Chapter 13 - Concepts of Fluid and Electrolyte Balances
At 0900, the nurse hangs an IV of 1000 mL D5LR to infuse at 125 mL/hr. What time will the nurse need to hang a new bag of IV fluid? Provide your answer in military time: _____ hours.
1700
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
The nurse has begun an infusion of fresh frozen plasma (FFP). Which symptom indicates an allergic reaction to the FFP? a. Respirations: 30/min b. Urine output: 50 mL/hr c. Heart rate: 62 beats/min d. Temperature: 39 C (102.2 F)
A
Which electrolytes are most detrimentally affected by low magnesium levels? Select all that apply. A. Calcium B. Chloride C. Hydrogen D. Potassium E. Sodium F. Sulfate
AD
Which clinical indicators are most relevant for the nurse to monitor during IV fluid replacement for a client with dehydration? Select all that apply. A. Blood pressure B. Deep tendon reflexes C. Hand-grip strength D. Pulse rate and quality E. Skin turgor F. Urine output
ADF
A nurse is assessing clients on a medical-surgical unit. Which adult client does the nurse identify as being at greatest risk for insensible water loss? a. Client taking furosemide. b. Anxious client who has tachypnea. c. Client who is on fluid restrictions. d. Client who is constipated with abdominal pain
B
A patient with an excessive alcohol intake has a reduced amount of antidiuretic hormone (ADH). Which symptom is the patient likely to exhibit? a. Dysuria b. Polyuria c. Oliguria d. Hematuria
B
Which client will the nurse recognize as having the greatest risk for development of hypocalcemia? a. A 26 year old with hyperparathyroidism b. A 70 year old who has alcoholism and malnutrition c. A 40 year old taking tetracycline for an infection d. A 35 year old athlete taking NSAIDs for joint pain
B
You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a vague historian. The patient appears malnourished and on day 3 of the patient's admission total parenteral nutrition (TPN) has been started. Why would you know to start the infusion of TPN slowly? A) Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly. B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively. C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia. D) Patients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to accumulate
B
For a patient with a nursing diagnosis of Fluid Volume Deficit, the nurse is alert to which signs and symptoms? (Select all that apply.) a. Hypertension b. Flushed skin c. Dry mucous membranes d. Weak, thready pulse e. Pale yellow urine
BCD
A nurse teaches a client who is at risk for mild hypernatremia. Which statement should the nurse include in this clients 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
After administering potassium chloride, a nurse evaluates the client's response. Which signs and symptoms 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)
CD
Which body areas are best for the nurse to use when assessing skin indications of hydration status for an older client? (Select all that apply.) a. Tops of the forearms b. Skin of the shins c. Skin of the forehead d. Skin over the abdomen e. Skin over the sternum f. Back of the hand
CDE
A 65-year-old female patient is a two-pack-a-day cigarette smoker with a history of chronic obstructive pulmonary disease (COPD). What is the interpretation of her arterial blood gas values (pH 7.34, PCO2 55, PO2 82, HCO3 32)? a. Partially compensated respiratory alkalosis b. Uncompensated metabolic acidosis c. Uncompensated respiratory alkalosis d. Partially compensated respiratory acidosis
D
The nurse is discontinuing a central venous access device. When she removes the catheter, she notes that a portion of the tip is missing. What action must she take? a) Apply a tourniquet above the site. b) Start a new peripheral IV. c) Apply warm compresses to the site. d) Notify the physician and radiologist.
D
Which action will the nurse perform first to prevent harm for a client suspected to have fluid overload? a. Checking for presence of dependent edema b. Assessing blood pressure c. Measuring intake and output d. Elevating the head of the bed
D
The physician has ordered 1000 mL of D5NS to infuse over 6 hours. The IV tubing has a drop factor of 10 gtts/min. Calculate the flow rate in cc/mL and gtts/min. Round to the nearest whole number for each calculation: ___________ mL/hr; ___________ gtts/min
167;28
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
A
A nurse is assessing a client with hypokalemia, and notes that the client's hand grip strength has diminished since the previous assessment 1 hour ago. What action does the nurse takefirst? 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 primary health care provider.
A
A nurse is assessing clients for fluid and electrolyte imbalances. Which client will the nurse assess first for potential hyponatremia? a. A 34 year old who is NPO and receiving rapid intravenous D5W infusions. 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. d. A 73 year old with tachycardia who is receiving digoxin.
A
A nurse is caring for a client who has the following laboratory results: potassium 2.4 mEq/L(2.4 mmol/L), magnesium 1.8 mEq/L (0.74 mmol/L), calcium 8.5 mEq/L (2.13 mmol/L), and sodium 144 mEq/L (144 mmol/L). Which assessment does the nurse complete first? a. Depth of respirations b. Bowel sounds c. Grip strength d. Electrocardiography
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
A
A patient has questioned the nurses administration of IV normal saline, asking whether sterile water would be a more appropriate choice than saltwater. Under what circumstances would the nurse administer electrolyte-free water intravenously? A) Never, because it rapidly enters red blood cells, causing them to rupture. B) When the patient is severely dehydrated resulting in neurologic signs and symptoms C) When the patient is in excess of calcium and/or magnesium ions D) When a patients fluid volume deficit is due to acute or chronic renal failure
A
A patient who is being treated for pneumonia starts complaining of sudden shortness of breath. Anarterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg,HCO3 = 24 mm Hg. What does the ABG reflect? A) Respiratory acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Metabolic acidosis
A
The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the medication orders? A) Cimetidine B) Maalox C) Potassium chloride elixir D) Furosemide A
A
The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process? A) Diffusion B) Osmosis C) Active transport D) Filtration
A
The student nurse is reviewing a patient's laboratory reports. Which of the following results should be reported to the primary care provider? a) Na+ = 126 mEq/L b) K+ = 3.8 mEq/L c) Ca2+ = 9.2 mg/dL d) Mg2+ = 1.8 mg/dL
A
What responses does the nurse expect as a result of infusing 500 mL liter of a 3% saline intravenous solution into a client over a 1 hour time period? a. Plasma volume osmolarity increases; blood pressure increases b. Plasma volume osmolarity decreases; blood pressure increases c. Plasma volume osmolarity increases; blood pressure decreases d. Plasma volume osmolarity decreases; blood pressure decreases
A
Which activity is important to include in the plan of care for a client with a peripherally inserted central catheter (PICC)? a. Use sterile technique when changing the PICC dressing. b. Change the IV tubing every 72 hours. c. Take blood pressure in the arm with the PICC line. d. Use only macrodrip tubing with IV infusions through the PICC line.
A
Which assessment is most important for the nurse to perform on a client whose serum potassium level is 2.0 mEq/L (mmol/L)? a. Checking pulse oximetry b. Measuring blood pressure c. Listening to bowel sounds in all four quadrants d. Observing the ECG for flat T-waves
A
Which body fluid lies in the spaces between the body cells? a) Interstitial b) Intracellular c) Intravascular d) Transcellular
A
Which client electrocardiography (ECG) change from baseline will alert the nurse to possible development of hypercalcemia? a. Shortened QT-interval b. Absent P wave c. Prominent U wave d, Inverted T waves
A
Which client will the nurse consider to be at greatest risk for dehydration? a. A 75-year-old woman with chronic back pain b. A 25-year-old woman taking oral contraceptives c. A 75-year-old man who has a vitamin deficiency d. A 25-year-old man who has frequent esophageal reflux
A
Which of the following is considered a first-line intravenous solution for a patient with hypovolemia? a) 0.9% NaCl (normal saline) b) 0.45% NaCl (½ normal saline) c) Dextran (a plasma expander) d) D5W (5% dextrose in water)
A
Which of the following would the nurse expect to be included in the plan of care for a patient receiving total parenteral nutrition (TPN)? a. Blood sugar levels are checked on a routine basis b. Maintaining NPO status c. Hourly urine output d. Vital signs every 4 hours
A
Which sign or symptom indicates to the nurse that treatment for a client's hypokalemia is effective? a. Reports having a bowel movement daily. b. ECG shows an inverted T wave. c.Fasting blood glucose level is 106 mg/dL. d. Two lb weight gain during the past week.
A
You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patient's most recent laboratory reports, you note that the patient's magnesium levels are high. You should prioritize assessment for which of the following health problems? A) Diminished deep tendon reflexes B) Tachycardia C) Cool, clammy skin D) Acute flank pain
A
You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle accident. You and your colleague note that the patient's labs indicate minimally elevated serum creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older adults? A) Substantially reduced renal function B) Acute kidney injury C) Decreased cardiac output D) Alterations in ratio of body fluids to muscle mass
A
You are the nurse caring for a patient who is to receive IV daunorubicin, a chemotherapeutic agent. You start the infusion and check the insertion site as per protocol. During your most recent check, you note that the IV has infiltrated so you stop the infusion. What is your main concern with this infiltration? A) Extravasation of the medication B) Discomfort to the patient C) Blanching at the site D) Hypersensitivity reaction to the medication
A
You are the nurse evaluating a newly admitted patient's laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone (ADH)? A) Increased serum sodium B) Decreased serum potassium C) Decreased hemoglobin D) Increased platelets
A
patient is brought to the emergency department (ED) by paramedics after a bystander saw him fall on a crowded street. He has a history of alcoholism and is frequently brought to the ED. The nurse finds the patient to be disoriented; he has periods of being calm mixed with episodes of being disruptive and loud. His vital signs are the following: BP, 138/84 mm Hg; pulse, 135 beats/min, regular and strong; respiratory rate, 22 breaths/min; temperature, 37.1°C (98.1°F). What electrolyte imbalance might the nurse suspect? a) Hypomagnesemia b) Hyypocalcemia c) Hyperkalemia d) Hypernatremia
A
Which of the following statements would be considered incorrect when transfusing packed red blood cells (RBCs)? (Select all that apply.) a. Adjust the infusion rate to ensure unit is infused within 6 hours. b. Begin an infusion of D5W prior to the packed RBCs. c. Obtain baseline vital signs, including temperature and pulse oximetry. d. Verify the patient ID and blood unit number with another nurse prior to administration
AB
A nurse is caring for clients with electrolyte imbalances on a medical-surgical unit. Which clinical signs and symptoms are correctly paired with the contributing electrolyte imbalance?(Select all that apply.) a. Hypokalemia—muscle weakness with respiratory depression b. Hypermagnesemia—bradycardia and hypotension c. Hyponatremia—decreased level of consciousness d. Hypercalcemia—positive Trousseau and Chvostek signs e. Hypomagnesemia—hyperactive deep tendon reflexes f. Hypernatremia—weak peripheral pulses
ABCEF
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
ABE
Which of the following findings would indicate effectiveness of fluid replacement for a patient admitted with dehydration? (Select all that apply.) a. Blood urea nitrogen - 18 mg/dL b. Pulse - 82 c. Blood pressure - 140/90 d. Urine specific gravity - 1.033 e. 24-hour fluid balance - +200
ABE
A nurse assesses a client who is admitted for treatment of fluid overload. Which signs andsymptoms does 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 f. Visual disturbances
ABEF
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 Trousseaus and Chvosteks signs e. Hypomagnesemia Bradycardia, peripheral vasodilation, and hypotension
AC
In collaboration with the registered dietitian nutritionist (RDN), which foods will the nurse teach as client who is taking a potassium-sparing diuretic to avoid or use cautiously? (Select all that apply.) a. Red meat b. Cereal c. Citrus fruit d. Salt substitutes e. Eggs f. Bread
ACD
Which assessment findings will the nurse consider as possible causes for a client to have a serum potassium level of 6.3 mE/L (mmol/L)? (Select all that apply.) a. Management of hypertension with an angiotensin converting enzyme inhibitor b. Presence of chronic kidney disease c. Vegan diet d. Excessive use of salt substitute e. Daily therapy with a potassium-sparing diuretics f. Past history of hepatitis A
ACD
You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? Select all that apply. A) Milk B) Beef C) Poultry D) Green vegetables E) Liver
ACE
A nurse develops a plan of care for an older client who has a fluid overload. What interventions will the nurse include in this client's care plan? (Select all that apply.) a. Calculate pulse pressure with each blood pressure reading. b. Assess skin turgor using the back of the client's hand. c. Assess for pitting edema in dependent body areas. d. Monitor trends in the client's daily weights. e. Assist the client to change positions frequently .f. Teach client and family how to read food labels for sodium.
ACEDF
A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration inolder adults. What factors contribute to this phenomenon? Select all that apply. A) Decreased kidney mass B) Increased conservation of sodium C) Increased total body water D) Decreased renal blood flow E) Decreased excretion of potassium
ADE
A nurse is assessing a client who has an electrolyte imbalance related to renal failure. For which potential complications of this electrolyte imbalance does the nurse assess? (Select all that apply.) a. Reports of palpitations b. Slow, shallow respirations c. Orthostatic hypotension d. Paralytic ileus e. Skeletal muscle weaknessf. Tall, peaked T waves on ECG
AEF
A client is receiving an intravenous infusion of 100 mEq (mmol) of potassium chloride in 1000 mL of normal saline. How many mEq (mmol) of potassium per hour does the nurse calculate the client will receive if the IV is infused at a rate of 150 mL/hour? A. 12 mEq (mmol) B. 15 mEq (mmol) C. 18 mEq (mmol)mEq (mmol) D. 20 mEq (mmol)
B
A medical nurse educator is reviewing a patients recent episode of metabolic acidosis with members ofthe nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? A) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. B) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. C) The kidneys react rapidly to compensate for imbalances in the body. D) The kidneys regulate the bicarbonate level in the intracellular fluid.
B
A nurse in the emergency department is caring for an adult patient with numerous draining wounds from gunshots. The patient's pulse rate has increased from 100 to 130 beats/min over the past hour. For which imbalance should the nurse assess symptoms? a. Respiratory acidosis b. Extracellular fluid volume deficit c. Metabolic alkalosis d. Intracellular fluid volume excess
B
A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? A) Hydrostatic pressure B) Osmosis and osmolality C) Diffusion D) Active transport
B
A nurse is caring for a client who has a serum calcium level of 14 mg/dL (3.5 mmol/L).Which primary health care provider order does 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.
B
A nurse is caring for an older client who exhibits dehydration-induced confusion. Which intervention by the nurse is best? a. Measure intake and output every 4 hours. b. Assess client further for fall risk. c. Increase the IV flow rate to 250 mL/hr. d. Place the client in a high-Fowler position.
B
A patient is in respiratory distress. The provider has ordered arterial blood gases (ABGs). The results are the following: pH = 7.50; PCO2 = 26; HCO3 = 24 mEq/L. How should the nurse interpret the ABGs? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis
B
A patient was brought to the emergency department with complaints of extreme fatigue, nausea, vomiting, and muscle weakness. Lab results reveal the following: Na+ = 140 mEq/L; K+ = 2.0 mEq/L; Ca2+ = 8.6 mg/dL; Mg2+ = 1.6 mg/dL; and Cl- = 96 mEq/L. The electrocardiogram (ECG) tracing has a flat T wave and frequent PVCs (premature ventricular contractions). The patient's prescribed daily oral medications include furosemide 20 mg, digoxin 0.25 mg, and aspirin 81 mg. Why should the nurse question the order for digoxin 0.25 mg orally daily? a) Based on the digoxin level, the dose may need to be increased. b) The patient is at risk for an elevated digoxin level at this time. c) Digoxin and furosemide should never be taken together. d) The nurse should not be concerned about the order as written.
B
A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room.The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware thathyperventilation is the most common cause of which acidbase imbalance? A) Respiratory acidosis B) Respiratory alkalosis C) Increased PaCO2 D) CNS disturbances
B
About how many mL will the nurse record as having been replaced for a client with dehydration initially weighed 142 lb (64.5 kg) and now weighs 156 lb (70.9 kg) after 2 days of rehydration therapy? a. 3000 b. 6300 c. 9300 d. 7000
B
After teaching a client who is being treated for dehydration, a nurse assesses the client'sunderstanding. Which statement indicates that the client correctly understood the teaching? a. "I must drink a quart (liter) 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 p.m. so I won't have to get up at night."
B
The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom. What would be the nurse's best response? A) I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup. B) Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids. C) It is normal to be a little confused following surgery, and it is safe not to urinate at night. D) If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress.
B
The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated at a 3 on a 0-to-10 rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs) and you suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to exhibit? A) Diarrhea B) Dilute urine C) Increased muscle tone D) Joint pain
B
The nurse is caring for a client who has fluid overload. What action by the nurse takes priority? a. Administer high-ceiling (loop) diuretics. b. Assess the client's lung sounds every 2 hours. c. Place a pressure-relieving overlay on the mattress. d. Weigh the client daily at the same time on the same scale.
B
The nurse is preparing to insert an IV catheter with an intermittent infusion device (IID) into an elderly woman for medication administration. Which of the following considerations would be incorrect? a. Insert the IV catheter into nondominant hand/arm. b. Use a 16- or 18-gauge over-the-needle catheter. c. Release the tourniquet before attaching the IID. d. Flush the IID with 2 to 3 mL normal saline after insertion.
B
The physician has ordered a peripheral IV to be inserted before the patient goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter? A) Choose a hairless site if available. B) Consider potential effects on the patient's mobility when selecting a site. C) Have the patient briefly hold his arm over his head before insertion. D) Leave the tourniquet on for at least 3 minutes.
B
Which assessment data is most relevant for the nurse to obtain from a client who has a serum potassium level of 2.9 mEq/L? A. Asking about the use of sugar substitutes. B. Determining what drugs are taken daily C. Measuring the client's response to Chvostek testing D. Asking about a history of kidney disease
B
Which assessment finding on a client with hypervolemia indicates to the nurse that the client's condition may be worsening? a. Nose and ears have a slightly yellow-tinged appearance. b. Neck veins are now distended in the sitting position. c. Breath sounds can be heard in the right lower lung lobe. d. Weight is unchanged from that obtained yesterday
B
You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should you first suspect? A) Hypophosphatemia B) Hypocalcemia C) Hypermagnesemia D) Hyperkalemia
B
A nurse is caring for clients with electrolyte imbalances on a medical-surgical unit. Which common causes are correctly paired with the corresponding electrolyte imbalance? (Select all that apply.) a. Hypomagnesemia—kidney failure b. Hyperkalemia—salt substitutes c. Hyponatremia—heart failure d. Hypernatremia—hyperaldosteronism e. Hypocalcemia—diarrhea f. Hypokalemia—loop diuretics
BCDEF
A nurse is caring for several clients at risk for fluid imbalances. Which laboratory results arepaired with the correct potential imbalance? (Select all that apply.) a. Sodium: 160 mEq/L (mmol/L): Overhydration b. Potassium: 5.4 mEq/L (mmol/L): Dehydration c. Osmolarity: 250 mOsm/L: Overhydration d. Hematocrit: 68%: Dehydration e. BUN: 39 mg/dL: Overhydration f. Magnesium: 0.8 mg/dL: Dehydration
BCDF
A nurse develops a plan of care for a client who has a history of hypocalcemia. What interventions should the nurse include in this clients 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.
BD
The patient is to receive potassium 20 mEq every morning. Which of the following orders would the nurse question? (Select all that apply.) a. Potassium 10 mEq capsules. Administer 2 capsules PO. b. Potassium 15 mEq/5 mL liquid. Administer 10 cc of liquid PO. c. Potassium 2 mEq/1 mL solution. Add 10 cc to 1000 cc Lactated Ringers; infuse at 50 mL/h. d. Potassium 5 mEq/1 mL solution. Administer 4 cc IV over 10 minutes.
BD
A nurse assesses a client who is prescribed a medication that inhibits aldosterone secretionand release. For which potential complications will the nurse assess? (Select all that apply.) a. Urine output of 25 mL/hr b. Serum potassium level of 5.4 mEq/L (5.4 mmol/L) c. Urine specific gravity of 1.02 g/mL d. Serum sodium level of 128 mEq/L (128 mmol/L) e. Blood osmolality of 250 mOsm/kg (250 mmol/kg)
BE
A client at risk for developing hyperkalemia states, I love fruit and usually eat it every day, but now I cant 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.
C
A client with severe diarrhea reports tingling lips and foot cramps. What is the nurse's best first action to prevent harm? A. Hold the next dose of the prescribed antidiarrheal drug B. Assess bowel sounds in all four abdominal quadrants C. Assess the client's response to the Chvostek test D. Increase the IV flow rate of the normal saline infusion
C
A new nurse is preparing to administer IV potassium to a client with hypokalemia. What action indicates the nurse needs to review this procedure? a. Notifies the pharmacy of the IV potassium order. b. Assesses the client's IV site every hour during infusion. c. Sets the IV pump to deliver 30 mEq of potassium an hour. d. Double-checks the IV bag against the order with the precepting nurse.
C
A nurse assesses clients at a family practice clinic for risk factors that could lead to 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 who recently received intravenous fluids. c. A 76 year old who is cognitively impaired. d. An 83 year old with congestive heart failure
C
A nurse cares for a client who has a serum potassium of 6.5 mEq/L (6.5 mmol/L) and is exhibiting cardiovascular changes. Which intervention will the nurse implement first? a. Prepare to administer patiromer 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.
C
A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How should these nurses be encouraged to deal with excess hair at the intended site? A) Leave the hair intact. B) Shave the area. C) Clip the hair in the area. D) Remove the hair with a depilatory.
C
A nurse is caring for an 80-year-old patient who is receiving bumetanide (a loop diuretic) for hypertension. The nurse notes that the patient admits to taking bisacodyl (Dulcolax) daily to stimulate her bowels. The nurse should assess the patient for possible symptoms of a. hypoglycemia. b. hypoparathyroidism. c. hypokalemia. d. hypocalcemia.
C
A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, Apatient in renal failure partially loses the ability to regulate changes in pH. What is the cause of thispartial inability? A) The kidneys regulate and reabsorb carbonic acid to change and maintain pH. B) The kidneys buffer acids through electrolyte changes. C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH. D) The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
C
A nurse teaches a client who is at risk for hyponatremia. Which statement does the nurse include in this client's teaching? a. "Have you spouse watch you for irritability and anxiety." b. "Notify the clinic if you notice muscle twitching." c. "Call your primary health care provider for diarrhea." d. "Bake or grill your meat rather than frying it."
C
A patient was brought to the emergency department with complaints of extreme fatigue, nausea, vomiting, and muscle weakness. Lab results reveal the following: Na+ = 140 mEq/L; K+ = 2.0 mEq/L; Ca2+ = 8.6 mg/dL; Mg2+ = 1.6 mg/dL; and Cl- = 96 mEq/L. The electrocardiogram (ECG) tracing has a flat T wave and frequent PVCs (premature ventricular contractions). The patient's prescribed daily oral medications include furosemide 20 mg, digoxin 0.25 mg, and aspirin 81 mg. The nurse recognizes that these symptoms and diagnostic information are consistent with which of the following? a) Hypocalcemia b) Hypernatremia c) Hypokalemia d) Hypermagnesemia
C
A physician has prescribed 1,000 ml of 0.9% NaCl (normal saline) over 4 hours for a hypovolemic patient. The drop (gtt) factor is 60. What would the nurse set the drip rate at? a) 75 gtt/min b) 100 gtt/min c) 250 gtt/min d) 500 gtt/min
C
After receiving the change-of-shift report, which client does the nurse assess first? a. 67 year old with nausea and vomiting who reports abdominal cramps. b. A 77 year old with normal saline infusing at 150 mL/hr with an average hourly urine output of 75 mL. c. A 57 year old receiving IV diuretics whose blood pressure is 88/52 mm Hg. d. A 45 year old with a nasogastric (NG) tube who has dry oral mucosa and reports feeling very thirsty.
C
After teaching a client to increase dietary potassium intake, a nurse assesses the clients 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
C
For a patient in respiratory distress, the first arterial blood gases (ABGs) were: pH = 7.50; PCO2 = 26; HCO3 = 24 mEq/L. The ABGs were repeated the next morning. The new results are the following: pH = 7.47; PCO2 = 26 mmol/L; HCO3 = 20 mEq/L. The nurse recognizes that the values have changed and that the patient is now experiencing a) respiratory acidosis. b) metabolic alkalosis. c) partial compensation. d) complete compensation.
C
In reviewing the electrolytes of a client the nurse notes the serum potassium level has increased from 4.6 mEq/L (mmol/L) to 6.1 mEq/L (mmol/L). Which assessment does the nurse perform first to prevent harm? A. Deep tendon reflexes B. Oxygen saturation C. Pulse rate and rhythm D. Respiratory rate and depth
C
One day after a patient is admitted to the medical unit, you note that the patient is oliguric. You notify the acute-care nurse practitioner who orders a fluid challenge of 200 mL of normal saline solution over 15 minutes. This intervention will achieve which of the following? A) Help distinguish hyponatremia from hypernatremia B) Help evaluate pituitary gland function C) Help distinguish reduced renal blood flow from decreased renal function D) Help provide an effective treatment for hypertension-induced oliguria
C
The client who is confined to bed in the recumbent position has gained 5 lb (2.3 kg) in the past 24 hours. In which area does the nurse assess skin turgor for accurate determination of dependent edema? A. Foot and ankle B. Forehead C. Sacrum D. Chest
C
The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequateventilation. What diagnosis could the patient have that could cause inadequate ventilation? A) Endocarditis B) Multiple myeloma C) Guillain-Barr syndrome D) Overdose of amphetamines
C
The nurse is assessing the intravenous (IV) site in the right forearm and notices the area around it is cool, swollen, firm, and tender to touch. Which complication is most likely occurring? a. Infection b. Speed shock c. Infiltration d. Phlebitis
C
The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance would a positive Chvostek's sign indicate? A) Hypermagnesemia B) Hyponatremia C) Hypocalcemia D) Hyperkalemia
C
The nurse is caring for a patient who needs to increase calcium in her diet but does not like milk. Which food should the nurse encourage the patient to consume? a. Cod b. Eggs c. Spinach d. Tomatoes
C
The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV antibiotics. How should the nurse always start the process of insertion? A) Leave one hand ungloved to assess the site. B) Cleanse the skin with normal saline. C) Ask the patient about allergies to latex or iodine. D) Remove excessive hair from the selected site.
C
What effect does the nurse expect that an infusion of 200 mL of albumin will have immediately on a client's plasma osmotic and hydrostatic pressures? a.Decreased osmotic pressure; decreased hydrostatic pressure b. Decreased osmotic pressure; increased hydrostatic pressure c. Increased osmotic pressure; increased hydrostatic pressure d. Increased osmotic pressure; decreased hydrostatic pressure
C
What response does the nurse expect to see in the blood volume and blood osmolarity of a client whose secretion of aldosterone is abnormally low? a. Decreased blood volume; increased blood osmolarity b. Increased blood volume; decreased blood osmolarity c. Decreased blood volume; decreased blood osmolarity
C
Which assessment is most important for the nurse to perform on a client who is receiving IV magnesium sulfate? a. Monitoring 24-hour urine output b. Monitoring the serum calcium levels c. Assessing the blood pressure hourly d. Asking the client whether a headache is present
C
Which assessment on an older client with some degree of dehydration will the nurse perform to determine whether the client is safe for independent ambulation? a. Ensuring that the most recent serum potassium level is above 3.5 mEq/L (mmol/L) b. Assessing for furrows on the tongue to determine dryness of oral mucous membranes c. Comparing blood pressure measurements in the lying, sitting, and standing positions d. Ensuring that the pulse rate obtained radially is within 2 beats/min of that obtained apically
C
Which condition or symptom indicates to the nurse that the client's treatment for hyperkalemia is effective? a. Chvostek sign is negative. b. Respiratory rate is 22 breaths/min. c. Pulse rate is 76 beats/min and regular. d. Hematocrit is 42%.
C
Which of the following IV solutions is considered hypertonic? a. Lactated Ringers b. D5W c. D5 0.45% NS d. 0.9% normal saline
C
Which serum electrolyte value indicates to the nurse that the client has hypernatremia? a. Sodium 132 mEq/L (mmol/L) b. Potassium 3.5 mEq/L (mmol/L) c. Sodium 148 mEq/L (mmol/L) d. Potassium 5.3 mEq/L (mmol/L)
C
You are called to your patient's room by a family member who voices concern about the patient's status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patient's signs and symptoms? A) Hypocalcemia B) Hyponatremia C) Hyperchloremia D) Hypophosphatemia
C
You are caring for a 65-year-old male patient admitted to your medical unit 72 hours ago with pyloricstenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since.Upon review of the mornings blood work, you notice that the patients potassium is below referencerange. You should recognize that the patient may be at risk for what imbalance? A) Hypercalcemia B) Metabolic acidosis C) Metabolic alkalosis D) Respiratory acidosis
C
You are making initial shift assessments on your patients. While assessing one patient's peripheral IV site, you note edema around the insertion site. How should you document this complication related to IV therapy? A) Air emboli B) Phlebitis C) Infiltration D) Fluid overload
C
You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patient's skin turgor? A) Overhydration is common among healthy older adults. B) Dehydration causes the skin to appear spongy. C) Inelastic skin turgor is a normal part of aging. D) Skin turgor cannot be assessed in patients over 70.
C
Which actions are considered best practices for the nurse to use during the administration of parenteral potassium to a client with a serum potassium level of 1.9 mEq/L (mmol/L) (Select all that apply.) a. Keeping the client NPO during drug treatment b. Pushing the drug as a bolus slowly over 5 minutes c. Using an IV controller to deliver the drug d. Checking IV access for blood return after the infusion e. Initiating the IV in a hand vein for rapid access f. Ensuring that the concentration is no greater than 1 mEq/10mL (mmol/10 mL) of solution
CF
A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurse's most likely explanation for the low urine output? A) The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place. B) The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin. C) The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output. D) The man is having a sympathetic reaction, which has stimulated the reninñangiotensinñaldosterone system that results in diminished urine output.
D
A newly graduated nurse is admitting a patient with a long history of emphysema. The new nursespreceptor is going over the patients past lab reports with the new nurse. The nurse takes note that thepatients PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the newnurse why they will be cautious administering oxygen. What is the new nurses best response? A) The patients calcium will rise dramatically due to pituitary stimulation. B) Oxygen will increase the patients intracranial pressure and create confusion. C) Oxygen may cause the patient to hyperventilate and become acidotic. D) Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.
D
A nurse caring for a hospitalized patient is told in the shift change report that the patient's laboratory results are sodium = 140 mEq/L; potassium = 4.1 mEq/L; calcium = 9.5 mg/dL; and magnesium = 3.4 mEq/L. Which abnormal level will the nurse report to the primary care provider? a. High sodium level b. Low potassium c. Low calcium level d. High magnesium level
D
A nurse is caring for a client with hypocalcemia. Which action by the nurse shows poor understanding of this condition? a. Assesses the client's Chvostek and Trousseau sign. b. Keeps the client's room quiet and dimly lit. c. Moves the client carefully to avoid fracturing bones. d. Administers bisphosphonates as prescribed.
D
A nurse is caring for an adult patient who has gastric suction following abdominal surgery. The patient tells the nurse that he has tingling in his fingers and toes and is feeling dizzy. Which acid-base imbalance is the patient most likely experiencing? a. Respiratory alkalosis b. Metabolic acidosis c. Respiratory acidosis d. Metabolic alkalosis
D
A nurse is caring for an older adult client who is admitted with moderate dehydration. Which intervention will 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 L of fluids each shift. d. Dangle the client on the bedside before ambulating.
D
A nurse is evaluating a client who is being treated for dehydration. Which assessment result does the nurse correlate with a therapeutic response to the treatment plan? a. Increased respiratory rate from 12 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 changes when standing
D
A patient has been admitted to the hospital with medical diagnoses of hypervolemia, acute renal failure, and cardiac dysrhythmias. The patient's vital signs are: T = 98.4°F (36.9°C); P = 110; R = 32; BP = 162/102. On physical examination, the nurse notes distended neck veins and 3+ pitting edema in both lower extremities. The patient reports he has been drinking and eating as usual but has been unable to urinate. Which is the most appropriate nursing diagnosis for this patient? a) Excess Fluid Volume related to excessive food and fluid intake b) Deficient Fluid Volume related to increased metabolic demands c) Imbalanced Electrolytes secondary to fluid shifts d) Excess Fluid Volume secondary to acute renal failure
D
A patient has reported a 2-kg (4.4-lb) weight gain over the past 3 days. Which factor should the nurse question? a. Protein intake b. Potassium intake c. Calorie intake d. Sodium intake
D
A patient is to receive two units of packed red blood cells. Her blood group is O+. The nurse knows that the patient may receive blood from which of the following donors? a) AB+, A-, B+, and O- b) A+ and O+ c) AB- and O+ d) O+ and O-
D
A patient's most recent laboratory results show a slight decrease in potassium. The physician has opted to forego drug therapy but has suggested increasing the patient's dietary intake of potassium. Which of the following would be a good source of potassium? A) Apples B) Asparagus C) Carrots D) Bananas
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 that 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
D
Chloride, bicarbonate, phosphate, and sulfate are examples of what type of charged particles and why? a) Cations, because they carry a positive charge b) Cations, because they carry a negative charge c) Anions, because they carry a positive charge d) Anions, because they carry a negative charge
D
Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high aniongap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis? A) Metastases B) Excessive potassium intake C) Water intoxication D) Excessive administration of chloride
D
The ICU nurse is caring for a patient who experienced trauma in a workplace accident. The patient is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH7.28, PaCO2 50 mm Hg, HCO3 23 mEq/L. The nurse should recognize the likelihood of what acid base disorder? A) Respiratory acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Mixed acid-base disorder
D
The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect? A) Decrease in the release of aldosterone B) Increase of filtration in the Loop of Henle C) Decrease in the reabsorption of sodium D) Decrease in glomerular filtration
D
The passive process by which molecules of a solute move through a cell membrane from an area of higher concentration to an area of lower concentration is called which of the following? a) Osmosis b) Filtration c) Hydrostatic pressure d) Diffusion
D
When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur? A) Active transport of hydrogen ions across the capillary walls B) Pressure of the blood in the renal capillaries C) Action of the dissolved particles contained in a unit of blood D) Hydrostatic pressure resulting from the pumping action of the heart
D
Which action will the nurse perform first for the client who has a serum potassium level of 6.9 mEq/L (mmol/L)? a. Teaching the client which foods to avoid b. Administering sodium polystyrene sulfonate orally c. Collaborating with the registered dietitian nutritionist to provide a potssium-restricted diet d. Initiating continuous cardiac monitoring
D
Which assessment finding indicates to the nurse that the older client's therapy for dehydration is successful? a. Pulse pressure has decreased. b. Client reports feeling hungry. c. Hematocrit is 58% (0.58 volume fraction). d. Hourly urine output is greater than 15 mL.
D
Which condition or manifestation in the client with a serum sodium level of 149 mEq/L indicates to the nurse that this electrolyte imbalance may be caused by excessive fluid loss? A. The client has calf muscle cramping. B. The serum chloride level is low. C. The urine specific gravity is high. D. The hematocrit is 52%.
D
Which laboratory value indicates to the nurse that a client's hyponatremia may be related to a fluid volume excess? a. Serum chloride level is 100 mEq/L (mmol/L) b. Blood urea nitrogen (BUN) is elevated c. Arterial blood pH is 7.37 d. Hematocrit is 29% (0.29 volume fraction)
D
With which client does the nurse remain alert for and assess most frequently for signs and symptoms of hypokalemia? With which client does the nurse remain alert for and assess most frequently for signs and symptoms of hypokalemia? A. 72-year-old taking the diuretic spironolactone for control of hypertension B. 62-year-old receiving an IV solution of Ringer's lactate at a rate of 200 mL/hour C. 42-year-old trauma victim receiving a third infusion of packed red blood cells in 12 hours D. 22-year-old receiving an IV infusion of regular insulin to manage an episode of ketoacidosis
D
You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results? A) Respiratory acidosis with no compensation B) Metabolic alkalosis with a compensatory alkalosis C) Metabolic acidosis with no compensation D) Metabolic acidosis with a compensatory respiratory alkalosis
D
You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. During your assessment, you note the patient complains of a new onset of weakness with abdominal pain. Further assessment suggests that the patient likely has a fluid volume deficit. You should recognize that this patient may be experiencing what electrolyte imbalance? A) Hypernatremia B) Hypomagnesemia C) Hypophosphatemia D) Hypercalcemia
D
You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis? A) Hypertension B) Kussmaul respirations C) Increased DTRs D) Shallow respirations
D
You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance? A) Metabolic alkalosis B) Hypermagnesemia C) Hypercalcemia D) Hypovolemia
D
