Fluid & Electrolytes - Prep U

When a client's ventilation is impaired, the body retains which substance? Nitrous oxide Sodium bicarbonate Carbon dioxide Oxygen

Carbon dioxide - When ventilation is impaired, the body retains carbon dioxide (CO2) because the carbonic acid level increases in the blood. Sodium bicarbonate is used to treat acidosis. Nitrous oxide, which has analgesic and anesthetic properties, commonly is administered before minor surgical procedures. When ventilation is impaired, the body doesn't retain oxygen. Instead, the tissues use oxygen and CO2 results.

A client reports 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 client's laboratory work has returned? Potassium Phosphorus Calcium Iron

Calcium - Calcium deficit is associated with the following symptoms: numbness and tingling of the fingers, toes, and circumoral region; positive Trousseau's sign and Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, decreased prothrombin, diarrhea, and hypotension. Electrocardiogram findings associated with hypocalcemia include prolonged QT interval and lengthened ST.

Which solution is hypotonic? Lactated Ringer solution 5% NaCl 0.45% NaCl 0.9% NaCl

0.45% NaCl - Half-strength saline is hypotonic. Lactated Ringer solution and normal saline (0.9% NaCl) are isotonic. A 5% NaCl solution is hypertonic.

Which is considered an isotonic solution? 0.45% normal saline Dextran in normal saline 0.9% normal saline 3% NaCl

0.9% normal saline - An isotonic solution is 0.9% normal saline (NaCl). Dextran in normal saline is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.

The nurse knows which is the normal serum value for potassium? 135-145 mEq/L (135-145 mmol/L). 96-106 mEq/L (96-106 mmol/L). 8.5-10.5 mg/dL (2.13-2.63 mmol/L). 3.5-5.0 mEq/L (3.5-5.0 mmol/L).

3.5-5.0 mEq/L (3.5-5.0 mmol/L). - Serum potassium must be within normal limits to prevent cardiac dysrhythmia. Normal serum sodium is 135-145 mEq/L (3.5-5.0 mmol/L). Normal serum chloride is 96-106 mEq/L (96-106 mmol/L). Normal total serum calcium is 8.5-10.5 mg/dL (2.13-2.63 mmol/L).

To evaluate a client for hypoxia, the physician is most likely to order which laboratory test? Arterial blood gas (ABG) analysis Red blood cell count Sputum culture Total hemoglobin

Arterial blood gas (ABG) analysis - Red blood cell count, sputum culture, total hemoglobin, and ABG analysis all help evaluate a client with respiratory problems. However, ABG analysis is the only test that evaluates gas exchange in the lungs, providing information about the client's oxygenation status.

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? Hallucinations Headache Nausea Confusion

Confusion - Normal serum concentration ranges from 135 to 145 mEq/L (135-145 mmol/L). Hyponatremia exists when the serum concentration decreases below 135 mEq/L (135 mmol/L). When the serum sodium concentration decreases to <115 mEq/L (<115 mmol/L), signs of increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur. General manifestations of hyponatremia include poor skin turgor, dry mucosa, headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic changes, including altered mental status, status epilepticus, and coma, are probably related to cellular swelling and cerebral edema associated with hyponatremia. Hallucinations are associated with increased serum sodium concentrations.

Which nerve is implicated in the Chvostek's sign? Facial Hypoglossal Spinal accessory Optic

Facial - Chvostek's sign consists of twitching of muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch.

The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance? Hyperchloremia Hypocalcemia Hyponatremia Hypermagnesemia

Hypocalcemia - The client is experiencing an elevated serum phosphorus concentration. Hyperphosphatemia is defined as a serum phosphorus that exceeds 4.5 mg/dL (1.45 mmol/L). Because of the reciprocal relationship between phosphorus and calcium, a high serum phosphorus concentration tends to cause a low serum calcium concentration.

Oral intake is controlled by the thirst center, located in which of the following cerebral areas? Cerebellum Thalamus Hypothalamus Brainstem

Hypothalamus - Oral intake is controlled by the thirst center located in the hypothalamus. The thirst center is not located in the cerebellum, brainstem, or thalamus.

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which? Cardiovascular compromise Insensible fluid loss Lung function Summer allergies

Insensible fluid loss - Due to the high heat and humidity, geriatric clients are at a high risk for insensible fluid loss through perspiration and vapor in the exhaled air. These losses are noted as unnoticeable and unmeasurable. Those with respiratory deficits and allergies may be only able to be outside for a limited period. Those with cardiovascular compromise may need to alternate outdoor activities with indoor rest.

The nurse is providing discharge education to a client who had hypophosphatemia while in the hospital. The client has a diet prescribed that is high in phosphate. Which foods should the nurse teach this client to include in the diet? Select all that apply. Milk Liver Potatoes Beef Green vegetables

Milk Beef Liver - If the client experiences mild hypophosphatemia, foods rich in phosphorus, such as milk and milk products, meats, and beans, should be encouraged. Potatoes and green leafy vegetables are not rich in phosphorus.

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? Sodium: 138 mEq/L Calcium: 10 mg/dL Magnesium:2 mEq/L Potassium: 5.8 mEq/L

Potassium: 5.8 mEq/L - Normal potassium level is approximately 3.5 to 5.0 mEq/L. Elevated potassium levels can lead to muscle weakness, paresthesias, and cardiac dysrhythmias.

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias? Serum sodium level Serum chloride level Serum calcium level Serum potassium level

Serum potassium level - The nurse should monitor the client's potassium level because during periods of acidosis, potassium leaves the cell, causing hyperkalemia. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser affect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias.

A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess: Homans' sign. Goodell's sign. Trousseau's sign. Hegar's sign.

Trousseau's sign. - This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

A client presents with muscle weakness, tremors, slow muscle movements, and vertigo. The following are the client's laboratory values: Sodium 134 mEq/L (134 mmol/L) Potassium 3.2 mEq/L (3.2 mmol/L) Chloride 111 mEq/L (111 mmol/L) Magnesium 1.1 mg/dL (0.45 mmol/L) Calcium 8.4 mg/dL (2.1 mmol/L) What fluid and electrolyte imbalance would the nurse relate to the client's findings? hypokalemia hypocalcemia hypomagnesemia hyponatremia

hypomagnesemia - Magnesium, the second most abundant intracellular cation, plays a role in both carbohydrate and protein metabolism. The most common cause of this imbalance is loss in the gastrointestinal tract. Hypomagnesemia is a value less than 1.3 mg/dL (0.45 mmol/L). Signs and symptoms include muscle weakness, tremors, irregular movements, tetany, vertigo, focal seizures, and positive Chvostek's and Trousseau's signs.

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. PaCO2 pH Glucose K+ Na+ HCO3

pH PaCO2 HCO3 - Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate (HCO3). The two types of acid-base imbalances are acidosis and alkalosis.

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? Lactated Ringer's solution 5% dextrose and normal saline solution 10% dextrose in water Half-normal saline solution

Lactated Ringer's solution - Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L, is isotonic. The nurse shouldn't give half-normal saline solution because it's hypotonic, with an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L) also would be incorrect because these solutions are hypertonic.

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? dehydration hypercalcemia hypervolemia hyperkalemia

dehydration - Dehydration results when the volume of body fluid is significantly reduced in both extracellular and intracellular compartments. In dehydration, all fluid compartments have decreased volumes; in hypovolemia, only blood volume is low. The most common fluid imbalance in older adults is dehydration. Hypervolemia is caused by fluid intake that exceeds fluid loss, such as from excessive oral intake or rapid IV infusion of fluid. Early signs of hypervolemia are weight gain, elevated BP, and increased breathing effort. Hypercalcemia occurs when the serum calcium level is higher than normal. Some of its signs include tingling in the extremities and the area around the mouth (circumoral paresthesia) and muscle and abdominal cramps. Hyperkalemia is an excess of potassium in the blood. Symptoms include diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias.

The nurse assesses a client who is diagnosed with bulimia nervosa and at risk for alterations in both fluid and electrolyte balance. Complete the following sentence by choosing from the lists of options. During the assessment, the nurse focuses on monitoring the client for ____ as evidenced by ____

hypokalemia cardiac arrhythmia Fluid and electrolyte imbalances are common for clients who are diagnosed with eating disorders, including bulimia nervosa. The client who vomits as a result of purging behavior when diagnosed with bulimia nervosa is at risk for fluid and electrolyte imbalances, including hypokalemia (i.e., low serum potassium level). The client who experiences low serum potassium levels (i.e., hypokalemia) due to a diagnosed eating disorder must be monitored for cardiac arsrhythmia, a potentially life-threatening consequence of this electrolyte imbalance. The client who is diagnosed with bulimia nervosa is at risk for hypovolemia (e.g., dehydration) and hyponatremia (i.e., low serum sodium level), not hypervolemia or hypernatremia (i.e., elevated serum sodium level). While peripheral edema is a symptom of hypervolemia and extreme thirst is a symptom of hypernatremia, this client is at risk for hypovolemia (e.g., dehydration), which is manifested by dry mucous membranes, and hyponatremia, which is manifested by muscle weakness.

A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should: administer antibiotics as ordered. administer acetaminophen as ordered. instruct the client to breathe into a paper bag. insert a nasogastric tube (NG) as ordered.

instruct the client to breathe into a paper bag. - A client recovering from an acute asthma attack who experiences respiratory alkalosis should breathe into a paper bag to increase arterial carbon dioxide tension and ease anxiety (which may exacerbate the alkalosis). An NG tube would be indicated for a client with metabolic alkalosis secondary to ingestion of toxic substances; there is no reason to believe that this has occurred. Fever may cause metabolic (not respiratory) alkalosis and would be treated with acetaminophen. A client with sepsis also may have metabolic alkalosis and probably would receive antibiotics; however, this clinical situation doesn't suggest sepsis.