Fluid Balance and Electrolyte

A client who has been immobile for a prolonged time develops hypercalcemia. Which findings are consistent with this condition? Select all that apply. A. Bone pain B. Convulsions C. Muscle spasms D. Tingling of extremities E. Depressed deep tendon reflexes

A. Bone pain E. Depressed deep tendon reflexes

The nurse is caring for four different clients admitted with fluid overload. Which client should be considered a priority requiring immediate care? A. Client A Age 88 Condition Bounding pulse rate B. Client B Age 12 Condition Pale skin with pitting edema C. Client C Age 21 Condition Severe headache D. Client D Age 36 Condition Increased gastrointestinal motility

A. Client A Age 88 Condition Bounding pulse rate

The nurse is caring for a client 4 days after the client was admitted to the hospital with burns on the trunk and arms. The nurse collaborates with the dietician to develop a dietary plan for the following day. Which plan will the nurse follow? A. High caloric intake, liberal potassium intake, and 3 g protein/kg/day B. High caloric intake, restricted potassium intake, and 1 g protein/kg/day C. Moderate caloric intake, liberal potassium intake, and 3 g protein/kg/day D. Moderate caloric intake, restricted potassium intake, and 1 g protein/kg/day

A. High caloric intake, liberal potassium intake, and 3 g protein/kg/day

A 65 year old client experiencing confusion and convulsions with a sodium of 150mEq/L. The confusion and convulsions are caused by: A. High sodium in the blood vessels pulling water out of the brain cells into the blood vessels, causing brain cells to shrink. B. High sodium in the blood vessels draws chloride into the brain cells followed by water, causing the brain cells to swell as hypertonic. C. High sodium in the blood vessels pulls potassium out of the brain cells, which slows the cardiac activity in the brain. D. High sodium in the blood vessels decreases the blood pressure

A. High sodium in the blood vessels pulling water out of the brain cells into the blood vessels, causing brain cells to shrink.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse would monitor the client for which complications? Select all that apply. A. Hyperglycemia B. Infection C. Hepatitis D. Anorexia E. Dysrhythmias

A. Hyperglycemia B. Infection

An 85 year old client has a serum potassium level of 6.7 mEq/L (6.7mmol/L). Which nursing action is the priority at this time? A. Monitor for cardiovascular irregularities. B. Inquire about changes in bowel patterns. C. Assess for leg muscle twitching or weakness. D. Assess for signs and symptoms of dehydration.

A. Monitor for cardiovascular irregularities.

What dietary choices should the nurse instruct the client taking spironolactone to avoid increasing? Select all that apply. A. Potatoes B. Red Meat C. Cantaloupe D. Wheat Bread E. Flavored Yogurt

A. Potatoes C. Cantaloupe

Following a major abdominal surgery, a client has a nasogastric tube attached to continuous low suction. The nurse caring for the client postoperatively monitors the client for what signs of hypokalemia? Select all that apply. A. Short term irritability B. Dysrhythmias C. Muscle weakness D. Abdominal cramps E. Acidosis

A. Short term irritability B. Dysrhythmias C. Muscle weakness

Which should the nurse identify as a risk factor for hyponatremia? A. Inadequate fluid intake B. Drainage from a T-tube C. Total parenteral nutrition D. Hypertonic tube feedings

B. Drainage from a T-tube

A nurse is caring for an infant whose vomiting is intractable. Which complication is most likely to occur? A. Metabolic Acidosis (Hyperkalemia) B. Metabolic Alkalosis (Hypokalemia) C. Hyperkalemia D. Hypernatremia

B. Metabolic Alkalosis (Hypokalemia)

A nurse is assessing a client for dehydration. The client has had diarrhea and vomiting for 48 hours. Which assessment findings alert the nurse that the client is dehydrated? Select all that apply. A. Protruding eyeballs B. Postural hypotension C. The client reporting eating an average of three meals daily D. The skin on the client's forehead remains tented after being pinched E. Within four days, the client gained two pounds (0.9kg) of weight

B. Postural hypotension D. The skin on the client's forehead remains tented after being pinched

A nurse is caring for a client whose laboratory values indicate the presence of hyponatremia. Which factors does the nurse determine were the most likely cause of the hyponatremia? Select all that apply. A. Diabetes insipidus B. Profuse diaphoresis C. Excess sodium intake D. Removal of the parathyroid glands E. Rapid intravenous (IV) infusion of 5% dextrose in water

B. Profuse diaphoresis E. Rapid intravenous (IV) infusion of 5% dextrose in water

When monitoring a client for hyponatremia, which assessment findings should the nurse consider significant? Select all that apply. A. Thirst B. Seizures C. Erythema D. Confusion E. Constipation

B. Seizures D. Confusion

A nurse is conducting an assessment of a young infant who is dehydrated. Which clinical sign is the most important indication of an accurate degree of dehydration? A. Dry skin B. Weight loss C. Sunken fontanel D. Decreased urine output

B. Weight loss

An older adult client states, "I walk 2 miles [3.2 km] a day for exercise, but now that the weather is hot, I am worried about becoming dehydrated." What should the clinic nurse teach the client? A. "Drink fruit juices if you start to feel dehydrated." B. "Thirst is a good guide to use to determine fluid intake." C. "Fluids should be increased if the urine is getting darker." D. "Water should be consumed when the skin becomes dry."

C. "Fluids should be increased if the urine is getting darker."

The primary healthcare provider prescribes 80 mg of furosemide by mouth daily. Before administering the furosemide, which action is the priority? A. Weigh the client B. Assess skin turgor C. Check the potassium lab results D. Check the total intake and output for the last 24 hours

C. Check the potassium lab results

A nurse is caring for a postoperative client who has a nasogastric tube attached to low continuous suction. Which assessment finding indicate that the client may be experiencing hypokalemia? A. Tingling of the fingertips and toes B. Dry and sticky mucous membranes C. Abdominal cramping and irritability D. Muscle weakness and cardiac dysrhythmias

D. Muscle weakness and cardiac dysrhythmias