Self Check Review

1
Self Check Review

• Electrolyte Imbalances

2
Review Concepts Related to Electrolytes
3
What are the 3 functions of sodium?
4
3 Functions of Na include

• Controlling water distribution
• Maintain plasma osmolarity
• Nerve transmission.

5
True or False??

• If a person with a normal sodium balance drinks A
  LOT of water, they will develop hypernatremia
• If a person with a normal sodium balance eats
  very salty food PLUS drinks a lot of fluid it is
  likely that their Na will remain in a normal
  range.

6
True or False??

• If a person with a normal sodium balance drinks A
  LOT of water, they will develop hypernatremia
• False
• If a person with a normal sodium balance eats
  very salty food PLUS drinks a lot of fluid it is
  likely that their Na will remain in a normal
  range.
• True

7
True or False??

• If a patient has hypernatremia, increasing their
  water intake is a way to correct the problem.
• If a patient has hyponatremia, increasing their
  water intake is a way to correct the problem

8
True or False??

• If a patient has hypernatremia, increasing their
  water intake is a way to correct the problem.
• True (or limit sodium)
• If a patient has hyponatremia, increasing their
  water intake is a way to correct the problem
• False (Decrease water or increase Na)

9
Abnormalities in sodium balance often result in
abnormal symptoms in which body system?
10
Abnormalities in sodium balance often result in
abnormal symptoms in which body system?

• Neurological
• Confusion, alertness, irritability, coma, seizures

11
What type of IV fluid will increase the
osmolarity of the blood and lead to possible
vascular overload?
12
What type of IV fluid will increase the
osmolarity of the blood and lead to possible
vascular overload?

• Hypertonic
• 3 NS or 5 NS
• The osmotic pressure is increased, causing fluid
  to leave the cells and enter the extracellular
  space.

13
When assessing a patient with hypotonic
overhydration (low serum osmolarity), the nurse
can expect to find

• hyponatremia
• B. altered level of consciousness
• C. headache
• D. all of the above

14

• D
• Symptoms of hypotonic overhydration are
  hyponatremia, altered level of consciousness, and
  headache.
• Additional signs of hypotonic overhydration are
  increased pulse rate, bounding pulses, confusion,
  increased BP, moist crackles, nonpitting edema

15
When assessing a patient for hypernatremia, the
nurse would expect to find

• serum sodium level of 142 mEq/L
• headache
• thirst
• hypoactive deep tendon reflexes

16
C

• Thirst can indicate hypernatremia
• Serum sodium level is greater than 145 in
  hypernatremia
• Headache is found in HYPOnatremia
• Reflexes are hyperactive, not hypoactive
• See the chart your Ignatavicius Workman
  textbook for additional key features.

17
Which of the following IV solutions would the
nurse administer for a patient with
hypernatremia?

• 3 sodium chloride
• 0.33 sodium chloride
• D5/0.9 sodium chloride
• Lactated Ringers solution

18
B

• Hypotonic solutions are prescribed for a patient
  with hypernatremia 0.33 saline is hypotonic
• 3 saline solution is hypertonic
• D5W is used cautiously because of the possibility
  of fluid overload
• LR NS is incorrect, they provide too much Na

19
When hyponatremia exists, the adrenal glands
respond by sending aldosterone to the kidneys to

• increase sodium reabsorption
• decrease sodium reabsorption
• increase water reabsorption
• decrease water reabsorption

20
A

• When serum sodium is decreased, the adrenal
  glands send aldosterone to the kidneys to
  increase sodium reabsorption in an attempt to
  balance sodium levels
• Aldosterone controls sodium and potassium.
• Do NOT think of aldosterone as a hormone that is
  used to control water. Think of it as a
  substance that controls minerals.

21
Which of the following findings would the nurse
NOT expect to find in a pt with isotonic
overhydration (hypervolemia)?

• rales
• distended neck and hand veins
• postural hypotension
• weight gain

22
C

• Postural hypotension is seen in pts with
  dehydration
• Rales, distended neck and hand veins, and weight
  gain are signs of overhydration

23
Which of the following solution types will cause
the greatest increase in vascular volume when
given to a patient in shock?

• crystalloid
• colloids
• hypotonic
• isotonic

24
B

• Colloids are hypertonic solutions containing
  solutes of high molecular weight that pull fluids
  from the intracellular and interstitial spaces,
  these solutions are used as a plasma volume
  expander.
• Crystalloids are IV solutions with solutes of
  lower molecular weight. Fluid distribution is
  not limited to the intravascular space.

25
Which of the following interventions would the
nurse implement for a patient receiving a
maintenance IV of D5/0.45 NS with 30 mEq/KCl
because of the type of solution ordered?

• cardiac monitor
• monitor pulse
• monitor blood pressure
• assess the IV site

26
D

• Potassium supplements are irritating, so careful
  IV site assessment is necessary
• The other interventions are not related to IV
  administration of potassium (although they could
  be used during a K imbalance)

27

• Before administering any medication containing
  potassium, an important nursing intervention is
  to check the patients
• EKG
• level of pain
• vital signs
• urine output

28
D

• since kidney failure can lead to hyperkalemia, it
  is important that the nurse determine the
  patients urine output before administering
  medications containing potassium
• the other interventions are important parameters
  to assess, but are not specific to potassium
  being in an IV

29

• When educating a patient about foods high in
  calcium, the nurse would recommend
• sardines
• cantaloupe
• baked potato
• eggs

30
A

• Sardines and other canned fish are high in
  calcium (I think of the bones in canned fish to
  remember this)
• Cantaloupe and baked potatoes are high in
  potassium
• Eggs are high in phosphorous

31
Which of the following would be seen in a patient
with hypocalcemia?

• Excessive blood clotting
• Jitteriness
• Constipation
• Fractures
• Trousseaus sign
• Diminished DTRs
• Laryngeal spasm

• Thirst
• Seizures
• Ileus
• Anorexia
• Paresthesia
• Petechiae
• Cardiac arrest
• Respiratory arrest

32
The following BLUE, CAPITALIZED items would be
seen in a patient with hypocalcemia.

• Excessive blood clotting
• JITTERINESS
• Constipation
• FRACTURES
• TROUSSEAUS SIGN
• Diminished DTRs
• LARYNGEAL SPASM

• Thirst
• SEIZURES
• Ileus
• Anorexia
• PARESHESIA
• PETACHIAE
• Cardiac arrest
• RESPIRATORY ARREST

33
Which of the following would be seen in a patient
with hypercalcemia?

• Excessive blood clotting
• Jitteriness
• Constipation
• Fractures
• Trousseaus sign
• Diminished DTRs
• Laryngeal spasm

• Thirst
• Seizures
• Ileus
• Anorexia
• Paresthesia
• Petechiae
• Cardiac arrest
• Respiratory arrest

34
The following would be seen in a patient with
hypercalcemia

• Excessive blood clotting
• Constipation
• Pathological fractures
• Diminished DTRs
• Thirst
• Ileus
• Anorexia
• Cardiac arrest

35
Lightly tapping on the facial nerve leads to a
contraction of the facial muscles. This is
called
36
Lightly tapping on the facial nerve leads to a
contraction of the facial muscles. This is
called

• Chvosteks (vos teks)

37
Inflating a blood pressure cuff and noting that
palmar flexion results is interpreted as
38
Inflating a blood pressure cuff and noting that
palmar flexion results is interpreted as

• A positive Trousseaus sign

39
A complication of thyroid surgery is damage to
the PARATHYROID GLAND, this can result in
40
A complication of thyroid surgery is damage to
the PARATHYROID GLAND, this can result in

• Hypocalcemia
• Lack of parathyroid hormone is a concern (and not
  a lack of calcitonin)

41
True or False??

• The preferred route for calcium replacement in
  the patient with symptomatic hypocalcemia is IM
• When administering oral potassium supplements it
  is best to administer the drug with food.

42
True or False??

• The preferred route for calcium replacement in
  the patient with symptomatic hypocalcemia is IM
• False
• When administering oral potassium supplements it
  is best to administer the drug with food.
• True

43
True or False??

• Liquid oral potassium should be minimally diluted
  in 30ml of liquid.
• The maximum amount of intravenous KCl to give in
  one hour is 20 mEq.
• A dilution of no more than 1mEq/10mL of solution
  is recommended.

44
True or False??

• Liquid oral potassium should be minimally diluted
  in 30ml of liquid.
• False (at least 4 ounces)
• The maximum amount of intravenous KCl to give in
  one hour is 20 mEq.
• True (although 5 10 mEq/hour is recommended)
• A dilution of no more than 1mEq/10mL of solution
  is recommended.
• True (according to your Ignatavicius Workman
  text.) Many people will not be able to tolerate
  this high concentration.

45
Identify 3 possible causes of hyperkalemia.
46
Hyperkalemia can be caused by

• Blood administered through too small of a needle
• Spironolactone or another potassium sparing
  diuretic.
• Renal failure
• Massive soft tissue damage
• Acidosis
• Low aldosterone levels (adrenal insufficiency)
• See the Table in your Ignatavicius Workman
  textbook

47
Identify 3 possible causes of hypokalemia
48
Hypokalemia can be caused by

• Many diuretics
• Increased aldosterone (Cushings syndrome)
• GI loss (diarrhea, vomiting)
• Alkalosis
• Hyperinsulinism
• Heat induced excessive diaphoresis
• See the table in your Ignatavicius Workman
  textbook

49
Which of the following are symptoms of
hypokalemia?

• Arrhythmias
• Muscle weakness
• Seizures
• Diarrhea
• Paresthesia
• Anorexia
• NV
• Muscle twitching

50
Hypokalemia symptoms include

• Arrhythmias
• Muscle weakness
• Anorexia
• NV

51
Which of the following are symptoms of
hyperkalemia?

• Arrhythmias
• Muscle weakness
• Seizures
• Diarrhea
• Paresthesia
• Anorexia
• NV
• Muscle twitching

52
Hyperkalemia symptoms include

• Arrhythmias
• Seizures
• Diarrhea
• Paresthesia
• Nausea
• Muscle twitching

53
Why is insulin and glucose used to treat
hyperkalemia?
54

• Insulin promotes the movement of potassium from
  the extracellular fluid into the cells
• Glucose must be given with insulin, otherwise
  hypoglycemia will occur

55
What is the classic drug used to lower potassium
levels that can be given PO or rectally?
56
What is the classic drug used to lower potassium
levels that can be given PO or rectally?

• Kayexalate

57
What is bone resorption?
58
Bone resorption is the movement of calcium OUT OF
the bone
59
Identify key components in the treatment of
hypercalcemia.
60
Treating hypercalcemia

• Increase fluid intake (3000 4000 ml/day)
• Use measures to prevent constipation
• Use Lasix (but not thiazide diuretics!)
• Give calcitonin to prevent bone resorption
• Give saline IVs to rehydrate and inhibit tubular
  reabsorption
• Prevent constipation

61
True or False??

• Metastatic bone lesions elevate calcium levels
  because of increase bone resorption
• Symptoms of hypocalcemia can occur when calcium
  is bound by citrate

• A patient with pancreatitis is at risk for
  hypercalcemia
• When phosphorus is increased, calcium is
  decreased.
• Vitamin D is used in the treatment of
  hypercalcemia

62
True or False??

• Metastatic bone lesions elevate calcium levels
  because of increase bone resorption
• True
• Symptoms of hypocalcemia can occur when calcium
  is bound by citrate
• True

• A patient with pancreatitis is at risk for
  hypercalcemia
• False
• When phosphorus is increased, calcium is
  decreased.
• True
• Vitamin D is used in the treatment of
  hypercalcemia
• False

63
The normal lab results for the following are

• Na
• K
• Ca

64
Na 135-145 mEq/L
65
K 3.5 5.0 mEq/L
66
Total Ca 8.5 10.5 mg/dL