fluid and electrolytes
The nurse is teaching proper nutrition to a patient who has been prescribed high-ceiling diuretic therapy. Which patient response indicates a need for further teaching? "I should eat more eggs and cereals to maintain a high potassium intake." "Eating meat will help with my potassium needs." "I should eat fish a few times a week." "I should have fruits such as oranges, kiwi, and bananas every day."
"I should eat more eggs and cereals to maintain a high potassium intake." Breads, eggs, and cereal grains contain the least amount of natural potassium. Meats, fish, fruits, and some vegetables are highest in potassium. Diuretics that increase the kidney excretion of potassium can cause hypokalemia. The patient should be encouraged to eat foods high in potassium when taking high-ceiling diuretic agents to help compensate for potassium loss.
A patient has a serum magnesium level of 1.2 mEq/L. Which instruction by the nurse is appropriate? "Notify me if you have diarrhea." "I will be giving you an intramuscular injection of magnesium sulfate." "I will be administering a phosphorus supplement in addition to the magnesium supplement." "Your urine may become darker and more concentrated in appearance."
"Notify me if you have diarrhea." A serum magnesium level of 1.2 mEq/L represents mild hypomagnesemia (normal is 1.3-2.1 mEq/L) for which oral magnesium supplements are administered. Oral magnesium may lead to diarrhea; diarrhea contributes to magnesium loss. With severe hypomagnesemia, the IV route (instead of IM) is used because the IM route causes tissue damage and pain. Any medications containing phosphorus are contraindicated because they would contribute to associated hypocalcemia. Magnesium therapy does not affect the urine.
The nurse is performing discharge dietary teaching for a patient with hyperkalemia. Which statement does the nurse include in the teaching? "You may eat avocados, broccoli, and cantaloupe." "You may use salt substitutes." "You may eat apples, strawberries, and peaches." "You don't need to restrict dairy products."
"You may eat apples, strawberries, and peaches." The patient with hyperkalemia should be instructed to consume foods low in potassium such as apples, strawberries, and peaches. The patient should avoid foods high in potassium, which include avocados, broccoli, cantaloupe, and dairy products. Salt substitutes contain potassium.
A patient with severe hypokalemia is prescribed parenteral administration of potassium. How does the nurse administer potassium to the patient? 1 mEq of potassium to 10 mL intravenous solution. 10 mEq of potassium to 10 mL intravenous solution. 1 mEq of potassium to 10 mL solution intramuscularly. 10 mEq of potassium to 10 mL solution intramuscularly.
1 mEq of potassium to 10 mL intravenous solution. Potassium is given intravenously for severe hypokalemia, but only mixed in a solution. It is available in many concentrations. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations of such solutions. Therefore, 1 mEq of potassium to 10 mL of solution is the preferred dilution to prevent the risk associated with hyperkalemia. A concentration of 10 mEq of potassium to 10 ml of solution is too high and can cause tissue irritation. Potassium is a severe tissue irritant; it may cause necrosis and loss of function of the tissue, and so is never given as an intramuscular or subcutaneous injection.
The nurse manager of the medical-surgical unit assigns which patient to the LPN/LVN? 44-year-old admitted with dehydration who has a heart rate of 126. 54-year-old just admitted with hyperkalemia who takes a potassium-sparing diuretic at home. 64-year-old admitted yesterday with heart failure who still has dependent pedal edema. 74-year-old who has just been admitted with severe nausea, vomiting, and diarrhea.
64-year-old admitted yesterday with heart failure who still has dependent pedal edema. Because the patient with heart failure is the most stable of the four patients, this patient is most appropriate to assign to the LPN/LVN. Dehydration, tachycardia, potassium overload, and GI signs and symptoms in a patient indicate that he or she is unstable and should be cared for by RN staff members.
Which laboratory value requires a priority response by the nurse to notify the primary health care provider? Sodium 133 mEq/L Potassium 5.0 mEq/L Calcium 9.0 mg/dL Magnesium 4.2 mEq/L
A magnesium level of 4.2 is markedly elevated (normal 1.3-2.1 mEq/L). Manifestations are not usually apparent until levels exceed 4 mEq/L. Patients with severe hypermagnesemia are in danger of cardiac arrest, so a level of 4.2 mEq/L requires prompt attention. A sodium level of 133 mEq/L is slightly low, but does not require immediate notification of the health care provider. A potassium level of 5.0 mEq/L is normal. A calcium level of 9.0 mg/dL is normal.
When administering 20 mEq potassium chloride intravenously (IV), which is the priority intervention? Monitor for pain or burning at the IV infusion site. Administer at a rate of 10 mEq/hr. Monitor respiratory rate and depth. Place the patient on a heart monitor during administration
Administer at a rate of 10 mEq/hr. The maximum recommended infusion rate is 5-10 mEq/hr to avoid potentially lethal cardiac dysrhythmias. Monitoring for pain at the IV infusion site, assessing respiratory rate and depth, and placing the patient on a heart monitor are all appropriate options, but because a rapid rate of administration could have lethal effects, it has the greatest priority.
A hypertensive patient was brought to the emergency department with a heart rate of 115 beats per minute and an abnormal electrocardiogram showing a shortened QT interval. The laboratory findings of the patient show a serum calcium level of 11 mg/dL. What nursing interventions would help stabilize the patient? Select all that apply. Administering thiazide diuretics Administering high ceiling or loop diuretics Administering 0.9% normal saline intravenously Administering Ringer's lactate solution intravenously Administering non-steroidal, anti-inflammatory agents
Administering high ceiling or loop diuretics. Administering 0.9% normal saline intravenously. Hypercalcemia clinically manifests as serum calcium levels above 10.5 mg/dL. This condition can be managed by using loop diuretics such as furosemide, which promote the excretion of calcium. One cause of hypercalcemia is dehydration, which can be well managed by administering 0.9% normal saline intravenously. Thiazide diuretics do not promote the excretion of calcium and thus are not suitable treatments for hypercalcemia. Ringer's lactate solution contains calcium; administering this solution does not help decrease the serum calcium levels. Administering non-steroidal, anti-inflammatory agents prevents hypercalcemia by calcium resorption from the bone; however, it does not treat hypercalcemia.
Laboratory results for a patient with a large draining abdominal wound show a serum sodium decrease from 138 mEq/L to 131 mEq/L. What is the nurse's first action? Assess the patient's respiratory status. Establish intravenous access. Notify the provider of laboratory results. Assess for orthostatic hypotension.
Assess the patient's respiratory status. Hyponatremia may present with neuromuscular changes including muscle weakness of the legs, arms, and respiratory muscles. The nurse should assess the respiratory effectiveness of a patient with hyponatremia as a priority. Obtaining assessment data is important when calling the provider in addition to reporting the laboratory result. Establishing IV access and assessing for orthostatic hypotension are important, but are lower-priority interventions.
A patient with a history of renal failure has a heart rate of 58 beats per minute, serum potassium levels of 5.5 mEq/L, and T wave spikes on the electrocardiogram (ECG). What nursing intervention may stabilize the patient? dministering furosemide Administering spironolactone Administering potassium supplements Administering sodium polystyrene sulfonate
Administering sodium polystyrene sulfonate Serum potassium levels above 5.0 mEq/L with symptoms of bradycardia and changes in electrocardiogram (ECG) indicate hyperkalemia. This condition can be well managed by decreasing the serum potassium levels. Drug therapy to increase potassium excretion in a patient with renal failure includes cation exchange resins such as sodium polystyrene sulfonate, which promote intestinal sodium absorption and potassium excretion. Furosemide can be administered in a patient with normal kidney function to decrease serum potassium levels. Spironolactone is a potassium sparing diuretic used for hypokalemic patients. Potassium supplements are also given to patients with hypokalemia.
A patient receiving insulin and glucose infusion therapy for hyperkalemia now has a serum potassium level of 3.6 mEq/L. What is the nurse's first action? Assess the patient's heart rate, rhythm, and respiratory status. Stop the infusion immediately. Continue the infusion at the prescribed rate. Slow the infusion and increase the frequency of vital sign assessment.
Assess the patient's heart rate, rhythm, and respiratory status. The serum potassium is now at the low end of normal range (3.5-5.0 mEq/L). The nurse must first assess the patient's response to the infusion and subsequent change in serum potassium (notably a change in respiratory effectiveness and quality and regularity of the heart rate). Once assessment data are obtained, the nurse should contact the provider and the infusion may be stopped, but it does not have to occur immediately.
What history and assessment findings may be associated with hypocalcemia in a 22-year-old man? Select all that apply. Decreased deep tendon reflexes without paresthesia. Awakening at night with muscle spasms in the calf. Recent blunt trauma to the throat during a football game. Absent bowel sounds. Tingling around the mouth.
Awakening at night with muscle spasms in the calf. Recent blunt trauma to the throat during a football game. Tingling around the mouth. A history of anterior neck injury may be associated with hypocalcemia. Symptoms of hypocalcemia include "charley horses" in the calf during rest or sleep, and tingling in the lips. Hypocalcemia does not affect bowel sounds. Decreased deep tendon reflexes without paresthesia is a neuromuscular change in hypercalcemia.
Which electrolyte imbalance does the nurse anticipate in association with a serum magnesium reading of 1.1 mEq/L? Potassium 5.7 mEq/L Calcium 7.8 mg/dL Sodium 149 mEq/L Phosphorus 2.6 mg/dL
Calcium 7.8 mg/dL Hypocalcemia often occurs with hypomagnesemia. A calcium level of 7.8 mg/dL is low. A sodium level of 149 mEq/L is slightly elevated, but not related to the low magnesium level. A phosphorus level of 2.6 mg/dL is slightly low, but not related to hypomagnesemia.
The nurse manager of a medical-surgical unit is completing assignments for the day shift staff. The patient with which electrolyte laboratory value is assigned to the LPN/LVN? Calcium level of 9.5 mg/dL Magnesium level of 4.1 mEq/L Potassium level of 6.0 mEq/L Sodium level of 120 mEq/L
Calcium level of 9.5 mg/dL Because a calcium level of 9.5 mg/dL is within normal limits, it is appropriate to assign this patient to an LPN/LVN. A magnesium level of 4.1 mEq/L, potassium level of 6.0 mEq/L, and a sodium level of 120 mEq/L are abnormalities in electrolytes that can cause serious complications and will require assessments and/or interventions by the RN.
A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). Her laboratory results include a potassium level of 7.0 mEq/L. What does the nurse include in the patient's medication teaching? Select all that apply. Daily weights are a poor indicator of fluid loss or gain. Diuretics can lead to fluid and electrolyte imbalances. Diuretics increase fluid retention. Laxatives can lead to fluid imbalance. It is important to weigh daily at the same time.
Diuretics can lead to fluid and electrolyte imbalances. Laxatives can lead to fluid imbalance. It is important to weigh daily at the same time. Diuretics decrease fluid retention and increase loss of fluids, thus can lead to fluid and electrolyte imbalances. Laxatives can also lead to fluid imbalance. Daily weight recording is a good indicator of fluid retention. Patients should be taught to weigh themselves at the same time, in the same clothing, and on the same scale.
Which patient is at greatest risk for hypernatremia? 17-year-old with a serum blood glucose of 189 mg/dL 30-year-old on a low-salt diet 42-year-old receiving hypotonic fluids 54-year old who is sweating profusely
Excessive sweating is a common cause of hypernatremia. Hyperglycemia, a low-salt diet, and hypotonic fluid administration are common causes of hyponatremia, not hypernatremia.
The nurse is teaching a patient who is taking a potassium-sparing diuretic about what foods to avoid. Which foods contain high amounts of potassium? Select all that apply.
Foods high in potassium include bananas, cantaloupe, kiwi, oranges, avocados, broccoli, dried beans, lima beans, mushrooms, potatoes, seaweed, soybeans, and spinach. Apples are considered to be low in potassium.
Laboratory results report a patient's serum potassium at 5.6 mEq/L. What does the nurse immediately assess in the patient?
Heart rate. Cardiovascular changes, specifically bradycardia; tall, peaked T waves; rhythm changes to complete heart block; asystole; and ventricular fibrillation are life-threatening consequences of elevated potassium. The provider or Rapid Response Team may need to be notified if changes in heart rate and rhythm are assessed. Paresthesias in the arms and feet and increased intestinal motility are lower-priority signs of elevated potassium. Level of consciousness would not be affected.
The nurse instructs an older adult patient to increase intake of dietary potassium when the patient is prescribed which classification of drugs?
High-ceiling (loop) diuretics High-ceiling (loop) diuretics are potassium-depleting drugs. The patient should increase intake of dietary potassium to compensate for this depletion. Alpha antagonists, beta blockers, and corticosteroids are not potassium-depleting drugs.
The nurse is caring for a patient who is receiving intravenous (IV) magnesium sulfate. Which assessment parameter is critical? 24-hour urine output Asking the patient about feeling depressed Hourly deep tendon reflexes (DTRs) Monitoring of serum calcium levels
Hourly deep tendon reflexes (DTRs) The patient who is receiving IV magnesium sulfate should be assessed for signs of toxicity every hour by assessment of DTRs. Most patients who have fluid and electrolyte problems will be monitored for intake and output (I&O); this will not immediately generate data about problems with magnesium overdose. Low magnesium levels can cause psychological depression, but assessing this parameter as the levels are restored would not be a method by which to safely assess a safe dose or an overdose. Although administration of magnesium sulfate can cause a drop in calcium levels, this occurs over a period of time and would not be the best way to assess magnesium toxicity.
A patient's electrocardiogram demonstrates a heart rate of 52 beats/min, prolonged PR interval with widened QRS complex, and the patient is also hypotensive. The nurse reviews the morning labs for which conditions? Hyperkalemia, hypercalcemia, hypermagnesemia Hypokalemia, hypocalcemia, hypermagnesemia Hypocalcemia, hyperkalemia, hypernatremia Hypernatremia, hypercalcemia, hypophosphatemia
Hyperkalemia, hypercalcemia, hypermagnesemia Cardiovascular changes are consistent with elevated potassium, calcium, and magnesium. These signs and symptoms may progress to life-threatening cardiac emergency. Although hypocalcemia can interfere with cardiac contractility, hypokalemia and hypophosphatemia do not.
Which condition is assessed using Trousseau's and Chvostek's signs?
Hypocalcemia Hypocalcemia is a decrease in serum calcium levels and is assessed by testing for Trousseau's and Chvostek's signs. Chvostek's sign is the twitching of the facial muscles in response to tapping over the area of the facial nerve. Hypokalemia, hyponatremia, and hypomagnesemia are not assessed by testing for Trousseau's and Chvostek's signs. Hypokalemia is determined by EKG changes. Hyponatremia can be detected by assessing a patient's mental status for changes. Hypermagnesemia causes muscle weakness.
A patient who recently experienced an anterior neck injury reports frequent and painful muscle spasms in the calf during sleep. Which condition does the nurse suspect in the patient? Hypokalemia Hypocalcemia Hyponatremia Hypophosphatemia
Hypocalcemia Patients with a history of anterior neck injury are at a high risk for hypocalcemia. Frequent painful muscle spasms in the calf or foot during rest or sleep (charley horses) indicate hypocalcemia. Hypokalemia, hyponatremia, and hypophosphatemia do not cause painful calf muscle spasms.
A patient who is homeless reports severe muscle weakness and chest discomfort. The nurse reviews the laboratory results for the presence of which disorder?
Hypophosphatemia Primary symptoms of hypophosphatemia include cardiac depression and weak skeletal muscles that may progress to muscle breakdown. Malnutrition and starvation are common causes of phosphorous imbalances; a homeless patient may not have adequate nutrition, placing him or her at risk of this electrolyte imbalance.
A patient with Crohn's disease reports numbness, tingling, and painful muscle contractions. After assessing the deep tendon reflexes of the patient, which intervention does the nurse perform next? Intravenous administration of sodium Intravenous administration of bicarbonate Intravenous administration of phosphorus Intravenous administration of magnesium sulfate
Intravenous administration of magnesium sulfate. Patients with Crohn's disease are at a high risk for magnesium imbalance, mainly hypomagnesemia. A decrease in the levels of magnesium may cause increased nerve impulse transmission causing hyperactive deep tendon reflexes, numbness, tingling, and painful muscle contractions. This condition can be well treated by administering magnesium sulfate intravenously. Intravenous administration of sodium, bicarbonate, or phosphorous is not a suitable intervention.
Which component of a patient history would most likely be associated with hyperphosphatemia? Chronic bronchitis Kidney failure Hyperparathyroidism Colon cancer
Kidney failure Hyperphosphatemia in acute or chronic kidney disease results from decreased loss of phosphorus due to the poor function of the kidneys. Chronic bronchitis does not affect phosphorus levels. Hypoparathyroidism (not hyperparathyroidism) may contribute to hyperphosphatemia. Certain cancer treatments, not the cancer itself, may cause hyperphosphatemia.
Which drug therapies might be used to manage symptoms of hypocalcemia? Select all that apply. Magnesium sulfate Calcium chloride Potassium chloride Vitamin D Zinc sulfate Vitamin E
Magnesium sulfate Calcium chloride Vitamin D Magnesium sulfate may be used to manage neuromuscular symptoms of hypocalcemia. Calcium supplements are given to restore serum calcium levels. Vitamin D enhances the absorption of oral calcium. Potassium, zinc, and vitamin E are not indicated for the management of hypocalcemia.
The nurse is reviewing lab values for a patient recently admitted to the medical-surgical unit. Which lab result is severely abnormal? Potassium, 3.5 mEq/L Sodium, 137 mEq/L Chloride, 107 mEq/L Magnesium, 6.2 mEq/L
Magnesium, 6.2 mEq/L A magnesium level of 6.2 mEq/L is greatly elevated. Patients with severe hypermagnesemia are in grave danger of cardiac arrest. The normal magnesium level is 1.3-2.1 mEq/L. The sodium and potassium results are within normal limits. The chloride level is just slightly elevated, with the normal range being between 98-106 mEq/L.
A patient with mild hypokalemia caused by diuretic use is discharged home. The home health nurse delegates which of these interventions to the home health aide? Assessment of muscle tone and strength. Education about potassium-rich foods. Instruction on the proper use of drugs. Measurement of the patient's urine output.
Measurement of the patient's urine output. A home health aide may measure the patient's intake and output, which then would be reported to the RN. Assessment, education, and instruction are higher-level nursing actions that should be done by the RN.
When planning care for a patient with hypercalcemia, which intervention does the nurse consider?
Monitor cardiac rhythm for changes. Hypercalcemia increases the risk for cardiac dysrhythmias. It does not impair gas exchange, so oxygen saturation does not need to be routinely monitored. There is a greater tendency to clot, especially with slow venous perfusion, so invasive procedures do not need to be avoided and increased activity (not restriction) is recommended.
The nurse is assessing a patient with hyponatremia. Which finding requires immediate action? Diminished bowel sounds Heightened acuity Muscular weakness Urine output of 35 mL/hr
Muscular weakness Muscle weakness in patients with hyponatremia requires immediate action. If muscle weakness is present, immediately check respiratory effectiveness because ventilation is dependent on adequate strength of the respiratory muscles. Excessive bowel sounds, not diminished bowel sounds, are expected in the patient with hyponatremia, as well as mild confusion, not heightened acuity. A urine output of 35 mL/hr is normal (minimally) and does not require immediate action.
A patient with hyperkalemia is being treated with drugs to improve the condition. Which potassium level indicates that therapy is effective?
Normal levels are 3.5 to 5.0 mEq/L
Which newly written prescription does the nurse administer first? Intravenous (IV) normal saline to a patient with a serum sodium of 132 mEq/L. Oral calcium supplements to a patient with severe osteoporosis. Oral phosphorus supplements to a patient with acute hypophosphatemia. Oral potassium chloride (KCl) to a patient whose serum potassium is 3 mEq/L.
Oral potassium chloride (KCl) to a patient whose serum potassium is 3 mEq/L Because minor changes in serum potassium level can cause life-threatening dysrhythmias, the first priority should be to administer potassium supplements to the patient with hypokalemia. The electrolyte disturbance (sodium level of 132 and low phosphorus level) and the need for calcium in this patient are not immediately life-threatening.
An older adult patient is admitted with dehydration. Which nursing assessment data identify that the patient is at risk for falling?
Orthostatic blood pressure changes Blood pressure decreases when changing positions. The patient may not have sufficient blood flow to the brain, causing sensations of lightheadedness and dizziness. This problem increases the risk for falling, especially in older adults. Assessment of oral mucous membranes and the pulse rate can detect symptoms of dehydration, but these are not the best ways to assess for a fall risk. Checking serum potassium does not assess for fall risk.
Which electrolyte imbalance is a risk factor for rhabdomyolysis? Sodium Chloride Potassium Phosphorous
Phosphorous Rhabdomyolysis is a serious syndrome caused by a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream. This can lead to complications such as renal failure. Decreased serum phosphorus levels cause musculoskeletal changes such as weak skeletal muscles that may progress to acute muscle breakdown. Imbalances of sodium, chloride, and potassium are not associated with rhabdomyolosis.
The health care provider writes orders for a patient who is admitted with a serum potassium (K) level of 6.9 mEq/L. What does the nurse implement first?
Place the patient on a cardiac monitor. Because hyperkalemia can lead to life-threatening bradycardia, the initial action should be to place the patient on a cardiac monitor. Administering a potassium-reducing medication, recommending a potassium-restricted diet, and teaching the patient about diet are appropriate but will not immediately decrease the serum potassium level and do not need to be implemented as quickly as monitoring cardiac rhythm.
Which written order does the nurse clarify with the provider when caring for a patient with a serum sodium level of 149 mEq/L? Institute seizure precautions. Weigh the patient daily. Place the patient on nothing by mouth (NPO) status. Monitor intake and output
Place the patient on nothing by mouth (NPO) status. Ensuring adequate water intake is an important nutritional therapy in the treatment of hypernatremia; the nurse should ask for clarification of the NPO order. The other orders are appropriate in the management of patients with hypernatremia.
Which nursing action is recommended when providing care to a patient with hypokalemia? Question the continued administration of bumetanide. Obtain the prescribed vial of IV potassium chloride from the pharmacy and dilute before administration. Establish a peripheral IV, preferably in the hand, for administering IV potassium chloride. Administer prescribed oral potassium chloride before a meal or snack.
Question the continued administration of bumetanide. Bumetanide is a loop diuretic, which contributes to potassium loss and should be questioned. The Joint Commission has mandated that all concentrated electrolytes be mixed by a pharmacist and that vials of KCl should not be available in patient care areas. A large vein with high blood flow should be accessed to avoid phlebitis; it is recommended that the hand be avoided. Oral potassium supplements should be given with or following a snack or meal to avoid nausea.
A patient is brought to the emergency department with symptoms of diarrhea, chest discomfort, and paresthesia. The patient has a heart rate of 60 beats per minute. The electrocardiogram (ECG) of the patient shows missed P waves, tall T waves, prolonged PR intervals, and wide QRS complexes. Which laboratory finding would be consistent with the patient's condition?
Serum potassium levels above 5.0 mEq/L. Laboratory data confirms hyperkalemia if serum potassium levels are above 5.0 mEq/L. Hyperkalemia clinically manifests with cardiovascular changes such as bradycardia, hypotension, and electrocardiogram (ECG) changes that include missed P waves, tall T waves, prolonged PR intervals, and wide QRS complexes. A neuromuscular change associated with hyperkalemia is numbness around the mouth, or paresthesia. Intestinal changes include frequent and watery bowel movements. Abnormalities in sodium levels are not associated with hyperkalemia. Hypokalemia is associated with serum potassium levels below 3.5 mEq/L, which do not show any such electrocardiogram (ECG) changes.
Which electrolyte deficiency results in decreased depolarization in the excitable cells and increased cellular swelling?
Sodium Hyponatremia occurs when sodium levels are low; this condition causes decreased depolarization in excitable cells and increased cellular swelling. Low serum calcium levels lead to muscle cramping and cardiac arrhythmias. A potassium deficiency causes cardiac dysrhythmias. A decrease in the level of magnesium may cause increased nerve impulse transmission.
Which electrolyte excess results in irritability and severe cellular dehydration?
Sodium. Hypernatremia occurs when serum sodium levels are very high; this condition causes excitable tissues to overrespond to stimuli. This leads to irritability and severe cellular dehydration. Hypercalcemia, an excess of calcium, decreases the sensitivity of excitable tissues to normal stimuli. Hyperphosphatemia (excess phosphorus) causes hypocalcemia. Hypermagnesemia (excess magnesium) causes hypotension, bradycardia, central nervous system changes, and neuromuscular changes.
A 90-year-old patient with hypermagnesemia is seen in the emergency department (ED). The ED nurse prepares the patient for admission to which inpatient unit?
Telemetry/cardiac stepdown Because hypermagnesemia causes changes in the electrocardiogram that may result in cardiac arrest, the patient should be admitted to the telemetry/cardiac stepdown unit. Dialysis/home care units, geriatric/rehabilitation units, and medical-surgical units typically do not have cardiac monitoring capabilities.
A patient is admitted to the hospital with a heart rate of 166 beats/min, increased thirst, restlessness, and agitation. Which electrolyte imbalance does the nurse suspect?
These symptoms are indicative of hypernatremia. Clinical manifestations of hypomagnesemia are seen in the neuromuscular, central nervous, and intestinal systems. Hypercalcemia manifests with an altered level of consciousness that can range from confusion and lethargy to coma, and severe hypercalcemia depresses electrical conduction, slowing heart rate. Hyperphosphatemia causes few direct problems with body function (although hypocalcemia is usually also present).
The nurse is planning care for a patient with hypocalcemia. Which nursing action is appropriate to delegate to unlicensed assistive personnel (UAP)? Collaborating with the dietitian to provide calcium-rich foods for the patient. Evaluating the patient's laboratory results. Implementing seizure precautions for the patient. Transferring the patient from the bed to a stretcher using a lift sheet.
Transferring the patient from the bed to a stretcher using a lift sheet Transferring patients is a nursing skill that is included in UAP education and scope of practice. Collaborating with the dietitian, evaluating the patient's laboratory results, and implementing seizure precautions all require broader education and scope of practice and should be done by licensed nursing personnel.
Positive Trousseau's and Chvostek's signs are consistent with which electrolyte imbalance?
Trousseau's sign (palmar flexion) and Chvostek's sign (facial twitching) are consistent with acute hypocalcemia. These manifestations are caused by overstimulation of the nerves and muscles. Trousseau's and Chvostek's signs are not used to assess for potassium imbalances.
