NRS 326: Practice Questions
Which IV fluid is most appropriate for a patient experiencing diabetic ketoacidosis?
HYPOTONIC SOLUTION In DKA there is profound hyperglycemia, which contributes to dehydration! (Think hyperglycemia = increased thirst & urine output) Very high glucose can also increase overall osmolality, drawing water out of the cells.... Hypotonic fluids help fix this! (They may start on something isotonic initially, but the hypotonic helps restore hydration)
Which IV fluid is most appropriate for a patient needing water replacement?
HYPOTONIC SOLUTION We might replace water in a patient who is very dehydrated! Hypotonic solutions are the most hydrating to the cells/tissues (But that makes them prone to FVE)
The nurse is caring for a patient with a positive Chvostek's sign. Which electrolyte imbalance is the patient likely experiencing?
Hypocalcemia
A nurse is teaching a client about the importance of increasing fluids when experiencing the early stages of dehydration. What response would indicate client understanding?
"I should drink more water when I feel thirsty or becoming irritable"
A healthcare provider is going to order an IV hypotonic solution for a patient. Which solution does the nurse anticipate is going to be administered to the patient?
- 1/2 NS - 0.45% NS - Dextrose 5% in water (D5W)
How can fluid & electrolyte imbalances impair cerebral function?
- Osmolality imbalances cause shriveling (hypernatremia) or swelling (hyponatremia) of cells, including brain cells - decreased LOC, which occurs on a continuum from drowsiness to coma - intracranial pressure
Which of the following nursing actions are appropriate for a patient experiencing a postpartum hemorrhage?
-Administer Packed Red Blood Cells -Massage the fundus -Lay the patient down
The nurse is reviewing a patients complete blood count (CBC) following the administration of 2 units packed red blood cells. The nurse anticipates which values will have changed as a a result of that administration
-RBC Count -Hemoglobin -Hematocrit
How does edema impact gas exchange?
A fluid that develops from the 1st space to the 2nd/3rd space pushes cells farther away from the capillaries and creates a larger distance for oxygen diffusion
Where, in the body, is the most notable impact of osmolality imbalances?
Brain
A client with lower extremity edema and excess fluid in the lungs has been discharged home with the medication furosemide. For this client, which finding is the best indicator that the medication is working effectively
Consistent daily weight
What solution(s) is insulin usually paired with to avoid HYPOglycemia?
D10 or D50
You are caring for a patient receiving an infusion of 0.45% NS. Which assessment finding is more concerning?
Decreased LOC
Which IV fluid is most appropriate for a patient experiencing increased intracranial pressure?
HYPERTONIC SOLUTION Fluid is often the problem in increased ICP (d/t swelling of the tissues) - hypertonic fluids could help draw water out and relieve the pressure
Which IV fluid is most appropriate for a patient experiencing severe hyponatremia?
HYPERTONIC SOLUTION Low sodium in the blood causes fluid to naturally shift into the tissues. Giving a hypertonic fluid could fix that AND because 3% Sodium Chloride is a hypertonic fluid, we'd also be restoring sodium directly.
Which IV fluid is most appropriate for a patient experiencing septic shock?
ISOTONIC SOLUTION Low BP in septic shock, and leaky blood vessels! Isotonic fluids help restore volume to the vasculature and stabilize BP. (You might be tempted to give hypertonic fluids since septic shock causes fluid to leak into the tissues... but in shock our priority is stabilizing the BP and we usually don't try to fix a fluid shift by inducing an opposite fluid shift)
Which IV fluid is most appropriate for a patient undergoing surgery and needing maintenance fluid?
ISOTONIC SOLUTION Often isotonic fluids are given to bolster overall blood volume during surgery
Which IV fluid is most appropriate for a patient experiencing blood loss?
ISOTONIC SOLUTION This is a loss of fluid in the vasculature! Best treatment is to give a fluid to restore fluid to the vasculature.
Which IV fluid is most appropriate for a patient renal failure?
Kidneys help us get rid of fluid from the body.... Failing kidneys don't do that well! Very easy to fluid overload, we'll question giving fluids and give them very carefully if we do end up administering.
A client is taking furosemide and digoxin for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day?
Maintaining serum potassium levels
Which to give first for a patient who is bleeding out and in shock: 0.9% NS or PRBCs?
NS can be administered faster than blood for immediate help, getting the patient out of danger quickly
Which of the following nursing actions is the priority for a patient experiencing a potential transfusion reaction?
Stop the transfusion
Which IV fluid is most appropriate for a patient experiencing a pulmonary embolism?
The problem is a clot! We don't need to fluid shift with a hyper/hypotonic solution. Isotonic solutions would also increase preload (blood return to the heart/lungs) which could contribute to obstructive shock.
Which IV fluid is most appropriate for a patient experiencing heart failure?
Very easy to fluid overload a patient with heart failure! Question giving IV fluids: more fluids = more overworked heart. (Can you think of a scenario where it might be okay to give an IV fluid to someone in HF?)
The nurse is reviewing laboratory values for a patient suspected of having a fluid imbalance. Which laboratory value should indicate a diagnosis of dehydration to the nurse?
below normal hematocrit
How does high Calcium/Magnesium impair neuromuscular function?
decrease neuromuscular excitability: muscle weakness, depressed reflexes, and lethargy
How can severe fluid volume deficit impact perfusion?
decreasing arterial BP and blood volume → hypovolemic shock, which can cause reduction in circulating blood volume, lower venous return and, in profound cases, arterial hypotension
What might happen if a patient with fluid loss tries to replace it with ONLY water?
develop dilutional electrolyte state
True or false: Crystalloids replace volume for volume
false
True or false: There are screenings for fluid & electrolyte imbalances for the general population
false
True or false: Following a hip fracture, the nurse can recommend magnesium-rich foods to the patient
false, calcium-rich
True or false: We primarily use colloids
false, crystalloids
True or false: Patients with edema will have normal healing time to the edematous tissue
false, delayed
True or false: Insulin can be used to treat hypokalemia
false, hyperkalemia
True or false: In hypotonic solutions, water leaves the intracellular space into the vascular space
false, hypertonic
True or false: In hypertonic solutions, water moves from the vascular space into the cell (intracellular space)
false, hypotonic
true or false: salt substitutes are a potential source of more magnesium
false, potassium. substitutes in forms of herbs (no minerals) or potassium
When administering IV fluids, why is it important to monitor for edema/cough?
fluid volume overload. edema = pooling cough = secretions pooling in lungs
When D5W is first administered, it behaves for a moment like an _____________ solution. But soon after administration, D5W is ______________ by the body. Afterward, D5W turns into a _________________ solution
isotonic; metabolized (converted to glucose); *hypotonic*
A patient with chronic kidney disease will have high or low levels of phosphorus?
low levels
How does low Calcium/Magnesium impair neuromuscular function?
muscle twitching and cramping, hyperactive reflexes, and seizures if very severe
What type of saline solution should be used with blood infusions?
only 0.9% NS can run w/ blood products
True or false: Higher infusion rate of IV fluids increases r/o fluid volume overload
true
True or false: When a patient has low levels of K+, it increases their risk of digoxin toxicity
true
True or false: When potassium is imbalanced, the muscles can become more flaccid/weak
true
True or false: It is safe to give Magnesium during pregnancy
true, may be given to slow labor