NUR1211 – UNIT ONE TEST – STUDY GUIDE
1. Know the most accurate way of evaluating fluid balance in patients.
- Body weight change, especially sudden, is an excellent indicator of overall fluid volume loss
or gain. 1L of water weighs 2.2 lbs (1kg)
- Weight the patient at the same time everyday preferably in the morning
2. Know ABGs for: Metabolic Acidosis, Metabolic Alkalosis, Respiratory Acidosis, and
Respiratory Alkalosis. (FOUR QUESTIONS)
- Step 1: Determine if pH is acidotic or alkalotic
- Step 2: Analyze PaCO2 to determine if patient has respiratory acidosis or alkalosis
- Step 3: Analyze HCO3 to determine if patient has metabolic acidosis or alkalosis
• RESPIRATORY
• Opposite
o Alkalosis ↑ pH ↓ PaCO2
o Acidosis ↓ pH ↑ PaCO2
• METABOLIC
• Equal
o Acidosis ↓ pH ↓ HCO3
o Alkalosis ↑ pH ↑ HCO3
3. Know priority monitorization for patients receiving fluids infusion.
When correcting dehydration with IV fluids, the patient requires close monitoring to
prevent FLUID OVERLOAD.
The patient experiencing dangerous cardiac dysrhythmias should receive IV
calcium gluconate
IMMEDIATELY. Monitor blood pressure because rapid administration of calcium can
cause hypotension.
Monitor vital signs and USE AN INFUSION PUMP as too rapid administration of
magnesium can lead to cardiac or respiratory arrest.
Quickly reducing serum sodium levels can cause a rapid shift of water back into the
cells, resulting in cerebral edema and neurologic complications
The rate for the IV administration of KCl SHOULD NOT EXCEED 10 mEq/hr and
MUST be given by infusion pump to ensure correct administration rate.
Sudden symptomatic hypocalcemia, secondary to increased calcium phosphorus
binding, is a potential complication of IV phosphorus administration
4. Know concepts: Osmosis, Facilitated diffusion, Diffusion, and Active transport.
- Osmosis: the movement of water “down” a concentration gradient (from low to high);
requires no outside energy source and stops when concentration differences disappear; the
higher the concentration the greater the solution’s pulling (osmotic pressure)
- Osmolarity: measure of total milliosmoles per liter
- Osmolality: measure of number of milliosmoles per kg of water
,- Simple Diffusion: movement of molecules from an area of high concentration to low; stops
when concentrations are equal; passive and requires no energy
- Facilitated Diffusion: involves use of a protein carrier in the cell membrane
- protein carrier combines with a molecule and assists in moving the molecule
across the membrane from high to low
- Ex: glucose transport
- Active Transport: molecules move against concentration gradient from low to high
- energy source is adenosine triphosphate (ATP)
- Ex: sodium-potassium pump
5. Know concepts: Osmotic pressure, Oncotic pressure, and Hydrostatic pressure.
- Osmotic Pressure: the pressure required to prevent water from moving across a
membrane due to differences in concentrations; aka the force required to maintain
equilibrium between solutions with different concentrations measured in milliosmoles
(mOsm) and may be expressed as either fluid osmolarity or fluid osmolality
- Oncotic Pressure: aka colloid oncotic pressure; created by the protein (mainly albumin)in
the bloodstream; pulls fluid in
- Explanation: Albumin is located in blood plasma; it is very large that it does not
escape from capillary wall therefore causing a high concentration - causing
osmotic pressure and water to come into the capillaries; if a patient has low
albumin level then water will then leave plasma area (hydrostatic pressure) and
go into interstitial space causing tissue swelling or edema
- Hydrostatic Pressure: opposite of oncotic; pressure/weight/force of a fluid inside restricted
space (blood vessels); this pressure is created by cardiac contractions
- Highest at the arterial end of the capillary (fluid moves into interstitial space)
and lowest as the venous end (fluid moves back into capillary)
* Increased venous pressure can be caused by: fluid overload, heart failure, liver
failure, obstruction of venous return (such as tourniquets or restrictive clothing)
and venous insufficiency
- The pressure pushes water and solutes out of the blood vessels into interstitial
spaces aka filtration
- When hydrostatic pressure rises, oncotic pressure decreases
6. Know causes of: Metabolic Acidosis, Metabolic Alkalosis, Respiratory Acidosis, and
Respiratory Alkalosis. (TWO QUESTIONS)
- Acidosis = increase in carbonic acid (respiratory acidosis) or decrease in bicarbonate
(metabolic acidosis)
- CNS is depressed
- Alkalosis = decrease in carbonic acid (metabolic alkalosis) or increase in bicarbonate
(metabolic alkalosis)
- CNS is irritated
- Metabolic Acidosis: occurs when an acid other than carbonic acid accumulates in the body
or when bicarbonate is lost
, - As compensation, CO2 excretion is increased by lungs; rapid breathing; kidneys
also attempt to excrete additional acid
- Causes: DKA, starvation, severe diarrhea, renal failure, shock
- Metabolic Alkalosis: occurs when there is a loss of acid (prolonged vomiting) or a gain in
bicarbonate (ingestion of baking soda)
- Renal excretion of bicarbonate occurs in response; also decreased respiratory
rate to increase CO2
- Causes: severe vomiting, diuretic therapy, potassium deficit
- Respiratory Acidosis: carbon acid excess; hypoventilation; buildup of carbon dioxide
resulting in accumulation of carbonic acid
- To compensate, kidneys conserve bicarbonate and secrete excess hydrogen ions
into the urine
- Causes: COPD, sedative overdose, pneumonia
- Respiratory Alkalosis: carbonic acid deficit that occurs with hyperventilation; primary
cause is hypoxemia from acute pulmonary disorders
- Hyperventilation blows off CO2 leading to decreased carbonic acid
- Compensation is rare
- Causes: hyperventilation
7. Know nursing DELEGATION. (TWO QUESTIONS)
8. Know IV fluids: Isotonic solutions, Hypotonic solutions, and Hypertonic solutions.
- Isotonic: a solution with the same osmolality as blood
- Composed of 0.9% NaCl
- Do not provoke water movement
- Hypotonic: a solution with an osmolality lower than that of serum
- Composed of less NaCl concentration than blood; 0.45% NaCl
- Less solute but more water than bloodstream
- Used to move water from the ECF into the ICF (treating dehydration)
- Hypertonic: a solution with an osmolality higher than that of serum
- Composed of more NaCl than that blood
- More solute and less water
- Used to more water from ICF into ECF (causing dehydration)
9. Pharm/Math Question – (SIX QUESTIONS)
1. Know the most accurate way of evaluating fluid balance in patients.
- Body weight change, especially sudden, is an excellent indicator of overall fluid volume loss
or gain. 1L of water weighs 2.2 lbs (1kg)
- Weight the patient at the same time everyday preferably in the morning
2. Know ABGs for: Metabolic Acidosis, Metabolic Alkalosis, Respiratory Acidosis, and
Respiratory Alkalosis. (FOUR QUESTIONS)
- Step 1: Determine if pH is acidotic or alkalotic
- Step 2: Analyze PaCO2 to determine if patient has respiratory acidosis or alkalosis
- Step 3: Analyze HCO3 to determine if patient has metabolic acidosis or alkalosis
• RESPIRATORY
• Opposite
o Alkalosis ↑ pH ↓ PaCO2
o Acidosis ↓ pH ↑ PaCO2
• METABOLIC
• Equal
o Acidosis ↓ pH ↓ HCO3
o Alkalosis ↑ pH ↑ HCO3
3. Know priority monitorization for patients receiving fluids infusion.
When correcting dehydration with IV fluids, the patient requires close monitoring to
prevent FLUID OVERLOAD.
The patient experiencing dangerous cardiac dysrhythmias should receive IV
calcium gluconate
IMMEDIATELY. Monitor blood pressure because rapid administration of calcium can
cause hypotension.
Monitor vital signs and USE AN INFUSION PUMP as too rapid administration of
magnesium can lead to cardiac or respiratory arrest.
Quickly reducing serum sodium levels can cause a rapid shift of water back into the
cells, resulting in cerebral edema and neurologic complications
The rate for the IV administration of KCl SHOULD NOT EXCEED 10 mEq/hr and
MUST be given by infusion pump to ensure correct administration rate.
Sudden symptomatic hypocalcemia, secondary to increased calcium phosphorus
binding, is a potential complication of IV phosphorus administration
4. Know concepts: Osmosis, Facilitated diffusion, Diffusion, and Active transport.
- Osmosis: the movement of water “down” a concentration gradient (from low to high);
requires no outside energy source and stops when concentration differences disappear; the
higher the concentration the greater the solution’s pulling (osmotic pressure)
- Osmolarity: measure of total milliosmoles per liter
- Osmolality: measure of number of milliosmoles per kg of water
,- Simple Diffusion: movement of molecules from an area of high concentration to low; stops
when concentrations are equal; passive and requires no energy
- Facilitated Diffusion: involves use of a protein carrier in the cell membrane
- protein carrier combines with a molecule and assists in moving the molecule
across the membrane from high to low
- Ex: glucose transport
- Active Transport: molecules move against concentration gradient from low to high
- energy source is adenosine triphosphate (ATP)
- Ex: sodium-potassium pump
5. Know concepts: Osmotic pressure, Oncotic pressure, and Hydrostatic pressure.
- Osmotic Pressure: the pressure required to prevent water from moving across a
membrane due to differences in concentrations; aka the force required to maintain
equilibrium between solutions with different concentrations measured in milliosmoles
(mOsm) and may be expressed as either fluid osmolarity or fluid osmolality
- Oncotic Pressure: aka colloid oncotic pressure; created by the protein (mainly albumin)in
the bloodstream; pulls fluid in
- Explanation: Albumin is located in blood plasma; it is very large that it does not
escape from capillary wall therefore causing a high concentration - causing
osmotic pressure and water to come into the capillaries; if a patient has low
albumin level then water will then leave plasma area (hydrostatic pressure) and
go into interstitial space causing tissue swelling or edema
- Hydrostatic Pressure: opposite of oncotic; pressure/weight/force of a fluid inside restricted
space (blood vessels); this pressure is created by cardiac contractions
- Highest at the arterial end of the capillary (fluid moves into interstitial space)
and lowest as the venous end (fluid moves back into capillary)
* Increased venous pressure can be caused by: fluid overload, heart failure, liver
failure, obstruction of venous return (such as tourniquets or restrictive clothing)
and venous insufficiency
- The pressure pushes water and solutes out of the blood vessels into interstitial
spaces aka filtration
- When hydrostatic pressure rises, oncotic pressure decreases
6. Know causes of: Metabolic Acidosis, Metabolic Alkalosis, Respiratory Acidosis, and
Respiratory Alkalosis. (TWO QUESTIONS)
- Acidosis = increase in carbonic acid (respiratory acidosis) or decrease in bicarbonate
(metabolic acidosis)
- CNS is depressed
- Alkalosis = decrease in carbonic acid (metabolic alkalosis) or increase in bicarbonate
(metabolic alkalosis)
- CNS is irritated
- Metabolic Acidosis: occurs when an acid other than carbonic acid accumulates in the body
or when bicarbonate is lost
, - As compensation, CO2 excretion is increased by lungs; rapid breathing; kidneys
also attempt to excrete additional acid
- Causes: DKA, starvation, severe diarrhea, renal failure, shock
- Metabolic Alkalosis: occurs when there is a loss of acid (prolonged vomiting) or a gain in
bicarbonate (ingestion of baking soda)
- Renal excretion of bicarbonate occurs in response; also decreased respiratory
rate to increase CO2
- Causes: severe vomiting, diuretic therapy, potassium deficit
- Respiratory Acidosis: carbon acid excess; hypoventilation; buildup of carbon dioxide
resulting in accumulation of carbonic acid
- To compensate, kidneys conserve bicarbonate and secrete excess hydrogen ions
into the urine
- Causes: COPD, sedative overdose, pneumonia
- Respiratory Alkalosis: carbonic acid deficit that occurs with hyperventilation; primary
cause is hypoxemia from acute pulmonary disorders
- Hyperventilation blows off CO2 leading to decreased carbonic acid
- Compensation is rare
- Causes: hyperventilation
7. Know nursing DELEGATION. (TWO QUESTIONS)
8. Know IV fluids: Isotonic solutions, Hypotonic solutions, and Hypertonic solutions.
- Isotonic: a solution with the same osmolality as blood
- Composed of 0.9% NaCl
- Do not provoke water movement
- Hypotonic: a solution with an osmolality lower than that of serum
- Composed of less NaCl concentration than blood; 0.45% NaCl
- Less solute but more water than bloodstream
- Used to move water from the ECF into the ICF (treating dehydration)
- Hypertonic: a solution with an osmolality higher than that of serum
- Composed of more NaCl than that blood
- More solute and less water
- Used to more water from ICF into ECF (causing dehydration)
9. Pharm/Math Question – (SIX QUESTIONS)
