Fluid/Electrolytes(1)

9. A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? a. "I can expect improvement within a few hours after taking this drug." b. "I need to stop taking potassium supplements." c. "I should use salt substitutes to prevent toxic side effects." d. "I should watch closely for dehydration."

ANS: B Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for hyperkalemia when taking this medication, so they should be advised to stop the supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration is not increased.

A patient who has been hospitalized for 2 days has been receiving normal saline IV at 100 ml/hr, has a nasogastric tube to low suction, and is NPO. Which assessment finding by the nurse is the priority to report to the health care provider? a. Serum sodium level of 138 mEq/L (138 mmol/L) b. Gradually decreasing level of consciousness (LOC) c. Oral temperature of 100.1° F with bibasilar lung crackles d. Weight gain of 2 pounds (1 kg) above the admission weight

ANS: B Gradually decreasing level of consciousness (LOC) The patient's history and change in LOC could be indicative of several fluid and electrolyte disturbances: extracellular fluid (ECF) excess, ECF deficit, hyponatremia, hypernatremia, hypokalemia, or metabolic alkalosis. Further diagnostic information will be ordered by the health care provider to determine the cause of the change in LOC and the appropriate interventions. The weight gain, elevated temperature, crackles, and serum sodium level also will be reported, but do not indicate a need for rapid action to avoid complications.

Which of these actions can the nurse who is caring for a critically ill patient with multiple intravenous (IV) lines delegate to an experienced LPN? a. Administer IV antibiotics through the implantable port. b. Monitor the IV sites for redness, swelling, or tenderness. c. Remove the patient's nontunneled subclavian central venous catheter. d. Adjust the flow rate of the 0.9% normal saline in the peripheral IV line.

ANS: B Monitor the IV sites for redness, swelling, or tenderness. An experienced LPN has the education, experience, and scope of practice to monitor IV sites for signs of infection. Administration of medications, adjustment of infusion rates, and removal of central catheters in critically ill patients require RN level education and scope of practice.

A patient with advanced lung cancer is admitted to the emergency department with urinary retention caused by renal calculi. Which of these laboratory values will require the most immediate action by the nurse? a. Arterial blood pH is 7.32. b. Serum calcium is 18 mEq/L. c. Serum potassium is 5.1 mEq/L. d. Arterial oxygen saturation is 91%.

ANS: B Serum calcium is 18 mEq/L. The serum calcium is well above the normal level and puts the patient at risk for cardiac dysrhythmias. The nurse should initiate cardiac monitoring and notify the health care provider. The potassium, oxygen saturation, and pH also are abnormal, and the nurse should notify the health care provider about these values as well, but they are not immediately life-threatening.

The following data are obtained by the nurse when assessing a pregnant patient with eclampsia who is receiving IV magnesium sulfate. Which finding is most important to report to the health care provider immediately? a. The bibasilar breath sounds are decreased. b. The patellar and triceps reflexes are absent. c. The patient has been sleeping most of the day. d. The patient reports feeling "sick to my stomach."

ANS: B The patellar and triceps reflexes are absent. The loss of the deep tendon reflexes indicates that the patient's magnesium level may be reaching toxic levels. Nausea and lethargy also are side effects associated with magnesium elevation and should be reported, but they are not as significant as the loss of deep tendon reflexes. The decreased breath sounds suggest that the patient needs to cough and deep breathe to prevent atelectasis.

Which action will the nurse include in the plan of care for a patient who has a central venous access device (CVAD)? a. Avoid using friction when cleaning around the CVAD insertion site. b. Use the push-pause method to flush the CVAD after giving medications. c. Obtain an order from the health care provider to change CVAD dressing. d. Have the patient turn the head toward the CAVD during injection cap changes.

ANS: B Use the push-pause method to flush the CVAD after giving medications. The push-pause enhances the removal of debris from the CVAD lumen and decreases the risk for clotting. To decrease infection risk, friction should be used when cleaning the CVAD insertion site. The dressing should be changed whenever it becomes damp, loose, or visibly soiled and the patient should turn away from the CVAD during cap changes.

When the nurse is evaluating the fluid balance for a patient admitted for hypovolemia associated with multiple draining wounds, the most accurate assessment to include is a. skin turgor. b. daily weight. c. presence of edema. d. hourly urine output.

ANS: B daily weight. Daily weight is the most easily obtained and accurate means of assessing volume status. Skin turgor varies considerably with age. Considerable excess fluid volume may be present before fluid moves into the interstitial space and causes edema. Hourly urine outputs do not take account of fluid intake or of fluid loss through insensible loss, sweating, or loss from the gastrointestinal tract or wounds.

The home health nurse notes that an elderly patient has a low serum protein level. The nurse will plan to assess for a. pallor. b. edema. c. confusion. d. restlessness.

ANS: B edema. Low serum protein levels cause a decrease in plasma oncotic pressure and allow fluid to remain in interstitial tissues, causing edema. Confusion, restlessness, and pallor are not associated with low serum protein levels.

When caring for an alert and oriented elderly patient with a history of dehydration, the home health nurse will teach the patient to increase fluid intake a. in the late evening hours. b. if the oral mucosa feels dry. c. when the patient feels thirsty. d. as soon as changes in level of consciousness (LOC) occur.

ANS: B if the oral mucosa feels dry. An alert, elderly patient will be able to self-assess for signs of oral dryness such as thick oral secretions or dry-appearing mucosa. The thirst mechanism decreases with age and is not an accurate indicator of volume depletion. Many older patients prefer to restrict fluids slightly in the evening to improve sleep quality. The patient will not be likely to notice and act appropriately when changes in LOC occur.

Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." The nurse will immediately check for a. an elevated serum potassium level. b. the presence of Chvostek's sign. c. a decreased thyroid hormone level. d. bleeding on the patient's dressing.

ANS: B the presence of Chvostek's sign. The patient's symptoms indicate possible hypocalcemia, which can occur secondary to parathyroid injury/removal during thyroidectomy. There is no indication of a need to check the potassium level, the thyroid hormone level, or for bleeding.

7. A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? a. Frequent nocturia b. Headaches c. Ringing in the ears d. Urinary retention

ANS: C Patients taking furosemide should be advised that the risk of furosemide-induced hearing loss can be increased when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to report tinnitus, dizziness, or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide. Urinary retention is not an expected side effect.

3. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? a. Bumetanide [Bumex] b. Furosemide [Lasix] c. Spironolactone [Aldactone] d. Hydrochlorothiazide [HydroDIURIL]

ANS: C Spironolactone is a non-potassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.

2. A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? a. Blood glucose level of 120 mg/dL b. Oxygen saturation of 90% c. Potassium level of 3.5 mEq/L d. Sodium level of 140 mEq/L

ANS: C This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient's serum potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent this complication. This patient's serum glucose and sodium levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to be monitored, although it may improve with diuresis.

The long-term care nurse is evaluating the effectiveness of protein supplements on a patient who has low serum total protein level. Which of these data indicate that the patient's condition has improved? a. Hematocrit 28% b. Good skin turgor c. Absence of peripheral edema d. Blood pressure 110/72 mm Hg

ANS: C Absence of peripheral edema Edema is caused by low oncotic pressure in individuals with low serum protein levels; the absence of edema indicates an improvement in the patient's protein status. Good skin turgor is an indicator of fluid balance, not protein status. A low hematocrit could be caused by poor protein intake. Blood pressure does not provide a useful clinical tool for monitoring protein status.

A patient receiving isoosmolar continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory result is most important to report to the health care provider? a. K+ 3.4 mEq/L (3.4 mmol/L) b. Ca+2 7.8 mg/dl (1.95 mmol/L) c. Na+ 154 mEq/L (154 mmol/L) d. PO4-3 4.8 mg/dl (1.55 mmol/L)

ANS: C Na+ 154 mEq/L (154 mmol/L) The elevated serum sodium level is consistent with the patient's neurologic symptoms and indicates a need for immediate action to prevent further serious complications such as seizures. The potassium and calcium levels vary slightly from the normal but do not require any immediate action by the nurse. The phosphate level is within the normal parameters.

A patient with renal failure who has been taking aluminum hydroxide/magnesium hydroxide suspension (Maalox) at home for indigestion is somnolent and has decreased deep tendon reflexes. Which action should the nurse take first? a. Notify the patient's health care provider. b. Withhold the next scheduled dose of Maalox. c. Review the magnesium level on the patient's chart. d. Check the chart for the most recent potassium level.

ANS: C Review the magnesium level on the patient's chart. The patient has a history and symptoms consistent with hypermagnesemia; the nurse should check the chart for a recent serum magnesium level. Notification of the health care provider will be done after the nurse knows the magnesium level. The Maalox should be held, but more immediate action is needed to correct the patient's decreased deep tendon reflexes (DTRs) and somnolence. Monitoring of potassium levels also is important for patients with renal failure, but the patient's current symptoms are not consistent with hyperkalemia.

A recently admitted patient has a small cell carcinoma of the lung, which is causing the syndrome of inappropriate antidiuretic hormone (SIADH). The nurse will monitor carefully for a. increased total urinary output. b. elevation of serum hematocrit. c. decreased serum sodium level. d. rapid and unexpected weight loss.

ANS: C decreased serum sodium level. SIADH causes water retention and a decrease in serum sodium level. Weight loss, increased urine output, and elevated serum hematocrit may be associated with excessive loss of water, but not with SIADH and water retention.

When assessing a patient with increased extracellular fluid (ECF) osmolality, the priority assessment for the nurse to obtain is a. skin turgor. b. heart sounds. c. mental status. d. capillary refill.

ANS: C mental status. Changes in ECF osmolality lead to swelling or shrinking of cells in the central nervous system, initially causing confusion, which may progress to coma or seizures. Although skin turgor, capillary refill, and heart sounds also may be affected by ECF osmolality changes and resultant fluid shifts, these are signs that occur later and do not have as immediate an impact on patient outcomes.

A patient who has an infusion of 50% dextrose prescribed asks the nurse why a peripherally inserted central catheter must be inserted. Which explanation by the nurse is correct? a. The prescribed infusion can be given much more rapidly when the patient has a central line. b. There is a decreased risk for infection when 50% dextrose is infused through a central line. c. The 50% dextrose is hypertonic and will be more rapidly diluted when given through a central line. d. The required blood glucose monitoring is more accurate when samples are obtained from a central line.

ANS: C. The 50% dextrose is hypertonic and will be more rapidly diluted when given through a central line. Shrinkage of red blood cells can occur when solutions with dextrose concentrations greater than 10% are administered intravenously. Blood glucose testing is not more accurate when samples are obtained from a central line. The infection risk is higher with a central catheter than with peripheral IV lines. Hypertonic or concentrated IV solutions are not given rapidly.

5. A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? a. Bumetanide [Bumex] b. Chlorothiazide [Diuril] c. Hydrochlorothiazide [HydroDIURIL] d. Spironolactone [Aldactone]

ANS: D Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.

4. A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate? a. Administer the medications as ordered. b. Ask the patient about the use of salt substitutes. c. Contact the provider to request an order for serum electrolytes. d. Request an order for furosemide [Lasix].

ANS: D Spironolactone takes up to 48 hours for its effects to develop, so it should not be used when the patient needs immediate diuresis. This patient has shortness of breath, crackles, and edema and needs a short-acting diuretic, such as furosemide. Asking the patient about the use of salt substitutes is not indicated. The patient does not need assessment of serum electrolytes.

Spironolactone (Aldactone), an aldosterone antagonist, is prescribed for a patient as a diuretic. Which statement by the patient indicates that the teaching about this medication has been effective? a. "I will try to drink at least 8 glasses of water every day." b. "I will use a salt substitute to decrease my sodium intake." c. "I will increase my intake of potassium-containing foods." d. "I will drink apple juice instead of orange juice for breakfast."

ANS: D "I will drink apple juice instead of orange juice for breakfast." Since spironolactone is a potassium-sparing diuretic, patients should be taught to choose low potassium foods such as apple juice rather than foods that have higher levels of potassium, such as citrus fruits. Because the patient is using spironolactone as a diuretic, the nurse would not encourage the patient to increase fluid intake. Teach patients to avoid salt substitutes, which are high in potassium.

A postoperative patient who is receiving nasogastric suction is complaining of anxiety and incisional pain. The patient's respiratory rate is 32 breaths/minute and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first? a. Discontinue the nasogastric suctions for a few hours. b. Notify the health care provider about the ABG results. c. Teach the patient about the need to take slow, deep breaths. d. Give the patient the PRN morphine sulfate 4 mg intravenously.

ANS: D Give the patient the PRN morphine sulfate 4 mg intravenously. The patient's respiratory alkalosis is caused by the increased respiratory rate associated with pain and anxiety. The nurse's first action should be to medicate the patient for pain. Although the nasogastric suction may contribute to the alkalosis, it is not appropriate to discontinue the tube when the patient needs gastric suction. The health care provider may be notified about the ABGs but is likely to instruct the nurse to medicate for pain. The patient will not be able to take slow, deep breaths when experiencing pain.

The nurse has administered 3% saline to a patient with hyponatremia. Which one of these assessment data will require the most rapid response by the nurse? a. The patient's radial pulse is 105 beats/minute. b. There is sediment and blood in the patient's urine. c. The blood pressure increases from 120/80 to 142/94. d. There are crackles audible throughout both lung fields.

ANS: D There are crackles audible throughout both lung fields. Crackles throughout both lungs suggest that the patient may be experiencing pulmonary edema, a life-threatening adverse effect of hypertonic solutions. The increased pulse rate and blood pressure and the appearance of the urine also should be reported, but they are not as dangerous as the presence of fluid in the alveoli.

The nurse recognizes that magnesium sulfate is contraindicated in patients with which cardiac abnormality? Bradycardia Sick sinus syndrome Atrioventricular block Ventricular tachycardia

Atrioventricular block Elevated magnesium levels can suppress conduction of impulses through the atrioventricular (AV) node. Therefore, magnesium is contraindicated in the treatment of patients with a history of AV block.

Which of the following are the insensible mechanisms of fluid loss? a) Urination b) Nausea c) Bowel elimination d) Breathing

Breathing

A patient with hypomagnesemia is undergoing treatment with a continuous IV infusion of magnesium. Which supply does the nurse ensure is at the bedside of this patient? 10% glucose Sodium chloride Calcium gluconate Potassium chloride

Calcium gluconate Calcium gluconate is indicated in the treatment of hypermagnesemia, which can occur with continuous IV infusion of magnesium. Because hypermagnesemia causes neuromuscular blockade, these patients are at risk for paralysis of respiratory muscles. Calcium gluconate can counteract the neuromuscular blocking actions of magnesium.

Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism? a) Hypertension b) Chest pain c) Slow pulse d) Jaundice

Chest pain

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. Na + 130 mEq/L K + 4.6 mEq/L Cl - 94 mEq/L Mg ++ 2.8 mg/dL Ca ++ 13 mg/dL Which of the following alterations is consistent with the client's findings? a) Hyperkalemia b) Hyponatremia c) Hypermagnesemia d) Hypercalcemia

Hypercalcemia

Which laboratory value places the patient at greatest risk of digoxin toxicity? Hypokalemia Hyponatremia Hypocalcemia Hypomagnesemia

Hypokalemia Hypokalemia increases the risk of digoxin toxicity. Potassium has a major role in nerve impulse conduction and maintaining the electrical excitability of muscles.

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which? a) Lung function b) Cardiovascular compromise c) Insensible fluid loss d) Summer allergies

Insensible fluid loss

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? a) Metabolic acidosis b) Respiratory alkalosis c) Metabolic alkalosis d) Respiratory acidosis

Metabolic acidosis

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic alkalosis d) Metabolic acidosis

Metabolic alkalosis

The nurse monitors the patient with hypermagnesemia for what clinical manifestation? Seizures Disorientation Muscle weakness Hyperactive reflexes

Muscle weakness Clinical manifestations of hypermagnesemia include increasing muscle weakness related to neuromuscular blockade. Depression of respiration can occur. Additionally, hypotension, sedation, and ECG changes are associated with elevated magnesium levels.

A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client? a) No, sodium intake should be restricted. b) No, start with the sodium chloride IV. c) Yes, this will correct the sodium deficit. d) Yes, along with the hypotonic IV.

No, sodium intake should be restricted.

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? a) Monitor the client's heart rhythm. b) Prepare to assist with ventilation. c) Obtain a urine specimen for drug screening. d) Prepare for gastric lavage.

Prepare to assist with ventilation.

Which ECG changes would the nurse expect to observe in a patient with hyperkalemia? Widened QRS Inverted P wave Inverted T waves Prolonged PR interval

Prolonged PR interval An increased serum potassium level is associated with cardiac changes, including a prolonged PR interval. These changes are attributed to disruption of the electrical activity in the heart.

The nurse notes that a patient is hyperventilating and assesses him for which acid-base imbalance? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Respiratory alkalosis Hyperventilation leads to the blowing off of carbon dioxide, resulting in respiratory alkalosis.

The nurse notes that a patient's serum potassium level is 2.8 mEq/L. The nurse monitors her for which clinical manifestation as consistent with this laboratory value? Seizures Paresthesias Loss of consciousness Skeletal muscle weakness

Skeletal muscle weakness Hypokalemia is manifested by muscle weakness that may lead to paralysis with continued decreases in potassium. This electrolyte disorder can also lead to fatal dysthythmias.

In analyzing a patient's serum osmolality, the nurse recognizes which electrolyte as the principal extracellular ion? Chloride Glucose Potassium Sodium

Sodium Sodium is the primary serum electrolyte and contributes approximately 50% of the electrolytes used in the determination of serum osmolality.

A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis? a) The client has never traveled outside of the country. b) The client works in a health care insurance office. c) The client sees his physician for a check-up yearly. d) The client had a liver transplant 2 years ago.

The client had a liver transplant 2 years ago.

The nurse correlates isotonic contraction with which condition? (Select all that apply.) Vomiting Excessive sweating Diarrhea Hyperaldosteronism Kidney disease Extensive burns

Vomiting Diarrhea Kidney disease Isotonic contraction is related to loss of water and sodium in equal proportions. Causes of isotonic contraction include vomiting, diarrhea, kidney disease, and misuse of diuretics. Hypertonic contraction is related to loss of water in greater proportion than sodium; causes include excessive sweating, osmotic diuresis, and extensive burns. Hypotonic contraction is defined as volume contraction in which sodium loss exceeds water loss; causes include diuretic therapy, chronic renal insufficiency, and lack of aldosterone.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? a) PaCO 36 b) pH 7.48 c) HCO 21 mEq/L d) O saturation 95%

pH 7.48

The nurse is instructing a patient with recurrent hyperkalemia about following a potassium-restricted diet. Which of the following patient statements indicates the need for additional instruction? a) "Bananas have a lot of potassium in them, I'll stop buying them." b) "I need to check if my cola beverage has potassium in it." c) "I will not salt my food, instead I'll use salt substitute." d) "I'll drink cranberry juice with my breakfast instead of coffee."

"I will not salt my food, instead I'll use salt substitute."

Which of the following is considered an isotonic solution? a) 3% NaCl b) 0.9% normal saline c) 0.45% normal saline d) Dextran in NS

0.9% normal saline

In reviewing a patient's laboratory results, the nurse determines that the serum osmolality is within normal limits if the value is what? 198 mOsm/kg 238 mOsm/kg 287 mOsm/kg 327 mOsm/kg

287 mOsm/kg Normal serum osmolality is between 280 and 300 mOsm, with sodium the primary electrolyte involved in the determination of serum osmolality.

The nurse prepares to infuse which intravenous solution in the patient with hypertonic dehydration? 0.9% normal saline Lactated Ringer's 3% sodium chloride 5% dextrose in water

5% dextrose in water Patients with hypertonic dehydration (contraction) have a higher solute-to-water ratio. The administration of a hypotonic fluid is indicated, and 5% dextrose in water is the only hypotonic fluid listed here. Normal saline at 0.9% and lactated Ringer's solution are isotonic, whereas 3% sodium chloride is hypertonic.

1. A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? a. Furosemide [Lasix] b. Hydrochlorothiazide [HydroDIURIL] c. Mannitol [Osmitrol] d. Spironolactone [Aldactone]

ANS: A Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur.

8. An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? a. Elevated creatinine clearance b. Elevated serum potassium level c. Normal blood glucose level d. Low levels of low-density lipoprotein (LDL) cholesterol

ANS: A Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore, an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium-wasting drugs and thus may actually improve the patient's potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL cholesterol; however, this patient's levels are low, so this is not a risk.

6. A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to: a. reduce intracranial pressure. b. reduce renal perfusion. c. reduce peripheral edema. d. restore extracellular fluid.

ANS: A Mannitol is an osmotic diuretic that is used to reduce intracranial pressure by relieving cerebral edema. The presence of mannitol in blood vessels in the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Mannitol can also be used to increase renal perfusion. It can cause peripheral edema and is not used to restore extracellular fluid.

A postoperative patient who has been receiving nasogastric suction for 3 days has a serum sodium level of 125 mEq/L (125 mmol/L). Which of these prescribed therapies that the patient has been receiving should the nurse question? a. Infuse 5% dextrose in water at 125 ml/hr. b. Administer IV morphine sulfate 4 mg every 2 hours PRN. c. Give IV metoclopramide (Reglan) 10 mg every 6 hours PRN for nausea. d. Administer 3% saline if serum sodium drops to less than 128 mEq/L.

ANS: A Infuse 5% dextrose in water at 125 ml/hr. Because the patient's gastric suction has been depleting electrolytes, the IV solution should include electrolyte replacement. Solutions such as lactated Ringer's solution would usually be ordered for this patient. The other orders are appropriate for a postoperative patient with gastric suction.

The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take? a. Notify the patient's health care provider. b. Give the prescribed PRN lorazepam (Ativan). c. Start the prescribed PRN oxygen at 2 to 4 L/min. d. Encourage the patient to take deep, slow breaths.

ANS: A Notify the patient's health care provider. The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the need for actions such as administration of sodium bicarbonate, which will require a prescription by the health care provider. Oxygen therapy is not indicated because there is no indication that the increased respiratory rate is related to hypoxemia. The respiratory pattern is compensatory, and the patient will not be able to slow the respiratory rate. Ativan administration will slow the respiratory rate and increase the level of acidosis.

When caring for a patient admitted with hyponatremia, which actions will the nurse anticipate taking? a. Restrict patient's oral free water intake. b. Avoid use of electrolyte-containing drinks. c. Infuse a solution of 5% dextrose in 0.45% saline. d. Administer vasopressin (antidiuretic hormone, [ADH]).

ANS: A Restrict patient's oral free water intake. To help improve serum sodium levels, water intake is restricted. Electrolyte-containing beverages will improve the patient's sodium level. Administration of vasopressin or hypotonic IV solutions will decrease the serum sodium level further.

The nurse obtains all of the following assessment data about a patient with deficient fluid volume caused by a massive burn injury. Which of the following assessment data will be of greatest concern? a. The blood pressure is 90/40 mm Hg. b. Urine output is 30 ml over the last hour. c. Oral fluid intake is 100 ml for the last 8 hours. d. There is prolonged skin tenting over the sternum.

ANS: A The blood pressure is 90/40 mm Hg. The blood pressure indicates that the patient may be developing hypovolemic shock as a result of fluid loss. This will require immediate intervention to prevent the complications associated with systemic hypoperfusion. The poor oral intake, decreased urine output, and skin tenting all indicate the need for increasing the patient's fluid intake but not as urgently as the hypotension.

Which assessment finding about a patient who has a serum calcium level of 7.0 mEq/L is most important for the nurse to report to the health care provider? a. The patient is experiencing laryngeal stridor. b. The patient complains of generalized fatigue. c. The patient's bowels have not moved for 4 days. d. The patient has numbness and tingling of the lips.

ANS: A The patient is experiencing laryngeal stridor. Laryngeal stridor may lead to respiratory arrest and requires rapid action to correct the patient's calcium level. The other data also are consistent with hypocalcemia, but do not indicate a need for immediate action.

The nurse in the outpatient clinic who notes that a patient has a decreased magnesium level should ask the patient about a. daily alcohol intake. b. intake of dietary protein. c. multivitamin/mineral use. d. use of over-the-counter (OTC) laxatives.

ANS: A daily alcohol intake. Hypomagnesemia is associated with alcoholism. Protein intake would not have a significant effect on magnesium level. OTC laxatives (such as milk of magnesia) and use of multivitamin/mineral supplements would tend to increase magnesium level.

When teaching a patient with renal failure about a low phosphate diet, the nurse will include information to restrict a. ingestion of dairy products. b. the amount of high-fat foods. c. the quantity of fruits and juices. d. intake of green, leafy vegetables.

ANS: A ingestion of dairy products. Foods high in phosphate include milk and other dairy products, so these are restricted on low-phosphate diets. Green, leafy vegetables; high-fat foods; and fruits/juices are not high in phosphate and are not restricted.

A patient is receiving 3% NaCl solution for correction of hyponatremia. During administration of the solution, the most important assessment for the nurse to monitor is a. lung sounds. b. urinary output. c. peripheral pulses. d. peripheral edema.

ANS: A lung sounds. Hypertonic solutions cause water retention, so the patient should be monitored for symptoms of fluid excess. Crackles in the lungs may indicate the onset of pulmonary edema and are the most serious of the symptoms of fluid excess listed. Bounding peripheral pulses, peripheral edema, or changes in urine output also are important to monitor when administering hypertonic solutions, but they do not indicate acute respiratory or cardiac decompensation.

A patient has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. The nurse interprets these results as a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

ANS: A metabolic acidosis. The pH and HCO3 indicate that the patient has a metabolic acidosis. The ABGs are inconsistent with the other responses.

A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.1 mEq/L. Of the following medications that the patient has been taking at home, the nurse will be most concerned about a. oral digoxin (Lanoxin) 0.25 mg daily. b. ibuprofen (Motrin) 400 mg every 6 hours. c. metoprolol (Lopressor) 12.5 mg orally daily. d. lantus insulin 24 U subcutaneously every evening.

ANS: A oral digoxin (Lanoxin) 0.25 mg daily Hypokalemia increases the risk for digoxin toxicity, which can cause serious dysrhythmias. The nurse also will need to do more assessment regarding the other medications, but there is not as much concern with the potassium level.

Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.) a. Diabetes insipidus b. Hepatic failure c. Increased intracranial pressure d. Intraocular pressure e. Postmenopausal osteoporosis

ANS: A, B, E Thiazide diuretics have the paradoxical effect of reducing urine output in patients with diabetes insipidus. They can also be used to mobilize edema associated with liver disease. They promote tubular reabsorption of calcium, which may reduce the risk of osteoporosis in postmenopausal women. Mannitol is used to treat edema that causes increased intracranial pressure and intraocular pressure.

Intravenous potassium chloride (KCl) 60 mEq is prescribed for treatment of a patient with severe hypokalemia. Which action should the nurse take? a. Administer the KCl as a rapid IV bolus. b. Infuse the KCl at a rate of 20 mEq/hour. c. Give the KCl only through a central venous line. d. Add no more than 40 mEq/L to a liter of IV fluid.

ANS: B ANS: B Infuse the KCl at a rate of 20 mEq/hour. Intravenous KCl is administered at a maximal rate of 20 mEq/hr. Rapid IV infusion of KCl can cause cardiac arrest. Although the preferred concentration for KCl is no more than 40 mEq/L, concentrations up to 80 mEq/L may be used for some patients. KCl can cause inflammation of peripheral veins, but it can be administered by this route.

Which set of arterial blood gas (ABG) results requires further investigation? a) pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L b) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L c) pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L d) pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L

pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

A patient with hypercalcemia is being cared for on the medical unit. Nursing actions included on the care plan will include a. maintaining the patient on bed rest. b. auscultating lung sounds every 4 hours. c. monitoring for Trousseau's and Chvostek's signs. d. encouraging fluid intake up to 4000 ml every day.

ANS: D encouraging fluid intake up to 4000 ml every day. To decrease the risk for renal calculi, the patient should have an intake of 3000 to 4000 ml daily. Ambulation helps decrease the loss of calcium from bone and is encouraged in patients with hypercalcemia. Trousseau's and Chvostek's signs are monitored when there is a possibility of hypocalcemia. There is no indication that the patient needs frequent assessment of lung sounds, although these would be assessed every shift.

A patient is taking a potassium-wasting diuretic for treatment of hypertension. The nurse will teach the patient to report symptoms of adverse effects such as a. personality changes. b. frequent loose stools. c. facial muscle spasms. d.generalized weakness.

ANS: D generalized weakness. Generalized weakness progressing to flaccidity is a manifestation of hypokalemia. Facial muscle spasms might occur with hypocalcemia. Loose stools are associated with hyperkalemia. Personality changes are not associated with electrolyte disturbances, although changes in mental status are common manifestations with sodium excess or deficit.

A patient who has required prolonged mechanical ventilation has the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L. The nurse interprets these results as a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

ANS: D respiratory alkalosis. The pH indicates that the patient has alkalosis and the low PaCO2 indicates a respiratory cause. The other responses are incorrect based on the pH and the normal HCO3.

Which of the following is the most common cause of symptomatic hypomagnesemia? a) IV drug use b) Alcoholism c) Sedentary lifestyle d) Burns

Alcoholism

Oral intake is controlled by the thirst center, located in which of the following cerebral areas? a) Hypothalamus b) Cerebellum c) Thalamus d) Brainstem

Hypothalamus

The nurse understands that the serum level of potassium is regulated by which organ? Liver Lungs Kidneys Small intestine

Kidneys The kidneys, largely under the control of aldosterone from the adrenal cortex, retain potassium while losing sodium and water.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? a) Nausea or vomiting b) Abdominal pain or diarrhea c) Hallucinations or tinnitus d) Light-headedness or paresthesia

Light-headedness or paresthesia

The calcium level of the blood is regulated by which mechanism? a) Parathyroid hormone (PTH) b) Androgens c) Adrenal gland d) Thyroid hormone (TH)

Parathyroid hormone (PTH)

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? a) pH 7.26 b) Serum bicarbonate of 21 mEq/L c) pH 7.30 d) Serum bicarbonate of 28 mEq/L

Serum bicarbonate of 28 mEq/L

Patients diagnosed with hypervolemia should avoid sweet or dry food because a) it can cause dehydration. b) it obstructs water elimination. c) it increases the patient's desire to consume fluid. d) it can lead to weight gain.

it increases the patient's desire to consume fluid.

The nurse is caring for a patient diagnosed with hyperchloremia. Signs and symptoms of hyperchloremia include which of the following? Select all that apply. a) Tachypnea b) Hypotension c) Dehydration d) Lethargy e) Weakness

• Tachypnea • Weakness • Lethargy