Pharmacology II Fluid and Electrolytes
What are the different signs and symptoms of hypokalemia
(Low Blood Potassium) Note: Potassium—normal laboratory values 3.5 to 5 mEq/L • Anorexia • Nausea and vomiting • Muscle twitching • Depression • Confusion • Bradycardia • Impaired thought processes • Drowsiness
What would education to a client receiving treatment for fluid and/or electrolyte imbalances include?
• Provide explanation for treatment and method of administration • Have patient verbalize treatment schedule if treatment is to be self administered • Keep all appointments • Know s/sx of adverse reactions/overdose
Normal saline contains what percentage of sodium chloride? A.) 0.9% B.) 0.45% C.) 0.5 % D.) 0.1%
A.) 0.9% Normal saline solution contains 0.9% of sodium chloride. Half normal saline is 0.45%. Dextrose is normally 5% and water (D5W). The value of 0.1% is not a valid value, but 1.0% can indicate amount of medication such as 1% lidocaine used for local anesthesia.
What are the different signs and symptoms of hyperkalemia?
(High Blood Potassium) Note: Potassium—normal laboratory values 3.5 to 5 mEq/L • Irritability • Anxiety • Confusion • Muscle cramps • Numbness, or tingling sensation • Nausea • Diarrhea • Cardiac arrhythmias • Flaccid paralysis
Potassium Normal laboratory values
3.5-5.0 mEq/La
Calcium Normal laboratory values
4.5-5.3 mEq/L or 9-11 mg/dLa
The client has a blood pH of 7.29, is experiencing nausea and vomiting, and reports a headache. This client is demonstrating signs of: A.) metabolic acidosis. B.) metabolic alkalosis. C.) respiratory acidosis. D.) respiratory alkalosis.
A.) metabolic acidosis. Metabolic acidosis is an imbalance manifested by decreased blood pH resulting from excess hydrogen ions in the extracellular fluid. It can be treated with alkalinizing drugs. This client has a pH of 7.29, which is low (normal is 7.35 to 7.45). It is not alkalosis, in which the pH would be elevated above 7.45. The limited data given do not indicate a respiratory problem.
After teaching a group of nursing students about electrolytes, the instructor determines that the teaching was successful when the students identify which as a major intracellular fluid electrolyte? A.) potassium B.) sodium C.) calcium D.) chloride
A.) potassium Potassium is a major intracellular fluid electrolyte. Sodium and calcium are major extracellular fluid electrolytes. Chloride is an extracellular fluid electrolyte.
A nurse is preparing to administer an electrolyte that is a major component of extracellular fluid. Which would most likely be administered? A.) sodium B.) potassium C.) magnesium D.) phosphate
A.) sodium Sodium is a major extracellular fluid electrolyte. Potassium and magnesium are major intracellular electrolytes. Phosphate is an intracellular electrolyte.
What is the action of acidifying drugs and when are they used?
Acidifying Drug: Ammonium Chloride Ammonium chloride lowers the blood pH by being metabolized first into urea, then to hydrochloric acid, which is further metabolized to hydrogen ions to acidify the blood
A client who reports frequent and increased urination is diagnosed with diabetes insipidus. The electrolyte report of the client is as follows: sodium, 150 mEq/L; potassium, 4.5 mEq/L; calcium, 5.2 mEq/L; and chloride, 96 mEq/L. The health care provider orders diet modification accordingly. What dietary restriction will be recommended for this client? A.) Potassium B.) Calcium C.) Chloride D.) Sodium
D.) Sodium The nurse should recommend a sodium restricted diet. Sodium restriction is required because the electrolyte report of the client indicates the presence of hypernatremia. Hypernatremia is an elevation of the blood sodium levels. Potassium level, calcium, and chloride levels are within the normal range, and hence no dietary restriction for these minerals is required.
Hypernatremia
Fever; hot, dry skin; dry, sticky mucous membranes; rough, dry tongue; edema; weight gain; intense thirst; excitement; restlessness; agitation; oliguria or anuria
What are causes of hyponatremia?
Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Sodium is an electrolyte, and it helps regulate the amount of water that's in and around your cells.
Hyperkalemia
Irritability, anxiety, listlessness, mental confusion, nausea, diarrhea, abdominal distress, GI hyperactivity, paresthesias, weakness and heaviness of the legs, flaccid paralysis, hypotension, cardiac arrhythmias, electrocardiographic changes
Hypermagnesemia
Lethargy, drowsiness, impaired respiration, flushing, sweating, hypotension, weak to absent deep tendon reflexes
What are the signs and symptoms of hypomagnesemia?
Magnesium Normal laboratory values: 1.5-2.5 mEq/L or 1.8-3.0 mg/dLa Leg and foot cramps, hypertension, tachycardia, neuromuscular irritability, tremor, hyperactive deep tendon reflexes, confusion, disorientation, visual or auditory hallucinations, painful paresthesias, positive Trousseau sign, positive Chvostek sign, convulsions
What are the signs and symptoms of hypermagnesemia?
Magnesium Normal laboratory values: 1.5-2.5 mEq/L or 1.8-3.0 mg/dLa Lethargy, drowsiness, impaired respiration, flushing, sweating, hypotension, weak to absent deep tendon reflexes
What are indications for magnesium therapy?
Magnesium (Mg++) Magnesium plays an important role in the transmission of nerve impulses. It is also important in the activity of many enzyme reactions, such as carbohydrate metabolism. Magnesium sulfate (MgSO4) is used as replacement therapy in hypomagnesemia. Magnesium is also used in the prevention and control of seizures in obstetric patients with pregnancy-induced hypertension (PIH; also referred to as eclampsia and preeclampsia). It may also be added to TPN mixtures.
What is metabolic acidosis?
Metabolic acidosis—decrease in the blood pH caused by an excess of hydrogen ions in the extracellular fluid (treated with alkalinizing drugs)
What are indications for administration of combined oral electrolyte solutions?
Oral electrolyte solutions contain a carbohydrate and various electrolytes. Examples of combined oral electrolyte solutions are Pedialyte and Rehydralyte. Oral electrolyte solutions are most often used to replace lost electrolytes and fluids in conditions such as severe vomiting or diarrhea.
Magnesium Normal laboratory values
1.5-2.5 mEq/L or 1.8-3.0 mg/dLa
Sodium Normal laboratory values
132-145 mEq/La
Below which serum sodium level may convulsions or coma can occur? A.) 135 mEq/L B.) 145 mEq/L C.) 140 mEq/L D.) 142 mEq/L
A.) 135 mEq/L Normal serum concentration level ranges from 135 to 145 mEq/L. When the level dips below 135 mEq/L, there is hyponatremia. Manifestations of hyponatremia include mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the deficit is severe. Values of 140, 142, and 145 mEq/L are within the normal range.
A 45-year-old is admitted for a low calcium level. The client reports bone tenderness, polyuria, polydipsia, constipation, dehydration, and muscle weakness. Which calcium blood level results confirms hypocalcemia? A.) 3.2 mEq/L B.) 10 mg/dL C.) 4.5 mEq/L D.) 9 mg/dL
A.) 3.2 mEq/L Normal laboratory values for calcium are 4.5 to 5.3 mEq/L or 9 to 11 mg/dL.
A client is admitted to the clinic for management of body fluids. Before administering an IV solution, the nursing assessment should include which of the following? Select all that apply. A.) Assess the client's general status. B.) Review recent laboratory test results. C.) Weigh the client. D.) Vital signs after the infusion is complete. E.) Ask the client how he or she feels.
A.) Assess the client's general status. B.) Review recent laboratory test results. C.) Weigh the client. E.) Ask the client how he or she feels Assessing the client's general status, reviewing recent laboratory test results, weighing the client, and asking client how he or she feels is necessary to form a baseline for the postinfusion assessment. Vital signs would be taken before the infusion begins for a postinfusion baseline, and for comparison during the infusion in the event of complications.
A nurse is caring for a client who is to receive IV potassium. Which action would be appropriate? A.) Ensure that potassium infuses in no less than 4 hours. B.) Administer the potassium before meals. C.) Use the veins in the back of the hand. D.) Inject potassium directly into the client's vein.
A.) Ensure that potassium infuses in no less than 4 hours When administering potassium to the client, the nurse should ensure that the entire IV solution infuses in no less than 4 hours. Concentrated potassium solutions are for IV mixtures only and should never be used undiluted. Direct IV injection of potassium could result in sudden death. When potassium is given IV, it is always diluted in 500 to 1000 mL of an IV solution. The nurse should use a large vein for administration of potassium, so the veins in the back of the hand should be avoided. If potassium is to be taken orally, then it should always be administered after meals with a full glass of water to decrease the incidence of GI disturbances and nausea.
A 69-year-old client is admitted to the critical care unit post-gastrectomy. The client has been ordered to have total parenteral nutrition (TPN). The nurse should assess the client's blood glucose how many times per day? A.) Every 4 to 6 hours to monitor for hyperglycemia and to guide the dosage of dextrose and insulin. B.) Every 6 to 8 hours to monitor for hyperglycemia and to guide the dosage of dextrose and insulin. C.) Every 8 to 12 hours to monitor for hyperglycemia and to guide the dosage of dextrose and insulin. D.) Every 12 to 24 hours to monitor for hyperglycemia and to guide the dosage of dextrose and insulin.
A.) Every 4 to 6 hours to monitor for hyperglycemia and to guide the dosage of dextrose and insulin.
When administering medications through a feeding tube, what intervention should the nurse implement? A.) Obtain liquid forms of medications whenever possible. B.) Withhold medications that cannot be administered parenterally. C.) Provide ample fluids when having the client swallow medications. D.)Aspirate the residual drug 15 minutes after administration through the feeding tube.
A.) Obtain liquid forms of medications whenever possible. When medications are prescribed for a client with a feeding tube, liquid preparations are preferable. It is unsafe to discontinue all enteral medications. Oral administration would constitute an aspiration risk. Residual drugs are not aspirated from the tube.
A senior level nurse is teaching a new nurse about lifespan considerations. Which of the following information would the nurse include while teaching the subject? A.) Older adults are at increased risk for fluid overload because of an increased risk of cardiac and renal disease. B.) Older adults are at increased risk for fluid overload because of an increased risk of cardiac and liver disease. C.) Older adults are at decreased risk for fluid overload because of an increased risk of cardiac and renal disease. D.) Older adults are at decreased risk for fluid overload because of an increased risk of cardiac and liver disease.
A.) Older adults are at increased risk for fluid overload because of an increased risk of cardiac and renal disease. Older adults are at increased risk for fluid overload because of an increased risk of cardiac and renal disease that can no longer handle large volumes of fluids. The liver is not involved in offloading volume.
A nurse is caring for client with a serum potassium level of 5.8 mEq/L. Which treatment does the nurse anticipate the prescriber to order? A.) Polystyrene sulfonate B.) Glucose and insulin C.) Calcium gluconate D.) Normal saline
A.) Polystyrene sulfonate With less severe hyperkalemia, sodium polystyrene sulfonate, a cation exchange resin, administered orally, removes potassium from the body in the stool. Glucose and insulin and calcium gluconate are used to treat severe hyperkalemia. Normal saline can assist with increased fluid intake but is not prescribed as treatment for hyperkalemia.
Which way(s) is/are the correct way to maintain intravenous (IV) access ? (Select all that apply.) A.) direct IV push B.) intermittent infusion C.) extravasation D.) continuous infusion D.) infiltration
A.) direct IV push B.) intermittent infusion D.) continuous infusion Fluids, electrolytes, and drugs are given by direct IV push, intermittent infusion, or continuous infusion. Infiltration refers to the collection of fluid into tissues. Extravasation refers to the escape of fluid from a blood vessel into surrounding tissues.
A client who exhibits which should be an indicator to the nurse that total parenteral nutrition (TPN) is being infused too rapidly? A.) hyperglycemia B.) hypotension C.) nausea D.) diarrhea
A.) hyperglycemia A too-rapid infusion of TPN may result in hyperglycemia, glycosuria, mental confusion, and loss of consciousness. The administration of plasma expanders can result in hypotension and nausea. Nausea, vomiting, and diarrhea are seen with administration of potassium both oral and IV.
What is an effervescent tablet?
An effervescent tablet, which fizzes and dissolves on contact with water. Effervescent tablets must stop fizzing before the solution is sipped slowly during a period of 5 to 15 minutes.
Hypokalemia
Anorexia, nausea, vomiting, mental depression, confusion, delayed or impaired thought processes, drowsiness, abdominal distention, decreased bowel sounds, paralytic ileus, muscle weakness or fatigue, flaccid paralysis, absent or diminished deep tendon reflexes, weak and irregular pulse, paresthesias, leg cramps, electrocardiographic changes
A nursing student is learning in skills lab how to insert an intravenous (IV) catheter. The student demonstrates understanding of correct protocol when stating that one should make only how many attempts when trying to start an IV line on a client? A.) 1 B.) 2 C.) 3 D.) 4
B.) 2 Performing a venipuncture requires practice. The nurse should never repeatedly and unsuccessfully attempt a venipuncture. Two unsuccessful attempts on the same client warrant having a more skilled person attempt the procedure.
The nurse is aware that concentrated potassium mixtures should always be diluted in intravenous (IV) fluids because undiluted forms can lead to sudden death. The maximum recommended concentration of potassium is which of the following? A.) 40 meq/1000 ml B.) 80 meq/1000 ml C.) 100 meq/1000 ml D.) 20 meq/1000 ml
B.) 80 meq/1000 ml Concentrated potassium solutions are for intravenous (IV) mixtures only and should never be used undiluted. Direct IV injections of potassium could result in sudden death. When IV potassium is given, it is always diluted in 500 to 1000 ml of an IV solution. The maximum recommended concentration of potassium is 80 meq/1000 ml of IV solution.
Water is a vital element for the human body. What is one of its functions? A.) Serves as an emulsifier for vitamins and glucose B.)Aids in digestion and absorption C.)Decreases structure in cells D.)Provides energy for metabolism
B.) Aids in digestion and absorption Water provides shape and structure to cells; regulates body temperature; aids in the digestion and absorption of nutrients; transports nutrients and oxygen to cells; servers as a solvent for vitamins, glucose, and amino acids; participates in metabolic reactions; eliminates waste products; and is a major component of mucus and other lubricating fluids. Serves as an emulsifier for vitamins and glucose and providing energy is not a function of water.
The physician has ordered a peripheral IV to be inserted before the client goes to the operating room. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter? A.) Choose a proximal site B.)Choose a distal site C.)Have the client hold the arm over the head D.)Leave the tourniquet on for at least 5 minutes
B.) Choose a distal site When selecting a site for insertion of an IV catheter, the nurse should choose a distal site, not a proximal site. Selection of a distal site leaves the upper veins available for subsequent cannulations. Instruct the client to hold the arm in a dependent position to increase blood flow. Never leave a tourniquet in place longer than 2 minutes.
A 69-year-old client, who has been prescribed a daily diuretic, is admitted to critical care with a cardiac arrhythmia. Which electrolyte should be monitored due to its' effect on heart rate and excretion or retention during diuretic therapy? A.) TPN B.) Potassium C.) 0.9% NACL D.) Plasma
B.) Potassium Potassium is the major electrolyte in the intracellular body fluid that is excreted or retained during diuretic therapy. Potassium cannot be stored and needs to be replaced by daily consumption. Potassium is responsible for cardiac muscle contraction; if too high or too low the electrolyte can cause cardiac arrhythmia. Plasma, 0.9% NACL, and TPN are IV solutions that are administered to a client.
What is a major electrolyte in extracellular fluid that influences the distribution of water and maintains acid-base balance and nerve function? A.) Potassium B.) Sodium C.) Calcium D.) Phosphorus
B.) Sodium Sodium is a major electrolyte in ECF that influences the distribution of water and maintains acid base balance and nerve function. Potassium controls cellular osmotic pressure, activates enzymes, regulates acid-base balance, maintains nerve and muscle function, and influences kidney function and sugar uptake. Calcium is a major component of bones and teeth that affects permeability of cell membranes and plays a role in blood coagulation and maintenance of heartbeat. Phosphorus is a component of bone and is involved in most metabolic processes.
The nursing supervisor on a coronary care unit is working with a student nurse. The student is assigned to a client who is to receive a 40 mEq infusion of potassium for a K+ level of 2.8. The student withdraws the potassium from the vial in a 10 cc syringe and gets ready to inject the potassium into the client's saline lock. Which of the following immediate actions would the supervisor take? A.) Stop the student and explain that concentrated potassium solutions are for IV mixtures only and cannot be used undiluted as it could result in sudden death. B.) Stop the student and explain that concentrated potassium solutions when injected directly are not effective C.) Allow the student to proceed as planned. Provide positive feedback upon completing the administration of the electorlyte D.) Allow the student to proceed as planned after dividing the concentrated dose between two syringes for injection 15-20 minutes apart
B.) Stop the student and explain that concentrated potassium solutions are for IV mixtures only and cannot be used undiluted as it could result in sudden death. Stop the student and explain (outside the client's room) that concentrated potassium solutions are for IV mixtures only and should never be used undiluted, because direct IV potassium injection could result in sudden death. Any other action listed could cause sudden death.
A 78-year-old client presents to the emergency department with acute coronary syndrome. Before determining an IV rate for this client, the nurse knows that the client will need to be assessed for which factors? A.) The client's cardiac status and adequacy of gastrointestinal function B.) The client's cardiac status and adequacy of renal function C.) The client's cardiac status and adequacy of skeletal function D.) The client's cardiac status and adequacy of cognitive function
B.) The client's cardiac status and adequacy of renal function The amount of fluid and the rate of administration can cause fluid overload, depending on the client's cardiac pump status and adequacy of renal function to off-load fluid. The gastrointestinal function, skeletal function, and cognitive function do not cause fluid overload.
A client is admitted to a medical-surgical unit with a diagnosis of nausea, vomiting, and dehydration related to an antibiotic allergy. Which electrolyte-associated imbalance does the nurse expect with this diagnosis? A.) hyperkalemia B.) hypernatremia C.) hypermagnesia D.) hyperchloremia
B.) hypernatremia Sodium assists in regulating osmotic pressure, water balance, and electrolytes. When a client experiences dehydration, an elevated sodium is observed. Magnesium is required for conduction of nerve impulses and contraction of muscle in skeletal and cardiac cells. Potassium helps with conduction of nerve impulses and contraction of muscle in the cardiac cycle. Chloride helps to maintain osmotic pressure and water balance, similar to sodium. In dehydration, the sodium would be elevated and the chloride and potassium would be decreased. Magnesium does not have a role in dehydration.
The nurse caring for a client with an intravenous (IV) line inspects the site frequently for any signs of edema or redness. If noted, these would indicate which complication? A.) eviscerations B.) infiltration C.) extravasation D.) dehiscence
B.) infiltration Infiltration is collection of fluid into tissues. Signs include edema and redness at the site. Extravasation is escape of fluid from a blood vessel into surrounding tissues. Dehiscence is when a surgical wound begins to open. Evisceration is when a wound completely opens and internal organs begin to protrude outside the body through the open incision.
A nursing student has been instructed that total parenteral nutrition (TPN) should never be stopped suddenly but instead the client should gradually be weaned from it. The rationale is that sudden withdrawal of TPN can cause: A.) rebound hyperglycemia. B.) rebound hypoglycemia. C.) hypotension. D.) hypertension.
B.) rebound hypoglycemia To prevent a rebound hypoglycemic reaction from sudden withdrawal of TPN containing a concentrated dose of dextrose, the rate of administration is slowly reduced or the concentration of dextrose gradually decreased. Withdrawal of TPN has no known effects on the blood pressure.
The nurse is preparing to give a client morphine intravenously (IV) through a heparin lock. Prior to giving the drug, the nurse flushes the heparin lock with normal saline. This is done for which reason? A.) to make the morphine more potent B.) to prevent incompatibility of heparin with other drugs C.) to prevent the morphine from burning when infusing D.) to counteract the side effects of morphine
B.) to prevent incompatibility of heparin with other drugs A heparin lock is flushed with heparin per protocol to prevent small clots from obstructing the cannula of the IV set. To prevent incompatibility of heparin with other drugs, the heparin lock is flushed with sterile normal saline solution before and after any drug is given through the IV line. The other options are not true.
For clients where oral intake is contraindicated, the student correctly identifies what as the process of administering nutrients by an intravenous (IV) route? A.) enteral feeding B.) total parenteral nutrition (TPN) C.) peg feeding D.) nasogastric (NG) feeding
B.) total parenteral nutrition (TPN) When normal enteral feedings are not possible or inadequate to meet a person's nutritional needs, IV nutritional therapy, or TPN, is required. TPN is a method of administering nutrients intravenously to the body. It is not enteral feeding and cannot be given through a peg or NG tube.
What is the action of alkalinizing drugs and when are they used? Alkalinizing Drug: Bicarbonate (HCO3-)
Bicarbonate (HCO3-) plays a vital role in the acid-base balance of the body. Alkalinizing drugs are used to treat metabolic acidosis and to increase blood pH. Bicarbonate may be given IV as sodium bicarbonate (NaHCO3) in the treatment of metabolic acidosis, a state of imbalance that may be seen in diseases or conditions such as severe shock, diabetic acidosis, severe diarrhea, extracorporeal circulation of blood, severe renal disease, and cardiac arrest.
A client was admitted to the critical care unit one week ago for total parenteral nutrition administration, and has developed a hypercatabolic state. The physician has ordered the addition of lipids. The nurse asks the client which of the following questions before administering the lipid solution? A.) "Are you allergic to peanut butter?" B.) "Are you allergic to fried foods?" C.) "Are you allergic to eggs?" D.) "Are you allergic to steak?"
C.) "Are you allergic to eggs?" The nurse should ask the client before administering the lipid solution if he is allergic to eggs, because egg allergy is listed as a contraindication. There is no relationship between steak, peanut butter, or fried food allergies and fat-emulsion allergic reactions.
The normal serum value for potassium is A.) 135 to 145 mEq/L. B.) 96 to 106 mEq/L. C.) 3.5 to 5.5 mEq/L. D.) 8.5 to 10.5 mg/dL.
C.) 3.5 to 5.5 mEq/L. Serum potassium must be within normal limits to prevent cardiac dysrhythmia. Normal serum sodium is 135 to 145 mEq/L. Normal serum chloride is 96 to 106 mEq/L. Normal total serum calcium is 8.5 to 10.5 mg/dL.
An elderly client has been ordered magnesium 483 mg daily orally. The student nurse is about to administer that dose when the nursing instructor questions it. The student states that the regular dose is 54 to 483 mg/day. Why did the instructor question this dose? A.) The student should be dividing the single dose in several administrations to improve processing of the medication. B.) To ensure that the student knows medication values well. C.) Because older adults may need a reduced dosage as a result of decreased renal function. D.) To be cautious because magnesium interacts poorly with several other drugs.
C.) Because older adults may need a reduced dosage as a result of decreased renal function. Older adults may need a reduced dosage of magnesium because of decreased renal function. The nurse should closely monitor serum magnesium levels when magnesium is administered to older adults.
The nurse is reviewing the lab results for a client with congestive heart failure. The report is as follows: sodium, 142 mEq/L; potassium, 2.5 mEq/L; calcium, 5 mEq/L; and chloride, 98 mEq/L. Which electrolyte disturbances should the nurse report? A.) Hyponatremia B.) Hypochloremia C.) Hypokalemia D.) Hypocalcemia
C.) Hypokalemia The nurse should report to the HCP the presence of hypokalemia in this client because the potassium level is below the normal range of 3.5 to 5.5 mEq/L. Sodium, chloride, and calcium levels in this client are within the normal range. The normal range for sodium is 135 to 145 mEq/L, chloride 95 to 105 mEq/L, and calcium 4.5 to 5.5 mEq/L.
A nurse is making initial shift assessments on clients. While assessing one client's peripheral IV site, the nurse notes edema around the insertion site. How will the nurse document this complication related to IV therapy? A.) Air emboli B.)Phlebitis C.)Infiltration D.)Fluid overload
C.) Infiltration Infiltration is the administration of nonvesicant solution or medication into the surrounding tissue. This can occur when the IV cannula dislodges or perforates the wall of the vein. Infiltration is characterized by edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness in the area of infiltration, and a significant decrease in the flow rate. Air emboli, phlebitis, and fluid overload are not indications of infiltration.
A senior-level nurse is teaching a course on lifespan considerations when administering magnesium infusions. Which of the following information would the nurse include while teaching the subject? A.) Older adults may need an increased dose because of increased renal function. B.) Older adults may need a reduced dose because of increased liver function. C.) Older adults may need a reduced dose because of decreased renal function. D.) Older adults may need a reduced dose because of decreased liver function.
C.) Older adults may need a reduced dose because of decreased renal function. Older adults may need a reduced dose because of decreased renal function. Liver function is not an issue because magnesium is excreted in the urine.
The nurse knows that which two major electrolytes are normally found in extracellular body fluid? A.) Magnesium and potassium B.) Sodium and magnesium C.) Sodium and Calcium D.) Calcium and potassium
C.) Sodium and Calcium Sodium and calcium are the two major electrolytes normally found in extracellular body fluid. Magnesium and potassium are the two major electrolytes normally found in intracellular body fluid.
The nurse correctly identifies parenteral administration as which of the following? A.) any solution delivered through a nasogastric (NG) tube B.) any solution delivered through a peg tube C.) any solution delivered through a vein D.) solution delivered via mouth
C.) any solution delivered through a vein Parenteral administration means injecting drugs or solutions directly into a vein. Enteral feeding refers to the delivery of a nutritionally complete feed, containing protein, carbohydrates, fat, water, minerals, and vitamins directly into the stomach, duodenum, or jejunum via a peg tube or NG tube as well as various other tubes.
What are the signs and symptoms for hypercalcemia?
Calcium Normal laboratory values: 4.5-5.3 mEq/L or 9-11 mg/dLa Anorexia, nausea, vomiting, lethargy, bone tenderness or pain, polyuria, polydipsia, constipation, dehydration, muscle weakness and atrophy, stupor, coma, cardiac arrest
What are the signs and symptoms for hypocalcemia
Calcium Normal laboratory values: 4.5-5.3 mEq/L or 9-11 mg/dLa Hypocalcemia Hyperactive reflexes, carpopedal spasm, perioral paresthesias, positive Trousseau sign, positive Chvostek sign, muscle twitching, muscle cramps, tetany (numbness, tingling, and muscular twitching usually of the extremities), laryngospasm, cardiac arrhythmias, nausea, vomiting, anxiety, confusion, emotional lability, convulsions
Hyponatremia
Cold and clammy skin, decreased skin turgor, apprehension, confusion, irritability, anxiety, hypotension, postural hypotension, tachycardia, headache, tremors, convulsions, abdominal cramps, nausea, vomiting, diarrhea
An elderly client postoperative 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? A.) 150 mEq/L B.) 145 mEq/L C.) 135 mEq/L D.) 130 mEq/L
D.) 130 mEq/L Hyponatremia, a serum sodium level of less than 135 mEq/L, usually results from excessive water retention.
The nurse is caring for a 69-year-old client who was admitted to the critical care unit one week ago post gastrectomy for total parenteral nutrition administration. The provider has ordered the addition of an intravenous diuretic to be administered in the line delivering the lipid solution. The nursing intervention should include which action? A.) Administer the diuretic as ordered in the lipid infusion line. B.) Avoid administering the medication through the existing intravenous lines and prepare the diuretic by intramuscular route. C.) Hold the diuretic until the provider returns to the bedside to discuss the order. D.) Discuss with the provider that there is a third line that can be used and that, generally, fat emulsions should not be combined with any other solution or drugs.
D.) Discuss with the provider that there is a third line that can be used and that, generally, fat emulsions should not be combined with any other solution or drugs. The nursing intervention would include discussing with the provider that there is a third line that can be used and that, generally, fat emulsions should not be combined with any other solution or drugs. Administering the drug as ordered or holding the drug is contraindicated. The diuretic must be administered by the route ordered, intravenously.
A nurse is to administer intravenous antibiotics to a client. Before hanging the medication, the nurse assesses the intravenous (IV) site and notes it to be slightly swollen and cool to touch. What problem does the nurse suspect? A.) Infection B.) Phlebitis C.) Dehiscence D.) Infiltration
D.) Infiltration Infiltration, or leakage of fluid into the tissues, can advance rapidly. Signs include edema, coolness to touch, redness, and pain. Infection would be accompanied by redness, heat, and pain, while dehiscence is a surgical complication when a wound breaks open along the surgical suture. Phlebitis is an inflammation of a vein, usually in the legs, characterized by redness, burning, swelling, and the vein being hard and cord-like.
The nurse knows to monitor the IV site for which of the following complications during parenteral management of body fluids? A.) Potassium and chloride B.) Pain in the most proximal body part C.) Pain in the most distal body part D.) Phlebitis and/or thrombosis
D.) Phlebitis and/or thrombosis The IV site is monitored for phlebitis and/or thrombosis. Pain in the proximal and distal body parts are not considered at the IV site. Monitoring potassium and chloride would require a blood test.
What are adverse reactions associated with administration of potassium?
Potassium (k+) Adverse reactions • N/V • Diarrhea • Phlebitis/Extravasation
When is sodium administration contraindicated?
Hypernatremia Fluid retention
Hypomagnesemia
Leg and foot cramps, hypertension, tachycardia, neuromuscular irritability, tremor, hyperactive deep tendon reflexes, confusion, disorientation, visual or auditory hallucinations, painful paresthesias, positive Trousseau sign, positive Chvostek sign, convulsions
Can concentrated potassium solutions be administered undiluted IV? Explain.
NO POTASSIUM CAN NOT BE USED UNDILUTED Concentrated potassium solutions are for IV mixtures only and should never be used undiluted. Direct IV injection of potassium could result in sudden death. When potassium is given IV, it is always diluted in 500 to 1000 mL of an IV solution. The maximum recommended concentration of potassium is 80 mEq in 1000 mL of IV solution (although in acute emergency situations, a higher concentration of potassium may be required).
What are the nursing interventions for administering potassium orally?
Patients receiving oral potassium should have their blood pressure and pulse monitored every 4 hours, especially during early therapy. Observe the patient for signs of hyperkalemia. Which would indicate that the dose of potassium is too high. Signs of hypokalemia may also occur during therapy and may indicate that the dose of potassium is too low and must be increased. If signs of hypokalemia or hyperkalemia are apparent or suspected, contact the primary health care provider. In some instances, frequent laboratory monitoring of the serum potassium may be ordered. When given orally, potassium may cause GI distress. Therefore, it is given immediately after meals or with food and a full glass of water. Oral potassium must not be crushed or chewed. If the patient has difficulty swallowing, consult the primary health care provider regarding the use of a solution or an effervescent tablet, which fizzes and dissolves on contact with water. Potassium in the form of effervescent tablets, powder, or liquid must be thoroughly mixed with 4 to 8 ounces of cold water, juice, or other beverage. Effervescent tablets must stop fizzing before the solution is sipped slowly during a period of 5 to 15 minutes. Oral liquids and soluble powders that have been mixed and dissolved in cold water or juice are also sipped slowly over a period of 5 to 15 minutes. Advise patients that liquid potassium solutions have a salty taste. Some of these products are flavored to make the solution more palatable.
What should a nurse assess when providing care to a client receiving a solution for management of body fluids?
Preadministration assessment • Assess for S/Sx of electrolyte imbalances • Review recent laboratory and diagnostic test • Vital signs • Ongoing assessment • Lab values • V/S • Changes in patient condition r/t therapy
What are the signs and symptoms for hyponatremia
Sodium Normal laboratory values: 132-145 mEq/La Cold and clammy skin, decreased skin turgor, apprehension, confusion, irritability, anxiety, hypotension, postural hypotension, tachycardia, headache, tremors, convulsions, abdominal cramps, nausea, vomiting, diarrhea
What are the signs and symptoms for hypernatremia?
Sodium Normal laboratory values: 132-145 mEq/La Fever; hot, dry skin; dry, sticky mucous membranes; rough, dry tongue; edema; weight gain; intense thirst; excitement; restlessness; agitation; oliguria or anuria
What is Chvostek's sign
The Chvostek sign is one of the signs of tetany seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcemia with resultant hyperexcitability of nerves.
Hypocalcemia
Too Little Calcium Hyperactive reflexes, carpopedal spasm, perioral paresthesias, positive Trousseau sign, positive Chvostek sign, muscle twitching, muscle cramps, tetany (numbness, tingling, and muscular twitching usually of the extremities), laryngospasm, cardiac arrhythmias, nausea, vomiting, anxiety, confusion, emotional lability, convulsions
Hypercalcemia
Too Much Calcium Anorexia, nausea, vomiting, lethargy, bone tenderness or pain, polyuria, polydipsia, constipation, dehydration, muscle weakness and atrophy, stupor, coma, cardiac arrest
What is Trousseau's sign? What electrolyte imbalances are they associated
Trousseau sign of latent tetany is a medical sign observed in patients with low calcium. This sign may become positive before other gross manifestations of hypocalcemia such as hyperreflexia and tetany To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct.
What are causes of hypokalemia?
hypokalemia (low blood potassium) resulting from increased potassium excretion or depletion. Examples of causes of hypokalemia are a marked loss of GI fluids (severe vomiting, diarrhea, nasogastric suction, draining intestinal fistulas), diabetic acidosis, marked diuresis, severe malnutrition, use of a potassium-depleting diuretic, excess antidiuretic hormone, and excessive urination.
What are the available sodium chloride IV solutions?
• 0.9% normal saline • 0.45% normal saline • D5NS, D5 ½NS • 3% Sodium Chloride
What are adverse reactions associated with administration of magnesium?
• Flushing • Hypotension • Muscle Weakness • Sweating • Depressed reflexes • Circulatory collapse
What is metabolic alkalosis?
• Metabolic alkalosis—increase in the blood pH caused by an excess of bicarbonate in the extracellular fluid (treated with acidifying drugs)
