PREPU: Fluid & Electrolytes

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

Chest pain

The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L). The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving? Change the lactated Ringer solution to 2.5% dextrose. Discontinue the intravenous lactated Ringer solution. Change the lactated Ringer solution to 3% saline. Increase the rate of the intravenous lactated Ringer solution.

Discontinue the intravenous lactated Ringer solution.

A client with a magnesium concentration of 2.6 mEq/L (1.3 mmol/L) is being treated on a medical-surgical unit. Which treatment should the nurse anticipate will be used? Intravenous furosemide Fluid restriction Dialysis Oral magnesium oxide

Intravenous furosemide

The calcium concentration in the blood is regulated by which mechanism? Adrenal gland Thyroid hormone (TH) Androgens Parathyroid hormone (PTH)

Parathyroid hormone (PTH)

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? Respirations Temperature Blood pressure Pulse

Pulse

Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality? Potassium Sodium Calcium Magnesium

Sodium

A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess: Goodell's sign. Homans' sign. Hegar's sign. Trousseau's sign.

Trousseau's sign.

What does the nurse understand is the primary method by which fluid volume is regulated? Urine excretion Breathing Bowel elimination Perspiration

Urine excretion

The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching? "I will take a potassium supplement daily as prescribed." "I can use laxatives and enemas but only once a week." "A good breakfast for me will include milk and a couple of bananas." "I will be sure to buy frozen vegetables when I grocery shop."

"I can use laxatives and enemas but only once a week."

The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem? Acute flank pain Diminished deep tendon reflexes Cool, clammy skin Tachycardia

Diminished deep tendon reflexes Explanation: To gauge a client's magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with hypermagnesemia.

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? Rapid respiration Low heart rate Subnormal temperature Elevated blood pressure

Elevated blood pressure

The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance? Hyperchloremia Hyponatremia Hypermagnesemia Hypocalcemia

Hypocalcemia

A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply. Respond to thirst Drink water as an inexpensive way to meet fluid needs. Drink caffeinated beverages to retain fluid. Drink carbonated beverages to help balance fluid volume. Drink at least eight glasses of fluid each day.

Respond to thirst Drink water as an inexpensive way to meet fluid needs. Drink at least eight glasses of fluid each day.

A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators? Potassium level of 6 mEq/L Sodium level of 150 mEq/L Sodium level of 137 mEq/L Potassium level of 3.8 mEq/L

Sodium level of 150 mEq/L

Clients diagnosed with hypervolemia should avoid sweet or dry food because it obstructs water elimination. can lead to weight gain. can cause dehydration. increases the client's desire to consume fluid.

increases the client's desire to consume fluid.

The nurse knows which is the normal serum value for potassium? 3.5-5.0 mEq/L (3.5-5.0 mmol/L). 8.5-10.5 mg/dL (2.13-2.63 mmol/L). 96-106 mEq/L (96-106 mmol/L). 135-145 mEq/L (135-145 mmol/L).

3.5-5.0 mEq/L (3.5-5.0 mmol/L)

The health care provider ordered an IV solution for a dehydrated patient with a head injury. Select the IV solution that the nurse knows would be contraindicated. 3% NS 5% DW 0.9% NaCl 0.45% NS

5% DW

The nurse is caring for a 72-year-old client who has been admitted to the unit for a fluid volume imbalance. The nurse knows which of the following is the most common fluid imbalance in older adults? Fluid volume excess Hypovolemia Hypervolemia Dehydration

Dehydration

Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply. Distended neck veins Decreased blood pressure Bradycardia Crackles in the lung fields Shortness of breath

Distended neck veins Crackles in the lung fields Shortness of breath

The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume? Select all that apply. Electrolyte imbalance Low protein level in the urine An elevated hematocrit level Absence of ketones in urine A low urine specific gravity

Electrolyte imbalance An elevated hematocrit level

The nurse is caring for a client who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). The plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the client's health? Nutritional status Fluid volume status Calcium balance Potassium balance

Fluid volume status

You are caring for a new client on your unit who is third-spacing fluid. You know to assess for what type of edema? Generalized Dependent Brassy Pitting

Generalized

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

Hypothalamus

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? Summer allergies Insensible fluid loss Lung function Cardiovascular compromise

Insensible fluid loss

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? Assess for dehydration. Give medications that promote fluid retention. Teach client behaviors that decrease urination. Limit sodium and water intake.

Limit sodium and water intake.

A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status? edema weight intake and output vital signs

weight

A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? Blood urea nitrogen (BUN) level of 29 mg/dl Serum sodium level of 132 mEq/L Urine specific gravity of 1.025 Serum potassium level of 3 mEq/L

Serum potassium level of 3 mEq/L

A 54-year-old male patient is admitted to the hospital with a case of severe dehydration. The nurse reviews the patient's laboratory results. Which of the following results are consistent with the diagnosis? Select all that apply. Serum glucose of 90 mg/dL Serum sodium of 148 mEq/L Serum osmolality of 310 mOsm/kg Blood urea nitrogen (BUN) of 23 mg/dL Urine specific gravity of 1.03 Hematocrit level of 48%

Serum sodium of 148 mEq/L Serum osmolality of 310 mOsm/kg Blood urea nitrogen (BUN) of 23 mg/dL Urine specific gravity of 1.03

What clinical indication of hyperphosphatemia does the nurse assess in a patient? Bone pain Paresthesia Seizures Tetany

Tetany

A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypertension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? hypercalcemia hypocalcemia hypokalemia hyperkalemia

hypokalemia

The nurse is evaluating a newly admitted client's laboratory results, which include several values that are outside of reference ranges. Which of the following alterations would cause the release of antidiuretic hormone (ADH)? Decreased hemoglobin Increased serum sodium Increased platelets Decreased serum potassium

Increased serum sodium

A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine-specific gravity of 1.020. What is the most likely serum sodium value for this client? 165 mEq/L 145 mEq/L 130 mEq/L 110 mEq/L

165 mEq/L

To evaluate a client for hypoxia, the physician is most likely to order which laboratory test? Red blood cell count Total hemoglobin Sputum culture Arterial blood gas (ABG) analysis

Arterial blood gas (ABG) analysis

The nurse is caring for a client diagnosed with hyperchloremia. Which are signs and symptoms of hyperchloremia? Select all that apply. Weakness Hypotension Lethargy Dehydration Tachypnea

Weakness Lethargy Tachypnea

The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? 5% glucose in normal saline solution 5% glucose in water 0.45% sodium chloride 0.9% sodium chloride

0.45% sodium chloride

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? Yes, along with the hypotonic IV. Yes, this will correct the sodium deficit. No, start with the sodium chloride IV. No, sodium intake should be restricted.

No, sodium intake should be restricted.

At which serum sodium concentration might convulsions or coma occur? 142 mEq/L (142 mmol/L) 145 mEq/L (145 mmol/L) 130 mEq/L (130 mmol/L) 140 mEq/L (140 mmol/L)

130 mEq/L (130 mmol/L)

The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? Hallucinations Headache Confusion Nausea

Confusion

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? Flaccidity and thirst Sunken eyeballs and spasticity Tetany and increased blood urea nitrogen (BUN) levels Confusion and seizures

Confusion and seizures

In which of the following medical conditions would administering IV normal saline solution be inappropriate? Select all that apply. Heart failure Pulmonary edema Severe hemorrhage Renal impairment Burns

Heart failure Pulmonary edema Renal impairment

A 73-year-old female patient with cirrhosis of the liver is evaluated for clinical manifestations of FVE. Which of the following signs are consistent with that diagnosis? Select all that apply. Hematocrit level of 32% Central venous pressure (CVP) reading of 4 mm Hg Blood pressure of 90/60 BUN of 8 mg/dL Blood pressure of 140/110 Crackles

Hematocrit level of 32% BUN of 8 mg/dL Blood pressure of 140/110 Crackles

A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed? spironolactone metolazone hydrochlorothiazide furosemide

furosemide

The nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricted diet. Which statement by the client indicates the need for additional instruction? "I will not salt my food; instead I'll use salt substitute." "Bananas have a lot of potassium in them; I'll stop buying them." "I need to check to see whether my cola beverage has potassium in it." "I'll drink cranberry juice with my breakfast instead of coffee."

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

The community health nurse is performing a home visit to an older client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response? "I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup." "Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids." "If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress. " "It is normal to be a little confused following surgery, and it is safe not to urinate at night."

"Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids."

Which solution is hypotonic? Lactated Ringer solution 5% NaCl 0.9% NaCl 0.45% NaCl

0.45% NaCl Explanation: Half-strength saline is hypotonic. Lactated Ringer solution and normal saline (0.9% NaCl) are isotonic. A 5% NaCl solution is hypertonic.

Which is considered an isotonic solution? 3% NaCl Dextran in normal saline 0.45% normal saline 0.9% normal saline

0.9% normal saline

The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance? A 52-year-old with diarrhea A 65-year-old with a myocardial infarction A 7-year-old with a fracture tibia A 72-year-old with a total knee repair

A 52-year-old with diarrhea

Which of the following is the most common cause of symptomatic hypomagnesemia in the United States? Loss of gastric acid Intestinal resection Alcoholism Inflammatory bowel disease

Alcoholism

The nurse has been assigned to care for various clients. Which client is at the highest risk for a fluid and electrolyte imbalance? A 45-year-old client who had a laparoscopic appendectomy 24 hours ago and is being advanced to a regular diet. An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide. A 66-year-old client who had an open cholecystectomy with a T-tube placed that is draining 125 mL of bile per shift. A 79-year-old client admitted with a diagnosis of pneumonia

An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide.

The nurse is caring for a patient with a diagnosis of hyponatremia. What nursing intervention is appropriate to include in the plan of care for this patient? (Select all that apply.) Encouraging the intake of low-sodium liquids Assessing for symptoms of nausea and malaise Encouraging the use of salt substitute instead of salt Restricting tap water intake Monitoring neurologic status

Assessing for symptoms of nausea and malaise Restricting tap water intake Monitoring neurologic status

A client's most recent laboratory results show a slight decrease in potassium. The health care provider has opted to forgo drug therapy but has suggested increasing the client's dietary intake of potassium. What should the nurse recommend? Apples Fish Bananas Rice

Bananas. Teach patient to eat food rich in potassium: Potatoes, Oranges, Tomatoes, Avocados, Strawberries, Spinach, fIsh, mUshrooms, Melons

The physician has prescribed a peripheral IV to be inserted before the client goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter? Choose a hairless site if available. Consider potential effects on the client's mobility when selecting a site. Leave the tourniquet on for at least 3 minutes. Have the client briefly hold his arm over his head before insertion.

Consider potential effects on the client's mobility when selecting a site.

The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? Distended jugular veins Dark, concentrated urine Cool and pale skin Crackles in the lung fields

Dark, concentrated urine

A client with hypertension has been prescribed hydrochlorothiazide. What nursing action will best reduce the client's risk for electrolyte disturbances? Maintain a low sodium diet. Ensure the client has sufficient potassium intake. Encourage the use of over-the-counter calcium supplements. Encourage fluid intake.

Ensure the client has sufficient potassium intake.

Which nerve is implicated in the Chvostek's sign? Spinal accessory Optic Hypoglossal Facial

Facial

The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in her lips and fingers. She states that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should the nurse first suspect? Hypocalcemia Hypermagnesemia Hypophosphatemia Hyperkalemia

Hypocalcemia

The nurse is conducting a lecture on the difference between hypovolemia and dehydration. When completing a verbal comparison, which point needs to be clarified? Hypovolemia contains only low blood volume. Similar causes are present in both conditions. In dehydration, only extracellular is depleted. Both conditions result in abnormal laboratory studies.

In dehydration, only extracellular is depleted Explanation: In clients diagnosed with dehydration, all fluid compartments including the intracellular and extracellular compartment are reduced. The other options are correct. Both states can be from similar disease process such as vomiting, fever, diarrhea and difficulty swallowing and also have abnormal lab work. It is correct that hypovolemia relates to low blood volume.

The nurse is caring for a client who was admitted with fluid volume excess (FVE). Which nursing assessments should the nurse include in the ongoing monitoring of the client? Select all that apply. Intake and output, urine volume, and color Nutritional status and diet Strength testing for muscle wasting Blood pressure, heart rate, and rhythm Skin assessment for edema and turgor

Intake and output, urine volume, and color Nutritional status and diet Blood pressure, heart rate, and rhythm Skin assessment for edema and turgor Explanation: To assess for FVE the nurse measures blood pressure, heart rate and rhythm, and breath sounds; inspects the skin to look for edema and turgor; and inspects neck veins. Intake and output, daily weight, urine volume and color, dyspnea, and thirst are assessments that will assist the nurse in identifying improvement or worsening of the fluid volume excess. In addition, the nurse will be able to identify potential fluid volume deficit from overtreatment of the fluid volume excess. Treatment of FVE typically involves dietary restriction of sodium.

A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action? Polyuria Weight loss Tetanic contractions Jugular vein distention

Jugular vein distention

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? 10% dextrose in water Half-normal saline solution Lactated Ringer's solution 5% dextrose and normal saline solution

Lactated Ringer's solution

Which of the following would be appropriate nursing interventions for a client with hypokalemia? Select all that apply. Administer the ordered furosemide 60 mg po. Monitor intake and output every shift. Offer a diet with fruit juices and citrus fruits. Administer the ordered Kayexalate enema. Administer the ordered potassium 40 mg IV push.

Monitor intake and output every shift. Offer a diet with fruit juices and citrus fruits.

A priority nursing intervention for a client with hypervolemia involves which of the following? Monitoring respiratory status for signs and symptoms of pulmonary complications. Encouraging the client to consume sodium-free fluids. Establishing I.V. access with a large-bore catheter. Drawing a blood sample for typing and crossmatching.

Monitoring respiratory status for signs and symptoms of pulmonary complications.

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? Sodium CO2 Potassium Chloride

Potassium

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? Potassium: 5.8 mEq/L Sodium: 138 mEq/L Calcium: 10 mg/dL Magnesium:2 mEq/L

Potassium: 5.8 mEq/L

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? Administering vasopressin as ordered Restricting sodium intake to 1 gm/day Elevating the head of the client's bed to 90 degrees Restricting fluids to 800 ml/day

Restricting fluids to 800 ml/day

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? Increased urine output Tachycardia Bradycardia Vasodilation

Tachycardia

A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The nurse expects that the compensatory mechanisms associated with hypovolemia would cause what clinical manifestations? (Select all that apply.) Bradycardia Tachypnea Tachycardia Oliguria Hypertension

Tachypnea Tachycardia Oliguria

A client comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The client fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurse's most likely explanation for the low urine output? The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output. The man is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output. The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place. The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin.

The man is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.

Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)? Tomato juice, low-fat cottage cheese, and three slices of bacon Three ounces of sliced ham, beets, and a salad Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad A frozen, packaged low-fat dinner with a side salad

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

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. sodium 137 mEq/L (137 mmol/L) potassium 4.6 mEq/L (4.6 mmol/L) chloride 94 mEq/L (94 mmol/L) calcium 12.9 mg/dL (3.2 mmol/L) What laboratory value is of highest concern to the nurse? chloride 94 mEq/L (94 mmol/L) calcium 12.9 mg/dL (3.2 mmol/L) potassium 4.6 mEq/L (4.6 mmol/L) sodium 137 mEq/L (137 mmol/L)

calcium 12.9 mg/dL (3.2 mmol/L)

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

dehydration

Early signs of hypervolemia include increased breathing effort and weight gain. thirst. moist breath sounds. a decrease in blood pressure.

increased breathing effort and weight gain

A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the client has a history of alcohol abuse. client may be developing hyperaldosteronism. client's diet is lacking in calcium-rich food products. malignancy is causing the electrolyte imbalance.

malignancy is causing the electrolyte imbalance.

A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting? pitting edema anasarca third-spacing hypovolemia

third-spacing

A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching? polyuria hypertension flank pain tingling sensation in the fingers

tingling sensation in the fingers