Fluid and Electrolytes PrepU

The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? 500 mL 1250 mL 1 L 1500 mL

1 Liter A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.

When fluid intake is normal, the specific gravity of urine should be:

1.010 to 1.025 Urine-specific gravity is a measurement of the kidneys' ability to concentrate urine. The specific gravity of water is 1.000. A urine-specific gravity less than 1.010 may indicate inadequate fluid intake. A urine-specific gravity greater than 1.025 may indicate overhydration.

The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client's serum sodium value would be

155 mEq/L (155 mmol/L) The client is experiencing signs and symptoms (S/S) of hypernatremia. Hypernatremia is a serum sodium concentration >145 mEq/L (>145 mmol/L). A cause of hypernatremia is near drowning in seawater (which contains a sodium concentration of approximately 500 mEq/L). S/S of hypernatremia include thirst, elevated body temperature, swollen and dry tongue and sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, simple partial or tonic-clonic seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia, elevated pulse, and elevated blood pressure.

A 68-year-old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which statement best captures an aspect of this client's condition? The client has possibly exhibited phosphate retention leading to calcium deposits. Paget disease, cancer with metastases, or excess vitamin D may have been contributors. Increased calcium intake over time may have contributed to the problem. The client has possibly undergone damage as a result of calcification following cellular injury.

The client has possibly undergone damage as a result of calcification following cellular injury Dystrophic calcification is a result of deposition of calcium following cellular injury, such as that which commonly occurs in heart valves. The other options refer to phenomenon associated with metastatic calcification and the associated increases in serum calcium levels.

Fluid moves into the arterial end of a capillary due to:

Hydrostatic pressure Hydrostatic pressure regulates the movement of fluids at the arterial end of the capillary; entotic pressure regulates this movement at the venous end of the capillary. It is the pressure that directs flow through the loosely connected endothelial cells of the capillary.

Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate?

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction In addition to increasing water intake to decrease vasopressin levels, the angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may be used to interrupt the renin-angiotensin-aldosterone system as a means of reducing intraglomerular pressure and renal vasoconstriction. Although not approved by the Food and Drug Administration (FDA), there has been recent interest in the use of vasopressin receptor antagonists (vaptans) to decrease cyst development.

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? Hypovolemia Dehydration Hypervolemia Fluid volume excess

Dehydration 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 wound care nurse evaluates a client's wound after being consulted. The client's wound healing has been slow. Upon assessment of the wound, the wound care nurse informs the medical-surgical nurse that the wound healing is being delayed due to the client's state of dehydration and dehydrated tissues in the wound that are crusty. What is another term for localized dehydration in a wound? Maceration Necrosis Evisceration Desiccation

Desiccation Desiccation is localized wound dehydration. Maceration is localized wound overhydration or excessive moisture. Necrosis is death of tissue in the wound. Evisceration is complete separation of the wound, with protrusion of viscera through the incisional area.

A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant? Avoid eating spicy food. Drink plenty of fluids at bedtime. Avoid foods such as cheese. Eat dry crackers or toast before rising.

Eat dry crackers or toast before rising The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.

The parent of a 5-year-old child tells the nurse that on two occasions her son has lost control of urination when he had to wait to go to the bathroom at school. What is the appropriate nursing response? "It would be appropriate to place your son in incontinence undergarments." "Let's review the types of fluids that your child drinks in the morning." "I would only worry about this if you were raising a daughter." "This is extremely abnormal. You will need to see your son's pediatrician."

"Let's review the types of fluids that your child drinks in the morning." Bladder irritants such as caffeine can cause urge incontinence; it is appropriate to determine whether the child is consuming fluids that contain caffeine. The child's urge incontinence is not extremely abnormal, and this physiological response is not related to gender. It is too soon to refer the client to the health care provider without taking a history, and it is impractical to simply recommend incontinence undergarments.

A client with a traumatic amputation of the lower leg has lost >40% of blood volume and is currently not producing any urine output. The nurse bases this phenomena on which humoral substance that is responsible for causing severe vasoconstriction of the renal vessels?

Angiotensin II and antidiuretic hormone Increased sympathetic activity causes constriction of the afferent arterioles, creating a reduction in renal blood flow. Intense sympathetic stimulation can produce marked decreases in renal blood flow and glomerular filtration rate. Humoral substances, including angiotensin II, antidiuretic hormone, and endothelins produce vasoconstriction of renal blood flow. Aquaporin-2 channels, potassium ions, and albumin do not have vasoconstriction properties.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? Take measures to acidify the urine and prevent uric acid crystallization. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Encourage fluid intake to dilute the urine. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

Encourage fluid intake to dilute the urine The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage.

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition

End-stage renal disease Certain illnesses require advanced technology for survival, or intensive care for periods of weeks or months, as in end-stage renal disease (ESRD). People with this condition are chronically critical and progressively ill. Some chronic illnesses have little effect on quality of life, but others, like ESRD, have a considerable effect because it can result in a chronic progressive deterioration.

A patient comes to the clinic with complaints of severe thirst. The patient has been drinking up to 10 L of cold water a day, and the patient's urine looks like water. What diagnostic test does the nurse anticipate the physician will order for diagnosis?

Fluid deprivation test Diabetes insipidus (DI) is the most common disorder of the posterior lobe of the pituitary gland and is characterized by a deficiency of ADH (vasopressin). Excessive thirst (polydipsia) and large volumes of dilute urine are manifestations of the disorder. The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patient is weighed frequently during the test. Plasma and urine osmolality studies are performed at the beginning and end of the test. The inability to increase the specific gravity and osmolality of the urine is characteristic of DI.

A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?

Fluid intake should be about equal to the urine output. Normally, fluid intake is about equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isn't inversely proportional to the urine output.

Which is the primary nursing intervention in the care of a client with burns exceeding 20% of total body surface area? Strict intake and output Fluid resuscitation Prevent infection Endotracheal tube placement

Fluid resuscitation Fluid resuscitation requirements are paramount in the management of clients having burns that exceed 20% of TBSA. Fluid resuscitation with crystalloid and colloid solutions is calculated from the time the burn injury occurred to restore the intravascular volume and prevent hypovolemic shock and renal failure. Infection prevention is a care consideration with all burns. Endotracheal tube placement may be necessary if respiratory factors indicate the need. Intake and output records are maintained to determine the success of fluid resuscitation efforts.

The nurse understands that asystole can be caused by several conditions. Select all that apply.

Hypoxia Hypovolemia Hypothermia Acidosis Ventricular asystole is treated the same as pulseless electrical activity (PEA), focusing on high-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and identifying underlying and contributing factors. The key to successful treatment is a rapid assessment to identify a possible cause, which is known as the "Hs and Ts": hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary).

A client has partial-thickness burns on both lower extremities and portions of the trunk. Which IV fluid does the nurse plan to administer first?

Lactated Ringer's solution Lactated Ringer's solution replaces lost sodium and corrects metabolic acidosis, both of which commonly occur following a burn. Albumin is used as adjunct therapy, not as primary fluid replacement. D5W isn't given to burn clients during the first 24 hours because it can cause pseudodiabetes. The client is hyperkalemic as a result of the potassium shift from the intracellular space to the plasma, so giving potassium would be detrimental.

The nurse is developing a plan of care for a client with Meniere's disease and identifies a nursing diagnosis of excess fluid volume related to fluid retention in the inner ear. Which intervention would be most appropriate to include in the plan of care? Restrict high-potassium foods. Limit foods that are high in sodium. Encourage intake of caffeinated fluids. Administer prescribed antihistamine.

Limit foods that are high in sodium. Sodium and fluid retention disrupts the delicate balance between the endolymph and perilymph in the inner ear. Therefore, many clients can control their symptoms by adhering to a low-sodium diet. Caffeinated fluids are to be avoided because of their diuretic effect. Diuretics, not antihistamines, would be prescribed to lower the pressure in the endolymphatic system. Foods high in potassium would be encouraged if the client is prescribed a diuretic that causes potassium loss.

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema? Hands Abdomen Lower extremities Eyelids

Lower extremities Initially, the edema caused by nephritic syndrome presents in the dependent parts of the body, such as the lower extremities, but becomes more generalized as the disease progresses.

A client has experienced hypovolemic shock and is being treated with 2 liters of lactated Ringer's solution. It is now most important for the nurse to assess

Lung sounds The nurse must monitor the client during fluid replacement for side effects and complications. The most common and serious side effects include cardiovascular overload and pulmonary edema, which would be exhibited as adventitious lung sounds. Other assessments that the nurse would make include skin perfusion, changes in mentation, and bowel sounds.

Blood administration is ordered for a client receiving chemotherapy. The nurse is obtaining all supplies needed for infusion. Which intravenous solution is obtained? Lactated Ringer's Normal Saline D5 1/2 Normal Saline D5 1/4 Normal Saline +20 mEq Potassium

Normal saline solution 0.9 NS is the only fluid compatible with blood administration. Lactated Ringers and dextrose solutions are not infused with blood products due to compatibility.

The nurse has identified a collaborative problem of Risk for Complications of Electrolyte Imbalance for a client with diarrhea. The client begins to exhibit a decrease in level of consciousness. What is the nurse's most appropriate action?

Notify the physician for additional orders. The client's decreased level of consciousness could indicate that the client is developing an electrolyte imbalance. The change in the client's status requires notification of the physician. Medication orders are required to treat the electrolyte imbalance. Documenting the level of consciousness is appropriate, but not as the priority action. Another nurse is not necessary to check the nurse's assessment. Decreasing stimulation and allowing the client to rest with no further action may result in harm to the client.

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed: Filtration Osmosis Diffusion Active transport

Osmosis Osmosis is the force that moves water from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water. Active transport is the movement of ions against an electrical or chemical gradient. Diffusion is the process by which particles in solution move from an area of higher concentration to lower, resulting in equal distribution. Filtration is the process of passing a liquid through a filter that is accomplished by gravity, vacuum, or pressure.

Which glands regulate calcium and phosphorous metabolism?

Parathyroid Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism. The thyroid gland controls cellular metabolic activity. The adrenal medulla at the center of the adrenal gland secretes catecholamines, and the outer portion of the gland, the adrenal cortex, secretes steroid hormones. The pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands.

The nurse is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to find? hyperkalemia reduced BUN hypernatremia hyperglycemia

Serum potassium level of 6.8 mEq/L A serum potassium level of 6.8 mEq/L indicates hyperkalemia, which can occur in adrenal insufficiency as a result of reduced aldosterone secretion. A BUN level of 2.3 mg/dl is lower than normal. A client in addisonian crisis is likely to have an increased BUN level because the glomerular filtration rate is reduced. A serum sodium level of 156 mEq/L indicates hypernatremia. Hyponatremia is more likely in this client because of reduced aldosterone secretion. A serum glucose level of 236 mg/dl indicates hyperglycemia. This client is likely to have hypoglycemia caused by reduced cortisol secretion, which impairs glyconeogenesis.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?

Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

Which is a potassium-sparing diuretic used in the treatment of heart failure?

Spironolactone Spironolactone is a potassium-sparing diuretic. Chlorothiazide is a thiazide diuretic. Bumetanide and ethacrynic acid are loop diuretics.

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?

Will prevent the conversion of angiotensin I to angiotensin II Among the drugs used in the treatment of hypertension are ACE inhibitors. The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?

aspirin Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for:

dehydration With this form of the disorder, children are unable to produce aldosterone. This leads to the inability to retain sodium and fluid.

Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into the intravascular compartment?

hypertonic The osmolarity of a hypertonic solution is higher than that of serum. A hypertonic solution draws fluid into the intravascular compartment from the intracellular and interstitial compartments. An isotonic solution's osmolarity is about equal to that of serum. It expands the intravascular and interstitial compartments. A hypotonic solution's osmolarity is lower than serum's. A hypotonic solution hydrates the intracellular and interstitial compartments by shifting fluid out of the intravascular compartment. Electrotonic solution is incorrect.

A full-term neonate is suspected of having hydrocephalus. The nurse collects what assessment finding to best assist in confirming the diagnosis? decreased level of consciousness increasing occipital frontal circumference evidence of seizure activity increased body temperature

increasing occipital frontal circumference Hydrocephalus is an increase in cerebrospinal fluid in the ventricles of the brain. The nurse should assess the infant's head circumference and note any increases. Hydrocephalus is associated with an increased occipitofrontal diameter. When palpated, the head has widened sutures with wide, open fontanels. Typically the fontanels will feel tense and bulging. Other, less specific signs of hydrocephalus include poor feeding, "setting sun" eyes, vomiting, lethargy, prominent veins, and seizure activity due to increased intracranial pressure. Meningitis can develop and result in fever.

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and sodium magnesium phosphorus potassium

phosphorus PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

A major complication of prolonged bed rest is an increased risk of kidney stones. The nurse knows that this is most likely related to: a limited access to fluids while hospitalized. increased urine levels of citrate. saturation of urine with calcium salts. frequency of urination.

saturation of urine with calcium salts Saturation of urine with calcium salts increases the risk for the development of calcium-containing kidney stones. Elevated urine levels of citrate are a prominent inhibitor of calcium stone formation. Fluid intake is not likely to be limited but regardless, it would not contribute to kidney stone formation. Urinary frequency is not a factor in kidney stone formation.

When caring for the client with hyperkalemia, the nurse recognizes the body should respond in which of these ways? Actively reabsorb calcium store sodium and potassium for future use retain bicarbonate and potassium secrete potassium in the distal tubules for excretion

secrete potassium in the distal tubules for excretion When the body is confronted with a potassium excess, as occurs with a diet high in potassium content, the amount of potassium secreted at this site may exceed the amount filtered in the glomerulus.

The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop: sodium and water retention. potassium and sodium excretion. potassium retention and water excretion. water and potassium retention.

sodium and water retention Aldosterone acts at the level of the cortical-collecting tubules of the kidneys to increase sodium reabsorption and water retention while increasing potassium elimination. Potassium retention and water excretion as well as potassium and sodium excretion refer to a decreased level of aldosterone. Water and potassium retention is incorrect as the potassium level would be decreased.

A client has been admitted with severe burns. Lactated Ringer's has been ordered to infuse via a pump. Why is this solution being used?

to prevent signs of hypovolemic shock and restore circulation Lactated Ringer's is infused to restore circulating fluid volume and prevent signs of hypovolemic shock. Intravenous administration of dextrose to restore glucose is not the priority at this time. Lactated Ringer's will not affect sodium, and this is not a priority. The client has severe burns, so improving skin integrity is not an issue at this time.