Chapter 13- Fluid and Electrolytes
chest pain
Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism?
osmosis
Fluid and 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
pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L
The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis?
0.45% NaCl
A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering?
respiratory alkalosis
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?
Metabolic acidosis
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?
Light-headedness or paresthesia
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
Metabolic alkalosis
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?
Presence of Trousseau sign
A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance?
Restricting fluids to 800 ml/day
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH?
Serum sodium level of 124 mEq/L
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result?
electrocardiogram (ECG) results
A client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment?
potassium 3.0 mEq/L (3.0 mmol/L)
A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. The laboratory values are as follows:sodium 147 mEq/L (147 mmol/L)potassium 3.0 mEq/L (3.0 mmol/L)chloride 112 mEq/L (112 mmol/L)Magnesium 2.3 mg/dL (0.95 mmol/L) What laboratory value is consistent with the client's symptoms?
dehydration
A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition?
Drink at least eight glasses of fluid each day. Drink water as an inexpensive way to meet fluid needs. Respond to thirst
A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply.
pH, 7.25; PaCO2 50 mm Hg
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
prepare to assist with ventilation
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?
Reddened area along the path of the vein Tender area around the insertion site
A client with an intravenous infusion is rubbing his arm. The nurse assesses the site and decides to discontinue the current infusion because of concern that the client has developed phlebitis. Which of the following clinical manifestations would the nurse assess with phlebitis? Select all that apply.
malignancy is causing the electrolyte imbalance.
A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the
Pulse
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?
chronic respiratory acidosis
A client with emphysema is at a greater risk for developing which acid-base imbalance
Potassium
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?
800 mL/24 h
A febrile client's fluid output is in excess of normal because of diaphoresis. What rate of fluid replacement should the nurse plan for the client?
Jugular vein distention
A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action?
Respiratory acidosis
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?
Hypercalcemia
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?
Extracellular fluid volume deficit
A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following?
peaked T waves
A nurse is monitoring a client being evaluated who has a potassium level of 7 mEq/L (mmol/L). Which electrocardiogram changes will the client display?
bicarbonate-carbonic acid buffer system
A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse?
urine ph of 3.0
A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?
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?
Calcium
A patient complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patient's laboratory work has returned?
Sodium level of 150 mEq/L
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
Tachycardia
An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the mostserious adverse effect of diuretic use?
Extreme anxiety
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis?
parathyroid hormone (PTH)
The calcium concentration in the blood is regulated by which mechanism?
increased breathing effort and weight gain.
Early signs of hypervolemia include
Bicarbonate
The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?
"I can use laxatives and enemas but only once a week.
The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching?
elevated blood pressure
The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process?
confusion
The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition?
Lungs and kidney
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation?
Intracellular fluid
The nurse is caring for a geriatric client in the home setting. Due to geriatric changes decreasing thirst, the nurse is likely to see a decrease in which fluid location which contains the most body water?
1 L
The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining?
metabolic acidosis
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for?
Send the client for a chest x-ray.
The nurse is participating in the care of a client who had a peripherally inserted central catheter (PICC) placed in the right arm. After catheter placement, the nurse should complete which action?
3.5-5.0 mEq/L (3.5-5.0 mmol/L)
The nurse knows which is the normal serum value for potassium?
115 mEq/L
The nurse should assess the patient for signs of lethargy, increasing intracranial pressure, and seizures when the serum sodium reaches what level?
Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms.
The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply
0.45% sodium chloride
The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer?
increases the client's desire to consume fluid
To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?
Arterial blood gas (ABG) analysis
To evaluate a client for hypoxia, the physician is most likely to order which laboratory test?
Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad
Treatment of FVE 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)
Fruits such as bananas and apricots
What foods can the nurse recommend for the patient with hypokalemia
pH 7.48
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
Potassium
Which electrolyte is a major cation in body fluid?
Instruct the client to breathe into a paper bag
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.
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?
Alcoholsim
Which is the most common cause of symptomatic hypomagnesemia?
Sodium bicarbonate
Which medication does the nurse anticipate administering to antagonize the effects of potassium on the heart for a patient in severe metabolic acidosis?
Facial
Which nerve is implicated in the Chvostek's sign?
Serum bicarbonate of 28 mEq/L
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
Which set of arterial blood gas (ABG) results requires further investigation?
0.45% NaCl
Which solution is hypotonic?
Dehydration
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?