fluid and electrolytes quiz

Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)?

three ounces of light or dark meat chicken, 1 cup of spaghetti, and a garden salad

Hypocalcemia Etiology/ Risk factors

vitamin d deficiency hypoparathyroid (or removal of) L.T. corticosteroid use

Hypernatremia (too little water) etiology and risk factors

vomiting, diarrhea, diuretics, not drinking enough water, uncontrolled diabetes, burn, dehydration

Hypovolemia pathophysiology

circ volume decreases which results in lower BP and higher HR Hemoconcentration increases resulting in higher blood clots, kidney stones, and build up of nitrogenous wastes eventually in menstration

Hypocalcemia assessment findings

circumoral paresthesia (numbness around the mouth) muscle cramps/ abd cramps positive chvosteks sign positive trousseau spasms, twitching, seizure precautions

miss green has been in an automobile accident and sustained several crushing injuries to her legs, and has fractured her pelvis. Her heart rate is normal but has become irregular. The EKG reveals peaked T waves.

hyperkalemia

an elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?

hypokalemia

Hypervolemia Pathophysiology

increased BP Increased force of heart contraction and pulmonary function

Early signs of hypovolemia include

increased breathing effort and weight gain

clients diagnosed with hypervolemia should avoid sweet or dry food because it

increases the client's desire to consume more fluid

the nurse is performing an admission assessment on a 79 year old newly admitted client for end stage liver disease. What principle should guide the nurse's assessment of the client's skin turgor?

inelastic turgor is a normal part of aging

hyperkalemia etiology and risk factors

kidney failure burns, crush injuries, addison's k sparing diuretics salt substitutes, too much K in iv fluids

A client with edema is started on spironolactone (Aldactone) to promote diuresis. The client wants to know what the advantage of this medication is over the other available drugs. What is an appropriate response by the nurse?

"There will be less of a drop in potassium levels while you are on this drug."

Hyponatremia Assessment Findings

(below range of 135-145mEq/L) - VS: hypothermia, tachycardia, thready pulse, hypotension, orthostatic hypotension - NUERO: Headache, confusion, lethargy

hypovolemia assessment findings

-Increased HR, decreased BP, weak pulses, poor skin turgor, dry mucous membranes, confusion and decreased urine output weight loss> 2 lb/day dark yellow urine decreased mental status weakness

Hypercalcemia interventions

-Restrict calcium and increase fluid intake -Monitor the client for pathological fractures -diuretic furosemide to excrete Ca

the physician has prescribed a hypotonic IV solutions for a patient. Which IV solutions should the nurse administer?

0.45 % sodium chloride

Mg

1.3-2.1 mEq/L

A patient is admitted with severe vomiting for 24 hours as well as weakness and " feeling exhausted". The nurse observes flat T waves and ST segment depression on the electrocardiogram. Which potassium level does the nurse observe when the laboratory studies are complete?

2.5

K

3.5-5.0 mEq/L

Ca

9-11 mg/dL

SaO2

95-100%

Cl

96-106 mEq/L

A nurse is instructing a client how to decrease the intake of calcium in the diet. The nurse tells the patient which of the following food items would contain the least amount of calcium?

Butter

A pt complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patient's laboratory work has returned?

Calcium

Lawrence WIlkens, a 73 year old male, was admitted to your hospital unit after two days of vomiting and diarrhea. His wife became alarmed when he demonstrated confusion, elevated temperature and reported, "dry mouth". From what conditions would you suspect Lawrence may be suffering?

Dehydration

If your patient has a deficit or increase in potassium which assessment would be most important?

EKG and HR and rhythm

Which of the following signs and symptoms may point toward a FVE?

Elevated BP, Weight gain of 4 lbs in 2 days, edema in extremities, rales, respiratory rate of 26 bpm

Hypovolemia Etiology and Risk Factors

G decreased thirst sensation leading to decrease fluid intake G medications such as diuretics, laxatives bleeding Vomiting/ Diarrhea profuse urination third spacing; ascites

A nurse is documenting the electrolyte report of a client on diuretic therapy for congestive heart failure. The reports is as follows: sodium-142, K-2.5, Ca-9, Cl-98 mEq/L. Which of the following electrolyte disturbances should the nurse report to the physician?

Hypokalemia

Salle Bean, 2 years of age, has had profuse watery diarrhea for 5 days. She is thirsty and her oral intake has been inadequate. Her urinary output has decreased. Her skin is flushed, and her mucous membranes are dry and sticky. She is weak and nauseated

Hypovolemia

Your female patient has been admitted with a diagnosis of hypocalcemia. She has a positive Chvosteks. The physician has asked you to initiate seizure precautions. Which medication would you have ready for the physician to administer?

IV Calcium gluconate

a client with pancreatic cancer has the following blood chemistry profile: glucose-204 mg/dl, BUN-12 mg/dl, creatinine-0.9 mg/dl, sodium-136 mEq/L, K-2.2 mEq/L, Cl-99 mEq/L, CO2-33 mEq/L. Which result should the nurse identify as critical and report immediately?

K potassium

Potassium is well controlled in the body, which one of the body's organs is responsible for controlling potassium?

Kidney

Mrs. Mangini is receiving intravenous magnesium sulfate. To avoid administering an excess, which hourly observation of the pt. must be made?

LOC, decreased BP and HR and RR. DTR

hypernatremia Interventions

VS, LOC, daily weights, Is & Os, increase fluid intake, start IV, restrict Na

Hyponatremia Etiology/Risk factors

Na loss, poor Na intake, excess water intake or retention Decreased secretion of aldosterone Vomiting, diarrhea, diuretics (loss of fluid AND electrolytes) CHF, Liver disease, chronic renal failure

a client is diagnosed with hypocalcemia. Which of the following conditions most commonly causes this condition?

Parathyroid hormone deficit

a pt suffers from numbness and tingling around the mouth and has a positive Trousseau's sign after a parathyroidectomy. Which of the following medications will be administered?

Parenteral calcium gluconate

Which assessment finding is indicative of hypocalcemia?

Positive Chvostek's sign

a client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6. Which physical examination finding is consistent with this electrolyte imbalance?

Presence of Trousseau sign

Hypovolemia interventions

Provide patient with fluids (IV or oral) Monitor daily weight Provide oxygen if ordered Monitor vital signs Educate patient on maintaining adequate hydration and nutrition gatorade/ pedialyte

Hyperkalemia interventions

VS- HR & rhythm restrict K stop oral supplements, or d/c IV KCl give sodium polystyrene sulfonate (kayexalate) {which gets rids of K through feces} Severe IV insulin w/ glucose (insulin will carry K back to cell)

Hypervolemia Etiology and Risk factors

Rapid IV infusion excessive fluid intaker (Na) HF Kidney disease side effect corticosteroids

A client with complaints of frequent and increased urination is diagnosed with diabetes insipidus. The electrolyte report of the client is as follows : Na-150, K-4.5, Ca-9.2, Cl-96 mEq/L. The client is reported to have hypernatremia. The physician instructs the nurse to modify the diet accordingly. What dietary restriction should the nurse recommend in the diet plan for this client?

Sodium

hypokalemia interventions

Vitals, labs. HR monitor. Encourage foods high in K NEVER IV Push KCl supplements, consider spironolactone (K sparing diuretic)

treatment of fluid volume excess involves dietary restriction of sodium. Which of the following food choices would be part of a low sodium diet, mild restriction (2-3 g/day)?

Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad

a client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching?

Tingling sensation in the fingers

the nurse is caring four four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance?

a 52 year old with diarrhea.

a client reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Chvostek's signs. Which decreased laboratory results does the nurse observe when the client's laboratory work has returned?

calcium

a client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values: Na 137 K 4.6 Cl 94 Ca 12.9 What laboratory value is of highest concern to the nurse?

calcium 12.9

hypercalcemia pathophysiology

calcium in the blood instead of in bone

Tests are ordered for a client to measure the serum electrolytes potassium, sodium, and magnesium. What might an increase or decrease in the level of these electrolytes cause?

cardiac dysrhythmia

hyponatremia diet

deli meat, chips, soups, cheese

the nurse is reviewing the diagnostic laboratory results for a client. The body needs all electrolytes and more for normal functioning of nerves and muscles, developing body cells, blood clotting, and coordinating all body activities. Based on this information, the nurse notices that the client's potassium is low. What food sources should the nurse encourage the client to eat to help raise the potassium level?

milk, potatoes, broccoli, green leafy vegetables, dry fruits, nuts, cantaloupe, apricots

A priority nursing intervention for a client with hypervolemia involves which of the following?

monitoring respiratory status for signs and symptoms of pulmonary complications

Hyperkalemia Assessment Findings

n/d, muscle weakness, paresthesias, dysrhythmias, PEAKED T WAVES

Russell Thompkins, a 77-year-old retired male, visits your general practice office twice monthly to maintain control of his congestive heart failure. He measures his weight daily and phones it to your office for his medical record. In a 24-hour period, how much fluid is Russell retaining if his weight increases by two pounds? a) One liter b) 1250 ml c) 1500 ml d) 500 ml

one liter

the nurse is reviewing the diagnostic laboratory results for a client. The body needs all electrolytes and more for normal functioning of nerves and muscles, developing body cells, blood clotting, and coordinating all body activities. Based on this information, what is the major ion of the intracellular fluid that is responsible for the normal functioning of neurons and muscle cells, including the heart, that the nurse needs to review on the diagnostic test results?

potassium

A pt. is being administered furosemide (Lasix). Which medication will be administered if the patient's serum potassium level is 2.0?

potassium chloride KCl

a pt. is taking furosemide (Lasix), a loop diuretic for the treatment of mild CHF. What laboratory study result indicates a complication of the diuretic therapy?

potassium level of 2.8 mEq/L (too low, normal range: 3.5-5.0)

hypercalcemia etiology and risk factors

prolonged immobolization can lead to osteporosis cancers bone, bone marrow, blood hyperparathyroidism bone disease- paget's

hypokalemia Fxn

range: 3.5-5.0 mEq/L major intracellular electrolyte nerve and muscle; especially the heart

an elderly client post op hip replacement is experiencing signs of hyponatremia. The nurse checks the client's electrolyte levels. Which of the following serum sodium levels confirms this diagnosis?

130 mEq/L

a 42 year old client has chronic hyponatremia, whihc requires weekly blood labs to keep him from lapsing into convulsions or a coma. What is the level of serum sodium below which convulsions or coma can occur?

135 mEq/L

Na

135-145 mEq/L

While assessing a client's peripheral site, the nurse observes edema and coolness around the insertion site. How should the nurse document this observation?

Infiltration

At which serum sodium concentration might convulsions or coma occur?

130 mEq/L

the nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with dehydration?

dark, concentrated urine, vomiting, confusion, fever, dry mouth

Hypercalcemia Assessment Findings

deep bone pain, constipation, anorexia, polyuria, pathologic fractures, kidney stones decrease memory and attention span

a client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported dry mouth. The nurse suspects the client is experiencing which condition?

dehydration

Hypernatremia Assessment Findings

dehydration, thirst, dry mucous membranes, decreased urine output, lethargy, increased in temperature

hypokalemia etiology

diuretic use thiazides n/d, laxative overuse corticosteroids (increase Na, decrease K) Do not use diuretic if K decreases

A client was admitted to the unit with a diagnosis of hypovolemia. When is it time to complete discharge teaching, which of the following will the nurse teach the client and family?

drink at least 8 glasses of fluid each day, drink water as an inexpensive way to meet fluid needs, and respond to thirst

A client was admitted to your unit with a diagnosis of hypovolemia. When is it time to complete discharge teaching, which of the following will the nurse teach the client and his family?

drink at least 8 glasses of fluid each day, drink water as an inexpensive way to meet fluid needs, and respond to thirst

hypernatremia (excess Na) etiology

eating too much salt and not enough water

a client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment?

electrocardiogram (ECG) results

Mr. Davis has severe peritonitis as a consequence of a ruptured gallbladder. He has noted muscular cramping, and has numbness and tingling of the fingertips and mouth.

electrolyte imbalance, hypocalcemia

the nurse is caring for a client who has a peripheral IV in place for fluid replacement. When caring for the client's IV site, the nurse should

ensure that the tubing is firmly anchored to the client's skin

a patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The pt's ileostomy output has been unexpectedly high in the 2 days since surgery, and the pt's bloodwork has indications of K level 2.7. This potassium level should prompt the nurse to assess for which of the following physical manifestations.

fatigue, cramps, and weakness

Hypokalemia Assessment Findings

fatigue, weakness, muscle weakness, leg cramps, paresthesias, nausea, vomiting, anorexia, dysrythmias, FLAT T WAVES

Hypocalcemia Pathophysiology

found in bones, parathyroid hormone regulates Ca levels neuromuscular, strong bones, blood cloting we need vitamin D to absorb Ca

Tom 20 year old was in a motorcycle accident two weeks ago. He sustained a fracture of his avetabulum (hip joint) as well as three other fractures of his right fibula. Consequently, he will remain in skeletal tractions for another four weeks. He has compained of deep bone pain, constipation, nausea, and decrease in muscle tone has also been observed.

hypercalcemia

miss smith suddenly complains of SOB, headache, and you find that she has a bounding pulse, puffy eyelids, is very flushed and has tachypnea.

hypervolemia

The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in the lips and fingers. The client also reports an intermittent spasm in the wrist and hand and exhibits increased muscle tone. Which electrolyte imbalance should the nurse first expect?

hypocalcemia

mr. brown has been hospitalized due to severe vomiting and anorexia. He is generally weak, and has oliguria. He alsi has very poor skin turgor (tenting).

hypovolemia

the nurse is working on a burn unit and an acutely ill client is exhibiting s/s of third spacing. Based on this change in status, the nurse should expect the client to exhibit s/s of which imbalance?

hypovolemia

hypocalcemia interventions

increase ca in diet/ supplements increase vitamin d iv calcium gluconate (surgery) monitor for bleeding

Hypervolemia assessment findings

increase weight> 2 lbs/day increased bp and rr moist resp. rales (crackles) pitting edema IVD anasarca

a priority nursing intervention for a client with hypervolemia involves which of the following?

monitoring respiratory status for signs and symptoms of pulmonary complications

the nurse is caring for a client with severe hypokalemia. The physician has prescribed IV potassium to be administered at 10 mEq/hr. The client reports burning along the veins. What should the nurse do?

seek a physician's prescription to dilute the infusion

Your pt has hypocalcemia. Nursing care should include:

seizure precautions

Which of the following is a major electrolyte in ECF that influences the distribution of water and maintains acid base balance and nerve function?

sodium

hyponatremia function

sodium regulates fluids, nerve, and muscle function. normal range is 135-145 mEq/L

hypervolemia interventions

stop IV give them ice chips if they're thirsty monitor VS, WOB o2 sat auscultate lung sounds elevate HOB, feet, give TEDs monitory daily weights

Hyponatremia Interventions

stop IV, restrict oral fluid intake, increase sodium intake, give normal saline

A client has been on med surg unit for 3 days. The assessment findings reveal a respiratory rate of 24 and shallow apical pulse of 52, plus 1 pitting edema in bilateral lower extremities, diuretics. Which condition is most likely responsible for the administration of diuretics by the nurse to the client?

systemic edema