NUR 250 STUDY GUIDE
total parenteral nutrition (TPN) - Answers -● The nurse will monitor glucose levels Q6H
for hyperglycemia due to high dextrose.
● The nurse will meticulously care for access site to avoid local or systemic infections.
● The nurse will measure pt's I/O, daily weight, and BUN to assess for renal status.
● The nurse will make rate changes gradually and not discontinue TPN abruptly.
peripheral Parentral Nutrition (PPN) - Answers -● The nurse will monitor glucose &
triglyceride levels Q6H for hyperglycemia and to assess tolerance to formula.
● The nurse will meticulously care for access site to avoid local or systemic infections.
● The nurse will measure pt's I/O, daily weight, and BUN to assess for renal status.
xerostomia - Answers -● The nurse will help pt. maintain mucosal integrity by...
(Pick One)
● providing and encouraging fluids
● providing saliva stimulating medication
● helping pt. with oral hygiene
acids - Answers -● The nurse will monitor high CO2 levels (22-30 mEq/L) which can
lead to respiratory acidosis and the pH of the blood <7.4 signifies metabolic acidosis
aldosterone - Answers -● The nurse will monitor for increased levels of aldosterone due
to...
(Choose one)
● dehydration
● hyponatremia/pt's low-sodium diet
● liver cirrhosis
● The nurse will monitor for decreased levels of aldosterone due to...
(Choose one)
● high-sodium diet
● DM
● The nurse will assess pt's BP due to increased levels of aldosterone.
akalis/bases - Answers -● The nurse will monitor the sodium bicarbonate levels which
should be in the range of 21-30 mEq/L in adults and also blood pH >7.40 indicates
alkalosis.
anion - Answers -● The nurse will assess for levels of anions, such as chloride, to
prevent electrolyte imbalances
,antidiuretic hormone (ADH) - Answers -● The nurse will assess for decreased urine
output less than 30mL/ hour.
atrial natriuretic peptide (ANP) - Answers -● The nurse will check patient's sodium
levels and assess for hydration status of patient.
● The nurse will monitor pt's BP.
● The nurse will assess for increased urine output.
base excess - Answers -● The nurse will monitor the patient's serum blood pH for base
excess (pH >7.4) that may indicate metabolic alkalosis
calciphylaxis - Answers -● The nurse will give 1 to 3g of IV calcium gluconate over a
period of 10 to 20 minutes, followed by slow IV infusion.
carbon dioxide - Answers -● The nurse will monitor for decreased levels of CO2 outside
the range of 20-31 mmol/L in pts. with...
(Choose one)
● DKA
● acute renal failure
● pts. on diuretics.
● The nurse will monitor for increased levels of CO2 outside the range of 20-31 mmol/L
in pts. with...
(Choose one)
● severe vomiting
● peptic ulcer
● emphysema
carbonic acid - Answers -● The nurse will monitor the patient's labs to ensure
bicarbonate to carbonic acid ratio remains 20:1 to ensure no plasma pH changes occur
cation - Answers -● The nurse will monitor the level of cations in the blood such as Na+
135-145 mEq/L, Ca2+ (9-11 mg/dL), and K+ (3.5-5.3 mEq/L). Nurse should also assess
for electrolyte imbalances in the blood.
compensation - Answers -● The nurse will observe the patient for signs of Kussmaul's
respirations that may indicate an attempt to correct serum pH levels
electromotive force - Answers -● The nurse will ensure electrolyte levels in the patient
are within normal range to allow for the conduction of normal body activities
electroneutrality - Answers -The nurse will assess the anion gap by adding the chloride
and bicarbonate levels together and deducting the total from the sum of the sodium and
potassium levels.
,hydrogen ion - Answers -● The nurse will assess serum pH levels to ensure no excess
or deficiency in hydrogen ions (too much = acidic, too little = basic)
hydrostatic pressure - Answers -● The nurse will monitor BP. Normal range should be
between 100-120 systolic and 60-80 diastolic for an average adult, however, this varies.
hydroxyapatite - Answers -The nurse will monitor for decreased calcium levels below 9
mg/dL.
hypercarbic drive - Answers -● The nurse will assess for hypoventilation.
● The nurse will monitor supplemental oxygen levels in patients with COPD to ensure
no respiratory depression occurs
hypertonic - Answers -● The nurse will assess for dehydration and administer an
isotonic IV fluid
hyperventilation - Answers -● The nurse will encourage slow, deep respirations.
hypotonic - Answers -● The nurse will assess for over-hydration by assessing for
edema or fluid retention
hypoventilation - Answers -● The nurse will position the patient sitting upright with arms
supported by bedside table
hypoxic drive - Answers -● The nurse will administer O2 at low flow rates in patient's
with COPD to ensure no respiratory depression
isotonic - Answers -● The nurse will check IV sites, assure patency of type, assess
hydration status of patient, and flow rate of IV.
● The nurse will monitor I&O.
minute ventilation - Answers -● The nurse will assess the patient's respiratory rate,
depth, and lung sounds. Normal respiratory rate should be between 12-20 rpm. Normal
resting depth tidal volume is 500 mL.
oncotic pressure - Answers -The nurse will administer albumin when there is edema
present to bring fluids back to circulation
osmolality - Answers -The nurse will check to make sure blood is between 275 to 295
mmol/kg of body weight to determine what type of solution you will infuse: isotonic,
hypertonic or hypotonic.
osmosis - Answers -● The nurse will assess I&O, BP, skin turgor, and lung sounds for
overhydration or underhydration.
, sodium bicarbonate - Answers -● The nurse will administer sodium bicarbonate therapy
to patient's that have metabolic acidosis upon doctor's orders
specific gravity (SG) - Answers -● The nurse will check to make sure it is between
1.015 to 1.024.
● The nurse will check patient's hydration status.
agglutinate - Answers -● The nurse will make sure the blood type matches to prevent
obstruction of blood flow to organs.
albumin - Answers -● The nurse will administer w/ diuretic to prevent volume overload.
apheresis - Answers -● The nurse will administer the plasma portion of the donor's
blood within 30 minutes after it's taken from the blood bank.
● The nurse will stay with client for the first 15 minutes in case he/she experiences
adverse reactions such as chills, SOB, hives, or itching.
autologous transfusion - Answers -● The nurse will be administering iron supplements
and erythropoietin to stimulate erythropoiesis.
blood transfusion - Answers -● The nurse will inspect blood for discoloration, gas
bubbles, or cloudiness as well as identification and expiration date.
● *The nurse will stay with client for the first 15 minutes in case he/she experiences
adverse reactions such as chills, SOB, hives, or itching.*
● The nurse will evaluate the pt's RBC, Hct, Hgb, platelets, and clotting factors.
● The nurse will assess VS, lung sounds, and test blood for compatibility.
blood type - Answers -● The nurse will make sure blood types are compatible when
preparing for transfusions.
catheter embolism - Answers -● *The nurse will observe pt. for signs of cyanosis,
chestpain, hypotension, and tachycardia.*
● The nurse will secure a tourniquet in pt's arm and place the pt. on bed rest to
minimize movement of catheter.
● The nurse will notify physician if signs of shock are present.
central vascular access device (CVAD) - Answers -● The nurse will make sure the line
is clean, dry, and intact at all times.
● *The nurse will ask for an CXR to ensure the tip of the catheter is in the vena cava
before administering medication.*
● The nurse will instruct the pt. to breathe normally and remain inactive and recumbent
for approximately 30 minutes to achieve hemostasis.
chelation - Answers -● The nurse will initiate therapy when levels of iron (or metals) is
found to be extremely high post blood transfusion to prevent organ damage.
total parenteral nutrition (TPN) - Answers -● The nurse will monitor glucose levels Q6H
for hyperglycemia due to high dextrose.
● The nurse will meticulously care for access site to avoid local or systemic infections.
● The nurse will measure pt's I/O, daily weight, and BUN to assess for renal status.
● The nurse will make rate changes gradually and not discontinue TPN abruptly.
peripheral Parentral Nutrition (PPN) - Answers -● The nurse will monitor glucose &
triglyceride levels Q6H for hyperglycemia and to assess tolerance to formula.
● The nurse will meticulously care for access site to avoid local or systemic infections.
● The nurse will measure pt's I/O, daily weight, and BUN to assess for renal status.
xerostomia - Answers -● The nurse will help pt. maintain mucosal integrity by...
(Pick One)
● providing and encouraging fluids
● providing saliva stimulating medication
● helping pt. with oral hygiene
acids - Answers -● The nurse will monitor high CO2 levels (22-30 mEq/L) which can
lead to respiratory acidosis and the pH of the blood <7.4 signifies metabolic acidosis
aldosterone - Answers -● The nurse will monitor for increased levels of aldosterone due
to...
(Choose one)
● dehydration
● hyponatremia/pt's low-sodium diet
● liver cirrhosis
● The nurse will monitor for decreased levels of aldosterone due to...
(Choose one)
● high-sodium diet
● DM
● The nurse will assess pt's BP due to increased levels of aldosterone.
akalis/bases - Answers -● The nurse will monitor the sodium bicarbonate levels which
should be in the range of 21-30 mEq/L in adults and also blood pH >7.40 indicates
alkalosis.
anion - Answers -● The nurse will assess for levels of anions, such as chloride, to
prevent electrolyte imbalances
,antidiuretic hormone (ADH) - Answers -● The nurse will assess for decreased urine
output less than 30mL/ hour.
atrial natriuretic peptide (ANP) - Answers -● The nurse will check patient's sodium
levels and assess for hydration status of patient.
● The nurse will monitor pt's BP.
● The nurse will assess for increased urine output.
base excess - Answers -● The nurse will monitor the patient's serum blood pH for base
excess (pH >7.4) that may indicate metabolic alkalosis
calciphylaxis - Answers -● The nurse will give 1 to 3g of IV calcium gluconate over a
period of 10 to 20 minutes, followed by slow IV infusion.
carbon dioxide - Answers -● The nurse will monitor for decreased levels of CO2 outside
the range of 20-31 mmol/L in pts. with...
(Choose one)
● DKA
● acute renal failure
● pts. on diuretics.
● The nurse will monitor for increased levels of CO2 outside the range of 20-31 mmol/L
in pts. with...
(Choose one)
● severe vomiting
● peptic ulcer
● emphysema
carbonic acid - Answers -● The nurse will monitor the patient's labs to ensure
bicarbonate to carbonic acid ratio remains 20:1 to ensure no plasma pH changes occur
cation - Answers -● The nurse will monitor the level of cations in the blood such as Na+
135-145 mEq/L, Ca2+ (9-11 mg/dL), and K+ (3.5-5.3 mEq/L). Nurse should also assess
for electrolyte imbalances in the blood.
compensation - Answers -● The nurse will observe the patient for signs of Kussmaul's
respirations that may indicate an attempt to correct serum pH levels
electromotive force - Answers -● The nurse will ensure electrolyte levels in the patient
are within normal range to allow for the conduction of normal body activities
electroneutrality - Answers -The nurse will assess the anion gap by adding the chloride
and bicarbonate levels together and deducting the total from the sum of the sodium and
potassium levels.
,hydrogen ion - Answers -● The nurse will assess serum pH levels to ensure no excess
or deficiency in hydrogen ions (too much = acidic, too little = basic)
hydrostatic pressure - Answers -● The nurse will monitor BP. Normal range should be
between 100-120 systolic and 60-80 diastolic for an average adult, however, this varies.
hydroxyapatite - Answers -The nurse will monitor for decreased calcium levels below 9
mg/dL.
hypercarbic drive - Answers -● The nurse will assess for hypoventilation.
● The nurse will monitor supplemental oxygen levels in patients with COPD to ensure
no respiratory depression occurs
hypertonic - Answers -● The nurse will assess for dehydration and administer an
isotonic IV fluid
hyperventilation - Answers -● The nurse will encourage slow, deep respirations.
hypotonic - Answers -● The nurse will assess for over-hydration by assessing for
edema or fluid retention
hypoventilation - Answers -● The nurse will position the patient sitting upright with arms
supported by bedside table
hypoxic drive - Answers -● The nurse will administer O2 at low flow rates in patient's
with COPD to ensure no respiratory depression
isotonic - Answers -● The nurse will check IV sites, assure patency of type, assess
hydration status of patient, and flow rate of IV.
● The nurse will monitor I&O.
minute ventilation - Answers -● The nurse will assess the patient's respiratory rate,
depth, and lung sounds. Normal respiratory rate should be between 12-20 rpm. Normal
resting depth tidal volume is 500 mL.
oncotic pressure - Answers -The nurse will administer albumin when there is edema
present to bring fluids back to circulation
osmolality - Answers -The nurse will check to make sure blood is between 275 to 295
mmol/kg of body weight to determine what type of solution you will infuse: isotonic,
hypertonic or hypotonic.
osmosis - Answers -● The nurse will assess I&O, BP, skin turgor, and lung sounds for
overhydration or underhydration.
, sodium bicarbonate - Answers -● The nurse will administer sodium bicarbonate therapy
to patient's that have metabolic acidosis upon doctor's orders
specific gravity (SG) - Answers -● The nurse will check to make sure it is between
1.015 to 1.024.
● The nurse will check patient's hydration status.
agglutinate - Answers -● The nurse will make sure the blood type matches to prevent
obstruction of blood flow to organs.
albumin - Answers -● The nurse will administer w/ diuretic to prevent volume overload.
apheresis - Answers -● The nurse will administer the plasma portion of the donor's
blood within 30 minutes after it's taken from the blood bank.
● The nurse will stay with client for the first 15 minutes in case he/she experiences
adverse reactions such as chills, SOB, hives, or itching.
autologous transfusion - Answers -● The nurse will be administering iron supplements
and erythropoietin to stimulate erythropoiesis.
blood transfusion - Answers -● The nurse will inspect blood for discoloration, gas
bubbles, or cloudiness as well as identification and expiration date.
● *The nurse will stay with client for the first 15 minutes in case he/she experiences
adverse reactions such as chills, SOB, hives, or itching.*
● The nurse will evaluate the pt's RBC, Hct, Hgb, platelets, and clotting factors.
● The nurse will assess VS, lung sounds, and test blood for compatibility.
blood type - Answers -● The nurse will make sure blood types are compatible when
preparing for transfusions.
catheter embolism - Answers -● *The nurse will observe pt. for signs of cyanosis,
chestpain, hypotension, and tachycardia.*
● The nurse will secure a tourniquet in pt's arm and place the pt. on bed rest to
minimize movement of catheter.
● The nurse will notify physician if signs of shock are present.
central vascular access device (CVAD) - Answers -● The nurse will make sure the line
is clean, dry, and intact at all times.
● *The nurse will ask for an CXR to ensure the tip of the catheter is in the vena cava
before administering medication.*
● The nurse will instruct the pt. to breathe normally and remain inactive and recumbent
for approximately 30 minutes to achieve hemostasis.
chelation - Answers -● The nurse will initiate therapy when levels of iron (or metals) is
found to be extremely high post blood transfusion to prevent organ damage.
