Acid Base, Fluid & Electrolytes
When feeding a neonate with a cleft lip, the nurse should expect to: a) use a bulb syringe with a rubber tip. b) provide thickened formula. c) perform gastric gavage. d) administer I.V. fluids.
a) use a bulb syringe with a rubber tip. The nurse should expect to use a bulb syringe with a rubber tip because it is a safe, effective feeding device for a neonate with a cleft lip. I.V. fluids are required only during the immediate postoperative period, until the neonate can tolerate oral fluids. Thickened formula and gastric gavage rarely are necessary for a neonate with a cleft lip.
Picture saved under Fat Embolism Question *EDIT* Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome? a) Column D b) Column C c) Column B d) Column A
c) Column B Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.
A neonate is born 8 weeks premature. At birth, he has no spontaneous respirations, but he is successfully resuscitated. Within several hours he develops respiratory grunting, cyanosis, tachypnea, nasal flaring, and retractions. He's diagnosed with respiratory distress syndrome, intubated, and placed on a ventilator. Which nursing action should be included in the neonate's care plan to prevent retinopathy of prematurity? a) Keep his body temperature low. b) Humidify the oxygen. c) Monitor partial pressure of oxygen (PaO2) levels. d) Cover his eyes while receiving oxygen.
c) Monitor partial pressure of oxygen (PaO2) levels. Monitoring PaO2 levels and reducing the oxygen concentration to keep PaO2 within normal limits reduces the risk of retinopathy of prematurity in a premature neonate receiving oxygen. Covering the neonate's eyes and humidifying the oxygen don't reduce the risk of retinopathy of prematurity. Because cooling increases the risk of acidosis, the neonate should be kept warm so that his respiratory distress isn't aggravated.
A client receiving chemotherapy for metastatic colon cancer is admitted to the hospital because of prolonged vomiting. Assessment findings include irregular pulse of 120 bpm, blood pressure 88/48 mm Hg, respiratory rate of 14 breaths/min, serum potassium of 2.9 mEq/L (2.9 mmol/L), and arterial blood gas—pH 7.46, PCO2 45 mm Hg (6.0 kPA), PO2 95 mm Hg (12.6 kPa), bicarbonate level 29 mEq/L (29 mmol/L). The nurse should implement which prescription first? a) 12-lead ECG b) Repeat laboratory work in 4 hours c) Oxygen at 4L per nasal cannula d) 5% Dextrose in 0.45% normal saline with KCl 40 mEq/L at 125 mL/h
d) 5% Dextrose in 0.45% normal saline with KCl 40 mEq/L at 125 mL/h The vital signs suggest that the client is dehydrated from the vomiting, and the nurse should first infuse the IV fluids with the addition of potassium. There is no indication that the client needs oxygen at this time since the PO2 is 95 (12.6 kPa). Although the client has a rapid and irregular pulse, the infusion of fluids may cause the heart rate to return to normal, and the 12-lead ECG can be prescribed after starting the intravenous fluids.
The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which of the following acid-base imbalances? a) Respiratory alkalosis b) Metabolic alkalosis c) Respiratory acidosis d) Metabolic acidosis
d) Metabolic acidosis The client is at risk for developing metabolic acidosis. Metabolic acidosis is caused by diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate).
A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? a) Absence of protein b) Absence of glucose c) Specific gravity of 1.03 d) Urine pH of 3.0
d) Urine pH of 3.0 Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: a) encouraging fluids. b) restricting fluids. c) restricting sodium. d) restricting potassium.
a) encouraging fluids. The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.
During the emergent (resuscitative) phase of burn injury, which finding indicates that the client requires additional volume with fluid resuscitation? a) serum creatinine level of 2.5 mg/dL (221 µmol/L) b) hourly urine output of 60 mL c) little fluctuation in daily weight d) serum albumin level of 3.8 g/dL (38 g/L)
a) serum creatinine level of 2.5 mg/dL (221 µmol/L) Fluid shifting into the interstitial space causes intravascular volume depletion and decreased perfusion to the kidneys. This would result in an increase in serum creatinine. Urine output should be frequently monitored and adequately maintained with intravenous fluid resuscitation that would be increased when a drop in urine output occurs. Urine output should be at least 30 mL/h. Fluid replacement is based on the Parkland or Brooke formula and also the client's response by monitoring urine output, vital signs, and CVP readings. Daily weight is important to monitor for fluid status. Little fluctuation in weight suggests that there is no fluid retention and the intake is equal to output. Exudative loss of albumin occurs in burns, causing a decrease in colloid osmotic pressure. The normal serum albumin is 3.5 to 5 g/dL (35 to 50 g/L).
