NCLEX HURST REVIEW TEST QUESTIONS ANSWERS 100% CORRECT

What three things contain a lot of Na? - 1. Effervescent soluble medications 2. Canned processed foods 3. IVF with Na What is aldosterone? Where is it found? - Steroid or mineralocorticoids; adrenal glands When blood volume is low what happens to aldosterone secretion? - It increases and Na/H2O are retained in order to increase volume What are two examples of too much aldosterone? Too little? - Cushings & Herpaldosteronism (Conn's syndrome); Addisons What is ADH also called? - Vasopressin What does ADH do? - Makes you retain ONLY H20 If you have too much ADH what happens? - Retain H20 FVE urine is concentrated blood is dilute If you have too little ADH what happens? - Lose/diuresis H20 FVD urine is dilute blood is concentrated How does SIADH become FVE? - The kidney can't excrete waste so they retain water because the body is producing too much ADH Where is ADH found? - Pituitary What type of surgery is an example that can lead to an ADH problem? - Sinus surgery but really anything that leads to an increased ICP What is the pt at risk for developing after sinus surgery? How is is prevented? - DI or going into shock; given ADH replacement (vasopressin/desmopressin acetate) Where is CVP measured? what's normal? - Right atrium; 2-6mmHg How do you treat FVE? - 1. Diuretics 2. Bedrest 3. Low Na/fluid restrictions 4. Daily weights/I&Os 5. Physical assessment 6. Give IVFs to elderly/young and pts with a hx of heart/kidney disease slowly How do you treat FVD? - 1. Prevent further losses 2. Replace volume (mild deficit: PO fluids, severe deficit: IVFs) 3. High risk for falls, monitor for overload what type of pts do you not use isotonic fluids for? - Pts with HTN, cardiac or renal disease because they can cause FVE, HTN or hypernatremia Do hypotonic solutions cause HTN? - No, because they rehydrate the cell but don't stay in the vascular space What type of pts do you use hypotonic solutions for? - Pts with HTN, cardiac or renal disease or pts who need fluid replacement because of n/v, burns, hemorrhage or for dilution when a pt has hypernatremia and cellular dehydration What type of pts do you use hypertonic solutions for? - Pts with HYPOnatremia or pts who have shifted large amounts of vascular volume to a 3rd space or has severe edema, burns or ascites because a hypertonic solution will return the fluid volume to the vascular space If a pt is receiving 3% NS or 5% NS what do you monitor? - Vitals but especially CVP Where is magnesium excreted? - Kidneys What causes hyperMg? How do you treat it? - Renal failure and antacids Ventilator, dialysis, calcium gluconate What causes hypoMg? How do you treat it? - Diarrhea, alcoholism, alcohol suppresses ADH and its hypertonic Give Mg, check kidney function, seizure precautions, eat Mg What causes hyperCa? How do you treat it? - Too much PTH, thiazides (retain Ca), immobilization Move, fluids prevent kidney stones, Ca has an inverse relationship with phosphorus, steroids, meds What meds decrease serum calcium? - Biphosphates and calcitonin What causes hypoCa? How do you treat it? - Hypoparathroidism, radical neck, thyroidectomy (NOT enough PTH) PO Ca, IV Ca, Vit D, phosphate binders What are two phosphate binders? - Sevelamer hydrochloride and calcium acetate What causes hyperNa? How do you treat it? - Hyperventilation, heat stroke, DI restrict Na, dilute fluids, DW, I&Os, lab work What causes hypoNa? How so you treat it? - Drinking H20 for fluid replacement, psychogenic poly dips is loves to drink H20, D5W, SIADH Need Na, do not need H20, if having neuro problems need hypertonic solution (3%NS or 5%NS) Where is potassium excreted by? - Kidneys What happens to the serum K level if the kidneys are not working? - It goes up What causes hyperK? How do you treat it? - Kidney trouble, spironolactone dialysis, calcium gluconate decreases arrhythmias, glu and insulin (insulin carries glu and K into the cell), sodium polystyrene sulfonate (kayexalate) What causes hypoK? How do you treat it? - Vomiting, NG suction, diuretics, not eating Give K, spironolactone, eat more K During respiratory acidosis the body must excrete and retain what? - Excrete hydrogen and retain bicarb What are s/s of respiratory acidosis? - Headache, confusion, sleepy During respiratory alkalosis the body must excrete and retain what? - Excrete bicarb and retain hydrogen What causes respiratory alkalosis? - hyperventilation What are the s/s of respiratory alkalosis? - lightheaded, faint, peri-oral numbness, tingling in the fingers & toes What organ is the problem with metabolic acidosis? - Kidneys What causes metabolic acidosis? - DKA/starvation because the cells are starving because glucose is not available. The body will breakdown fat for energy and as a result produce ketones OR kidney failure, severe diarrhea What organ is the problem with metabolic alkalosis? - Kidneys What causes metabolic alkalosis? - Loss of GI contents or too many antacids Is metabolic acidosis and metabolic alkalosis, hyperK or hypoK? - Metabolic acidosis is HYPER K Metabolic alkalosis is HYPO K When does plasma seep out of tissue the most due to a burn? What is it caused by? - 1st 24 hrs; increased capillary permeability What is secreted in order to vasocontrict so blood is shunted towards the vital organs? What is also secreted? - Epinephrine and noreprinephrine aldosterone to retain Na & H20 ADH to retain H20 If the systolic BP is less than what, when will the pt not have adequate tissue perfusion? - <90 What is the #1 injury in burns? - Inhalation injury is the #1 cause of death which is caused by inhaling carbon monoxide and hydrogen cyanide How do you get carbon monoxide poisoning? (In the body) - Oxygen normally binds with Hbg but now CO binds to Hgb leaving the pt hypoxia because O2 can't bind to Hgb anymore If a pt is cherry red, what is wrong with them? - Hydrogen cyanide poisoning What type of fluids are used in fluid replacement for a burn pt? - LR (crystalloids) and albumin (colloids)