1. The diagnosis is hyponatremia if the serum sodium is less than_____mEq/l.

135

G7 p.7:107mm

2. The syndrome is SIADH

G7 p.7:107mm

a. if the serum osmolality is less than_____mOsm/l

275

b. and the urine osmolality is more than_____mOsm/l.

100

3. The syndrome is CSW if the urinary sodium is greater than_____mEq/l.

20

G7 p.7:123mm

4. Severe hyponatremia is considered a sodium lower than_____mEq/l.

125

G7 p.7:142mm

5. Hyponatremia is considered

G7 p.7:145mm

a. mild if sodium is_____mEq/l

135

b. moderate if sodium is_____mEq/l

130

c. severe if sodium is_____mEq/l

125

6. Matching. For Na metabolism, match the conditions with their characteristics and treatment.

G7 p.7:145mm

Characteristics and treatment: hyponatremia; increased intravascular volume; treat with volume restriction; volume depletion; treat with Na + volume replacement; symptoms made worse by fluid restriction

Conditions:

a. inappropriate antidiuretic hormone (ADH)

, ,

b. cerebral salt wasting

, , ,

7. Complete the equation to calculate serum osmolality.

G7 p.8:175mm

a. Effective serum osmolality = measured osmolality −

BUN

8. Matching. Match symptoms with severity of hyponatremia.

G7 p.9:150mm

Hyponatremia: mild hyponatremia is less than 130 mEq/l, severe hyponatremia is less than 125 mEq/l

Symptoms:

a. headache

b. cerebral edema

c. anorexia

d. nausea vomiting

e. muscle weakness

f. muscle twitching

g. seizures

h. respiratory arrest

     i. difficulty concentrating

9. List the symptoms of hyponatremia.

G7 p.9:158mm

Hint: c⁶natremia

a. cep_____

cephalgia

b. cer_____e_____

cerebral edema

c. com_____

coma

d. con_____

confusion

e. conv_____

convulsions

f. c_____

cramps

g. n_____

nausea

h. a_____

anorexia

     i. t_____

twitching

j. r_____ a_____

respiratory arrest

k. e_____

excitability

l. m_____ w_____

muscle weakness

m. i_____

irritability

a

10. SIADH criteria are

G7 p.10:115mm

a. NA is_____

low

b. Urine osmolality is_____

high

c. Volemia is_____

high

d. Due to release of_____

ADH

     i. without_____stimuli

osmotic

     ii. creates_____hyponatremia

dilutional

e. The release of ADH without a stimulus is what makes the release_____

inappropriate

11. One of the major effects of antidiuretic hormone is to

G7 p.11:155mm

a. _____the permeability of the

increase

b. _____renal tubule. This results in

distal

c. _____ _____ of water.

increased reabsorption

d. Its effects on the circulating blood?

dilutes it

e. Its effect on urine volume?

reduces urine volume

f. Its effect on urine concentration?

increases urine concentration

12. True or False. SIADH stands for syndrome of inappropriate antidiuretic hormone.

true

G7 p.10:115mm

13. SIADH can also stand for s_____i_____a_____d_____h_____.

sodium is abnormal dilutionally hyponatremic

G7 p.10:115mm

14. Complete the following regarding the treatment of hyponatremia:

G7 p.10:140mm

a. Avoid_____correction.

rapid

b. Avoid_____correction.

over

c. Do not exceed_____mEq/l per hour.

1

d. Do not exceed_____mEq/l per 24 hours.

8

e. Do not exceed_____mEq/l per 48 hours.

18

15. Matching. Diagnosis of SIADH depends on three diagnostic criteria. Match the laboratory value with the appropriate test.

G7 p. 11:28mm

Test:

serum Na; serum K; serum osmolality; urinary osmolality; urinary Na; urinary K; blood urea nitrogen (BUN) creatinine Laboratory value:

a. low

b. high

c. normal

16. Give the expected result for each test in the diagnosis of SIADH.

G7 p.11:35mm

a. serum Na_____ _____ _____

low—below 134 mEq/l

b. serum osmol _____ _____ _____

low—below 280 mOsm/L

c. urinary Na _____ _____ _____

high—above 18 mEq/l

d. urinary Na may be as high as _____

50 to 150 mEq/l

e. serum BUN below_____

10

f. serum creatinine_____

normal

17. Na at what level is always symptomatic?

120 to 125 mEq/l

G7 p.11:95mm

18. Characterize the symptoms of SIADH.

G7 p11:95mm

a. Symptoms are almost always present at a Na of_____to_____

120 to 125mEq/l

b. May treat if asymptomatic with_____restriction

fluid

c. Avoid too rapid_____

correction

19. Central pontine myelinolysis (CPM) is

G7 p.11:150mm

a. aka o_____ d _____syndrome

osmotic demyelination

b. due to r_____ c_____ of hyponatremia

rapid correction

c. a disorder of p_____ w_____ m_____

pontine white matter

d. Its symptoms are

     i. f_____ q_____

flaccid quadriplegia

     ii. m_____s_____changes

mental status

     iii. c_____ n_____ abnormalitie

cranial nerve

     iv. p_____ p_____ appearance

pseudobulbar palsy

20. Features common to patients who develop CPM are

G7 p.11:178mm

Hint: rodi

a. r_____c_____

rapid correction

b. o_____c_____

over correction

c. d_____ in d_____ for more than_____hours

delay in diagnosis, 48

d. increase in NA by more than_____mEq/l within_____hours

25; 48

21. To treat mild SIADH you could modify the following by:

G7 p.13:100mm

a. H₂O_____ _____

restrict fluid

b. Salt_____ _____

use 3% NaCl (to increase Na)

22. To treat cerebral salt wasting (CSW) you could modify the following by:

G7 p.14:65mm

a. H₂O_____ _____

give fluid

b. Salt_____ _____

give salt (Hint: CSW—cure with salt and water.)

23. What is the treatment of severe hyponatremia?

G7 p.12:140mm

a. Correct hyponatremia that is below_____mEq/l.

125

b. Start with a _____% correction.

10%

24. Do not exceed a correction of

G7 p.13:15mm

a. more than_____mEq/l/hr

1.3

b. more than _____ mEq/l/24/hrs

10

c. use _____% NaCl

3%

d. this has_____Eq/NaCl

513

e. start with_____cc/hr

25

f. simultaneously administer _____

furosemide

25. List the expected patient laboratory result when comparing SIADH with CSW.

G7 p.14:20mm

a. water: in SIADH _____, in CSW_____

SIADH: hypervolemic, CSW: hypovolemic

b. Na (serum): in SIADH_____, in CSW_____

SIADH: low, CSW: low

c. osmol (serum): in SIADH_____, in CSW_____

SIADH: low, CSW: high

d. osmol (urine): in SIADH _____, in CSW_____

SIADH: high, CSW: high

e. Na (urine): in SIADH _____, in CSW_____

SIADH: high, CSW: high

f. Hct: in SIADH_____, in CSW_____

SIADH: low, CSW: high

26. What is the treatment of CSW?

G7 p.14:70mm

a. Hydrate

     i. with _____%_____ saline

0.9%, normal

     ii. at_____cc/hr

100 to 125

b. Use furosemide (yes or no?)

no

c. Avoid_____correction

rapid

27. In neurosurgical patients hyponatremia is seen in

G7 p.14:140mm

a. c_____ s_____ w_____

cerebral salt wasting

b. and S_____.

SIADH

28. In neurological patients hypernatremia is seen in

G7 p.14:144mm

a. d_____i_____.

diabetes insipidus

b. Define hypernatremia.

Na above 150mEq/l

29. Characterize diabetes insipidus.

G7 p.15:40mm

a. Due to low level of_____.

ADH

b. Urine output is >_____ cc/hr.

200

c. Specific gravity of urine is <_____.

1.003

d. Serum osmolarity is normal or_____.

high

e. Serum sodium is_____.

high

30. In diabetes insipidus is the following low or high?

G7 p.15:40mm

a. ADH is_____.

low

b. Urine specific gravity is_____.

low

c. Urine output is_____.

high

d. Serum osmolality is_____.

high

e. Serum sodium is_____.

high

31. Diabetes insipidus features:

G7 p.15:40mm

a. Urine output is_____.

high

b. Urine mOsm/l is below_____.

200

c. Specific gravity is below_____.

1.003

d. Serum osmol is_____.

high or normal

e. Normal serum osmol is between _____ and _____ mOsm/l.

282 and 295 mOsm/l

32. Diabetes insipidus etiology:

G7 p.15:80mm

a. neu_____

neurogenic

b. nep_____

nephrogenic

33. Diagnosis of diabetes insipidus occurs when

G7 p.16:110mm

a. urine output is above_____.

250 cc/hr

b. urine osmol is below_____.

200 mOsm/l

c. specific gravity is below_____.

1.003

34. Characterize serum osmolality.

G7 p.19:30mm

a. Normal range is between _____ to _____ mOsm/l

282 to 295

b. Dangerous if below_____ mOsm/l

240

c. Dangerous if above_____mOsm/l

320

d. Risk of renal failure if above_____ mOsm/l

320

e. Seizures can occur if above_____ mOsm/l

400

35. List the effects of labetalol on the following:

G7 p.20:50mm

a. ICP

no change

b. pulse

no change

c. cardiac output

no change

d. coronary ischemia

no change

e. renal failure

no change

36. List the plasma expanders that are useful cardiovascular agents for treating shock.

G7 p.22:50mm

a. cr_____

crystalloids

b. co_____

colloids

c. bl_____p_____

blood products

37. Describe the method of dosage for an intravenous (IV) drip of labetalol.

G7 p.20:70mm

a. add_____ml (200 mg)

40

b. to_____ml volume to create a volume

160

c. of_____ml and infuse

200

d. at_____ml/min until

2

e. _____mg is given or the desired blood pressure (BP) is achieved.

300

38. For the listed pressors complete the following statements to describe the cautions required.

a. Neo-Synephrine: avoid in s_____c_____i_____

spinal cord injuries

G7 p.22:170mm

b. Dopamine: may cause h_____

hyperglycemia

G7 p.22:100mm

c. Dobutamine: may cause dysfunction of p_____

platelets

G7 p.22:127mm

39. The Richmond Scale: Rass quantitates _____and_____ levels.

agitation and sedation

G7 p.23:90mm

40. True or False. Indicate whether the following statements are true or false:

G7 p.24:25mm

a. Methohexital (Brevital) is more potent and shorter acting than thiopental.

true

b. Fentanyl causes dose-dependent respiratory depression.

true (also causes chest wall rigidity if given rapidly)

c. Propofol has better neuroprotection than barbiturates (during aneurysm surgery).

false (barbiturates are better)

d. Haldol can cause neuroleptic malignant syndrome.

true

41. True or False. The following sedatives may induce seizures:

G7 p.24:30mm

a. thiopental

false

b. methohexital

true

c. fentanyl

false

d. propofol

false

e. haloperidol

false

42. True or False. The drug that can produce a neuroleptic malignant syndrome as a secondary effect is

G7 p.24:47mm

a. propofol

false

b. benzodiazepines

false

c. fentanyl

false

d. haloperidol

true

e. thiopental

false

43. Complete the following statements about the neuroleptic malignant syndrome:

G7 p.24:47mm

a. Characterized by Hint: neuroleptic

     i. n_____

motor, mutism

     ii. e_____

elevation of temperature

     iii. u_____

unconsciousness

     iv. r_____

rigid muscles, rapid heart rate, respiratory failure

     v. o_____

opisthotonus

     vi. l_____

lethargy, leucocytosis

     vii. e_____

elevated CPK

     viii. p_____

potentially lethal

     ix. t_____

trembling

     x. i_____

imbalance of autonomic system

     xi. c_____

coma

44. True or False. Regarding thiopental:

G7 p.24:86mm

a. It’s a long-acting barbiturate.

false (Thiopental is a short-acting barbiturate with consciousness returning after 20 to 30 minutes.)

b. It causes dose-related respiratory depression.

true

c. It causes myocardial depression.

true

d. It is an antianalgesic.

true

e. It causes hypotension in hypovolemic patients.

true

45. True or False. The following sedative causes necrosis when injected intraarterially:

G7 p.24:94mm

a. thiopental

true

b. fentanyl

false

c. propofol

false

46. True or False. Choose the correct order from long-acting to short-acting for the following neuromuscular blocking agents:

G7 p.24:120mm

a. succinylcholine, vecuronium, pancuronium, nocuronium

false

b. vecuronium, pancuronium, succinylcholine, rocuronium

false

c. pancuronium, vecuronium, rocuronium, succinylcholine

true—pancuronium (Pavulon)—60 to 180 minutes vecuronium (Norcuron)—40 to 60 minutes

rocuronium (Zemuron)—40 to 60 minutes (but shorter onset)

succinylcholine (Anectine)—20 minutes

d. rocuronium, succinylcholine, pancuronium, vecuronium

false

e. vecuronium, pancuronium, rocuronium, succinylcholine

false

47. True or False. The following is always required in a conscious patient simultaneously with a paralytic agent and as ventilation is being established:

G7 p.25:100mm

a. arterial line

false

b. Swan-Ganz catheter

false

c. sedation

true

d. intracranial pressure (ICP) monitor

false

e. all of the above

false

48. True or False.

G7 p.25:165mm

a. Pancuronium is a long-acting agent.

true

b. Rocuronium is a short-acting agent.

true

c. Succinylcholine is a competitive blocker and is short acting.

noncompetitive blocker and false (Succinylcholine is a is considered the only depolarizing ganglionic blocker. It has been linked to malignant hyperthermia.)

d. Sedation is required for conscious patients.

true

49. True or False. The only depolarizing ganglionic blocker among the following paralytics is

G7 p.26:25mm

a. succinylcholine

true

b. rapacuronium

false

c. mivacurium

false

d. rocuronium

false

50. True or False. Possible side effects of succinylcholine include

G7 p.26:53mm

a. elevated serum K+

true (Succinylcholine can cause elevated K+, especially in patients with neuronal [spinal cord injury, hemiparesis] or muscular pathology, causing hyperkalemia.)

b. cardiac arrest in adolescents and children

true (Adolescents and children with undiagnosed cardiac myopathies may arrest.)

c. sinus bradycardia

true (It causes dysrhythmia, mainly sinus bradycardia.)

d. malignant hyperthermia

true (It has been linked to malignant hyperthermia.)

51. True or False. The following paralytic is contraindicated in the acute phase of injury because of the risk of hyperkalemia:

G7 p.26:60mm

a. succinylcholine

true

b. metocurine

false

c. doxacurium

false

d. pancuronium

false

e. vecuronium

false

52. True or False. The shortest-acting nondepolarizing neuromuscular blocking agent (NMBA) is

G7 p.26:162mm

a. mivacurium

false

b. rocuronium

false

c. vecuronium

true

d. metocurine

false

e. doxacurium

false

53. True or False. The nondepolarizing paralytic that does not affect ICP or CPP is

G7 p.26:168mm

a. vecuronium

true

b. pancuronium

false

c. succinylcholine

false

d. rapacuronium

false

e. rocuronium

false

54. True or False. The main difference between cisatracrium and its isomer atracurium is

G7 p.27:40mm

a. cost

false

b. onset of action

false

c. duration

false

d. cisatracrium does not release histamine

true

e. none of the above

false

55. The complete reversal of Pavulon’s effect takes _____ minutes.

20

G7 p.27:55mm

56. True or False. It is true about pancuronium that

G7 p.27:55mm

a. it is not reversible

false (It is reversible with anticholinesterases.)

b. it is not a competitive paralytic

false (It is a competitive paralytic.)

c. it increases cardiac output, pulse rate, and ICP

true

d. it is eliminated through the liver

false (It is eliminated through the kidneys.)

57. True or False. Regarding atracurium:

G7 p.27:60mm

a. It is a nondepolarizing (competitive) blocker.

true

b. It can produce hypotension.

true

c. It is reversible with neostigmine.

true

d. It is metabolized in the kidneys and liver.

false