Ch 76 Disorders of Fluid and Electrolytes

carbonic acid

H2CO3

Bicarbonate ions

HCO3-

Liver function test

LFT

A nurse is caring for a client who was in a motor=vehicle crash. The client reports chest pain and difficulty breathing. A chest x-ray indicates that the client has a pneumothorax. Which of the following ABG results should the nurse expect? A- C- pH 7.06 PaCO2 52 mm Hg HCO3 24 mEq/L B- C- pH 7.42 PaCO2 38 mm Hg HCO3 23 mEq/L C- C- pH 7.20 PaCO2 39 mm Hg HCO3 18 mEq/L D- C- pH 7.58 PaCO2 38 mm Hg HCO3 29 mEq/L

A- C- pH 7.06 PaCO2 52 mm Hg HCO3 24 mEq/L

The nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/jL. which prescribed medication should the nurse plan to assist in administering to the client? A- Calcitonin B- Calcium chloride C- Calcium gluconate D- Large doses of vitamin D

A- Calcitonin

A nurse is collecting data from a client who reports nausea, vomiting, and weakness. The client has dry oral mucous membranes. Which of the following findings should the nurse identify as manifestations of fluid volume deficit? Select all that apply A- Decreased skin turgor B- Concentrated urine C- Bradycardia D- Low-grade fever E- Tachypnea

A- Decreased skin turgor B- Concentrated urine D- Low-grade fever E- Tachypnea

Excess water in the extracellular spaces

overhydration

A nurse assessing a client documents +4 pitting edema in several different locations. What condition is commonly associated with +4 pitting edema? A-Sacral edema B-Dependent edema C-Anasarca D-Pulmonary edema

C-Anasarca

A nurse is caring for a client who has a serum sodium level of 133 mEq/L and a serum potassium level of 3.4 mEq/L. which of the following treatments is a risk factor for these laboratory findings? A- Three tap water enemas B- 0.9% sodium chloride IV C- Dextrose 5% in water with 20 mEQ of K+ IV D- Spironolactone therapy

A- Three tap water enemas

A client is scheduled for blood to be drawn from the radial artery for an arterial blood gas (ABG) determination. The nurse assists with performing Allen's test before drawing the blood to determine the adequacy of which? A- ulnar circulation B- Carotid circulation C- Femoral circulation D- Brachial circulation

A- ulnar circulation

The nurse caring for a postoperative client documents the following data: flush dry skin, dry mucous membranes, hypotension, and lethargy. The client states that he is thirsty and requests waters. Which medical condition is supported by this data? A-Hypernatremia B-Hyperkalemia C-Hypercalcemia D-Hypermagnesemia

A-Hypernatremia

For which electrolyte disturbances should the nurse monitor when caring for a client diagnosed with Hodgkin disease? A-Hyponatremia B-Hypercalcemia C-Hyperchloremia D-Hyperphosphatemia

A-Hyponatremia

A 16 - year- old presents at the emergency room with altered mental status, bradycardia, and cardiac dysrhythmia caused by uncontrolled diabetes mellitus. What acid-base imbalance is most likely occurring in this client? A-Metabolic acidosis B-Respiratory acidosis C-Metabolic alkalosis D-Respiratory alkalosis

A-Metabolic acidosis

A nurse is caring for a client admitted to the healthcare facility with narcotic overdose. The client has shallow respirations, tremors, headache, weakness, altered sensorium, and fruity-smelling breath. According to the arterial blood gas evaluation, the client's pH is decreased and PCO2 is increased. Which acid-base imbalance has occured? A-Respiratory acidosis B-Respiratory alkalosis C-Metabolic acidosis D-Metabolic alkalosis

A-Respiratory acidosis

Blood test used to indicate acidosis or alkalosis

ABG

Antidiuretic hormone

ADH

Form of energy

ATP

A nurse is collecting data from a client who has a serum potassium level of 5.4 mEq/L. which of the following manifestations should the nurse expect? Select all that apply A_ ECG changes B- Constipation C- Polyuria D- Hypotension E- Tachycardia

A_ ECG changes D- Hypotension

A nurse is caring for a client who has metabolic acidosis. Which of the following components of the client's medical history should the nurse identify as a risk factor for this acid-base imbalance? A- Diabetic ketoacidosis B- Sleep apnea C- Asthma D- Pulmonary edema

A- Diabetic ketoacidosis

A nurse is collecting data from a client who has hyperkalemia. which of the following disorders is a risk factor for this electrolyte imbalance? A- Diabetic ketoacidosis B- Heart failure C- Aldosterone excess D- Excessive sweating

A- Diabetic ketoacidosis

A nurse is observing an older adult client who is receiving packed RBCs. which of the following findings should the nurse identify as a manifestation of fluid volume excess and report to the charge nurse? Select all that apply A- Dyspnea B- Edema C- Bradycardia D- Hypertension E- Weakness

A- Dyspnea B- Edema D- Hypertension E- Weakness

The nurse is caring for a client with severe diarrhea. The nurse monitors the client closely, understanding that this client is at risk for developing which? A- Metabolic acidosis B- Metabolic alkalosis C- Respiratory acidosis D- Respiratory alkalosis

A- Metabolic acidosis

The nurse reviews the client's serum calcium level and notes that the level is 8.0 mg/d:. The nurse understands that which condition would cause this serum calcium level? A- Prolonged bed rest B- Adrenal insufficiency C- Hyperparathyroidism D- Excessive ingestion of vitamin D

A- Prolonged bed rest

A nurse is collecting data from a client who has pancreatitis. The client's ABGs indicate metabolic acidosis. which of the following findings should the nurse expect? Select all that apply A- Tachycardia B- Hypertension C- Bounding pulses D- Insomnia E- Dysrhythmias F- Tachypnea

A- Tachycardia E- Dysrhythmias F- Tachypnea

Generalized body edema

Anasarca

The nurse is caring for a client with respiratory insufficiency. The arterial blood gas (ABG) results indicate a pH of 7.50 and a PCO2 of 30mm Hg (30 mm Hg) and the nurse is told that the client is experiencing respiratory alkalosis. Which additional laboratory value should the nurse expect to note? A- a sodium level of 145 mEq/L (145 mmol/L) B- A potassium level of 3.0 mEq/L (3.0 mmol/L) C- A magnesium level of 1.3 mEq/L (0.65 mmol/L) D- A phosphorus level of 3.0 mg/dl (0.97 mmol/L)

B- A potassium level of 3.0 mEq/L (3.0 mmol/L)

The nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse should tell the client that which food item is least likely to contain calcium? A- Milk B- Butter C- Spinach D- Collard greens

B- Butter

A nurse is caring for a client who has nasogastric tube with low intermittent suctioning. The nurse should monitor the client for which of the following electrolyte imbalances? Select all that apply A- Hypercalcemia B- Hyponatremia C- Hyperphosphatemia D- Hypomagnesemia E- Hyperkalemia

B- Hyponatremia D- Hypomagnesemia

The nurse is caring for a client with a diagnosis of hyperparathyroidism. Laboratory studies are performed and the serum calcium level is 12.0 mg/dL. based on this laboratory value, the nurse should take which action? A- Document the value in the client's record B- Inform the registered nurse of the laboratory value C- Place the laboratory result form in the client's record D- Reassure the client that the laboratory result is normal

B- Inform the registered nurse of the laboratory value

The nurse is caring for a client with nasogastric tube that is attached to low suction. The nurse monitors the client closely for which acid base disorder that is most likely to occur in this situation? A- Metabolic acidosis B- Metabolic alkalosis C- Respiratory acidosis D- Respiratory alkalosis

B- Metabolic alkalosis

The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at risk for fluid volume deficit? A- The client with cirrhosis B- The client with a ileostomy C- The client with heart failure D- The client with decreased kidney function

B- The client with a ileostomy

The nurse reviews a client's electrolyte results and notes a potassium level of 5.5 mEq/L. The nurse understands tha ta potassium value at this level would be noted with which condition? A- Diarrhea B- Traumatic burn C- Cushing's syndrome D- Overuse of laxatives

B- Traumatic burn

An assessment indicates that the client's skin rebound from slight pressure in slightly less than 2 seconds. How should the nurse document this finding? A-No edema present B-+ 1 pitting edema C-+ 2 pitting edema D-Nonpitting edema present

B-+ 1 pitting edema

What is the preferred route of electrolyte administration when the oral route is contraindicated? A-Intramuscular B-Intravenous C-Subcutaneous D-Intradermal

B-Intravenous

The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease (COPD). The nurse should monitor the client for which acid base imbalance? A- Metabolic acidosis B- Metabolic alkalosis C- Respiratory acidosis D- Respiratory alkalosis

C- Respiratory acidosis

A nurse is collecting data from a client who has hypomagnesemia. which of the following techniques should the nurse use to check for Chvostek sign? A- Apply a blood pressure cuff to the client's arm B- Place the stethoscope's bell over the client's carotid artery C- Tap lightly on the client's cheek D- Ask the client to lower her chin to her chest

C- Tap lightly on the client's cheek

A nurse is caring for a client who has confusion and lethargy. The client was unresponsive at home, with an empty bottle of aspirin lying next to her bed. VS are BP 104/72, HR 116 and regular, and RR 42 with deep respirations. Which of the following arterial blood gas (ABG) results should the nurse expect? A- pH 7.68 PaCO2 38 mm Hg HCO3 28 mEq/L B- pH 7.48 PaCO2 28 mm Hg HCO3 23 mEq/L C- pH 7.16 PaCO2 38 mm Hg HCO3 18 mEq/L D- pH 7.58 PaCO2 38 mm Hg HCO3 29 mEq/L

C- pH 7.16 PaCO2 38 mm Hg HCO3 18 mEq/L

The registered nurse (RN) reviews the results of the arterial blood gas (ABG) values with the licensed practical nurse (LPN) and tells the LPN that the client is experiencing respiratory acidosis. The LPN should expect to note which on the laboratory result report? A- pH 7.50, Pco2 52 mm Hg B- pH 7.35, Pco2 40 mm Hg C- pH 7.25, Pco2 50 mm Hg D- pH 7.50, Pco2 30 mm Hg

C- pH 7.25, Pco2 50 mm Hg

Which client should this nurse monitor closely for an increased risk for developing edema? A-A 30 - year - old client with a prolonged fever B-A 16 - year - old client diagnosed with anorexia nervosa C-A 20 - year - old client who is vomiting excessively D- A 78 - year - old client diagnosed with liver cirrhosis

D- A 78 - year - old client diagnosed with liver cirrhosis

The nurse who is caring for a client with kidney failure notes that the client is dyspneic and crackles are heard when listening to breath sounds in the lungs. which additional sign/symptom should the nurse expect to note in this client? A- Rapid weight loss B- Flat hand and neck veins C- A weak and thready pulse D- An increase in blood pressure

D- An increase in blood pressure

A client has the following laboratory values: a pH of 7.55 an HCO3- level of 22 mEq/L (22 mmol/L), and PCO2 of 30 mm Hg (30 mm Hg). Which action should the nurse plan to take? A- Perform Allen's test B- Prepare the client for dialysis C- Administer insulin as prescribed D- Encourage the client to slow down breathing

D- Encourage the client to slow down breathing

The nurse is caring for a client with a suspected diagnosis of hypercalcemia. which sign/symptom would be an indication of this electrolyte imbalance? A- Twitching B- Positive Trousseau's sign C- Hyperactive bowel sounds D- Generalized muscle weakness

D- Generalized muscle weakness

The nurse is caring for a client who has been taking diuretics on a long-term basis. which finding should the nurse expect to note as a result of this long-term use? A- Gurgling respirations B- Increased blood pressure C- Decreased hematocrit level D- Increased specific gravity of the urine

D- Increased specific gravity of the urine

The nurse observes that a client with diabetic ketoacidosis is experiencing abnormally deep regular rapid respirations. How should the nurse correctly document this observation in the medical record? A- Apnea B- Bradypnea C- Cheyne strokes D- Kussmaul's respirations

D- Kussmaul's respirations

A nurse is checking ABG results for a client who has vomited repeatedly during the past 24 hr. Which of the following acid-base imbalances should the nurse expect? A- Respiratory acidosis B- Respiratory alkalosis C- Metabolic acidosis D- Metabolic alkalosis

D- Metabolic alkalosis

A nurse is caring for an older adult client in a long-term care facility who is dehydrated. Which of the following actions should the nurse take? A- Initiate fluid restrictions to limit the client's intake B- Observe for indications of peripheral edema C- Encourage the client to promote oxygenation by ambulating D- Monitor for orthostatic hypotension

D- Monitor for orthostatic hypotension

The nurse reviews a client's electrolyte results and notes that the potassium level is 5.4 mEq/L. What should the nurse look for on the cardiac monitor as a result of this laboratory value? A- ST elevation B- Peaked P waves C- Prominent U waves D- Narrow, peaked T waves

D- Narrow, peaked T waves

The nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. which additional sign/symptom should the nurse expect to note in this client if hyponatremia is present? A- Intense thirst B- Slow bounding pulse C- Dry mucous membranes D- Postural blood pressure changes

D- Postural blood pressure changes

The nurse is told that the arterial blood gas (ABG) results indicate a pH of 7.50 and a Pco2 of 32 mm Hg (32 mm Hg). The nurse determines that these results are indicative of which acid base disturbance? A- Metabolic acidosis B- Metabolic alkalosis C- Respiratory acidosis D- Respiratory alkalosis

D- Respiratory alkalosis

The nurse is reviewing the health records of assigned clients. the nurse should plan care knowing that which client is at risk for a potassium deficit? A- The client with Addison's disease B- The client with metabolic acidosis C- The client with intestinal obstruction D- The client receiving nasogastric suction

D- The client receiving nasogastric suction

The nurse is reading the PHCP's progress notes in the client's record and sees that the PHCP has documented "insensible fluid loss of approximately 800 mL daily." Which client is at risk for this loss? A- The client with sepsis B- The client with cirrhosis C- The client with kidney failure D- The client with DM

D- The client with DM

The nurse reviews electrolyte values and notes a sodium level of 130 mEq/l. The nurse expects that this sodium level would be noted in a client with which condition? A- The client with watery diarrhea B- The client with diabetes insipidus C- The client with an inadequate daily water intake D- The client with the syndrome of inappropriate secretion of antidiuretic hormone

D- The client with the syndrome of inappropriate secretion of antidiuretic hormone

A nurse is collecting data from a client who is dehydrated due to fluid volume deficit. which of the following findings should the nurse expect? A- Moist skin B- Distended neck veins C- Increased urinary output D- Thready pulses

D- Thready pulses

Which client would the nurse determine is at risk for development of metabolic alkalosis? Select all that apply A- client with emphysema B- client who is hyperventilating C- client with chronic kidney disease D- client who has been vomiting for 2 days E- Client receiving oral furosemide 40 mg daily F- Client admitted with acetylsalicylic acid overdose

D- client who has been vomiting for 2 days E- Client receiving oral furosemide 40 mg daily

What serum sodium level confirms a diagnosis of hyponatremia? A-150 mEq/L B-145 mEq/L C-135 mEq/L D-130 mEq/L

D-130 mEq/L

Which client condition poses a highest risk for the development of respiratory acidosis? A-Renal disease B-Hyperventilating C-Excessive gastric sunctioning D-Chronic emphysema

D-Chronic emphysema

Consists of the intravascular fluid and the interstitial fluid

ECF

Deficiency of fluid and electrolytes in the ECF

FVD

Excessive retention of water and sodium in the ECF

FVE

True or False Excess production of antidiuretic hormone causes salt retention in excess of water retention.

False

True or False Extracellular fluid is normally maintained at neutral pH.

False

True or False Hyponatremia is the term used for a decrease in serum potassium level.

False

Excessive retention of water and sodium in the ECF

Fluid Volume Excess

Swelling that does not indent when slight pressure is applied

Nonpitting edema

Total amount of water in the body expressed as a percentage of body weight

TBW

True or False An excess of serum bicarbonate causes metabolic alkalosis.

True

True or False Edematous skin is friable and prone to breakdown.

True

When the blood is more acidic than normal caused by a deficit of bicarbonate ions or an excess of hydrogen ions

acidosis

When the blood is more basic than normal due to loss of body acids, or excessive retention of alkaline substances

alkalosis

Generalized body edema is called _________.

anasarca

Calcitriol is a regulator of __________ metabolism

calcium

Decreased volume of water that does not occur without electrolyte changes

dehydration

Skin tenting is an indication of __________.

dehydration

Excessive accumulation of interstitial fluid

edema

Deficiency of fluid and electrolytes in the ECF

fluid volume deficit

Fluid within the cells

intracellular fluid (ICF)

Unit of measurement of electrolytes that is miliequivalents per liter

meq/L

Caused by an excess of bicarbonate, often due to excess bicarbonate antacid administration or the loss of acids

metabolic alkalosis

Milligrams per deciliter

mg/dL

________ is the major electrolyte in the intracellular fluid.

potassium

Increased carbon dioxide in the blood is seen in a condition called __________ acidosis.

respiratory

Increase in blood carbon dioxide caused by hypoventilation

respiratory acidosis

Decrease in blood carbon dioxide caused by hyperventilation

respiratory alkalosis

Elasticity or tonus of the skin

turgor