Chapter 13 electrolytes & fluids
normal range for normal serum concentration level ranges:
135- 145 mEq/L
What solution is hypertonic?
5% NaCl
A patient presents to the Emergency Department experiencing a severe anxiety attack and is hyperventilating. The nurse would expect the patient's pH value to be which of the following?
7.50 -the patient is experiencing respiratory alkalosis. Respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and PaCO2 is less than 38 mm Hg. Respiratory alkalosis is always caused by hyperventilation, which caused excessive "blowing off" of CO2 and hence, a decrease in the plasma carbonic acid concentration.
The nurse is caring for a patient with serum sodium level of 113 mEq/L. The nurse should monitor the patient for the development of which of the following?
Confusion Normal serum concentration level ranges from 135 -145 mEq/L. Hyponatremia exists when serum level is below 135 mEq/L. Less than 115mEq/L signs of increasing intracranial pressure such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur.
The nurse is assigned to care for a patient with serum phosphorus level of 5.0 mg/dL. The nurse anticipates that the patient will also experience which of the following electrolyte imbalances?
Hypocalcemia - The patient is eperiening an elevated serum phosphorus level. Hyperphosphatemia is defined as a serum phosphorus level that exceeds 4.5 mg/dL (1.45 mmol/L). Because of the reciprocal relationship between phosphorus and calcium, a high serum phosphorus level tends to cause a low serum calcium concentration.
A patient with a magnesium level of 2.6 mEq/L is being treated on a medical-surgical unit. Which of the following treatments should the nurse anticipate will be used?
IV furosemide (lasix) -Administration of loop diuretics (e.g., furosemide) and sodium chloride or LR IV solution enhances magnesium excretion in patients with adequate renal function.
What solution is isotonic?
Lactaid Ringer and normal saline 0.9% NaCl
The nurse is caring for a patient undergoing alcohol withdrawal. Which of the following serum laboratory values should the nurse monitor most closely?
Magnesium - Chronic alcohol abuse is a major cause of symptomatic hypo magnesia in the US. The serum magnesium level should be measured at least every 2 to 3 days in patients undergoing alcohol withdrawal. The serum magnesium level may be normal on admission but may decrease as a result of metabolic changes, such as intracellular shift of magnesium associated with IV glucose administration.
A patient is being treated in the ICU 24hrs after having a radical neck dissection completed. The patient's serum calcium level is 7.6 mg/dL. Which of the following physical examination findings is consistent with this electrolyte imbalance?
Presence of Trousseau's sign - A patient status post radical neck resection is prone to developing hypocalemia. Hypocalema is serum values lower than 8.6 mg/dL [2.15 mmol/L]. S/S include: Chvostek's sign, Trousseau's sign
Respiratory acidosis:
pH less than 7.35 and PaCO2 greater than 42 mm Hg
A patient is ordered to receive hypotonic IV solution to provide free water replacement. Which of the follow solutions will the nurse anticipate administering?
0.45% NaCl Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to replace cellular fluid because it is hypotonic compared with plasma. Another is to provide free water to excrete body wastes. This solution is used to treat hypernatremia and other hyperosmolar conditions. Lactated Ringer's solutions and normal saline (0.9% NaCl) are isotonic. 5% NaCl is hypertonic.
The nurse is instructing a patient with recurrent hyperkalemia about following a potassium-restricted diet. Which of the following patient statements indicates the need for additional instruction?
"I will not salt my food, instead I'll use salt substitute" -The patient should avoid salt susitutes due to the amount of potassium in it.
The nurse is caring for a patient in the intensive care unit (ICU) following a saltwater near-drowning event. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen dry tongue, flushed skin, and peripheral edema. The nurse anticipated that the patient's serum sodium value would be which of the following?
155 mEq/L - The patient is experiencing signs and symptoms of hypernatremia. Hypernatremia is a serum level higher than 145 mEq/L. A cause of hypernatremia is near drowning in seawater and the s/s include: thirst, elevated body temp, swollen dry tongue, sticky mucous membranes, hallucinations, lethargy, restless, irritability, simple partial or tonic clonic seizures, pulmonary edema, hyperflexia, twitching, nausea, vomiting, anorexia, elevated pulse and elevated BP.
The nurse is assessing a patient for local complication of IV therapy. Local complications include which of the following? SATA
A) Extravastation, C) Hematoma, D) Phlebitis -Local complications of IV therapy include infiltration and extravastation, phlebitis, thrombophlebitis, hematoma, and clotting of the needle. Systemic complications occur less frequently but are usually more serious than local complications and include circulatory overload, air embolism, febrile reaction, and infection
The nurse is caring for a patient diagnosed with hyperchloremia. Signs and symptoms of hyperchloremia include which of the following? SATA
A) Tachypnea B) Lethargy D) Weakness - S/S are the same as metabolic acidosis: hypervolemia, hypernatremia. Tachypnea, weakness, lethargy, deep, rapid respirations, diminished cognitive ability, hypertension. If untreated, hyperchloremia can lead to a <in cardiac output, dysrhthmias, and coma. A high chloride level is accompanied by a high sodium level and fluid retention.
The nurse has been assigned to care for the following patients. Which patient is at the highest risk for a fluid and electrolyte imbalance?
An 82 yr old woman who received all nutrition via tube feedings. Her medications include carvedilol (Coreg) and torsemide (Demadex) Risk factors: advanced age, tube feedings and use of diuretic (Demadex).
The nurse is caring for a patient with a metabolic acidosis (pH 7.25). Which of the following values is useful to the nurse in determining whether the cause of the acidosis is due to acid gain or to bicarbonate loss?
Anion gap - Metabolic acidosis is a common clinal distribution characterized by a low pH and a low plasma bicarbonate concentration. It can be produced by a gain of hydrogen or a loss of bicarbonate. It can be divided clinically into two forms, according to the values of the serum anion gap: high anion gap is within this normal range. An a notion gap greater than 16 mEq (Normal value for anion gap is 8-12 mEq/L) without potassium in the equation. If potassium is included in the equation, the normal value of the anion gap is 12-16 mEq/L and suggests an excessive accumulation of unmeasured anions and would indicate high anion gap metabolic acidosis as the type.
The nurse is caring for a patient who was admitted with fluid volume excess (FVE). Which of the following nursing assessments should the nurse include in the ongoing monitoring of the patients? SATA
B) Intake and output, urine volume and color C) BP, HR, and rhythm E) Skin assessment for edema and turgor
The nurse is caring for a patient with serum potassium level of 6.0 mEq/L. The patient is ordered to receive oral sodium polystyrene sulfonate (Kayexelate) and furosemide (Lasix). What other orders should the nurse anticipate giving?
Discontinue the IV lactated Ringer's solution -The lactated Ringer's fluid is contributing to both the fluid volume excess and the hyperkalemia. In addition to the volume of IV fluids contributing to the fluid volume excess, lactated Ringer contains more sodium than daily requirements and excess sodium worsens fluid volume excess. Lactated Ringer's also contains potassium, which would worsen the hyperkalemia.
A patient is being treated with loop diuretics; gastric suction has been initiated. The nurse understands the patient is at risk for developing which of the following electrolyte imbalances?
Hypokalemia -Potassium-lossing diuretics, such as thiazides and loop diuretics, can induce hypokalemia. Gastrointestinal (GI) loss of potassium is another common cause of potassium depletion. Vomting and gastric suction frequently lead to hypokalemia.
The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium level of 2.9 mEq/L. Which of the following statements made by the patient indicated the need for further teaching?
I can use laxatives and enemas but only once a week -The patient is experiencing hypokalemia most likely due to bulimia. Patients diagnosed with bulimia frequently suffer increased potassium loss through self-induced vomiting, misuse of laxatives, diuretics and enemas; thus the patient should avoid laxatives and enemas.
When caring for a patient who has risk factors for fluid and electrolyte imbalances, which of the following assessment findings is the highest priority for the nurse to follow up?
Irregular heart rate -this may indicate a potentially life-threatening cardiac dysrthmia. Potassium, magnesium and calcium imbalances may cause dysrhythmias. Weight loss is a good indicator of the amount of fluid lost, but following up on potential cardiac dysrhthmias is a higher priority.
The nurse is caring for a patient with severe diarrhea. The nurse recognizes that the patient is at-risk for developing which of the following acid-base imbalances?
Metabolic acidosis - The patient 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)
The nurse is analyzing the electrocardiographic (ECG) rhythm tracing of a patient experiencing hypercalcemia. Which of the following ECG changes is typically associated with this electrolyte imbalance?
Prolonged PR intervals -Cardiovascular changes associated with hypercalcemia may include a variety of dyshythmias (Heart block) and shortening of the QT interval and ST segment. The PR interval is sometimes prolonged.
The nurse is participating in the care of a patient who had a peripherally inserted central cather (PICC) inserted in the right arm. Following catheter placement, the nurse should complete which of the following actions?
Send the patient for a chest x-ray -A chest x-ray is needed to confirm the placement of catheter tip prior to initiation of ordered infusion. Consent should be obtained prior to the procedure, not after the procedure. No Bps should be taken on the extremity where the catheter is placed.
A patient with cancer is being treated on the oncology unit for bilateral breast cancer. The patient is undergoing chemotherapy. The nurse notes the patient's serum calcium level is 12.3 mg/dL. Given this lab finding, the nurse should suspect which of the following statements?
The patient's malignancy is causing the electrolyte imbalance. - Labs indicate hypercalcemia. Hypercalemia is defined as a calcium level greater than 10.2 mg/dL (2.6 mmil/L). The most common causes of hypercalcemia are malignancies and hyperparathyroidism. Malignant tumors can produce hypercalcemia by a variety of mechanisms.
Which of the following arterial blood gas results would the nurse anticipate for a patient with a 3 day history of vomiting?
pH: 7.55, PaCO2: 60 mmHg, HCO3 : 28 - The patients ABG would likely be metabolic alkalosis because the high pH and high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or loss of H+. A common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis where only gastric fluid is lost. The other results do not represent metabolic alkalosis.
General manifestations of hyponatremia:
poor skin turgor, dry mucosa, headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping.
A nurse is caring for a patient with acute renal failure and hypernatremia. Which of the following actions can be delegated to the nursing assistant?
provide oral care every 2-3 hours -Providing oral care for the patient every 2-3 hours is within the scope of practice of a nursing assistant.
