NRS 326: Practice Questions

Which IV fluid is most appropriate for a patient experiencing diabetic ketoacidosis?

HYPOTONIC SOLUTION In DKA there is profound hyperglycemia, which contributes to dehydration! (Think hyperglycemia = increased thirst & urine output) Very high glucose can also increase overall osmolality, drawing water out of the cells.... Hypotonic fluids help fix this! (They may start on something isotonic initially, but the hypotonic helps restore hydration)

Which IV fluid is most appropriate for a patient needing water replacement?

HYPOTONIC SOLUTION We might replace water in a patient who is very dehydrated! Hypotonic solutions are the most hydrating to the cells/tissues (But that makes them prone to FVE)

The nurse is caring for a patient with a positive Chvostek's sign. Which electrolyte imbalance is the patient likely experiencing?

Hypocalcemia

A nurse is teaching a client about the importance of increasing fluids when experiencing the early stages of dehydration. What response would indicate client understanding?

"I should drink more water when I feel thirsty or becoming irritable"

A healthcare provider is going to order an IV hypotonic solution for a patient. Which solution does the nurse anticipate is going to be administered to the patient?

- 1/2 NS - 0.45% NS - Dextrose 5% in water (D5W)

How can fluid & electrolyte imbalances impair cerebral function?

- Osmolality imbalances cause shriveling (hypernatremia) or swelling (hyponatremia) of cells, including brain cells - decreased LOC, which occurs on a continuum from drowsiness to coma - intracranial pressure

Which of the following nursing actions are appropriate for a patient experiencing a postpartum hemorrhage?

-Administer Packed Red Blood Cells -Massage the fundus -Lay the patient down

The nurse is reviewing a patients complete blood count (CBC) following the administration of 2 units packed red blood cells. The nurse anticipates which values will have changed as a a result of that administration

-RBC Count -Hemoglobin -Hematocrit

How does edema impact gas exchange?

A fluid that develops from the 1st space to the 2nd/3rd space pushes cells farther away from the capillaries and creates a larger distance for oxygen diffusion

Where, in the body, is the most notable impact of osmolality imbalances?

Brain

A client with lower extremity edema and excess fluid in the lungs has been discharged home with the medication furosemide. For this client, which finding is the best indicator that the medication is working effectively

Consistent daily weight

What solution(s) is insulin usually paired with to avoid HYPOglycemia?

D10 or D50

You are caring for a patient receiving an infusion of 0.45% NS. Which assessment finding is more concerning?

Decreased LOC

Which IV fluid is most appropriate for a patient experiencing increased intracranial pressure?

HYPERTONIC SOLUTION Fluid is often the problem in increased ICP (d/t swelling of the tissues) - hypertonic fluids could help draw water out and relieve the pressure

Which IV fluid is most appropriate for a patient experiencing severe hyponatremia?

HYPERTONIC SOLUTION Low sodium in the blood causes fluid to naturally shift into the tissues. Giving a hypertonic fluid could fix that AND because 3% Sodium Chloride is a hypertonic fluid, we'd also be restoring sodium directly.

Which IV fluid is most appropriate for a patient experiencing septic shock?

ISOTONIC SOLUTION Low BP in septic shock, and leaky blood vessels! Isotonic fluids help restore volume to the vasculature and stabilize BP. (You might be tempted to give hypertonic fluids since septic shock causes fluid to leak into the tissues... but in shock our priority is stabilizing the BP and we usually don't try to fix a fluid shift by inducing an opposite fluid shift)

Which IV fluid is most appropriate for a patient undergoing surgery and needing maintenance fluid?

ISOTONIC SOLUTION Often isotonic fluids are given to bolster overall blood volume during surgery

Which IV fluid is most appropriate for a patient experiencing blood loss?

ISOTONIC SOLUTION This is a loss of fluid in the vasculature! Best treatment is to give a fluid to restore fluid to the vasculature.

Which IV fluid is most appropriate for a patient renal failure?

Kidneys help us get rid of fluid from the body.... Failing kidneys don't do that well! Very easy to fluid overload, we'll question giving fluids and give them very carefully if we do end up administering.

A client is taking furosemide and digoxin for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day?

Maintaining serum potassium levels

Which to give first for a patient who is bleeding out and in shock: 0.9% NS or PRBCs?

NS can be administered faster than blood for immediate help, getting the patient out of danger quickly

Which of the following nursing actions is the priority for a patient experiencing a potential transfusion reaction?

Stop the transfusion

Which IV fluid is most appropriate for a patient experiencing a pulmonary embolism?

The problem is a clot! We don't need to fluid shift with a hyper/hypotonic solution. Isotonic solutions would also increase preload (blood return to the heart/lungs) which could contribute to obstructive shock.

Which IV fluid is most appropriate for a patient experiencing heart failure?

Very easy to fluid overload a patient with heart failure! Question giving IV fluids: more fluids = more overworked heart. (Can you think of a scenario where it might be okay to give an IV fluid to someone in HF?)

The nurse is reviewing laboratory values for a patient suspected of having a fluid imbalance. Which laboratory value should indicate a diagnosis of dehydration to the nurse?

below normal hematocrit

How does high Calcium/Magnesium impair neuromuscular function?

decrease neuromuscular excitability: muscle weakness, depressed reflexes, and lethargy

How can severe fluid volume deficit impact perfusion?

decreasing arterial BP and blood volume → hypovolemic shock, which can cause reduction in circulating blood volume, lower venous return and, in profound cases, arterial hypotension

What might happen if a patient with fluid loss tries to replace it with ONLY water?

develop dilutional electrolyte state

True or false: Crystalloids replace volume for volume

false

True or false: There are screenings for fluid & electrolyte imbalances for the general population

false

True or false: Following a hip fracture, the nurse can recommend magnesium-rich foods to the patient

false, calcium-rich

True or false: We primarily use colloids

false, crystalloids

True or false: Patients with edema will have normal healing time to the edematous tissue

false, delayed

True or false: Insulin can be used to treat hypokalemia

false, hyperkalemia

True or false: In hypotonic solutions, water leaves the intracellular space into the vascular space

false, hypertonic

True or false: In hypertonic solutions, water moves from the vascular space into the cell (intracellular space)

false, hypotonic

true or false: salt substitutes are a potential source of more magnesium

false, potassium. substitutes in forms of herbs (no minerals) or potassium

When administering IV fluids, why is it important to monitor for edema/cough?

fluid volume overload. edema = pooling cough = secretions pooling in lungs

When D5W is first administered, it behaves for a moment like an _____________ solution. But soon after administration, D5W is ______________ by the body. Afterward, D5W turns into a _________________ solution

isotonic; metabolized (converted to glucose); *hypotonic*

A patient with chronic kidney disease will have high or low levels of phosphorus?

low levels

How does low Calcium/Magnesium impair neuromuscular function?

muscle twitching and cramping, hyperactive reflexes, and seizures if very severe

What type of saline solution should be used with blood infusions?

only 0.9% NS can run w/ blood products

True or false: Higher infusion rate of IV fluids increases r/o fluid volume overload

true

True or false: When a patient has low levels of K+, it increases their risk of digoxin toxicity

true

True or false: When potassium is imbalanced, the muscles can become more flaccid/weak

true

True or false: It is safe to give Magnesium during pregnancy

true, may be given to slow labor