NSG 3023-NSG3023 FINAL EXAM STUDY GUIDE. Questions and Answers

NSG 3023-NSG3023 FINAL EXAM STUDY GUIDE. Questions and Answers CHAPTER 18 1) Know the difference between, diffusion, osmosis, filtration and active transport (TB Q#1)  Osmosis: movement of water across a semipermeable membrane from a compartment of lower particle concentration to one that has a higher particle concentration.  Diffusion: a passive movement of electrolytes or other particles from an area of higher concentration to one of lower concentration.  Filtration: The net effect of several forces that tend to move fluid across a membrane.  Active Transport: The energy-requiring movement of electrolytes or other substances across cell membranes against a concentration gradient (from an area of low concentration to one of higher concentration). A nurse is caring for a patient who is suffering from kidney failure and is receiving peritoneal dialysis. The nurse explains that peritoneal dialysis works by instilling a solution into the abdomen that contains dextrose that will pull extra fluid into the abdominal cavity. What is the name of this process? a. Diffusion b. Osmosis c. Filtration d. Active transport 2) Be able to describe and give rationale with examples of isotonic, hypertonic and hypotonic fluids (TB Q#2, #3) a. Isotonic: Fluids that have the same osmolality as normal blood. 0.9% sodium chloride is an example of an isotonic solution. It expands the body’s extracellular fluid volume without causing water to shift in or out of cells. b. Hypertonic: more concentrated than normal blood, pulls fluid by osmosis causing them to shrink. 3% sodium chloride is an example. c. Hypotonic: Less concentrated than normal blood after they are infused. They move water from extracellular compartment into the cells by osmosis causing them to swell. A patient has been admitted to the postsurgical nursing unit after surgery. The health care provider has ordered the patient to have an IV of 0.9% sodium chloride. The nurse who is caring for the patient recognizes this as what type of solution? a. Hypotonic b. Isotonic c. Hypertonic d. Hypnotic 3) Be able to describe the mechanism behind thirst (TB Q#4) a. Thirst is a conscious desire of water. It regulates fluid intake when plasma osmolality increases (osmoreceptor-mediated thirst) or the blood volume decreases. The thirst-control mechanism is in the hypothalamus of the brain. Osmoreceptors there continually monitor plasma osmolarity; when osmolality increases, the hypothalamus stimulates thirst. Two nursing students were having pizza one evening as they were studying. One student remarked that whenever she ate pizza, she was incredibly thirsty. The second student explained that this thirst was caused by: a. colloid osmotic pressure. b. osmoreceptors. c. oncotic pressure. d. hydrostatic pressure. 4) Describe insensible water loss and the effects on particular organs (TB Q#5) a. Fluid output occurs through 4 organs: the skin, GI tract, lungs and kidneys (Insensible water loss is not visible). It is continuous and occurs through the skin and lungs. Insensible water output increases with fever. A 7-year-old patient was admitted to the hospital with a high fever. The nurse caring for the child knows that the child has increased insensible water loss resulting from the fever and should receive additional water to prevent hypernatremia. Insensible water loss occurs through which organ? a. Kidneys b. GI tract c. Skin d. Stomach 5) Be able to describe the mechanism in which fluid and electrolyte balance is maintained or regulated partially by hormones (TB Q#7) a. The hypothalamus controls release of ADG from the posterior pituitary gland. Antidiuretic hormone circulates to the kidneys, where it acts on the collecting ducts causing them to reabsorb water. The bodys fluid and electrolyte balance is maintained partially by hormonal regulation. The nurse conveys an understanding of this mechanism in which statement? a. The pituitary gland secretes aldosterone. b. The kidney secretes antidiuretic hormone. c. The adrenal cortex secretes antidiuretic hormone. d. The pituitary gland secretes antidiuretic hormone. 6) Educations for clients at risk for ; (hypothalamus injury) Any injury to the hypothalamus impairs heat loss mechanisms. Educate patients at risk for hyperthermia to do which of the following? (Select all that apply.) a. Avoid strenuous exercise in hot, humid weather. b. Avoid exercising in areas with poor ventilation. c. Drink clear fluids before and after exercising, not during. d. Wear light, loose-fitting clothing. e. Do not visit hot climates. 7) A head injury could result in injury of hypothalamus or pituitary which could affect which organs or functions? (TB Q#8) a. It can affect/alter urine output. A 15-year-old patient suffered a head injury as the result of a bicycle accident. The nurse is concerned about potential fluid complications caused by the injury. What should the nurse monitor most closely? a. Aldosterone release b. Urine output c. Renin release d. Body temperature 8) Be able to describe signs and symptoms of hyponatremia, hypokalemia, and hypochloremia. (TB Q#9) a. Hyponatremia: water enters cells by osmosis causing them to swell. Signs of cerebral dysfunction occur when the brain cells swell b. Hypokalemia: causes muscle weakness and if severe, cardiac dysrhythmias. c. Hypochloremia: abnormally high blood chloride levels which occur with some types of acidosis some renal conditions and other electrolyte imbalances but has no unique signs or symptoms. The patient is taking furosemide (Lasix) and has been complaining of muscle weakness. The nurse should be most concerned about which imbalance? a. Hyponatremia b. Hypokalemia c. Hypochloremia d. Hyperchloremia 9) What concerns would a health care provider anticipate with a patient on a ventilator related to acid base imbalance? (TB Q#10) a. The healthcare provide would have concerns regarding the acid-base status. In determining the levels of the acid-base, the healthcare provider would do an Arterial blood gas analysis (ABG). It is an effective method of evaluating acidbase balance and oxygenation. The patient is on a ventilator. The health care provider has indicated concern about the patients acid-base status. The nurse anticipates that the health care provider will determine the acid-base levels via: a. PaO2 measurement. b. SaO2 levels. c. chloride levels. d. arterial blood gas analysis. 10) Be able to look at labs and distinguish between respiratory acidosis & alkalosis also metabolic acidosis and alkalosis by reading results of arterial blood gases (know the appropriate ranges of arterial blood gases) (TBQ#11, 12 and 13) a. Respiratory acidosis: is an increased PaCO2 and an increased hydrogen ion concentration (pH below 7.35) that reflects the excess carbonic acid (H2CO3) in the blood. b. Respiratory alkalosis: is a decrease PaCO2 and increases pH (above 7.45) that reflects the deficit of carbonic acid (H2CO3) in the blood. c. Metabolic acidosis results from conditions that increase metabolic acids in the body or decrease the amount of base (bicarbonate). The bicarbonate level is always low because the bicarbonate system buffers metabolic acids. d. Metabolic alkalosis: this results from a gain of bicarbonate or excessive excretion of metabolic acid. ***** Normal arterial blood pH value is 7.35-7.45 (acidic is less than 7.35 and alkalotic is greater than 7.45) ***** A 76-year-old patient is hospitalized with pneumonia and has become increasingly confused throughout the shift. The nurse becomes concerned about the patients condition and contacts the health care provider, who orders arterial blood gas analysis. The blood gas report shows a pH of 7.33, PaCO2 of 47, PaO2 of 78, and bicarbonate of 26. This indicates which imbalance? a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis d. Metabolic acidosis A patients arterial blood gas levels indicate a pH of 7.51, PaCO2 of 40 mm Hg, PaO2 of 85 mm Hg, and HCO3 of 32 mEq/L. The patient has been vomiting. The nurse knows the patient has which imbalance? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis A college freshman has bulimia. She vomits after eating and has recently noticed tingling of her fingers and toes and muscle cramps. Her roommate is a nursing student and is concerned about which imbalance? a. Respiratory acidosis b. Metabolic acidosis c. Respiratory alkalosis