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Case Study 1

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Questions 1 & 2 refer to the following scenario:

      Mr. Holmes has a history of CHF. He visited his health care provider with crackles bilaterally in lungs, edema and weight gain. He states he has not been following his low sodium diet. Upon questioning you discover he takes his diuretic only on days he will be staying home. Na⁺ 133, K⁺ 3.0, Cl^- 93.

1.   Which lab values are abnormal?

a.  sodium
b.  potassium
c.  chloride

2.  The fluid status reveals

a.  dehydration with hyponatremia
b.  fluid overload with hyponatremia
c.  dehydration with hypernatremia
d.  fluid overload with hypernatremia
e.  normal fluid status with hyponatremia
f.  normal fluid status with hypernatremia

Questions 3 & 4 refer to the following scenario:

Mrs. Ames has CHF and chronic renal insufficiency. She has been prescribed Lasix and a sodium restricted diet. She complains of the following symptoms for the last two weeks: light-headedness, fatigue, nausea and vomiting. Assessment reveals her weight has decreased by 5 pounds, there is no edema present and her lungs are clear. BP 120/60 lying, 90/50 standing, pulse 92 and irregular. Na⁺ 132, K+ 3.0, Cl^- 103.

 3.   Which lab values are abnormal?

a.   sodium
b.  potassium
c.  chloride

4. The fluid status reveals

a.  dehydration with hyponatremia
b.  fluid overload with hyponatremia
c.  dehydration with hypernatremia
d.  fluid overload with hypernatremia
e.  normal fluid status with hyponatremia
f.  normal fluid status with hypernatremia

Questions 5 & 6 refer to the following scenario:

      Ms. Brown has no edema, a normal BP and a weight gain of 5 pounds.  Na⁺ 126, K+ 3.5, Cl^- 93.

5. Which lab values are abnormal?

a.   sodium
b.  potassium
c.  chloride

6.  The fluid status reveals

a.  dehydration with hyponatremia
b.  fluid overload with hyponatremia
c.  dehydration with hypernatremia
d.  fluid overload with hypernatremia
e.  normal fluid status with hyponatremia
f.  normal fluid status with hypernatremia

Questions 7 & 8 refer to the following scenario:

      Ms. Jones, Pollard, age 78, is admitted with SOB, orthopnea, paleness, cool clammy skin, edema up 1/3 of lower legs. She is obese, has a 10-year history of hypertension with variable control and has been prescribed diuretics. Na⁺ 128, K+ 3.6, Cl^- 90.

7. Which lab values are abnormal?

a.   sodium
b.  potassium
c.  chloride

8.  The fluid status reveals

a.  dehydration with hyponatremia
b.  fluid overload with hyponatremia
c.  dehydration with hypernatremia
d.  fluid overload with hypernatremia
e.  normal fluid status with hyponatremia
f.  normal fluid status with hypernatremia

Questions 9 & 10 refer to the following scenario:

      Mr. Crawford, age 19, was in a motor vehicle crash and received 3 units of blood and 2000 cc of Lactated Ringers solution yesterday. Today's lab work: Na⁺ 130, K+ 3.0, Cl^- 92. Lungs are clear. There is slight generalized edema. BP 100/58, P 104, RR 38, T 37.8 ^oC.

9. Which lab values are abnormal?

a.   sodium
b.  potassium
c.  chloride

10.   The fluid status reveals

a.  dehydration with hyponatremia
b.  fluid overload with hyponatremia
c.  dehydration with hypernatremia
d.  fluid overload with hypernatremia
e.  normal fluid status with hyponatremia
f.  normal fluid status with hypernatremia

11. Jamie Rodgers, 8 months old, is brought to the ED with diarrhea for 3 days and poor feeding. T 38.4 ^oC, P 120, RR 44. Which lab abnormalities do you expect? (you can choose more than one)

a.   hypernatremia
b.  hyponatremia
c.  hyperkalemia
d.  hypokalemia
e.  hyperchloremia
f.  hypochloremia

      12.  Mr. Hovel was admitted with R/O pancreatitis. A NG tube was placed and 1200 cc of fluid was removed over the last 24 hours. Which lab abnormalities do you expect? (you can choose more than one)

      a.   hypernatremia
b.  hyponatremia
c.  hyperkalemia
d.  hypokalemia
e.  hyperchloremia
f.  hypochloremia