STUDY GUIDE # 3 Pharmacology

SG 2 FLUID VOLUME and ELECTROLYTES, VITAMIN & MINERAL REPLACEMENT & NUTRITIONAL SUPPORT
(Answers for this could be find in the lecture powerpoint or could be searched in the internet for values, etc.)

I Fluid Volume and Electrolytes

Match the electrolytes in Column 1 with its normal value in column 2
Column 1 Column 2
d 1. Magnesium a. 96 – 10 6 mEq/L
f 2. Calcium b. 135 – 145 mEq/L
b 3. Sodium c. 2.4 – 4.4 mEq/L
e 4. Potassium d. 1.5 – 2.5 mEq/L
a 5. Chloride e. 3.5 – 5 mEq/L
c 6. Phosphorus f. 8.6 – 10.2 mg/dL

Match the description in Column 1 with its term in Column 2

Column 1 Column 2
b 7. Similar to plasma concentration a. Osmolality
a 8. Based on milliosmoles per kilogram of water b. Isoosmolar
c 9. Fluids contain fewer particles and more water c. Hypoosmolar
d 10. Fluids have a higher solute / particle concentration d. Hyperosmolar

11. The patient has been diagnosed with hypokalemia and will be admitted to the hospital for IV potassium
replacement. What is the nurse’s best action when preparing to give this drug?
a. Prepare the syringe with the ordered amount drug to give IV push
b. Push the potassium into the IV bag and keep it still before administration
c. Push the potassium chloride into the IV bag and shake vigorously
d. Obtain an IV pump and pump tubing since this IV drug must be controlled.

12. A patient has been receiving IV potassium therapy and the nurse notices that the site has become
erythematous and edematous. What is the nurse’s best action?
a. Flush the IV site wit normal saline and increase the rate.
b. Flush the IV site with heparin.
c. Stop the IV and check for blood return.
d. Discontinue the IV and restart in another site.

13. A patient has been receiving IV potassium supplement. The nurse notices that the patient’s heart rate is
now 116 beats / min. What other symptom(s) might the nurse expect to see if the patient is becoming
hyperkalemia? (SELECT ALL THAT APPLY)
a. Abdominal distention
b. Nausea
c. Numbness in extremities
d. Confusion

14. The patient presents to the hospital and is found to be hyperkalemic. What will the nurse anticipate
administering?
a. 10 mEq/L magnesium mixed in 1000 mL of normal saline (NS)
STUDY GUIDE # 3 Pharmacology
b. 0.9% saline bolus of 500 mL
c. A fluid challenge of 250 mL of high-molecular-weight dextran
d. Sodium bicarbonate

15. The patient has been started on a potassium supplement. What should be included in the teaching plan for this
patient? (SELECT ALL THAT APPLY.)
a. List the signs and symptoms of both hypokalemia and hyperkalemia
b. Regular testing of serum potassium levels is required.
c. The patient should increase his intake of potassium-rich foods.
d. The drug must be taken on a full stomach or with a glass of water.
e. The patient should sit up for 30 minutes after taking the drug.

16. What is the normal range for serum osmolality?

a. 175 – 195 mOsm/kg
b. 275 – 295 mOsm/kg
c. 330 – 350 mOsm/kg
d. 475 – 495 mOsm/kg

17. A patient wit head trauma is receiving 3% saline. It has an osmolality of 900 mOsM/kg. This is considered
to be what type of solution?
a. Hypotonic
b. Hypertonic
c. Isotonic
d. Neotonic

18. How is the majority of potassium excreted?

a. Feces
b. Kidneys
c. Liver
d. Lungs

19. The patient has a serum potassium level of 3.2 mEq/L and has been prescribed an extended-release potassium
supplement. She asks the nurse why she has to take the supplement. What is the nurse’s best response?
a. “A low potassium level can be dangerous, and your level of 3.2 mE/L is low and should be corrected.”
b. “You will only be on the drug for a few days, so don’t worry.”
c. “You obviously aren’t taking enough in your diet, so you have to take this.”
d. “Have you been constipated lately? Constipation will cause a low potassium level.”

20. The patient has a serum potassium level of 6.1 mEq/L. What clinical manifestation(s) should the nurse expect to
assess in this patient? (SELECT ALL THAT APPLY)
a. Abdominal cramps
b. Muscle weakness
c. Oliguria
d. Paresthesias of the face
e. Tachycardia and later bradycardia

21. Which drugs are used to treat hyperkalemia? (SELECT ALL THAT APPPLY)
a. Digoxin and furosemide
b. Glucagon and magnesium
c. Glucose and insulin
STUDY GUIDE # 3 Pharmacology
d. Sodium polystyrene sulfonate and sorbitol
e. Sodium bicarbonate and calcium gluconate
22. The patient has pancreatitis. The nurse knows he is at risk for which electrolyte abnormality?
a. Hypocalcemia
b. Hypernatremia
c. Hypomagnesemia
d. Hyperkalemia

23. The nurse is teaching the patient about calcium absorption and includes the health teaching that Vitamin D is
needed for calcium absorption. Where in the body does Vitamin D help in calcium absorption?
a. Colon
b. GI tract
c. Kidneys
d. Liver

24. A patient is prescribed 2 L of IV fluids: 1000 mL of D 5W followed by 1000 mL of D51/2 NS. What are these fluids
classified as?
a. Colloid
b. Crystalloids
c. Lipids
d. Parental nutrition

25. The patient is in the hospital overnight after having surgery and the nurse has received an order to start an IV of D 5 ½
NS. What type of fluid is D5 ½ NS?
a. Hypotonic
b. Hypertonic
c. Isotonic
d. Normotonic

26. A patient is receiving high-molecular-weight dextran (a plasma expander) after an explosion has burned over 50% of
his body. What is the purpose of this fluid?
a. Temporarily restore circulating volume
b. Serve as a line to infuse blood into
c. Piggy back fluid for antibiotics
d. Whole blood substitute

27. Which body fluid has a similar composition to lactated Ringer’s IV solution?
a. Plasma
b. Skin
c. Tears
d. White blood cells

28. Magnesium deficiencies are frequently associated with which other electrolyte imbalance?
a. Hypocalcemia
b. Hyperkalemia
c. Hyponatremia
d. Hyperphoshatemia
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29. The patient has had diarrhea for several days and has a serum calcium level of 7.2 mg/dL. What clinical
manifestations will the nurse expect to see in this patient? ( SELECT ALL THAT APPLY.)
a. Hyperactive deep tendon reflexes
b. Irritability
c. Numbness of the fingers
d. Pathologic fractures
e. Tetany

II VITAMINS and MINERAL REPLACEMENT

Match the letter of fat-soluble or water soluble vitamins in Column 2 with the appropriate word or phrase in column 1

Column 1 Column 2

a 30. Toxic in excessive amounts a. Fat-soluble vitamins

a 31. Metabolized slowly b. Water-soluble vitamins
b 32. Minimal protein binding
b 33. Readily excreted in urine
a 34. Slowly excreted in urine

35. The patient has just given birth, and the nurse is preparing to administer vitamin K to the newborn. The patients
asks, “Why do you have to give that to my baby?” What is the nurse’s best response?
a. “It will help the baby’s digestive tract work better.”
b. “Vitamin K helps a baby maintain its temperature.”
c. “Newborns are vitamin K-deficient at birth.”
d. “This will help prevent infections for the first month.”

36. The patient presents for her annual well-woman exam. She states that she does not take any drugs but she knows
she is supposed to take “some supplement in case I get pregnant.” What is the nurse’s best response?
a. “Folic acid supplements are recommended in women who may become pregnant to prevent neural tube
defects.”
b. “Vitamin A 8000 units should be taken to promote bone growth.”
c. “Megadoses of iron are important for blood formation.”
d. “Vitamin C 1600 mg should be taken to prevent colds, which are more common in pregnancy.”

37. The patient has a history of heavy alcohol abuse. He presents to the emergency department confused, combative,
and complaining of double vision. The patient’s family states he has become very forgetful recently. The nurse will
anticipate that the provider will order which substance for this patient?
a. Vitamin C
b. Vitamin B1
c. Dextrose
d. Vitamin B6

38. The patient takes an antacid for reflux and an iron supplement for anemia. What information will the nurse be sure
to include in patient education regarding these drugs?
a. “These drugs have a synergistic effect.”
b. “Iron and antacids must be taken on alternate days.”
c. “Antacids will decrease iron absorption.”
d. “Iron will decrease the effectiveness of the antacids.”
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39. A 24-year-old patient has been prescribed large doses of vitamin A as treatment for acne. What will the nurse advise
this patient? (SELECT ALL THAT APPLY)
a. Contact the health care provider concerning drug dosing.
b. Report peeling skin, anorexia, or nausea and vomiting to the health care provider.
c. Do not exceed the recommended dosage without consulting the health care provider.
d. Avoid alcohol consumption.
e. Megadoses of vitamin A are necessary for several months to alleviate acne.

40. The patient has history of tuberculosis and is on isoniazid (INH) therapy. The patient presents to the clinic with
complaints of numbness and weakness in his hands and feet. He has no other significant medical history. Which
vitamin supplement might be considered for his condition?
a. Niacin
b. Pyridoxine
c. Riboflavin
d. Thiamine

41. The patient presents to the emergency department with an overdose of the oral anticoagulant warfarin. The nurse
will anticipate administration of which vitamin for this patient?
a. B2
b. C
c. E
d. K

III NUTRITIONAL SUPPORT

42. Nutritional support is considered if the patient has had little or no nutrition for more than 5 days. (True or False)
43. Parenteral and enteral nutrition are synonymous and are delivered through the same route. (True or False)
44. Nasodoudenal, nasojejunal, and jejunostomy enteral nutrition deliver food below the pyloric sphincter. (True or
False)

45. What is a common side effect associated with enteral nutrition?

a. Constipation
b. Diarrhea
c. Urinary retention
d. Yeast infection
STUDY GUIDE # 3 Pharmacology
46. Which complication(s) is/are associated with the use of TPN? (SELECT ALL THAT APPLY.)
a. Air embolism
b. Aspiration
c. Hyperglycemia
d. Pneumothorax

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