test 10

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1.

normal levels for sodium

135-145mEq/L

2.

normal blood gas

pH 7.35-7.45
PaCO2 35-45 mmHg

3.

normal levels for potassium

3.5-5.3 mEq/L

4.

normal levels for chloride

95-105mEq/L

5.

normal levels for Calcium

total 4.5-5.5 mEq/L or 8.5-10.5 mg/dL.

ionized (56% of total): 2.5mEq/L or 4.0-5.0 mg/dL

6.

normal levels for Magnesium

1.5-205mEq/L or 1.6-2.5mg/dl

7.

normal levels for phosphate

1.8-2.6mEq/L

8.

normal level for serum

osmolality

280-300 mOsm/kg water

9.

total cholesterol

less than 200mg/dl

10.

HDL

men: 35-65mg/dL
women: 35-80mg/dL

11.

LDL

less than 130mg/dl (in CAD less than 60mg/dL)

12.

HCT

men: 40%-%4%
women: 37%-50%

13.

what are the common cations of

the body

sodium, potassium, calcium, magnesium.

14.

what are the common anions of

the body

chloride, bicarbonate (HCO3-), Phosphate (HPO4--), Sulfate (SO4--)

15.

the major cations of the ICF

include?

Potassium, Magnesium

16.

the major anions of the ICF

include?

Phosphate (HPO4--), bicarbonate (HCO3-)

17.

the major cations of the ECF

include?

sodium,

18.

the major anions of the ECF

include?

chloride, bicarbonate (HCO3-)

19.

what can a nurse delegate to a

UAP for a sputum collection?

Nurse can instruct UAP how/when to obtain from a pt that can expectorate a sputum sample. May not
obtain via suctioning

20.

when documenting a sputum

specimen, what must be
included?

amount, color,consistency (thick, tenacious, watery), presence of hemoptysis, odor, any measures
needed to obtain, any discomfort experienced by client.

21.

ECG:

electrocardiography: a graphic recording of the hearts electrical activity. Electrocardiogram

22.

echocardiogram

noninvasive test that uses u/s to visualize structures of the heart and evaluate left ventricular function.

23.

describe the cough reflex:

nerve impulses from vagus nerve to medulla, 2.5L of air inspired, epiglottis and glottis close, strong
contraction raises pressure in lungs, epiglottis and glottis open, air rushes out w/ great velocity,
foreign particles and mucus dislodged.

24.

adequate ventilation depends on

several factors

clear airways, an intact CNS and resp center, intact thoracic cavity ca[able of expanding and
contracting, adequate pulmonary compliance and recoil.

25.

breathing controlled by?

respiratory centers of the medulla and the pons

26.

Interpleural pressure

the pressure in the pleural cavity surrounding the lungs (always negative to atmospheric pressure)

27.

how much air expelled/ inhaled

in each breath in an adult

500L called tidal volume

28.

what is the process of gas

exchange between the aveoli and
the capillary beds?

diffusion(movement from greater concentration to lesser concentration (or pressure))

29.

amount of oxygen that loosely combines with hgb

97% carried as oxyhemoglobin

30.

what are the factors that affect the rate of oxygen

transport from lungs to tissues?

cardiac output, number of eyrthrocytes and HCT, exercise

31.

hypoventilation leads to

hypercarbia or hypercapnia

32.

hyperventilation that accompanines metabolic

acidosis

kussmaul's breathing

33.

Biot's cluster respirations?

shallow breaths interrupted by apnea. (CNS disorders)

34.

signs of dyspnea

flaring of the nostrils, labored-appearing breathing, increased heart rate,

cyanosis, and diaphoresis

35.

signs of hypoxia

rapid pulse
rapid, shallow respirations and dyspnea
increased restlessness or light headedness
flaring of nares
substernal or intercostal retractions
cyanosis

36.

factors promoting healthy breathing:

Sit straight and stand erect to permit full lung expansion.

Exercise regularly.
Breathe through the nose.
Breathe in to expand the chest fully.
Do not smoke cigarettes, cigars, or pipes.
Eliminate or reduce the use of household pesticides and
irritating chemical substances.
Do not incinerate garbage in the house.
Avoid exposure to secondhand smoke.
Use building materials that do not emit vapors.
Make sure furnaces, ovens, and wood stoves are
correctly ventilated.
Support a pollution-free environment.

37.

Interventions by the nurse to maintain the normal

respirations of clients include:

Positioning the client to allow for maximum chest expansion.

Encouraging or providing frequent changes in position.
Encouraging deep breathing and coughing.
Encouraging ambulation.
Implementing measures that promote comfort, such as giving pain medications.

38.

medications used to assist breathing

bronchodialators, anti-inflammatory drugs, expectorants, and others improve

oxygenation by improving cardiac function

39.

postural drainage

changing body positions to induce drainage of secretions via gravity.

40.

Incentive spirometers

Improve pulmonary ventilation.

Counteract the effects of anesthesia or hypoventilation.
Loosen respiratory secretions.
Facilitate respiratory gaseous exchange.
Expand collapsed alveoli.

41.

nasopharyngeal airway must not be taped in place.

only used in altered level of consciousness because of gag reflex.

42.

what can the nurse delegate regarding

administering oxygen via cannula, face mask, or
face tent?

Nurse can delegate reapplying delivery device after it has been set up by the nurse.
UAP must report any client responses to oxygen therapy during usual care.

43.

factors affecting respiratory function include:

age, environment, lifestyle, health status, medications, and stress.

44.

the semi lunar valve are?

aortic and pulmonary valves

45.

the mitral (bicuspid) valve is found??

in the left ventricle

46.

the tricuspid valve is located where

in the right ventricle

47.

the aortic valve is located in the?

left atrium

48.

the pulmonary valve is located in the?

right atrium

49.

S1- first sound

Beginning of ventricular systole; the sound

is caused by closure of the atrioventricular
valvesthe tricuspid and the mitral

50.

s2 - second sound

Beginning of ventricular diastole; the

sound is caused by closure of the
semilunar valvesthe aortic and pulmonic

51.

Stroke volume

the amount of blood ejected with each contraction

52.

cardiac output

the amount of blood pumped by the ventricles in one minute. Calculated by multiplying
the stroke volume times the heart rate

53.

cardiac output is directly related to

heart rate

54.

afterload

is the resistance that the ventricle

must overcome during systole to eject blood into circulation.

55.

Cardiac output

(CO) Amount of blood ejected from the

heart each minute; CO = SV * HR

56.

Heart rate

(HR) Number of beats each minute

57.

Stroke volume

(SV) Amount of blood ejected from the

heart with each beat

58.

Contractility

Inotropic state of the myocardium,

strength of contraction

59.

Preload

Left ventricular end diastolic volume,

stretch of the myocardium

60.

Afterload

Resistance against which the heart

must pump

61.

Cardiovascular function can be altered by

conditions that affect:

1. The function of the heart as a pump

2. Blood flow to organs and peripheral tissues
3. The composition of the blood and its ability to transport
oxygen and carbon dioxide.

62.

Signs and symptoms of MI are variable and

may include the following:

Chest pain; substernal and/or radiating to the left arm, jaw

Nausea
Shortness of breath
Diaphoresis.

63.

Signs of heart failure

may include the following:

Pulmonary congestion; adventitious lung sounds

Shortness of breath
Dyspnea on exertion (DOE)
Increased heart rate
S3 heart sound
Increased respiratory rate
Nocturia
Orthopnea
Distended neck veins.

64.

Abnormalities of heart rate and rhythm are

known as dysrhythmias and can be
identified on an electrocardiogram (ECG).
Can affect cardiac output.

Very irregular or excessively rapid or slow heart rates can

also decrease cardiac output. With irregular or very rapid heart rates, the ventricles may
not fill adequately between beats, so stroke volume (amount pumped with each beat)
falls. If the heart rate is too slow, the heart may not be able to increase its stroke volume
enough to maintain the cardiac output.

65.

CONDITIONS THAT INCREASE

AFTERLOAD

Hypertension
Atherosclerosis

66.

Signs of impaired peripheral arterial

circulation
in the legs and feet may include the
following:

Decreased peripheral pulses

Pain or paresthesias
Pale skin color
Cool extremities
Decreased hair distribution.

67.

risk factors for peripheral atherosclerosis are ?

similar to those for CVD and include cigarette smoking, high fat intake,
obesity, and a sedentary lifestyle. Hypertension and diabete also increase the
risk for atherosclerosis, particularly if the blood pressure or blood glucose
levels are not maintained at near-normal levels.

68.

Signs of acute pulmonary

embolism (PE) can be nonspecific and variable but
may include the following:

Sudden onset of shortness of breath

Pleuritic chest pain.

69.

Signs of anemia may include the following:

Chronic fatigue
Pallor
Shortness of breath
Hypotension.

70.

client teaching in promoting a healthy heart

Exercise regularly, participating in at least 30 minutes of

moderate-intensity aerobic exercise five times a week.
Do not smoke.
Maintain your ideal weight.
Eat a diet low in total fat, saturated fats, and cholesterol.
Drink alcohol in moderation, if at all, consuming no more than 1 cocktail
or 1 to 1 1/2 glasses of wine or beer daily.
Reduce stress and manage anger.
Effectively manage diabetes and hypertension,
maintaining blood glucose and blood pressure levels
within normal limits.
If female, discuss with your health care provider the
advantages and risks of hormone replacement therapy
after menopause (or after a total hysterectomy).
Consult your primary care provider about the
advisability of low-dose aspirin therapy to further
reduce the risk of CVD.

71.

what can be delegated to a UAP regarding sequential

compression devices?

UAP can remove and reapply SCD's during care. instruct UAP that device
cannot be left off for long periods (negates purpose)

72.

Osmotic pressure is

the power of a solution to pull water

across a semipermeable membrane.

73.

colloid osmotic pressure or oncotic pressure

In the body, plasma proteins also exert osmotic pressure

called __________ _______ _____ __ ______ ______ , holding
water in plasma, and when necessary pulling water from the interstitial
space into the vascular compartment. This is an important mechanism in
maintaining vascular volume. Proteins are large molecules

74.

Thirst is normally relieved immediately after drinking

a small amount of fluid, when the ingested fluid
distends the upper gastrointestinal tract, but before
the fluid is actually absorbed from the
gastrointestinal tract.

the effect is only temporary and thirst returns in about 15 minutes. The thirst
is again temporarily relieved by drinking a small amount of fluid. This
mechanism
protects the individual from drinking too much, because it
takes between 30 minutes and 1 hour for fluid to be absorbed and distributed
throughout the body

75.

filtration pressure changes within a capillary bed.

On the arterial side, arterial blood pressure exceeds colloid osmotic

pressure, so that water and dissolved substances move out of the capillary
into the interstitial space. On the venous side, venous blood pressure is less
than colloid osmotic pressure, so that water and dissolved substances move
into the capillary.

76.

obligatory losses.

Certain fluid losses are required to maintain normal body

function. Approximately 500 mL of fluid must be excreted through the
kidneys of an adult each day to eliminate metabolic waste products. Water
lost through respirations, the skin, and in feces also are obligatory losses,
necessary for temperature regulation and
elimination of waste products. The total of all these losses is approximately
1,300 mL per day.

77.

other factors affecting the production and release of

ADH

including blood volume, temperature, pain, stress, and some drugs such as
opiates, barbiturates, and nicotine

78.

how ADH works

When serum osmolality rises, ADH is produced,

causing the collecting ducts to become more permeable to water. This increased
permeability allows more water to be reabsorbed into the blood. As more water is
reabsorbed, urine output falls and serum osmolality decreases because the water
dilutes body fluids. Conversely, if serum osmolality decreases, ADH is suppressed,
the collecting ducts become less permeable
to water, and urine output increases. Excess water is excreted, and serum
osmolality returns to normal.

79.

how renin-angiotensin-aldosterone system

If blood flow or pressure to the kidney decreases, renin is released. Renin causes
the conversion of angiotensinogen to angiotensin I, which is then converted to
angiotensin II by angiotensin-converting enzyme. Angiotensin II acts directly on
the nephrons to promote sodium and water retention. In addition, it stimulates the
release of aldosterone from the adrenal cortex. Aldosterone also promotes sodium
retention in the distal nephron. The net effect of the renin-angiotensin-aldosterone
system is to increase blood volume.

80.

Atrial natriuretic factor

(ANF) is released from cells in the atrium of the heart in response to excess blood
volume and stretching of the atrial walls. Acting on the nephrons, ANF promotes
sodium wasting and acts as a potent diuretic, thus decreasing blood volume. ANF
also inhibits thirst, reducing fluid intake.

81.

some potassium rich foods include

VEGETABLES
Avocado
Raw carrot
Baked potato
Raw tomato
Spinach
MEATS AND FISH
Beef
Cod
Pork
Veal
FRUITS
Dried fruits (e.g., raisins and dates)
Banana
Apricot
Cantaloupe
Orange
BEVERAGES
Milk
Orange juice
Apricot nectar

82.

The lungs and kidneys are the two major systems

that are
working on a continuous basis to help regulate
the acid-base balance in the body. In the
biochemical reactions acid-base balance, the
processes are all reversible and go back and forth
as the body's needs change. The lungs can work
very quickly and do their part by either retaining
or getting rid of carbon dioxide by
changing the rate and depth of respirations.

The kidneys work much more slowly; they may take hours to days to regulate the
balance by either excreting or conserving hydrogen and bicarbonate ions. Under
normal conditions, the two systems work together to maintain homeostasis.
CO2 + H2O <-> H2CO3 <-> H + HCO3

83.

Isotonic fluid volume deficit (FVD)

occurs when the body loses both water and electrolytes from the ECF in similar
proportions. Thus, the decreased volume of fluid remains isotonic. In FVD, fluid is
initially lost from the intravascular compartment, so it often is called
hypovolemia.

84.

FVD generally occurs as a result of

(a) abnormal losses through the skin, gastrointestinal tract, or kidney;

(b) decreased intake of fluid;
(c) bleeding; or
(d) movement of fluid into a third space.

85.

third space syndrome,

fluid shifts from the vascular space into an area where it is not readily accessible as extracellular fluid.

86.

Fluid volume excess

(FVE) occurs when

the body retains both water and sodium in similar proportions to normal ECF. This is commonly referred to as
hypervolemia (increased blood volume). remains isotonic

87.

Specific causes of FVE

include

(a) excessive intake of sodium chloride;

(b) administering sodium-containing infusions too rapidly, particularly to clients with impaired regulatory
mechanisms; and
(c) disease processes that alter regulatory mechanisms,
such as heart failure, renal failure, cirrhosis of the liver, and Cushing's syndrome.

88.

Dehydration, or a
hyperosmolar fluid
imbalance

occurs when water is lost from the body, leaving the client with excess sodium. Because water is lost while
electrolytes, particularly sodium, are retained, serum osmolality and serum sodium levels increase. leads to
cellular dehydration

89.

Respiratory Acidosis

Acute lung conditions that impair alveolar

gas exchange (e.g., pneumonia, acute
pulmonary edema, aspiration of foreign
body, near-drowning)
Chronic lung disease (e.g., asthma, cystic
fibrosis, or emphysema)
Overdose of narcotics or sedatives that
depress respiratory rate and depth
Brain injury that affects the respiratory
center
Airway obstruction

90.

Respiratory Alkalosis

Hyperventilation due to
Extreme anxiety
Elevated body temperature
Overventilation with a mechanical
ventilator
Hypoxia
Salicylate overdose
Brainstem injury
Fever
Increased basal metabolic rate

91.

Metabolic Acidosis

Conditions that increase nonvolatile acids

in the blood (e.g., renal impairment,
diabetes mellitus, starvation)
Conditions that decrease bicarbonate
(e.g., prolonged diarrhea)
Excessive infusion of chloride-containing
IV fluids (e.g., NaCl)
Excessive ingestion of acids such as
salicylates
Cardiac arrest

92.

Metabolic Alkalosis

Excessive acid losses due to

Vomiting
Gastric suction
Excessive use of potassium-losing
diuretics
Excessive adrenal corticoid hormones due
to
Cushing's syndrome
Hyperaldosteronism
Excessive bicarbonate intake from
Antacids
Parenteral NaHCO3

93.

normal values for arterial blood gases

pH 7.35-7.45
PaO2 80-100 mmHg
PaCO2 35-45 mmHg
HCO3- 22-26 mEq/L
Base excess -2 to +2 mEq/L
O2 saturation 95-98%

94.

isotonic solutions

0.9% NaCl (normal saline)

Lactated Ringer's (a balanced electrolyte solution)
5% dextrose in water (D5W)

95.

UAP cannot be delegated for IV infusion, insertion,

or inspection of sites

Nurse responsible for IV care

96.

Inspect the IV insertion site for fluid infiltration.

If an infiltration is present, stop the infusion and remove

the catheter. Restart the infusion at another site.
For hypertonic or hyperosmolar fluid infiltration, apply a
cold compress to the site of the infiltration. For certain nonvesicant drugs,
apply heat to the site; for isotonic or
hypotonic fluid infiltration, choose heat or cold based on
client comfort

97.

Inspect the insertion site for phlebitis

(inflammation of
a vein).

Inspect and palpate the site at least every 8 hours.

Phlebitis can occur as a result of injury to a vein, for example, because of
mechanical trauma or chemical
irritation. Chemical injury to a vein can occur from IV
electrolytes (especially potassium and magnesium)
and medications. The clinical signs are redness,
warmth, and swelling at the IV site and burning pain
along the course of a vein.
If phlebitis is detected, discontinue the infusion, and
apply warm or cold compresses to the venipuncture
site. Do not use this injured vein for further infusions.

98.

Inspect the IV site for bleeding.

Oozing or bleeding into the surrounding tissues can

occur while the infusion is freely flowing but is more
likely to occur after the catheter has been removed
from the vein.
Observation of the venipuncture site is extremely
important for clients who bleed readily, such as those
receiving anticoagulants.

99.

Signs and Symptoms INFILTRATION

Coolness of skin around site

Skin blanching
Edema at, above, or below the insertion site
Leakage at insertion site
Absence of or "pinkish" blood return
Difference in size of opposite hand or arm

100.

Signs and Symptoms EXTRAVASATION

Pain, tenderness, or discomfort

Edema at, above, or below the insertion site
Skin blanching
Change in temperature of skin at insertion site
Burning at insertion site
Feeling of tightness below the site

101.

Signs and Symptoms PHLEBITIS

Redness at the site

Skin warm
Swelling
Palpable cord along the vein
Increase in temperature