Fluid & Electrolytes - NCLEX Qs

Oral intake is controlled by the thirst center, located in which of the following cerebral areas? A. Hypothalamus B. Cerebellum C. Brainstem D. Thalamus

A. Hypothalamus Oral intake is controlled by the thirst center located in the hypothalamus. The thirst center is not located in the cerebellum, brainstem, or thalamus.

A client admitted with dehydration reports feeling dizzy with ambulation. What teaching would the nurse provide to the client? A. "Dizziness when you change position can occur when fluid volume in the body is decreased." B. "Dizziness can occur due to changes in the hospital environment." C. "Dizziness can occur when baroreceptors overreact to the changes in BP." D. "Dizziness is caused by very low blood pressure when you lay down."

A. "Dizziness when you change position can occur when fluid volume in the body is decreased." Dehydration is a cause for orthostatic hypotension, which causes temporary drop in BP when rising from a reclining position. Dizziness is not associated with environmental changes. Dizziness or changes in orthostatic BP occurs when baroreceptors do not respond quick enough to restore adequate circulation to the brain. Dizziness may be caused by low blood pressure. However, the client is dizzy with ambulation, not when laying down.

When fluid intake is normal, the specific gravity of urine should be which of the following? A. 1.010 to 1.025. B. 1.000. C. <1.010. D. >1.025.

A. 1.010 to 1.025. Urine specific gravity is a measurement of the kidney's ability to concentrate urine. The specific gravity of water is 1.000. A urine specific gravity of <1.010 may indicate overhydration. A urine specific gravity >1.025 may indicate dehydration.

A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action? A. Coordinate placing the peripheral IV and the lab blood draw. B. Delay both the IV start and blood draw until the child is well hydrated orally. C. Make sure the laboratory specimen is drawn prior to placing the IV access device. D. Place the IV and start intravenous fluids promptly; then request the laboratory obtain the blood specimen.

A. Coordinate placing the peripheral IV and the lab blood draw. Coordinate the IV placement and lab blood draw to minimize the number of venipunctures for the child. Gaining venous access for each purpose separately does not do this and is not necessary. Having a well-hydrated child makes venous access easier, but oral hydration will take some time, thus delaying needed treatment.

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? A. Hypocalcemia B. Hyponatremia C. Hyperkalemia D. Hypermagnesemia

A. Hypocalcemia Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.

When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? A. Inadequate fluid volume B. Normal glomerular filtration C. Overhydration D. Anuria

A. Inadequate fluid volume Urine output less than 0.5 mL/kg/h may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 0.5 mL/kg/h or more and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric client does not produce urine.

Mr. Jones is admitted to the nursing unit from the emergency department with a diagnosis of hypokalemia. His laboratory results show a serum potassium of 3.2 mEq/L (3.2 mmol/L). For what manifestations should the nurse be alert? A. Muscle weakness, fatigue, and dysrhythmias B. Nausea, vomiting, and constipation C. Diminished cognitive ability and hypertension D. Muscle weakness, fatigue, and constipation

A. Muscle weakness, fatigue, and dysrhythmias Typical signs of hypokalemia include muscle weakness and leg cramps, fatigue, paresthesias, and dysrhythmias. Manifestations of hypercalcemia include nausea, vomiting, constipation, bone pain, excessive urination, thirst, confusion, lethargy, and slurred speech. Diminished cognitive ability and hypertension may result from hyperchloremia. Constipation is a sign of hypercalcemia.

For the client who is receiving intravenous magnesium sulfate for severe preeclampsia, which assessment findings would alert the nurse to suspect hypermagnesemia? A. decreased deep tendon reflexes B. cool skin temperature C. rapid pulse rate D. tingling in the toes

A. decreased deep tendon reflexes Typical signs of hypermagnesemia include decreased deep tendon reflexes, sweating or a flushing of the skin, oliguria, decreased respirations, and lethargy progressing to coma as the toxicity increases. The nurse should check the client's patellar, biceps, and radial reflexes regularly during magnesium sulfate therapy. Cool skin temperature may result from peripheral vasodilation, but the opposite—flushing and sweating—are usually seen. A rapid pulse rate commonly occurs in hypomagnesemia. Tingling in the toes may suggest hypocalcemia, not hypermagnesemia.

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion? A. "That would probably help, but we'd have to do blood work first." B. "Actually, patients with renal failure usually can't take hydrochlorothiazide." C. "That would only work if he could come in twice a day to get it intravenously." D. "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys."

B. "Actually, patients with renal failure usually can't take hydrochlorothiazide." Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: A. Anorexia. B. Chronic diarrhea. C. Nausea and vomiting. D. Oral candida.

B. Chronic diarrhea Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload? A. Head of the bed elevated 30 degrees and legs elevated on pillows B. Head of the bed elevated 45 degrees and lower arms supported by pillows C. Supine with arms elevated on pillows above the level of the heart D. Prone with legs elevated on pillows

B. Head of the bed elevated 45 degrees and lower arms supported by pillows Preload refers to the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. The client is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the client may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the client's weight on the shoulder muscles.

The nurse is assigned to a client in the ICU. During the initial assessment, the nurse notes jugular vein distention and recognizes that the plan of care will follow which disorder? A. Abdominal aortic aneurysm B. Heart failure C. Myocardial infarction (MI) D. Pneumothorax

B. Heart failure Elevated venous pressure, exhibited as jugular vein distention, indicates the heart's failure to pump. Jugular vein distention is not a symptom of abdominal aortic aneurysm or pneumothorax. If severe enough, an MI can progress to heart failure, but an MI alone does not cause jugular vein distention.

A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? A. Vasculitis B. Nausea and vomiting C. Flexion contractures D. Enlargement of joints

B. Nausea and vomiting Digitalis medications are potent and may cause various toxic effects. The nurse should monitor the client for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. The most common signs and symptoms include nausea and vomiting which can lead to dehydration and electrolyte imbalance. Symptoms of toxicity do not include vasculitis, flexion contractures, or enlargement of joints.

A client reports nausea, vomiting, and diarrhea for 5 days. The nurse assesses the mucous membranes as pale and dry. The client has sunken eyes with the following vital signs: pulse 122 and thready, respirations 23, blood pressure 78/55, temperature 101.8°F oral. Which is the priority nursing intervention? A. Initiate oral rehydration therapy at 100 mL/kg of oral rehydration solution over 4 hours. B. Request an order from the physician for IV rehydration therapy. C. Assess vital signs every 15 minutes. D. Obtain stool specimen for analysis.

B. Request an order from the physician for IV rehydration therapy. The client is demonstrating hemodynamic instability that could lead to shock; therefore IV rehydration therapy is indicated. Oral rehydration therapy can begin once the client becomes hemodynamically stable. Although it is appropriate for the nurse to take vital signs frequently, the client needs fluid replacemen,t and that need should be addressed first. Stool specimens can be obtain once the client is hemodynamically stable.

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? A. Bradycardia B. Tachycardia C. Vasodilation D. Increased urine output

B. Tachycardia Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid heart rate, vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid, weak pulse and orthostatic hypotension.

What is the lab test commonly used in the assessment and treatment of acid-base balance? A. Complete blood count B. Basic metabolic panel C. Arterial blood gas D. Urinalysis

C. Arterial blood gas ABGs are used to assess acid-base balance. The pH of plasma indicates balance or impending acidosis or alkalosis. The complete blood cell count measures the components of the blood, focusing on the red and white blood cells. The urinalysis assesses the components of the urine. Basic metabolic panel (BMP) assess kidney function (BUN and creatinine), sodium and potassium levels, and blood glucose level.

A client who has been vomiting for 2 days has a nasogastric tube inserted. The nurse notes that over the past 10 hours the tube has drained 2 L of fluid. The nurse should further assess the client for: A. hypermagnesemia. B. hypernatremia. C. hypokalemia. D. hypocalcemia.

C. hypokalemia Loss of electrolytes from the gastrointestinal tract through vomiting, diarrhea, or nasogastric suction is a common cause of potassium loss, resulting in hypokalemia. Hypermagnesemia does not result from excessive loss of gastrointestinal fluids. Common causes of hypernatremia are water loss (as in diabetes insipidus or osmotic diuresis) and excessive sodium intake. Common causes of hypocalcemia include chronic renal failure, elevated phosphorus concentration, and primary hypoparathyroidism.

When the balloon on the distal tip of a pulmonary artery catheter is inflated and the pressure is measured, the measurement obtained is referred to as the: A. central venous pressure. B. pulmonary artery pressure. C. pulmonary artery wedge pressure. D. cardiac output.

C. pulmonary artery wedge pressure. When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary artery until it can no longer be passed. The pressure is recorded, reflecting left-atrial pressure and left-ventricular end-diastolic pressure. Central venous pressure is measured in the right atrium. Pulmonary artery pressure is measured when the balloon tip is not inflated. Cardiac output is determined through thermodilution, which involves injection of fluid into the pulmonary artery catheter.

A nurse is assessing a client who may be in the early stages of dehydration. Early manifestations of dehydration include: A. Coma or seizures. B. Sunken eyeballs and poor skin turgor. C. Increased heart rate with hypotension. D. Thirst or irritability.

D. Thirst or irritability Early signs and symptoms of dehydration include thirst, irritability, dry mucous membranes, and dizziness. Coma, seizures, sunken eyeballs, poor skin turgor, and increased heart rate with hypotension are all later signs.

Which indicator is the best for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? A. skin turgor B. temperature C. thirst D. daily weight

D. daily weight

A nurse is caring for a client with a low calcium level. Place the following options in chronological order to indicate the regulatory feedback mechanism of parathyroid hormone (PTH) release in relation to calcium levels. All options must be used. Calcium is reabsorbed. Low serum calcium level stimulates parathyroid gland. High serum calcium level inhibits PTH secretion Parathyroid gland releases PTH.

Low serum calcium level stimulates parathyroid gland. Parathyroid gland releases PTH. Calcium is reabsorbed. High serum calcium level inhibits PTH secretion