Acid-base fluid & electrolyte adaptive quiz
which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client?
serum potassium of 7.2 mEq/L (ratonale- normal range 3.5-5.0)
which ion is the regulator of extracellular osmolarity?
sodium (rationale- sodium is the most abundant extracellular fluid cation and regulates serum (extracellular) osmolarity as well as nerve impulse transmission and acid base balance)
a client is experiencing persistent vomiting, and serum electrolytes have been prescribed. the nurse would monitor which laboratory results?
sodium and chloride levels (rationale- sodium which helps regulate the extracellular fluid volume, is lost with vomiting and chloride which balances cations in the extracellular compartment is also lost with vomiting)
the nurse is caring for a client after abdominal surgery and encourages the client to engage in deep breathing exercises and turn from side to side. which complication is the nurse trying to prevent?
respiratory acidosis
which intravenous fluid is a hypertonic solution?
5% dextrose in normal saline (rationale- hypertonic solution has a higher osmolarity than body fluids, it pulls from cells causing them to shrink and the extracellular space to expand)
which process would the nurse consider when formulating a response to a client with acute kidney injury who states "Why am I experiencing twitching and tingling of my fingers and toes?"
calcium depletion (rationale- hypocalcemia causes tetany which causes twitching and tingling of the extremities)
a large family that is struggling financially is instructed by the home health nurse about ways to increase their dietary intake of calcium. Which suggestion would the nurse make?
collard greens or kale in one meal a day
which finding would the nurse expect when assessing a client with compensated metabolic acidosis?
deep and rapid respirations (rationale- deep, rapid respirations are an adaptation to a decreased serum pH)
which initial change in acid base balance will the nurse expect when a client is in the progressive stage of shock?
metabolic acidosis (rationale- occurs during he progressive stage of shock as a result of accumulated lactic acid)
which action by the nurse will be most effective in determining whether fluid overload is improving when caring for a client who was admitted with heart failure?
weighing the client
a client is diagnosed with parathyroid dysfunction. which serum calcium concentration supports the diagnosis?
7.8 mg/dL (rationale- normal serum calcium concentration ranges from 8.6-10.2, below indicates hypocalcemia, above indicates hypocalcemia)
Tic-Tac-Toe Problem: Ph 7.51 PCO2 50 HCO3 58
metabolic alkalosis
which assessment finding indicates that sodium polystyrene sulfonate has been effecitve?
a decrease in serum potassium level (rationale- ^ is given to treat hyperkalemia, the effectiveness is determined by a decreasing serum potassium level)
which explanation would the nurse include when teaching a client with heart failure about the reason for a low sodium diet?
decreased fluid retention (rationale- the purpose of a low sodium diet for clients with heart failure is to decrease fluid retention)
which clinical manifestations indicate to the nurse that the client has an inadequate fluid volume? (select all that apply)
decreased urine, hypotension, dry mucous membranes, poor skin turgor
which clinical finding would the nurse anticipate when admitting a client with an extracellular fluid volume excess?
distended jugular veins (rationale- because of fluid overload in the intravascular space, the neck veins become visibly distended)
which disease increases the risk of hyperkalemia?
end stage renal disease
a client has been admitted with a diagnosis of intractable vomiting and can tolerate only sips of water. the initial blood work shows a sodium level of 122 mEq/L and a potassium level of 3.6 mEq/L. the client is likely experiencing which condition?
hyponatremia (rationale- vomiting and use of diuretics (lasix) deplete the body of sodium)
in which category of fluids would the nurse classify an intravenous solution of 0.45% sodium chloride?
hypotonic solution (rationale- hypotonic solutions are less concentrated less than 0.85 g of sodium chloride in each 100 ml than body fluids)
which statement explains why metabolic acidosis develops with kidney failure?
inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate (rationale- bicarb buffering is limited, hydrogen ions accumulate, and acidosis results)
which method is an efficient way to correct decreased serum chloride levels found in a client with an acute episode of ulcerative colitis?
intravenous therapy (rationale- IV ensures a rapid, well controlled technique for electrolyte replacement)
Tic-Tac-Toe Problem: Ph 7.3 PCO2 35 HCO3 17
metabolic acidosis
which effect of sodium bicarb is the nurse trying to prevent when teaching about the dangers of using sodium bicarb regularly?
metabolic alkalosis (rationale- prolonged use of sodium bicarb may cause systemic alkalosis as well of retention of sodium and water)
the nurse advises a client receiving furosemide about potassium intake. which fruits would the nurse encourage the client to eat?
orange, banana, and dried fruit (rationale- they are foods high in potassium, furosemide is a diuretic that causes the body to lose potassium)
which serum hormone level elevates in response to a client's total serum calcium concentration of 7.9 mg/dL?
parathyroid hormone (PTH) (rationale- I normally range of serum calcium loss between 9 and 10.5, when total serum calcium concentration levels lower, secretion of the PTH increases and stimulates bones to promote osteoclastic activity which increases serum calcium levels)
which cation regulates intracellular osmolarity?
potassium (rationale- a decrease in serum potassium causes a decrease in the cell wall pressure gradient and results in water moving out of the cell)
which statement by a client receiving diuretic therapy indicates that the teaching about potassium supplements is understood?
"I will report any abdominal distress" (rationale- potassium supplements can cause GI ulceration and bleeding)
a client with end stage renal disease receiving hemodialysis has a prescribed diet restricting proteins, sodium, and potassium. Which client statement indicates understanding of provided dietary instructions?
"i should avoid using salt substitutes"
A pregnant client tells the nurse "Im sticking to my diet, and i don't eat anything containing salt" how should the nurse respond?
"salt is necessary in your diet. use a little when cooking, but avoid processed meats and canned foods with salt"
which assessment is necessary for the nurse to complete in a client with chronic kidney disease receiving loop diuretics?
intake and output measurement (diuretics are administered to increase urine output)
an ABG report indicates the clients pH is 7.25, PCO2 is 35, HCO3 is 20. which disturbance would the nurse identify based on these resluts?
metabolic acidosis
which nursing assessment would be performed by a RN before administering intravenous infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours? select all that apply
urinary output, last serum potassium levels, patency of the intravenous access (rationale- urinary output must be normal (if low it may damage renal cells), levels must be checked to ensure potassium placement is appropriate, IV access is essential because potassium is a very irritating and painful to subcutaneous tissue)
the ABGS for a client with acute respiratory distress are pH of 7.3 PaCO2 of 55 HCO3 of 23. how would the nurse interpret these findings?
uncompensated respiratory acidosis
the RN teaches a student nurse regarding the management of increased potassium levels in a client. which action performed by the student nurse indicates effective learning?
administering sodium polystyrene sulfonate (rationale- administering potassium binding and excreting resin, such as ^ can reduce potassium levels)
which hormonal imbalance would the nurse suspect in a client who has a low serum sodium levels?
aldosterone (rationale- secreted by the adrenal cortex that maintains sodium and water balance)
which collaborative action would hte nurse anticipate when caring for a client with pneumonia whose ABGS are pH of 7.24 PaCO2 of 60mm HCO3 of 20 PaO2 of 54mm and O2 sat of 88%?
intubation and mechanical ventilation (rationale- low Ph, HCO3, PaO2 and O2 sat, high PaCO2 indicate respiratory failure and the need for mechanical ventilation)
which nursing action has the highest priority when a patient when a client with a history of heart failure arrives for a scheduled clinic appointment and has gained 6lb (2.7 kg)?
listen to the clients breath sounds (rationale- need to further assess for fluid overload- lung congestion is associated with fluid overload)
an older client is admitted to the hospital for rehydration therapy after 3 days of diarrhea. in addition to sodium, which electrolyte would the nurse be most concerned about?
potassium (rationale- potassium, sodium, and bicarb are the electrolytes most often lost with diarrhea)
which medication is unsafe to administer as an intravenous bolus?
potassium chloride (rationale- can cause cardiac arrest)
an infant with a diagnosis of HF is being given furosemide twice a day. which lab value would the nurse report to the HCP?
potassium of 3.0 (rationale- furosemide is a potassium losing diuretic and should be frequently checked)
a client with COPD has a blood pH of 7.25 and PCO2 of 60. these blood gas results require nursing attention because they indicate which condition?
respiratory acidosis
which type of acid base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation?
respiratory acidosis caused by impaired respirations and increased formation of carbonic acid (rationale- restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide, as carbon dioxide accumulates in the body fluids it reacts with water to produce carbonic acid. The result is respiratory acidosis)
which electrolyte deficiency triggers the secretion of renin?
sodium (rationale- low sodium ion concentration causes decreased blood volume thereby resulting in decreased perfusion, decreased blood volume triggers the release of renin from the juxtaglomerular cells
which reason describes the purpose of restricting sodium for a client with hypertension?
to prevent reabsorption of water in the distal tubes
Which intravenous solution would the nurse anticipate administering when caring for a client with a history of severe diarrhea for the past three days it was admitted for dehydration?
0.9% sodium chloride (rationale- it is an isotonic solution that will act as a volume expander to quickly replace volume losses and promote physiological stabilization)
the nurse instructs a client that, in addition to building bones and teeth, calcium is also important for which process?
blood clotting (rationale- important for blood coagulation)
when teaching a client with hypertension about a 2 gram sodium diet, which foods would the nurse instruct the client to avoid? select all that apply
canned chili, luncheon meat
which client would a nurse recognize as having an age related impairment of the thirst mechanism when reviewing the lab reports of a group of older adult clients? A- serum sodium concentration- 167 B- serum sodium concentration- 143 C- serum sodium concentration- 118 D- serum sodium concentration- 101
client A 167 (rationale- older adult clients are at greater risk of fluid and electrolyte imbalances, such as dehydration, and hyponatremia, due to age related impairment of the thirst mechanism)
which symptom would the nurse monitor for when caring for a client who has hyponatremia?
change in level of consciousness (rationale- as sodium levels drop symptoms reflect cellular overhydration resulting from water movement from the relatively hypotonic serum into cells)
