NURS 753 Final Exam Testbank
Therapeutic Modalities 240
Practice Questions and correct
answers
The spinal cord is supplied by which arteries?
vertebral arteries and arteries that branch off the descending aorta.
CNS blood supply comes from?
The internal carotid arteries
The brain blood supply is from?
The vertebral arteries, which form the posterior circulation.
WHICH AREAS OF THE BRAIN, IF INJURED HAVE CONTRALATERAL SYMPTOMS
Cortex, cerebral cortext
WHICH AREAS OF THE BRAIN, IF INJURED HAVE IPSILATERAL SYMPTOMS
CEREBELLUM
,DIFFERENTIATE THE INTRACELLULAR COMPARTMENTS AND THEIR
SUBDIVISIONS.
Fluid found inside the cells is referred to as intracellular fluid (ICF)
§ Collectively, the ICF accounts for approximately two-thirds of the body's
water (weight 40% of total body weight).
§ Rich in potassium, magnesium, phosphate and electrolytes
DIFFERENTIATE THE INTRACELLULAR AND EXTRACELLULAR FLUID
COMPARTMENTS AND THEIR SUBDIVISIONS.
Fluid found outside the cells is referred to as extracellular fluid (ECF)
§ Interstitial (between the cells)
§ Intravascular (inside the blood vessels)
· Blood (serum) electrolyte tests examine only intravascular electrolytes, but
inferences from these tests can be made as to what is occurring in the other
compartments.
§ Transcellular (between epithelial lined spaces) compartments
· Fluid in the peritoneal, pleural, and pericardial cavities, cerebrospinal fluid,
and fluid in the joint spaces, lymph system, eyes and gastrointestinal tract.
§ The ECF makes up the remaining one third of the body fluid (20% of total
body weight)
§ Approximately three fourths of the ECF (i.e., 15% of total body weight) is
found in the interstitial compartment, and the remaining one fourth ( 5% of
total body weight) is found in the intravascular and transcellular
compartment.
§ Rich in sodium, chloride, and bicarbonate.
DEFINE TONICITY
,o is determined by the osmotic pressure of the solvent and solute separated
by a semipermeable membrane and the concentration relative to one
another on each side of the membrane.
§ Used to described cell's response to an external solution (electrolytes
containing Na, K, glucose)
Isotonic solutions:
Have concentrations of solutes equal to those in the intravascular
compartment. isotonic solutions allow fluid to move equally between
compartments and do not cause notable shifts in fluid volume.
§ 0.9% normal saline, Lactated Ringer's solution, 5% dextrose in water
solution
Hypotonic solutions:
Have a lower concentration of solutes than those in the intravascular
compartment and cause fluid to shift from the intravascular compartment to
the intracellular space.
§ 0.45% normal saline
Hypertonic solutions
Have a higher concentration of solutes than those in the intravascular
compartment and cause fluid to shift from the intracellular compartment to
the intravascular space.
§ 5% dextrose in 0.9% saline, 3% saline, 10% dextrose in water
· DESCRIBE THE PROCESS FOR EVALUATING AND MANAGING HYPONATREMIA.
, § Step One: Is the hyponatremia hypertonic, isotonic, hypotonic (most
common)?
· Patient at risk for isotonic or hypertonic hyponatremia?
o Severe hyperglycemia (Diabetic ketoacidosis or Hyperglycemic
Hyperosmolar State)
o Recent bladder or prostate surgery (Mannitol irrigation)
o Patient recently given mannitol or intravenous immunoglobulin?
· Any reason to suspect pseudohyponatremia? (This is a lab error due to
things like severe hyperlipidemia, severe obstructive jaundice or plasma cell
dyscrasia)
· If unsure, measure serum osmolality. If <280 mosm/kg (and your glucose is
<300mg/dl), you have hypotonic hyponatremia.
§ Step Two: Is the problem one of impaired water excretion (most common)
or is there normal water excretion?
· Remember: The renal response to a diluted blood plasma SHOULD BE
sodium retention and to maximally dilute the urine.
· ADH SHOULD be turned off to maximally dilute urine
· Check a urine osmolality
· Osmolality greater than 150 mosmol/kg and a specific gravity >1.003
indicates impaired water excretion
§ Step Three: What is the volume status of the patient?
· Physical Exam
· History
· Measure Urine Sodium
§ Treatment depends on the chronicity, the cause, the volume status of the
patient and the current symptoms
If pH < 7.35 and CO2 >45
respiratory acidosis
Therapeutic Modalities 240
Practice Questions and correct
answers
The spinal cord is supplied by which arteries?
vertebral arteries and arteries that branch off the descending aorta.
CNS blood supply comes from?
The internal carotid arteries
The brain blood supply is from?
The vertebral arteries, which form the posterior circulation.
WHICH AREAS OF THE BRAIN, IF INJURED HAVE CONTRALATERAL SYMPTOMS
Cortex, cerebral cortext
WHICH AREAS OF THE BRAIN, IF INJURED HAVE IPSILATERAL SYMPTOMS
CEREBELLUM
,DIFFERENTIATE THE INTRACELLULAR COMPARTMENTS AND THEIR
SUBDIVISIONS.
Fluid found inside the cells is referred to as intracellular fluid (ICF)
§ Collectively, the ICF accounts for approximately two-thirds of the body's
water (weight 40% of total body weight).
§ Rich in potassium, magnesium, phosphate and electrolytes
DIFFERENTIATE THE INTRACELLULAR AND EXTRACELLULAR FLUID
COMPARTMENTS AND THEIR SUBDIVISIONS.
Fluid found outside the cells is referred to as extracellular fluid (ECF)
§ Interstitial (between the cells)
§ Intravascular (inside the blood vessels)
· Blood (serum) electrolyte tests examine only intravascular electrolytes, but
inferences from these tests can be made as to what is occurring in the other
compartments.
§ Transcellular (between epithelial lined spaces) compartments
· Fluid in the peritoneal, pleural, and pericardial cavities, cerebrospinal fluid,
and fluid in the joint spaces, lymph system, eyes and gastrointestinal tract.
§ The ECF makes up the remaining one third of the body fluid (20% of total
body weight)
§ Approximately three fourths of the ECF (i.e., 15% of total body weight) is
found in the interstitial compartment, and the remaining one fourth ( 5% of
total body weight) is found in the intravascular and transcellular
compartment.
§ Rich in sodium, chloride, and bicarbonate.
DEFINE TONICITY
,o is determined by the osmotic pressure of the solvent and solute separated
by a semipermeable membrane and the concentration relative to one
another on each side of the membrane.
§ Used to described cell's response to an external solution (electrolytes
containing Na, K, glucose)
Isotonic solutions:
Have concentrations of solutes equal to those in the intravascular
compartment. isotonic solutions allow fluid to move equally between
compartments and do not cause notable shifts in fluid volume.
§ 0.9% normal saline, Lactated Ringer's solution, 5% dextrose in water
solution
Hypotonic solutions:
Have a lower concentration of solutes than those in the intravascular
compartment and cause fluid to shift from the intravascular compartment to
the intracellular space.
§ 0.45% normal saline
Hypertonic solutions
Have a higher concentration of solutes than those in the intravascular
compartment and cause fluid to shift from the intracellular compartment to
the intravascular space.
§ 5% dextrose in 0.9% saline, 3% saline, 10% dextrose in water
· DESCRIBE THE PROCESS FOR EVALUATING AND MANAGING HYPONATREMIA.
, § Step One: Is the hyponatremia hypertonic, isotonic, hypotonic (most
common)?
· Patient at risk for isotonic or hypertonic hyponatremia?
o Severe hyperglycemia (Diabetic ketoacidosis or Hyperglycemic
Hyperosmolar State)
o Recent bladder or prostate surgery (Mannitol irrigation)
o Patient recently given mannitol or intravenous immunoglobulin?
· Any reason to suspect pseudohyponatremia? (This is a lab error due to
things like severe hyperlipidemia, severe obstructive jaundice or plasma cell
dyscrasia)
· If unsure, measure serum osmolality. If <280 mosm/kg (and your glucose is
<300mg/dl), you have hypotonic hyponatremia.
§ Step Two: Is the problem one of impaired water excretion (most common)
or is there normal water excretion?
· Remember: The renal response to a diluted blood plasma SHOULD BE
sodium retention and to maximally dilute the urine.
· ADH SHOULD be turned off to maximally dilute urine
· Check a urine osmolality
· Osmolality greater than 150 mosmol/kg and a specific gravity >1.003
indicates impaired water excretion
§ Step Three: What is the volume status of the patient?
· Physical Exam
· History
· Measure Urine Sodium
§ Treatment depends on the chronicity, the cause, the volume status of the
patient and the current symptoms
If pH < 7.35 and CO2 >45
respiratory acidosis
