NR 324 / NR324 Exam 1 (2026–2027 NEW UPDATE) Adult Health I | Complete Q&A Study Guide | 100% Accurate Solutions | Guaranteed Grade A – Chamberlain

NR 324 / NR324 Exam 1 (2026–2027 NEW UPDATE) Adult Health I | Complete Q&A Study Guide | 100% Accurate Solutions | Guaranteed Grade A – Chamberlain Q. What is the definition of fluid volume deficit? ANSWER - occurrence w/ abnormal loss of Extracellular fluid (ECF) Q. What can cause fluid volume deficit? ANSWER - inadequate fluid intake - abnormal loss of body fluids - shift from ECF to ICF Q. What are some examples of abnormal fluid losses that can lead to Fluid Volume deficit? ANSWER - Diarrhea - Vomiting - Hemorrhage - Polyuria Q. What LOC changes are manifestations of ECF deficit? ANSWER - Restlessness - Drowsiness - Lethargy - Confusion - Dizziness Q. What integumentary manifestations occur with ECF deficit? ANSWER - Cold clammy skin - Decreases skin turgor - Dry mucous membranes Q. What cardiovascular manifestations occur with ECF deficit? ANSWER - decreased capillary refill time - Increase pulse rates - Decrease CVP - Postural hypotension Q. What does CVP stand for? ANSWER - Central venous pressure Q. What Respiratory manifestations occur with ECF deficit? ANSWER - Increased Respiratory rate Q. What urinary manifestations occur with ECF deficit? ANSWER - Decreased urinary output (Anuria) - Concentrated specific urinary gravity Q. What urinary specific gravity test results would indicate ECF deficit? ANSWER - 1.025 Q. What are some important nursing management skills to implement with ECF deficit and excess? ANSWER - Daily weight monitoring - Input /output monitoring - Vital signs monitoring Q. What weight gain should a patient report to their HCP regarding Fluid retention? ANSWER - increase in 1 Kg or 2.2 lbs Q. How much mL of water retention is retained with 1kg (2.2 lbs) increased in weight? ANSWER - 1,000 mL (1L) Q. What should be instructed to patient when it comes to monitoring weight? ANSWER - Weigh every day at the same time - typically wear like clothing - Use same calibrated scale Q. What should a nurse do prior to weighing a patient? ANSWER - remove excessive bedding - empty all drainage bags Q. What is included in input documentation? ANSWER - Oral intake - IV fluids - Tube feedings - Retained irrigation solutions Q. What is included in output documentation? ANSWER - Urine - Excessive perspiration (estimated) - Wound / tube drainage (estimated) - Vomitus - Diarrhea Q. What should be noted about urine? ANSWER - amount of urine - coloration of urine - measure specific urinary gravity Q. What is considered to be diluted urine gravity? ANSWER - 1.010 Q. When should a nurse perform a cardiovascular assessment with ECF deficit? ANSWER - PRN (ECF deficit Cardio) Q. `What causes the increased HR related to ECF volume deficit? ANSWER - Due to Peripheral Vasoconstriction Q. What pulse force is associated with ECF volume deficit? ANSWER - Weak / thready pulses (ECF deficit) Q. What should be implemented with a patient with ECF volume deficit? ANSWER - Fall precautions should be implemented Q. What is a normal skin turgor test look like? ANSWER - Readily moves and, when released rapidly returns to former position Q. What does a ECF Deficit Skin Turgor test result look like? ANSWER - Diminished skin turgor - Tenting skin - lag in pinched skinfold returning to original state Q. Where can skin turgor be tested at? ANSWER - Abdomen - Sternum - Anterior forearm Q. What skin changes are associated with mild ECF deficit? ANSWER - Skin will be warm - Skin will be dry / wrinkled Q. What skin changes are associated with severe ECF deficit? ANSWER - Cool skin - Moist skin Q. What occurs to the thirst mechanism with severe ECF deficit? ANSWER - Thirst sensations activated Q. What occurs to the mouth in association w/ ECF Deficit? ANSWER - Tongue becomes furrowed - Oral mucous dries up Q. How can a nurse maximize comfort for a patient w/ dehydration or on fluid restriction? ANSWER - Providing oral hygiene is kill for comfort Q. What sodium values are expected with ECF deficit? ANSWER - increase in sodium Q. What BUN levels are expected with ECF deficit? ANSWER - Increase in BUN levels Q. What occurs to the Hematocrit (hct) levels with ECF deficit? ANSWER - Increased hct count Q. What other factors increase related to ECF deficit? ANSWER - Plasma - Increased urine specific gravity (osmolality) Q. What IV drugs types can treat ECF deficit? ANSWER - Isotonic IV solutions - Lactating ringer (ISO) - Hypotonic IV solution What IV drugs are given to ECF deficit if severe ECF deficit is noted? - Hypotonic IV solutions What system failures can cause ECF excess? - Heart Failure - Renal Failure What Drugs can cause ECF excess? - Isotonic IV fluids - Hypotonic IV fluids What drugs, in long-term utilization, can cause ECF excess? - Corticosteroids What occurs to the BUN levels with ECF excess? - BUN Levels decrease due to ECF excess What occurs to the Hematocrit (hct) levels with ECF excess? - HCT levels decrease due to ECF excess What occurs to Urine Specific gravity levels with ECF excess? - Urine specific gravity levels decrease due to ECF excess What would be a Urine Specific Gravity level associated with ECF excess? - 1.010 What disease can cause ECF excess? - SIADH - Primary Polydipsia What is primary polydipsia? Increased water intake that leads to dilute urine and hyponatremia What occurs to the sodium levels with ECF excess? - Sodium levels will decrease due to ECF excess What S/S related to edema are associated with ECF excess? - Peripheral edema - Pulmonary edema What type of pulses are related to ECF excess? - bounding pulses w/ ECF excesss What heart sounds may be present with ECF excess? - S3 sounds may be present with ECF excess What LOC changes occurs w/ both ECF deficit and Excess? - Lethargy - Confusion What LOC changes occur w/ ECF excess? - Headaches (ECF excess) What causes headaches to occur with ECF excess? - increase in BP / bounding pulses What respiratory changes occur w/ ECF excess? - Dyspnea - Crackle sounds What lung sound will occur with ECF Excess? - Crackle sounds If normal renal function occurs, what urinary s/s will occur w/ ECF excess? - polyuria What cardiovascular s/s is related to fluid retention in ECF excess? - Jugular vein distention (JVD) What should a nurse do, beside the general information, with a patient with ECF Excess? - Monitor for JVD - Auscultation of heart for S3 sounds If a patient with hyponatremia, caused by HF/ SIADH, has ECF excess, what drug can be adminstered? - Tolvaptan PO What disease cause ECF Excess due to hyponatremia? - Heart Failure - SIADH What lab value is indicated of hyponatremia? - 136 mEq What lab value is indicated of hypernatremia? - 145 mEq What IV fluid can be utilized to treat Hypernatremia? - Sodium-free IV 5% dextrose in H2O What drug should be administered in order to treat hypernatremia? - Diuretics to excrete Na+ levels What behavioral S/S are associated with hypernatremia? - restlessness - lethargy - agitation What mouth S/S are related to Hypernatremia? Hypernatremia: - Swollen tongue - Dry tongue - Dry mucous membranes - intense thirst sensation What does S/S does hypernatremia mimic? - mimics ECF deficit What S/S does hyponatremia mimic? - mimics ECF Excess What occurs to the jugular venous filling time associated w/ hyponatremia? - decrease filling time What type/ rhythm of pulse is related to hyponatremia? - increased pulse rate - thready pulses What nonpharmacological treatments can help treat hyponatremia? - encourage oral intake of foods w/ high Na What IV fluids can treat hypona tremia by causing fluid replacement? - Isotonic Na containing IV - IV hypertonic 3% sodium chloride (NaCl) saline What drugs should be withheld when treating hyponatremia? - Diuretic drugs should be withheld while treating for hyponatremia If water excess is the cause of hyponatremia, what drug should be administered as ordered with loop diuretics? - Demeclocycline What drugs can be given to treat hyponatremia in patients who cannot handle fluid restriction? Vassopressors: - Conivaptan - Tolvaptan What drugs is administered via IV if the patient is suffering from severe hyponatremia? - Conivaptan (severe) What lab values indicate hypokalemia? - 3.5 mEq What lab values indicate hyperkalemia? - 5.0 mEq What behavioral s/s are related to hyperkalemia? - Fatigue - irritability Confusion What musculoskeletal s/s are related to hyperkalemia? - muscle weakness - muscle cramps - Tetany What Gastrointestinal S/S are related to hyperkalemia? - Abdominal cramping - Diarrhea What pulses are related to hyperkalemia? - irregular pulses (K+) What skin S/S are related to hyperkalemia? - Paresthesia What should be monitored for with patients suffering from hyperkalemia? - ECG / Central line access - BP (due to hypotension) - Hyperglycemia (if on insulin) What drugs can be utilized to decrease K+ levels in the body and treat hyperkalemia? - Loop diuretics - Thiazide diuretics What veggie food items contain K+? - Cooked broccoli - Raw carrots - greens - spinach What fruits contain K+ - Apricots - Prunes - Grapefruit - Honeydew - Oranges - Raisins What other food items contain K+? - Baked beans - Bran - Chocolate - Granola - Nut seeds If IV insulin is administered to help treat hyperkalemia, what should be administered with it? One of the following: - beta agonist - sodium bicarb - calcium chloride What LOC changes are associate w/ hypokalemia? Hypokalemia LOC s/s: - Fatigue - Nausea What occurs in the legs as a S/S of hypokalemia? - Muscle weakness - leg cramps What ECG changes are related to hypokalemia? - Flat T waves - Depressed ST segments - U-waves present - Prolonged QRS segments What diabetic s/s is related to hypokalemia? - Hyperglycemia What gastrointestinal s/s is related to hypokalemia? - Constipation - Nausea - Paralytic ileus What s/s related to the muscles are related to hypokalemia? - Soft muscles - Weak muscles - flabby muscles What type of respirations are associated w/ hypokalemia? - Shallow respirations What type of pulses are associated w/ hypokalemia? - Weak pulses - irregular pulses What should be administered to treat hyperkalemia? - KCL (PO or IV) What is the maximum dosage of KCL that can be administered per hour? - 10 mEq per hour (mEq/Hr) What are things to remember about administering IV KCL to a patient w/ hyperkalemia? - Dilute IV KCL to 10 mEq/ Hr - Never give as a bolus - Never give an IV push - Invert bag containing KCL several times - Do not add KCL to hanging bags - Administer via infusion pump What should be done prior to spiking the IV Bag for KCL? - acquire / set up infusion pump - invert IV KCL several times At what rate should a nurse monitor a patient on an IV KCL drip? - Q1H (Every hour) What serum levels are associated w/ hypocalcemia? - 9.0 mEq What serum levels are associated w/ hypercalcemia? - 10.5 mEq What LOC changes are s/s of hypercalcemia? - Lethargy - Decreased memory - Confusion - Psychosis - fatigue What occurs to the patient's reflexes as a s/s of hypercalcemia? - Depressed reflexes occurs What occurs to the BP with a patient w/ hypercalcemia? - An increase in BP occurs w/ hypercalcemia What stomach / gastrointestinal s/s are related to hypercalcemia? - Anorexia - Nausea - Vomiting What can occur to the bones as a s/s of hypercalcemia? - Bone pain - Bone fractures What occurs to the urinary system as a s/s of hypercalcemia? - polyuria - nephrolithiasis (kidney stones) What is nephrolithiasis? kidney stones What does polyuria cause as a s/s related to hypercalcemia? - Dehydration What tests should be monitored with a patient w/ hypercalcemia? Liver / kidney function tests: - ALT - AST What would a nurse monitor on an ECG for w/ a patient with hypercalcemia? - Tachycardia What should an RN instruct a patient to do to help treat hypercalcemia? - increase weight bearing exercises How much fluids should an individual increase their fluid intake to in order to help treat hypercalcemia? - 3,000 to 4,000 mL Fluids Why should a patient w/ hypercalcemia increase their fluid intake? - helps prevent nephrolithiasis What IV saline fluids should be administered per order with a patient suffering from severe hypercalcemia? Isotonic solutions: - Bisphosphonate Gold Standard - Calcitonin - Denosumab What should be administered to a patient with severe hypercalcemia caused by cancer? - Bisphosphonate gold standard How does calcitonin treat hypercalcemia? - rapidly increases renal excretion What should be administered to a patient w/ hypercalcemia if Bisphosphonate does not work? - Denosumab If no medications work for treating severe hypercalcemia, what should be performed as ordered? - Dialysis (hypercalcemia) What tests are performed to check for hypomagnesemia AND hypocalcemia? - Chvostek's sign - Trousseau's sign What LOC changes occur as a s/s of hypocalcemia? - Depression - Irritability - Confusion - Fatigue What occurs to the BP of a patient w/ hypocalcemia? - Decreased in BP (hypocalcemia) What CNS sensations occur as a s/s of Hypocalcemia? Numbness AND tingling in the following areas: - Extremities - Regions around the mouth Tetany Where does numbness/ tingling occur in a patient w/ hypocalcemia? - In extremities - Regions around the mouth What muscle spasms occur as a s/s of hypocalcemia? - tetany - Laryngeal - Bronchial Where can you observe spasms occurring as a result of hypocalcemia? - Laryngeal - Bronchial What type of surgeries put patients at risk for developing hypocalcemia? - Neck surgeries - Thyroid surgeries What are some lab values that should be monitored for in patients w/ hypocalcemia? - Ca serum levels - pH levels - CO2 levels What should a nurse instruct a patient to do if they have mild hypocalcemia? - increase vitamin D intake or absorption What can hypercalcemia cause respiratory wise in patients? - Hyperventilation What should a RN do to instruct a patient to retain CO2 in relationship to hyperventilation with hypocalcemia? - breath into a paper bag What IV solution should be administered to treat hypocalcemia? - IV Calcium gluconate What can breathing into a paper bag help treat in relationship to hypocalcemia? - Tetany - muscle spasms - anxiety (hyperventilation) If the patient is on diuretics and develops hypocalcemia, what type of diuretic should the patient be switched to? - Thiazide diuretics What serum level indicates hypophosphatemia? - 3.0 mEq What serum level indicates hyperphosphatemia? - 4.5 mEq What s/s does hyperphosphatemia mimic? - hypocalcemia When does hyperphosphatemia mimic hypocalcemia? - when phosphate binds to calcium If phosphate does not bind to calcium, what are the s/s of hyperphosphatemia? - Symptoms would be asymptomatic What cardiovascular s/s are related to hyperphosphatemia? - Hypotension - dysrhythmias What can form when hyperphosphatemia occurs? - Calcium-phosphate precipitates Where can calcium-phosphate precipitates form in regards to s/s of hyperphosphatemia? - Skin - Soft tissue - Cornea - Viscera - Blood vessels What can occur to the reflexes as a s/s of hyperphosphatemia? - hyperreflexia (hyperphosphatemia) How often should nurses monitor calcium AND phosphate serum levels w/ a patient suffering from hypophosphatemia? - Every 6-12 hours (Q6-12H) What serum levels should be monitored while patient is dealing with hyper or hypophosphatemia? - Serum phosphate - Serum Calcium What Vital signs are important to monitor for with patients w/ hyperphosphatemia? Monitor hyperphosphatemia patients VS for the following: - BP - ECG levels What should be performed if severe hyperphosphatemia occurs per order? - Hemodialysis What drugs can be administered as ordered with a hyperphosphatemia patient? - Loop diuretics (hyperphosphatemia) What does loop diuretics cause to occur with hyperphosphatemia patients? - Volume expansion - Forced diuresis What foods should be limited with a hyperphosphatemia patient? - Diary products should be limited Why should diary products be limited with a hyperphosphatemia patient? - b/c dairy products contain high phosphate levels What CNS (LOC) changes occur as a s/s of hypophosphatemia? - Confusion - Coma What disease can cause hypophosphatemia? - Rickets - Osteomalacia - Rhabdomyolysis What cardiovascular s/s are related to hypophosphatemia? - Dysrhythmias - Heart Failure (HF) What musculoskeletal s/s are related to hypophosphatemia? - Respiratory muscle weakness What type of neuropathy is a s/s of hypophosphatemia? - Polyneuropathy If MILD hypophosphatemia occurs, what should be done for treatment? - increase oral intake of dairy products - increase phosphate supplements if symptomatic hypophosphatemia occurs, what should be done for treatment? - IV fluids containing phosphate should be administered What type of IV fluids treat symptomatic hypophosphatemia? - IV sodium phosphate - IV Potassium Phosphate What teaching method should be taught to hypophosphatemia patients? - Teach about ADVERSE impacts of phosphate supplementation A nurse is assessing a client who has required bed rest for the past month. Which of the following should the RN ID as an indication that the client has developed thrombophlebitis? - Calf swelling A RN is administering and Otic medications to an older adult client. Which of the following actions should the RN take to ensure meds reach inner ear? - Pressing gently on the tragus of the ear Helps get medications into inner ear An RN is caring for a client who has a new prescription for wrist restraints. What should the RN do? - Pad clients wrists before applying restraints prevents abrade of the clients skin What should an RN do while performing medication reconciliation? - compare clients home medications to providers prescriptions What tasks can an AP perform? - Assist w/ baths - Check Vital signs (BP) post op - Communicate w/ patient What serum levels indicate hypomagnesemia? - 1.3 mEq What serum levels indicate hypermagnesemia? - 2.1 mEq What LOC changes can occur as a result of hypermagnesemia? The following can occur due to hypermagnesemia: - Lethargy - Drowsiness What urinary s/s are related to hypermagnesemia? - Urinary retention What vital signs decrease as a s/s of hypermagnesmia? - Pulse - BP What muscle changes occur as a s/s of hypermagnesemia? - Muscle weakness - Diminished Deep tendon reflexes What occurs to the deep tendon reflexes as a s/s of hypermagnesemia? - Deep tendon reflexes diminish What integumentary s/s are related to hypermagnesemia? - Flushed skin - Warm skin What VS should be monitored for hyper/hypomagnesemia? The following Mg related deficits or excess should be monitored: - VS - Pulse - ECG - BP - Serum Mg levels What IV fluids can be administered as ordered to treat hypermagnesemia? - IV calcium gluconate What does IV calcium gluconate do to symptomatic hypermagnesemia? - opposed effects of excessive Mg on cardiac muscles What should be avoided when pregnant with hypermagnesemia? - Laxatives - Antacids What types of foods have high amounts of Mg in them? - Greens - Veggies - Nuts - bananas - Oranges - Peanut butter - Chocolate What are some LOC changes that occur w/ hypomagnesemia? - Confusion - Vertigo What neurological s/s occur w/ hypomagnesia? - Tremors - Seizures What occurs to the deep tendon reflexes as a s/s of hypomagnesemia? - Hyperactive deep tendon reflexes What cardiac s/s are related to hypomagnesemia? - Increase BP - Increased Pulse - Dysrhythmias occur If Mild hypomagnesemia occurs what can one do to treat it? - increase Mg supplement - Add diet high in Mg if hypomagnesemia is severe, what IV fluids should be administered as ordered? - IV Magnesium sulfate via Infusion pump What is a Chvostek sign? Twitch of the corner of the mouth on tapping finger over facial nerve in front of the ear What is the Trousseau's sign? - BP cuff inflated and causes a carpal spasm. - Patient touches thumb / index digits together What does a positive Trousseau's / Chvostek's sign indicate? - Hypomagnesemia - Hypocalcemia What are the normal ranges of pH in the body? - 7.35 - 7.45 What is the normal Bicarbonate (HCO3) range in the body? - 22-26 mEq/L What is the normal PaCO2 range w/n the body? - 35-45 mmHg What ABG lab values indicate Metabolic Acidosis is occurring? - pH: 7.35 - HCO3: 22 What pH value indicates acidosis? - 7.35 What pH value indicates Alkalosis? - 7.45 What neurological s/s occur with metabolic acidosis? - Lethargy - Confusion - Dizziness - HA - Coma What cardiovascular s/s is related to metabolic acidosis? - Decrease BP - Dysrhythmias (M.Acid) why does dysrhythmias occur with Metabolic acidosis/ alkalosis s/s? - due to compensatory hyperkalemia What Gastrointestinal s/s is r/t Metabolic acidosis? - Abdominal pain (M.Acid) What respiratory s/s are r/t to Metabolic acidosis? - Deep respirations - Rapid respirations What lab values are r/t Metabolic Alkalosis? - pH: 7.45 - HCO3: 26 What respiratory s/s are associated with metabolic alkalosis? - Tachycardia - Dysrhythmias What gastrointestinal s/s are r/t to Metabolic Alkalosis? - Epigastric pains What neurological s/s are r/t to metabolic alkalosis - Tetany (M.Alk) - Tingling of extremities - Hyperreflexia - Seizures What does Metabolic Alkalosis closely resemble? - Hypocalcemia What respiratory s/s are r/t to Metabolic Alkalosis? - Hyperventilation (M. Alk) What lab values indicate respiratory acidosis? - pH: 7.35 - PaCO2: 45 What cardiovascular s/s are r/t to Respiratory acidosis? - Ventricular fibrillation - Decreased BP What integumentary s/s are r/t to Respiratory Acidosis? - Warm skin - Flushed skin What respiratory s/s are r/t to Respiratory Acidosis AND alkalosis? - Hypoventilation What occurs with Hypoventilation r/t to Respiratory Acidosis? - Hypoxia What Lab Values indicate Respiratory Alkalosis? - pH: 7.45 - PaCO2: 35 What behavior s/s are r/t to Respiratory Alkalosis? - Irritability What type of heart rhythm is r/t Respiratory Alkalosis? - Tachycardia (R. Alk) - Dysrhythmias What gastrointestinal s/s are r/t to Respiratory Alkalosis? - Anorexia - N/V What type of musculoskeletal s/s are r/t to Respiratory Alkalosis? - Hypertonic muscles - Muscle cramps What neurological s/s are r/t to Respiratory Alkalosis? - Tetany - Tremors - Tingling of toes/fingers - Seizures What are the three categories of fluids? - Isotonic - Hypotonic - Hypertonic How is isotonic fluid osmolality compared to blood? - Mimics osmolality of blood How is Hypertonic fluid osmolality compared to blood? - Has a higher osmolality compared to blood How is hypotonic fluid osmolality compared to blood? - Has a lower osmolality compared to blood What is isotonic fluids utilized for? - ECF expansion - Ideal for treatments r/t ECF deficits If a patient has an ECF deficit, what type of fluid should be utilized to treat? - isotonic fluids What are some examples of isotonic IV solutions? - 0.9% Sodium chloride - 5% dextrose in Normal Saline - Lactated Ringers - Ringers solution What can 0.9% Sodium Chloride treat? - Fluid loss r/t Vomiting AND diarrhea What serum levels are increased with 0.9% sodium chloride (isotonic)? - Na - Cl What can 5% dextrose (isotonic) be utilized to treat? - Hypernatremia - Hypertonic losses What does Ringers (isotonic) solutions treat? - ECF losses by expanding intravascular losses What electrolytes does lactating ringers (isotonic) contain? - Na - K - Cl - Ca - Lactate What is lactate? - Precursor to bicarbonate What is contraindicated to taking lactating ringer (isotonic) solutions? - Liver/ Kidney dysfunction What type of electrolyte excess should not take lactating ringers? - Hyperkalemia Why is Hypovolemia contraindicated to taking lactating ringers? - Due to the decreased ability to convert lactate to bicarbonate What type of diabetic event should not receive lactating ringers? - DKA What is lactating ringers ideal for treating? - Fluid loss (ECF) - Malnourishment - lack of electrolytes in diet What type of fluid loss events should lactating ringers administered as ordered to help treat? - Burns - Surgery - Gastrointestinal What does hypertonic IV solutions do to the ECF? - Causes fluid to be removed from the ECF How does hypertonic IV solutions impact blood osmolality? - increases serum osmolality What are some examples of Hypertonic IV solutions? - 3% Sodium chloride - 10% dextrose in water - 5% dextrose in 0.45% normal Saline (NS) - 5% dextrose in 0.9% NS What is 3% Sodium Chloride (Hypertonic) IV utilized to treat? - Symptomatic hyponatremia - Head injuries What is 10% dextrose in water (Hypertonic) IV utilized to treat? - Parenteral nutrition What is 5% dextrose in 0.45% NS (Hypertonic) utilized to treat? - Treatment is considered to be a maintenance solution What is 5% dextrose in 9% NS (Hypertonic) utilized to treat? - Metabolic alkalosis - Volume deficits in hyponatremia Who should not receive Hypertonic solutions? - patients w/ ECF deficits - Patients w/ Low BP What should be monitored while a patient is on a Hypertonic solution? - BP - Lung sounds - Serum Na levels Why should serum Sodium (Na) levels be monitored for in a patient taking hypertonic IV solutions? - Due to risk for intravascular fluid volume excess How does Hypotonic IV solutions impact ECF levels? - Dilutes ECF What does hypotonic IV solution do to the osmolality of blood? - Lowers serum osmolality What are some examples of hypotonic IV Solutions? - 0.45% Sodium Chloride - 5% dextrose in water What is 0.45% Sodium Chloride (hypotonic) utilized to treat? - Hypernatremia What is 5% dextrose in water indicated for? - Prevention of Ketosis associated w/ Starvation What can LOC changes in mentality indicate w/ hypotonic IV Solutions? - Cerebral edema occurrence What are the two greatest complications to an IV site with infusing KCL? - Phlebitis - Infiltration What does infiltration of an IV site cause? - Sloughing - Necrosis With Hypokalemic patients, what is extremely important to monitor while infusing KCL? - ECG monitoring is crucial for KCL infusion monitoring What is a bronchoscopy? Procedure in which the bronchi are visualized through a fiberoptic tube. Maybe used for diagnostic purposes to obtain biopsy specimens and assess changes resulting from treatments. What are some pre-Procedure considerations for a Bronchoscopy? - Implement NPO 6-12 hours prior to the procedure - Give Sedation as ordered - Ensure doc obtained informed consent What are some post-procedure considerations for a Bronchoscopy? - Keep NPO until gag reflex returns - Monitor sedation - Monitor for blood / Hemorrhage - Monitor for Pneumothorax What is a CT scan? An x-ray, using specialized equipment, that takes cross-sectional pictures of the body. What can CT scans diagnose? - Lesions that are hard to assess What systems of the body should be evaluated prior to administration of contrast w/ a CT scan? - Renal / Liver function should be assessed What allergies should be assess prior to administration of a CT scan? - Allergies to Shellfish How long should a patient be NPO for prior to a CT? 6 hours prior What should be encouraged in patients who took contrast after surgery? - Increase fluid intake to decrease renal complications What is a thoracentesis? Insertion of a large bore needle through the chest wall into the pleural space What is Thoracentesis utilized for? - Obtaining a specimen from the pleural space - Removal of pleural fluid - Administration of medications What are some post-operative s/s an RN should know about Thoracentesis? - Observe for Hypoxia - Observe for Pneumothorax What needs to be verified post-op of a thoracentesis? - Breath sounds occur in all lung fields What can be encouraged with a patient who is post-op for Thoracentesis? - Deep breathing to expand lungs What procedure should always be done after a Thoracentesis is performed? - X-ray to check for a pneumothorax What is a TB skin (Mantoux) test? - Test performed via intradermal injection to test if possible positive TB is present What does a positive TB skin (Mantoux) test look like? - Red blister will occur What should be remembered about TB skin (Mantoux) tests? - False positives / negatives occur and further Dx procedures should be utilized to determine if TB is present What are some things to remember about TB Skin (Mantoux) tests? - Do not press on injection site - Circle site - Draw diagram of forearm and hand - Label injection site when documenting What should be instructed to a patient regarding TB Skin (Mantoux) tests? - Results must be read w/n 72 hours of administration - Do not remove circled mark of injection site What diagnostic procedure is utilized to determine symptoms of TB are present within a patient? - Chest x-ray What test is utilized to determine if patient is truly positive for TB / determines treatment options for TB patient? - Sputum studies What is a sputum study? - A test to determine if Mycobacterium is present and the patient is positive for TB and can determine effective treatment options of TB When should a sputum culture be collected? - early in the morning after oral care is performed What should be performed is patient cannot deep cough to expectorate sputum? - A bronchoscopy may be needed to have patient produce sputum What LOC changes occur as a result of early inadequate oxygenation? - apprehension - restlessness or irritability - Confusion/ lethargy - Fatigue What Respiratory s/s occur as a result of early inadequate oxygenation? - Tachypnea - Dyspnea on exertion What Cardiovascular s/s occur as a result of early inadequate oxygenation? - Tachycardia - Mild Hypertension - Dysrhythmias What occurs to the urinary output as an s/'s of early inadequate oxygenation? - Decreased urinary output What integumentary s/s are associated with early and late inadequate oxygenation - Diaphoresis What are some LOC changes that occur to late inadequate oxygenation? - Unexplained confusion / lethargy - Combativeness - Coma What Respiratory s/s occur as a result of Late inadequate oxygenation? - Dyspnea - Use of accessory muscles - Retraction of intercostal spaces on inspiration - Pause of breath between sentences / words What Cardiovascular s/s occur as a result of Late inadequate oxygenation? - Dysrhythmias - Hypotension What are some integumentary s/s of late inadequate oxygenation? - Cyanosis - Cool / clammy skin Why is a tracheostomy utilized? - Establish a patent airway - bypass upper airway obstruction - facilitates removal of secretions - permits long mechanical ventilation What is some tracheostomy post-op care an RN should remember? - ENSURE patent airway - pain management What should be monitored for at the surgical site of a tracheostomy insertion? - Edema - Bleeding - s/s of infection What is the priority assessment of tracheostomy care? - assessment of O2 saturation before and after suctioning How often should tracheostomy assessments occur? - once per shift What should be monitored for with the tracheostomy tube? - confirmation of patency What should be monitored for with tracheostomy care - edema - redness - inflammation - Ulceration - signs of an infection How often should sterile dressing changes occur with tracheostomy care? - Every 12 hours (Q12H) what should be done after insertion of a tracheostomy? - Confirmation of tracheostomy placement with an X-ray What vital signs should be assessed prior to tracheostomy suctioning? - HR - Heart rhythm - RR - SpO2 How long should preoxygenation (hyperoxygenation) occur for prior to suctioning? - 30 seconds minimum How much O2 should the ventilator be adjusted to during the 30 second preoxygenation period of trach suctioning? - 100% O2 When should the RN stop inserting the suctioning device during a trach suction? - once the patient begins to cough (hits the carina) When should suctioning be applied during trach suctioning? - As the catheter is being slowly withdrawn How long should continuous suctioning be applying to while performing trach suctioning? - 10-15 seconds maximum What indications require the RN to immediately stop suctioning and to remove the catheter during trach suctioning? - Bradycardia - Hypotension - Dysrhythmias - SpO2 decreases less than 90% How long should you wait between trach suctioning passes? - 30 minutes What should be done during the 30 seconds between trach suctioning passes? - Hyperoxygenation How many passes can be performed during trach suctioning before a break may occur? - 3 attempts What should be documented about trach suctioning? - Time - Amount of secretions removed - Characteristics of secretions - Patient response to suctioning What should be kept in a room with a tracheostomy tube in place? - Replacement tube that is equal or of a smaller size What is the minimum time required prior to a trach tube being replaced? - 24 hours after insertion What should be assessed in a patient if dislodgement of a trach tube occurs? - LOC - Presence/ Absence of respiratory distress What should be done if respiratory distress occurs? - Use Catheter to to allow passage of air and serve as a guide to have new tube inserted over - Utilize a hemostat to spread opening, insert obturator and then insert tube into stoma and remove obturator What methods can be utilized for temporary speech loss patients? - White boards - Technology What does the utilization of temporary speech loss aids for patients depend on? - Patient preferences What are some long-term communication techniques for patient with permanent loss of speech - Esophageal speech - Electrolarynx - Transesophageal puncture What is the definition of pneumonia? - acute infection of the lung parenchyma What are the pneumonia risk factors? - Abdominal / chest surgery - Air pollution - 65 years old - Altered consciousness - Bed rest/ prolonged immobility - Chronic diseases - Debilitating illnesses - Immunosuppressive disease / therapy - intestinal / gastric feedings - Smoking - Tracheal intubation - URI - Malnutrition What LOC changes can cause pneumonia? - Alcoholism - Head injury - Seizures - Anesthesia - Drug overdose - Stroke What chronic disease can cause pneumonia? - Chronic lung disease - Liver disease - Diabetes - Heart disease - Cancer - Chronic kidney disease Exposure to what things can cause pneumonia? - Bats - Rabbits - Farm animal droppings What immunosuppressive diseases / therapies cause pneumonia? - Corticosteroids - Cancer chemotherapy - HIV infection - Organ transplant What type of gastric / intestinal feedings can cause pneumonia? - NG tubes What type of tracheal intubations can cause pneumonia? - Endotracheal intubation - tracheostomy What commonly causes pneumonia? - Aspiration - Inhalation - Hematogenous - Community-acquired - Medical-car associated What does hematogenous pneumonia mean? - Spread of microorganism to lungs from a primary infection elsewhere What does community-acquired pneumonia mean? - Acute infection of the lungs who have not been hospitalized or in care facilities w/n 14 days (2 weeks) What types of Medical-care associated pneumonia are there? - Hospital-acquired - Ventilator associated - Health-care associated What does hospital acquired pneumonia mean? - Pneumonia acquired w/n 48 hours of hospital admission What does ventilator associated pneumonia mean? - Pneumonia that after 48 hours of endotracheal intubation What does hospital-associated pneumonia mean? - pneumonia that occurs in patient who have been hospitalized What is the acronym associated with the manifestations of Pneumonia? - CURB-65 scale What does the "C" stand for in CURB-65 scale? Confusion (compared to baseline) What does the "U" stand for in CURB-65 scale? - Urinary (BUN) What BUN level is associated w/ pneumonia? - 20 mg/dL What does the "R" stand for in CURB-65 scale? - Respiratory Rate What Respiratory rate is associated w/ pneumonia? - 30 breaths per minute What does the "B" stand for in CURB-65 scale? - Blood pressure What systolic BP is associated w/ pneumonia? - 90 mmHg What diastolic BP is associated w/ pneumonia? - 60 mmHg What does the "65" stand for in CURB-65 scale? - 65 years of age What does the "SCALE" stand for in CURB-65 scale? - LDH 230 μ/L - Albumin = 3.5 g/dL - Platelet count = 100 x 10 ^9 / L What platelet count is associated w/ pneumonia? Platelet count = 100 x 10 ^9 / L What albumin level is associated w/ pneumonia? - 3.5 g/ dL What LDH level is associated w/ pneumonia? - 230 μ/L What causes the impaired gas exchange in pneumonia? - Fluid / exudate build up in capillary-alveolar membrane What devices can help the treatment of pneumonia? - Incentive spirometer utilization How can one decrease pneumonia risk in immobile patient? - early ambulation decrease immobility and decreases risk of pneumonia What are some manifestations of pneumonia? - Cough - Fever - Chills - dyspnea - tachypnea - pleuritic chest pain What lung sounds are associated w/ pneumonia? - Fine / coarse crackles What are some manifestations of pneumonia in elderly patients? - Confusion - Stupor (r/t hypoxia) What type of chest pain is associated w/ pneumonia? - Pleuritic chest pain What respiratory s/s are associated /w pneumonia? - Dyspnea - Tachypnea how much should fluids be increased to in pneumonia patients? - minimum of 3 L per day What drugs can be administered as ordered to treat pneumonia? - Antibiotics - Antipyretics - Analgesics - Nonsteroidal anti-inflammatory drugs What should be taught to pneumonia patients regarding activity? - Activity should be balanced w/ rest What does an incentive spirometer do? - Measures lung volumes and how much air can a person bring (SUCK) in What should be avoided with pneumonia patients? - smoking - ETOH What does ETOH / Smoking do to antibiotic drugs? - negates effects of antibiotics When should a chest x-ray be repeated with pneumonia patients? - 6-8 weeks after What vaccines should a patient be educate on with pneumonia? - pneumococcal vaccine - flu vaccine What is tuberculosis? an infectious bacterial disease caused by Mycobacterium tuberculosis that can be aerosolized and suspended in the air for a brief period of time What precautions should TB patient be placed into? - Airborne precautions What are some risk factors associated w/ TB? - Contact w/ TB patient - Lower socioeconomically status - immunocompromised - crowded / poor ventilated environments - 65 years old - Drug/ substance abuse - Traveling outside the US - limited access to HC What are some manifestations of TB? - Persistent cough - Purulent sputum - Fatigue - Lethargy - Weight loss - Night sweats - Low-grade fever What lab tests are associated w/ TB? - TB skin (Mantoux) test - QuantiFERON TB Gold blood tests - Sputum culture what type of sputum culture test is use to diagnosis TB? - Acid-Fast Bacilli smear & culture test What type of isolation is utilized in TB patients or potential TB patients? - Negative pressure isolation (airborne precautions) If a negative pressure room is unavailable, how can a TB patient or potential TB patient be isolated? - Via utilization of a mask What should be instructed to TB patients? - restrict visitations - Restrict travel plans - teach hand hygiene importance What is the biggest risk factor for Lung cancer? - Smoking What are the risk factors for lung cancer? - Gender - Pollutants - Radiation - Asbestos - Smoking What are the clinical manifestations of Lung cancer? - Chronic cough - Blood-tinged sputum - Dyspnea - Wheezing - Chest pain what % of lung cancer is caused by smoking? - 80-90% What should lung cancer patient teaching be focused on? - Stress response - course of treatment - smoking cessation How is lung cancer diagnosed? - History / Physical examination - Chest x-ray - Sputum culture - CT scan - Bronchoscopy What can cytological sputum tests determine in lung cancer? - Lung mass - Infiltration What is a chest tube? A disposable three‑chamber drainage system is most often used. What does chest tubes do? - Reestablishes negative pressure - Facilitates expansion of lungs - Returns intrapleural pressure to normal Where can chest tubes be inserted? - At bed side - In the ED - in the operating room What type of incision is utilized to insert the chest tube? - Thoracotomy incision When can a chest tube be removed? - When lung expansion has expended back to normal - There is no more fluid drainage What is the name of the first chamber of a chest tube? - Drainage chamber What is the name of the second chamber of a chest tube? - Water seal chamber What is the name of the third chamber of a chest tube? - Suction control chamber What are some complications to chest tubes? - Air leakage - Accidental disconnection - Accidental system blockage - Accidental removal What are some s/s of air leakage in a chest tube? - Constant bubbling w/n the water-seal chamber What should be instructed to the patient to do if a chest tube is discharged? - Exhale as much as possible to remove air - Cough to remove as much air as possible in pleural space What should a nurse do if the chest tube system is compromised? - Place chest tube tip end into a sterile water Why does one insert the chest tube tip into a sterile water cup if a chest tube system is compromised? - causes the water seal to be reestablished What should an RN do if a chest tube is accidently removed? - Dress the thoracotomy incision with dry / sterile gauze What are some s/s of a collapsed lung that is in need for a chest tube placement? - Cough - Pleuritic chest pain - Hemodynamic instability - absent breath sounds on the impacted side - Distended neck veins (JVD) - asymmetrical chest wall What does dullness on percussion / flatness on percussion indicate with a collapse lung? - Hemothorax - Pleural effusion What are some triggers of asthma? - allegens - air pollutants - drugs - inflammation - occupational exposure - exercise - stress - sudden temp changes - hormones - sinusitis - respiratory infections - cigarette smoke What are some clinical manifestations of asthma attacks? - Wheezing - Coughing - Dyspnea - Chest tightness What are some Diagnostic test for Asthma? - Peak respiratory flow rate (PEFR) - Peak flow meter - Spirometer - Oximetry - ABG - Chest x-ray - Allergy testing What does an Asthma action plan do? - Allows the ability for patient to safely manage an asthma attack What PaO2 rate should a severe attack requiring hospital administration of asthma? - 60 mmHg What SpO2 rate should a severe attack requiring hospital administration of asthma? - 93% What should an RN monitor in asthma patients? - PEFR - ABG - VS What VS should be monitored for in asthma patients? - RR - Pulse - SpO2 - HR What medications can be utilized to treat asthma? - IV corticosteroids - Short acting bronchodilators What is the rescue inhaler for asthma patients? Albuterol What are some education an RN can give to a chronic asthma patient? - Home Oxygen safety What should asthmatics avoid? - Trigger / irritants - Some medications What medications should be avoided by asthmatics? - NSAIDS - Aspirin What should be instructed to Asthmatics about upper respiratory infections/ sinusitis? - asthmatics should have upper respiratory infections (URI) / sinusitis diagnosed promptly What should be encouraged in asthmatic patients? - weight-loss - increase fluid intake - Good nutrition - adequate rest How much fluid intake should an asthmatic patient increase their fluid levels to? - 2-3 L per day What are some Pulmonary embolism risk factors? - immobility / reduced mobility - DVT - surgery w/n 3 months - History of VTE - Cancer - Obesity - Smoking - Oral contraceptive/ hormone therapy - Prolonged air/car travel - Pregnancy - HF - Clotting disorders What therapies can cause an increased risk for Pulmonary embolism? - Oral contraceptives - Hormone therapy What diseases increase the risk of pulmonary emobolism? - Heart failure (HF) - Cancer - Venous thromboembolism - Deep vein thrombosis What LOC s/s are associated w/ pulmonary embolism? - Change in mental status - Thoughts of impending doom / death - syncope What occurs to the veins in the neck as a s/s of pulmonary embolism? - Distended neck veins What respiratory s/s are associated w/ pulmonary embolism? - Pain upon inspiration - Chest wall tenderness - Dyspnea / air hunger - Pleural friction rub What VS s/s are associated w/ pulmonary embolism? - Decreased SpO2 What type of skin coloration s/s is associated w/ pulmonary embolism? - Cyanosis What diagnostic tests can diagnose pulmonary embolism? - D-Dimer - Spiral (helical) CT Scan/ CT angiography or CTA What is the most common diagnostic procedure utilized to Dx pulmonary embolism? - Spiral (helical) CT scan / CT angiography What causes D-Dimer elevation? - Any clot degradation What does troponin assess with pulmonary embolism? - If the heart was impacted by the pulmonary embolism and causes a Heart attack What is B-type natriuretic peptide (BNP) utilized to detect? - Heart failure - Electrolyte levels How can a nurse prevent Pulmonary embolisms? - Intermittent pneumatic compression devices - Early ambulation - Anticoagulant agents as ordered What position should the patient be in during immediate / priority care of pulmonary embolism? - Semi-fowler position What does administration of O2 as ordered do in priority care of pulmonary embolism? - Relieves hypoxemia - Dyspnea What should be monitored in pulmonary embolisms? - Coagulation times - Complications - LOC How often should respiratory status assessments be performed with pulmonary embolism? - Every 30 minutes What drugs can be administered as ordered for pulmonary embolism? - Anticoagulants - Fibrinolytic agents - other drugs What anticoagulation medications can be utilized to treat pulmonary embolism - Lower-molecular weight HEPARIN - unfractionated IV HEPARIN - Warfarin (Coumadin) How long should warfarin be utilized for in treatment of pulmonary embolism? - 3 months or longer What type of fibrinolytic agents can treat pulmonary embolism? - Tissue plasminogen activator (tPA) - Alteplase (activase) What other drugs can treat pulmonary embolism besides anticoagulation and fibrinolytic agents? - Enoxaparin - Fondaparinux What is the antidote of warfarin? Vitamin K What is the antidote for Heparin / Fondaparinux / Enoxaparin? - Protamine sulfate What is the biggest risk factor for COPD? - Smoking What deficiency can cause COPD? - AAT deficiency What type of cough is associated w/ COPD? - Sputum producing cough What type of chest changes occurs w/ COPD? - Barrel chest how does a patient mouth look like when breathing if they have COPD? - Pursed-lip breathing What position do you normally see patients breathing in with COPD? - Tripod breathing position What tests are utilized to Diagnose COPD? - Spirometry - Chest x-ray - AG - ECG - Sputum Culture/ sensitivity test - What should be of note when administering O2 to a patient w/ COPD? - Be careful administering O2 What drugs are utilized to treat COPD? - Bronchodilators - Corticosteroids What education should be discussed w/ a patient w/ COPD? - Smoking cessation - Vaccination education (Pneumonia / Flu) How long should a patient w/ COPD wait to exercise when food is about to be consumed - 1 hour before exercising - 1 hours after exercising What should a patient due prior to eating ? - Rest at a minimum of 30 minutes What type of diet should a COPD patient have a high macronutrient intake of? - Protein - High calories What type of macronutrients should a COPD patient consume a moderate amount of in their diet? - Fats - Carbohydrates How many meals should a COPD patient spread out their meals over? - 5-6 small meals What does spreading out meals w/ a COPD patient prevent? - Bloating - Early Satiety What should COPD patients avoid when constructing their meals? - Foods requiring a large amount of chewing - Gas-forming foods What are some examples of gas-forming foods? - Soda - Carbonated beverages What should be taught to COPD patients regarding O2 therapy? - Avoid smoking in a house w/ O2 therapy What is the definition of pneumonthorax? - Presence of air entering into the pleural cavity What are some causes of pneumothorax? - Blunt chest trauma - Penetrating chest wounds - Closed / occluded chest tubes What age group, and why they are at risk, are at a greater risk for pneumothorax? - Elderly patients, Due to decreased pulmonary reserves What causes decreased pulmonary reserves in elderly patients? - Decreased lung elasticity - Thickening Alveoli What are the s/s of a small pneumothorax? - Mild tachycardia - Mild dyspnea What are some breath sounds associated w/ severe pneumothorax? - absent breath sounds What occurs to the neck as a result of severe pneumothorax? - Trachea deviates (shifts) towards unimpacted side What type of assessments will be evident w/ severe pneumothorax? - Tracheal deviation - Asymmetrical lung cavity What occurs to the respiratory system as a result of severe pneumothorax? - Respiratory distress What are some s/s of respiratory distress associated w/ pneumothorax? - Tachycardia - Tachypnea - Hypoxia - Cyanosis - Dyspnea - Accessory muscle utilization What does a dull percussion indicate in pneumothorax? - A hemothorax is occurring How does one diagnose a pneumothorax? - with a chest x-ray (pneumo) What lab values are associated w/ pneumothorax? - PaO2 What occurs to the PaO2 as a result of a pneumothorax? - PaO2 80 mmHg How does one treat pneumothorax? - With a chest tube primarily What does treatment of a pneumothorax depend upon? - Severity - Underlying cause - Hemodynamic stability Where is the standard insertion site of a chest tube for a pneumothorax? - midaxillary What does a chest tube promote w/ a patient suffering from pneumothorax? - Lung expansion - Reestablishment of negative pressure - Drainage of pleural space What position should the bed be in when a chest tube is being inserted? - 30-60 degrees - arm raised above head What type of dressing is utilized w/ chest tubes? - Occlusive dressing What should be done after a chest tube is inserted? - X-ray should be performed to determine if location of the chest tube is correct If a patient is admitted to the ED w/ an impaled object that is causing pneumothorax, what should be done? - Stabilize item w/ bulky dressing - DO NOT PULL THE ITEM OUT! What is the priority treatment of pneumothorax? - Maintain airway / Breathing circulation How often should vital signs be monitored w/ a pneumothorax patient? - Every 4 hours (Q4H) pneumothorax What lab values should be monitored w/ a patient w/ pneumothorax? - ABG - SaO2 - CBC If a pneumothorax patient is on a ventilator, how often should the ventilator be monitored? - Q1H What position should a pneumothorax patient be placed in? - High fowlers position (90 degrees) - Hands on bed table - Sitting up What should be encouraged w/ a pneumothorax patient? - Encourage prompt medical attention when infections occur - Deep breathing exercises What does deep breathing exercises promote w/ a pneumothorax patient? - Lung expansion What central venous access can be utilized for a prolonged period of time? - PICC lines What can a PICC line be utilized to administer? - Chemotherapy - Prolonged antibiotic therapy - TPN administration Where are central lines placed / what do they allow? - Placed into a large vein and is considered a venous access Where is a peripheral line inserted? - on the peripheral aspect of the body What does Peripheral lines allow? - Venous access - IV therapy (Fluids) What is the definition of phlebitis? - Inflammation of a vein What can cause phlebitis? - Injury - Coagulation What does phlebitis look like? - Redness / Warmth around site - Pain - Swelling around site - Tenderness What can a nurse do to treat the redness/ warmth of phlebitis? - apply a cool compress What drugs can a nurse administer, and why they administer these drugs, w/ phlebitis? - NSAIDS, to reduce swelling of IV site What should a Nurse do when they see s/s of phlebitis? - Notify HCP - Change IV site What position change should an RN do to w/ phlebitis? - They should elevate the IV site What is the definition of infiltration? - Occurs when IV fluids leak into surrounding tissue sites What skin coloration changes occur as a result of infiltration? - Pallor / Blanching What temperature changes occur to site of infiltration? - site becomes cool to touch What sensations occur as as result of infiltration? - Discomfort - Burning What occurs to the skin around the IV site as a result of infiltration? - Swelling What are some complications of infiltration? - Necrosis - Sloughing of tissues What should the nurse do fist when s/s of infiltration appear? - Stop IV fusion immediately and remove IV site What tasks can an RN do to an infiltration IV that has stopped and the site once the site is removed? - Apply warm compress - Elevate affected area - Start a new IV site - Notify HCP - document finding What sensations are associated w/ infiltration of an IV site? - IV site will be cool to touch How does one treat the coolness of the iv site due to infiltration? - Apply warm compress