Med-Surg: Introductory Quiz-Fluid and Electrolytes

The nurse is assessing a patient prescribed an angiontensin-converting enzyme (ACE) inhibitor to treat blood pressure. The patient states, "This medication makes me urinate all the time. I didn't think it was a water pill." Which is the appropriate response by the nurse?

"This medication causes greater excretion of water and sodium in your urine." Angiotensin-converting enzyme (ACE) inhibitors disrupt the renin-angiotensin II pathway by reducing the amount of angiotensin converting enzyme (ACE) made so that less angiotensin II is present.

A patient is being monitored for daily weights. The night nurse asks the nursing assistant for the morning weight, and the assistant replies, "She was sleeping so well, I didn't want to wake her to get her weight." How does the nurse respond?

"Weigh her now. We need her weight daily, at the same time."

Which statement by the nurse is most appropriate when teaching a patient about maintaining fluid balance?

"Your intake and output has the most influence on your body's fluid balance."

Which situation can cause a patient to experience "insensible water loss?"

-Diarrhea. -Dry, hot weather. -Fever. -Increased respiratory rate. -Mechanical ventilation. Insensible water loss occurs through the intestinal tract as diarrhea. It can be caused and/or influenced by dry, hot weather. Insensible water loss occurs through the skin, lungs (increased rate of respirations) and intestinal tract. Etc.

Which will the nurse include when documenting a patient's fluid intake for the shift?

-Enemas. -Oral fluids. -Irrigation fluids. Solid foods are considered intake but these cannot be measured.

The nurse admits a patient with dehydration. Which electrolyte imbalances does the nurse anticipate based on this diagnosis?

-Hyperkalemia. -Hypernatremia. A patient who is admitted with dehydration will have hyperkalemia and hypernatremia.

The nurse is providing care to a patient who is admitted with fluid volume overload. Which electrolyte imbalances does the nurse anticipate for this patient based on the admitting diagnosis?

-Hyponatremia. -Hypokalemia. -Hypochloremia. A patient admitted with fluid volume overload will often experience hyponatremia, hypokalemia, and hypocholoremia.

The nurse is administering sodium chloride 0.9% (normal saline) intravenously to a patient who is dehydrated. Which assessments does the nurse perform to evaluate the effectiveness of rehydration therapy?

-Pulse rate and quality. -Urinary output.

How much fluid should a healthy adult consume each day to maintain adequate urine output?

2.3L/day. Most healthy adults take in about 2300 mL of fluid each day, which is equivalent to 2.3L/day.

Which value falls within the range for the minimal amount of urine that needs to be produced in 24 hours?

450 mL/day. The minimum volume of urine per day needed to excrete toxic waste products is 400 to 600 mL, and is called obligatory urine output. Urine output between 100 and 400 mL per day is called oliguria or hypothesis.

Which total urine output for the previous day would place a patient at risk for accumulating waste products?

500 mL. The minimum amount of urine per day needed to excrete toxic waste products is 400-600 mL. The MINIMUM volume is called the obligatory urine output. If the 24-hour urine output falls below the obligatory output amount, wastes are retained and can cause lethal electrolyte imbalances, acidosis, and a toxic buildup of nitrogen.

Which person attending an all-day outdoor festival on a hot August day is at greatest risk for dehydration?

72-year-old woman appearing to be at least 20 pounds overweight.

The charge nurse on a medical-surgical unit is completing assignments for the day shift. Which patient is assigned to the LPN/LVN?

76-year-old with poor skin turgor who has a serum osmolarity of 300 mOsm/L. Normal serum osmolarity = 270-300 mOsm/L.

Which age-related change to the endocrine gland affects fluid balance in the body?

Adrenal atrophy. An age-related change to the endocrine gland is adrenal atrophy, which causes poor regulation of sodium and potassium, placing the patient at risk for fluid imbalance.

Which medication may affect the assessment of a patient's fluid balance after a surgical intervention?

Angiotensin-converting enzyme inhibitor twice a day.

As adults age, which common physiologic change is likely to alter their hydration status?

Decreased muscle mass. Decreased muscle mass in the aging adult causes decreased TOTAL BODY WATER, thus altering the hydration status in the older adult.

Which age-related change to fluid balance does the nurse anticipate when conducting a neurological assessment for an older adult patient?

Decreased thirst reflex. An age-related neurological change that impacts fluid balance is a decreased thirst reflex.

Which medication classification does the nurse anticipate being prescribed to help a patient maintain an appropriate fluid balance?

Diuretics. Drug therapy for hypertension management may include diuretic drugs that increase the excretion of sodium so that less is present in the blood, resulting in a lower blood volume and increased urine output.

Which condition commonly occurs in patients who are on long-term furosemide therapy?

Hyponatremia. Furosemide is a high ceiling or loop diuretic. Prolonged use of this drug (furosemide[Lasix]) to manage fluid overload MAY cause loss of sodium along with extra water, leading to a decrease in sodium levels, AKA Hyponatremia.

The nurse is reviewing the basic metabolic panel for a patient who was admitted to the medical-surgical unit the previous day. Which finding indicates that the patient is suffering from fluid volume overload?

Hyponatremia. Most problems caused by fluid overload are related to excessive fluid in the vascular space or to dilution of specific electrolytes, lowering their serum levels. Hyponatremia, or a low level of sodium, is often manifested with fluid volume overload.

Which is a risk factor associated with tachypnea?

Increased insensible water loss. Tachypnea is characterized by rapid respiration. Risk factors associated with tachypnea include increased sensible water loss.

Which age-related change of the kidney increases an older adult patient's risk for dehydration?

Increased water loss. Older adult patients are at an increased risk for dehydration caused by increased water loss.

Which output source would the nurse exclude from the total output from the previous shift?

Lung vaporization. Lung vaporization is not a measurable output that the nurse would include on the intake and output (I&O) from the previous shift.

Which is a true statement regarding fluid balance in older adult patients?

Older adult patients have less total body water (TBW). Older adult patients have less total body water (TBW) than younger patients, which increases their risk for dehydration.

Which route of fluid loss is non-measureable?

Perspiration. Fluids lost by perspiration and vaporization through the lungs are non-measurable.

A patient with a history of hypertension asks the nurse what dietary changes are necessary to make in order to control the blood pressure. What does the nurse include in the instruction?

Reduce the intake of sodium. High sodium intake raises the serum sodium level, which in turn, causes more water to be retained. Increased water retention increases blood volume, which finally raises blood pressure.

The nurse is providing care for a patient who has hyperkalemia. Which disease process documented in the patient's medical record is the cause for this electrolyte imbalance?

Renal failure (or kidney disease) causes a decrease in urine output. This decrease in urine output caused by renal failure causes the patient to retain potassium, thus, developing hyperkalemia. Hyperkalemia is excess potassium. Retain urine (renal/kidney failure) leads to an accumulation of potassium, or hyperkalemia.

Which condition would stimulate the renin-angiotensin II to maintain fluid balance within the body?

Shock. The renin-angiotensin II pathway is highly stimulated whenever the patient is in shock or when the stress response occurs. This is why urine output is used as an indicator of perfusion adequacy after surgery or any time the patient has undergone an invasive procedure and is at risk for hemorrhage.

The nurse is assessing a patient's serum electrolyte values upon admission to the medical-surgical unit. Which value would cause the nurse to monitor the patient for dehydration?

Sodium 150 mEq/L. Hypernatremia (as indicated by a sodium level of 150 mEq/L) would cause the nurse to monitor the patient for dehydration.

Which assessment data is the best indication of perfusion after a surgical procedure?

Urine output is the best indication of perfusion after a surgical procedure.

Which parameter does the nurse assess for in a postoperative patient to determine perfusion adequacy?

Urine output.