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NR 324 Exam 1 Study Guide
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NR 324 Exam 1 Study GuideChapters 17, 26, 27, 28, 29, and ABG interpretation.
Fluid & Electrolyte
1. Potassium Chloride intravenous- care of patient, how much (meq/hr) is the infusion rate?(p.316)
Potassium Chloride intravenous can be administered to treat a patient with hypokalemia.
● Except in severe deficiencies, KCL is never given unless there is urine output of at least
0.5ml/kg of body weight per hour
Safety Alert:
● KCL given intravenously must always be diluted.
● Never give KCL via IV push or in concentrated amounts.
● IV bags containing KCL should be inverted several times to ensure even distribution in the bag.
● Never add KCL to a hanging IV bag to prevent giving a bolus dose.
How much (meq/hr) is the infusion rate?
The preferred maximum concentration is 40 mEq/L; however, stronger concentrations may be given
for severe hypokalemia (up to 80mEq/L) with continuous cardiac monitoring.
● The rate of IV administration of KCL should not exceed 10 to 20mEq per hour and should be
administered by infusion pump to ensure correct administration rate. Because KCL is
irritating to the vein, assess IV sites at least hourly for phlebitis and infiltration
o Infiltration can cause necrosis and sloughing of the surrounding tissue.
Central IV lines should be used when rapid correction of hypokalemia is necessary
2. ABG interpretation( do the practice questions that teacher gave& p324 & hesi 43,44)
An acid-base balance must be maintained in the body because alterations can result in alkalosis or
acidosis.
Maintain the acid –base balance involves 3 systems
● Chemical buffer
o The chemical buffer act immediately to prevent major change in the body fluid pH by
removing or releasing hydrogen ions.
▪ The main chemical buffer is the Bicarbonate-Carbonic acid (HCO3-
▪ H2CO30system.
● Normally there are 20parts of bicarbonate to 1 part of carbonic acid. If the
20:1 ratio is altered, the pH is changed( ratio is important not absolute
values)
● Carbonic acid (H2CO3) is form when carbon dioxide (CO2) combines
with water (H2O).
● Excess CO2 in the body alters the ratio and creates an imbalance. Other
buffer system involve:
, o Monohydrogen-dihydrogen phosphate
o Intracellular and plasma protein
o Hemoglobin
● Respiratory system (lungs)
o The respiratory system responds in minutes and reaches maximum effectiveness in hours
▪ Control CO2 content through respirations (carbonic acid content)
▪ Control, to a small extent, water balance (CO2+H2O=H2CO3)
▪ Release excess CO2 by increasing respiratory rate.
▪ Retain CO2 by decreasing respiratory rate.
The rate of the CO2 is control by the respiratory center in the medulla in the brainstem.
If the respiratory problem is the cause of an acid –base imbalance (e.g., respiratory failure), the
respiratory system loses its ability to correct a pH alteration.
● Renal system (kidney)
o The renal response takes 2 to 3 days to respond maximally, but the kidneys can maintain
balance indefinitely in chronic imbalance.
▪ Regulate bicarbonate levels by retaining and reabsorbing bicarbonate as needed.
▪ a very slow compensatory mechanism ( can require hour or days).
▪ Cannot help with compensation when metabolic acidosis is created by renal
failure
If the renal system is the cause of and acid-base imbalance (e.g., renal failure), it loses its ability
to correct a pH alteration.
Arterial Blood Gas (ABG) values provide valuable information about a patient’s acid-base status, the
underlying cause of the imbalance, the body’s ability to regulate pH, and the patient’s overall oxygen
status. (p. 324, shows the steps on how to diagnose acid disturbances and identification of compensatory
processes).
● Uncompensated respiratory Alkalosis with hypoxemia(Kidney clearance)
● Uncompensated Respiratory Acidosis with Hypoxemia
● Partially compensated Respiratory Acidosis
● Partially compensated Metabollic Alkalosis(Kidney and lungs are helping each other)
● Fully compensated Respiratory Alkalosis(Good prognosis)
Page44 hesi
Acid-base condition pH Pco2 HCO3
(mm Hg) (mEq/L)
Normal 7.34-7.45 35-45 22-26
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