Fluids and electrolytes

Fluids and Electrolytes

5 1

Medications to be given when treating severe hyperkalemia include:

Checking for Trousseau’s and Chvostek’s signs can aid in the diagnosis of: A)Hypocalcemia

A)Methylprednisolone and mannitol

B)Hypercalcemia

B)Mannitol and regular insulin

C)Hypermagnesemia

C)Digoxin and diuretics

D)Hyponatremia

D)10% calcium gluconate and regular insulin

E)Hypernatremia

E)Normal saline

6

Which of the following represents an appropriate use of albumin?

A)Nutritional supplementation

2

DS is a 51-year-old male admitted with lung cancer and neutropenia. Patient parameters are height 188 cm (6 ft, 2 in.) and weight 94 kg (207 lb). Determine the patient’s fluid requirements.

B)Hypotension in the setting of hemodialysis C)Acute or chronic pancreatitis

A)1,680 mL/day

D)Replacement of serum albumin

B)2,280 mL/day

E)Altering medication binding

C)2,500 mL/day

7

D)2,980 mL/day

A)Intracellular

E)3,380 mL/day

3

A 48-year-old man was admitted to the intensive care unit after sustaining head trauma. His sodium concentration increased from 142 mEq/L (142 mmol/L) on admission to 162 mEq/L (162 mmol/L) 2 days after admission. His weight at admission was 71 kg (156 lb). Which of the following amounts most closely approximates the free water deficit in this patient?

The majority of body fluids can be found in which compartment?

B)Extracellular C)Transcellular D)Interstitium E)Intravascular

8

A)2 L

A 44-year-old female is admitted with a working diagnosis of sepsis. Her BP is 95/55 and her serum sodium is 156 mEq/L (156 mmol/L). Which of the following would be the best initial strategy for fluid resuscitation?

B)4 L

A)Albumin

C)7 L

B)0.9% NaCl

D)10 L

C)3% normal saline

E)12 L

D)5% dextrose in water E)Ringer’s lactate

4

Which of the following medications is most likely to cause hypomagnesemia?

A)Levofloxacin (Levaquin) B)Gentamicin C)Indapamide (Lozol) D)Pipercillin/tazobactam (Zosyn) E)Cisatracurium (Nimbex)

9

Your patient has a serum calcium concentration of 7.9 mg/dL (1.98 mmol/L) and albumin of 2.8 g/dL (28 g/L). The corrected calcium is calculated to be?

A)7.9 mg/dL (1.98 mmol/L) B)8.9 mg/dL (2.23 mmol/L) C)9.1 mg/dL (2.28 mmol/L) D)9.5 mg/dL (2.38 mmol/L) E)10.8 mg/dL (2.7 mmol/L)

10

(Zocor) 40 mg daily, fexofenadine (Allegra) 180 mg daily, and levothyroxine (Synthroid) 0.05 mg daily. His laboratory results are sodium (Na) 138 mEq/L (138 mmol/L), potassium (K) 6.3 mEq/L (6.3 mmol/L), bicarbonate (HCO3) 20 mEq/L (20 mmol/L), chloride (Cl) 100 mEq/L (100 mmol./L), BUN 35 mg/dL (12.49 mmol/L), creatinine (Cr) 2.1 mg/dL (185 mmol/L), and glucose 160 mg/dL (8.88 mmol/L). Which of the current medications may be a cause of the hyperkalemia? Fexofenadrine (Allegra) a

Which medication may cause an increased osmolar gap?

A)Mannitol B)Amantadine (Symmetrel) C)Valproic acid (Depacon) D)Dexmedetomidine (Precedex) E)Ciprofloxacin (Cipro)

A)nd levothyroxine (Synthroid)

11

A 66-year-old woman with a history of lung cancer was admitted for obtundation, nausea, vomiting, and polyuria. The patient had recently lost 15 lb. Initial laboratory findings included sodium 138 mEq/L (138 mmol/L), potassium 4.8 mEq/L (4.8 mmol/L), chloride 106 mEq/L (106 mmol/L), bicarbonate 21 mEq/L (21 mmol/L), BUN 30 mg/dL (10.71 mmol/L), creatinine 1.6 mg/dL (141.44 micromol/L), albumin 2.8 mg/dL (28 g/L), calcium 13.6 mg/dL (3.4 mmol/L), phosphorus 2 mg/dL (0.65 mmol/L). What is the best option to manage this patient’s hypercalcemia?

B)Simvastatin (Zocor) and amlodipine (Norvasc) C)Captopril (Capoten) and ibuprofen (Motrin) D)Levothyroxine (Synthroid) and glyburide (Miconase, Diabeta) E)None of these medications is a potential cause of the hyperkalemia

14

A)Normal saline 1 L + 20 mg of IV furosemide (Lasix)

The treatment of symptomatic hypermagnesemia would include which of the following?

A)Sodium polysterene sulfonate (Kayexalate)

B)Zoledronic acid (Zometa) 4 mg IV B)Lithium C)Gallium 2 mg IV

12

C)Insulin

D)Hydrocortisone (Solu-Cortef) 200 mg IV three times daily

D)Calcium gluconate

E)Calcitonin (Miacalcin) 2 units/kg

E)Albuterol

The major risk of using 3% normal saline is a too rapid correction or overcorrection of hyponatremia. What type of patient do you think is appropriate to receive 3% normal saline?

A)Symptomatic hyponatremia (coma, seizures, high urine sodium loss) B)All patients with serum sodium below 130 mg/dL (130 mmol/L)

15

You are the pharmacist on the rounding team and your patient has a serum phosphate of 1.5 mg/dL (0.49 mmol/L).

Which of the following dosing regimens would you recommend to correct the hypophosphatemia? The patient is tolerating oral intake.

A)Calcium carbonate 500 to 1,000 mg orally three times daily with meals B)Na-Phos 20 mmol IV over 4 hours

C)All of the above C)K-Phos 20 mmol IV over 4 hours D)None of the above E)Unable to be determined

D)K-Phos one tablet orally four times daily and at bedtime E)None of the above are correct

13

You are asked to provide a pharmacy consult on a 47-year-old-male with diabetes mellitus who presents with hyperkalemia. His history is also positive for hypertension, hypothyroidism, and dyslipidemia. His medications include captopril (Capoten) 25 mg three times daily, ibuprofen (Motrin) 400 mg as needed, glyburide (Micronase, Diabeta) 10 mg daily, amlodipine (Norvasc) 10 mg daily, multivitamin daily, simvastatin

Hypotonic Solution

6 1

Which of the following causes of circulatory insufficiency can lead to shock as a result of decreased plasma volume?

Which of the following monitoring procedures is least useful in a conscious patient suspected of having circulatory insufficiency from decreased plasma volume?

A)Systolic and diastolic blood pressure B)Assessment of mental status

A)Penetrating trauma with blood loss C)Complete physical examination B)Gastrointestinal bleeding D)Hourly urine output (no catheter) C)Anaphylaxis because of medications D)All of the above

2

7

Patients admitted with hypovolemic shock usually have:

Which of the following statements regarding rehydration of children with acute diarrheal illness is true?

A)Intravenous rehydration is preferred for mild volume depletion

A)Very low serum sodium concentrations B)Rehydration should be avoided with moderate volume depletion

B)Very low serum chloride concentrations

3

C)Elevated blood urea nitrogen

C)Oral rehydration is preferred for uncomplicated gastroenteritis

D)Elevated diastolic blood pressure

D)Severe circulatory insufficiency can be treated in outpatient settings

Which of the parameters in the Starling equation is most likely to be measured in the clinical setting (usually the intensive care unit)?

8

A)Hydrostatic pressure in blood vessels

4

B)Hydrostatic pressure in interstitial space

A)Normal saline

C)Oncotic pressure in capillaries

B)5% dextrose

D)Oncotic pressure in interstitial space

C)25% albumin

Which of the following is the most likely cause of reperfusion injury?

A)Acute brain tissue damage from penetrating head trauma

5

Which of the following solutions is preferred for the initial treatment of most patients presenting with acute circulatory insufficiency caused by hypovolemia?

D)3% sodium chloride

9

Which of the following statements regarding the use of resuscitation solutions for hypovolemic shock is true?

B)Severe thermal injury leading to damaged skin

A)5% albumin significantly decreases mortality compared to normal saline

C)Microcirculatory changes resulting from mediators released by injury

B)25% albumin significantly decreases mortality compared to normal saline

D)Incision wound associated with an orthopedic surgical procedure

C)5% albumin significantly decreases mortality compared to 25% albumin

Which of the following medications is least likely to alter the usual presentation of patients presenting with hypovolemic shock?

A)Metoprolol B)Diltiazem C)Furosemide D)Cephalexin

D)Normal saline is as effective as 5% albumin with respect to mortality

10

Which of the following statements regarding vasopressor use in patients with hypovolemic shock is true?

A)Pressors are best reserved for patients not responding to fluids B)Epinephrine has been shown to decrease hospital mortality C)Norepinephrine is usually preferred before fluid administration D)Peripheral veins are always preferred for pressor administration