Fluid & Electrolyte Practice Questions

Hyponatremia with fluid volume deficit treatment

IV sodium chloride infusions

Causes of hypernatremia

decreased Na excretion increased Na intake decreased water intake increased water loss

isotonic dehydration is the most common type of________

dehydration

IV potassium is always __________

diluted and administered using an infusion device

hypotonic dehydration is when______

electrolyte loss exceeds water loss

A client with acute kidney injury or chronic kidney disease is at high risk for________

fluid volume excess

Hypertonic solutions definition

higher concentration of solutes than another, less concentrated solution more solute

numbers of cations and anions must be the same for _____________to exist.

homeostasis

filtration movement moves via

hydrostatic pressure

hypotonic dehydration treatment

hyper tonic fluid solutions

Total body fluid weight in humans=

Infants= 80% Adults= 60% Elderly= 55%

The nurse caring for a client who has been receiving intravenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition? 1. Weight loss and poor skin turgor 2. Lung congestion and increased heart rate 3. Decreased hematocrit and increased urine output 4. Increased respirations and increased blood pressure

1. Weight loss and poor skin turgor

The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit? 1. A client with an ileostomy 2. A client with heart failure 3. A client on long-term corticosteroid therapy 4. A client receiving frequent wound irrigations

1. A client with an ileostomy Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy. A client with heart failure or on long-term corticosteroid therapy or a client receiving frequent wound irrigations is most at risk for fluid volume excess.

Potassium chloride intravenously is prescribed for a client with hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply. 1. Obtain an intravenous (IV) infusion pump. 2. Monitor urine output during administration. 3. Prepare the medication for bolus administration. 4. Monitor the IV site for signs of infiltration or phlebitis. 5. Ensure that the medication is diluted in the appropriate volume of fluid. 6. Ensure that the bag is labeled so that it reads the volume of potassium in the solution.

1. Obtain an intravenous (IV) infusion pump. 2. Monitor urine output during administration. 4. Monitor the IV site for signs of infiltration or phlebitis. 5. Ensure that the medication is diluted in the appropriate volume of fluid. 6. Ensure that the bag is labeled so that it reads the volume of potassium in the solution.

Which client is at risk for the development of a sodium level at 130 mEq/L (130 mmol/L)? 1. The client who is taking diuretics 2. The client with hyperaldosteronism 3. The client with Cushing's syndrome 4. The client who is taking corticosteroids

1. The client who is taking diuretics A serum sodium level of 130 mEq/L (130 mmol/L) indicates hyponatremia. Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the client with hyperaldosteronism or Cushing's syndrome are at risk for hypernatremia.

The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? 1. Twitching 2. Hypoactive bowel sounds 3. Negative Trousseau's sign 4. Hypoactive deep tendon reflexes

1. Twitching

The nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 2.5 mEq/L (2.5 mmol/L). Which patterns should the nurse watch for on the electrocardiogram (ECG) as a result of the laboratory value? Select all that apply. 1. U waves 2. Absent P waves 3. Inverted T waves 4. Depressed ST segment 5. Widened QRS complex

1. U waves 3. Inverted T waves 4. Depressed ST segment

44. The nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.7 mEq/L (5.7 mmol/L). Which patterns would the nurse watch for on the cardiac monitor as a result of the laboratory value? Select all that apply. 1. ST depression 2. Prominent U wave 3. Tall peaked T waves 4. Prolonged ST segment 5. Widened QRS complexes

3. Tall peaked T waves 5. Widened QRS complexes

The nurse provides instructions to a client with a low potassium level about the foods that are high in potassium and tells the client to consume which foods? Select all that apply. 1. Peas 2. Raisins 3. Potatoes 4. Cantaloupe 5. Cauliflower 6. Strawberries

2. Raisins 3. Potatoes 4. Cantaloupe 6. Strawberries

The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client is at risk for developing the potassium deficit because of which situation? 1. Sustained tissue damage 2. Requires nasogastric suction 3. Has a history of Addison's disease 4. Uric acid level of 9.4 mg/dL (559 μmol/L)

2. Requires nasogastric suction Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client with hyperuricemia are at risk for hyperkalemia. The normal uric acid level for a female is 2.7 to 7.3 mg/dL

The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? 1. Weight loss and dry skin 2. Flat neck and hand veins and decreased urinary output 3. An increase in blood pressure and increased respirations 4. Weakness and decreased central venous pressure (CVP)

3. An increase in blood pressure and increased respirations

The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia? 1. Muscle twitches 2. Decreased urinary output 3. Hyperactive bowel sounds 4. Increased specific gravity of the urine

3. Hyperactive bowel sounds Hyperactive bowel sounds indicate hyponatremia. The remaining options are signs of hypernatremia. In hyponatremia, muscle weakness, increased urinary output, and decreased specific gravity of the urine would be noted.

The nurse is reading a health care provider's (HCP's) progress notes in the client's record and reads that the HCP has documented "insensible fluid loss of approximately 800 mL daily." The nurse makes a notation that insensible fluid loss occurs through which type of excretion? 1. Urinary output 2. Wound drainage 3. Integumentary output 4. The gastrointestinal tract

3. Integumentary output

52. Which client is at risk for the development of a potassium level of 5.5 mEq/L 1. The client with colitis 2. The client with Cushing's syndrome 3. The client who has been overusing laxatives 4. The client who has sustained a traumatic burn

4. The client who has sustained a traumatic burn The client with Cushing's syndrome or colitis and the client who has been overusing laxatives are at risk for hypokalemia.

On review of the clients' medical records, the nurse determines that which client is at risk for fluid volume excess? 1. The client taking diuretics and has tenting of the skin 2. The client with an ileostomy from a recent abdominal surgery 3. The client who requires intermittent gastrointestinal suctioning 4. The client with kidney disease and a 12-year history of diabetes mellitus

4. The client with kidney disease and a 12-year history of diabetes mellitus The causes of fluid volume excess include decreased kidney function, heart failure, use of hypotonic fluids to replace isotonic fluid losses, excessive irrigation of wounds and body cavities, and excessive ingestion of sodium. The client taking diuretics, the client with an ileostomy, and the client who requires gastrointestinal suctioning are at risk for fluid volume deficit.

The nurse notes the presence of U waves on a client's cardiac monitor screen. What actions should the nurse take?

Cardiac changes in hypokalemia include impaired repolarization, resulting in a flattening of the T wave and eventually the emergence of a U wave. Therefore, the nurse should suspect hypokalemia. immediately assess the client's vital signs and cardiac status for signs of hypokalemia. The nurse should also check the client's most recent serum potassium level and then contact the health care provider to report the findings and obtain prescriptions to treat the hypokalemic state.

Potassium is never administered ___________

IV push, intramuscular, or subcutaneous routes

Intravascular compartment:

Refers to fluid inside a blood vessel

Hypokalemia ECG changes

ST depression; shallow, flat, or inverted T wave; and prominent U wave

Hyperkalemia ECG Changes

Tall peaked T waves, flat P waves, widened QRS complexes, and prolonged PR intervals

Hypotonic overhydration casues

a. Early kidney disease b. Heart failure c. Syndrome of inappropriate antidiuretic hormone secretion d. Inadequately controlled IV therapy e. Replacement of isotonic fluid loss with hypotonic fluids f. Irrigation of wounds and body cavities with hypotonic fluids

Hypertonic overhydration causes

a. Excessive sodium ingestion b. Rapid infusion of hypertonic saline c. Excessive sodium bicarbonate therapy

Isotonic overhydration causes

a. Inadequately controlled IV therapy b. Kidney disease c. Long-term corticosteroid therapy

Extracellular compartment:

a. Refers to fluid outside the cells. b. The extracellular compartment includes the interstitial fluid, which is fluid between cells (sometimes called the third space), blood, lymph, bone, connective tissue, water, and transcellular fluid.

Intracellular compartment:

a. The intracellular compartment refers to all fluid inside the cells. b. Most bodily fluids are inside the cells.

localized edema

as a result of traumatic injury from accidents or surgery, local inflammatory processes, or burns.

Fluid Volume Excess Symptom

bounding, increased heart rate hypertension distended neck & hand veins elevated central venous pressure increased RR most crackles in lungs heard headache LOC visual disturbances pitting edema pale, cool skin increased motility in GI tract decreased serum osmolality, hematocrit, BUN, Na, & urine specific gravity

Potassium imbalance can cause ________ that can be very life-threatening.

cardiac dysrhythmias

Hypertonic overhydration

caused by excessive sodium intake rare ECF volume expands & intracellular fluid volume contracts

hypotonic dehydration is caused by

chronic illness, excessive fluid replacement, kidney disease, or chronic malnutrition

Hyperkalemia is due to

excessive K+ intake decreased K+ excretion movement of K from ICF into ECF

Potassium loss is due to

excessive use of diuretics increased secretion of aldosterone vomiting, diarrhea wound drainage, GI especially excessive diaphoresis kidney disease inadequate K+ intake

The nurse is reviewing laboratory results and notes that a client's serum sodium level is 150 mEq/L (150 mmol/L). The nurse reports the serum sodium level to the health care provider (HCP) and the HCP prescribes dietary instructions based on the sodium level. Which acceptable food items does the nurse instruct the client to consume? Select all that apply. 1. Peas 2. Nuts 3. Cheese 4. Cauliflower 5. Processed oat cereals

hypernatremia: avoid foods high in sodium 1. Peas 2. Nuts 4. Cauliflower

isotonic overhydration is known as

hypervolemia resulting from excessive fluid in the ECF causes circulatory overload

hypertonic dehydration treatment

hypotonic fluid solutions

cause of hyponatremia

increased Na excretion Inadequate Na intake Dilution of serum sodium

hypertonic dehydration is caused by_____

increased fluid loss, diabetes, or early stage kidney disease

generalized edema/ anasarca

is an excessive accumulation of fluid in the interstitial space throughout the body and occurs as a result of conditions such as cardiac, renal, or liver failure

Isotonic dehydration treatment

isotonic fluid solutions

Hypotonic solutions definition

lower concentration of salt or solute than another, more concentrated solution has less salt or more water than an isotonic solution less solute

Intervention for fluid excess=

monitor restore normal fluid balance administer diuretics restrict fluid & sodium

Hyponatremia with fluid volume excess treatment

osmotic diruretics

Hypernatremia symptoms

pulmonary edema muscle contractions or twitches skeletal muscle weakness altered cerebral function: most common agitation seizures coma lethargy extreme thirst decreased urine output dry & flushed skin dry mouth increased urinary specific gravity

Hyponatremia

serum sodium lower than 135

Hyponatremia symptoms

shallow breathing skeletal muscle weakness worse in extremities diminished deep tendon reflexes headache personality changes seizures coma hyperactive bowel sounds nausea abdominal cramping diarrhea increased urine output dry mucous membranes decreased urinary specific gravity

Hyperkalemia symptoms

slow, weak, & irregular heart rate hypotension profound weakness leading to respiratory failure muscle twitches, cramps burning followed by numbness in hands, feet, mouth paralysis hyperactive bowel sounds diarrhea

third spacing definition

the accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury.

Fluid volume deficit symptoms

thready increased pulse hypotension diminished peripheral pulses decreased central venous pressure Increased RR fever decreased urine output dry skin poor turgor dry mouth diminished bowel sounds decreased body weight increased serum osmolality, hematocrit, BUN, Na, & urinary specific gravity flat neck & hand veins

Hypokalemia symptoms

thready, weak, & irregular HR orthostatic hypotension shallow RR diminished breath sounds anxiety confusion skeletal muscle weakness decreased GI motility nausea, vomiting, constipation

Hypotonic overhydration

water intoxication excessive fluid moves in the intercellular space & all compartments in the body expand result of dilution

hypertonic dehydration is when ______________

water loss exceeds electrolyte loss

insensible loss

water lost through the skin or from the lungs

Potassium common food sources

• Avocado • Bananas oranges strawberries tomatoes • Cantaloupe • Carrots • Fish • Mushrooms • Potatoes • Pork, Beef, Veal • Raisins • Spinach