FLUIDS AND ELECTROCLYTES: Balance and Disturbance

Hypernatremia is associated with a: a. serum osmolality of 245 mOsm/kg. b. serum sodium of 150 mEq/L. c. urine specific gravity lower than 1.003. d. combination of all of the above.

B

A manifestation not associated with altered acid-base balance is: a. bradycardia. b. hypertension. c. lethargy. d. hypokalemia.

A

A nurse is directed to administer a hypotonic intravenous solution. Looking at the following labeled solutions, she should choose: a. 0.45% sodium chloride. b. 0.90% sodium chloride. c. 5% dextrose in water. d. 5% dextrose in normal saline solution.

A

A nursing plan of care for Harriet should include assessing blood pressure with the patient in the supine and upright positions. A diagnostic reading that should be recorded and reported is: a. supine, 140/90; sitting, 120/80; standing, 110/70 mm Hg. b. supine, 140/90; sitting, 130/90; standing, 130/90 mm Hg. c. supine, 140/90; sitting, 140/85; standing, 135/85 mm Hg. d. supine, 140/90; sitting, 140/90; standing, 130/90 mm Hg.

A

A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory mechanisms associated with hypovolemia would cause all of the following symptoms except: a. hypertension. b. oliguria. c. tachycardia. d. tachypnea.

A

A patient with abnormal sodium losses is receiving a house diet. To provide 1,600 mg of sodium daily, the nurse could supplement the patient's diet with: a. one beef cube and 8 oz of tomato juice. b. four beef cubes and 8 oz of tomato juice. c. one beef cube and 16 oz of tomato juice. d. one beef cube and 12 oz of tomato juice.

A

Choose the condition that exhibits blood values with a low pH and a high PCO2. a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

A

In terms of cellular buffering response, the nurse should expect the major electrolyte disturbance to be: a. hyperkalemia. b. hypernatremia. c. hypocalcemia. d. hypokalemia.

A

Isaac's arterial blood gas values are pH, 7.27; HCO3, 20 mEq/L; PaO2, 33 mm Hg. These values are con- sistent with a diagnosis of compensated: a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

A

Signs of lethargy, increasing intracranial pressure, and seizures may occur when the serum sodium level reaches: a. 115 mEq/L. b. 130 mEq/L. c. 145 mEq/l. d. 160 mEq/L.

A

The lungs regulate acid-base balance by all of the following mechanisms except: a. excreting HCO— into the blood. b. slowing ventilation. c. controlling carbon dioxide levels. d. increasing ventilation.

A

The nurse notes that a patient's urine osmolality is 980 mOsm/kg. The nurse knows to assess for the possible cause of: a. acidosis. b. fluid volume excess. c. diabetes insipidus. d. hyponatremia.

A

To supplement a diet with foods high in potassium, the nurse should recommend the addition of: a. fruits such as bananas and apricots. b. green leafy vegetables. c. milk and yogurt. d. nuts and legumes.

A

1. To return a patient with hyponatremia to normal sodium levels, it is safer to restrict fluid intake than to administer sodium: a. in patients who are unconscious. b. to prevent fluid overload. c. to prevent dehydration. d. in patients who show neurologic symptoms.

B

A febrile patient's fluid output is in excess of normal because of diaphoresis. The nurse should plan fluid replacement based on the knowledge that insensible losses in an afebrile person are normally not greater than: a. 300 mL/24 h. b. 600 mL/24 h. c. 900 mL/24 h. d. 1200 mL/24 h.

B

A patient is admitted with a diagnosis of renal failure. He also mentions that he has had stomach distress and has ingested numerous antacid tablets over the past 2 days. His blood pressure is 110/70 mm Hg, his face is flushed, and he is experiencing generalized weakness. Choose the most likely magnesium (Mg++) value for this patient. a. 11 mEq/L b. 5 mEq/L c. 2 mEq/L d. 1 mEq/L

B

A patient's serum sodium concentration is within the normal range. The nurse estimates that the serum osmolality should be: a. less than 136 mOsm/kg. b. 275 to 300 mOsm/kg. c. greater than 408 mOsm/kg. d. 350 to 544 mOsm/kg.

B

An isotonic solution that contains electrolytes similar to the concentration used in plasma is: a. 5% dextrose in water. b. lactated Ringer's solution. c. 3% NaCl solution. d. 5% NaCl solution.

B

During the assessment process, the nurse expects to identify all of the following except: a. a full pulse. b. decreased central venous pressure. c. edema. d. neck vein distention.

B

If a patient has severe hyperkalemia, it is possible to administer calcium gluconate intravenously to: a. immediately lower the potassium (K+) level by active transport. b. antagonize the action of K+ on the heart. c. prevent transient renal failure (TRF). d. accomplish all of the above.

B

Laboratory findings consistent with hypovolemia in a female would include all of the following except: a. hematocrit level of >47%. b. BUN-serum creatinine ratio of >12:1. c. urine specific gravity of 1.027. d. urine osmolality of >450 mOsm/kg.

B

Management of hypocalcemia includes all of the following actions except administration of: a. fluid to dilute the calcium levels. b. the diuretic furosemide (Lasix), without saline, to increase calcium excretion through the kidneys. c. inorganic phosphate salts. d. intravenous phosphate therapy.

B

Nursing intervention for George should include all of the following except: a. administering diuretics, as prescribed, to help remove excess fluid. b. assisting the patient to a recumbent position to minimize his breathing effort. c. inspecting for sacral edema to note the degree of fluid retention. d. teaching dietary restriction of sodium to help decrease water retention.

B

Nursing intervention for Harriet includes all of the following except: a. monitoring urinary output to assess kidney perfusion. b. placing the patient in the Trendelenburg position to maximize cerebral blood flow. c. positioning the patient flat in bed with legs elevated to maintain adequate circulating volume. d. teaching leg exercises to promote venous return and prevent postural hypotension when the patient stands.

B

Nursing intervention for a patient with a diagnosis of hyponatremia includes all of the following except: a. assessing for symptoms of nausea and malaise. b. encouraging the intake of low-sodium liquids, such as coffee or tea. c. monitoring neurologic status. d. restricting tap water intake.

B

One of the best indicators of renal function is: a. blood urea nitrogen. b. serum creatinine. c. specific gravity. d. urine osmolality.

B

The major indicator of extracellular FVD can be identified by assessing for: a. a full and bounding pulse. b. a drop in postural blood pressure. c. an elevated temperature. d. pitting edema of the lower extremities.

B

The nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory data for all of the following except: a. hypocalcemia. b. hypoglycemia. c. hypokalemia. d. hypoxemia.

B

A patient complains of tingling in his fingers. He has positive Trousseau's and Chvostek's signs. He says that he feels depressed. Choose the most likely serum calcium (Ca++) value for this patient. a. 11 mg/dL b. 9 mg/dL c. 7 mg/dL d. 5 mg/dL

C

A patient is admitted who has had severe vomiting for 24 hours. She states that she is exhausted and weak. The results of an admitting electrocardiogram (ECG) show flat T waves and ST-segment depression. Choose the most likely potassium (K+) value for this patient. a. 4.0 mEq/L b. 8.0 mEq/L c. 2.0 mEq/L d. 2.6 mEq/L

C

A semiconscious patient presents with restlessness and weakness. He has a dry, swollen tongue. His body temperature is 99.3°F, and his urine specific gravity is 1.020. Choose the most likely serum sodium (Na+) value for this patient. a. 110 mEq/L b. 140 mEq/L c. 155 mEq/L d. 165 mEq/L

C

Choose the condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration. a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

C

In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours? a. 400 b. 600 c. 800 d. 1,200

C

Management of the foregoing patient should include: a. a regular diet with extra fruits and green vegetables. b. potassium-sparing diuretics. c. discontinuance of any oral magnesium salts. d. all of the above measures.

C

One of the dangers of treating hypernatremia is: a. red blood cell crenation. b. red blood cell hydrolysis. c. cerebral edema. d. renal shutdown.

C

The ECG change that is specific to hypokalemia is: a. a depressed ST segment. b. a flat T wave. c. an elevated U wave. d. an inverted T wave.

C

The average daily urinary output in an adult is: a. 0.5 L. b. 1.0 L. c. 1.5 L. d. 2.5 L.

C

The kidneys regulate acid-base balance by all of the following mechanisms except: a. excreting hydrogen ions (H+). b. reabsorbing or excreting HCO — into the c. reabsorbing carbon dioxide into the blood. d. retaining hydrogen ions (H+). blood.

C

The nurse expects that a decrease in serum osmolality would occur with: a. diabetes insipidus. b. hyperglycemia. c. renal failure. d. uremia.

C

The nurse should anticipate that the physician will attempt to reverse this acid-base imbalance by prescribing intravenous administration of: a. potassium chloride. b. potassium iodide. c. sodium bicarbonate. d. sodium chloride.

C

The nurse should expect that a patient with mild fluid volume excess would be prescribed a diuretic that blocks sodium reabsorption in the distal tubule, such as: a. Bumex. b. Demadex. c. HydroDIURIL. d. Lasix.

C

The most common buffer system in the body is the: a. plasma protein buffer system. b. hemoglobin buffer system. c. phosphate buffer system. d. bicarbonate-carbonic acid buffer system.

D

A clinical indication of hypophosphatemia is: a. bone pain. b. paresthesia. c. seizures. d. tetany.

D

A clinical manifestation not found in hypovolemia is: a. muscle weakness. b. oliguria. c. postural hypotension. d. bradycardia.

D

A manifestation of extracellular volume excess is: a. altered serum osmolality. b. hyponatremia. c. increased hematocrit when volume excess develops quickly. d. rapid weight gain.

D

A normal oxygen saturation value for arterial blood is: a. 65%. b. 75%. c. 85%. d. 95%.

D

A nurse can estimate that a patient has a serum osmolality of if the patient's serum sodium is 140 mEq/L. a. 70 mOsm/kg b. 140 mOsm/kg c. 210 mOsm/kg d. 280 mOsm/kg

D

A nursing plan of care for George should include: a. auscultating for abnormal breath sounds. b. inspecting for leg edema. c. weighing the patient daily. d. all of the above.

D

Cardiac arrest will probably occur with a serum calcium level of: a. 9 mg/dL. b. 12 mg/dL. c. 15 mg/dL. d. 18 mg/dL.

D

Cardiac effects of hyperkalemia are usually present when the serum potassium level reaches: a. 5 mEq/L. b. 6 mEq/L. c. 7 mEq/L. d. 8 mEq/L.

D

Manifestations of extracellular FVD include all of the following except: a. collapsed neck veins. b. decreased serum albumin. c. elevated hematocrit. d. weight loss.

D

The most characteristic manifestation of hypocalcemia and hypomagnesemia is: a. anorexia and nausea. b. constipation. c. lack of coordination. d. tetany.

D

When assessing the weight of a patient who is on a sodium-restricted diet, the nurse knows that a weight gain of approximately 2 lb (2.2 lb = 1 kg) is equivalent to a gain of how much fluid? a. 0.5 L b. 1.0 L c. 1.5 L d. 2.0 L

D