Davis Ch. 8: Electrolyte Balance

Identify the assessment findings that you could expect to see for the identified electrolyte imbalance. Select all that apply. Sodium level of 150 mEq/dL

- Client hiking in the desert has ingested minimal water - Client is being treated for bipolar disorder with lithium therapy - Client has had limited fluid intake for several days with a high fever - Client has been drinking nutritional supplements for days - Client is experiencing polyuria from diabetes insipidus - Client with third degree burns on 50% of the body Rationale: Normal range of serum sodium is 135-145 mEq/dL, so this value represents hypernatremia. Lithium therapy can lead to hypernatremia. Limited fluid intake (with flu-like symptoms) or excessive loss (from hiking in the desert, polyuria, or burns) can lead to water depletion and increased sodium retention. Nutritional canned products have a high concentration without added water, which leads to a high sodium level. Diuretic therapy with a loop diuretic, such as furosemide, would lead to hyponatremia due to renal loss of sodium. Hemoglobin A1c level of 5.0% is within normal range and as such would not affect sodium levels. The nurse needs to be especially aware of neurological changes in the client with sodium imbalance since it can lead to cerebral edema and seizures.

Identify the assessment findings that you could expect to see for the identified electrolyte imbalance. Select all that apply. Phosphorus level of 1.0 mg/dL

- Client in a state of respiratory alkalosis - Client with acute kidney injury from a hypovolemic event - Client is suffering from excessive burns to the body - Client is experiencing refeeding syndrome Rationale: Normal phosphorus level is between 2.5 and 4.5 mg/dL. Phosphorus levels should be evaluated in comparison to calcium because of their inverse relationship. Refeeding syndrome leads to a decreased intestinal absorption of phosphorus. Respiratory alkalosis causes phosphate to shift into the cell. In extensive burns, the mechanism of development is unclear but likely due to salt and water diuresis. Acute kidney injury in the critically ill client causes increased phosphorus uptake due to catecholamine release. Rhabdomyolysis, decreased calcium levels, and hyperthyroidism all lead to hyperphosphatemia.

Identify the assessment findings that you could expect to see for the identified electrolyte imbalance. Select all that apply. Magnesium level of 0.8 mEq/L

- Client is an alcoholic - A malnourished client is from a developing country - Client is abusing laxatives - Client with a positive Chvostek sign Rationale: A normal magnesium level is between 1.6 and 2.2 mEq/L. A value below this range indicates decreased magnesium or hypomagnesemia. The presence of Chvostek sign indicates hypocalcemia, which is consistent with decreased magnesium levels. When a client is an alcoholic, abusing laxatives or malnourished he or she is at a higher risk of developing hypomagnesemia from excess loss or limited ingestion of magnesium. A potassium level of 4.0 mEq/L is within normal range. Both milk of magnesia and lithium toxicity cause hypermagnesemia, not hypomagnesemia. The treatment for hypomagnesemia includes the replace of magnesium by oral or intravenous routes.

Identify the assessment findings that you could expect to see for the identified electrolyte imbalance. Select all that apply. Potassium level of 6.5 mEq/L

- Client with adrenal cortex insufficiency - Client has been taking naproxen as directed for two doses - Client has a low GFR of 20 mL/min - Client has a high serum creatinine of 3.2 mg/dL - Client prescribed spironolactone for fluid volume excess Rationale: This serum sodium level represents moderate hyperkalemia. A normal potassium level would be between 3.5 and 5.0 mEq/L. Moderate hyperkalemia is often the result of renal dysfunction, which is supported by the GFR of 20 mL/min and a creatinine of 3.2 mg/dL. Normal renal function is indicated by a GFR of 60 or higher and a creatinine between 0.5 and 1.2 mg/dL. A client with adrenal cortex insufficiency (Addison's disease) has a lack of aldosterone, causing a secondary hyperkalemia. Spironolactone is a potassium sparing diuretic, causing a client to retain potassium. The use of NSAIDS such as naproxen could also impact renal function and lead to increased potassium levels when taken in excess. Two doses will not cause a problem. Diarrhea is associated with hypokalemia. A sulfa allergy does not predispose a client to hyperkalemia. The nurse needs to be especially aware of cardiac changes in the client with potassium imbalance since it can lead to dysrhythmias and sudden cardiac arrest.

Identify the assessment findings that you could expect to see for the identified electrolyte imbalance. Select all that apply. Total calcium level of 12.9 mg/dL

- Client with bone metastasis from breast cancer - Client with a lymphoma diagnosis - Client with theophylline toxicity Rationale: This total calcium value is consistent with hypercalcemia. A normal total calcium level is between 8.2 and 10.2 mg/dL. Malignant conditions, such as lymphoma and bone metastasis are commonly associated with an increased incidence of hypercalcemia. Use of theophylline also indicates a risk for increased calcium levels. Vitamin D deficiency, limited dairy intake, the presence of Trousseau sign, pregnancy, and chronic alcohol use are associated with hypocalcemia.

Identify the assessment findings that you could expect to see for the identified electrolyte imbalance. Select all that apply. Chloride level of 94 mEq/L

- Client with projectile vomiting from food poisoning - Client with an NG tube to intermittent suction - Client chronically retains CO2 from shallow respirations - Client with Addison's Disease Rationale: A normal chloride level is between 97 and 107 mEq/L. A chloride level of 94 mEq/L demonstrates hypochloremia and is a result of chloride loss. Common reasons include chronic respiratory acidosis, from the kidneys retaining bicarbonate and excreting chloride to re-establish acid-base balance. In metabolic alkalosis from severe vomiting, nasogastric suctioning, and adrenal cortex insufficiency, hypochloremia occurs as a result of increased bicarbonate concentration from hydrogen loss in the GI tract. The client receiving certain IV solutions with metabolic acidosis or hypernatremia will experience hyperchloremia. Daily vitamins will not impact chloride levels.

Which assessment changes can the nurse anticipate in a person experiencing fluid overload? Select all that apply.

- Crackles in lungs - Weight gain - Edema

The nurse is caring for a patient with hypokalemia and knows to never provide parenteral replacement of potassium via IV push due to the potential for which of the following complications? Select all that apply.

- Death - Cardiac dysrhythmias - Cardiac arrest

Which observations would the nurse anticipate seeing in a patient with hypernatremia? Select all that apply.

- Hallucinations - Elevated heart rate - Decreased urine output

A client with bipolar disorder is receiving lithium therapy. Which electrolyte disturbance should the nurse anticipate? Select all that apply.

- Sodium imbalance - Magnesium imbalance

Which finding in a patient's medical history may lead to an increased risk for euvolemic hyponatremia? Select all that apply.

- The patient has a diagnosis of SIADH. - The patient has a diagnosis of adrenal insufficiency. - The patient has severe hypothyroidism.

A patient has been diagnosed with chronic hyponatremia and replacement therapy has been started per protocol. Which finding would require that the nurse immediately contact the healthcare provider?

Correction total has been calculated to 20 mEq/L/day.

A patient presents with muscle cramps, paresthesia to weakness, abdominal cramping, and electrocardiogram changes. What electrolyte imbalance would the nurse suspect?

Hyperkalemia

A client with a history of alcoholism is admitted to the nursing unit. The nurse knows that this client would be at risk for which electrolyte imbalance?

Hypomagnesemia

Which finding may be associated with hypercalcemia?

Malignant tumor

How can the relationship of calcium and phosphorus in the body be classified?

Often, there is a reciprocal relationship