1. Name 2 isotonic solutions
Lactate Ringer
Normal saline

2. Normal values: K Na Hgb Hct Mag

3.5 – 5.0
135 – 145
15
45
1.5 – 2.4

3. In what cases would you see dilutional hyponatremia?
SIADH (syndrome of inappropriate antidiuretic hormone) abnormal retention of water diluting sodium
Overhydrating and renal disease
IV med error

4. List 5 foods high in sodium
Canned food
Processed
Frozen
Fast food
Pre-packaged
Cheese

5. What classification of medications is most often prescribed “first” with HTN?

Diuretics
HCTZ (hydrochlorothiazide)
6. Compare and contrast K+ sparing and K+ wasting diuretics
K+ sparing:
Spironolactone is a competitive antagonist of aldosterone and for this reason causes sodium and water to be excreted and potassium to be retained
Prescribed with thiazide when diuresis is needed
K+ wasting:
Used with HTN and fluid volume overload or retention
When is each prescribed, and why?
Class Loop diuretic (Lasix):
Inhibit NaCl reabsorption in loop of Henle increase excretion of NA and CL more potent less effective for hypertension
Give examples of classes of each
Class Thiazide (diuretics): inhibit NaCl reabsorption, increase excretion of NA and CL
7. Explain the renin angiotensin aldosterone system (RAAS)

Renin (kidneys) + angiotensinogen (liver) = Angiotensin I
Angiotensin I + ACE (lungs) = Angiotensin II
Angiotensin II = vasoconstriction and aldosterone (kidney) secretion

8. Estimate a person’s pack years, if he smoked 1 ppd x 10 years then 5 years

15 pack years
9. Why grapefruit juice is commonly contraindicated with cardiac medications?

Decrease metabolism of drug
Increase effect of drug
10. What diet teaching is important for a person taking spironolactone (Aldactone)?
Potassium sparing
Use with caution in patients taking digoxin as hyperkalemia may reduce the effect of digoxin
Avoid foods high in potassium (bananas, oranges, dried apricots, avocado, tomatoes, potatoes, raisins, OJ)
Assess for gynecomastia (swollen male tissue caused by a hormone imbalance – man boobs) due to long term use

11. s/s digoxin toxicity yellow halos dysrhythmias anorexia nausea vomiting

12. What function(s) does calcium serve in our body?
Bone density
Neuro excitability
Clotting
Normal cardiac function
Hormone secretions

13. What labs are monitored with the administration of “statin” drugs?

Liver enzymes
Cholesterol
BUN
Creatinine
14. What’s the best treatment for early dehydration
Fluids
What is your assessment?
Skin turgor
Mucus membranes
Vitals
Urine color

15. Differentiate between left sided and right sided heart failure
Left sided
Most common
Left ventricular dysfunction prevents normal blood flow and causes blood to back up into the left atrium and into pulmonary veins
The increased pulmonary pressure causes fluid extravasation from the pulmonary capillary bed into the interstitium and then the alveoli, which manifests as pulmonary congestion and edema

Right sided
Causes back up of blood into the right atrium and venous circulation
Venous congestion in systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the GI tract, and peripheral edema
Will often result in left failure results in pulmonary congestion and increased pressure in the blood vessels of the lungs (called pulmonary hypertension)
Eventually, chronic pulmonary HTN (increased right ventricular afterload) results in right sided hypertrophy and failure
Cor pulmonale (right ventricular dilation and hypertrophy caused by pulmonary disease can also cause right sided heart failure, as can right ventricular infarction.
What are early signs of each?
Shortness of breath
Persistent coughing or wheezing
Buildup of excess fluid in body tissues (edema)
Fatigue
Lack of appetite or nausea
Impaired thinking
Increased heart rate

16. What allergies do the health care team (HCT) specifically look for prior to sending a patient to cardiac catheterization?

Latex
Iodine