Fluid and electrolytes and Arterial Blood Gases
The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? A. Magnesium:2 mEq/L B. Potassium: 5.8 mEq/L C. Sodium: 138 mEq/L D. Calcium: 10 mg/dL
B. Potassium: 5.8 mEq/L Explanation: Normal potassium level is 3.5 to 5.5 mEq/L. Elevated potassium levels can lead to muscle weakness, paresthesias, and cardiac dysrhythmias.
The nurse is caring for a client who has developed postoperative respiratory acidosis. Which of these interventions will the nurse use to help correct this problem? Medicate for pain. Encourage use of incentive spirometer .Perform fingerstick blood glucose .Encourage protein intake.
Encourage use of incentive spirometer.
The nurse is caring for a client with acute respiratory failure and PaCO2 level of 88 mm Hg For which of these signs and symptoms will the nurse assess? Select all that apply. Hyperactivity Headache Shallow breathing pH 7.49 Fatigue
Fatigue Shallow breathing Headache
Respiratory Acidosis
hypo-ventilation-COPD pts.-Overdose of sedatives-Spinal Chord/ chest wall injuries -Respiratory problems with inadequate excretions of CO2.
The nursing assistant reports that the client with metabolic acidosis due to kidney failure is breathing rapidly and deeply. The nurse explains this to the nursing assistant in which of these manners? "The client is acting out and we should pay him no mind" "Rapid breathing is a way to compensate for acidosis caused by his condition" "Normally a client with this disorder will breathe slowly, I will go assess him" "Deep breathing is a symptom of diabetes, I will check his blood glucose" "Rapid breathing is a way to compensate for acidosis caused by his condition"
"Rapid breathing is a way to compensate for acidosis caused by his condition"
A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply. A. Drink water as an inexpensive way to meet fluid needs B. Drink carbonated beverages to help balance fluid volume .C. Drink caffeinated beverages to retain fluid .D. Respond to thirst E. Drink at least eight glasses of fluid each day.
A. Drink water as an inexpensive way to meet fluid needs D. Respond to thirst E. Drink at least eight glasses of fluid each day Explanation: In addition, the nurse teaches clients who have a potential for hypovolemia and their families to respond to thirst because it is an early indication of reduced fluid volume; consume at least 8 to 10 (8 ounce) glasses of fluid each day and more during hot, humid weather; drink water as an inexpensive means to meet fluid requirements; and avoid beverages with alcohol and caffeine because they increase urination and contribute to fluid deficits.
George Kent is a 54 year old widower with a history of COPD and was rushed to the ED with increasing SHOOB, pyrexia, and productive cough with yellow-green sputum. He has difficulty in communicating because of his inability to complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has tachycardia and a bounding pulse. Measurement of the arterial blood gas shows pH 7.3, PaCO2 68mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this?A. Respiratory Acidosis, UncompensatedB. Respiratory Acidosis, Partially CompensatedC. Metabolic Alkalosis, UncompensatedD. Metabolic Acidosis, Partially Compensated
Answer: B. Respiratory Acidosis, Partially Compensated The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease, with partial compensation.
Which is a correct route of administration for potassium? A. Subcutaneous B. Intramuscular C. IV (intravenous) push D. Oral
D. Oral Explanation:Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously.
Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?
A. Limit salt and water intake Explanation:Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.
Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment?A. Metabolic Acidosis, UncompensatedB. Metabolic Alkalosis, UncompensatedC. Respiratory Alkalosis, UncompensatedD. Metabolic Alkalosis, Partially Compensated
Answer: B. Metabolic Alkalosis, Uncompensated The postoperative client's ABG results show that he has metabolic alkalosis because of an increased pH and HCO3. It is uncompensated due to the normal PaCO2 which is within 35 to 45 mmHg.
Client Z is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?A. Metabolic Acidosis, UncompensatedB. Respiratory Alkalosis, Partially CompensatedC. Respiratory Alkalosis, UncompensatedD. Metabolic Alkalosis, Partially Compensated
Answer: C. Respiratory Alkalosis, Uncompensated The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3 which is within 22-26 mEq/L.
Carl, an elementary student, was rushed to the hospital due to vomiting and and decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), he is lethargic and irritable in response to stimulation. He appears to be dehydrated- his eyes are sunken and mucous membranes are dry- he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95mmol/L. What is your assessment?A. Respiratory Acidosis, UncompensatedB. Respiratory Acidosis, Partially CompensatedC. Metabolic Alkalosis, UncompensatedD. Metabolic Acidosis, Partially Compensated
Answer: D. Metabolic Acidosis, Partially, Compensated The student was diagnosed having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).
You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? A. Hypovolemia B. Dehydration C. Hypervolemia D. Fluid volume excess
B. Dehydration Explanation: The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.
The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? A. Headache B. Seizures C. Confusion D. Hallucinations
C. Confusion Normal serum concentration ranges from 135 to 145 mEq/L (135-145 mmol/L). Hyponatremia exists when the serum concentration decreases below 135 mEq/L (135 mmol/L). When the serum sodium concentration decreases to <115 mEq/L (<115 mmol/L), signs of increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur. General manifestations of hyponatremia include poor skin turgor, dry mucosa, headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic changes, including altered mental status, status epilepticus, and coma, are probably related to cellular swelling and cerebral edema associated with hyponatremia. Hallucinations are associated with increased serum sodium concentrations.
Below which serum sodium concentration might convulsions or coma occur? A. 145 mEq/L (145 mmol/L B. 140 mEq/L (140 mmol/L) C. 142 mEq/L (142 mmol/L) D. 135 mEq/L (135 mmol/L)
D. 135 mEq/L (135 mmol/L) Explanation:Normal serum concentration level ranges from 135 to 145 mEq/L (135-145 mmol/L). When the level dips below 135 mEq/L (135 mmol/L), hyponatremia occurs. Manifestations of hyponatremia include mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the deficit is severe. Values of 140, 142, and 145 mEq/L (mmol/L) are within the normal range.
The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance? A. A 72-year-old with a total knee repair B. A 65-year-old with a myocardial infarction C. A 7-year-old with a fracture tibia D. A 52-year-old with diarrhea
D. A 52-year-old with diarrhea Explanation:Electrolytes are in both intracellular and extracellular water. Electrolyte deficiency occurs from an inadequate intake of food, conditions that deplete water such as nausea and vomiting, or disease processes that cause an excess of electrolyte amounts. The 52-year-old with diarrhea would be the client most likely to have an electrolyte imbalance. The orthopedic client will not likely have an electrolyte imbalance. Myocardial infarction clients will occasionally have electrolyte imbalance, but this is the exception rather than the rule.
What foods can the nurse recommend for the patient with hypokalemia? A. Nuts and legumes B. Green, leafy vegetables C. Milk and yogurt D. Fruits such as bananas and apricots
D. Fruits such as bananas and apricots Explanation:Sources of potassium include fruit juices and bananas, melon, citrus fruits, fresh and frozen vegetables, lean meats, milk, and whole grains (Crawford & Harris, 2011b).
A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance? A. Hyperkalemia B. Hypokalemia C. Hypocalcemia D. Hypercalcemia
D. Hypercalcemia Explanation:The normal reference range for serum calcium is 9 to 11 mg/dl. A serum calcium level of 12 mg/dl clearly indicates hypercalcemia. The client's other laboratory findings are within their normal ranges, so the client doesn't have hypernatremia, hypochloremia, or hypokalemia.
An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? A. Hyperkalemia B. Hypernatremia C. Hypophosphatemia D. Hypokalemia
D. Hypokalemia Explanation Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a defict in total potassium stores. Potassium-losing diuretics, such as loop diuretics, can induce hypokalemia
