NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
Chapter 11: Care of Patients with Fluid and Electrolyte Balance
Hypervolemia
S/S: pitting edema, increased HR/BP/HR, distended neck and hand veins, weight gain, SOB, lung crackles,
pale/cool skin, decreased lab values, alter LOC
Treatment: patient safety (assess every 2 hours for PE), assess for skin breakdown (skin care),
provide supplemental O2 and position patient in semi-fowler’s to improve SOB, furosemide, fluid
restriction, monitor daily weight and output, restrict Na/low sodium diet (water follows)
Hypovolemia
S/S: increased HR, orthostatic hypotension (increased risk for falls), weak/thready pulse, flattened
neck/hand veins, increased RR, decreased turgor, warm/dry skin, dry mucous membranes, fever,
decreased urine and increased concentration, increased lab values
Treatment: fluid replacement (monitor pulse rate/quality and urine output of 30 ml/hr. during
rehydration), antidiarrheals, antiemetics, antipyretics
Calcium: Hypercalcemia
Causes: hyperparathyroidism/hyperthyroidism, dehydration, use of thiazide diuretics, use of
glucocorticoids, kidney failure, malignancy, excessive intake of calcium or vitamin D
S/S: (EKG CHANGES FROM CLOT): cyanosis, pallor, EKG changes, increased risk for blood clots, profound
muscle weakness, decreased DTR, decreased peristalsis/bowel sounds, constipation, kidney stone
formation
Calcium: Hypocalcemia
Causes: lactose intolerance, Crohn’s disease, celiac disease, acute pancreatitis, ESKD, diarrhea,
wound drainage, alkalosis (hyperventilation), hyperproteinemia
S/S: (HYPERACTIVE CRAMPS): muscle spasms (“charley horses”), tetany, hyperactive reflexes, +
Trousseau’s and Chvostek’s signs, arrythmias, weak/thready pulse, painful abdominal cramping,
diarrhea, loss of bone density (osteoporosis), brittle/fragile bones (may break with slight trauma),
confusion
Normal Calcium (Ca+): 9.0-10.5mg/dL
Potassium: Hypokalemia
Causes: diuretics, alkalosis (hyperventilation), TPN, NPO, Cushing’s syndrome, vomiting, wound drainage,
prolonged NG suctioning, heat-induced/excessive diaphoresis, corticosteroids, increased aldosterone
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
,NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
S/S: (SLOW, LOW, + LETHAL): low/shallow respirations, muscle weakness, reduced DTR, leg cramps, limp
muscles, lethal cardiac changes, low BP and HR, increased urine output, decreased bowel sounds
(constipation)
Normal Potassium (K+): 3.5-5.0 mEq/L
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
, NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
Magnesium: Hypomagnesemia
S/S: (HYPERACTIVE TWITCHING/SEIZING): HTN, dysrhythmias, constipation, hyperactive DTRs,
involuntary movements, + Trousseau’s and Chvostek’s signs, Torsade’s de Pointes, weak respirations
Normal Magnesium (Mg+): 1.8-2.6
mEq/L Sodium: Hyponatremia
S/S: (SALT LOSS): confusion, trouble concentrating, seizures, stupor, muscle weakness/spasms,
diminished DTRs, abdominal cramping, increased urine output, loss of appetite, shallow respirations,
orthostatic hypotension, diarrhea
Normal Sodium (Na+): 136-145 mEq/L
Chapter 12: Care of Patients with Problems of Acid-Base Balance
ABG Interpretation
1. Is the pH out of range? (in range and opposite direction-fully compensated; out of range and
opposite direction-partially compensated; same direction-uncompensated)
2. Is the PaCO2 normal/out of range? (respiratory)
3. Is the HCO3 normal/out of range? (metabolic)
4. Match the one (PaCO2 or HCO3) that is the same as the pH. (acidosis or alkalosis)
5. Does the one that does not match/remains go in the opposite direction of pH? (compensation)
6. Is PaO2 and O2 sat out of range? (hypoxemia)
Respiratory Acidosis/Metabolic Acidosis
Interpretation: Kussmaul breathing, hyperkalemia, warm/dry/pink skin
Causes: hypoventilation, asthma, COPD, pneumonia, in table below
Respiratory Alkalosis/Metabolic Alkalosis
Interpretation: hypocalcemia and hypokalemia, dizziness, twitching, tingling, increased HR and RR
Causes: in table below
Common Causes of Alkalosis
Metabolic Alkalosis
Increase of base components Oral ingestion of bases:
Antacids
Parenteral base administration:
Blood transfusion
Sodium bicarbonate
Total parenteral
nutrition
NUR 2356/MDC II Final
Decrease of acid components
Prolonged vomitingExam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Nasogastric suctioning
Hypercortisolism
CORRECT
Hyperaldosteronism
Thiazide diuretics
Respiratory Alkalosis
Excessive loss of carbon dioxide Hyperventilation, fear, anxiety
Mechanical ventilation
, NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
Common Causes of Acidosis
Metabolic Acidosis
Overproduction of hydrogen ions Excessive oxidation of fatty
acids: Diabetic ketoacidosis
Starvation
Hypermetabolism:
Heavy exercise
Seizure activity
Fever
Hypoxia, ischemia
Excessive ingestion of acids:
Ethanol or methanol
intoxication Salicylate
intoxication
Under-elimination of hydrogen ions Kidney failure
Underproduction of bicarbonate Kidney failure
Pancreatitis
Liver failure
Dehydration
Over-elimination of bicarbonate Diarrhea
Respiratory Acidosis
Under-elimination of hydrogen ions Respiratory depression:
Anesthetics
Drugs (especially opioids)
Electrolyte imbalance
Inadequate chest expansion:
Muscle weakness
Airway obstruction
Alveolar-capillary block
Acid-Base Assessment
TEST ARTERIAL SIGNIFICANCE OF ABNORMAL FINDINGS
pH Increased: Metabolic alkalosis, loss of gastric fluids, decreased potassium intake,
diuretic therapy, fever, salicylate toxicity, respiratory alkalosis, hyperventilation
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
Chapter 11: Care of Patients with Fluid and Electrolyte Balance
Hypervolemia
S/S: pitting edema, increased HR/BP/HR, distended neck and hand veins, weight gain, SOB, lung crackles,
pale/cool skin, decreased lab values, alter LOC
Treatment: patient safety (assess every 2 hours for PE), assess for skin breakdown (skin care),
provide supplemental O2 and position patient in semi-fowler’s to improve SOB, furosemide, fluid
restriction, monitor daily weight and output, restrict Na/low sodium diet (water follows)
Hypovolemia
S/S: increased HR, orthostatic hypotension (increased risk for falls), weak/thready pulse, flattened
neck/hand veins, increased RR, decreased turgor, warm/dry skin, dry mucous membranes, fever,
decreased urine and increased concentration, increased lab values
Treatment: fluid replacement (monitor pulse rate/quality and urine output of 30 ml/hr. during
rehydration), antidiarrheals, antiemetics, antipyretics
Calcium: Hypercalcemia
Causes: hyperparathyroidism/hyperthyroidism, dehydration, use of thiazide diuretics, use of
glucocorticoids, kidney failure, malignancy, excessive intake of calcium or vitamin D
S/S: (EKG CHANGES FROM CLOT): cyanosis, pallor, EKG changes, increased risk for blood clots, profound
muscle weakness, decreased DTR, decreased peristalsis/bowel sounds, constipation, kidney stone
formation
Calcium: Hypocalcemia
Causes: lactose intolerance, Crohn’s disease, celiac disease, acute pancreatitis, ESKD, diarrhea,
wound drainage, alkalosis (hyperventilation), hyperproteinemia
S/S: (HYPERACTIVE CRAMPS): muscle spasms (“charley horses”), tetany, hyperactive reflexes, +
Trousseau’s and Chvostek’s signs, arrythmias, weak/thready pulse, painful abdominal cramping,
diarrhea, loss of bone density (osteoporosis), brittle/fragile bones (may break with slight trauma),
confusion
Normal Calcium (Ca+): 9.0-10.5mg/dL
Potassium: Hypokalemia
Causes: diuretics, alkalosis (hyperventilation), TPN, NPO, Cushing’s syndrome, vomiting, wound drainage,
prolonged NG suctioning, heat-induced/excessive diaphoresis, corticosteroids, increased aldosterone
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
,NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
S/S: (SLOW, LOW, + LETHAL): low/shallow respirations, muscle weakness, reduced DTR, leg cramps, limp
muscles, lethal cardiac changes, low BP and HR, increased urine output, decreased bowel sounds
(constipation)
Normal Potassium (K+): 3.5-5.0 mEq/L
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
, NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
Magnesium: Hypomagnesemia
S/S: (HYPERACTIVE TWITCHING/SEIZING): HTN, dysrhythmias, constipation, hyperactive DTRs,
involuntary movements, + Trousseau’s and Chvostek’s signs, Torsade’s de Pointes, weak respirations
Normal Magnesium (Mg+): 1.8-2.6
mEq/L Sodium: Hyponatremia
S/S: (SALT LOSS): confusion, trouble concentrating, seizures, stupor, muscle weakness/spasms,
diminished DTRs, abdominal cramping, increased urine output, loss of appetite, shallow respirations,
orthostatic hypotension, diarrhea
Normal Sodium (Na+): 136-145 mEq/L
Chapter 12: Care of Patients with Problems of Acid-Base Balance
ABG Interpretation
1. Is the pH out of range? (in range and opposite direction-fully compensated; out of range and
opposite direction-partially compensated; same direction-uncompensated)
2. Is the PaCO2 normal/out of range? (respiratory)
3. Is the HCO3 normal/out of range? (metabolic)
4. Match the one (PaCO2 or HCO3) that is the same as the pH. (acidosis or alkalosis)
5. Does the one that does not match/remains go in the opposite direction of pH? (compensation)
6. Is PaO2 and O2 sat out of range? (hypoxemia)
Respiratory Acidosis/Metabolic Acidosis
Interpretation: Kussmaul breathing, hyperkalemia, warm/dry/pink skin
Causes: hypoventilation, asthma, COPD, pneumonia, in table below
Respiratory Alkalosis/Metabolic Alkalosis
Interpretation: hypocalcemia and hypokalemia, dizziness, twitching, tingling, increased HR and RR
Causes: in table below
Common Causes of Alkalosis
Metabolic Alkalosis
Increase of base components Oral ingestion of bases:
Antacids
Parenteral base administration:
Blood transfusion
Sodium bicarbonate
Total parenteral
nutrition
NUR 2356/MDC II Final
Decrease of acid components
Prolonged vomitingExam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Nasogastric suctioning
Hypercortisolism
CORRECT
Hyperaldosteronism
Thiazide diuretics
Respiratory Alkalosis
Excessive loss of carbon dioxide Hyperventilation, fear, anxiety
Mechanical ventilation
, NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
Common Causes of Acidosis
Metabolic Acidosis
Overproduction of hydrogen ions Excessive oxidation of fatty
acids: Diabetic ketoacidosis
Starvation
Hypermetabolism:
Heavy exercise
Seizure activity
Fever
Hypoxia, ischemia
Excessive ingestion of acids:
Ethanol or methanol
intoxication Salicylate
intoxication
Under-elimination of hydrogen ions Kidney failure
Underproduction of bicarbonate Kidney failure
Pancreatitis
Liver failure
Dehydration
Over-elimination of bicarbonate Diarrhea
Respiratory Acidosis
Under-elimination of hydrogen ions Respiratory depression:
Anesthetics
Drugs (especially opioids)
Electrolyte imbalance
Inadequate chest expansion:
Muscle weakness
Airway obstruction
Alveolar-capillary block
Acid-Base Assessment
TEST ARTERIAL SIGNIFICANCE OF ABNORMAL FINDINGS
pH Increased: Metabolic alkalosis, loss of gastric fluids, decreased potassium intake,
diuretic therapy, fever, salicylate toxicity, respiratory alkalosis, hyperventilation
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
CORRECT
