Assessment & Care of Patients with Fluid & Electrolyte Imbalances

A client with a traumatic closed head injury shows signs that indicate the presence of cerebral edema. Which intravenous solution would increase cellular swelling and cerebral edema? 1. 0.9% normal saline 2. 0.45% normal saline 3. 5% dextrose in water 4. Lactated Ringer's solution

0.45% normal saline Hypotonic solutions such as 0.45% normal saline are inappropriate for the client with cerebral edema because hypotonic solutions have the potential to cause cellular swelling and cerebral edema. The remaining choices of solutions would be appropriate because they are examples of isotonic solutions and thus are similar in composition to plasma. These fluids would remain in the intravascular space without potentiating the client's cerebral edema.

What is the preferred diuretic used for patients with hypokalemia? 1 Amiloride 2 Furosemide 3 Bumetanide 4 Chlorthiazide

1 Amiloride Diuretics that increase the kidney excretion of potassium can cause hypokalemia. A potassium sparing diuretic may be prescribed to increase the urine output without increasing potassium loss. Amiloride is an example of potassium sparing diuretic, which is preferred for patients diagnosed with hypokalemia. Furosemide, bumetanide, and chlorthaiazide are examples of high ceiling, loop, or thiazide diuretics. These loop and thiazide diuretics promote excretion of potassium along with water; therefore, they are not used in patients diagnosed with hypokalemia.

The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? 1. Twitching 2. Hypoactive bowel sounds 3. Negative Trousseau's sign 4. Hypoactive deep tendon reflexes

1. Twitching The normal serum calcium level is 8.6 to 10 mg/dL. A serum calcium level lower than 8.6 mg/dL indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.

How much fluid should a healthy adult consume each day to maintain adequate urine output? 1 2 L/day 2 2.3 L/day 3 2.6 L/day 4 2.9 L/day

2 2.3 L/day Most healthy adults take in about 2300 mL of fluid each day, which is equivalent to 2.3 L/day. The other figures do not accurately account for the amount of daily fluid from food and liquids.

A patient is brought in an unconscious state to the emergency department. The primary health care provider suspects dehydration and advises laboratory investigation to ascertain the cause. Which parameter in the laboratory investigations would indicate internal hemorrhage as a reason for dehydration? 1 Increased osmolarity 2 Absence of hemoconcentration 3 Elevated levels of blood components 4 Decreased levels of blood hemoglobin

2 Absence of hemoconcentration Hemoconcentration is not present when dehydration is caused by hemorrhage, because loss of all blood and plasma products occurs together. Increased osmolarity and elevated levels of blood components are also characteristic findings of dehydration, but do not indicate hemorrhage. Decreased blood hemoglobin indicates anemia but not dehydration.

The nurse is providing care to a patient who is experiencing severe nausea, vomiting, and diarrhea. Which is the patient at risk of developing? Select all that apply. 1 Dehydration 2 Hypertension 3 Hyperkalemia 4 Hypercalcemia 5 Hypernatremia

1 Dehydration 3 Hyperkalemia 5 Hypernatremia A patient who is experiencing severe nausea, vomiting, and diarrhea is at risk of developing dehydration and electrolyte imbalances such as hyperkalemia and hypernatremia. The patient is at risk for hypotension not hypertension. The patient is not a risk of developing hypercalcemia.

The primary health care provider prescribes intravenous administration of 100 mL of 20% glucose along with 20 units of insulin in a patient who is receiving furosemide therapy. What is the probable diagnosis of the patient? 1 Hyperkalemia 2 Hyperglycemia 3 Hypernatremia 4 Hypercalcemia

1 Hyperkalemia Hyperkalemia is a condition where serum potassium levels are high. Potassium movement into the cells is enhanced by insulin. Intravenous administration of 100 mL 10% to 20% glucose with 10 to 20 units of regular insulin helps decrease serum potassium levels. Insulin increases the activity of sodium-potassium pumps, which decreases serum potassium levels temporarily by moving potassium from the extracellular fluid to the cells. This therapy is prescribed as an add-on therapy along with diuretics in a hyperkalemic patient. Conditions such as hyperglycemia, hypernatremia, and hypercalcemia cannot be managed with this insulin and glucose therapy.

The nurse admits a patient with dehydration. Which electrolyte imbalances does the nurse anticipate based on this diagnosis? Select all that apply. 1 Hyperkalemia 2 Hypocalcemia 3 Hypochloremia 4 Hypernatremia 5 Hypermagnesemia

1 Hyperkalemia 4 Hypernatremia A patient who is admitted with dehydration will have hyperkalemia and hypernatremia. Hypocalcemia, hypochloremia, and hypermagnesemia are not expected electrolyte imbalances for a patient admitted with dehydration.

The nurse is providing care to a patient who is admitted with fluid volume overload. Which electrolyte imbalances does the nurse anticipate for this patient based on the admitting diagnosis? Select all that apply. 1 Hyponatremia 2 Hypokalemia 3 Hypercalcemia 4 Hypochloremia 5 Hypermagnesemia

1 Hyponatremia 2 Hypokalemia 4 Hypochloremia A patient admitted with fluid volume overload will often experience hyponatremia, hypokalemia, and hypocholoremia. Hypercalcemia and hypermagnesemia are not anticipated electrolyte imbalances associated with fluid volume overload.

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). Laboratory results include a potassium level of 7.0 mEq/L. Which medication does the nurse anticipate administering? 1 Insulin (regular insulin) and dextrose (D20W) 2 Loperamide 3 Sodium polystyrene sulfonate 4 Supplemental potassium

1 Insulin (regular insulin) and dextrose (D20W) If potassium levels are high, a combination of 20 units of regular insulin in 100 mL of 20% dextrose may be prescribed to promote movement of potassium from the blood into the intracellular fluid (ICF). Imodium is used in the treatment of diarrhea. Sodium polystyrene sulfonate is used for hyperkalemia, but not when the potassium level is this high (7.0). Additional potassium would make the patient's condition more critical.

Which drug therapies might be used to manage symptoms of hypocalcemia? Select all that apply. 1 Magnesium sulfate 2 Calcium chloride 3 Potassium chloride 4 Vitamin D 5 Zinc sulfate 6 Vitamin E

1 Magnesium sulfate 2 Calcium chloride 4 Vitamin D Magnesium sulfate may be used to manage neuromuscular symptoms of hypocalcemia. Calcium supplements are given to restore serum calcium levels. Vitamin D enhances the absorption of oral calcium. Potassium, zinc, and vitamin E are not indicated for the management of hypocalcemia.

Which nursing action is recommended when providing care to a patient with hypokalemia? 1 Question the continued administration of bumetanide. 2 Obtain the prescribed vial of IV potassium chloride from the pharmacy and dilute before administration. 3 Establish a peripheral IV, preferably in the hand, for administering IV potassium chloride. 4 Administer prescribed oral potassium chloride before a meal or snack.

1 Question the continued administration of bumetanide. Bumetanide is a loop diuretic, which contributes to potassium loss and should be questioned. The Joint Commission has mandated that all concentrated electrolytes be mixed by a pharmacist and that vials of KCl should not be available in patient care areas. A large vein with high blood flow should be accessed to avoid phlebitis; it is recommended that the hand be avoided. Oral potassium supplements should be given with or following a snack or meal to avoid nausea.

Which assessment finding is likely in a patient reporting diarrhea and vomiting with an elevated body temperature of 103° F for 2 days who is brought to the emergency department? 1 Urine output of 350 mL/day 2 Oral mucosal membranes are dry 3 Respiratory rate of 22 breaths per minute 4 Neck veins distended when the patient is in supine position

1 Urine output of 350 mL/day Normal urine output should be not less than 500 mL/day. A urine output of 350 mL/day indicates dehydration. Dry oral mucus membranes can be a manifestation of dehydration, but can be misleading because some drugs also cause dry mouth as a side effect. A respiratory rate of 22 breaths per minute indicates an increased respiratory rate, which may be due to many other reasons. Neck veins are generally flat in patients with dehydration.

The patient with fluid overload has been taking a diuretic for the past 2 days and now experiences these changes. Which changes indicate to the nurse that the diuretic resulted in overdiuresis? Select all that apply. 1 Weight loss of 9 pounds 2 Reports of lightheadedness when first standing from a lying position 3 Heart rate decrease from 80 to 72 beats/min 4 Heart rate increase from 70 to 96 beats/min 5 Respiratory rate decrease from 20 to 16 breaths/min 6 Morning blood glucose decrease from 142 mg/dL to 110 mg/dL 7 Reports of fatigue

1 Weight loss of 9 pounds 2 Reports of lightheadedness when first standing from a lying position 4 Heart rate increase from 70 to 96 beats/min 7 Reports of fatigue Diuretic drugs cause water loss and are often prescribed for edema. One liter of water weighs 2.2 pounds. Weight loss is expected when the patient gets rid of excess water. If the prescribed diuretic is overly effective, too much water may be excreted by the kidneys and signs of dehydration from overdiuresis may occur. A weight loss of 9 pounds is approximately 4 liters of fluid. Lightheadedness when changing positions may suggest orthostatic hypotension. Other signs of too much fluid loss include an increase in heart rate and fatigue. The decrease in heart rate and respiratory rate would suggest the diuretic was effective.

An older adult patient with a history of renal failure is brought in to the emergency department with sudden onset of acute confusion, worsening muscle weakness in the extremities, abdominal cramps, and a weak, rapid, and thready pulse. What are the immediate nursing interventions to stabilize the patient? Select all that apply. 1 Administering diuretics 2 Administering 0.9% saline 3 Administering antipsychotics 4 Administering calcium channel blockers 5 Administering 5% dextrose in 0.45% sodium chloride

1. Administering diuretics 2. Administering 0.9% saline 5. Administering 5% dextrose in 0.45% sodium chloride The patient's symptoms indicate hypernatremia. Administering diuretics that promote sodium loss and administering fluids such as 0.9% saline and 5% dextrose in 0.45% sodium chloride to restore the fluid balance are the immediate interventions needed to stabilize the patient. The patient's acute confusion is caused by high sodium levels, so antipsychotic drugs should not be administered. Sodium decreases the heart contractibility by retarding the movement of calcium into the heart cells. Therefore, calcium channel blockers should not be administered.

A client who is at risk for fluid imbalance is to be admitted to the nursing unit. In planning care for this client, the nurse is aware that which conditions cause the release of antidiuretic hormone (ADH)? Select all that apply. 1. Dehydration 2. Hypertension 3. Physiological stress 4. Decreased blood volume 5. Decreased plasma osmolarity

1. Dehydration 3. Physiological stress 4. Decreased blood volume Antidiuretic hormone, or vasopressin, is produced in the brain and stored in the posterior pituitary gland. Its release from the posterior pituitary gland is controlled by the hypothalamus in response to changes in blood osmolarity. Stimuli for ADH release are increased plasma osmolality, decreased blood volume, hypotension, pain, dehydration from nausea, vomiting, or diarrhea, and stress.

Which hormones play a role in the regulation of sodium balance by the kidneys? Select all that apply. 1 Cortisol 2 Aldosterone 3 Angiotensin 4 Natriuretic peptide (NP) 5 Antidiuretic hormone (ADH)

2 Aldosterone 4 Natriuretic peptide (NP) 5 Antidiuretic hormone (ADH) Serum sodium levels are regulated by the kidneys under the influence of aldosterone, natriuretic peptide (NP), and antidiuretic hormone (ADH). Low serum sodium levels inhibit the secretion of antidiuretic hormone (ADH) and natriuretic peptide (NP) and trigger the secretion of aldosterone. This increases the serum sodium levels by increasing the reabsorption of sodium and enhancing water loss by the kidney. High serum sodium levels inhibit aldosterone secretion and stimulate the secretion of antidiuretic hormone (ADH) and natriuretic peptide (NP). These hormones increase the excretion of sodium and reabsorption of water by the kidney. Cortisol and angiotensin do not regulate the serum sodium levels.

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). She is receiving lactated Ringer's solution IV for rehydration. What clinical manifestations does the nurse monitor during rehydration of the patient? Select all that apply. 1 Blood serum glucose 2 Blood pressure 3 Pulse rate and quality 4 Urinary output 5 Urine specific gravity levels

2 Blood pressure 3 Pulse rate and quality 4 Urinary output 5 Urine specific gravity levels The two most important areas to monitor during rehydration are pulse rate and quality and urine output; however, decreasing specific gravity of urine is also an indication of rehydration. Blood pressure is also important to monitor during rehydration. Blood glucose changes do not have a direct relation to a patient's rehydration status.

Which electrolyte imbalance does the nurse anticipate in association with a serum magnesium reading of 1.1 mEq/L? 1 Potassium 5.7 mEq/L 2 Calcium 7.8 mg/dL 3 Sodium 149 mEq/L 4 Phosphorus 2.6 mg/dL

2 Calcium 7.8 mg/dL Hypocalcemia often occurs with hypomagnesemia. A calcium level of 7.8 mg/dL is low. A sodium level of 149 mEq/L is slightly elevated, but not related to the low magnesium level. A phosphorus level of 2.6 mg/dL is slightly low, but not related to hypomagnesemia.

A patient develops fluid overload while in the intensive care unit. Which nursing intervention does the nurse perform first? 1 Draws blood for laboratory tests 2 Elevates the head of the bed 3 Places the extremities in a dependent position 4 Puts the patient in a side-lying position

2 Elevates the head of the bed Elevating the head of the bed will ease breathing for the patient, so it should be done first. Although drawing blood for laboratory tests may be indicated, the nurse should perform interventions that will help with physiological changes caused by fluid overload first. Placing the extremities in a dependent position increases peripheral edema, and positioning the patient in a side-lying position increases the work of breathing.

A patient who recently experienced an anterior neck injury reports frequent and painful muscle spasms in the calf during sleep. Which condition does the nurse suspect in the patient? 1 Hypokalemia 2 Hypocalcemia 3 Hyponatremia 4 Hypophosphatemia

2 Hypocalcemia Patients with a history of anterior neck injury are at a high risk for hypocalcemia. Frequent painful muscle spasms in the calf or foot during rest or sleep (charley horses) indicate hypocalcemia. Hypokalemia, hyponatremia, and hypophosphatemia do not cause painful calf muscle spasms.

The nurse is providing care to a patient who is experiencing tachypnea. Which intervention is most appropriate to maintain the patient's fluid balance? 1 Encourage oral fluids. 2 Increase intravenous fluids. 3 Implement fluid restrictions. 4 Administer prescribed diuretic.

2 Increase intravenous fluids. Tachypnea: rapid breathing. The patient who is experiencing tachypnea will experience an increase in insensible water loss, increasing the risk for dehydration. The most appropriate intervention by the nurse is to increase intravenous fluids. Encouraging oral fluids is not recommended due to the increased risk for aspiration that occurs with tachypnea. Fluid restrictions and diuretics are not recommended, as these will increase the patient's risk for dehydration.

What is the function of aldosterone in the body? 1 It causes constriction of renal arterioles. 2 It promotes resorption of water and sodium. 3 It stimulates secretion of renin for the kidneys. 4 It causes constriction of peripheral blood vessels.

2 It promotes resorption of water and sodium. Aldosterone promotes reabsorption of sodium and water into the body, which helps in maintaining blood pressure. Angiotensin II causes constriction of renal arterioles, resulting in low urine output. Factors such as low blood pressure, low blood volume, low oxygen, and low sodium trigger secretion of renin. Angiotensin II causes constriction of peripheral blood vessels and helps in maintaining perfusion to vital organs.

Which assessment findings would indicate decreased tissue perfusion stimulating the secretion of renin from the kidney tubular system? Select all that apply. 1 High urine output 2 Low blood volume 3 Low blood oxygen 4 High blood sodium 5 High blood pressure

2 Low blood volume 3 Low blood oxygen Low blood volume and low blood oxygen are two conditions that signal decreased tissue perfusion, which stimulates the secretion of renin from the kidney tubular system. High urine output, high sodium, and high blood pressure are not conditions that indicate decreased tissue perfusion, which would stimulate the secretion of renin from the kidney tubular system.

The nurse is administering sodium chloride 0.9% (normal saline) intravenously to a patient who is dehydrated. Which assessments does the nurse perform to evaluate the effectiveness of rehydration therapy? Select all that apply. 1 Temperature 2 Pulse rate and quality 3 Level of consciousness 4 Urinary output 5 Bowel sounds

2 Pulse rate and quality 4 Urinary output Pulse rate and quality as well as urinary output best reflect improving volume status with rehydration therapy. Temperature, level of consciousness, and bowel sounds are not indicators of an improving volume state.

Which assessment data is the best indication of perfusion after a surgical procedure? 1 Heart rate 2 Urine output 3 Blood pressure 4 Pulse oximetry

2 Urine output The renin-angiotensin II pathway is highly stimulated whenever the patient is in shock or when the stress response occurs. This is why urine output is used as an indicator of perfusion adequacy after surgery or any time the patient has undergone an invasive procedure and is at risk for hemorrhage. While heart rate, blood pressure, and pulse oximetry are also useful when monitoring perfusion, they are not the most important indicator of perfusion adequacy.

A client's kidneys are retaining increased amounts of sodium. The nurse plans care, anticipating that the kidneys also are retaining greater amounts of which substances? 1. Calcium and chloride 2. Chloride and bicarbonate 3. Potassium and phosphates 4. Aluminum and magnesium

2. Chloride and bicarbonate Sodium is a cation. With increased retention of sodium, the kidneys also increase reabsorption of chloride and bicarbonate, which are anions. Options 1 and 3 are incorrect because calcium and potassium are cations. The same is true for option 4.

The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client was at risk for developing the potassium deficit because of which situation? 1. Sustained tissue damage 2. Requires nasogastric suction 3. Has a history of Addison's disease 4. Is taking a potassium-retaining diuretic

2. Requires nasogastric suction The normal serum potassium level is 3.5 mEq/L to 5.0 mEq/L. A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client taking a potassium-retaining diuretic are at risk for hyperkalemia.

The nurse is performing discharge dietary teaching for a patient with hyperkalemia. Which statement does the nurse include in the teaching? 1 "You may eat avocados, broccoli, and cantaloupe." 2 "You may use salt substitutes." 3 "You may eat apples, strawberries, and peaches." 4 "You don't need to restrict dairy products."

3 "You may eat apples, strawberries, and peaches." The patient with hyperkalemia should be instructed to consume foods low in potassium such as apples, strawberries, and peaches. The patient should avoid foods high in potassium, which include avocados, broccoli, cantaloupe, and dairy products. Salt substitutes contain potassium.

Which patient is at increased risk for fluid and electrolyte imbalance? Select all that apply. 1 22-year-old pregnant woman in her third trimester 2 24-year-old male athlete 3 45-year-old man on diuretics 4 47-year-old man traveling to South America in summer 5 76-year-old bedridden woman

3 45-year-old man on diuretics 4 47-year-old man traveling to South America in summer 5 76-year-old bedridden woman An athlete is at risk for dehydration. An older man on diuretics is at risk for fluid and electrolyte imbalances owing to the action(s) of the drugs. Many of the high-ceiling (loop) diuretics cause loss of potassium as they enable the body to rid itself of excess fluids. A middle-aged man who is traveling to a hot climate and/or high altitude is at risk for insensible water loss as he acclimates to warmer temperatures. Older adults have decreased thirst mechanisms and are at risk for dehydration and subsequent fluid and electrolyte problems. A pregnant patient in the third trimester does have an increase in total body fluids, but this accumulation occurs gradually throughout the pregnancy.

Which condition is least likely to cause fluid overload? 1 Heart failure 2 Kidney failure 3 Diabetes insipidus 4 Psychiatric disorders

3 Diabetes insipidus Diabetes insipidus is manifested as polyuria, which means the passage of frequent and large amounts of urine, leading to dehydration. Heart failure is manifested as peripheral edema, which refers to the retention of fluid in the lower extremities of the body. Kidney failure is manifested as decreasing or no production of urine, which causes retention of fluids in the body, resulting in fluid overload. Psychiatric disorders may lead to polydipsia, which may lead also to fluid overload.

The nurse is caring for a patient who is receiving intravenous (IV) magnesium sulfate. Which assessment parameter is critical? 1 24-hour urine output 2 Asking the patient about feeling depressed 3 Hourly deep tendon reflexes (DTRs) 4 Monitoring of serum calcium levels

3 Hourly deep tendon reflexes (DTRs) The patient who is receiving IV magnesium sulfate should be assessed for signs of toxicity every hour by assessment of DTRs. Most patients who have fluid and electrolyte problems will be monitored for intake and output (I&O); this will not immediately generate data about problems with magnesium overdose. Low magnesium levels can cause psychological depression, but assessing this parameter as the levels are restored would not be a method by which to safely assess a safe dose or an overdose. Although administration of magnesium sulfate can cause a drop in calcium levels, this occurs over a period of time and would not be the best way to assess magnesium toxicity.

Which electrolyte imbalance should be anticipated and monitored in a patient with hyperphosphatemia? 1 Hypernatremia 2 Hypokalemia 3 Hypocalcemia 4 Hypermagnesemia

3 Hypocalcemia Phosphorus and calcium have an inverse or reciprocal relationship. When one is increased, the other is usually decreased. Therefore, a patient with hyperphosphatemia should be monitored for hypocalcemia. Hyperphosphatemia does not cause hypernatremia, hypokalemia, or hypermagnesemia.

A patient admitted with fluid overload from heart failure is treated with diuretic therapy. What laboratory test demonstrates effectiveness of the diuretic therapy? 1 Serum magnesium 2 Serum osmolality 3 Natriuretic peptide 4 Serum creatinine

3 Natriuretic peptide Natriuretic peptides (atrial and brain natriuretic peptides) are hormones secreted by cells that line the atria and ventricles of the heart in response to changes in blood volume and pressure. Serum osmolality may be monitored if the patient is over- or underdiuresed. Serum magnesium and creatinine would not be indicated as a measure of diuretic therapy.

The health care provider writes orders for a patient who is admitted with a serum potassium (K) level of 6.9 mEq/L. What does the nurse implement first? 1 Administer sodium polystyrene sulfonate orally. 2 Ensure that a potassium-restricted diet is ordered. 3 Place the patient on a cardiac monitor. 4 Teach the patient about foods that are high in potassium.

3 Place the patient on a cardiac monitor. Because hyperkalemia can lead to life-threatening bradycardia, the initial action should be to place the patient on a cardiac monitor. Administering a potassium-reducing medication, recommending a potassium-restricted diet, and teaching the patient about diet are appropriate but will not immediately decrease the serum potassium level and do not need to be implemented as quickly as monitoring cardiac rhythm.

When caring for a patient with hyponatremia, which intervention does the nurse implement? 1 Intravenous administration of 0.45% normal saline 2 Administration of furosemide 3 Small-volume intravenous infusions of 3% normal saline 4 2-gram sodium diet

3 Small-volume intravenous infusions of 3% normal saline 3% saline is hypertonic and is given in small volumes to replenish serum sodium. 0.45% saline is hypotonic and will further dilute serum sodium levels. Furosemide causes sodium loss in the kidneys and would further contribute to hyponatremia. A 2-gram sodium diet restricts sodium intake; the goal of nutritional therapy with hyponatremia is to increase sodium intake.

The nurse who is caring for a client with severe malnutrition reviews the laboratory results and notes that the client has a magnesium level of 1.0 mg/dL. Which electrocardiographic change would the nurse expect to observe based on the client's magnesium level? 1. Prominent U waves 2. Prolonged PR interval 3. Depressed ST segment 4. Widened QRS complexes

3. Depressed ST segment The normal magnesium level is 1.6 to 2.6 mg/dL. A magnesium level of 1.0 mg/dL indicates hypomagnesemia. In hypomagnesemia, tall T waves and a depressed ST segment would be observed. Options 2 and 4 would be noted in a client experiencing hypermagnesemia. Prominent U waves occur with hypokalemia.

What is a risk factor associated with tachypnea? 1 Increased heart rate 2 Increased urine output 3 Increased blood volume 4 Increased insensible water loss

4 Increased insensible water loss Tachypnea is characterized by rapid respiration. Risk factors associated with tachypnea include increased insensible water loss. An increased heart rate, increased urine output, and increased blood volume are not associated with tachypnea.

Which laboratory value requires a priority response by the nurse to notify the primary health care provider? 1 Sodium 133 mEq/L 2 Potassium 5.0 mEq/L 3 Calcium 9.0 mg/dL 4 Magnesium 4.2 mEq/L

4 Magnesium 4.2 mEq/L A magnesium level of 4.2 is markedly elevated (normal 1.3-2.1 mEq/L). Manifestations are not usually apparent until levels exceed 4 mEq/L. Patients with severe hypermagnesemia are in danger of cardiac arrest, so a level of 4.2 mEq/L requires prompt attention. A sodium level of 133 mEq/L is slightly low, but does not require immediate notification of the health care provider. A potassium level of 5.0 mEq/L is normal. A calcium level of 9.0 mg/dL is normal.

A client becomes hypovolemic as a result of excess blood loss during surgery. The nurse plans care, knowing that which physiological response is needed to restore adequate circulating volume? 1. Decreased production of angiotensin 2. Decreased production of aldosterone 3. Increased production of erythropoietin 4. Increased production of antidiuretic hormone (ADH)

4. Increased production of antidiuretic hormone (ADH) The client must produce increased ADH, which will increase reabsorption of water in the renal tubules and increase circulating volume. The production of angiotensin is stimulated, not inhibited, so that vasoconstriction may occur. A decrease in aldosterone will decrease the reabsorption of sodium and water in the kidneys. The client does not require increased erythropoietin to restore circulating volume.

A client who had intracranial surgery is experiencing diabetes insipidus. The nurse plans care, knowing that the client is experiencing which problem? 1. Water intoxication 2. Excess production of dopamine 3. Excess production of angiotensin II 4. Insufficient production of antidiuretic hormone (ADH)

4. Insufficient production of antidiuretic hormone (ADH) In diabetes insipidus there is insufficient ADH production, which causes the kidneys to excrete large volumes of urine. Water intoxication occurs when there is excess ADH production, resulting in water retention. Options 2 and 3 have nothing to do with diabetes insipidus.

The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which cardiovascular manifestation would the nurse expect to note? 1. Hypotension 2. Increased heart rate 3. Bounding peripheral pulses 4. Shortened QT interval on electrocardiography (ECG)

4. Shortened QT interval on electrocardiography (ECG) Cardiovascular manifestations that occur with hypocalcemia include decreased heart rate, diminished peripheral pulses, and hypotension. On the electrocardiogram (ECG), the nurse would note a prolonged ST interval and a prolonged QT interval.

The nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.7 mEq/L. Which finding would the nurse expect to note on the electrocardiogram as a result of the laboratory value? 1. ST depression 2. Inverted T wave 3. Prominent U wave 4. Tall peaked T waves

4. Tall peaked T waves A serum potassium level greater than 5.0 mEq/L indicates hyperkalemia. Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves.

Which will the nurse include when documenting a patient's fluid intake for the shift? Select all that apply. 1 Emesis 2 Enemas 3 Oral fluids 4 Solid foods 5 Irrigation fluids

2 Enemas 3 Oral fluids 5 Irrigation fluids Intake that is considered measurable when documenting a patient's fluid intake for the shift include enemas, oral fluids, and irrigation fluids. Emesis is a measurable output. Solid foods are considered intake but these cannot be measured.