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ACNP II Exam 1 – Questions & Accurate Answers (100%)
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ACNP II Exam 1 – Questions & Accurate Answers (100%)
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ACNP II Exam 1 – Questions & Accurate Answers(100%)
Which of the following is most accurate regarding treatment of hyponatremia?
a. use of a V2 receptor antagonist is contraindicated in asymptomatic patients
with hypovolemic hyponatremia.
b. hypertonic saline is recommended in normovolemic (euvolemic),
asymptomatic patients with hyponatremia.
c. in general, chronic hyponatremia can be safely corrected more quickly than
acute hyponatremia.
d. consider potassium repletion in patients with hypovolemia secondary to
the use of diuretics. Right Ans - d. consider potassium repletion in patients
with hypovolemia secondary to the use of diuretics.
Hyponatremia that occurs when there is a low serum osmolality (SOsm).
There is an excess of body water with both intra- and extracellular fluid (ECF)
dilution. The patient's clinical signs occur due to the excess water causing cell
swelling. Right Ans - Hypotonic hyponatremia
Hyponatremia that occurs when there is a normal SOsm. It occurs when there
is a laboratory artifact, hyperlipidemia that is extreme, or hyperproteinemia
that displaces water in the lab sample. The patient's body water is normal, and
they are asymptomatic. Right Ans - isotonic hyponatremia
Hyponatremia that occurs when there is a high SOsm. There is dilution of
extracellular fluid sodium by the water shifting from cells into high
concentrations of non-sodium solute (e.g., glucose or mannitol). The patient's
clinical signs occur from the primary disorder and not from the redistribution
of water Right Ans - hypertonic hyponatremia
Causes of hyponatremia include Right Ans - Water excretion is less than
water consumption. Causes may include: • Decreased kidney function,
impaired GFR
• Diuretic effect that impairs formation of dilute
• Non-osmotic antidiuretic hormone (ADH) release concentrating urine
,Hyponatremia with edematous state of excess total body sodium content with
or without hemodynamic compromise. ADH secretion is stimulated. Right
Ans - Hypervolemic hyponatremia
Causes of hypervolemic hyponatremia Right Ans - CHF, nephrotic
syndrome with massive edema, cirrhosis causing peripheral vasodilation
Hyponatremia that may result from any cause of sodium loss, is a state of
deficient total body sodium content. ADH secretion is stimulated. Right Ans
- Hypovolemic hyponatremia
Causes of hypovolemic hyponatremia Right Ans - • Blood loss
• Non-renal causes: GI fluid loss (vomiting, diarrhea, tube loss)
• Renal fluid loss through diuresis or aldosterone deficiency (adrenal
insufficiency), impaired renal tubular function leading to salt and water loss
• Skin fluid loss (insensible loss)
• Thiazide diuretics
Hyponatremia with normal body sodium content, no edema, normal
hemodynamics Right Ans - euvolemic hyponatremia
Causes of euvolemic hyponatremia Right Ans - • SIADH - most frequent
cause
• Use of diuretics
• Renal failure both acute and chronic
• Moderate to severe hypothyroidism
• Water ingestion exceeding excretion
Which sodium level do these symptoms correlate with?
o Acute: nausea, seizures, coma
o Chronic: Rarely none, greater confusion, or lethargy Right Ans - Serum Na
less than 110 mEq/L
Which sodium level do these symptoms correlate with?
o Acute: Nausea, malaise, gait instability
o Chronic: none to gait instability (fall risk in elderly) Right Ans - Serum Na
120-125 mEq/L
Which sodium level do these symptoms correlate with?
,o Acute: headache, confusion, lethargy, nausea o Chronic: Occasionally none to
mild confusion or lethargy Right Ans - Serum Na 110-120 mEq/L
What should you assess in hyponatremic pt? Right Ans - Assess their
volume status:
-Skin, mucus membranes, heart and lung sounds, presence of JVD and/or
peripheral edema.
Assess neuro status.
Your patient has a serum Na less than 135 and an SOsm less than 270 (norm
280-295), what type of hyponatremia do they have?
a. hypotonic hyponatremia
b. isotonic hyponatremia
c. hypertonic hyponatremia Right Ans - a. hypotonic hyponatremia
Your pt has a serum Na less than 135 and their SOsm is between 280-295.
You're suspicious because they have extremely high triglycerides. What type
of hyponatremia do they have?
a. hypotonic hyponatremia
b. isotonic hyponatremia
c. hypertonic hyponatremia Right Ans - b. isotonic hyponatremia
Your pt has a serum Na less than 135 and their SOsm is greater than 290.
What type of hyponatremia do they have?
a. hypotonic hyponatremia
b. isotonic hyponatremia
c. hypertonic hyponatremia Right Ans - c. hypertonic hyponatremia
What condition is seen in hypertonic hyponatremia? What infusions are
associated with it? Right Ans - Seen in hyperglycemia
***each time BS increases by 100, the Na decreases by 1.6 mEq/L***
Seen in mannitol or glycerol infusions.
What are the differential diagnoses for hyponatremia? Right Ans - a.
Pseudohyponatremia - can be seen in patients with hypertriglyceridemia
greater than 1,000 mg/dL, familial hypercholesterolemia and proteinemia
greater than 10 gm/dL as in multiple myeloma
b. Dilutional hyponatremia resulting in increased total body water +/- solutes
, c. Solute depletion hyponatremia resulting in decreased solutes and increased
total body water
What is the only type of hyponatremia that requires the treatment to be
directed at the serum Na?
a. hypotonic hyponatremia
b. isotonic hyponatremia
c. hypertonic hyponatremia Right Ans - a. hypotonic hyponatremia
Otherwise, treatment includes:
• Therapy is guided by symptoms, level of serum sodium and rapidity of
development
• Rate of correction is critical to avoid CNS insult
You have a patient with a Na less than 120 and they're experiencing seizures
and/or coma. What fluid do you use?
How fast can you bring up the Na?
To what level should you bring the Na to? Right Ans - -Use 3% hypertonic
saline
-increase serum Na by only 1-2 mEq/L/hr until Na rises by 12-15 mEq/L OR
to a level of 120 mEq/L
-Max correction rate is 8-12 mEq/L/24 hr or 25 mEq/L/48 hrs
Your pt has a Na less that 115 mEq/L and are having moderate symptoms.
How should you treat them? Right Ans - Two options:
1. Give 3% hypertonic as in severe symptoms
2. OR treat on basis of volume status as discussed in mild or asymptomatic
patients.
Your patient is hyponatremic but has either mild or no symptoms at all. How
do you treat them? Right Ans - • If the patient is hypovolemic, give NS to
correct the volume status. ADH secretion will stop, kidneys will excrete the
excess water
• If the patient is Hypervolemic, administer loop diuretics. Lasix 40-80 mg IV
or PO is the usual treatment. ADH stops, kidneys excrete extra water
E. All cases: restrict water or total fluid intake to 1000ml/24 hours or less
F. DC drugs that enhance Na excretion
G. Associated hypokalemia: supplement with PO or intravenous PRN
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