Electrolyte Imbalances

What specific changes would you expect to see on the ECG of a hyperkalemic patient? Which are most often seen with this electrolyte imbalance?

- Wide, flat P wave - Prolonged PR interval - Decreased R wave amplitude - Widened QRS complex - ST depression - Tall peaked T waves

The client is being evaluated for a low calcium condition. Clinical manifestations of low calcium include which of the following: Select all that apply. 1) Tetany 2) Muscle flaccidity 3) Negative Trousseau's sign 4) Positive Chvostek's sign 5) Skeletal fractures

1) Tetany 4) Positive Chvostek's sign 5) Skeletal fractures

Be able to identify the different areas on the charting "fish" for electrolytes.

1: Sodium (Na+) 2: Potassium (K) 3: Chloride (Cl) 4: Carbon Dioxide (CO2) 5: Blood Urea Nitrogen (BUN) 6: Creatinine 7: Glucose

A patient with hypotension is in the emergency department being evaluated. The patients sodium level has come back at 146 mmol/L. What interventions by the nurse would be most appropriate in caring for this patient with hypernatremia? Select all that apply. 1) Administer hypertonic solution by IV as ordered 2) Perform neurological assessments at least every 4 hours 3) Limit oral intake of sodium 4) Encourage the patient to use incentive spirometry 5) Provide pain medication as ordered PRN

2) Perform neurological assessments at least every 4 hours 3) Limit oral intake of sodium

A client has a calcium reading of 11. What does the nurse expect the clients phosphorous reading to be? A) 2 B) 3 C) 4 D) 5

A) 2

The nurse reviews a client's lab report and notes that the client's serum phosphorous (phosphate) level is 1.8 mg/dL. Which condition most likely caused this serum phosphorous level? A) Malnutrition B) Renal insufficiency C) Hypoparathyroidism D) Tumor lysis syndrome

A) Malnutrition Rationale: The normal serum phosphorous level is 3.0-4.5 mg/dL. The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based or magnesium-based antacids. Renal insufficiency , hypoparathyroidism, and tumor lysis syndrome are causative factors for hyperphosphatemia.

When administering a hypertonic solution the nurse should closely watch for: A) Signs of dehydration B) Pulmonary edema C) Fluid overload D) Increased Lactate level

A) Signs of dehydration

Describe appropriate interventions for hypophosphatemia.

Assist with identifying/treating the underlying cause, give adequate amounts of phosphorous (1:1 ratio phosphorous and calcium dietary allowance, with the exception of infants), give oral or IV phosphate (no faster than 10 mEq/hr) in moderate to severe deficiency

A client who had a recent surgery has been vomiting and becomes dizzy while standing up to go to the bathroom. After assisting the client back to bed, the nurse notes that the blood pressure is 55/30 mm/Hg and the pulse is 140. The nurse hangs which of the following IV fluids to correct this condition? A) D5.45 NS at 50 mL/hr B) 0.9 NS at an open rate C) D5W at 125 mL/hr D) 0.45 NS at open rate

B) 0.9 NS at an open rate This client is hypovolemic and requires plasma volume expansion. Isotonic fluids such as 0.9 NS will expand volume. Hypotonic fluids such as 0.45 NS will leave the intravascular space. D5W will metabolize into free water and leave the intravascular space. D5.45 NS is a good maintenance fluid but a rate of 50 mL/hr is not sufficient to expand the vascular volume quickly. From: StudyBlue.com

A nurse notes that a client is receiving IV Lactated Ringers when the orders state that the solution should be D5W. What is the first thing the nurse should do? A) Report the event to the charge nurse B) Change the solution to D5W C) Tell the nurse who made the error D) Write out an incident report

B) Change the solution to D5W

What specific changes would you expect to see on the ECG of a hypermagnesemic patient?

Bradycardia, tall T waves

The physician orders an electrolyte replacement on a client with a calcium of 5.6. The nurse knows this is indicative of which condition? A) Hypokalemia B) Hyperkalemia C) Hypocalcemia D) Hypercalcemia

C) Hypocalcemia

What is Trousseau's sign? What is it indicative of?

Carpopedal spasm caused by inflating the blood pressure cuff to a level above systolic pressure for 3+ minutes Indicative of hypocalcemia *Helpful trick: Trousseau = Tourniquet

The nurse is caring for a patient with a pituitary tumor. The nurse assesses the urine and reviews the lab results. The urine specific gravity is 1.075 and urine output is minimal. What would the nurse expect the sodium level to be in this patient? A) 140 B) 155 C) 135 D) 125

D) 125

Describe appropriate interventions for hypernatremia for all levels of ECF.

Decreased ECF: fluid replacement with hypotonic IV fluids and restrict sodium intake Normal to increased ECF: diuretics and restrict sodium intake

Describe appropriate interventions for hyperkalemia.

Eliminate potassium intake, increase potassium elimination (Kayexalate), force potassium out of the ECF and into the ICF, and correct membrane potential by giving 10% calcium gluconate

What is hypercalcemia?

High serum calcium levels (above 10.2 mg/dL)

Describe appropriate interventions for hypocalcemia.

Increase oral intake of calcium via diet and supplements, give IV calcium via 10% calcium chloride or 10% calcium gluconate in D5W (via slow IV, NEVER IM), monitor serum calcium and digitalis levels, decrease serum phosphorous, increase serum magnesium, give vitamin D (active form) so they can absorb calcium, implement seizure precautions

What kind of relationship do calcium and phosphorous have?

Inverse

What kind of relationship do sodium and potassium have?

Inverse

Describe the relationship between magnesium and blood pressure.

Magnesium causes vasodilation and a decrease in peripheral vascular resistance, thereby decreasing blood pressure

What is the most common cause of hyperkalemia?

Renal failure

What specific changes would you expect to see on the ECG of a hypokalemic patient? Which are most often seen with this electrolyte imbalance?

- Slightly peaked P wave - Slightly prolonged PR interval - ST depression - Shallow T wave - Prominent U wave

A nurse is caring for a patient who has had thyroid surgery. The patient's calcium result has returned at 7.5 mg/dL. Which nursing interventions are necessary based on this calcium level? Select all that apply. 1) Implement seizure precautions 2) Assess for positive Chvostek sign in the patient 3) Administer oral digoxin 4) Monitor IV site for phlebitis and irritation 5) Administer IV calcium gluconate

1) Implement seizure precautions 2) Assess for positive Chvostek sign in the patient 4) Monitor IV site for phlebitis and irritation 5) Administer IV calcium gluconate

Potassium chloride intravenously is prescribed for a client with heart failure experiencing hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply. 1) Obtain an IV infusion pump 2) Monitor urine output during the administration 3) Prepare the medication for bolus administration 4) Monitor the IV site for signs of infiltration or phlebitis 5) Ensure that the medication is diluted in the appropriate volume of fluid 6) Ensure that the bag is labeled to that it reads the volume of potassium in the solution

1) Obtain an IV infusion pump 2) Monitor urine output during the administration 4) Monitor the IV site for signs of infiltration or phlebitis 5) Ensure that the medication is diluted in the appropriate volume of fluid 6) Ensure that the bag is labeled to that it reads the volume of potassium in the solution Rationale: Potassium chloride administered IV must always be diluted in IV fluid and infused via IV infusion pump. Potassium chloride is never given via bolus (IV push) as this can result in cardiac arrest. The nurse should ensure the potassium is diluted in the appropriate volume of fluid and that the IV bag containing the potassium chloride is labeled with the volume of potassium it contains. Potassium chloride is irritating to the veins and there is a risk of phlebitis so the nurse should monitor the IV site. The nurse should monitor urinary output during administration and contact the physician is output is less than 30mL/hr.

A patient has an order for a bolus dose of potassium solution because of his electrolyte levels. The nurse is setting up the bolus to administer. Which information would the nurse include when explaining the bolus to the patient? Select all that apply. 1) The potassium is being administered because the patients potassium level is low 2) The patient will have a cardiac monitor in place when getting the potassium bolus 3) The patient should ensure that he does not develop pain with urination during the bolus 4) Flushing, tachycardia, and a rash on the face and chest are common responses to potassium administration 5) The patient should notify the nurse if he feels pain at the IV site during the administration

1) The potassium is being administered because the patients potassium level is low 2) The patient will have a cardiac monitor in place when getting the potassium bolus 5) The patient should notify the nurse if he feels pain at the IV site during the administration

The nurse reviews a client's electrolyte lab report and notes that the potassium level is 2.5 mEq/L. Which patterns should the nurse watch for on the ECG as a result of the lab value? Select all that apply. 1) U waves 2) Absent P waves 3) Inverted T waves 4) Depressed ST segment 5) Widened QRS complex

1) U waves 3) Inverted T waves 4) Depressed ST segment Rationale: A serum potassium level of 2.5 indicates hypokalemia. Potassium deficit is a potentially life-threatening electrolyte imbalance. ECG changes include shallow, flat, or inverted T waves, ST depression, and prominent U waves. Absent P waves are noted in atrial fibrillation, junctional rhythms, or ventricular rhythms. A widened QRS complex is noted in hyperkalemia and hypermagnesemia.

A client admitted with squamous cell carcinoma of the lung has a serum calcium level of 14 mg/dL. The nurse should instruct the client to avoid which of the following foods upon discharge? Select all that apply. 1) Eggs 2) Broccoli 3) Organ meats 4) Nuts 5) Canned salmon

2) Broccoli 4) Nuts 5) Canned salmon Fish, eggs, and organ meats are high in phosphorus. Broccoli, nuts, and canned salmon are high in calcium. Clients with lung or breast cancer often have elevated calcium levels due to tumor-induced hyperparathyroidism. From: StudyBlue.com

A client with heart failure is complaining of nausea. The client has received IV furosemide (Lasix), and the urine output has been 2500 mL over the past 12 hours. The client's home drugs include metoprolol (Lopressor), digoxin (Lanoxin), furosemide, and multivitamins. Which of the following are the appropriate nursing actions before administering the digoxin? Select all that apply. 1) Administer an antiemetic prior to giving the digoxin 2) Encourage the client to increase fluid intake 3) Call the physician 4) Report the urine output 5) Report indications of nausea

3) Call the physician 4) Report the urine output 5) Report indications of nausea Potassium is lost during diuresis with a loop diuretic such as furosemide (Lasix). Hypokalemia can cause digitalis toxicity, which often results in nausea. The physician should be notified, and digoxin should be held until potassium levels and digoxin levels are checked. Peaked T waves and widened QRS are manifestations of hyperkalemia. From: StudyBlue.com

Describe the breakdown of serum calcium (i.e., what is total calcium, what is ionized calcium, and what are the respective values).

50% is total calcium (bound to proteins), 40% is ionized calcium (biologically active form), 10% is bound to other things (phosphate, citrate, carbonate)

The nurse evaluates which of the following clients to be at risk for developing hypernatremia? A) 50-year-old with pneumonia, diaphoresis, and high fevers B) 62-year-old with congestive heart failure taking loop diuretics C) 39-year-old with diarrhea and vomiting D) 60-year-old with lung cancer and syndrome of inappropriate antidiuretic hormone (SIADH)

A) 50-year-old with pneumonia, diaphoresis, and high fevers Diaphoresis and a high fever can lead to free water loss through the skin, resulting in hypernatremia. Loop diuretics are more likely to result in hypovolemic hyponatremia. Diarrhea and vomiting both cause both sodium and water losses. Clients with SIADH have hyponatremia due to increased water reabsorption in the renal tubules From: StudyBlue.com

Which patient is at most risk for hypomagnesemia? A) A 55 year old chronic alcoholic B) A 57 year old with hyperthroidism C) A patient reporting overuse of anatacids and laxatives D) A 25 year old suffering from hypoglycemia

A) A 55 year old chronic alcoholic Patients who suffer from alcoholism have an increased secretion of magnesium and usually do not eat a proper diet, therefore, they are at risk for lower magnesium levels. From: RegisteredNurseRN.com

A client is receiving an intravenous magnesium infusion to correct a serum level of 1.4 mEq/L. Which of the following assessments would alert the nurse to immediately stop the infusion? A) Absent patellar reflex B) Diarrhea C) Premature ventricular contractions D) Increase in blood pressure

A) Absent patellar reflex Clinical manifestations of hypermagnesemia are the result of depressed neuromuscular transmission. Absent reflexes indicate a magnesium level around 7 mEq/L. Diarrhea and PVCs are not clinical manifestations of high magnesium levels. Hypermagnesemia causes hypotension. From: StudyBlue.com

A nurse reviews a client's laboratory report and notes that the client's serum phosphorus level is 2.0 mg/dL. Which condition most likely caused this serum phosphorus level? A) Alcoholism B) Renal insufficiency C) Hypoparathyroidism D) Tumor lysis syndrome

A) Alcoholism From: StudyBlue.com

Which patient is at more risk for an electrolyte imbalance? A) An 8 month old with a fever of 102.3 'F and diarrhea B) A 55 year old diabetic with nausea and vomiting C) A 5 year old with RSV D) A healthy 87 year old with intermittent episodes of gout

A) An 8 month old with a fever of 102.3 and diarrhea The 8 month old with a fever of 102.3 'F and diarrhea is the correct answer. Infants (age 1 and under) and older adults are at a higher risk of fluid-related problems than any other age group. This is because infants have the highest amount of total body fluid (80% of the body is made up of fluid) and if any type of illness especially GI effects the body this increases the chances of an electrolyte imbalance. From: RegisteredNurseRN.com

Which of the following assessment findings would indicate to the nurse that a client's diabetic ketoacidosis is deteriorating? A) Deep tendon reflexes decreasing from +2 to +1 B) Bicarbonate rising from 20 mEq/L to 22 mEq/L C) Urine pH less than 6 D) Serum potassium decreasing from 6.0 mEq/L to 4.5 mEq/L

A) Deep tendon reflexes decreasing from +2 to +1 A decrease in deep tendon reflexes is a sign that pH is dropping and that metabolic acidosis is worsening to diabetic ketoacidosis. An increasing bicarbonate would indicate that the acidosis is being corrected. A urine pH less than 6 indicates the kidneys are excreting acid. Serum potassium levels are expected to fall because acidosis is corrected and potassium moves back into the intracellular space. From: StudyBlue.com

The nurse is caring for a bedridden client admitted with multiple myeloma and a serum calcium level of 13 mg/dL. Which of the following is the most appropriate nursing action? A) Provide passive ROM exercises and encourage fluid intake B) Teach the client to increase intake of whole grains and nuts C) Place a tracheotomy tray at the bedside D) Administer calcium gluconate IM as ordered

A) Provide passive ROM exercises and encourage fluid intake A client who has a serum calcium of 13 mg/dL has hypercalcemia. Fluid intake promotes renal excretion of excess calcium. ROM exercises promote reabsorption of calcium into bone. Placing a tracheostomy at the beside is a nursing intervention for hypocalcemia. Although calcium gluconate may be administered in hypocalcemia, it is never administered IM. From: StudyBlue.com

A client has +3 pitting edema in their legs and a potassium of 2.3 mEq/L, the nurse known which of the following diuretics is likely to be ordered? A) Spironolactone (Aldactone) B) Bumetanide (Bumex) C) Furosemide (Lasix) D) Ethacrynic Acid (Edecrin)

A) Spironolactone (Aldactone)

The nurse is assessing a client with a lactose intolerance disorder for a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? A) Twitching B) Hypoactive bowel sounds C) Negative Trousseau's sign D) Hypoactive deep tendon reflexes

A) Twitching Rationale: A client with lactose intolerance is at risk for developing hypocalcemia because food products that contain calcium also contain lactose. The normal serum calcium level is 9-10.5 mg/dL. A serum level of less than 9 mg/dL indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. GI symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.

The nurse is admitting a client with a potassium level of 6.0 mEq/L. The nurse reports this finding as a result of: A) acute renal failure B) malabsorption syndrome C) nasogastric drainage D) laxative abuse

A) acute renal failure A serum potassium level of 6.0 mEq/L is indicative of acute renal failure. Malabsorption syndrome, nasogastric drainage, and laxative abuse may result in a low serum potassium level, because output may be greater than input. Diarrhea results in malabsorption syndrome and can come from laxative abuse. Fluids and electrolytes may be lost in the nasogastric drainage. Normal serum potassium is 3.5 to 5.5 mEq/L. From: StudyBlue.com

Which client is at risk for the development of a sodium level at 130 mEq/L? The client... A) who is taking diuretics B) with hyperaldosteronism C) with Cushing's syndrome D) who is taking corticosteroids

A) who is taking diuretics Rationale: The normal serum sodium level is 135-145 mEq/L. A serum level of 130 mEq/L indicates hyponatremia. Hyponatremia can occur while taking diuretics. The client taking corticosteroids, the client with hyperaldosteronism, and the client with Cushing's syndrome are all at risk for hypernatremia.

Describe appropriate interventions for hyperphosphatemia.

Assist with identifying/treating the underlying cause, restrict phosphate-containing foods, increase hydration (promotes renal excretion), administer phosphate-binding agents (with food), administer diuretics, correct calcium levels

The nurse should monitor for clinical manifestations of hypophosphatemia in which of the following clients? A) A client with osteoporosis taking Vitamin D and Calcium supplements B) A client who is alcoholic receiving total parenteral nutrition C) A client with chronic renal failure awaiting the first dialysis run D) A client with hypoparathyroidism secondary to thyroid surgery

B) A client who is alcoholic receiving total parenteral nutrition A client with osteoporosis taking vitamin and calcium supplements, a client with chronic renal failure awaiting dialysis, and a client with hypoparathyroidism secondary to thyroid surgery are at risk for hyperphosphatemia. Alcoholics and clients receiving TPN are at risk for low phosphorus levels due to pro intestinal absorption and shifting of phosphorus into cells along with insulin and glucose. From: StudyBlue.com

Which patient below would have a potassium level of 5.5? A) A 76 year old who reports taking lasix four times a day B) A patient with Addison's disease C) A 55 year old woman who have been vomiting for 3 days consistently D) A patient with liver failure

B) A patient with Addison's disease A patient with Addison disease suffers from increased potassium levels due to adrenal insufficiency. Therefore, potassium levels higher than 5.1 may present in patients with Addison's disease. From: RegisteredNurseRN.com

A patient is admitted to the ER with the following findings: heart rate of 110 (thready upon palpation), 80/62 blood pressure, 25 ml/hr urinary output, and Sodium level of 160. What interventions do you expect the medical doctor to order for this patient? A) Restrict fluid intake and monitor daily weights B) Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output C) Administer hypotonic IV fluid and administer sodium tablets D) No interventions are expected

B) Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output The patient must be re-hyrdated and the sodium levels should be decreased at the same time. So a hypertonic solution of 5% dextrose and 0.45% NA will help do this. The solution is hypertonic because of the 5% Dextrose which will rapidly metabolize to the cells. When the dextrose metabolizes to the cells it leaves behind 0.9% NA which acts as a isotonic solution. This allows the 0.45% NA to act as a hypotonic solution to repair the vascular compartment. After these fluids are infused the patient's NA level should decrease, BP increase, HR return to normal etc. It is a complicated physiological process because the Dextrose has unique capabilities when it is metabolized....although the solution is labeled as hypertonic it becomes a hypotonic solution when the Dextrose is metabolized by the cells. From: RegisteredNurseRN.com

The nurse expects the long-term treatment of a patient with hyperphosphatemia from renal failure will include: A) Fluid restriction B) Calcium supplements C) Magnesium supplements D) Increased intake of dairy products

B) Calcium supplements Rationale: The major conditions that can lead to hyperphosphatemia are acute kidney injury and chronic kidney disease that alter the ability of the kidneys to excrete phosphate. For the patient with renal failure, long-term measures to reduce serum phosphate levels include phosphatebinding agents or gels, such as calcium carbonate, fluid replacement therapy, and dietary phosphate restrictions.

A client is admitted with diabetic ketoacidosis who, with treatment, has a normal blood glucose, pH, and serum osmolality. During assessment, the client complains of weakness in the legs. Which of the following is a priority nursing intervention? A) Request a physical therapy consult from the physician B) Ensure the client is safe from falls and check the most potassium level C) Allow uninterrupted rest periods throughout the day D) Encourage the client to increase intake of dairy products and green leafy vegetables

B) Ensure the client is safe from falls and check the most potassium level In the treatment of DKA, the blood sugar is lowered, the pH is corrected, and potassium moves back into the cells resulting in low serum potassium. Client safety and the correction of a low potassium level are a priority. The weakness in the legs is a clinical manifestation of the hypokalemia. Dairy products and green, leafy vegetables are a source of calcium. From: StudyBlue.com

A client with hypoparathyroidism complains of numbness and tingling in his fingers and around the mouth. The nurse would assess for what electrolyte imbalance? A) Hyponatremia B) Hypocalcemia C) Hyperkalemia D) Hypermagnesemia

B) Hypocalcemia Hypoparathyroidism can cause low serum calcium levels. Numbness and tingling in extremities and in the circumoral area around the mouth are hallmark signs of hypocalcemia From: StudyBlue.com

The nurse is caring for a client who has been in good health up to the present and is admitted with cellulitis of the hand. The client's serum potassium level was 4.5 mEq/L yesterday. Today the level is 7 mEq/L. Which of the following is the next appropriate nursing action? A) Call the physician and report results B) Question the results and redraw the specimen C) Encourage the client to increase the intake of bananas D) Initiate seizure precautions

B) Question the results and redraw the specimen False high results should be suspected because of hemolysis of the specimen. The physician would likely question results as well. Bananas are a food high in potassium which would lead to hyperkalemia. The patient also has no risk factors for hyperkalemia. Seizures are not a clinical manifestation of hyperkalemia. From: StudyBlue.com

An older adult client admitted with heart failure and a sodium level of 113 mEq/L is behaving aggressively toward staff and does not recognize family members. When the family expresses concern about the client's behavior, the nurse would respond most appropriately by stating: A) "The client may be suffering from dementia, an the hospitalization has worsened the confusion." B) "Most older adults get confused in the hospital." C) "The sodium level is low, and the confusion will resolve as the levels normalize." D) "The sodium level is high and the behavior is a result of dehydration."

C) "The sodium level is low, and the confusion will resolve as the levels normalize." Neurological symptoms occur when sodium levels fall below 120 mEq/L. The confusion is an acute condition that will go away as the sodium levels normalize. Dementia is an irreversible condition. From: StudyBlue.com

The doctor orders an isotonic fluid for a patient. Which of the following is not an isotonic fluid? A) 0.9% normal saline B) Lactated Ringers C) 0.45% saline D) 5% dextrose in 0.225% saline

C) 0.45% saline

Which patient is at greatest risk for developing hypermagnesemia? A) 83-year-old man with lung cancer and hypertension B) 65-year-old woman with hypertension taking beta-adrenergic blockers C) 42-year-old woman with systemic lupus erythematosus and renal failure D) 50-year-old man with benign prostatic hyperplasia and a urinary tract infection

C) 42-year-old woman with systemic lupus erythematosus and renal failure Rationale: Causes of hypermagnesemia include renal failure (especially if the patient is given magnesium products), excess magnesium administration for treatment of eclampsia, and adrenal insufficiency.

The nurse evaluates which of the following clients to have hypermagnesemia? A) A client who has chronic alcoholism and a magnesium level of 1.3 mEq/L B) A client who has hyperthyroidism and a magnesium level of 1.6 mEq/L C) A client who has renal failure, takes antacids, and has a magnesium level of 2.9 mEq/L D) A client who has congestive heart disease, takes a diuretic, and has a magnesium level of 2.3 mEq/L

C) A client who has renal failure, takes antacids, and has a magnesium level of 2.9 mEq/L From: StudyBlue.com

A patient's central line has just been inserted by the physician while the nurse assisted. The physician writes orders to start normal saline fluids to run in the catheter and leaves to document the procedure. Which of the following should the nurse do first? A) Set up and begin to run the infusion B) Clarify the order with the physician C) Ask the physician to order a chest x-ray D) Contact the pharmacy

C) Ask the physician to order a chest x-ray

A client with a serum sodium of 115 mEq/L has been receiving 3% NS at 50mL/hr for 16 hours. This morning the client feels tired and short of breath. Which of the following interventions is a priority? A) Turn down the infusion B) Check the latest sodium level C) Assess for signs of fluid overload D) Place a call to the physician

C) Assess for signs of fluid overload A complication of hypertonic sodium solution administration is fluid overload. While turning down the infusion, check the latest sodium level, and notifying the physician may all be reasonable, the priority nursing intervention is to assess for manifestations of fluid overload. Assessment is always the priority to determine with action to take next. From: StudyBlue.com

A client with a potassium level of 5.5 mEq/L is to receive sodium polystyrene sulfonate (Kayexalate) orally. After administering the drug, the priority nursing action is to monitor: A) Urine output B) Blood pressure C) Bowel movements D) ECG for tall, peaked T waves

C) Bowel movements Kayexalate causes potassium to be exchanged for sodium in the intestines and excreted through bowel movements. If the client does not have stools, the drug cannot work properly. Blood pressure and urine output are not of primary importance. The nurse would already expect changes in T waves with hyperkalemia prior to drug administration. From: StudyBlue.com

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition would be a cause for these findings? A) Overhydration B) Anemia C) Dehydration D) Renal failure

C) Dehydration From: StudyBlue.com

The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia? A) Muscle twitches B) Decreased urinary output C) Hyperactive bowel sounds D) Increased specific gravity of urine

C) Hyperactive bowel sounds Rationale: Hyperactive bowel sounds are indicative of hyponatremia. The remaining options are indicative of hypernatremia.

In report from a transferring facility you receive information that your patient's Magnesium level is 1.2. When the patient arrives you are ordered by the doctor to administer Magnesium Sulfate via IV. Which of the following interventions takes priority? A) Set-up bedside suction B) Set-up IV Atropine at bedside due to the bradycardia effects of Magnesium Sulfate C) Monitor the patient's for reduced deep tendon reflexes and initiate seizure precautions D) None of the above are correct

C) Monitor the patient's for reduced deep tendon reflexes and initiate seizure precautions As the nurse administering Magnesium sulfate IV, you must monitor for reduced deep tendon reflexes because the patient could quickly develop hypermagnesemia. In addition, seizure precautions should be initiated due to the patient's low magnesium level. From: RegisteredNurseRN.com

A client with a recent thyroidectomy complains of numbness and tingling around the mouth. Which of the following findings indicates the serum calcium is low? A) Bone pain B) Depressed deep tendon reflexes C) Positive Chvostek's sign D) Nausea

C) Positive Chvostek's sign Numbness and tingling around the mouth indicates hypocalcemia, which results in neuromuscular irritability. A positive Chvostek's sign is the contraction of facial muscles when the facial nerve in front of the ear is tapped. Bone pain, nausea, and depressed deep tendon reflexes are signs of hypercalcemia. From: StudyBlue.com

After obtaining an EKG on a patient you notice that ST depression is present along with an inverted T wave and prominent U wave. What lab value would be the cause of this finding? A) Magnesium level of 2.2 B) Potassium level of 5.6 C) Potassium level of 2.2 D) Phosphorus level of 2.0

C) Potassium level of 2.2 Hypokalemia (normal potassium levels are 3.5 to 5.1) will present with these type of EKG findings. From: RegisteredNurseRN.com

A nurse receives an order to administer norepinephrine IV to a patient at a rate of 30 mL/hr. The nurse receives the medication in a 500 mL bag of D5W that contains 40 mg of the drug. How many mcg/min will the patient receive? A) 80 mcg/min B) 60 mcg/min C) 20 mcg/min D) 40 mcg/min

D) 40 mcg/min

A client with chronic renal failure reports a 10 pound weight loss over 3 months and has had difficulty taking calcium supplements. The total calcium is 6.9 mg/dL. Which of the following would be the first nursing action? A) Assess for depressed deep tendon reflexes B) Call the physician to report the calcium level C) Place an intravenous catheter in anticipation of administering calcium gluconate D) Check to see if a serum albumin level is available

D) Check to see if a serum albumin level is available This client is poorly nourished and likely to have hypoalbuminemia. A drop in serum albumin will result in a false low total calcium level. Placing an IV is not a priority intervention. Depressed reflexes are a sign of hypercalcemia. From: StudyBlue.com

A patient receiving a tube feeding develops diarrhea. The nurse understands that the primary reason tube feedings cause diarrhea is because they are: A) Icteric B) Isotonic C) Hypotonic D) Hypertonic

D) Hypertonic Hypertonic solutions have a greater concentration of solutes than does the blood. The high osmolarity of a hypertonic tube feeding exerts an osmotic force that pulls fluid into the stomach and intestine, resulting in intestinal cramping and diarrhea. From: StudyBlue.com

A client with pancreatitis has been receiving potassium supplementation for four days since being admitted with a serum potassium of 3.0 mEq/L. Today, the potassium level is 3.1 mEq/L. Which of the following laboratory values should the nurse check before notifying the physician of the client's failure to respond to treatment? A) Sodium B) Phosphorus C) Calcium D) Magnesium

D) Magnesium Low serum magnesium levels can inhibit potassium ions from crossing cell membranes, resulting in potassium loss through the urine. Generally, low magnesium levels must be corrected before potassium replacement is effective. From: StudyBlue.com

A client is receiving intravenous potassium supplementation in addition to maintenance fluids. The urine output has been 120 mL every 8 hours for the past 16 hours and the next dose is due. Before administering the next potassium dose, which of the following is a priority nursing intervention? A) Encourage the client to increase fluid intake B) Administer the dose as ordered C) Draw a potassium level and administer the dose if the level is low or normal D) Notify the physician of the urine output and hold the dose

D) Notify the physician of the urine output and hold the dose Urine output is an indication of renal function. Normal urine output is at least 30mL/hr. Client with impaired renal function are at risk for hyperkalemia. Initiating a lab draw requires a physician order. From: StudyBlue.com

You are taking a patient's blood pressure manually. As you pump up the cuff above the systolic pressure for a few minutes you notice that the patient develop a carpal spasm. Which of the following is true? A) The patient is having a normal nervous response to an inflating blood pressure cuff that is inflated above the systolic pressure B) This is known as Trousseau's Sign and is present in patients with hypercalcemia C) This is known as Chvostek's Sign D) This is known as Trousseau's Sign and is present in patients with hypocalcemia

D) This is known as Trousseau's Sign and is present in patients with hypocalcemia Patient's with hypokalemia may present with a positive Trousseau's and Chvostek sign. From: RegisteredNurseRN.com

Which client is at risk for developing a potassium level of 5.5 mEq/L? The client... A) with colitis B) with Cushing's syndrome C) who has been overusing laxatives D) who has sustained a traumatic burn

D) who has sustained a traumatic burn Rationale: A serum level of 5.5 indicates hyperkalemia. Clients who experience cellular shifting of potassium in the early stages of massive cell destruction, such as with burns, trauma, sepsis, or metabolic or respiratory acidosis, are at risk for hyperkalemia. The client with Cushing's syndrome, the client overusing laxatives, and the client with colitis are all at risk for hypokalemia.

Describe appropriate interventions for hyponatremia for all levels of ECF.

Decreased ECF: fluid replacement with sodium-containing fluids (i.e., sports drinks if PO, IV isotonic fluids) Normal to increased ECF: implement fluid restrictions and medications that block ADH ("-vaptan" drugs) *If there are seizures, administer small amounts of hypertonic fluids

Describe the effect of hypocalcemia on the heart.

Decreased myocardial contractility, prolonged QT interval, and hypotension

What is hypermagnesemia?

High serum magnesium levels (above 2.5 mg/dL)

What is hyperphosphatemia?

High serum phosphorous levels (above 4.4 mg/dL)

What is hyperkalemia?

High serum potassium levels (above 5.0 mEq/L)

What is hypernatremia?

High serum sodium levels (above 145 mEq/L)

Describe appropriate interventions for hypermagnesemia.

Hold magnesium-containing products, administer calcium chloride or calcium gluconate IV for acute symptoms, administer IV fluids and diuretics, monitor vital signs, LOC, and patellar reflexes

Describe appropriate interventions for hypokalemia.

Hydrate to maintain urine output of >0.5 mL/kg/hr, oral replacement via diet and supplementation (as ordered), IV replacement (no more than 10-20 mEq/hr by IV pump and no more than 40 mEq/L unless pt. is in ICU and cardiac monitored)

What is the most common cause of hypocalcemia?

Hypoparathyroidism (either due to decreased function or surgical removal)

Describe appropriate interventions for hypomagnesemia.

In mild cases: promote increased magnesium intake through diet and magnesium salts In severe cases: MgSO4 IM or slow IV drip Generally: Monitor LOC, serum levels q12 hours, vital signs, swallow and patellar reflexes, implement seizure precautions

What is the most important sign/symptom when assessing sodium levels?

Level of consciousness

What is hypocalcemia?

Low serum calcium levels (below 8.6 mg/dL)

What is hypomagnesemia?

Low serum magnesium levels (below 1.5 mg/dL)

What is hypophosphatemia?

Low serum phosphorous levels (below 2.4 mg/dL)

What is hypokalemia?

Low serum potassium levels (below 3.5 mEq/L)

What is hyponatremia?

Low serum sodium levels (below 135 mEq/L)

What is the most important thing to remember when administering IV replacement potassium?

NEVER give potassium IV push, only ever give potassium IV via infusion pump

What kind of relationship do calcium and magnesium have?

Parallel (they tend to run together)

If a patient is taking a loop diuretic, what supplementation do they need?

Potassium supplementation

What specific changes would you expect to see on the ECG of a hypomagnesemic patient?

Premature ventricular contractions, ventricular tachycardia, and/or ventricular fibrillation

Describe appropriate interventions for hypercalcemia.

Promote excretion through IV fluids and loop diuretics, promote calcium reabsoprtion into the bones, inhibit bone loss of calcium, give calcimimetics

Describe the expected signs/symptoms of a patient with hypernatremia and identify the key differences between signs/symptoms seen in hypernatremia with decreased ECF and in hypernatremia with normal to increased ECF.

S/S for general hypernatremia include restlessness, agitation, twitching, seizures, coma, and intense thirst S/S for hypernatremia w/ decreased ECF include postural hypotension, decreased CVP, weight loss, weakness, and lethargy *This type can lead to permanent brain damage because fluid is being pulled from the nerve cells S/S for hypernatremia w/ normal to increased ECF include weight gain, peripheral and pulmonary edema, hypertension, and increased CVP

Describe the expected signs/symptoms of a patient with hyponatremia and identify the key differences between signs/symptoms seen in hyponatremia with decreased ECF and in hyponatremia with normal to increased ECF.

S/S for general hyponatremia include muscle spasms, seizures, confusion, and coma S/S for hyponatremia w/ decreased ECF include personality changes, postural hypotension, decreased CVP, irritability, apprehension, dizziness, tachycardia, thready pulse, cold clammy skin, and jugular venous filling S/S for hyponatremia w/ normal to increased ECF headache, apathy, nausea, vomiting, diarrhea, abdominal cramps, weight gain, hypertension, and increased CVP

What is Babinski's sign? What is it indicative of?

The big toe bends up and back to the top of the foot and the other toes fan out Positive Babinski is seen in babies and should always be negative in adults, but can be positive if there is hypomagnesemia

What is Chvostek's sign? What is it indicative of?

Twitching of the facial muscles in response to tapping over the area of the facial nerve Indicative of hypocalcemia *Helpful trick: Chvostek = Cheek