Adult Health Chapter 6 Electrolyte and Acid Base Imbalances

Normal serum magnesium is

1.5-2.5 mEq/L

Normal level of serum sodium is

135-145 mEq/L

The nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse would tell the client which food item is LEAST LIKELY to contain calcium. 1. Milk 2. Butter 3. Spinach 4. Collard greens

2 Butter comes from milk fat and does not contain significant amounts of calcium. Milk, spinach, and collard greens are calcium-containing foods and must be avoided by the client on a calcium-restricted diet

The nurse is told in a report that the client has hypocalcemia. Which signs would the nurse expect to note during the data collection? Select all that apply! 1. Coma 2. Tetany 3. A positive Chvostek sign 4. Hypoactive bowel sounds 5. A positive Trousseau sign

2, 3, 5 Calcium is an electrolyte that is necessary for muscle movement. The adult normal calcium level is 9 to 10.5 mg/dL (2.25-2.75 mmol/L). A low calcium level tends to cause muscle irritability. A positive Chvostek sign (striking the side of the face and noting twitching) and positive Trousseau sign (applying a blood pressure cuff and pumping it up above the systolic BP for 3 to 5 minutes resulting in a carpal spasm or palmar flexion) are indicative of hypocalcemia. Other signs and symptoms include tachycardia, hypotension, paresthesia, twitching, cramps, tetany, seizures, hyperactive bowel sounds, and a prolonged QT interval on the electrocardiogram rhythm.

A client with a chronic airflow limitation is experiencing respiratory acidosis as a complication. The nurse trying to enhance the client's respiratory status would avoid performing which actions? Select all that apply. 1. Keeping the head of the bed elevated 2. Monitoring the client's oxygen saturation level 3. Increasing the liter flow to 5 L per nasal cannula 4. Assisting the client to turn, cough, and deep breathe 5. Encouraging the client to breathe slowly and shallowly

3, 5 The client with respiratory acidosis is experiencing elevated carbon dioxide levels because of insufficient ventilation. The nurse would encourage the client to breathe slowly and deeply (not shallowly) to expand the alveoli and to promote better gas exchange. The nurse should increase the client's oxygen flow rate per nasal cannula to no more than 2 L, not 5L. Remember that the client with chronic pulmonary disease often does not respond to a high carbon dioxide level to breathe, but only low oxygen. If the nurse increases the oxygen too high, the client will have no stimulus to breathe. Elevating the head of the bed, monitoring the client's oxygen saturation level, and assisting the client to turn, cough, and deep breathe are helpful actions on the part of the nurse.

Normal amount of potassium is

3.5-5 mEq/L

The nurse is caring for a client who has been taking diuretics on a long-term basis. Which finding would the nurse expect to note as a result of this long-term use? 1. Gurgling respirations 2. Increased blood pressure 3. Decreased hematocrit level 4. Increased specific gravity of the urine

4 Clients taking diuretics on a long-term basis are at risk for fluid volume deficit. Findings of fluid volume deficit include increased respiration & heart rate, decreased central venous pressure, weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased hematocrit levels, and altered LOC. Gurgling respirations, increased blood pressure, and decreased hematocrit as a result of hemodilution are seen in a client with fluid volume excess.

Etidronate, an antihypercalcemic medication, is prescribed for a client. Which information would the nurse reinforce when instructing the client about taking this medication? Take with milk 2. Take with meals. 3. Take with an antacid. 4. Take 2 hours before meals.

4 Etidronate is a bisphosphonate that works by slowing the resorption of bone and allowing new bone to be formed. Etidronate should be taken on an empty stomach 2 hours before meals. It should not be taken within 2 hours of vitamins, mineral supplements, antacids, or medications high in calcium, magnesium, iron, or albumin.

The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign/symptom would be an indication of this electrolyte imbalance? 1. Twitching 2. Positive Trousseau's sign 3. Hyperactive bowel sounds 4. Generalized muscle weakness

4 Generalized muscle weakness is seen in clients with hypercalcemia. Twitching, positive Trousseau's sign, and hyperactive bowel sounds are signs of hypocalcemia

Normal calcium levels are

9-11 mg/dL

Hypotonic

A solution that has a lower osmolaity than blood

Anion

Carry a negative electrical charge

Cation

Carry a positive electrical charge

Osmosis

Movement of water from an area of low substance concentration across a semipermeable membrane to an area of higher concentration

Hypertonic

Solutions exert greater osmotic pressure than blood

Normal Arterial Blood Gas Values

pH- 7.35-7.45 pco2: 32-45 mm Hg HCO3: 20-26 mEq/L

metabolic alkalosis lab values

pH- higher than 7.45, Pco2: Normal, HCO3: higher than 26 mEq/L

Respiratory Alkalosis lab values

pH- higher than 7.45, Pco2: lower than 32, HCO3: Normal

metabolic acidosis lab values

pH- lower than 7.35, Pco2: Normal, HCO3: higher than 26 mEq/L

Respiratory acidosis lab values

pH- lower than 7.35, Pco2: higher than 45 mm Hg, HCO3: Normal

Osmolarity

refers to the concentration of the substance in body fluids

Hydrostatic

the force that exerts water

Diffusion

the movement of a substance from an area of higher concentration to an area of lower concentration

The nurse is monitoring a group of clients for acid-base imbalances. Which clients are at the highest risk for metabolic acidosis? Select all that apply 1. Client with asthma 2. Client with pancreatitis 3. Malnourished clients 4. Client with Diabetes Mellitus 5. Client with Status Epilepticus 6. Client with severe prolonged diarrhea

2, 3, 4, 5, 6 Clients who produce excessive acid, under produce bicarbonate, or overly eliminate bicarbonate develop metabolic acidosis. Clients with malnourishment, diabetes mellitus, and status epilepticus produce excessive acids leading to metabolic acidosis. Clients with pancreatitis under produce bicarbonate and develop metabolic acidosis. Clients with severe prolonged diarrhea develop metabolic acidosis due to the over elimination of bicarbonate. The client with asthma could develop an acid-base imbalance from a respiratory problem.

The nurse is caring for a client for a client with a diagnosis of hyperparathyroidism. Laboratory studies are performed & the serum calcium level is 12.0 mg/dL. Based on this laboratory value, the nurse would take which action? 1. Document the value in the client's record 2. Inform the registered nurse of the laboratory value 3. Place the laboratory result form in the client's record 4. Reassure the laboratory result the laboratory result is normal

2 Rational: The normal serum calcium level ranges from 9 mg/dL- 10.5 mg/dL. The client is experiencing hypercalcemia, the remaining options are incorrect.

The nurse is caring for a client with kidney failure. The nurse is told that the blood gas results indicate a pH of 7.30 and a HCO3- of 20 mm Hg, and that the client is experiencing metabolic acidosis. The nurse reviews the laboratory results and finds which value to be of concern? 1. Sodium level, 145 mEq/L 2. Potassium level, 5.6 mEq/L 3. Magnesium level, 2.6 mg/dL 4. Phosphorus level, 4.5 mg/dL

2 Signs/symptoms of metabolic acidosis include weakness, malaise, and headache. Hyperkalemia will occur because the cells will draw hydrogen into the cell and in exchange will push potassium out of the cell into the blood. The pH will be lower than 7.35, and the HCO3- ion level will be lower than 22 mEq/L. The remaining options identify normal laboratory values, whereas a potassium level of 5.6 mEq/L indicates hyperkalemia.