CHAPTER 11 Fluid and Electrolytes Imbalances

d. Offer the patient bottled water to drink.

1. After a 5-km run on a hot summer day, a diaphoretic patient tells the volunteer nurse that she is very thirsty. What is the nurse's best action? a. Instruct the patient to sit down. b. Apply ice to the patient's axilla areas. c. Tell the patient to breathe slowly and deeply. d. Offer the patient bottled water to drink.

a. Offer patients a choice of fluids every 1 hour.

10. The nurse is working in a long-term care facility where there are numerous patients who are immobile and at risk for dehydration. Which task is best to delegate to the unli- censed assistive personnel (UAP)? a. Offer patients a choice of fluids every 1 hour. b. Check patients at the beginning of the shift to see who is thirsty. c. Give patients extra fluids around medication times. d. Evaluate oral intake and urinary output.

a. Bradycardia and hypotension

100. The nurse is assessing a patient with severe hypermagnesemia. Which assessment findings are associated with this electrolyte imbalance? a. Bradycardia and hypotension b. Tachycardia and weak palpable pulse c. Hypertension and irritability d. Irregular pulse and deep respirations

c. Discontinue parenteral magnesium.

101. A patient in the hospital has a severely elevated magnesium level. Which intervention should the nurse complete first? a. Discontinue oral magnesium. b. Administer furosemide (Lasix). c. Discontinue parenteral magnesium. d. Administer calcium to treat bradycardia.

d. IV magnesium sulfate and discontinuation of diuretic therapy

102. A patient has a magnesium level of 0.8 mg/dL. Which treatment does the nurse expect to be ordered for this patient? a. Intramuscular magnesium sulfate b. Increased intake of fruits and vegetables c. Oral preparations of magnesium sulfate d. IV magnesium sulfate and discontinuation of diuretic therapy

a. Deep tendon reflexes

103. The nurse monitors the effectiveness of magnesium sulfate by assessing which factor every hour? a. Deep tendon reflexes b. Vital signs c. Serum laboratory values d. Urine output

c. Chronic kidney disease

104. Which condition places a patient at risk for hypocalcemia, hyperkalemia, and hypernatremia? a. Hypothyroidism b. Diabetes mellitus c. Chronic kidney disease d. Adrenal insufficiency

a. Hypocalcemia c. Hyponatremia e. Hypokalemia

105. A patient with congestive heart failure is receiving a loop diuretic. The nurse monitors for which electrolyte imbalances? Select all that apply. a. Hypocalcemia b. Hypercalcemia c. Hyponatremia d. Hypernatremia e. Hypokalemia f. Hyperkalemia

b. Notify the health care provider immediately.

106. The patient with a serum magnesium level of 2.9 mEq/L develops bradycardia with a prolonged P-R interval and a widened QRS. What is the nurse's best first action? a. Start an IV with 5% dextrose at 100 mL/hr. b. Notify the health care provider immediately. c. Auscultate the patient's apical heart rate. d. Prepare to administer supplemental magnesium by IV.

c. Decreasing urine output may mean hemorrhage and risk for shock.

11. The nurse is caring for a postoperative surgical patient in the recovery room. What is the main reason for carefully monitoring the patient's urine output? a. Decreasing urine output indicates poor kidney function. b. Increasing urine output can indicate too much IV fluid during surgery. c. Decreasing urine output may mean hemorrhage and risk for shock. d. Increasing urine output may mean that kidney function is returning to normal.

b. Age c. Gender e. Body fat f. Weight

12. Which factors affect the amount and distribution of body fluids? Select all that apply. a. Race b. Age c. Gender d. Height e. Body fat f. Weight

b. Increased respiratory rate, because the body perceives hypovolemia as hypoxia

13. The nurse is caring for a patient with hypovolemia secondary to severe diarrhea and vomiting. In evaluating the respiratory system for this patient, what does the nurse expect to find on assessment? a. No changes, because the respiratory system is not involved b. Increased respiratory rate, because the body perceives hypovolemia as hypoxia c. Hypoventilation, because the respiratory system is trying to compensate for low pH d. Normal respiratory rate, but a decreased oxygen saturation

d. Pinch the skin over the sternum and observe for tenting and resumption of skin to its normal position after release.

14. The nurse is assessing skin turgor in a 65-year-old patient. What is the correct technique to use with this patient? a. Observe the skin for a dry, scaly appearance and compare it to a previous assessment. b. Pinch the skin over the back of the hand and observe for tenting; count the number of seconds for the skin to recover position. c. Observe the mucous membranes and tongue for cracks, fissures, or a pasty coating. d. Pinch the skin over the sternum and observe for tenting and resumption of skin to its normal position after release.

a. Hemoconcentration

15. The emergency department (ED) nurse is caring for a patient who was brought in for significant alcohol intoxication and minor trauma to the wrist. What will serial hematocrits for this patient likely show? a. Hemoconcentration b. Normal and stable Hematocrits c. Progressively lower hemotocrits d. Decreasing osmolarity

a. Tall peaked T waves

16. Which changes on a patient's electrocardiogram (ECG) reflect hyperkalemia? a. Tall peaked T waves b. Narrow QRS complex c. Tall P waves d. Normal P-R interval

c. Stay with patients while they drink fluids and note the exact amount ingested.

17. The nurse is caring for several older adult patients who are at risk for dehydration. Which task can be delegated to the unlicensed assistive personnel (UAP)? a. Withhold fluids if patients have bowel or bladder incontinence. b. Assess for and report any difficulties that patients are having in swallowing. c. Stay with patients while they drink fluids and note the exact amount ingested. d. Divide the total amount of fluids needed

b. Fluid volume excess

18.The nurse assessing a patient notes a bounding pulse quality, neck vein distention when supine, presence of crackles in the lungs, and increasing peripheral edema. What fluid disorder do these findings reflect? a. Fluid volume deficit b. Fluid volume excess c. Fluid homeostasis d. Fluid dehydration

d. Assist the patient to change position every 2 hours.

19. A patient is at risk for fluid volume excess and dependent edema. Which task does the nurse delegate to the UAP? a. Massage the legs and heels to stimulate circulation. b. Evaluate the effectiveness of a pressure-reducing mattress. c. Assess the coccyx, elbows, and hips daily for signs of redness. d. Assist the patient to change position every 2 hours.

a. Increased, bounding pulse b. Jugular venous distention c. Presence of crackles e. Elevated blood pressure

2. Which findings indicate that a patient may have hypervolemia? Select all that apply. a. Increased, bounding pulse b. Jugular venous distention c. Presence of crackles d. Excessive thirst e. Elevated blood pressure f. Orthostatic hypotension

c. End-stage renal disease

20. The nurse is reviewing orders for several patients who are at risk for fluid volume overload. For which patient condition does the nurse question an order for diuretics? a. Pulmonary edema b. Congestive heart failure c. End-stage renal disease d. Ascites

c. Assess the patient for signs of fluid imbalance and check the specific gravity of the urine.

21. The unlicensed assistive personnel (UAP) reports to the nurse that a patient being evaluated for kidney problems has produced a large amount of pale-yellow urine. What does the nurse do next? a. Instruct the UAP to measure the amount carefully and then discard the urine. b. Instruct the UAP to save the urine in a large bottle for a 24-hour urine specimen. c. Assess the patient for signs of fluid imbalance and check the specific gravity of the urine. d. Compare the amount of urine output to the fluid intake for the previous 8 hours.

b. 1000

22. On admission, a patient with pulmonary edema weighed 151 lbs; now the patient's weight is 149 lbs. Assuming the patient was weighed both times with the same clothing, on the same scale, and at the same time of day, how many milliliters of fluid does the nurse estimate the patient has lost? a. 500 b. 1000 c. 2000 d. 2500

a. Greater than 3 lbs gained in a week or greater than 1 to 2 lbs gained in a 24-hour period

23. The nurse is giving discharge instructions to the patient with advanced heart failure who is at continued risk for fluid volume overload. For which physical change does the nurse instruct the patient to call the health care provider? a. Greater than 3 lbs gained in a week or greater than 1 to 2 lbs gained in a 24-hour period b. Greater than 5 lbs gained in a week or greater than 1 to 2 lbs gained in a 24-hour period c. Greater than 15 lbs gained in a month or greater than 5 lbs gained in a week d. Greater than 20 lbs gained in a month or greater than 5 lbs gained in a week

c. Help the incontinent patient to toilet every 1-2 hours.

24. The nurse is caring for several patients at risk for falls because of fluid and electrolyte imbalances. Which task related to patient safety and fall prevention does the nurse delegate to the UAP? a. Assess for orthostatic hypotension. b. Orient the patient to the environment. c. Help the incontinent patient to toilet every 1-2 hours. d. Encourage family members or significant other to stay with the patient.

b. Dehydration

25. The nurse is assessing a patient's urine specific gravity. The value is 1.035. How does the nurse interpret this result? a. Overhydration b. Dehydration c. Normal value for an adult d. Renal disease

b. Controls intracellular osmolarity and volume d. Functions as the major cation of intracellular fluid (ICF) e. Regulates glucose use and storage f. Helps maintain normal cardiac rhythm

26. What are the functions of potassium in the body? Select all that apply. a. Regulates hydration status b. Controls intracellular osmolarity and volume c. Stimulates the secretion of antidiuretic hormone (ADH) d. Functions as the major cation of intracellular fluid (ICF) e. Regulates glucose use and storage f. Helps maintain normal cardiac rhythm

a. Maintains electroneutrality d. Regulates water balance e. Low sodium stimulates secretion of aldosterone f. Regulates plasma osmolality

27. What impacts does sodium have on body function? Select all that apply. a. Maintains electroneutrality b. Maintains electrical membrane excitability c. Aids in carbohydrate and lipid metabolism d. Regulates water balance e. Low sodium stimulates secretion of aldosterone f. Regulates plasma osmolality

b. Carbohydrate metabolism c. Contraction of skeletal muscle e. Vitamin activation f. Blood coagulation

28. The electrolyte magnesium is responsible for which functions? Select all that apply. a. Formation of hydrochloric acid b. Carbohydrate metabolism c. Contraction of skeletal muscle d. Regulation of intracellular osmolarity e. Vitamin activation f. Blood coagulation

c. "I love Chinese food, but I gave it up because of the soy sauce."

29. A patient is talking to the nurse about sodium intake. Which statement by the patient indicates an understanding of high- sodium food sources? a. "I have bacon and eggs every morning for breakfast." b. "We never eat seafood because of the salt water." c. "I love Chinese food, but I gave it up because of the soy sauce." d. "Pickled herring is a fish, and my doctor told me to eat a lot of fish."

b. Concentration gradient

3. What is the term for a difference in concentration of particles that is greater on one side of a permeable membrane than on the other side? a. Hydrostatic pressure b. Concentration gradient c. Passive transport d. Active transport

a. It increases permeability to water in the tubules, causing a decrease in urine output.

30. Which statement best explains how antidi- uretic hormone (ADH) affects urine output? a. It increases permeability to water in the tubules, causing a decrease in urine output. b. It increases urine output as a result of water being absorbed by the tubules. c. Urine output is reduced as the posterior pituitary decreases ADH production. d. Increased urine output results from increased osmolarity and fluid in the extracellular space.

a. Hyperactive bowel sounds on auscultation d. Frequent watery bowel movements e. Abdominal cramping f. Nausea

31. A patient with hyponatremia would have which gastrointestinal findings upon assessment? Select all that apply. a. Hyperactive bowel sounds on auscultation b. Hard, dark-brown stools c. Hypoactive bowel sounds on auscultation d. Frequent watery bowel movements e. Abdominal cramping f. Nausea

b. Turn on a bed alarm when the patient is in bed. d. Place the patient on a low bed. e. Ensure the top side rails are up when the patient is in bed.

32. The nurse is caring for a patient with severe hypocalcemia. What safety measures does the nurse put in place for this patient? Select all that apply. a. Encourage the patient to use a cane when ambulating. b. Turn on a bed alarm when the patient is in bed. c. Obtain an order for zolpidem (Ambien) to ensure the patient sleeps at night. d. Place the patient on a low bed. e. Ensure the top side rails are up when the patient is in bed. f. Raise all four side rails.

a. Postoperative patient who has been NPO (nothing by mouth) for 24 hours with no IV fluid infusing c. Patient receiving excessive intravenous fluids with 5% dextrose d. Diabetic patient with blood glucose of 250 mg/dL f. Tennis player in 100°F (37.7oC) weather who has been drinking water

33. Which patients are at risk for developing hyponatremia? Select all that apply. a. Postoperative patient who has been NPO (nothing by mouth) for 24 hours with no IV fluid infusing b. Patient with decreased fluid intake for three days c. Patient receiving excessive intravenous fluids with 5% dextrose d. Diabetic patient with blood glucose of 250 mg/dL e. Patient with overactive adrenal glands f. Tennis player in 100°F (37.7oC) weather who has been drinking water

d. Hypernatremia

34. The nurse is evaluating the lab results of a patient with hyperaldosteronism. What abnormal electrolyte finding does the nurse expect to see? a. Hyponatremia b. Hyperkalemia c. Hypocalcemia d. Hypernatremia

c. Assess the patient.

35. The unlicensed assistive personnel (UAP) informs the nurse that a patient with hypernatremia who was initially confused and disoriented on admission to the hospital is now trying to pull out the IV access and indwelling urinary catheter. What is the nurse's first action? a. Place bilateral soft wrist restraints. b. Inform the provider of the patient's change in behavior and obtain an order for restraints. c. Assess the patient. d. Offer the patient oral fluids.

c. Severe diarrhea d. Decreased kidney function e. Profound diaphoresis f. Cushing's syndrome

36. Patients with which conditions are at risk for developing hypernatremia? Select all that apply. a. Chronic constipation b. Heart failure c. Severe diarrhea d. Decreased kidney function e. Profound diaphoresis f. Cushing's syndrome

a. Conivaptan

37. The provider has ordered therapy for a patient with low sodium and signs of hypervolemia. Which diuretic is best for this patient? a. Conivaptan b. Furosemide c. Hydrochlorothiazide d. Bumetanide

a. Muscle twitching and irregular muscle contractions

38. The nurse is assessing a patient with a mild increase in sodium level. What early manifes- tation does the nurse observe in this patient? a. Muscle twitching and irregular muscle contractions b. Inability of muscles and nerves to respond to a stimulus c. Muscle weakness occurring bilaterally with no specific pattern d. Reduced or absent bilateral deep tendon reflexes

d. 0.9% sodium chloride

39. The nurse is caring for a patient with hyperna- tremia caused by fluid loss. What type of IV solution is best for treating this patient? a. Hypotonic 0.225% sodium chloride b. Small-volume infusions of hypertonic (2%-3%) saline c. Isotonic sodium chloride (NaCl) d. 0.9% sodium chloride

b. Thirst

4. A patient's blood osmolarity is 302 mOsm/L. What manifestation does the nurse expect to see in the patient? a. increased Urine Output b. Thirst c. Pheripherial Edema d. Nausea

a. Sodium less than 136 mEq/L

40. Which serum value does the nurse expect to see for a patient with hyponatremia? a. Sodium less than 136 mEq/L b. Chloride less than 95 mEq/L c. Sodium less than 145 mEq/L d. Chloride less than 103 mEq/L

b. Change in mental status/increased intracranial pressure

41. The nurse is caring for a psychiatric patient who is continuously drinking water. The nurse monitors for which complication related to potential hyponatremia? a. Proteinuria/prerenal failure b. Change in mental status/increased intracranial pressure c. Pitting edema/circulatory failure d. Possible occult blood/gastrointestinal bleeding in stool

d. Administration of bumetanide f. Diuretics such as furosemide

42. What interventions are appropriate for a patient with hypernatremia caused by reduced kidney sodium excretion? Select all that apply. a. Hypotonic solutions b. 0.45% sodium chloride intravenous infusion c. D5W intravenous infusion d. Administration of bumetanide e. Ensure adequate water intake f. Diuretics such as furosemide

d. Long-term NPO status

43. The nurse is caring for several patients at risk for fluid and electrolyte imbalances. Which patient problem or condition can result in a relative hypernatremia? a. Use of a salt substitute b. Presence of a feeding tube c. Drinking too much water d. Long-term NPO status

b. Increased pulse rate e. Muscle weakness f. Difficulty palpating peripheral pulses

44. The nurse is caring for an older adult patient whose serum sodium level is 150 mEq/L. The nurse assesses the patient for which com- mon signs and symptoms associated with this sodium level? Select all that apply. a. Intact recall of recent events b. Increased pulse rate c. Rigidity of extremities d. Hyperactivity e. Muscle weakness f. Difficulty palpating peripheral pulses

c. Read labels on canned or packaged foods to determine sodium content.

45. Which precaution or intervention does the nurse teach a patient at continued risk for hypernatremia? a. Avoid salt substitutes. b. Avoid aspirin and aspirin-containing products. c. Read labels on canned or packaged foods to determine sodium content. d. Increase daily intake of caffeine- containing foods and beverages.

a. Hypokalemia

46. On assessment, the patient has respiratory muscle weakness resulting in shallow respira- tions. Which electrolyte abnormality would the nurse suspect? a. Hypokalemia b. Hyperkalemia c. Hypocalcemia d. Hypercalcemia

a. Administration of furosemide b. Hemodialysis d. Dietary sodium restriction

47. A patient with renal failure that results in hypernatremia will require which interven- tions? Select all that apply. a. Administration of furosemide b. Hemodialysis c. IV infusion of 0.9% sodium chloride d. Dietary sodium restriction e. Administration of potassium supplement f. Administration of demeclocycline

a.Do not add salt to ordinary table foods.

48. The patient with mild fluid volume overload has been instructed by the provider to follow dietary sodium restriction. What would the nurse teach this patient about sodium restriction? a.Do not add salt to ordinary table foods. b. Restrict sodium intake to 2 gm per day. c. Restrict sodium intake to 4 gm per day. d. Do not add salt when cooking or eating

b. Hyperkalemia

49. A hospitalized patient who is known to be homeless has been diagnosed with severe malnutrition, end-stage renal disease, and anemia. He is transfused with three units of packed red blood cells. Which potential electrolyte imbalance does the nurse anticipate could occur in this patient? a. Hypernatremia b. Hyperkalemia c. Hypercalcemia d. Hypermagnesemia

d. Mental status changes

5. An older adult patient at risk for fluid and electrolyte problems is carefully monitored by the nurse for the first indication of a fluid balance problem. What is this indication? a. Fever b. Elevated blood pressure c. Poor skin turgor d. Mental status changes

B

50. The patient has severe hypokalemia (2.4 mEq/L). For which intestinal complication does the nurse monitor? a. Hypoactive bowel sounds b. c. Nausea d. Constipation

b. Obtain a list of the patient's home medications. c. Assess the patient for hyperkalemia. d. Ask about the patient's method of taking medications at home.

51. A newly admitted patient with congestive heart failure has a potassium level of 5.7 mEq/L. How does the nurse identify contributing factors for the electrolyte imbalance? Select all that apply. a. Assess the patient for hypokalemia. b. Obtain a list of the patient's home medications. c. Assess the patient for hyperkalemia. d. Ask about the patient's method of taking medications at home. e. Evaluate the patient's appetite. f. Auscultate for hypoactive bowel sounds.

d. Hyperkalemia

52. A young adult patient is in the early stages of being treated for severe burns. Which electrolyte imbalance does the nurse expect to assess in this patient? a. Hypernatremia b. Hypokalemia c. Hypercalcemia d. Hyperkalemia

b. Metabolic alkalosis c. Cushing's syndrome e. Paralytic ileus

53. A patient with hypokalemia is likely to have which conditions? Select all that apply. a. Liver failure b. Metabolic alkalosis c. Cushing's syndrome d. Hypothyroidism e. Paralytic ileus f. Kidney failure

a. Hyperkalemia

54. The nurse is taking care of a trauma patient who was in a motor vehicle accident. The patient has a history of hypertension, which is managed with spironolactone. This patient is at risk for developing which electrolyte imbalance? a. Hyperkalemia b. Hypernatremia c. Hypokalemia d. Hypocalcemia

d. Potassium less than 3.5 mEq/L

55. Which serum laboratory value does the nurse expect to see in the patient with hypokalemia? a. Calcium less than 8.0 mg/dL b. Potassium less than 5.0 mEq/L c. Calcium less than 11.0 mg/dL d. Potassium less than 3.5 mEq/L

a. General skeletal muscle weakness c. Lethargy e. Weak hand grasps f. Weak, thready pulse

56. The patient's potassium level is 2.5 mEq/L. Which clinical findings does the nurse expect to see when assessing this patient? Select all that apply. a. General skeletal muscle weakness b. Moist crackles and tachypnea c. Lethargy d. Decreased urine output e. Weak hand grasps f. Weak, thready pulse

b. Cardiac dysrhythmia

57. The nurse administering potassium to a patient carefully monitors the infusion because of the risk for which condition? a. Pulmonary edema b. Cardiac dysrhythmia c. Postural hypotension d. Renal failure

b. KCl10mEqin100mLNS

58. The patient with hypokalemia has an IV potassium supplement ordered. Which IV potassium supplement can be administered safely? a. KCl 5 mEq in 20 mL NS b. KCl10mEqin100mLNS c. KCl15mEqin50mLNS d. KCl20mEqin100mLNS

b. "When I take the liquid potassium in the evening, I'll eat a snack beforehand."

59. The nurse is teaching the patient about hypokalemia. Which statement by the patient indicates a correct understanding of the treatment of hypokalemia? a. "My wife does all the cooking. She shops for food high in calcium." b. "When I take the liquid potassium in the evening, I'll eat a snack beforehand." c. "I will avoid bananas, orange juice, and salt substitutes." d. "I hate being stuck with needles all the time to monitor how much sugar I can eat.

a. Lethal electrolyte imbalances d. Toxic buildup of nitrogen f. Acidosis

6. What are the consequences for a patient who does not meet the obligatory urine output? Select all that apply. a. Lethal electrolyte imbalances b. Alkalosis c. Urine becomes diluted d. Toxic buildup of nitrogen e. Urine output increases f. Acidosis

b. Digoxin toxicity can result if hypokalemia is present.

60. The nurse is caring for a patient who takes potassium and digoxin. For what reason does the nurse monitor both laboratory results? a. Digoxin increases potassium loss through the kidneys. b. Digoxin toxicity can result if hypokalemia is present. c. Digoxin may cause potassium levels to rise to toxic levels. d. Hypokalemia causes the cardiac muscle to be less sensitive to digoxin.

d. Potassium greater than 5.0 mEq/L

61. Which serum laboratory value does the nurse expect to see in a patient with hyperkalemia? a. Calcium greater than 8.0 mg/dL b. Potassium greater than 3.5 mEq/L c. Calcium greater than 11.0 mg/dL d. Potassium greater than 5.0 mEq/L

b. Numbness in hands and feet and around the mouth c. Frequent, watery stools d. Irregular heart rate f. Muscle weakness

62. A patient has an elevated potassium level. Which assessment findings are associated with hyperkalemia? Select all that apply. a. Wheezing on exhalation b. Numbness in hands and feet and around the mouth c. Frequent, watery stools d. Irregular heart rate e. Circumoral cyanosis f. Muscle weakness

a. Soybeans c. Cantaloupe d. Potatoes f. Bananas

63. The nurse is teaching a patient with hypokale- mia about foods high in potassium. Which food items does the nurse recommend to this patient? Select all that apply. a. Soybeans b. Lettuce c. Cantaloupe d. Potatoes e. Peaches f. Bananas

b. Cardiac dysrhythmia

64. A patient's serum potassium value is below 2.8 mEq/L. The patient is also on digoxin. The nurse quickly assesses the patient for which cardiac problem before notifying the provider? a. Cardiac murmur b. Cardiac dysrhythmia c. Congestive heart failure d. Cardiac tamponade

b. 3.5 mmol/L c. 4.5 mmol/L d. 5.0 mmol/L

65. Which potassium levels are within normal limits? Select all that apply. a. 2.0 mmol/L b. 3.5 mmol/L c. 4.5 mmol/L d. 5.0 mmol/L e. 6.0 mmol/L

a. Increased hematocrit and hemoglobin levels

66. A patient has hyperkalemia resulting from dehydration. Which additional laboratory findings does the nurse anticipate for this patient? a. Increased hematocrit and hemoglobin levels b. Decreased serum electrolyte levels c. Increased urine potassium levels d. Decreased serum creatinine

c. Normal for the patient's age

67. A 65-year-old patient has a potassium labora- tory value of 5.0 mEq/L. How does the nurse interpret this value? a. High for the patient's age b. Low for the patient's age c. Normal for the patient's age d. Dependent upon the medical diagnosis

a. Elevated serum creatinine b. Decreased blood pH d. Low to normal hematocrit

68. A patient's potassium level is high secondary to kidney failure. What laboratory changes does the nurse expect to see? Select all that apply. a. Elevated serum creatinine b. Decreased blood pH c. Elevated sodium d. Low to normal hematocrit e. Elevated hemoglobin f. Decreased blood urea nitrogen

b. The extracellular compartment d. Interstitial fluid e. Intravascular fluid

69. Plasma is part of which body fluid space compartments? Select all that apply. a. The intracellular compartment b. The extracellular compartment c. All fluid within the cells d. Interstitial fluid e. Intravascular fluid f. Fluid within joint capsules

b. 400 to 600 mL

7. What is the minimum amount of urine output per day needed to excrete toxic waste products? a. 200 to 300 mL b. 400 to 600 mL c. 500 to 1000 mL d. 1000 to 1500 mL

c. Extracellular fluid is highest in sodium and chloride.

70. Which fluid has the highest corresponding electrolyte content? a. Intracellular fluid is highest in potassium. b. Extracellular fluid is highest in sodium. c. Extracellular fluid is highest in sodium and chloride. d. Intracellular fluid is highest in magnesium and sodium.

b. Intracellular fluid

71. Which component has a high content of potassium and phosphorus? a. Extracellular fluid b. Intracellular fluid c. Extracellular fluid and the intravascular space d. Intracellular fluid and lymph fluid

b. Double-check the provider's order and call the pharmacy.

72. A patient with low potassium requires an IV potassium infusion. The pharmacy sends a 250-mL IV bag of dextrose in water with 40 mEq of potassium. The label is marked "to infuse over 1 hour." What is the nurse's best action? a. Obtain a pump and administer the solution. b. Double-check the provider's order and call the pharmacy. c. Hold the infusion because there is an error in labeling. d. Recalculate the rate so that it is safe for the patient.

b. Ask the patient's preference of juice and mix the drug with a small amount.

73. An older adult patient needs an oral potassium solution but is refusing it because it has a strong and unpleasant taste. What is the best strategy the nurse can use to administer the drug? a. Tell the patient that failure to take the drug could result in serious heart problems. b. Ask the patient's preference of juice and mix the drug with a small amount. c. Mix the solution into food on the patient's meal tray and encourage the patient to eat everything. d. Offer the drug to the patient several times and then document the patient's refusal.

a. Intravenous line patency

74. A patient has a low potassium level, and the provider has ordered an IV infusion. Before starting an IV potassium infusion, what does the nurse assess? a. Intravenous line patency b. Oxygen saturation level c. Baseline mental status d. Apical pulse

b. Dried beans c. Potatoes e. Cantaloupe f. Canned sausage

75. Which foods will the nurse instruct a patient with kidney disease and hyperkalemia to avoid? Select all that apply. a. Canned apricots b. Dried beans c. Potatoes d. Cabbage e. Cantaloupe f. Canned sausage

c. It binds with potassium in the GI tract and decreases its absorption.

76. The patient with hyperkalemia is prescribed patiromer. Which statement most accurately describes the function of this drug? a. It works in the kidneys to increase excretion of potassium. b. The drug prevents the kidneys from absorbing potassium. c. It binds with potassium in the GI tract and decreases its absorption. d. The drug increases motility in the GI tract, eliminating potassium in diarrhea stools.

a. Releasing free calcium from the bones c. Stimulating kidney reabsorption of calcium d. Causing vitamin D activation e. Increasing calcium absorption in the GI tract

77. By which mechanisms does parathyroid hormone (PTH) increase serum calcium levels? Select all that apply. a. Releasing free calcium from the bones b. Increasing calcium excretion in the urine c. Stimulating kidney reabsorption of calcium d. Causing vitamin D activation e. Increasing calcium absorption in the GI tract f. Pulling calcium out of the cells

a. Increased heart rate c. Decreased deep tendon reflexes d. Hypoactive bowel sounds e. Shortened QT interval

78. Which assessment findings are related to mild hypercalcemia? Select all that apply. a. Increased heart rate b. Paresthesia c. Decreased deep tendon reflexes d. Hypoactive bowel sounds e. Shortened QT interval f. Profound muscle weakness

a. Increased heart rate b. Paresthesia d. Hypoactive bowel sounds

79. Which assessment findings are related to mild hypercalcemia? Select all that apply. a. Increased heart rate b. Paresthesia c. Decreased deep tendon reflexes d. Hypoactive bowel sounds e. Shortened QT interval

a. Patient with continuous GI suctioning

8. Which patient is at risk for excess insensible water loss? a. Patient with continuous GI suctioning b. Patient with slow, deep respirations c. Patient receiving oxygen therapy d. Patient with hypothermia

b. 8.0 mg/dL

80. The nurse is reviewing the laboratory calcium level results for a patient. Which value indicates mild hypocalcemia? a. 5.0 mg/dL b. 8.0 mg/dL c. 10.0 mg/dL d. 12.0 mg/dL

a. Hypocalcemia

81. A patient with a recent history of anterior neck injury reports muscle twitching and spasms with tingling in the lips, nose, and ears. The nurse suspects these symptoms may be caused by which condition? a. Hypocalcemia b. Hypokalemia c. Hyponatremia d. Hypomagnesemia

a. Crohn's disease b. Acute pancreatitis c. Removal or destruction of parathyroid glands d. Immobility f. GI wound drainage

82. Which conditions cause a patient to be at risk for hypocalcemia? Select all that apply. a. Crohn's disease b. Acute pancreatitis c. Removal or destruction of parathyroid glands d. Immobility e. Use of digitalis f. GI wound drainage

c. Tap the patient's face just below and in front of the ear to trigger facial twitching of one side of the mouth, nose, and cheek.

83. The nurse is assessing the patient with a risk for hypocalcemia. What is the correct technique to test for Chvostek's sign? a. Patient flexes arms against the chest and examiner attempts to pull the arms away from the chest. b. Place a blood pressure cuff around the upper arm and inflate the cuff to greater than the patient's systolic pressure. c. Tap the patient's face just below and in front of the ear to trigger facial twitching of one side of the mouth, nose, and cheek. d. Lightly tap the patient's patellar and Achilles tendons with a reflex hammer and measure the movement.

d. Placing the patient on seizure precautions

84. The nurse is caring for several patients with electrolyte imbalances. Which intervention is included in the plan of care for a patient with hypomagnesemia? a. Implementing an oral fluid restriction of 1500 mL/day b. Implementing a renal diet c. Providing moderate environmental stimulation with music d. Placing the patient on seizure precautions

b. Increased intestinal and gastric motility

85. Which clinical condition can result from hypocalcemia? a. Stimulated cardiac muscle contraction b. Increased intestinal and gastric motility c. Decreased peripheral nerve excitability d. Increased bone density

c. 60-year-old African-American woman with a recent ileostomy

86. Which patient is at greatest risk of developing hypocalcemia? a. 30-year-old Asian woman with breast cancer b. 45-year-old Caucasian man with hypertension and diuretic therapy c. 60-year-old African-American woman with a recent ileostomy d. 70-year-old Caucasian man on long-term lithium therapy

a. Increase daily dietary calcium and vitamin D intake.

87.Which is a preventive measure for patients at risk for developing hypocalcemia? a. Increase daily dietary calcium and vitamin D intake. b. Increase intake of phosphorus. c. Apply sunblock and wear protective clothing whenever outdoors. d. Administer calcium-containing IV fluids to patients receiving multiple blood transfusions.

a. Thyroidectomy

88. The patient who has undergone which surgical procedure is most at risk for hypocalcemia? a. Thyroidectomy b. Adrenalectomy c. Pancreatectomy d. Gastrectomy

b. 50-year-old postmenopausal woman

89. Which patient is at greatest risk for chronic hypocalcemia? a. 38-year-old man with chronic kidney disease b. 50-year-old postmenopausal woman c. 62-year-old man with type 2 diabetes d. 78-year-old woman with dehydration

a. Fever of 103°F (39.4oC) b. Extensive burns c. Thyroid crisis e. Continuous fistula drainage f. Diabetes insipidus

9. Patients with which conditions are at greatest risk for deficient fluid volume? Select all that apply. a. Fever of 103°F (39.4oC) b. Extensive burns c. Thyroid crisis d. Water intoxication e. Continuous fistula drainage f. Diabetes insipidus

a. Positive Chvostek's sign c. Diarrhea d. Prolonged ST interval f. Positive Trousseau's sign

90. Which are typical nursing assessment findings for a patient with hypocalcemia? Select all that apply. a. Positive Chvostek's sign b. Hypertension c. Diarrhea d. Prolonged ST interval e. Elevated T wave f. Positive Trousseau's sign

d. Provide adequate intake of vitamin D and calcium-rich foods.

91. Which intervention does the nurse implement for a patient with hypocalcemia? a. Encourage activity by the patient as tolerated, including weight-lifting. b. Encourage socialization and active participation in stimulating activities. c. Keep a tracheostomy tray at the bedside for emergency use. d. Provide adequate intake of vitamin D and calcium-rich foods.

b. Cheese e. Milk f. Salmon

92. A patient with hypocalcemia needs supple- mental diet therapy. Which foods does the nurse recommend, providing both calcium and vitamin D? Select all that apply. a. Tofu b. Cheese c. Eggs d. Broccoli e. Milk f. Salmon

a. IV calcium

93. A patient shows a positive Trousseau's or Chvostek's sign. The nurse prepares to give the patient which urgent treatment? a. IV calcium b. Calcitonin c. IV potassium chloride d. Large doses of oral calcium

a. Administer IV normal saline (0.9% sodium chloride). c. Ensure adequate hydration. f. Provide continuous cardiac monitoring.

94. Which are appropriate interventions for a patient who has hypercalcemia? Select all that apply. a. Administer IV normal saline (0.9% sodium chloride). b. Administer hydrochlorothiazide (HCTZ). c. Ensure adequate hydration. d. Administer calcium-based antacid for GI upset. e. Discourage weight-bearing activity such as walking. f. Provide continuous cardiac monitoring.

b. Calcitonin c. Furosemide d. Plicamycin

95. The nurse caring for a patient with hypercalce- mia anticipates orders for which medications? Select all that apply. a. Magnesium sulfate b. Calcitonin c. Furosemide d. Plicamycin e. Calcium gluconate f. Aluminum hydroxide

c. Older woman with hypocalcemia

96. The nurse instructs the unlicensed assistive personnel (UAP) to use precautions with moving and using a lift sheet for which patient with an electrolyte imbalance? a. Young woman with diabetes and hyperkalemia b. Patient with psychiatric illness and hyponatremia c. Older woman with hypocalcemia d. Child with severe diarrhea and hypomagnesemia

a. Inadequate intake of magnesium e. Prescription of loop diuretics

97. Which are major causes of hypomagnesemia? Select all that apply. a. Inadequate intake of magnesium b. Inadequate intake of sodium c. Use of potassium-sparing diuretics d. Decreased kidney excretion of magnesium e. Prescription of loop diuretics f. Cessation of alcohol intake

d. Intravenous

98. The health care provider orders magnesium sulfate (MgSO4) for a patient with severe hypomagnesemia. What is the preferred route of administration for this drug? a. Oral b. Subcutaneous c. Intramuscular d. Intravenous

b. Potassium and calcium

99. In addition to magnesium levels, which other lab values should the nurse be sure to monitor when a patient has hypomagnesemia? a. Sodium and potassium b. Potassium and calcium c. Calcium and sodium d. Chloride and sodium

C

A client at risk for developing hyperkalemia states, "I love fruit and usually eat it every day, but now I can't because of my high potassium level." How should the nurse respond? a. "Potatoes and avocados can be substituted for fruit." b. "If you cook the fruit, the amount of potassium will be lower." c. "Berries, cherries, apples, and peaches are low in potassium." d. "You are correct. Fruit is very high in potassium."

D. Blood pressure has increased from 100/50 mm Hg to 112/70 mm Hg.

A client is receiving 250 mL of a 3% sodium chloride solution intravenously for severe hyponatremia. Which signs or symptoms indicate to the nurse that this therapy is effective? A. The client reports hand swelling. B. Bowel sounds are present in all four abdominal quadrants. C. Serum potassium level has decreased from 4.4 mEq/L (mmol/L) to 4.2 mEq/L (mmol/L). D. Blood pressure has increased from 100/50 mm Hg to 112/70 mm Hg.

A B E

A nurse assesses a client who is admitted for treatment of fluid overload. Which manifestations should the nurse expect to find? (Select all that apply.) a. Increased pulse rate b. Distended neck veins c. Decreased blood pressure d. Warm and pink skin e. Skeletal muscle weakness

B E

A nurse assesses a client who is prescribed a medication that inhibits aldosterone secretion and release. For which potential complications should the nurse assess? (Select all that apply.) a. Urine output of 25 mL/hr b. Serum potassium level of 5.4 mEq/L c. Urine specific gravity of 1.02 g/mL d. Serum sodium level of 128 mEq/L e. Blood osmolality of 250 mOsm/L

A

A nurse assesses a client who is prescribed a medication that inhibits angiotensin I from converting into angiotensin II (angiotensin-converting enzyme [ACE] inhibitor). For which expected therapeutic effect should the nurse assess? a. Blood pressure decrease from 180/72 mm Hg to 144/50 mm Hg b. Daily weight increase from 55 kg to 57 kg c. Heart rate decrease from 100 beats/min to 82 beats/min d. Respiratory rate increase from 12 breaths/min to 15 breaths/min

C

A nurse cares for a client who has a serum potassium of 7.5 mEq/L and is exhibiting cardiovascular changes. Which prescription should the nurse implement first? a. Prepare to administer sodium polystyrene sulfate (Kayexalate) 15 g by mouth. b. Provide a heart healthy, low-potassium diet. c. Prepare to administer dextrose 20% and 10 units of regular insulin IV push. d. Prepare the client for hemodialysis treatment.

B D

A nurse develops a plan of care for a client who has a history of hypocalcemia. What interventions should the nurse include in this client's care plan? (Select all that apply.) a. Encourage oral fluid intake of at least 2 L/day. b. Use a draw sheet to reposition the client in bed. c. Strain all urine output and assess for urinary stones. d. Provide nonslip footwear for the client to use when out of bed. e. Rotate the client from side to side every 2 hours.

A D E

A nurse is assessing a client who has an electrolyte imbalance related to renal failure. For which potential complications of this electrolyte imbalance should the nurse assess? (Select all that apply.) a. Electrocardiogram changes b. Slow, shallow respirations c. Orthostatic hypotension d. Paralytic ileus e. Skeletal muscle weakness

A

A nurse is assessing a client with hypokalemia, and notes that the client's handgrip strength has diminished since the previous assessment 1 hour ago. Which action should the nurse take first? a. Assess the client's respiratory rate, rhythm, and depth. b. Measure the client's pulse and blood pressure. c. Document findings and monitor the client. d. Call the health care provider.

ANS: A

A nurse is assessing clients for fluid and electrolyte imbalances. Which client should the nurse assess first for potential hyponatremia? a. A 34-year-old on NPO status who is receiving intravenous D5W b. A 50-year-old with an infection who is prescribed a sulfonamide antibiotic c. A 67-year-old who is experiencing pain and is prescribed ibuprofen (Motrin) d. A 73-year-old with tachycardia who is receiving digoxin (Lanoxin)

B

A nurse is assessing clients on a medical-surgical unit. Which adult client should the nurse identify as being at greatest risk for insensible water loss? a. Client taking furosemide (Lasix) b. Anxious client who has tachypnea c. Client who is on fluid restrictions d. Client who is constipated with abdominal pain

A

A nurse is assessing clients on a medical-surgical unit. Which client is at risk for hypokalemia? a. Client with pancreatitis who has continuous nasogastric suctioning b. Client who is prescribed an angiotensin-converting enzyme (ACE) inhibitor c. Client in a motor vehicle crash who is receiving 6 units of packed red blood cells d. Client with uncontrolled diabetes and a serum pH level of 7.33

A B E

A nurse is assessing clients on a medical-surgical unit. Which clients are at increased risk for hypophosphatemia? (Select all that apply.) a. A 36-year-old who is malnourished b. A 42-year-old with uncontrolled diabetes c. A 50-year-old with hyperparathyroidism d. A 58-year-old with chronic renal failure e. A 76-year-old who is prescribed antacids

B

A nurse is caring for a client who exhibits dehydration-induced confusion. Which intervention should the nurse implement first? a. Measure intake and output every 4 hours. b. Apply oxygen by mask or nasal cannula. c. Increase the IV flow rate to 250 mL/hr. d. Place the client in a high-Fowler's position.

B

A nurse is caring for a client who has a serum calcium level of 14 mg/dL. Which provider order should the nurse implement first? a. Encourage oral fluid intake. b. Connect the client to a cardiac monitor. c. Assess urinary output. d. Administer oral calcitonin (Calcimar).

A

A nurse is caring for a client who has the following laboratory results: potassium 3.4 mEq/L, magnesium 1.8 mEq/L, calcium 8.5 mEq/L, sodium 144 mEq/L. Which assessment should the nurse complete first? a. Depth of respirations b. Bowel sounds c. Grip strength d. Electrocardiography

D

A nurse is caring for an older adult client who is admitted with moderate dehydration. Which intervention should the nurse implement to prevent injury while in the hospital? a. Ask family members to speak quietly to keep the client calm. b. Assess urine color, amount, and specific gravity each day. c. Encourage the client to drink at least 1 liter of fluids each shift. d. Dangle the client on the bedside before ambulating.

A C

A nurse is caring for clients with electrolyte imbalances on a medical-surgical unit. Which clinical manifestations are correctly paired with the contributing electrolyte imbalance? (Select all that apply.) a. Hypokalemia - Flaccid paralysis with respiratory depression b. Hyperphosphatemia - Paresthesia with sensations of tingling and numbness c. Hyponatremia - Decreased level of consciousness d. Hypercalcemia - Positive Trousseau's and Chvostek's signs e. Hypomagnesemia - Bradycardia, peripheral vasodilation, and hypotension

D

A nurse is evaluating a client who is being treated for dehydration. Which assessment result should the nurse correlate with a therapeutic response to the treatment plan? a. Increased respiratory rate from 12 breaths/min to 22 breaths/min b. Decreased skin turgor on the client's posterior hand and forehead c. Increased urine specific gravity from 1.012 to 1.030 g/mL d. Decreased orthostatic light-headedness and dizziness

C

A nurse teaches a client who is at risk for mild hypernatremia. Which statement should the nurse include in this client's teaching? a. "Weigh yourself every morning and every night." b. "Check your radial pulse twice a day." c. "Read food labels to determine sodium content." d. "Bake or grill the meat rather than frying it."

C

A nurse teaches clients at a community center about risks for dehydration. Which client is at greatest risk for dehydration? a. A 36-year-old who is prescribed long-term steroid therapy b. A 55-year-old receiving hypertonic intravenous fluids c. A 76-year-old who is cognitively impaired d. An 83-year-old with congestive heart failure

C D

After administering 40 mEq of potassium chloride, a nurse evaluates the client's response. Which manifestations indicate that treatment is improving the client's hypokalemia? (Select all that apply.) a. Respiratory rate of 8 breaths/min b. Absent deep tendon reflexes c. Strong productive cough d. Active bowel sounds e. U waves present on the electrocardiogram (ECG)

C

After teaching a client to increase dietary potassium intake, a nurse assesses the client's understanding. Which dietary meal selection indicates the client correctly understands the teaching? a. Toasted English muffin with butter and blueberry jam, and tea with sugar b. Two scrambled eggs, a slice of white toast, and a half cup of strawberries c. Sausage, one slice of whole wheat toast, half cup of raisins, and a glass of milk d. Bowl of oatmeal with brown sugar, a half cup of sliced peaches, and coffee

B

After teaching a client who is being treated for dehydration, a nurse assesses the client's understanding. Which statement indicates the client correctly understood the teaching? a. "I must drink a quart of water or other liquid each day." b. "I will weigh myself each morning before I eat or drink." c. "I will use a salt substitute when making and eating my meals." d. "I will not drink liquids after 6 PM so I won't have to get up at night."

D

After teaching a client who is prescribed a restricted sodium diet, a nurse assesses the client's understanding. Which food choice for lunch indicates the client correctly understood the teaching? a. Slices of smoked ham with potato salad b. Bowl of tomato soup with a grilled cheese sandwich c. Salami and cheese on whole wheat crackers d. Grilled chicken breast with glazed carrots

B. 42-year-old client who has diabetes insipidus D. 68-year-old client with poorly controlled type 2 diabetes mellitus E. 72-year-old client taking 80 mg of furosemide orally every day F. 74-year-old undergoing a bowel preparation with multiple enemas before colon surgery

For which clients is it most important for the nurse to check frequently for dehydration? Select all that apply. A. 24-year-old athlete who is NPO for 4 hours awaiting an appendectomy B. 42-year-old client who has diabetes insipidus C. 56-year-old client recently diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) D. 68-year-old client with poorly controlled type 2 diabetes mellitus E. 72-year-old client taking 80 mg of furosemide orally every day F. 74-year-old undergoing a bowel preparation with multiple enemas before colon surgery

C. Extracellular fluid (ECF) osmolarity is unchanged; body weight increases.

What immediate response does the nurse expect as a result of infusing 1 L of an isotonic intravenous solution into a client over a 3-hour time period if urine output remains at 100 mL per hour? A. Extracellular fluid (ECF) osmolarity increases; body weight increases. B. Extracellular fluid (ECF) osmolarity decreases; body weight decreases. C. Extracellular fluid (ECF) osmolarity is unchanged; body weight increases. D. Extracellular fluid (ECF) osmolarity is unchanged; body weight decreases.

A. Assess the skin turgor on the client's forehead.

When evaluating the hydration status of a new 84-year-old nursing home client, the nurse observes tenting of the skin on the back of the client's hand. What is the nurse's best action? A. Assess the skin turgor on the client's forehead. B. Ask the client when he or she last had anything to drink. C. Examine the client's dependent body areas, especially the ankles. D. Document this observation in the client's record as the only action.

B. Cantaloupe, broccoli, sweet potatoes

Which food items selected by a client who must restrict potassium because of a continuing risk for hyperkalemia indicates to the nurse that more teaching is needed? A. Strawberries, Cheerios, eggs B. Cantaloupe, broccoli, sweet potatoes C. Apple pie, black coffee with sugar, carrot sticks D. Whole wheat toast with butter, canned pineapple chunks