Alterations in Fluid and Electrolyte Balance

The nurse is concerned that a patient's arterial blood carbon dioxide level is increasing because this can contribute to the development of which of the following disorders? 1. hyperkalemia 2. hypokalemia 3. hypercalcemia 4. hypocalcemia

Answer: 1 Rationale: A rise in arterial blood carbon dioxide is a diagnostic indicator of acidosis. Acidosis contributes to hyperkalemia because excess hydrogen ions shift into the cells, forcing potassium out into the serum. The nurse should be concerned about the patient developing hyperkalemia. Acidosis does not contribute to the development of the other disorders.

A patient has a serum calcium level of 7.9 mg/dL. Which of the following interventions would be appropriate for this patient? 1. place on seizure precautions 2. strain urine 3. assess for hypertension 4. treat tachycardia

Answer: 1 Rationale: A serum calcium level of less than 8.5 mg/dL is indicative of hypocalcemia. Nursing interventions appropriate for the patient would include monitoring the patient for seizures, signs and symptoms of decreased cardiac output, bradycardia, and ventricular dysrhythmias. Interventions that would not be appropriate for hypocalcemia include straining urine, assessing for hypertension, and treating tachycardia

A patient with fluid volume excess has a hemoglobin level of 9.0 mg/dL. The nurse realizes this laboratory value is due to 1. plasma dilution from excess fluid. 2. undiagnosed bleeding disorder. 3. iron deficiency anemia. 4. chronic anemia.

Answer: 1 Rationale: An altered serum laboratory value, such as a hemoglobin level of 9.0 mg/dl, is the result of plasma dilution from excess extracellular fluid volume. There is not enough information to determine if the patient has an undiagnosed bleeding disorder, iron deficiency anemia, or chronic anemia.

The nurse is assessing a patient diagnosed with hyperphosphatemia. In which of the following medical conditions is this electrolyte imbalance most likely to be seen? 1. chronic renal failure 2. rheumatoid arthritis 3. heart failure 4. chronic obstructive pulmonary disease

Answer: 1 Rationale: Hyperphosphatemia is less commonly seen in the high acuity patient. It is predominantly associated with chronic renal failure even though other causes include hyperthyroidism, hypoparathyroidism, severe catabolic states, and conditions causing hypocalcemia. This electrolyte imbalance is not associated with rheumatoid arthritis, heart failure, or chronic obstructive pulmonary disease

A patient, diagnosed with chronic renal failure, is admitted with hypermagnesemia. Which of the following history data would contribute to this electrolyte imbalance? 1. ingestion of magnesium-containing antacids for epigastric reflux for 3 weeks 2. reduced intake of caffeine-containing fluids 3. recovering from nasal congestion 4. sprained wrist one week ago while carrying heavy groceries up stairs

Answer: 1 Rationale: The patient has chronic renal failure. Even though this abnormality is rare, it can occur with diminished renal excretion as seen in renal dysfunction, or excessive magnesium intake. Consumption of large quantities of magnesium-containing antacids or laxatives can be a source of excessive intake. The history data of ingestion of magnesium-containing antacids for epigastric reflux for 3 weeks is most likely what contributed to this electrolyte imbalance in the patient. The other history data would not have contributed to this imbalance.

A patient is demonstrating upon electrocardiogram a prolonged P-R interval and ST segment depression. The nurse realizes these changes are seen in which of the following electrolyte imbalances? 1. hypokalemia 2. hyperkalemia 3. hypernatremia 4. hypocalcemia

Answer: 2 Rationale: Cardiovascular manifestations of hyperkalemia include prolonged P-R interval; flat or absent P wave; slurring of QRS; tall peaked T wave; and ST segment depression. These same electrocardiogram changes are not seen in hypokalemia, hypernatremia, or hypocalcemia

A patient has a serum calcium level of 11.0 mg/dL. The nurse realizes that which of the following is contributing to this patient's elevated calcium level? 1. diagnosis of hypoparathyroidism 2. thiazide diuretics and immobility 3. diagnosis of acute pancreatitis 4. low serum magnesium level

Answer: 2 Rationale: Hypercalcemia is seen in patients with malignancies in addition to those who are prescribed thiazide diuretics. It develops from prolonged immobility, hyperparathyroidism and thyrotoxicosis. The diagnosis of hypoparathyroidism and acute pancreatitis are associated with hypocalcemia. A low serum magnesium level is also seen in hypocalcemia.

A patient, with a history of heart failure, is admitted with dehydration, malnutrition, and fatigue. The nurse learns that the patient has been taking multiple doses of a thiazide diuretic. Which of the following electrolyte disorders should be investigated for this patient? 1. hypocalcemia 2. hypophosphatemia 3. hypernatremia 4. hypermagnesemia

Answer: 2 Rationale: Hypophosphatemia is associated with malnourished states and is a relatively common imbalance in the high acuity patient. Other conditions that can cause hypophosphatemia include those disorders that cause hypercalcemia. Thiazide diuretics can cause hypercalcemia. The patient was found to be taking multiple doses of a thiazide diuretic. Therefore, the patient's phosphorus level should be evaluated. Hypophosphatemia is also associated with muscle fatigue, another symptom that the patient is demonstrating. Dehydration, malnutrition, and fatigue are not directly linked to hypocalcemia, hypernatremia, or hypermagnesemia.

A patient is admitted for hypermagnesemia. The nurse realizes that which of the following will be provided to the patient? 1. intravenous fluids of 5% dextrose and 0.45% normal saline 2. calcium 3. maintain on bed rest 4. treatment for tetany

Answer: 2 Rationale: In the patient with the diagnosis of hypermagnesemia, medications containing magnesium should not be given. The first line treatment for elevated magnesium levels is to give calcium. Intravenous fluid infusion of 5% dextrose and 0.45% normal saline is not indicated. The patient does not need to be maintained on bedrest. Tetany is seen in hypomagnesemia and not hypermagnesemia.

A patient is in the intensive care unit experiencing a gastrointestinal hemorrhage. The nurse realizes that the intravenous solution of choice to help this patient would be 1. 0.45% normal saline. 2. 0.9% normal saline. 3. 2.5% dextrose. 4. 5% dextrose and 0.45% normal saline

Answer: 2 Rationale: The patient needs an isotonic solution to expand the blood volume. The appropriate intravenous solution would be 0.9% normal saline. Both 0.45% normal saline and 2.5% dextrose are hypotonic solutions and would not help expand the patient's blood volume. The solution 5% dextrose and 0.45% normal saline is a hypertonic solution and also would not expand the patient's blood volume

The nurse is planning the care of a patient with the risk of developing fluid volume deficit. Which of the following assessment findings would contribute to this risk? 1. loose bowel movement one per day 2. diuretic therapy two doses per day 3. first degree steam burn on forearm 4. temperature 97.6 degrees F

Answer: 2 Rationale: The patient receiving two doses of diuretic therapy per day is at risk for high volumes of urine output which could increase the risk of developing a fluid volume deficit. Other causes of fluid volume deficit include diarrhea and not one loose bowel movement per day. Burns also can cause a fluid volume deficit but it is unlikely that a first degree burn on the forearm will produce these results. Fluid volume deficit is also associated with febrile states. The patient's temperature is below normal and therefore would not add to the risk of a fluid volume deficit.

The nurse is preparing to administer intravenous fluids to a patient diagnosed with hyperphosphatemia. Which of the following solutions would be the most beneficial for this patient? 1. 5% dextrose and water 2. 0.9% normal saline 3. Lactated Ringer's solute 4. 5% dextrose and 0.25% normal saline

Answer: 2 Rationale: Treatment of hyperphosphatemia is directed at lowering serum levels. This is accomplished by either administering agents that bind phosphate in the gastrointestinal tract or administering an intravenous solution with saline since saline promotes the renal excretion of phosphate. The intravenous solution of choice for this patient would be 0.9% normal saline. The other intravenous solutions either do not contain saline or contain saline in insufficient amounts.

The nurse is caring for a patient with a serum sodium level of 149 mEq/L. The nursing diagnoses appropriate for the patient at this time would be 1. risk for imbalanced fluid volume. 2. risk for ineffective cerebral perfusion. 3. risk for injury. 4. anxiety.

Answer: 3 Rationale: A nursing diagnosis appropriate for a patient with hypernatremia is risk for injury because when administering water replacement, the changes in serum sodium can cause rapid fluid shifts in the brain and result in cerebral edema. The patient should be monitored for neurologic deterioration. Risk for imbalanced fluid volume and risk for ineffective cerebral perfusion are nursing diagnoses applicable to the patient with hyponatremia. There is no evidence to suggest the nursing diagnosis of anxiety would be applicable for the patient at this time.

A patient, being treated for fluid volume excess, is experiencing an elevated blood glucose level. The nurse realizes the diuretic that this patient most likely has been prescribed would be 1. Lasix. 2. Aldactone. 3. hydrochlorothiazide. 4. calcium chloride

Answer: 3 Rationale: Hydrochlorothiazide has hyperglycemia as a major side effect. Lasix and Aldactone do not have hyperglycemia as a major side effect. Calcium chloride is not a diuretic.

The nurse is preparing intravenous fluids for a patient with hypernatremia. Which of the following types of fluids would be indicated for this patient? 1. 5% dextrose and 0.45% normal saline 2. 10% dextrose in water 3. 0.45% normal saline 4. Lactated Ringer's

Answer: 3 Rationale: To effectively treat hypernatremia, the patient will need to be provided with hypotonic intravenous fluids. The fluid 0.45% normal saline is a hypotonic fluid. The fluids of 5% dextrose and 0.45% normal saline and 10% dextrose in water are hypertonic solutions and would not be used to treat hypernatremia. Lactated Ringer's is an isotonic solution and would not be effective when treating hypernatremia.

The nurse is assessing the effectiveness of fluid replacement therapy in a patient with the nursing diagnosis of fluid volume deficit. Which of the following assessment findings would indicate the therapy is effective? 1. blood pressure 90/48 mm Hg 2. weight loss 1 pound per day 3. mucous membranes dry 4. urine output 40 cc per hour

Answer: 4 Rationale: Evidence of a normal fluid balance would include a urine output of at least 30 cc per hour. The patient is demonstrating a urine output of 40 cc per hour which means the patient is demonstrating effectiveness of fluid replacement therapy. The other assessment findings would indicate that the patient is still under-hydrated or continues to lose fluid volume as evidenced by the weight loss of 1 pound per day. The blood pressure is low and the mucous membranes are dry which both indicate fluid volume deficit.

A patient is receiving several units of packed red blood cells over several days to replace the blood lost during an active gastrointestinal bleed. The nurse realizes that this patient is prone to developing which of the following disorders? 1. hypercalcemia 2. hyponatremia 3. hypernatremia 4. hypocalcemia

Answer: 4 Rationale: Hypocalcemia can be induced by the administration of large amounts of stored blood because stored blood is preserved with citrate. Citrate is added to stored blood as a preservative. When blood is administered, the citrate binds with calcium, which lowers ionized calcium. The administration of blood does not cause hypercalcemia, hyponatremia, or hypernatremia.

The nurse, caring for a patient receiving digoxin, realizes that which of the following electrolytes needs to be monitored for early detection of dysrhythmias? 1. sodium 2. chloride 3. bicarbonate 4. potassium

Answer: 4 Rationale: In patients receiving digoxin therapy, low serum potassium levels can increase the risk for development of dysrhythmias. Although important, the other electrolytes do not provide the same risk for the development of dysrhythmias as potassium.

. A patient comes into the emergency department with complaints of feeling weak, confused, and having abdominal cramps after spending several hours in the hot sun attending a baseball game. The patient's blood pressure is 96/58 mmHg. Which of the following would these signs and symptoms suggest to the nurse? 1. hypernatremia 2. hypocalcemia 3. hypercalcemia 4. hyponatremia

Answer: 4 Rationale: Manifestations of hyponatremia include hypotension, confusion, headache, lethargy, seizures, decreased muscle tone, muscle twitching, tremors, vomiting, diarrhea, and cramping. The patient is complaining of feeling weak and confused with abdominal cramps which are symptoms associated with hyponatremia. The blood pressure of 96/58 mm Hg is another indication of hyponatremia. Manifestations of hypernatremia include hypertension, thirst, nausea, and vomiting. Because the patient was sitting out doors in the hot sun for several hours, the patient mostly likely is experiencing hyponatremia. Neither hypocalcemia nor hypercalcemia has the same manifestations as hyponatremia and it is unlikely that the patient is experiencing either of these electrolyte disorders.

A patient is demonstrating tremors and a positive Chvostek's sign even though the serum calcium level is low normal. Which of the following should the nurse suspect is occurring with this patient? 1. elevated magnesium level 2. low potassium level 3. elevated sodium level 4. low magnesium level

Answer: 4 Rationale: The symptoms associated with a low magnesium level are similar to those seen in a low calcium level. Therefore, the nurse should suspect that the patient is experiencing a low magnesium level since tremors and a positive Chvostek's sign is also seen with a low calcium level. These symptoms are not seen in an elevated magnesium level, low potassium level, or elevated sodium level.