Adult Health I Chapter 4
The average daily urinary output in an adult is
1.5 L
Approximate size of body compartments in a 70 kg man. How much water is in the interstitial space or 14% of body weight?
10 liters
In SIADH, the serum sodium level can be as low as _____.
100 mEq/L
Which of the following is a factor affecting an increase in serum osmolality?
Free water loss
Which of the following factors increases blood urea nitrogen (BUN)?
Gastrointestinal bleeding, dehydration, increased protein intake, and fever
A term used to describe the balance of fluid and electrolytes as a dynamic process.
Homeostasis
The pressure exerted by the fluid on the walls of the blood vessel by the heart.
Hydrostatic
At the arterial end of the capillary, fluids are filtered through its wall by a hydrostatic pressure that exceeds the oncotic pressure exerted by plasma protein; thus, water and electrolytes leave the bloodstream to feed the interstitial and intracellular space.
Hydrostatic pressure
Explain the important role of two opposing forces, hydrostatic pressure and osmotic pressure, in maintaining fluid movement through blood vessels.
Hydrostatic pressure (pressure exerted by fluid on the walls of the blood vessels) affects the movement of fluids through the capillary walls of the blood vessels. Osmotic pressure is pressure exerted by proteins in the plasma. Both pressures help maintain a high extracellular concentration of sodium and a high intracellular concentration of potassium.
A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance?
Hypercalcemia
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
Hyperkalemia
A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing?
Hyperkalemia
Which of the following electrolyte imbalances occur with adrenal insufficiency?
Hyperkalemia
Results from increased insensible losses and diabetes insipidus
Hypernatremia
A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. Laboratory values are as follows: Na + 147 mEq/L K + 3.0 mEq/L Cl - 112 mEq/L Mg ++ 2.3 mg/dL Ca ++ 1.5 mg/dL Which of the following is consistent with the client's findings?
Hypokalemia
An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?
Hypokalemia
Occurs with gastrointestinal and renal losses.
Hypokalemia.
A client presents with muscle weakness, tremors, slow muscle movements, and vertigo. The following are the client's laboratory values: Na+ 134 mEq/L K+ 3.2 mEq/L Cl- 111 mEq/L Mg++ 1.1 mg/dL Ca++ 8.4 mg/dL Identify which of the following alterations is consistent with the client's findings.
Hypomagnesemia
Which of the following conditions does the nurse need to confirm when he or she taps the facial nerve of a client who has dysphagia?
Hypomagnesemia
A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for:
Hyponatremia
Occurs with increased thirst and antidiuretic hormone release
Hyponatremia
Oral intake is controlled by the thirst center, located in which of the following cerebral areas?
Hypothalamus
Which of the following is a potential cause of respiratory acidosis?
Hypoventilation
Which of the following would be a potential cause of respiratory acidosis?
Hypoventilation
A condition that occurs when loss of extracellular fluid volume exceeds the intake of fluid.
Hypovolemia
A nurse caring for a patient with metabolic alkalosis knows to assess for the primary, compensatory mechanism of:
Increased PaCO2
List the three causes of edema, a common manifestation of fluid volume excess.
Increased capillary fluid pressure, decreased capillary oncotic pressure, or increased interstitial oncotic pressure
Which of the following may occur with respiratory acidosis?
Increased intracranial pressure (ICP)
Which of the following is a function of calcitonin?
Increases deposition of calcium in bones, reduces bone resorption, increases urinary excretion of calcium
Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?
Instruct the client to breathe into a paper bag
Comprises 50% of blood volume
Interstitial space
The smallest compartment of the extracellular fluid space.
Interstitial space
Comprises the intravascular, interstitial, and transcellular fluid.
Intracellular space
Compromises about one third of body fluid
Intracellular space
Comprises the cerebrospinal and pericardial fluids
Intravascular fluid volume deficit
Space where plasma is contained
Intravascular fluid volume deficit
Comprises fluid surrounding cell.
Intravascular space
Signs include hypotension, edema, tachycardia.
Intravascular space
Patients diagnosed with hypervolemia should avoid sweet or dry food because:
It increases the patient's desire to consume fluid
The nurse monitors a patient who is being evaluated from hyperkalemia. She is aware that ECG changes and serum potassium levels are diagnostic. Which of the following are the earliest changes that the nurse should report?
K+ = 7 mEq/L; peaked T waves
A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer?
Lactated Ringer's solution
sense changes in sodium concentration.
Osmoreceptor
Signs of lethargy, increasing intracranial pressure, and seizures may occur when the serum sodium level reaches:
115 mEq/L
When the serum sodium level s less than ______, signs of increased intracranial pressure occur.
115 mEq/L
The normal pH of the blood is within a range of ______.
7.35 to 7.45
Cardiac effects of hyperkalemia are usually present when the serum potassium level reaches:
8 mEq/L
Which of the following is a normal serum value for calcium?
8.5 to 10.5 mg/dL
What percentage of potassium, excreted daily, leaves the body by way of the kidneys?
80
n a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours?
800
The movement of water caused by a concentration gradient when two solutions are separated by an impermeable membrane.
Osmosis
Which conditions lead to chronic respiratory acidosis in older adults?
Thoracic skeletal change
The most common buffer system in the body is the:
bicarbonate-carbonic acid buffer system
Approximate size of body compartments in a 70 kg man. How much water is in the transcellular space or 1% of body weight?
1 liter
When assessing the weight of a patient who is on a sodium-restricted diet, the nurse knows that a weight gain of approximately 2 lb (2.2 lb a. 0.5 L b. 1.0 L 1 kg) is equivalent to a gain of how much fluid?
1.0 L
Which of the following is considered a hypotonic solution?
0.45% Normal saline
A nurse is directed to administer a hypotonic intravenous solution. Looking at the following labeled solutions, she should choose:
0.45% sodium chloride
A patient diagnosed with hypernatremia needs IV sodium replacement. Select the solution that is considered the safest to administer.
0.45% sodium chloride
Which of the following is considered an isotonic solution?
0.9% Normal saline
Below which serum sodium level may convulsions or coma occur?
135 mEq/L
Which of the following is a normal serum value for sodium?
135 to 145 mEq/L
A semiconscious patient presents with restlessness and weakness. He has a dry, swollen tongue. His body temperature is 99.3F, and his urine specific gravity is 1.020. Choose the most likely serum sodium (Na) value for this patient.
155 mEq/L
A 160-pound patient, diagnosed with hypovolemia, is weighed every day. The healthcare provider asked to be notified if the patient loses 1,000 mL of fluid in 24 hours. Choose the weight that would be consistent with this amount of fluid loss.
158 lbs
The nurse assesses a cardiac patient's urinary output. The patient weighs 175 pounds. Based on the normal daily range of urine volume, the nurse expects a 4-hour output of:
160 to 320 mL
Explain why the administration of a 3% to 5% sodium chloride solution requires intense monitoring.
17
Cardiac arrest will probably occur with a serum calcium level of:
18 mg/dL
A patient is admitted who has had severe vomiting for 24 hours. She states that she is exhausted and weak. The results of an admitting electrocardiogram (ECG) show flat T waves and ST-segment depression. Choose the most likely potassium (K) value for this patient.
2.0 mEq/L
A patient's serum sodium concentration is within the normal range. The nurse estimates that the serum osmolality should be:
275 to 300 mOsm/kg
Approximate size of body compartments in a 70 kg man. How much water is in the intracellular space or 40% of body weight?
28 liters
A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:
280 mOsm/kg
A nurse can estimate that a patient has a serum osmolality of ______________ if the patient's serum sodium is 140 mEq/L.
280 mOsm/kg
Which of the following is considered a hypertonic solution?
3% NaCl
Approximate size of body compartments in a 70 kg man. How much water is in plasma or 5% of body weight?
3.5 liters
Which of the following is a normal serum value for potassium?
3.5 to 5.5 mEq/L
The presence of pitting edema is associated with a gain of _____ of fluid in the interstitial space.
4.5 liters
A patient is admitted with a diagnosis of renal failure. He also mentions that he has had stomach distress and has ingested numerous antacid tablets over the past 2 days. His blood pressure is 110/70 mm Hg, his face is flushed, and he is experiencing generalized weakness. Choose the most likely magnesium (Mg) value for this patient.
5 mEq/L
The health care provider ordered an IV solution for a dehydrated patient with a head injury. Select the IV solution that the nurse knows would be contraindicated.
5% DW
About _________________% of the __________________ L of total blood volume is _________________________.
50; 6; plasma
The upper and lower blood pH levels that are incompatible with life are: ________________________ and __________________.
6.8; 7.8
A febrile patient's fluid output is in excess of normal because of diaphoresis. The nurse should plan fluid replacement based on the knowledge that insensible losses in an afebrile person are normally not greater than:
600 mL/24 hours
About ___________________% of total body fluid is in the intracellular space.
66
A patient complains of tingling in his fingers. He has positive Trousseau's and Chvostek's signs. He says that he feels depressed. Choose the most likely serum calcium (Ca) value for this patient.
7 mg/dL
It is important for a nurse to know how to calculate the corrected serum calcium level for a patient when hypocalcemia is seen along with low serum albumin levels. Calculate the corrected serum calcium when the serum calcium is 9 mg/dL and the serum albumin is 3 g/dL.
9.8 mg/dL
A normal oxygen saturation value for arterial blood is:
95%
Which of the following is a normal serum value for chloride?
96 to 106 mEq/L
Describe what happens to the cell in hyponatremia.
A cell swells as water is pulled in from the extracellular fluid; low solute-to-water ratio.
Explain the concept of interstitial fluid shift, or "third spacing".
A decrease in urine output despite adequate fluid intake. Urine output decreases because fluid shifts out of the intravascular space; the kidneys then receive less blood attempt to compensate by decreasing urine output.
You are making rounds on your clients. You find one of your clients struggling to breathe, appears confused, has tachycardia, and the skin appears dusky. What should you do to restore normal pH if ventilation efforts are not very successful?
Administer sodium bicarbonate IV
Which of the following is the most common cause of symptomatic hypomagnesemia in the United States?
Alcoholism
Which of the following is the most common cause of symptomatic hypomangesemia?
Alcoholism
__________ is currently the most common cause of symptomatic hypomagnesemia in the United States.
Alcoholism
Explain why decreased urine output, despite adequate fluid intake, is an early indicator of a third space fluid shift.
An early indicator of a third space fluid shift is a decrease in urinary output despite adequate fluid intake. This occurs because fluid shifts out of the intravascular space. The kidneys, receiving less blood, attempt to compensate by decreasing urine output.
True or False. Plasma bicarbonate has a inverse relationship with chloride.
False
True or False. Potassium can be administered IV push.
False
List the ten manifestations of hypokalemia.
Fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesia (numbness and tingling) arrhythmias, and increased sensitivity to digitalis.
The movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure.
Filtration
The nurse is caring for a client who is exhibiting symptoms of tachypnea and circumoral paresthesias. What should be the nurse's first course of action?
Find and correct the cause of tachypnea
To evaluate a client for hypoxia, the physician is most likely to order which laboratory test?
Arterial blood gas (ABG) analysis
A form of edema in which fluid accumulates in the peritoneal cavity.
Ascites
Increased nitrogen levels in the blood.
Azotemia
made up of urea, is an end product of protein (muscle and dietary) metabolism by the liver.
BUN
Laboratory findings consistent with hypovolemia in a female would include all of the following:
BUN-serum creatinine ratio of > 12:1
A volume-depleted patient would present with which of the following diagnostic lab results?
BUN-to-creatinine ratio of 24:1
re responsible for monitoring the circulating volume, are small nerve receptors that detect changes in pressure within blood vessels.
Baroreceptor
A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond?
Bicarbonate-carbonic acid buffer system
A 54-year-old male patient is admitted to the hospital with a case of severe dehydration. The nurse reviews the patient's laboratory results. Which of the following results are consistent with the diagnosis?
Blood urea nitrogen of 23 mg/dL; Serum osmolality of 310 mOsm/kg; Serum sodium of 148 mEq/L; Urine specific gravity of 1.03
The primary concentration of phosphorous (85%) is located in the _______________________, with about 15% is located in _______________________________.
Bones; soft tissue
A clinical manifestation not found in hypovolemia is:
Bradycardia
Which of the following are insensible mechanisms of fluid loss?
Breathing
Which electrolyte imbalance is characterized by numbness and tingling of the fingers and toes?
Calcium deficit
Describe how the nurse would assess for Trousseau's sign.
Can be elicited by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic pressure; within 2 to 5 minutes, carpal spasm will occur as ischemia of the ulnar nerve develops.
Describe what happens to the cell in hypernatremia.
Cell shrinks as water is pulled out into the extracellular fluid; high solute-to-solvent ration.
One of the dangers of treating hypernatremia is:
Cerebral edema
Which of the following electrolytes is a major anion in body fluid?
Chloride
Which electrolyte imbalance is characterized by hypertonicity and tetany?
Chloride deficit
Consists of twitching of muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch.
Chvostek's sign
Which electrolyte imbalance is characterized by prolonged capillary filling time?
Fluid volume deficit
Which electrolyte imbalance is characterized by distended jugular veins?
Fluid volume excess
Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?
Confusion and seizures
Describe how the nurse would assess for Chvostek's sign.
Consists of twitching of muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch.
A 73-year-old female patient with cirrhosis of the liver is evaluated for clinical manifestations of fluid volume excess. Which of the following signs are consistent with that diagnosis?
Crackles; Hematocrit level of 32%; Blood pressure of 140/110; BUN of 8 mg/dL
the end product of muscle metabolism, is a better indicator of renal function than BUN.
Creatinine
A nurse caring for a patient who is receiving an IV solution via a central vein suspects the complication of an air embolism. Which of the following are signs and symptoms consistent with that diagnosis?
Cyanosis, shoulder pain, dyspnea, tachycardia
Vitamin __________ therapy is instituted to increase calcium from the GI tract.
D
What is the sequence of the fluid regulation cycle?
Decreased blood volume and blood pressure stimulates baroreceptors; fewer impulses are transmitted from the carotid sinuses and the aortic arch; the sympathetic nervous system is stimulated and the parasympathetic nervous system is inhibited; the heart rate increases and antidiuretic hormone is released; the kidneys reabsorb water; sodium and water reabsorption is increased and there is a loss potassium.
A nurse reviews blood gases from a patient diagnosed with metabolic acidosis. Select the reading that is most consistent with that diagnosis.
Decreased pH, decreased bicarbonate, or normal PaCO2
You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults?
Dehydration
Describe indicators of fluid volume excess that the nurse would evaluate.
Dependent edema; distended neck veins; crackles; tachycardia; increased blood pressure, pulse pressure and central venous pressure; increased weight; increased urine output; shortness of breath and/or wheezing. Laboratory data useful includes a decreased BUN and hematocrit levels because of hemodilution.
Which of the following is considered a colloid solution?
Dextran in normal saline
The natural tendency of a substance to move from an area of higher concentration to one of lower concentration.
Diffusion
__________ is the natural tendency of a substance to move from an area of higher concentration to one of lower concentration.
Diffusion
Clarify the differences between diffusion and filtration.
Diffusion is the movement of a substance from an area of higher concentration to one of lower concentration. Filtration is the movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure, for example, the filtration of water and electrolytes by the kidneys.
You are caring for a client with severe hypokalemia. The physician has ordered IV potassium to be administered at 10 mEq/hour. The client complains of burning along their vein. What should you do?
Dilute the infusion
Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism?
Dyspnea and cyanosis; hypotension; weak, rapid pulse; loss of consciousness; chest, shoulder, and low back pain
A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her:
Electrocardiogram (ECG) results
A nurse reviews the results of an electrocardiogram for a patient who is being assessed for hypokalemia. Which of the following would the nurse notice as the most significant diagnostic indicator?
Elevated U wave
Nursing intervention for a patient with a diagnosis of hyponatremia includes all of the following:
Encouraging the intake of low-sodium liquids, such as coffee or tea
Hypokalemia can cause which of the following symptoms to occur?
Excessive thirst
Hypokalemia can cause which of the following to occur?
Excessive thirst
Comprises about 60% of body fluid.
Extracellular fluid compartment
Found mostly in skeletal muscle mass
Extracellular fluid compartment
Which nerve is implicated in the Chvostek's sign?
Facial
True or False. In metabolic alkalosis, the respiratory rate increases, causing greater elimination of CO2.
False
A patient with severe hypervolemia is prescribed a loop diuretic. The nurse knows that this drug can cause a significant loss of sodium and has to be carefully monitored. Which of the following drugs is most likely the one that was prescribed?
Lasix
Respiratory acidosis is a clinical disorder that occurs when the pH is _____ and the PaCO2 is _____.
Less than 7.35; greater than 45 mm Hg
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
Lightheadedness or paresthesia
A low-sodium diet and restricted oral fluids would be part of the medical plan of care for fluid volume excess. Describe the range of the amount of sodium restriction recommended in restricted diets.
Low-sodium diets can range from a mild restriction to as little as 250 mg of sodium per day, depending on the patient's needs. A mild sodium-restricted diet allows only light sating of food, about half the usual amount, in cooking and at the table, and no addition of salt to commercially prepared foods that are already seasoned. Of course, foods high in sodium must be avoided.
Which electrolyte imbalance is characterized by flat or inverted T waves?
Magnesium deficit
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?
Metabolic acidosis
Choose the condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration.
Metabolic acidosis
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?
Metabolic alkalosis
A clinical disturbance characterized by a high pH and high plasma bicarbonate concentration.
Metabolic alkalosis
A priority nursing intervention for a client with hypervolemia involves which of the following?
Monitoring respiratory status for signs and symptoms of pulmonary complications.
A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client?
No, sodium intake should be restricted.
Which of the following would be appropriate nursing interventions for a client with hypokalemia?
Offer a diet with fruit juices and citrus fruits; Monitor intake and output every shift.
A patient with abnormal sodium losses is receiving a house diet. To provide 1,600 mg of sodium daily, the nurse could supplement the patient's diet with:
One beef cube and 8 oz of tomato juice
Russell Thompkins, a 77-year-old retired male, visits your general practice office twice monthly to maintain control of his congestive heart failure. He measures his weight daily and phones it to your office for his medical record. In a 24-hour period, how much fluid is Russell retaining if his weight increases by two pounds?
One liter
Which of the following is a correct route of administration for potassium?
Oral
Refers to the number of dissolved particles contained in a unit of fluid
Osmolality
The concentration of fluid that affects the movement of water between fluid compartments by osmosis.
Osmolality
Define the terms osmolality and osmolarity and explain how each is measured.
Osmolality refers to the concentration of fluid that affects the movement of water between the fluid compartments by osmosis. It measures the solute concentration per kilogram in the blood and urine. Osmolarity describes the concentration of solutions and is measured in milliosmoles per liter (mOsm/L).
Translocation is a term used to describe the general movement of fluid and chemicals within body fluids. In every client's body, fluid-electrolyte balance is maintained through the process of translocation. What specific process allows water to pass through a membrane from a dilute to a more concentrated area?
Osmosis
Define the term osmosis, and explain how a fluid concentration gradient influences the movement between fluid compartments.
Osmosis is the movement of fluid, through a semipermeable membrane, from an area of low solute concentration to an area of high solute concentration until the solutions are of equal concentration. Diffusion is the movement of a substance from an area of higher concentration to one of lower concentration. The concentration of dissolved substances (fluid concentration gradient) draws fluid in that direction.
Give some examples of osmosis ___________________________, diffusion ___________________________, and filtration ___________________________.
Osmosis: the oncotic pressure of plasma proteins (albumin); diffusion: the filtration of water and electrolytes by the kidneys; and filtration: the exchange of oxygen and carbon dioxide between the pulmonary capillaries and the alveoli.
Occurs when the urine output increases due to excretion of substances such as glucose.
Osmotic diuresis
The amount of pressure needed to stop the flow of water by osmosis
Osmotic pressure
The oncotic pressure exerted primarily by albumin is greater than hydrostatic pressure in the venous end of the capillary; thus, fluids reenter the capillary.
Osmotic pressure
the amount of hydrostatic pressure needed to stop the flow of water by osmosis. It is primarily determined by the concentration of solutes.
Osmotic pressure
Oncotic pressure refers to the:
Osmotic pressure exerted by proteins; is a pulling pressure exerted by proteins such as albumin
Distinguish between osmotic pressure, oncotic pressure, and osmotic diuresis.
Osmotic pressure, determined by the concentration of solutes, is the amount of hydrostatic pressure needed to stop the flow of water by osmosis. Oncotic pressure is the osmotic pressure exerted by proteins. Osmotic diuresis is urine output caused by the excretion of substances such as glucose and mannitol.
The calcium level of the blood is regulated by which mechanism?
Parathyroid hormone
Which electrolyte imbalance is characterized by nystagmus and paresthesias?
Phosphorous deficit
A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately?
Potassium
Which of the following electrolytes is a major cation in body fluid?
Potassium
Which electrolyte imbalance is characterized by tall, tented T waves and absent P waves?
Potassium excess
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?
Prepare to assist with ventilation
In which of the following medical conditions would administering IV normal saline solution be inappropriate?
Pulmonary edema, renal impairment, heart failure
Management goal in hypervolemia
Reduce fluid volume
Describe the four major functions of the kidneys in maintaining fluid balance.
Regulation of extracellular fluid volume and osmolality by selective retention and excretion of body fluids; regulation of electrolyte levels in the extracellular fluid by selective retention of needed substances and excretion of unneeded substances; regulation of the pH of the extracellular fluid by retention of hydrogen ions and/or bicarbonate and excretion of metabolic wastes and toxic substances.
What is the sequence of the renin-angiotensin-aldosterone system?
Renin is released in response to decreased renal perfusion; angiotensin I is converted to angiotensin II; angiotensin II increases arterial perfusion pressure; aldosterone is released by the adrenal cortex in response to sympathetic nervous system stimulation; sodium is reabsorbed, plasma volume is increased, and blood pressure is increased.
Is due to inadequate excretion of carbon dioxide, with inadequate ventilation, resulting in elevated plasma carbon dioxide concentrations, consequently, increased levels of carbonic acid.
Respiratory acidosis
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects:
Respiratory alkalosis
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?
Respiratory alkalosis
A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate?
Respiratory alkalosis
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L
Primarily reflects the concentration of sodium, although blood urea nitrogen and glucose also play a major role in determining serum osmolality.
Serum osmolality
Which of the following is a clinical manifestation of fluid volume excess?
Shortness of breath, crackles in the lung fields, distended neck veins, increased blood pressure, tachycardia
Plays a major role in controlling water distribution throughout the body because it does not easily cross the intracellular wall membrane and because of its abundance and high concentration in the body.
Sodium
Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality?
Sodium
Which electrolyte imbalance is characterized by increased serum sodium urine specific gravity and osmolality?
Sodium excess
A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators?
Sodium level of 150 mEq/L
Which of the following is a factor affecting an increase in urine osmolality?
Syndrome of inappropriate antidiuretic hormone release (SIADH)
Potassium can be administered by which of the following forms?
Tablet, elixir, IV
To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?
Tachycardia
List the six major signs and symptoms of hyperchloremia.
Tachypnea, weakness, lethargy, deep rapid respirations, diminished cognitive ability, and hypertension
The body's major extracellular buffer system is _____, which maintains a ratio of _____.
The bicarbonate-carbonic acid buffer system that maintains a ratio of 20 parts of bicarbonate to one art of carbonic acid.
The primary goal for medical management of fluid volume excess is to reduce the workload on the heart by reducing preload and afterload. Diuretics are routinely prescribed. List three criteria that are used to select the type of diuretic, and compare the action of thiazide and loop diuretics.
The choice is based on the severity of the hypervolemic state, the degree of impairment of renal function, and the potency of the duretic. Thiazide diuretics block sodium reabsorption in the distal tubule. Loop diuretics can cause a greater loss of both sodium and water because they block sodium reabsorption in the ascending limb of the loop of Henle, where 20% to 30% of filtered sodium is normally reabsorbed. Generally, thiazide diuretics are prescribed for mild to moderate hypervolemia and loop diuretics for severe hypervolemia.
Explain how the osmolality of a solution is determined.
The number of dissolved particles, within a unit of fluid, determines the osmolality of a solution. It is the osmolality that influences the movement of fluid between compartments.
Determine the normal daily urine output of an adult. Calculate the usual per hour output for adults with the following weights: 110 lb, 132 lb, and 176 lb.
The usual daily urine output is 1.0 L/kg of body weight/h. The per hour output would be: 110 lb (50 mL), 132 lb (60 mL), and 176 lb (80 mL).
A 57-year-old homeless female with a history of alcohol abuse has been admitted to your hospital unit. She was admitted with signs and symptoms of hypovolemia - minus the weight loss. She exhibits a localized enlargement of her abdomen. What condition could she be presenting?
Third-spacing
Treatment of fluid volume excess involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)?
Three ounces of light or dark meat chicken, 1 cup of spaghetti, and a garden salad
A patient is diagnosed with hypocalcemia. The nurse advises the patient and his family to immediately report the most characteristic manifestation. What is the most characteristic manifestation?
Tingling or twitching sensation in the fingers
Name nine foods, high in chloride, that should be encouraged for a patient with hypochloremia.
Tomato juice, bananas, dates, eggs, cheese, milk, salty broth, canned vegetables, and processed meats
The ability of all the solutes in a solution to cause an osmotic driving force.
Tonicity
Explain the concept of tonicity and how it affects cell size.
Tonicity is the osmotic driving force of all the solutes. Tonicity determines cellular size and hydration.
Is equal to about 8 L in adult
Transcellular space
Third space fluid shift
Transcellular space
True or False. Buffer systems can act quickly to prevent excessive changes in H+ concentration.
True
True or False. The normal range of pH is 7.35 to 7.45.
True
Which of the following are sensible mechanisms of fluid loss?
Urination and bowel elimination
Determined by urea, creatinine, and uric acid. When measured with serum osmolality, urine osmolality is the most reliable indicator of concentration.
Urine osmolality
measures the kidney's ability to excrete or conserve water.
Urine specific gravity
Which of the following may be the first sign of respiratory acidosis in anesthetized patients?
Ventricular fibrillation
Explain how a fluid challenge is administered.
Volumes of fluid are administered at specific rates and intervals while the patient's hemodynamic response to this treatment is monitored (i.e. vital signs, breath sounds, sensorium, central venous pressure, pulmonary capillary wedge pressure values, and urine output). An example involves administering 100 to 200 mL of normal saline solution over 15 minutes.
Early signs of hypervolemia include which of the following?
Weight gain, increased breathing effort
A client is brought in by ambulance in a nauseous and confused state and demonstrating carpopedal spasm. Initial arterial blood gases show increased pH and HCO3 and normal PaCO2 levels. Breathing is slow and shallow. As the nurse caring for this client, you know that potassium salt should be a part of the treatment for this client when?
When hypokalemia is present
Harriet, 30 years old, has been admitted to the burn treatment center with full-thickness burns over 30% of her upper body. Her diagnosis is consistent with extracellular fluid volume deficit (FVD). The major indicator of extracellular fluid volume deficit can be identified by assessing for:
a drop in postural blood pressure
George, 88 years old, is suffering from congestive heart failure. He was admitted to the hospital with a diagnosis of extracellular fluid volume excess. He was frightened, slightly confused, and dyspneic on exertion. During the assessment process, the nurse expects to identify all of the following:
a full pulse; edema; neck vein distention
The nurse notes that a patient's urine osmolality is 980 mOsm/kg. The nurse knows to assess for the possible cause of:
acidosis
George, 88 years old, is suffering from congestive heart failure. He was admitted to the hospital with a diagnosis of extracellular fluid volume excess. He was frightened, slightly confused, and dyspneic on exertion. Nursing intervention for George should include all of the following:
administering diuretics, as prescribed, to help remove excess fluid; inspecting for sacral edema to note the degree of fluid retention; teaching dietary restriction of sodium to help decrease water retention
The most common cause of symptomatic hypomagnesemia in the United States is ______.
alcoholism
The ECG change that is specific to hypokalemia is:
an elevated U wave
If a patient has severe hyperkalemia, it is possible to administer calcium gluconate intravenously to:
antagonize the action of potassium on the heart
George, 88 years old, is suffering from congestive heart failure. He was admitted to the hospital with a diagnosis of extracellular fluid volume excess. He was frightened, slightly confused, and dyspneic on exertion. A nursing plan of care for George should include:
auscultating for abnormal breath sounds; inspecting for leg edema; weighing the patient daily
Isaac, 63 years old, was admitted to the hospital with a diagnosis of diabetes mellitus. On his admission, the nurse observed rapid respirations, confusion, and signs of dehydration. A manifestation not associated with altered acid-base balance is:
bradycardia
The parathyroid glands regulate __________ and phosphate balance by means of the parathyroid hormone (PTH).
calcium
Jill, an 84-year old woman, was admitted to the hospital for treatment dehydration. The physician immediately ordered intravenous therapy, 1,000 Ml of D5W, q8H. Four systemic intravenous complications are:
circulatory overload, air embolism, febrile reaction, and infections
Harriet, 30 years old, has been admitted to the burn treatment center with full-thickness burns over 30% of her upper body. Her diagnosis is consistent with extracellular fluid volume deficit (FVD). Manifestations of extracellular fluid volume deficit include all of the following:
collapsed neck veins; elevated hematocrit; weight loss
The nurse should expect that a patient with mild fluid volume excess would be prescribed a diuretic that blocks sodium reabsorption in the distal tubule, such as:
hydroDIURIL
Management of the foregoing patient should include:
discontinuance of any oral magnesium salts
Which of the following are factors affecting a decrease in serum osmolality?
diuretic use, overhydration, and hyponatremia
List the six symptoms associated with air embolism, a complication of intravenous therapy: ____________________, ____________________, ____________________, and ____________________.
dyspnea, cyanosis, a weak pulse, hypotension, unresponsiveness, and pain (chest, shoulder, low back)
The kidneys regulate acid-base balance by all of the following mechanisms:
excreting hydrogen ions; reabsorbing or excreting bicarbonate into the blood; retaining hydrogen ions
To supplement a diet with foods high in potassium, the nurse should recommend the addition of:
fruits such as bananas and apricots
Isaac, 63 years old, was admitted to the hospital with a diagnosis of diabetes mellitus. On his admission, the nurse observed rapid respirations, confusion, and signs of dehydration. In terms of cellular buffering response, the nurse should expect the major electrolyte disturbance to be:
hyperkalemia
A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory mechanisms associated with hypovolemia would cause all of the following symptoms:
hypertension
The nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory data for all of the following:
hypocalcemia; hypokalemia; hypoxemia
__________ occurs when loss of ECF volume exceeds the intake of fluid
hypovolemia
Jill, an 84-year old woman, was admitted to the hospital for treatment dehydration. The physician immediately ordered intravenous therapy, 1,000 Ml of D5W, q8H. A positive-pressure infusion pump maintains a steady infusion by overcoming vascular resistance caused by two things: the ______ and the ______.
increased tubing length and the low height of the intravenous container
Jill, an 84-year old woman, was admitted to the hospital for treatment dehydration. The physician immediately ordered intravenous therapy, 1,000 Ml of D5W, q8H. Five local complications of intravenous therapy are:
infiltration and extravasation, phlebitis, thrombophlebitis, hematoma, and clotting of the needle
The extracellular space is divided into three compartments: ________________, _________________________, and ______________________
intravascular, interstitial, and transcultural
A client with Gullain-Barre syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
pH, 7.25; PaCO2, 50 mm Hg
An isotonic solution that contains electrolytes similar to the concentration used in plasma is:
lactated Ringer's solution
Jill, an 84-year old woman, was admitted to the hospital for treatment dehydration. The physician immediately ordered intravenous therapy, 1,000 Ml of D5W, q8H. Since the flow of the intravenous infusion is inversely proportional to the fluid viscosity, an infusion of blood would require ______ than that used for saline or water.
larger cannula
Isaac, 63 years old, was admitted to the hospital with a diagnosis of diabetes mellitus. On his admission, the nurse observed rapid respirations, confusion, and signs of dehydration. Isaac's arterial blood gas values are pH 7.27; HCO3, 20 mEq/L; PaO2, 33 mm Hg. These values are consistent with a diagnosis of compensated.
metabolic acidosis
Jill, an 84-year old woman, was admitted to the hospital for treatment dehydration. The physician immediately ordered intravenous therapy, 1,000 Ml of D5W, q8H. The nurse knows that one of these four arm veins would be a recommended site:
metacarpal, cephalic, basilica, and median veins
The primary complication of hyperphosphatemia is: ___________________________________, which occurs when the calcium-magnesium product exceeds 70 mg/dL.
metastatic calcification of soft tissue, joints, and arteries
Harriet, 30 years old, has been admitted to the burn treatment center with full-thickness burns over 30% of her upper body. Her diagnosis is consistent with extracellular fluid volume deficit (FVD). Nursing intervention for Harriet includes all of the following:
monitoring urinary output to assess kidney perfusion; positioning the patient flat in bed with legs elevated to maintain adequate circulating volume; teaching leg exercises to promote venous return and prevent postural hypotension when the patient stands
Sodium establishes the electrochemical state necessary for ______________________ and the ___________________________________.
muscle contraction and the transmission of nerve impulses
Sodium, the most abundant electrolyte in extracellular fluid, is primarily responsible for maintaining fluid. ______________________________, which ________________________________________________.
osmolality, affects the movement of water between fluid compartments
The nursing student asks their instructor what the term is for the amount of hydrogen ions in a solution. What should the instructor respond?
pH
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
pH 7.46
The major positively charged ion in intracellular fluid is ________________.
potassium
George, 88 years old, is suffering from congestive heart failure. He was admitted to the hospital with a diagnosis of extracellular fluid volume excess. He was frightened, slightly confused, and dyspneic on exertion. A manifestation of extracellular volume excess is:
rapid weight gain
The nurse expects that a decrease in serum osmolality would occur with:
renal failure
Choose the condition that exhibits blood values with a low pH and a high PCO2.
respiratory acidosis
One of the best indicators of renal function is:
serum creatinine
Hypernatremia is associated with a:
serum sodium of 150 mEq/L
The lungs regulate acid-base balance by all of the following mechanisms:
slowing ventilation; controlling carbon dioxide levels; increasing ventilation
The major positively charged ion in extracellular fluid is ________________.
sodium
Isaac, 63 years old, was admitted to the hospital with a diagnosis of diabetes mellitus. On his admission, the nurse observed rapid respirations, confusion, and signs of dehydration.The nurse should anticipate that the physician will attempt to reverse this acid-base imbalance by prescribing intravenous administration of:
sodium bicarbonate
Jill, an 84-year old woman, was admitted to the hospital for treatment dehydration. The physician immediately ordered intravenous therapy, 1,000 Ml of D5W, q8H. The nurse also knows that if a central vein is needed it would most likely include either the _____ or ______ vein.
subclavian or internal jugular
Harriet, 30 years old, has been admitted to the burn treatment center with full-thickness burns over 30% of her upper body. Her diagnosis is consistent with extracellular fluid volume deficit (FVD). A nursing plan of care Harriet should include assessing blood pressure with the patient in the supine and upright positions. A diagnostic reading that should be recorded and reported is:
supine, 140/90; sitting 120/80; standing, 110/70 mm Hg
A clinical indication of hypophosphatemia is:
tetany
The most characteristic manifestation of hypocalcemia and hypomagnesemia is:
tetany
Calcium levels are primarily regulated by: ______________________.
the combined actions of parathyroid hormone and vitamin D
Management of hypocalcemia includes all of the following actions:
the diuretic furosemide (Lasix), without saline, to increase calcium excretion through the kidneys
Sodium is regulated by ______________________, ________________________, and the _____________________ system.
thirst, antidiuretic hormone (ADH), and the rennin-angiotensin aldosterone system
To return a patient with hyponatremia to normal sodium levels, it is safer to restrict fluid intake than to administer sodium:
to prevent fluid overload
Jill, an 84-year old woman, was admitted to the hospital for treatment dehydration. The physician immediately ordered intravenous therapy, 1,000 Ml of D5W, q8H. The formula to calculate flow rate at milliliter per hour (mL/h) is:
total volume (mL) divided by total time (hours) mL/h.
