops around erythema, surgical removal needed. Healing depends on blood supply.

a. first degree

b. second degree

c. third degree

d. fourth degree

c

Determine the degree of this burn

MEDICAL EMERGENCY- involves skin, tendons, nerves, and possibly muscles. May cause permanent damage to the affected area and lead to amputation

a. first degree

b. second degree

c. third degree

d. fourth degree

d

Pathophysiology of burns (sort in correct order)

1. Increased capillary permeability with 3rd spacing edema

2. Fluid loss and sodium depletion

3. Burn injury occurs

4. Blood vessel vasodilation, BV and BP decreases

5. Inflammatory response- release of histamines, vasoconstriction and blood clots

3, 5, 1, 2, 4

Third spacing: fluid loss from _______ space into the ______ due to vasodilation

Edema adjacent to burn

intravascular, interstitial