NR 324 Exam 1 Study Guide
*Make sure that you understand all of the terms you are studying, if you don’t know what a term means,
look it up before you continue studying. Take your thinking a step further by asking yourself “why” as you
are reviewing material you are studying. This will lead to understanding of the material versus
memorization which will better help you answer application questions. Remember, this study guide
does not mirror the exam and you are responsible for all course content; ensure that you have an
understanding of concepts. That being said, if you complete and understand this study guide, you will be
well prepared for the next exam.
Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances
1. What are possible causes of hypervolemia?
Excessive intake of fluids, abnormal retention of fluids (heart failure, renal failure), SIADH,
Cushing’s.
2. What are the clinical manifestations of hypervolemia?
Increased BP, bounding pulse
Edema
HA
Polyuria
Crackles, dyspnea
3. What are remarks that a patient might say if they are experiencing fluid volume overload?
4. What are the vital signs changes you’ll see with hypervolemia?
BP, pulse, JVD distention, LOC
5. What are specific nursing assessments to assess for hypervolemia?
24-hour intake and output, assess cardio changes, Resp changes, LOC, PEERLA, daily weights,
skin.
6. What is the treatment for these patients? Diet, fluid/sodium restriction, fluids, diuretics
o What are the different types of diuretics?
Loop diuretics: Furosemide – Lasix
Thiazides: Hydrochlorothiazide
Potassium sparing: Spiro lactone
Quinzoline: metolazone
o How would you educate your patient with each type?
Loop diuretics cause the kidneys to increase flow of urine. This helps reduce the amount
of water in your body and lower your blood pressure. Take this med in the morning.
Thiazides reduce the amount of sodium and water in the body. Thiazides are the only
type of diuretic that dilates (widens) the blood vessels, which also helps to lower blood
pressure.
, Potassium-sparing used to reduce the amount of water in the body. Unlike the other
diuretic medicines, these medicines do not cause your body to lose potassium. Do not
increase the potassium you eat.
7. What are possible causes of hypovolemia?
Fever, heatstroke, Diabetes insipidus, GI losses, Hemorrhage, dehydration
8. What are the clinical manifestations of hypovolemia?
Poor skin turgor
Lethargy
Thirst, dry mucous membranes
Decreased urine output, concentrated
Increased respiratory rate
Orthostatic hypotension
9. What are remarks that a patient might say if they are experiencing dehydration?
10. What are the vital signs changes you’ll see with hypervolemia?
Decreased BP, Increased HR, Increased RR, flattened neck veins, thread pulse
11. What are specific nursing assessments to assess for hypovolemia?
Skin turgor, skin (dry, breakdown), daily weights, intake and output
12. What is the treatment for these patients?
Increase fluids
13. What are way’s to measure fluid volume status?
Intake and output, daily weight
14. Which measurement is the best way to measure total body fluid gains/loss?
Daily weight
15. What are lab value ranges, action in the body, clinical manifestation and treatments of the
following:
o Sodium (NA) : 135-145
Maintains the concentration and volume of ECF and influences water distribution.
Where water goes sodium follows.
Hypernatremia
Manifestations: Restlessness, agitation twitching, seizures, coma
Treatments: treat underlying cause, hypotonic solution (5% dextrose)
Hyponatremia:
Manifestation: Lethargy, confusion, decreased reflexes, seizures, and coma
Treatments: treat underlying cause, fluid restriction, hypertonic saline in small amounts
o Potassium (K): 3.5-5.0 HEART
Regulates intracellular osmolality and promotes cellular growth. Neuromuscular and
cardiac function are commonly affected.
Hyperkalemia (renal failure, rapid TPN)
Manifestations: irregular pulse, paresthesia, weakness, irritability
Treatments: Kayexalate, IV insulin and glucose (pushes K+ into cells), Hemodialysis
Hypokalemia (GI losses, diarrhea, vomiting, NG suction)
Manifestations: muscles weakness, irregular pulse, fatigue, hyperglycemia
Treatments: treat with oral or IV K+ (needs to be on pump and cannot exceed 10-20 mEq
per hour
*Make sure that you understand all of the terms you are studying, if you don’t know what a term means,
look it up before you continue studying. Take your thinking a step further by asking yourself “why” as you
are reviewing material you are studying. This will lead to understanding of the material versus
memorization which will better help you answer application questions. Remember, this study guide
does not mirror the exam and you are responsible for all course content; ensure that you have an
understanding of concepts. That being said, if you complete and understand this study guide, you will be
well prepared for the next exam.
Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances
1. What are possible causes of hypervolemia?
Excessive intake of fluids, abnormal retention of fluids (heart failure, renal failure), SIADH,
Cushing’s.
2. What are the clinical manifestations of hypervolemia?
Increased BP, bounding pulse
Edema
HA
Polyuria
Crackles, dyspnea
3. What are remarks that a patient might say if they are experiencing fluid volume overload?
4. What are the vital signs changes you’ll see with hypervolemia?
BP, pulse, JVD distention, LOC
5. What are specific nursing assessments to assess for hypervolemia?
24-hour intake and output, assess cardio changes, Resp changes, LOC, PEERLA, daily weights,
skin.
6. What is the treatment for these patients? Diet, fluid/sodium restriction, fluids, diuretics
o What are the different types of diuretics?
Loop diuretics: Furosemide – Lasix
Thiazides: Hydrochlorothiazide
Potassium sparing: Spiro lactone
Quinzoline: metolazone
o How would you educate your patient with each type?
Loop diuretics cause the kidneys to increase flow of urine. This helps reduce the amount
of water in your body and lower your blood pressure. Take this med in the morning.
Thiazides reduce the amount of sodium and water in the body. Thiazides are the only
type of diuretic that dilates (widens) the blood vessels, which also helps to lower blood
pressure.
, Potassium-sparing used to reduce the amount of water in the body. Unlike the other
diuretic medicines, these medicines do not cause your body to lose potassium. Do not
increase the potassium you eat.
7. What are possible causes of hypovolemia?
Fever, heatstroke, Diabetes insipidus, GI losses, Hemorrhage, dehydration
8. What are the clinical manifestations of hypovolemia?
Poor skin turgor
Lethargy
Thirst, dry mucous membranes
Decreased urine output, concentrated
Increased respiratory rate
Orthostatic hypotension
9. What are remarks that a patient might say if they are experiencing dehydration?
10. What are the vital signs changes you’ll see with hypervolemia?
Decreased BP, Increased HR, Increased RR, flattened neck veins, thread pulse
11. What are specific nursing assessments to assess for hypovolemia?
Skin turgor, skin (dry, breakdown), daily weights, intake and output
12. What is the treatment for these patients?
Increase fluids
13. What are way’s to measure fluid volume status?
Intake and output, daily weight
14. Which measurement is the best way to measure total body fluid gains/loss?
Daily weight
15. What are lab value ranges, action in the body, clinical manifestation and treatments of the
following:
o Sodium (NA) : 135-145
Maintains the concentration and volume of ECF and influences water distribution.
Where water goes sodium follows.
Hypernatremia
Manifestations: Restlessness, agitation twitching, seizures, coma
Treatments: treat underlying cause, hypotonic solution (5% dextrose)
Hyponatremia:
Manifestation: Lethargy, confusion, decreased reflexes, seizures, and coma
Treatments: treat underlying cause, fluid restriction, hypertonic saline in small amounts
o Potassium (K): 3.5-5.0 HEART
Regulates intracellular osmolality and promotes cellular growth. Neuromuscular and
cardiac function are commonly affected.
Hyperkalemia (renal failure, rapid TPN)
Manifestations: irregular pulse, paresthesia, weakness, irritability
Treatments: Kayexalate, IV insulin and glucose (pushes K+ into cells), Hemodialysis
Hypokalemia (GI losses, diarrhea, vomiting, NG suction)
Manifestations: muscles weakness, irregular pulse, fatigue, hyperglycemia
Treatments: treat with oral or IV K+ (needs to be on pump and cannot exceed 10-20 mEq
per hour
