NURS 106: FINAL EXAM
COMPETENCIES QUESTIONS AND
ANSWERS
Properly assess a client prior to the administration of diuretics - ans-~Assess skin for
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fluid volume deficit or retention (edema)
5 5 5 5 5 5
~Check for hypertension (monitor BP and pulse)
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~Administer IV diuretics slowly to prevent abrupt changes in fluid & electrolytes
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Describe the signs and symptoms of electrolyte imbalances - ans-fatigue, muscle
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cramps/weakness, irritability, confusion, dizziness, constipation, increased HR
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Severe~ heart rhythm abnormalities, seizures, death
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Describe the pathophysiology contributing to acid-base imbalances - ans-People
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develop acid-base imbalances when their normal homeostatic mechanisms are
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dysfunctional or overwhelmed. The body has compensatory mechanisms that
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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
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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;
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respiratory compensation= hypoventilation
5 5 5
, Describe hormones that affect fluid balance - ans-1. Antidiuretic hormone (ADH)
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~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
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(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+
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~"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
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Differentiate between the cations in the extracellular fluid - ans-1. Sodium~ 90% in
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ECF (regulated by intake and aldosterone)
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*Functions: water balance, nerve impulse transmission, neuro acid/base balance
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2. Potassium~ 2% in ECF (regulated by diet and renal excretion)
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*Functions: glycogen, cardiac rhythm, nerve impulse, muscle contraction
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3. Calcium~ 1% in ECF (regulated by hormones)
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*Functions: bone & teeth, clotting, cardiac, nerve impulse, muscle contractions
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4. Magnesium (regulated by diet, renal, hormones)
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*Functions: enzymes, neurochemical, cardiac, muscle
5 5 5 5
Identify sensible and insensible water losses - ans-1. Sensible
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~fluid loss that can be measured
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~ex: urination, defecation, vomiting, excess perspiration
5 5 5 5 5
2. Insensible
5
~fluid loss that cannot be measured
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~ex: perspiration, respiration, changes in humidity levels/RR and depth
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Discuss the diagnostic tools used in acid-base disturbances - ans-ABG
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Explain buffering - ans-Buffers are pairs of chemicals that work together to maintain
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normal pH of bodily fluids
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major buffer in the ECF is HCO3- (buffers metabolic acids)
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examples of buffers: HCO3, hemoglobin, protein, phosphate, cellular, bone buffers
5 5 5 5 5 5 5 5 5
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
