RN 200 Introduction to Medical/Surgical Nursing Exam 1
Chapter 16 – Fluids, Electrolytes and Acid-Base Balance (20
questions)
Review on the
... [Show More] mechanisms of fluid & electrolyte movement:
a.Diffusion – p. 271; Wk 1.3 PPT slide 10
Many different processes are involved in the movement of electrolytes and water between the ICF and
ECF.
Diffusion is the movement of molecules across a permeable membrane from an area of high
concentration to one of low concentration
The net movement of molecules stops when the concentrations are equal on both sides of
semipermeable membrane.
Simple diffusion is passive and requires no external energy.
a. Facilitated diffusion – p. 272 ; Wk 1.3 PPT slide 10
involves the use of a protein carrier in the cell membrane to move molecules that cannot otherwise pass
through the membrane.
Glucose transport into the cell is an example of facilitated diffusion.
A carrier molecule on most cells increases or facilitates the rate of diffusion of glucose into these cells.
a.Active Transport p. 272; Wk 1.3 PPT slide 12
Process in which molecules move against concentration gradient
External energy is required for this process
uses external energy to move molecules against the concentration gradient—from an area of low
concentration to an area of high concentration.
An example of active transport is the sodium-potassium pump. ATP is used to move sodium out of the
cell and potassium into the cell.
The energy source for this movement is adenosine triphosphate (ATP), which is made in the cell's
mitochondria
a.Osmosis – p. 272; Wk 1.3 PPT slide 14, 15
Movement of water “down” concentration gradient
From a region of low solute concentration to one of high solute concentration
Across a semipermeable membrane that does not allow solutes to cross.
Water moves from the less concentrated side (has more water) to the more concentrated side (has less
water).
Requires no energy.
Water movement stops when the concentration differences disappear or hydrostatic pressure builds and
opposes any further movement of water.
Whenever dissolved substances are contained in a space with a semipermeable membrane, they can pull
water into the space by osmosis. The concentration of the solution determines the strength of the
osmotic pull. The higher the concentration, the greater a solution’s pull, or osmotic pressure
a.Osmotic pressure – p. 272; Wk 1.3 PPT slide 16
is measured in milliosmoles (mOsm) and may be expressed as either fluid osmolarity or fluid osmolality.
Osmolarity measures the total milliosmoles per liter of solution, or the concentration of molecules per
volume of solution (mOsm/L).
Osmolality measures the number of milliosmoles per kilogram of water, or the concentration of
molecules per weight of water
Osmolality is the preferred measure to evaluate the concentration of plasma, urine, and body fluids
a.Hydrostatic pressure – p. 273; WK 1.3 PPT slide 20
Blood pressure generated by heart contraction
Ms. V. Cacacho, BSN RN, PCCN, CMSRN
Clinical Coordinator / Instructor
RN 100 / RN 101 / RN 104
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RN 200 Introduction to Medical/Surgical Nursing Exam 1
At the capillary level, hydrostatic pressure is the major force that pushes water out of the vascular
system and into the interstitial space
a.Oncotic pressure – p. 273; Wk 1.3 PPT slide 20
Osmotic pressure caused by plasma proteins
The plasma protein molecules attract water, pulling fluid from the tissue space to the vascular space
Metabolic Acidosis – p. 288-289; Wk 1.1 PPT slide 31, 32
Excess carbonic acid or base bicarbonate deficit caused by
Ketoacidosis: Ketoacidosis accumulation in diabetic ketoacidosis and lactic acid accumulation with shock
are examples of acid accumulation
Severe diarrhea: results in loss of bicarbonate
Kidney disease: In renal disease, the kidneys lose their ability to reabsorb bicarbonate and secrete
hydrogen ions
Compensatory mechanisms for metabolic acidosis
Increased CO2 excretion by lungs
Kussmaul respirations (deep and rapid)
Kidneys excrete acid
Calculating Anion gap can help determine source of metabolic acidosis
Calculate using formula Na+
– (Cl –
+ HCO3–
)
Normal: 8–12 mmol/L
Anion gap Increased with acid gain
Respiratory Alkalosis – p. 288-289; Wk 1.1 PPT slide 27
Respiratory alkalosis is carbonic acid deficit that occurs with hyperventilation, or an increase in
respiratory rate or volume.
The primary cause of respiratory alkalosis is hypoxemia from acute pulmonary disorders.
Hyperventilation “blows off” CO2, leading to a decreased carbonic acid concentration in the blood and an
increased pH.
Compensated respiratory alkalosis is rare
In acute respiratory alkalosis, aggressive treatment of the causes of hypoxemia is essential and usually
does not allow time for compensation to occur
Some buffering may occur with shifting of bicarbonate (HCO3
–
) into cells in exchange for Cl–
In chronic respiratory alkalosis that occurs with pulmonary fibrosis or CNS disorders, compensation may
include renal excretion of bicarbonate
Hypercalcemia: Nursing implication – p. 283; Wk 1.3 PPT slide 83
promoting urinary excretion of calcium by administering a loop diuretic (e.g., furosemide [Lasix]) and
hydrating the patient with isotonic saline infusions.
The patient must drink 3000 to 4000 mL of fluid daily to promote the renal excretion of calcium and
decrease the possibility of kidney stone formation.
diet low in calcium and an increase in weight-bearing activity to enhance bone mineralization.
Bisphosphonates (e.g., pamidronate [Aredia], zoledronic acid [Zometa]), are the most effective agents in
treating hypercalcemia as a result of malignancy
IM or SC calcitonin for an immediate effect
Hypocalcemia: Manifestations – p. 284; Wk 1.3 PPT slide 85
Low levels of calcium allow sodium to move into excitable cells, decreasing the threshold of action
potentials with subsequent depolarization of the cells. This results in increased nerve excitability and
sustained muscle contraction (tetany).
A positive Trousseau’s or Chvostek’s sign is indicative of hyperreflexia noted with hypercalcemia
Ms. V. Cacacho, BSN RN, PCCN, CMSRN
Clinical Coordinator / Instructor
RN 100 / RN 101 / RN 104
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RN 200 Introduction to Medical/Surgical Nursing Exam 1
A. Chvostek’s sign is contraction of facial muscles in response to a light tap over the facial nerve in front
of the ear.
B. Trousseau’s sign is a carpal spasm induced by inflating a blood pressure cuff (C) above the systolic
pressure for a few minutes.
stridor, dysphagia, paresthesia’s, and numbness and tingling around mouth or in extremities
decreased cardiac contractility and ECG changes. A prolonged QT interval may develop into a ventricular
tachycardia, cardiac dysrhythmias
Hyperphosphatemia: Nursing implication – p. 285; Wk 1.3 PPT slide 91, 93
High serum PO43- caused by:
Acute kidney injury or chronic kidney disease
Chemotherapy
Excess intake of phosphate or vitamin D
Hypoparathyroidism
Management:
Identify and treat underlying cause
Restrict foods and fluids containing phosphorus
Oral phosphate-binding agents
Volume expansion and forced diuresis
Correct any hypocalcemia
Hemodialysis
Hypermagnesemia – p. 286; Wk 1.3 PPT slide 99-101
usually occurs only with an increase in magnesium intake accompanied by renal insufficiency or failure.
A patient with chronic kidney disease who ingests products containing magnesium (e.g., Maalox, milk of
magnesia) will have a problem with excess magnesium.
Magnesium excess could develop in the pregnant woman who receives magnesium sulfate for the
management of eclampsia
Excess magnesium inhibits acetylcholine release at the myoneural junction and calcium movement into
cells, impairing nerve and muscle function.
Initial manifestations include hypotension, facial flushing, lethargy, urinary retention, nausea, and
vomiting.
As the serum magnesium level increases, deep tendon reflexes are lost, followed muscle paralysis and
coma
Lethargy
Nausea and vomiting
Impaired reflexes
Muscle paralysis
Respiratory and cardiac arrest
Management begins with avoiding magnesium-containing drugs and limiting diet intake of magnesiumcontaining foods (e.g., green vegetables, nuts, bananas, oranges, peanut butter, chocolate).
If renal function is adequate, promoting urinary excretion with oral and parenteral fluids and IV
furosemide (Lasix) decreases magnesium levels.
The patient with impaired renal function will require dialysis because the kidneys are the major route of
excretion for magnesium.
If hypomagnesemia is symptomatic, giving IV calcium gluconate will oppose the effects of the excess
magnesium on cardiac muscle
Hypokalemia: nursing consideration – p. 282; Wk 1.3 PPT slide 68,75
Ms. V. Cacacho, BSN RN, PCCN, CMSRN
Clinical Coordinator / Instructor
RN 100 / RN 101 / RN 104
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RN 200 Introduction to Medical/Surgical Nursing Exam 1
Low serum potassium caused by:
Increased loss of K+ via the kidneys or gastrointestinal tract
Increased shift of K+ from ECF to ICF
Dietary K+ deficiency (rare)
Treatment of hypokalemia consists of oral or IV potassium chloride supplements and increased dietary
intake of potassium.
Except in severe deficiencies, KCl is not given unless there is urine output of at least 0.5 mL/kg of body
weight per hour.
IV KCl must always be diluted and never given in concentrated amounts.
Invert IV bags containing KCl several times to ensure even distribution in the bag.
Do not add KCl to a hanging IV bag to prevent giving a bolus dose. NEVER give IV push or bolus.
The rate of IV administration of KCl should not exceed 10 mEq per hour and must be administered by
infusion pump to ensure correct administration rate.
Because KCl is irritating to the vein, assess IV sites at least hourly for phlebitis and infiltration. Infiltration
can cause necrosis and sloughing of the surrounding tissue.
Patients who are critically ill and those at risk for hypokalemia and those who are critically ill should have
cardiac monitoring to detect cardiac changes related to potassium imbalances
Fluid Volume Deficit – p. 276; Wk 1.3 PPT slide 34
ECF volume deficit (hypovolemia)
Abnormal loss of body fluids, inadequate fluid intake, or plasma to interstitial fluid shift
Clinical manifestations related to loss of vascular volume as well as CNS effects
can occur from loss of body fluids (e.g., diarrhea, vomiting, hemorrhage, polyuria), inadequate fluid
intake, or a plasma to interstitial fluid shift.
The terms fluid volume deficit and dehydration are not the same. Dehydration refers to loss of pure
water alone without corresponding loss of sodium.
Clinical manifestations include restlessness, drowsiness, lethargy, confusion, postural hypotension,
tachycardia, tachypnea, weakness, dizziness, weight loss, seizures, and coma. Skin turgor, capillary refill,
and urine output are all decreased
Hypomagnesemia – p. 286; Wk 1.3 PPT slide 102
Low serum Mg caused by:
Prolonged fasting or starvation
Chronic alcoholism
Fluid loss from gastrointestinal tract
Prolonged parenteral nutrition without supplementation
Diuretics
Hyperglycemic osmotic diuresis
• Chapter 17 – Preoperative Care (10
questions)
Patient interview: review of genitourinary system p. 306; Wk 2.1 PPT slide 38, 39
History of urinary or renal diseases
Renal dysfunction contributes to:
Fluid and electrolyte imbalances
Increased risk of infection
Impaired wound healing
Altered response to drugs and their elimination
Ms. V. Cacacho, BSN RN, PCCN, CMSRN
Clinical Coordinator / Instructor
RN 100 / RN 101 / RN 104
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RN 200 Introduction to Medical/Surgical Nursing Exam 1
Assess the preoperative patient for glomerulonephritis, chronic kidney disease, or repeated urinary tract
infections. Record the present disease state and current treatment of the disease
Renal function tests, such as serum creatinine and blood urea nitrogen, are commonly ordered
preoperatively.
Male patients may have physical alterations, such as an enlarged prostate, which can interfere with the
insertion of a urinary catheter during surgery or can impair voiding in the postoperative period.
For women of child-bearing age, determine if they are pregnant or think they could be pregnant. The
surgeon should be informed immediately if the patient states that she might be pregnant, because
maternal and subsequent fetal exposure to anesthetics should be avoided during the first trimester
Note problems voiding, and inform operative team
Patient interview: Allergies – p. 305; Wk 2.1 PPT slide 29
Allergies (drug and nondrug)
Screen for latex allergy
Risk factors
Contact urticarial or dermatitis
Aerosol reactions
History of reactions suggesting latex allergy
Patient interview: Medications – p. 304; Wk 2.1 PPT slide 28
Current medications
Prescription and OTC: patients asked to bring bag of meds; can interfere w/anesthetics
Herbs
Dietary supplements
Antiplatelets/NSAIDs: can contribute to bleeding; antiplatelet aggregation
Recreational Drugs: Alcohol, Tobacco; can affect amount of anesthetic used
Consent for surgery – p. 309-310; Wk 2.1 PPT slide 66, 67
Three conditions must be met for consent to be valid.
First, information must include adequate disclosure of the diagnosis; the nature and purpose of the
proposed treatment; the risks and consequences of the proposed treatment; the probability of a
successful outcome; the availability, benefits, and risks of alternative treatments; and the prognosis if
treatment is not instituted.
Second, the patient must demonstrate clear understanding and comprehension of the information being
provided before receiving sedating preoperative medications. If a patient is sedated prior to signing the
consent, surgery may be cancelled or delayed.
Third, the recipient of care must give consent voluntarily. The patient must not be persuaded or coerced
in any way by anyone to undergo the procedure.
Surgeon responsible for obtaining consent
Nurse may witness signature
Verify patient has understanding
Permission may be withdrawn at any time
You can be the patient advocate, verifying that the patient (or caregiver) understands the information
presented in the consent form, the implications of consent, and that consent for surgery is truly
voluntary
Preoperative teaching – p. 308-309; Wk 2.1 PPT slide 63
Teach deep breathing, coughing, and early ambulation as appropriate
Inform if tubes, drains, monitoring devices, or special equipment will be used postoperatively
Provide surgery-specific information
Ms. V. Cacacho, BSN RN, PCCN, CMSRN
Clinical Coordinator / Instructor
RN 100 / RN 101 / RN 104
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RN 200 Introduction to Medical/Surgical Nursing Exam 1
The patient should also receive accurate surgery-specific information.
For example, a patient having a total joint replacement may have an immobilizer following surgery, or a
patient having heart surgery should be told about waking up in the intensive care unit
Preoperative medications: nursing consideration – p. 311; Wk 2.1 PPT slide 76, 77
Many preoperative medications interfere with balance and increase the risk for a fall when ambulating,
in which case the patient may need to use a bedpan.
Benzodiazepines are used for their sedative and amnesic properties.
Anticholinergics will reduce secretions.
Opioids are given to decrease pain and intraoperative anesthetic requirements.
Antiemetics may be given to decrease nausea and vomiting.
Antibiotics may be given to decrease the risk of endocarditis in patients with a history of congenital or
valvular heart disease, and for patients with previous joint replacement. They may also be ordered for
the patient undergoing surgery where wound contamination is a potential risk (GI surgery) or where
wound infection could have serious postoperative consequences (cardiac or joint replacement surgery).
Antibiotics are typically administered IV.
β-Adrenergic blockers (β-blockers) are sometimes used in people with known hypertension or coronary
artery disease to control BP or reduce the chances of MI and cardiac arrest.
People with diabetes are also carefully monitored and may receive insulin in the preoperative period.
Eye drops are often ordered and given preoperatively for the patient undergoing cataract and other eye
surgery
Past Health History – p. 304; Wk 2.1 PPT slide 25-26
Diagnosed medical conditions (previous and current)
Previous surgeries and problems
Menstrual/obstetric history
You will need to determine if the patient understands the reason for surgery. For example, the patient
scheduled for a total knee replacement may indicate that increasing pain and immobility are the reasons
for the surgery
Familial diseases
Inherited traits
Conditions
Reactions/problems to anesthesia (patient or family)
Record any family history of cardiac and endocrine problems.
With regard to reactions to anesthesia, the genetic predisposition for malignant hyperthermia is well
documented, and measures can be taken to limit complications associated with this condition
• Chapter 18 – Intraoperative (10 questions)
• Intraoperative Nursing activities: Circulating nurse – p. 317
• Gerontologic considerations – p. 327; Wk 2.2 PPT slide 48, 49, 50
• Anesthesia – p. 322
• Inhalation agents – p. 323; Wk 2.2 PPT slide 64
• Monitored Anesthesia Care (MAC) – p. 322; Wk 2.2 PPT slide 61
• Malignant Hyperthermia – p. 327; Wk 2.2 PPT slide
• Neuromuscular Blocking Agents – p. 326; Wk 2.2 PPT Slide 68, 69, 70
• Department layout: Semi-restricted – p. 315; Wk 2.2 PPT slide 6
• Surgical Team: RNFA – p. 317; Wk 2.2 PPT slide 26
• Surgical Team: Surgical Technologist – p. 317; Wk 2.2 PPT slide 23
Ms. V. Cacacho, BSN RN, PCCN, CMSRN
Clinical Coordinator / Instructor
RN 100 / RN 101 / RN 104
This study source was downloaded by 100000820529148 from CourseHero.com on 10-03-2022 17:33:32 GMT -05:00
https://www.coursehero.com/file/38976949/Med-surg-exam-1docx/
RN 200 Introduction to Medical/Surgical Nursing Exam 1
• Chapter 19 – Postoperative Care (10 questions)
• Post-operative Respiratory Complications – p. 333; Wk 2.3 PPT slide 11, 12, 13,15
• Nursing management: nursing implementation – p. 340; Wk 2.3 PPT Slide 27
• Cardiovascular Problems: VTE, Hypotension – p. 337; Wk 2.3 PPT slide 20, 22
• Emergence Delirium: Nursing consideration – p. 338; Wk 2.3 PPT slide 23
• Respiratory problems: Atelectasis – p. 334; Wk 2.3 PPT slide 11, 15
Ms. V. Cacacho, BSN RN, PCCN, CMSRN
Clinical Coordinator / Instructor
RN 100 / RN 101 / RN 104
This study source was downloaded by 100000820529148 from CourseHero.com on 10-03-2022 17:33:32 GMT -05:00
https://www.coursehero.com/file/38976949/Med-surg-exam-1docx/
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