fluid and electrolytes

An older adult patient is admitted with dehydration. Which nursing assessment data identify that the patient is at risk for falling? Dry oral mucous membranes Orthostatic blood pressure changes Serum potassium level of 4.0 mEq/L Pulse rate of 72 beats/min and bounding

Orthostatic blood pressure changes Blood pressure decreases when changing positions. The patient may not have sufficient blood flow to the brain, causing sensations of lightheadedness and dizziness. This problem increases the risk for falling, especially in older adults. Assessment of oral mucous membranes and the pulse rate can detect symptoms of dehydration, but these are not the best ways to assess for a fall risk. Checking serum potassium does not assess for fall risk. P 168

Which foods will the nurse teach a patient with hyperkalemia to avoid? Select all that apply. Sugar Oranges Broccoli Cranberries Dairy products

Rationale A patient with hyperkalemia has high levels of potassium, so the nurse should instruct the patient to avoid oranges, broccoli, and dairy products, which are all high in potassium. Sugar is low in potassium, so this patient does not necessarily need to avoid it in order to manage his or her hyperkalemia, but he or she should limit sugar consumption to healthy levels. Cranberries are low in potassium, so telling the patient to avoid cranberries is unnecessary. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. p. 179

Which are common symptoms of hypokalemia? Select all that apply. Parenthesis Bradycardia Shallow respirations Weak, thready pulse Musculoskeletal weakness

Shallow respirations Weak, thready pulse Musculoskeletal weakness Rationale Common symptoms of hypokalemia include shallow respirations; weak, thready pulse; and musculoskeletal weakness. Paresthesia and bradycardia are symptoms of hyperkalemia. p. 176

When caring for a patient with hyponatremia, which intervention does the nurse implement? 2-gram sodium diet Administer of furosemide Intravenous administration of 0.45% normal saline Small-volume intravenous infusions of 3% normal saline

Small-volume intravenous infusions of 3% normal saline Rationale 3% saline is hypertonic and is given in small volumes to replenish serum sodium. 0.45% saline is hypotonic and will further dilute serum sodium levels. Furosemide causes sodium loss in the kidneys and would further contribute to hyponatremia. A 2-gram sodium diet restricts sodium intake; the goal of nutritional therapy with hyponatremia is to increase sodium intake. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. p. 173

Which electrolyte deficiency results in decreased depolarization in the excitable cells and increased cellular swelling?

Sodium Hyponatremia occurs when sodium levels are low; this condition causes decreased depolarization in excitable cells and increased cellular swelling. Low serum calcium levels lead to muscle cramping and cardiac arrhythmias. A potassium deficiency causes cardiac dysrhythmias. A decrease in the level of magnesium may cause increased nerve impulse transmission.

The nurse is planning care for a patient with hypocalcemia. Which nursing action is appropriate to delegate to unlicensed assistive personnel (UAP)? Collaborating with the dietitian to provide calcium-rich foods for the patient. Evaluating the patient's laboratory results. Implementing seizure precautions for the patient. Transferring the patient from the bed to a stretcher using a lift sheet.

Transferring the patient from the bed to a stretcher using a lift sheet Transferring patients is a nursing skill that is included in UAP education and scope of practice. Collaborating with the dietitian, evaluating the patient's laboratory results, and implementing seizure precautions all require broader education and scope of practice and should be done by licensed nursing personnel. P 181

Hyponatremia most affects the cells of which body systems? Select all that apply. Cerebral Endocrine Respiratory Cardiovascular Neuromuscular

Cerebral, cardiovascular, neuromuscular Rationale The cells of the cerebral, cardiovascular, and neuromuscular systems are most affected by hyponatremia. The cells of the endocrine and respiratory systems are not as affected. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 173

The nurse is teaching proper nutrition to a patient who has been prescribed high-ceiling diuretic therapy. Which patient response indicates a need for further teaching? "I should eat more eggs and cereals to maintain a high potassium intake." "Eating meat will help with my potassium needs." "I should eat fish a few times a week." "I should have fruits such as oranges, kiwi, and bananas every day."

"I should eat more eggs and cereals to maintain a high potassium intake." Breads, eggs, and cereal grains contain the least amount of natural potassium. Meats, fish, fruits, and some vegetables are highest in potassium. Diuretics that increase the kidney excretion of potassium can cause hypokalemia. The patient should be encouraged to eat foods high in potassium when taking high-ceiling diuretic agents to help compensate for potassium loss. STUDY TIP: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts. p. 175

A patient has a serum magnesium level of 1.2 mEq/L. Which instruction by the nurse is appropriate?

"Notify me if you have diarrhea." Rationale A serum magnesium level of 1.2 mEq/L represents mild hypomagnesemia (normal is 1.3-2.1 mEq/L) for which oral magnesium supplements are administered. Oral magnesium may lead to diarrhea; diarrhea contributes to magnesium loss. With severe hypomagnesemia, the IV route (instead of IM) is used because the IM route causes tissue damage and pain. Any medications containing phosphorus are contraindicated because they would contribute to associated hypocalcemia. Magnesium therapy does not affect the urine. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. p. 181

A patient has a serum magnesium level of 1.2 mEq/L. Which instruction by the nurse is appropriate? "Notify me if you have diarrhea." "I will be giving you an intramuscular injection of magnesium sulfate." "I will be administering a phosphorus supplement in addition to the magnesium supplement." "Your urine may become darker and more concentrated in appearance."

"Notify me if you have diarrhea." A serum magnesium level of 1.2 mEq/L represents mild hypomagnesemia (normal is 1.3-2.1 mEq/L) for which oral magnesium supplements are administered. Oral magnesium may lead to diarrhea; diarrhea contributes to magnesium loss. With severe hypomagnesemia, the IV route (instead of IM) is used because the IM route causes tissue damage and pain. Any medications containing phosphorus are contraindicated because they would contribute to associated hypocalcemia. Magnesium therapy does not affect the urine.

The nurse is performing discharge dietary teaching for a patient with hyperkalemia. Which statement does the nurse include in the teaching? "You may eat avocados, broccoli, and cantaloupe." "You may use salt substitutes." "You may eat apples, strawberries, and peaches." "You don't need to restrict dairy products."

"You may eat apples, strawberries, and peaches." The patient with hyperkalemia should be instructed to consume foods low in potassium such as apples, strawberries, and peaches. The patient should avoid foods high in potassium, which include avocados, broccoli, cantaloupe, and dairy products. Salt substitutes contain potassium. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. p. 178

A patient with severe hypokalemia is prescribed parenteral administration of potassium. How does the nurse administer potassium to the patient? 1 mEq of potassium to 10 mL intravenous solution. 10 mEq of potassium to 10 mL intravenous solution. 1 mEq of potassium to 10 mL solution intramuscularly. 10 mEq of potassium to 10 mL solution intramuscularly.

1 mEq of potassium to 10 mL intravenous solution. Potassium is given intravenously for severe hypokalemia, but only mixed in a solution. It is available in many concentrations. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of such solutions. Therefore, 1 mEq of potassium to 10 mL of solution is the preferred dilution to prevent the risk associated with hyperkalemia. A concentration of 10 mEq of potassium to 10 ml of solution is too high and can cause tissue irritation. Potassium is a severe tissue irritant; it may cause necrosis and loss of function of the tissue, and so is never given as an intramuscular or subcutaneous injection. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 177

Which patient is at greatest risk for hypernatremia? 17-year-old with a serum blood glucose of 189 mg/dL 30-year-old on a low-salt diet 42-year-old receiving hypotonic fluids 54-year old who is sweating profusely

54-year old who is sweating profusely Excessive sweating is a common cause of hypernatremia. Hyperglycemia, a low-salt diet, and hypotonic fluid administration are common causes of hyponatremia, not hypernatremia. P 174

The nurse manager of the medical-surgical unit assigns which patient to the LPN/LVN? 44-year-old admitted with dehydration who has a heart rate of 126. 54-year-old just admitted with hyperkalemia who takes a potassium-sparing diuretic at home. 64-year-old admitted yesterday with heart failure who still has dependent pedal edema. 74-year-old who has just been admitted with severe nausea, vomiting, and diarrhea.

64-year-old admitted yesterday with heart failure who still has dependent pedal edema. Because the patient with heart failure is the most stable of the four patients, this patient is most appropriate to assign to the LPN/LVN. Dehydration, tachycardia, potassium overload, and GI signs and symptoms in a patient indicate that he or she is unstable and should be cared for by RN staff members. P 169

Which laboratory value requires a priority response by the nurse to notify the primary health care provider? Sodium 133 mEq/L Potassium 5.0 mEq/L Calcium 9.0 mg/dL Magnesium 4.2 mEq/L

A magnesium level of 4.2 is markedly elevated (normal 1.3-2.1 mEq/L). Manifestations are not usually apparent until levels exceed 4 mEq/L. Patients with severe hypermagnesemia are in danger of cardiac arrest, so a level of 4.2 mEq/L requires prompt attention. A sodium level of 133 mEq/L is slightly low, but does not require immediate notification of the health care provider. A potassium level of 5.0 mEq/L is normal. A calcium level of 9.0 mg/dL is normal. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points. p. 182

When administering 20 mEq potassium chloride intravenously (IV), which is the priority intervention? Monitor for pain or burning at the IV infusion site. Administer at a rate of 10 mEq/hr. Monitor respiratory rate and depth. Place the patient on a heart monitor during administration

Administer at a rate of 10 mEq/hr. The maximum recommended infusion rate is 5-10 mEq/hr to avoid potentially lethal cardiac dysrhythmias. Monitoring for pain at the IV infusion site, assessing respiratory rate and depth, and placing the patient on a heart monitor are all appropriate options, but because a rapid rate of administration could have lethal effects, it has the greatest priority. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. p. 177

A hypertensive patient was brought to the emergency department with a heart rate of 115 beats per minute and an abnormal electrocardiogram showing a shortened QT interval. The laboratory findings of the patient show a serum calcium level of 11 mg/dL. What nursing interventions would help stabilize the patient? Select all that apply. Administering thiazide diuretics Administering high ceiling or loop diuretics Administering 0.9% normal saline intravenously Administering Ringer's lactate solution intravenously Administering non-steroidal, anti-inflammatory agents

Administering high ceiling or loop diuretics. Administering 0.9% normal saline intravenously. Hypercalcemia clinically manifests as serum calcium levels above 10.5 mg/dL. This condition can be managed by using loop diuretics such as furosemide, which promote the excretion of calcium. One cause of hypercalcemia is dehydration, which can be well managed by administering 0.9% normal saline intravenously. Thiazide diuretics do not promote the excretion of calcium and thus are not suitable treatments for hypercalcemia. Ringer's lactate solution contains calcium; administering this solution does not help decrease the serum calcium levels. Administering non-steroidal, anti-inflammatory agents prevents hypercalcemia by calcium resorption from the bone; however, it does not treat hypercalcemia. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 181

A patient with a history of renal failure has a heart rate of 58 beats per minute, serum potassium levels of 5.5 mEq/L, and T wave spikes on the electrocardiogram (ECG). What nursing intervention may stabilize the patient? dministering furosemide Administering spironolactone Administering potassium supplements Administering sodium polystyrene sulfonate

Administering sodium polystyrene sulfonate Serum potassium levels above 5.0 mEq/L with symptoms of bradycardia and changes in electrocardiogram (ECG) indicate hyperkalemia. This condition can be well managed by decreasing the serum potassium levels. Drug therapy to increase potassium excretion in a patient with renal failure includes cation exchange resins such as sodium polystyrene sulfonate, which promote intestinal sodium absorption and potassium excretion. Furosemide can be administered in a patient with normal kidney function to decrease serum potassium levels. Spironolactone is a potassium sparing diuretic used for hypokalemic patients. Potassium supplements are also given to patients with hypokalemia.

Which hormone regulates fluid and electrolyte balance by preventing water and sodium loss?

Aldosterone Rationale Aldosterone stimulates the nephrons to reabsorb sodium and water into the blood, preventing sodium and water loss. NP hormone levels are altered in response to increased blood volume and blood pressure. Antidiuretic hormone acts on the collecting ducts of the kidney to normalize the blood osmolarity. Thyrotropin is a thyroid-stimulating hormone that is released in response to low levels of the thyroid hormone. p. 165

A patient receiving insulin and glucose infusion therapy for hyperkalemia now has a serum potassium level of 3.6 mEq/L. What is the nurse's first action? - Assess the patient's heart rate, rhythm, and respiratory status. - Stop the infusion immediately. - Continue the infusion at the prescribed rate. - Slow the infusion and increase the frequency of vital sign assessment.

Assess the patient's heart rate, rhythm, and respiratory status. The serum potassium is now at the low end of normal range (3.5-5.0 mEq/L). The nurse must first assess the patient's response to the infusion and subsequent change in serum potassium (notably a change in respiratory effectiveness and quality and regularity of the heart rate). Once assessment data are obtained, the nurse should contact the provider and the infusion may be stopped, but it does not have to occur immediately. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. Item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." p. 175

Laboratory results for a patient with a large draining abdominal wound show a serum sodium decrease from 138 mEq/L to 131 mEq/L. What is the nurse's first action? Establish intravenous (IV0 access Assess for orthostatic hypotension Assess the patient's respiratory status Notify the provider of laboratory results

Assess the patient's respiratory status Rationale Hyponatremia may present with neuromuscular changes including muscle weakness of the legs, arms, and respiratory muscles. The nurse should assess the respiratory effectiveness of a patient with hyponatremia as a priority. Obtaining assessment data is important when calling the provider in addition to reporting the laboratory result. Establishing IV access and assessing for orthostatic hypotension are important but are lower-priority interventions. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively. p. 173

Laboratory results for a patient with a large draining abdominal wound show a serum sodium decrease from 138 mEq/L to 131 mEq/L. What is the nurse's first action? Assess the patient's respiratory status. Establish intravenous access. Notify the provider of laboratory results. Assess for orthostatic hypotension.

Assess the patient's respiratory status. Hyponatremia may present with neuromuscular changes including muscle weakness of the legs, arms, and respiratory muscles. The nurse should assess the respiratory effectiveness of a patient with hyponatremia as a priority. Obtaining assessment data is important when calling the provider in addition to reporting the laboratory result. Establishing IV access and assessing for orthostatic hypotension are important, but are lower-priority interventions.

What history and assessment findings may be associated with hypocalcemia in a 22-year-old man? Select all that apply. Decreased deep tendon reflexes without paresthesia. Awakening at night with muscle spasms in the calf. Recent blunt trauma to the throat during a football game. Absent bowel sounds. Tingling around the mouth.

Awakening at night with muscle spasms in the calf. Recent blunt trauma to the throat during a football game. Tingling around the mouth. A history of anterior neck injury may be associated with hypocalcemia. Symptoms of hypocalcemia include "charley horses" in the calf during rest or sleep, and tingling in the lips. Hypocalcemia does not affect bowel sounds. Decreased deep tendon reflexes without paresthesia is a neuromuscular change in hypercalcemia. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. p. 179

A patient's morning laboratory results show a serum ionized calcium of 2.85 mmol/L. For what sign must the nurse assess? Tachypnea Blood clotting Muscle spasms Increased peristalsis

Blood clotting Rationale Hypercalcemia allows blood clots to form more easily, especially in the lower legs and pelvic region. The nurse should assess for signs of blood clotting associated with the elevated serum calcium. Increased peristalsis and muscle spasms are associated with hypocalcemia. Tachycardia can occur initially with mild hypercalcemia, but bradycardia is associated with severe hypercalcemia. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. p. 179

A patient's morning laboratory results show a serum ionized calcium of 2.85 mmol/L. For what sign must the nurse assess? Tachypnea Blood clotting Muscle spasms Increases peristalsis

Blood clotting Rationale Hypercalcemia allows blood clots to form more easily, especially in the lower legs and pelvic region. The nurse should assess for signs of blood clotting associated with the elevated serum calcium. Increased peristalsis and muscle spasms are associated with hypocalcemia. Tachycardia can occur initially with mild hypercalcemia, but bradycardia is associated with severe hypercalcemia. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. p. 179

Which electrolyte imbalance does the nurse anticipate in association with a serum magnesium reading of 1.1 mEq/L? Potassium 5.7 mEq/L Calcium 7.8 mg/dL Sodium 149 mEq/L Phosphorus 2.6 mg/dL

Calcium 7.8 mg/dL Hypocalcemia often occurs with hypomagnesemia. A calcium level of 7.8 mg/dL is low. A sodium level of 149 mEq/L is slightly elevated, but not related to the low magnesium level. A phosphorus level of 2.6 mg/dL is slightly low, but not related to hypomagnesemia. A potassium lee of 5.7 is elevated, but not related to low magnesium levels. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 182

Which drug therapies might be used to manage symptoms of hypocalcemia? Magnesium sulfate Potassium chloride Vitamin D Zinc sulfate

Calcium chloride Rationale Calcium supplements are given to restore serum calcium levels. Vitamin D enhances the absorption of oral calcium. Potassium, zinc, and vitamin E are not indicated for the management of hypocalcemia. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections. p. 181

The nurse manager of a medical-surgical unit is completing assignments for the day shift staff. The patient with which electrolyte laboratory value is assigned to the LPN/LVN? Calcium level of 9.5 mg/dL Magnesium level of 4.1 mEq/L Potassium level of 6.0 mEq/L Sodium level of 120 mEq/L

Calcium level of 9.5 mg/dL Because a calcium level of 9.5 mg/dL is within normal limits, it is appropriate to assign this patient to an LPN/LVN. A magnesium level of 4.1 mEq/L, potassium level of 6.0 mEq/L, and a sodium level of 120 mEq/L are abnormalities in electrolytes that can cause serious complications and will require assessments and/or interventions by the RN. P 179

When treating a patient for hyponatremia, which type of drug must be altered to decrease sodium loss?

Diuretics Rationale When treating a patient with hyponatremia, if the patient is already taking diuretics, his or her dosage must be adjusted because diuretics increase sodium loss. Biphosphates are used to prevent hypercalcemia. Corticosteroids can cause hypernatremia. Beta-adrenergic agonists can cause hypokalemia. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 174

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). Her laboratory results include a potassium level of 7.0 mEq/L. What does the nurse include in the patient's medication teaching? Select all that apply. Daily weights are a poor indicator of fluid loss or gain. Diuretics can lead to fluid and electrolyte imbalances. Diuretics increase fluid retention. Laxatives can lead to fluid imbalance. It is important to weigh daily at the same time.

Diuretics can lead to fluid and electrolyte imbalances. Laxatives can lead to fluid imbalance. It is important to weigh daily at the same time. Diuretics decrease fluid retention and increase loss of fluids, thus can lead to fluid and electrolyte imbalances. Laxatives can also lead to fluid imbalance. Daily weight recording is a good indicator of fluid retention. Patients should be taught to weigh themselves at the same time, in the same clothing, and on the same scale. P 176

Which nursing interventions are consistent with safe administration of intravenous (IV) potassium to a patient with hypokalemia? Select all that apply. Evaluate the heart rate and regularity Establish and evaluate the latency of a large vein Obtain an IV controller device (pump) Plan to assess the respiratory rate and oxygen saturation every hour Prepare to administer potassium IV push to reduce the risk o infiltration Encourage the patient to ambulate independently to relieve muscle cramps

Evaluate the heart rate and regularity Establish and evaluate the latency of a large vein Obtain an IV controller device (pump) Plan to assess the respiratory rate and oxygen saturation every hour Rationale Pulse irregularities (rapid to slow and irregular) may occur with changes in serum potassium levels and should be evaluated. To safely administer IV potassium, the nurse would ensure that the patient has IV access in a large vein if possible, obtain an IV pump to regulate the infusion rate at no greater than 10 mEq of potassium per hour, and evaluate the patient's respiratory status hourly during and immediately following infusion (as respiratory insufficiency is the major cause of death). Potassium should never be given IV push, as it will result in cardiac arrest. Patients with hypokalemia have skeletal muscle weakness, so fall precautions should be implemented, and the patient should have assistance with ambulation. Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questions you would ask if you were composing the test. Consider what would be a good question, what would be the right answer, and what would be other answers that would appear right but would in fact be incorrect. p. 175

The nurse is teaching a patient who is taking a potassium-sparing diuretic about what foods to avoid. Which foods contain high amounts of potassium? Select all that apply.

Foods high in potassium include bananas, cantaloupe, kiwi, oranges, avocados, broccoli, dried beans, lima beans, mushrooms, potatoes, seaweed, soybeans, and spinach. Apples are considered to be low in potassium.

Laboratory results report a patient's serum potassium at 5.6 mEq/L. What does the nurse immediately assess in the patient? Heart rate Bowel sounds Feet for paresthesias Level of consciousness

Heart rate. Cardiovascular changes, specifically bradycardia; tall, peaked T waves; rhythm changes to complete heart block; asystole; and ventricular fibrillation are life-threatening consequences of elevated potassium. The provider or Rapid Response Team may need to be notified if changes in heart rate and rhythm are assessed. Paresthesias in the arms and feet and increased intestinal motility are lower-priority signs of elevated potassium. Level of consciousness would not be affected. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience. p. 178

The nurse instructs an older adult patient to increase intake of dietary potassium when the patient is prescribed which classification of drugs?

High-ceiling (loop) diuretics High-ceiling (loop) diuretics are potassium-depleting drugs. The patient should increase intake of dietary potassium to compensate for this depletion. Alpha antagonists, beta blockers, and corticosteroids are not potassium-depleting drugs. P 176

The nurse is caring for a patient who is receiving intravenous (IV) magnesium sulfate. Which assessment parameter is critical? 24-hour urine output Asking the patient about feeling depressed Hourly deep tendon reflexes (DTRs) Monitoring of serum calcium levels

Hourly deep tendon reflexes (DTRs) The patient who is receiving IV magnesium sulfate should be assessed for signs of toxicity every hour by assessment of DTRs. Most patients who have fluid and electrolyte problems will be monitored for intake and output (I&O); this will not immediately generate data about problems with magnesium overdose. Low magnesium levels can cause psychological depression, but assessing this parameter as the levels are restored would not be a method by which to safely assess a safe dose or an overdose. Although administration of magnesium sulfate can cause a drop in calcium levels, this occurs over a period of time and would not be the best way to assess magnesium toxicity. P 182

The primary health care provider prescribes intravenous administration of 100 mL of 20% glucose along with 20 units of insulin in a patient who is receiving furosemide therapy. What is the probable diagnosis of the patient? Hyperkalemia Hyperglycemia Hypernatremia Hypercalcemia

Hyperkalemia Rationale Hyperkalemia is a condition where serum potassium levels are high. Potassium movement into the cells is enhanced by insulin. Intravenous administration of 100 mL 10% to 20% glucose with 10 to 20 units of regular insulin helps decrease serum potassium levels. Insulin increases the activity of sodium-potassium pumps, which decreases serum potassium levels temporarily by moving potassium from the extracellular fluid to the cells. This therapy is prescribed as an add-on therapy along with diuretics in a hyperkalemic patient. Conditions such as hyperglycemia, hypernatremia, and hypercalcemia cannot be managed with this insulin and glucose therapy. Test-Taking Tip: Look for answers that focus on the patient or are directed toward feelings. p. 178

A patient's electrocardiogram demonstrates a heart rate of 52 beats/min, prolonged PR interval with widened QRS complex, and the patient is also hypotensive. The nurse reviews the morning labs for which conditions? Hyperkalemia, hypercalcemia, hypermagnesemia Hypokalemia, hypocalcemia, hypermagnesemia Hypocalcemia, hyperkalemia, hypernatremia Hypernatremia, hypercalcemia, hypophosphatemia

Hyperkalemia, hypercalcemia, hypermagnesemia Cardiovascular changes are consistent with elevated potassium, calcium, and magnesium. These signs and symptoms may progress to life-threatening cardiac emergency. Although hypocalcemia can interfere with cardiac contractility, hypokalemia and hypophosphatemia do not. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections. pp. 178-182

A patient is admitted to the hospital with a heart rate of 166 beats/min, increased thirst, restlessness, and agitation. Which electrolyte imbalance does the nurse suspect?

Hypernatremia These symptoms are indicative of hypernatremia. Clinical manifestations of hypomagnesemia are seen in the neuromuscular, central nervous, and intestinal systems. Hypercalcemia manifests with an altered level of consciousness that can range from confusion and lethargy to coma, and severe hypercalcemia depresses electrical conduction, slowing heart rate. Hyperphosphatemia causes few direct problems with body function (although hypocalcemia is usually also present).

When assessing the laboratory results of a patient who has hypomagnesemia, for which additional electrolyte imbalance should the nurse monitor?

Hypocalcemia Rationale Hypocalcemia often occurs with hypomagnesemia, so the nurse would monitor for signs and symptoms of low calcium levels. Hypomagnesemia may increase potassium secretion in certain circumstances, leading the health care provider to be aware that replacement of magnesium is crucial before attempting to replace potassium if the patient is deficient in both. Hypernatremia and hypophosphatemia are not related to hypomagnesemia. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success. p. 182

Which electrolyte imbalance should be anticipated and monitored in a patient with hyeperphosphatemia?

Hypocalcemia Rationale Phosphorus and calcium have an inverse or reciprocal relationship. When one is increased, the other is usually decreased. Therefore a patient with hyperphosphatemia should be monitored for hypocalcemia. Hyperphosphatemia does not cause hypernatremia, hypokalemia, or hypermagnesemia. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. Item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." p. 180

Which condition is assessed using Trousseau's and Chvostek's signs?

Rationale Hypocalcemia is a decrease in serum calcium levels and is assessed by testing for Trousseau's and Chvostek's signs. Hypokalemia, hyponatremia, and hypomagnesemia are not assessed by testing for Trousseau's and Chvostek's signs. Hypokalemia is determined by electrocardiogram changes. Hyponatremia can be detected by assessing a patient's mental status for changes. Hypomagnesemia causes muscle weakness. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 180

A patient reports painful muscle spasms in the lower legs at rest, a tingling sensation in the hands and lips, and abdominal cramping and diarrhea. The nurse reviews the patient's laboratory results for the presence of which disorder? Hypocalcemia Hypernatremia Hypermagnesemia Hypophosphatemia

Hypocalcemia Rationale The primary symptoms of hypocalcemia are neuromuscular changes, specifically painful muscle cramps, and paresthesias that may spread to the face, progressing to tetany. Abdominal cramping and diarrhea may also occur. Muscle spasms in lower legs at rest, tingling sensation in the hands and lips, and abdominal cramping and diarrhea are not primary characteristics of hypernatremia, hypermagnesemia, or hypophosphatemia. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress. p. 180

Which condition is assessed using Trousseau's and Chvostek's signs?

Hypocalcemia Hypocalcemia is a decrease in serum calcium levels and is assessed by testing for Trousseau's and Chvostek's signs. Chvostek's sign is the twitching of the facial muscles in response to tapping over the area of the facial nerve. Hypokalemia, hyponatremia, and hypomagnesemia are not assessed by testing for Trousseau's and Chvostek's signs. Hypokalemia is determined by EKG changes. Hyponatremia can be detected by assessing a patient's mental status for changes. Hypermagnesemia causes muscle weakness.

A patient who recently experienced an anterior neck injury reports frequent and painful muscle spasms in the calf during sleep. Which condition does the nurse suspect in the patient? Hypokalemia Hypocalcemia Hyponatremia Hypophosphatemia

Hypocalcemia Patients with a history of anterior neck injury are at a high risk for hypocalcemia. Frequent painful muscle spasms in the calf or foot during rest or sleep (charley horses) indicate hypocalcemia. Hypokalemia, hyponatremia, and hypophosphatemia do not cause painful calf muscle spasms. Test-Taking Tip: Muscle spasms are involuntary contractions of a muscle or group of muscle. Try to recall your knowledge on the electrolyte that regulates muscle contraction. p. 179

Which two electrolyte imbalances does the nurse suspect based on the following assessment data of a patient? Hypercalcemia and hypernatremia Hypokalemia and hypermagnesemia Hypomagnesemia and hypocalcemia Hyperphosphatemia and hypercalcemia

Hypomagnesemia and hypocalcemia Rationale Electrolyte imbalances frequently occur concurrently. The assessment data are consistent with hypomagnesemia and hypocalcemia. The patient's nutrition history also supports nutrient intake that is insufficient in calcium (i.e., dairy products). Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the patient in formats such as the hospital record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and nurse/patient interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking. p. 182

A patient who is homeless reports severe muscle weakness and chest discomfort. The nurse reviews the laboratory results for the presence of which disorder?

Hypophosphatemia Primary symptoms of hypophosphatemia include cardiac depression and weak skeletal muscles that may progress to muscle breakdown. Malnutrition and starvation are common causes of phosphorous imbalances; a homeless patient may not have adequate nutrition, placing him or her at risk of this electrolyte imbalance.

A patient has a low serum potassium level and is ordered a dose of parenteral potassium chloride (KCl). How does a nurse safely administer KCl to the patient? Infuses 10 mEq over a 1-hour period Administers 5 mEq intramuscularly (IM) Pushes 5 mEq through a central access line Dilutes 200 mEq in 1 liter of normal saline and infuses at 100 mL/hr

Infuses 10 mEq over a 1-hour period Rationale A dose of KCl 10 mEq given over 1 hour is appropriate for this patient. A dose of KCl 200 mEq in 1 liter of normal saline infused at 100 mL/hr is too concentrated and can cause injury. Potassium is a severe tissue irritant and is never given by the intramuscular or subcutaneous route. Because rapid infusion of potassium can cause cardiac arrest, potassium is not administered through central lines. p. 177

A patient with Crohn's disease reports numbness, tingling, and painful muscle contractions. After assessing the deep tendon reflexes of the patient, which intervention does the nurse perform next? Intravenous administration of sodium Intravenous administration of bicarbonate Intravenous administration of phosphorus Intravenous administration of magnesium sulfate

Intravenous administration of magnesium sulfate. Patients with Crohn's disease are at a high risk for magnesium imbalance, mainly hypomagnesemia. A decrease in the levels of magnesium may cause increased nerve impulse transmission causing hyperactive deep tendon reflexes, numbness, tingling, and painful muscle contractions. This condition can be well treated by administering magnesium sulfate intravenously. Intravenous administration of sodium, bicarbonate, or phosphorous is not a suitable intervention. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. p. 182

Which component of a patient history would most likely be associated with hyperphosphatemia? Chronic bronchitis Kidney failure Hyperparathyroidism Colon cancer

Kidney failure Hyperphosphatemia in acute or chronic kidney disease results from decreased loss of phosphorus due to the poor function of the kidneys. Chronic bronchitis does not affect phosphorus levels. Hypoparathyroidism (not hyperparathyroidism) may contribute to hyperphosphatemia. Certain cancer treatments, not the cancer itself, may cause hyperphosphatemia.

Which fruit will the nurse remove from the dietary tray of a patient with high potassium levels?

Kiwi Rationale Kiwis are high in potassium, so the nurse will remove this food from the tray. However, berries, apricots, and grapefruits are low in potassium, so this patient does not need to avoid them. p. 179

The nurse is reviewing lab values for a patient recently admitted to the medical-surgical unit. Which lab result is severely abnormal? Potassium, 3.5 mEq/L Sodium, 137 mEq/L Chloride, 107 mEq/L Magnesium, 6.2 mEq/L

Magnesium, 6.2 mEq/L A magnesium level of 6.2 mEq/L is greatly elevated. Patients with severe hypermagnesemia are in grave danger of cardiac arrest. The normal magnesium level is 1.3-2.1 mEq/L. The sodium and potassium results are within normal limits. The chloride level is just slightly elevated, with the normal range being between 98-106 mEq/L. Pg 181

A patient with mild hypokalemia caused by diuretic use is discharged home. The home health nurse delegates which of these interventions to the home health aide? Assessment of muscle tone and strength. Education about potassium-rich foods. Instruction on the proper use of drugs. Measurement of the patient's urine output.

Measurement of the patient's urine output. A home health aide may measure the patient's intake and output, which then would be reported to the RN. Assessment, education, and instruction are higher-level nursing actions that should be done by the RN. P 177

When planning care for a patient with hypercalcemia, which intervention does the nurse consider? Monitor cardiac rhythm for changes Limit activities to protect against injury Assess oxygen to protect against injury Avoid invasive procedures due to increased bleeding tendency

Monitor cardiac rhythm for changes. Hypercalcemia increases the risk for cardiac dysrhythmias. It does not impair gas exchange, so oxygen saturation does not need to be routinely monitored. There is a greater tendency to clot, especially with slow venous perfusion, so invasive procedures do not need to be avoided and increased activity (not restriction) is recommended. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency. p. 181

The nurse is assessing a patient with hyponatremia. Which finding requires immediate action? Heightened acuity Muscular weakness Urine output of 35 mL/hr Diminished bowel sounds

Muscular weakness Rationale Muscle weakness in patients with hyponatremia requires immediate action. If muscle weakness is present, immediately check respiratory effectiveness because ventilation is dependent on adequate strength of the respiratory muscles. Excessive bowel sounds, not diminished bowel sounds, are expected in the patient with hyponatremia, as well as mild confusion, not heightened acuity. A urine output of 35 mL/hr is normal (minimally) and does not require immediate action. p. 174

The nurse is assessing a patient with hyponatremia. Which finding requires immediate action? Diminished bowel sounds Heightened acuity Muscular weakness Urine output of 35 mL/hr

Muscular weakness Muscle weakness in patients with hyponatremia requires immediate action. If muscle weakness is present, immediately check respiratory effectiveness because ventilation is dependent on adequate strength of the respiratory muscles. Excessive bowel sounds, not diminished bowel sounds, are expected in the patient with hyponatremia, as well as mild confusion, not heightened acuity. A urine output of 35 mL/hr is normal (minimally) and does not require immediate action. P 174

A patient with hyperkalemia is being treated with drugs to improve the condition. Which potassium level indicates that therapy is effective?

Normal levels are 3.5 to 5.0 mEq/L Rationale A potassium level of 4.6 mEq/L is a normal level, indicating that therapy was effective. Normal levels are 3.5 to 5.0 mEq/L. A potassium level of 2.6 mEq/L indicates hypokalemia. A potassium level of 5.6 mEq/L indicates hyperkalemia. A potassium level of 7.6 mEq/L indicates severe hyperkalemia. p. 178

A patient is admitted to the nursing unit with a diagnosis of hypokalemia. Which assessment does the nurse complete first? Auscultating bowel sounds Obtaining a pulse oximetry reading Checking deep tendon reflexes (DTRs) Determining the level of consciousness (LOC)

Obtaining a pulse oximetry reading Rationale Because hypokalemia may cause respiratory insufficiency and respiratory arrest, the patient's respiratory status should be assessed first. Bowel sounds, DTRs, and LOC may change in a patient with hypokalemia, but these changes are not immediately life-threatening. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter. p. 175

Which newly written prescription does the nurse administer first? Intravenous (IV) normal saline to a patient with a serum sodium of 132 mEq/L. Oral calcium supplements to a patient with severe osteoporosis. Oral phosphorus supplements to a patient with acute hypophosphatemia. Oral potassium chloride (KCl) to a patient whose serum potassium is 3 mEq/L.

Oral potassium chloride (KCl) to a patient whose serum potassium is 3 mEq/L Because minor changes in serum potassium level can cause life-threatening dysrhythmias, the first priority should be to administer potassium supplements to the patient with hypokalemia. The electrolyte disturbance (sodium level of 132 and low phosphorus level) and the need for calcium in this patient are not immediately life-threatening. P 176

Which electrolyte imbalance is a risk factor for rhabdomyolysis? Sodium Chloride Potassium Phosphorous

Phosphorous Rhabdomyolysis is a serious syndrome caused by a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream. This can lead to complications such as renal failure. Decreased serum phosphorus levels cause musculoskeletal changes such as weak skeletal muscles that may progress to acute muscle breakdown. Imbalances of sodium, chloride, and potassium are not associated with rhabdomyolosis.

The health care provider writes orders for a patient who is admitted with a serum potassium (K) level of 6.9 mEq/L. What does the nurse implement first? Place the patient on a cardiac monitor Administer sodium polystyrene sulfonate orally Ensure that a potassium-restricted diet is ordered Teach the patient about foods that are high in potassium

Place the patient on a cardiac monitor. Because hyperkalemia can lead to life-threatening bradycardia, the initial action should be to place the patient on a cardiac monitor. Administering a potassium-reducing medication, recommending a potassium-restricted diet, and teaching the patient about diet are appropriate but will not immediately decrease the serum potassium level and do not need to be implemented as quickly as monitoring cardiac rhythm. P 178

Which written order does the nurse clarify with the provider when caring for a patient with a serum sodium level of 149 mEq/L? Institute seizure precautions. Weigh the patient daily. Place the patient on nothing by mouth (NPO) status. Monitor intake and output

Place the patient on nothing by mouth (NPO) status. Ensuring adequate water intake is an important nutritional therapy in the treatment of hypernatremia; the nurse should ask for clarification of the NPO order. The other orders are appropriate in the management of patients with hypernatremia. Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all, and none. If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative, such as "When assessing for pain, you should not," the false option is the correct choice. p. 175

The nurse is reviewing serum electrolytes and blood chemistry for a newly admitted patient. Which result causes the greatest concern? Glucose: 97 mg/dL Sodium: 143 mEq/L Potassium: 5.9 mEq/L Magnesium: 2.1 mEq/L

Potassium: 5.9 mEq/L Rationale A potassium value of 5.9 mEq/L is high, and the patient should be assessed further. A glucose value of 97 mg/dL, a magnesium value of 2.1 mEq/L, and a sodium value of 143 mEq/L are normal values. p. 178

An electrocardiogram (ECG) is ordered for a patient who was placed on intravenous (IV) fluids containing potassium. Which ECG finding is consistent with hyperkalemia?

Prolonged PR intervals Rationale When hyperkalemia is present, an individual may show absent P waves, tall T waves, prolonged PR intervals, and widened QRS complexes. p. 177

A patient is admitted with hypokalemia and skeletal muscle weakness. Which assessment does the nurse perform first? Pulse Respirations Temperature Blood pressure

Pulse Rationale Respiratory changes are likely because of weakness of the muscles needed for breathing. Skeletal muscle weakness results in shallow respirations. Thus respiratory status should be assessed first in any patient who might have hypokalemia. Blood pressure and pulse will be altered in this patient, but they are not the priority assessment. Temperature is not a priority assessment for the patient with hypokalemia. p. 175

Which nursing action is recommended when providing care to a patient with hypokalemia? - Question the continued administration of bumetanide. - Obtain the prescribed vial of IV potassium chloride from the pharmacy and dilute before administration. - Establish a peripheral IV, preferably in the hand, for administering IV potassium chloride. - Administer prescribed oral potassium chloride before a meal or snack.

Question the continued administration of bumetanide. Bumetanide is a loop diuretic, which contributes to potassium loss and should be questioned. The Joint Commission has mandated that all concentrated electrolytes be mixed by a pharmacist and that vials of KCl should not be available in patient care areas. A large vein with high blood flow should be accessed to avoid phlebitis; it is recommended that the hand be avoided. Oral potassium supplements should be given with or following a snack or meal to avoid nausea. STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage. p. 175

What is the major cause of death in patients diagnosed with hypokalemia?

Respiratory insufficiency Rationale Respiratory changes may occur in patients with hypokalemia because of respiratory muscle weakness resulting in shallow respirations. The respiratory status of a patient with hypokalemia should be assessed at least every 2 hours because respiratory insufficiency is the major cause of death for these patients. A stroke is not a risk factor for hypokalemia. Hypokalemia does not cause renal failure; rather, hyperkalemia is caused by renal failure. Dysrhythmias may occur due to hypokalemia but are not the major cause of death in patients with hypokalemia. Test-Taking Tip: Hypokalemia may result in muscle weakness. Use this tip to answer the question. p. 176

A patient is brought to the emergency department with symptoms of diarrhea, chest discomfort, and paresthesia. The patient has a heart rate of 60 beats per minute. The electrocardiogram (ECG) of the patient shows missed P waves, tall T waves, prolonged PR intervals, and wide QRS complexes. Which laboratory finding would be consistent with the patient's condition? Serum sodium levels below 135 mEq/L Serum sodium levels above 145 mEq/L Serum potassium levels below 3.5 mEq/L Serum potassium levels above 5.0 mEq/L

Serum potassium levels above 5.0 mEq/L. Laboratory data confirms hyperkalemia if serum potassium levels are above 5.0 mEq/L. Hyperkalemia clinically manifests with cardiovascular changes such as bradycardia, hypotension, and electrocardiogram (ECG) changes that include missed P waves, tall T waves, prolonged PR intervals, and wide QRS complexes. A neuromuscular change associated with hyperkalemia is numbness around the mouth, or paresthesia. Intestinal changes include frequent and watery bowel movements. Abnormalities in sodium levels are not associated with hyperkalemia. Hypokalemia is associated with serum potassium levels below 3.5 mEq/L, which do not show any such electrocardiogram (ECG) changes. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. p. 178

Which electrolyte excess results in irritability and severe cellular dehydration?

Sodium. Hypernatremia occurs when serum sodium levels are very high; this condition causes excitable tissues to overrespond to stimuli. This leads to irritability and severe cellular dehydration. Hypercalcemia, an excess of calcium, decreases the sensitivity of excitable tissues to normal stimuli. Hyperphosphatemia (excess phosphorus) causes hypocalcemia. Hypermagnesemia (excess magnesium) causes hypotension, bradycardia, central nervous system changes, and neuromuscular changes.

A 90-year-old patient with hypermagnesemia is seen in the emergency department (ED). The ED nurse prepares the patient for admission to which inpatient unit?

Telemetry/cardiac stepdown Because hypermagnesemia causes changes in the electrocardiogram that may result in cardiac arrest, the patient should be admitted to the telemetry/cardiac stepdown unit. Dialysis/home care units, geriatric/rehabilitation units, and medical-surgical units typically do not have cardiac monitoring capabilities.

Positive Trousseau's and Chvostek's signs are consistent with which electrolyte imbalance?

Trousseau's sign (palmar flexion) and Chvostek's sign (facial twitching) are consistent with acute hypocalcemia. These manifestations are caused by overstimulation of the nerves and muscles. Trousseau's and Chvostek's signs are not used to assess for potassium imbalances. Study Tip: Regular exercise, even if only a 10-minute brisk walk each day, aids in reducing stress. Although you may have been able to enjoy regular sessions at the health club or at an exercise class several times a week, you now may have to cut down on that time without giving up a set schedule for an exercise routine. Using an exercise bicycle that has a book rack on it at home, the YMCA, or a health club can help you accomplish two goals at once. You can exercise while beginning a reading assignment or while studying notes for an exam. Listening to lecture recordings while doing floor exercises is another option. At least a couple of times a week, however, the exercise routine should be done without the mental connection to school; time for the mind to unwind is necessary, too. Pg 180