PrepU fluid and Electrolyte Balance

A child with diabetic ketoacidosis is being treated for a blood glucose level of 738 mg/dl (41.0 mmol/L). The nurse should anticipate an order for: a) normal saline with regular insulin. b) 5% dextrose in water with NPH insulin. c) normal saline with ultralente insulin. d) 5% dextrose in water with PZI insulin.

A

A client has vomited several times over the past 12 hours. The nurse should recognize the risk of what complication? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Respiratory alkalosis

A

Which indicates hypovolemic shock in a client who has had a 15% blood loss? a) pulse rate less than 60 bpm b) systolic blood pressure less than 90 mm Hg c) pupils unequally dilated d) respiratory rate of 4 breaths/minute

B

A client with cirrhosis begins to develop ascites. Spironolactone is prescribed to treat the ascites. The nurse should monitor the client closely for which drug-related adverse effect? a) constipation b) irregular pulse c) hyperkalemia d) dysuria

C

A client who is 12 hours post total thyroidectomy reports tingling around the mouth. Which assessment is the priority? a) Potassium level b) Sodium level c) Blood pressure d) Calcium level

D

A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? a) Calcium b) Potassium c) Chloride d) Sodium

D

A client is brought to the emergency department with abdominal trauma following an automobile accident. The vital signs are as follows: heart rate, 132 bpm; respirations, 28 breaths/min; blood pressure, 84/58 mm Hg; temperature, 97.0° F (36.1° C); oxygen saturation 89% on room air. Which prescription should the nurse implement first? a) Insert an indwelling urinary catheter. b) Administer 1 liter 0.9% saline IV. c) Obtain an abdominal x-ray. d) Draw a complete blood count (CBC) with hematocrit and hemoglobin.

B

A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." The CSU nurse should be especially observant for: a) high urine output. b) dry mucous membranes. c) hypertension. d) pulmonary crackles.

D

An older adult client diagnosed with end stage-renal disease (ESRD) presents with fluid volume excess. Which of the following is the priority nursing intervention? a) Assess the client's heart rate and blood pressure b) Weigh the client c) Assess the client's lung sounds d) Place the client on intake and output measurement

C

A client with renal insufficiency is admitted to the hospital with pneumonia. He's being treated with gentamicin. Which laboratory value should be closely monitored? a) Blood urea nitrogen (BUN) b) Alkaline phosphatase c) Sodium level d) White blood cell (WBC) count

A

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when he makes which statement? a) "I sleep on three pillows each night." b) "I don't have the same appetite I used to." c) "My pants don't fit around my waist." d) "My feet are bigger than normal."

A

Which adverse effects occur when there is too rapid an infusion of TPN solution? a) circulatory overload b) hypokalemia c) negative nitrogen balance d) hypoglycemia

A

The health care provider (HCP) prescribes intravenous fluid replacement therapy with potassium chloride to be added for a child with severe gastroenteritis. Before hanging the IV fluids with potassium chloride, which assessments would be most important? a) passage of stool today b) baseline electrocardiogram c) ability to void d) serum calcium level

C

The nurse is caring for a 9-month-old child with severe diarrhea that has lasted 3 days. Which of the following would be a priority assessment for the nurse to make? a) Hyponatremia b) Anemia c) Poor skin turgor d) Jaundice

C

A 29-month-old child who is dehydrated as a result of vomiting requires oral rehydration. Which concept regarding oral rehydration therapy should the nurse consider? a) A child who has three wet diapers each day isn't considered dehydrated. b) Sugar is a good source of nutrition when rehydrating a child. c) If symptoms persist for more than 72 hours, contact the physician. d) Give 1 to 3 teaspoons (5-15 mL) of fluid every 10 to 15 minutes.

D

A client with a long history of ulcerative colitis takes sulfasalazine to control the condition. The nurse should evaluate the client for which nutritional deficit that can occur as a result of taking this drug? a) iron deficit b) cobalamin deficit c) niacin deficit d) folic acid deficit

D

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? a) Hypermagnesemia b) Hyponatremia c) Hyperkalemia d) Hypocalcemia

D

The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink: a) as much water or juice as possible. b) twice as much fluid as usual. c) at least 1,000 mL more than usual. d) at least 3,000 mL of fluids daily.

D

A primigravid with severe gestational hypertension has been receiving magnesium sulfate I.V. for 3 hours. The latest assessment reveals deep tendon reflexes (DTR) of +1, blood pressure of 150/100 mm Hg, a pulse of 92 beats/minute, a respiratory rate of 10 breaths/minute, and a urine output of 20 ml/hour. Which action should the nurse perform next? a) Continue monitoring per standards of care. b) Decrease the infusion rate by 5 gtt/minute. c) Stop the magnesium sulfate infusion. d) Increase the infusion rate by 5 gtt/minute.

C

A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client: a) retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. b) retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. c) retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn't necessary to reduce the potassium level. d) retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn't necessary to reduce the potassium level.

A

A nurse must deliver 1,000 ml of normal saline solution over 8 hours. The I.V. tubing has a drop factor of 10 gtt/ml. The nurse should set the flow rate as: a) 21 gtt/minute b) 20.5 gtt/minute c) 25 gtt/minute d) 31 gtt/minute

A

A 26-year-old primigravida visiting the prenatal clinic for her regular visit at 34 weeks' gestation tells the nurse that she takes mineral oil for occasional constipation. What should the nurse should instruct the client to do? a) Take the mineral oil with fruit juice to increase the action of the mineral oil. b) Avoid mineral oil because it interferes with the absorption of fat-soluble vitamins. c) Use the mineral oil regularly on a weekly basis to prevent constipation. d) Avoid mineral oil because it can lead to vitamin C deficiency in pregnant clients.

B

A 4-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. The nurse should suspect that the child's I.V. fluid intake is excessive if assessment reveals: a) nausea and vomiting. b) worsening dyspnea. c) gastric distention. d) a temperature of 102° F (38.9° C).

B

After completion of peritoneal dialysis, the nurse should assess the client for: a) increased urine output. b) weight loss. c) hematuria. d) hypertension.

B

A client who is recovering from transurethral resection of the prostate (TURP) experiences urinary incontinence and has decreased the fluid intake because of the incontinence. What would be the nurse's best response to the client? a) "Limiting your fluids will cause kidney stones." b) "Yes, limiting your fluids can decrease your incontinence." c) "If your incontinence continues, we will reinsert your catheter." d) "Drink eight glasses of water a day and urinate every 2 hours."

D

During the first 48 to 72 hours of fluid resuscitation therapy after a major burn injury, the nurse should monitor hourly which information that will be used to determine the IV infusion rate? a) body weight b) urine specific gravity c) body temperature d) urine output

D

The nurse is evaluating the effectiveness of fluid resuscitation during the emergency period of burn management. Which finding indicates that adequate fluid replacement has been achieved in the client? a) urine output greater than 35 mL/hour b) an increase in body weight c) blood pressure of 90/60 mm Hg d) fluid intake less than urinary output

A

When caring for the neonate of a mother with gestational diabetes, which finding is most indicative of a hypoglycemic episode? a) Jitteriness b) Serum glucose level of 60 mg/dl (3.3 mmol/L) c) Positive Babinski's reflex d) Hyperalert state

A

Which is the most important initial postprocedure nursing assessment for a client who has had a cardiac catheterization? a) Observe the puncture site for swelling and bleeding. b) Monitor the laboratory values. c) Monitor skin warmth and turgor. d) Observe neurologic function every 15 minutes.

A

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Serum creatinine level of 1.2 mg/dl (0.1 mmol/L) b) Blood urea nitrogen (BUN) level of 22 mg/dl (1.2 mmol/L) c) Temperature of 100.2° F (37.8° C) d) Urine output of 250 ml/24 hours

D

A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for: a) paresthesia. b) dehydration. c) pruritus. d) cardiac arrhythmia.

D

The nurse is assessing a client who is restless and agitated, has dry mucous membranes, and has intense thirst. The nurse should assess the client further for which electrolyte imbalance? a) hypokalemia b) hypercalcemia c) hypomagnesemia d) hypernatremia

D

Which serum electrolytes findings should the nurse expect to find in an infant with persistent vomiting? a) K+, 3.2; Cl-, 92; Na+, 120 b) K+, 3.4; Cl-, 120; Na+, 140 c) K+, 3.5; Cl-, 90; Na+, 145 d) K+, 5.5; Cl-, 110; Na+, 130

A

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: a) sodium and chloride abnormalities. b) calcium and phosphorus abnormalities. c) sodium and potassium abnormalities. d) chloride and magnesium abnormalities.

C

A client has been admitted with severe burns. Lactated Ringer's has been ordered to infuse via a pump. Why is this solution being used? a) To improve skin integrity and maintain a barrier b) To prevent signs of hypovolemic shock and restore circulation c) To maintain appropriate glucose levels in the blood d) To restore sodium stores that were lost from the burns

B

What is the primary goal of nursing care during the emergent phase after a burn injury? a) Prevent infection. b) Replace lost fluids. c) Control pain. d) Promote wound healing.

B

A nurse is caring for an infant who is in critical condition. The nurse notes that the child weighs 11 lb (5 kg) and has had a blood loss of 100 mL. Assessment reveals a decreased urine output, mild tachycardia, and restlessness. Which of the following should be the priority action for the nurse to take? a) Application of telemetry monitoring b) Insertion of a Foley indwelling catheter c) Neurologic assessment with the Glasgow Coma Scale d) IV administration of lactated Ringer's

D

A nurse is caring for a woman receiving a lumbar epidural anesthetic block to control labor pain. What should the nurse do to prevent hypotension? a) Administer ephedrine to raise her blood pressure. b) Ensure adequate hydration before the anesthetic is administered. c) Administer oxygen using a mask. d) Place the woman supine with her legs raised.

B

The nurse monitors IV replacement therapy for a client with a nasogastric (NG) tube attached to low suction in order to: a) equalize intake and output. b) maintain fluid and electrolyte balance. c) facilitate osmotic diuresis. d) promote urination.

B

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? a) Hematocrit of 52% b) Serum sodium level of 124 mEq/L c) Serum creatinine level of 0.4 mg/dl d) Serum blood urea nitrogen (BUN) level of 8.6 mg/dl

B

The nurse is teaching an older adult with a urinary tract infection about the importance of increasing fluids in the diet. What puts this client at a risk for not obtaining sufficient fluids? a) decreased production of aldosterone b) decreased ability to detect thirst c) increased production of antidiuretic hormone d) diminished liver function

B

A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? a) Jugular vein distention b) Dependent edema c) Bibasilar crackles d) Right upper quadrant pain

C

A client is scheduled for a creatinine clearance test. What should the nurse do? a) Prepare to insert an indwelling urethral catheter. b) Instruct the client to force fluids to 3,000 mL/day. c) Instruct the client about the need to collect urine for 24 hours. d) Provide the client with a sterile urine collection container.

C

A physician orders a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance? a) Hypervolemia b) Hyperkalemia c) Hypokalemia d) Hypernatremia

C

The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. The nurse should report which finding to the health care provider (HCP)? a) temperature, 99.8° F (37.7° C) b) A 2" × 2" (5 cm x 5 cm) area of serosanguineous drainage on the flank dressing c) urine output, 20 mL/h d) Absence of bowel sounds

C

The nurse is administering an IV potassium chloride supplement to a client who has heart failure. When developing a plan of care for this client, the nurse should consider that: a) metabolic alkalosis will increase the client's serum potassium levels. b) hyperkalemia will intensify the action of the client's digoxin preparation. c) the client's potassium levels will be unaffected by a potassium-sparing diuretic. d) the administration of the IV potassium chloride should not exceed 10 mEq/h or a concentration of 40 mEq/L.

D

The nurse is caring for a client admitted with pyloric stenosis. A nasogastric tube placed upon admission is on low intermittent suction. Upon review of the morning's blood work, the nurse observes that the patient's potassium is below reference range. The nurse should recognize that the patient may be at risk for what imbalance? a) Respiratory acidosis b) Hypercalcemia c) Metabolic acidosis d) Metabolic alkalosis

D

When admitting an elderly client for nausea and vomiting that has lasted for 3 days, the nurse should assess for which clinical findings? a) bradycardia b) hypertension c) polyuria d) poor skin turgor

D