NURS 106: FINAL EXAM COMPETENCIES QUESTIONS AND ANSWERS

NURS 106: FINAL EXAM
COMPETENCIES QUESTIONS AND
ANSWERS

Properly assess a client prior to the administration of diuretics - ans-~Assess skin for
5 5 5 5 5 5 5 5 5 5 5 5 5


fluid volume deficit or retention (edema)
5 5 5 5 5 5


~Check for hypertension (monitor BP and pulse)
5 5 5 5 5 5


~Administer IV diuretics slowly to prevent abrupt changes in fluid & electrolytes
5 5 5 5 5 5 5 5 5 5 5




Describe the signs and symptoms of electrolyte imbalances - ans-fatigue, muscle
5 5 5 5 5 5 5 5 5 5


cramps/weakness, irritability, confusion, dizziness, constipation, increased HR
5 5 5 5 5 5 5




Severe~ heart rhythm abnormalities, seizures, death
5 5 5 5 5




Describe the pathophysiology contributing to acid-base imbalances - ans-People
5 5 5 5 5 5 5 5


develop acid-base imbalances when their normal homeostatic mechanisms are
5 5 5 5 5 5 5 5 5


dysfunctional or overwhelmed. The body has compensatory mechanisms that
5 5 5 5 5 5 5 5 5


compensate by involving physiological changes to help normalize pH, but cannot fully
5 5 5 5 5 5 5 5 5 5 5 5


fix the problem. FOR EXAMPLE, if there is a respiratory acid-base imbalance, only
5 5 5 5 5 5 5 5 5 5 5 5 5


the lungs can fix the problem but the kidneys can compensate by changing the
5 5 5 5 5 5 5 5 5 5 5 5 5 5


amount of metabolic acid in the blood
5 5 5 5 5 5 5




Imbalances:
1. Respiratory Acidosis~ alveolar hypoventilation; lungs are unable to excrete enough
5 5 5 5 5 5 5 5 5 5


5CO2, so the PaCO2 rises to create an excess of carbonic acid in the blood with
5 5 5 5 5 5 5 5 5 5 5 5 5 5 5


5increases pH. To compensate, the kidneys increase excretion of metabolic acids in
5 5 5 5 5 5 5 5 5 5 5


5the urine which increases blood HCO3
5 5 5 5 5




2. Respiratory Alkalosis~ alveolar hyperventilation; lungs excrete too much carbonic
5 5 5 5 5 5 5 5 5


acid so the PACO2 falls, creating a deficit of carbonic acid in the blood which
5 5 5 5 5 5 5 5 5 5 5 5 5 5 5


increases pH. Because this is short lived, the kidneys do not have time to
5 5 5 5 5 5 5 5 5 5 5 5 5 5


compensate
5




3. Metabolic Acidosis~ increased metabolic acid or decreased bicarbonate; the
5 5 5 5 5 5 5 5 5


kidneys are unable to excrete enough metabolic acid OR bicarbonate is removed
5 5 5 5 5 5 5 5 5 5 5 5


from the body (as with diarrhea). This causes the pH to fall which stimulates
5 5 5 5 5 5 5 5 5 5 5 5 5 5


chemoreceptors, so the respiratory system compensates with hyperventilation
5 5 5 5 5 5 5 5




4. Metabolic Alkalosis~ direct increase of HCO3 or decrease of metabolic acid;
5 5 5 5 5 5 5 5 5 5 5


respiratory compensation= hypoventilation
5 5 5

, Describe hormones that affect fluid balance - ans-1. Antidiuretic hormone (ADH)
5 5 5 5 5 5 5 5 5 5


~Released from the posterior pituitary 5 5 5 5


~Stimulates thirst 5


~Helps control BP by acting on the kidneys and blood vessels
5 5 5 5 5 5 5 5 5 5


~Conserves fluid volume of body by reducing the amount of water passed in urine
5 5 5 5 5 5 5 5 5 5 5 5 5


(reabsorption of water)
5 5 5




2. Renin-angiotensin-(aldosterone) system (RAAS)
5 5 5


~Secreted from the adrenal cortex 5 5 5 5


~Regulates BP by increasing the reabsorption of Na and excretion of K+
5 5 5 5 5 5 5 5 5 5 5


~"salt and water balancer"
5 5 5




3. Atrial natriuretic peptides (ANPs)
5 5 5 5


~Produced by the heart 5 5 5


~Increases renal Na excretion and intravascular fluid volume
5 5 5 5 5 5 5




Differentiate between the cations in the extracellular fluid - ans-1. Sodium~ 90% in
5 5 5 5 5 5 5 5 5 5 5 5


ECF (regulated by intake and aldosterone)
5 5 5 5 5 5


*Functions: water balance, nerve impulse transmission, neuro acid/base balance
5 5 5 5 5 5 5 5




2. Potassium~ 2% in ECF (regulated by diet and renal excretion)
5 5 5 5 5 5 5 5 5 5


*Functions: glycogen, cardiac rhythm, nerve impulse, muscle contraction
5 5 5 5 5 5 5




3. Calcium~ 1% in ECF (regulated by hormones)
5 5 5 5 5 5 5


*Functions: bone & teeth, clotting, cardiac, nerve impulse, muscle contractions
5 5 5 5 5 5 5 5 5




4. Magnesium (regulated by diet, renal, hormones)
5 5 5 5 5 5


*Functions: enzymes, neurochemical, cardiac, muscle
5 5 5 5




Identify sensible and insensible water losses - ans-1. Sensible
5 5 5 5 5 5 5 5 5


~fluid loss that can be measured
5 5 5 5 5


~ex: urination, defecation, vomiting, excess perspiration
5 5 5 5 5




2. Insensible
5


~fluid loss that cannot be measured
5 5 5 5 5


~ex: perspiration, respiration, changes in humidity levels/RR and depth
5 5 5 5 5 5 5 5




Discuss the diagnostic tools used in acid-base disturbances - ans-ABG
5 5 5 5 5 5 5 5 5




Explain buffering - ans-Buffers are pairs of chemicals that work together to maintain
5 5 5 5 5 5 5 5 5 5 5 5


normal pH of bodily fluids
5 5 5 5 5




major buffer in the ECF is HCO3- (buffers metabolic acids)
5 5 5 5 5 5 5 5 5




examples of buffers: HCO3, hemoglobin, protein, phosphate, cellular, bone buffers
5 5 5 5 5 5 5 5 5