CH 39 - Fluid, Electrolyte, and Acid-Base Balance

Your patient had 200 mL of ice chips and 900 mL intravenous fluid during your shift. Which total intake would you record? 700 mL 900 mL 1000 mL 1100 mL

1000 mL Add one-half the volume of ice chips to other fluids to calculate total intake.

Which needle gauge will be best for the nurse to use when providing intravenous therapy for an elderly patient with dehydration? 16 18 22 24

24 A 24-gauge needle work best for elderly patients. An elderly patient who is dehydrated will have smaller veins, and the smaller needle will be easier to insert. Needles that are 16- to 18-gauge are used for blood transfusions, for rapid infusion of fluids in patients with trauma, or for patients who have undergone surgery. Needles that are 20- to 22-gauge are generally used for general and intermittent solutions.

A patient who has an intravenous line has pain at the access site associated with erythema, edema, red streaks, and a palpable vein. Which grade does the nurse assign while entering the phlebitis grade in the patient's record? 1 2 3 4

3 A patient with grade 3 phlebitis may complain of pain and has erythema at the access site. The nurse can observe streak formation over the vein, and the vein is palpable. In grade 1 phlebitis, there will be just pain and erythema. In grade 2 phlebitis, there will be pain, erythema, and edema. In grade 4, there will purulent discharge in addition to grade 3 changes.

How much fluid is lost daily through the skin (including perspiration) in a healthy adult? Record your answer using a whole number. mL

500 mL

While reviewing the diagnostic reports of a patient, the nurse finds that the sodium level is 148 mEq/L, the potassium level is 4.8 mEq/L, the calcium level is 6.5 mg/dL, and the magnesium level is 1.1 mEq/L. Which electrolyte imbalance does the nurse infer from these findings? Low calcium levels Low sodium levels High potassium levels High magnesium levels

A calcium level of 6.5 mg/dL indicates that the patient has hypocalcemia; normal calcium levels range from 8.5 to 10.5 mg/dL. Normal sodium levels range from 135 to 145 mEq/L; a sodium level of 148 mEq/L indicates a high sodium level, or hypernatremia. Normal potassium levels range from 3.5 to 5.0 mEq/L; a potassium level of 4.8 mEq/L is normal. Normal magnesium levels range from 1.3 to 2.1 mEq/L; a magnesium level of 1.1 mEq/L indicates that the patient has low magnesium levels, or hypomagnesemia.

Which dietary instructions does the nurse give to a patient with a calcium level of 8.0 mg/dL? "Include dairy products in your diet." "Do not regularly consume potatoes." "Include cured meats in your diet." "Avoid eating green leafy vegetables."

A level of 8.0 mg/dL indicates the patient has hypocalcemia, so the nurse instructs the patient to include calcium-rich foods such as dairy products in the diet. Potatoes are a rich source of potassium and should be avoided in case of hyperkalemia, not hypocalcemia. Cured meat is a rich source of sodium and thus should be included in the diet of a patient who has hyponatremia. Green leafy vegetables are rich in magnesium content and should be included in the diets of patients with hypomagnesemia.

The nurse is caring for a patient who is receiving intravenous (IV) therapy. Which assessment finding in this patient would indicate phlebitis? Blanched skin Reddened area Increased heart rate Increased blood pressure

A reddened area and inflammation near the IV catheter insertion site indicate phlebitis. Other signs of phlebitis include tenderness, redness, swelling, pain, burning at the site, heat along the vein, and a palpable venous cord. Blanched skin at the IV catheter insertion site indicates that the patient has an infiltration. An increased pulse rate and increased blood pressure can indicate fluid overload, which can occur due to the rapid flow rate of the IV solution.

Which patient being cared for by the nurse is at the highest risk of developing respiratory acidosis? A patient with hypokalemia A patient with pulmonary fibrosis A patient with salicylate overdose A patient with chronic obstructive pulmonary disease (COPD)

Chronic respiratory acidosis is most commonly caused by COPD. Hypokalemia, pulmonary fibrosis, and salicylate overdose do not predispose a patient to respiratory acidosis. Hypokalemia can lead to cardiac dysrhythmias. Pulmonary fibrosis can result in respiratory arrest, and salicylate overdose results in central nervous system changes.

The nurse works in an acute care facility. Which patient conditions would the nurse monitor for development of hypokalemia? Select all that apply. Adrenal insufficiency End-stage renal disease Diarrhea Vomiting Potassium-wasting diuretics usage

Diarrhea Vomiting Potassium-wasting diuretics usage Hypokalemia is common when potassium output is increased. Diarrhea and vomiting can increase potassium loss through the gastrointestinal tract. Potassium-wasting diuretics may increase potassium loss in urine. Adrenal insufficiency leads to hyperkalemia by decreasing excretion of potassium. Oliguria in end-stage renal disease may cause decreased excretion of potassium in the urine, leading to hyperkalemia.

A patient is suffering from syndrome of inappropriate of antidiuretic hormone (SIADH) secretion. For which electrolyte disturbance would the nurse evaluate the patient? Hypernatremia Hyponatremia Hemoconcentration Increased serum osmolality

Hyponatremia Patients with SIADH secretion have excess antidiuretic hormone (ADH) secretion. Therefore the patient is most likely to have hyponatremia due to excess retention of water from the kidney, which is disproportionate to salt retention. SIADH is not related to hypernatremia. SIADH is most likely found in deficiency of ADH (diabetes insipidus). Hemoconcentration is seen in conditions associated with extracellular water depletion. In conditions associated with excess ADH, there is a decrease in serum osmolality.

The nurse is teaching a group of nursing students about the acid-base regulation process. Which organ would the nurse identify as being responsible for the excretion of carbonic acid? Liver Lungs Kidneys Intestines

Lungs The lungs are responsible for the excretion of carbonic acid from the body in the form of exhaled carbon dioxide. Thus the lungs help maintain the acid-base balance of the body. The liver is not involved in the excretion of metabolic acids and carbonic acid, and it has no role in the acid-base balance of the body. Kidneys help in the excretion of all acids except for carbonic acid. They play an important role in fluid and electrolyte balance. The intestines are not involved in the excretion of metabolic acids and carbonic acid, and have no role in the acid-base balance of the body.

The nurse is studying the laboratory results for a patient with Crohn's disease. Which electrolyte level does the nurse expect to find in this patient? Phosphate level of 1.5 mEq/L Phosphate level of 2.8 mEq/L Magnesium level of 1.1 mEq/L Magnesium level of 1.5 mEq/L

Magnesium level of 1.1 mEq/L Crohn's disease is a type of inflammatory bowel disease that causes malabsorption in the intestines. This can lead to magnesium not being absorbed into the bloodstream, resulting in hypomagnesemia, which is a serum magnesium level lower than 1.3 mEq/L. The normal phosphate level is between 1.7 and 2.6 mEq/L; therefore a phosphate level of 1.5 mEq/L indicates hypophosphatemia. A phosphate level of 2.8 mEq/L indicates hypoparathyroidism. Hypophosphatemia and hypoparathyroidism are not associated with Crohn's disease.

A patient who is comatose is admitted to the hospital with an unknown history. Respirations are deep and rapid. Arterial blood gas levels on admission are pH, 7.20; PaCO 2, 21 mm Hg; PaO 2, 92 mm Hg; and HCO 3 -, 8. Which condition would these laboratory values indicate? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis The low pH indicates acidosis. The low PaCO 2 is caused by the hyperventilation, either from primary respiratory alkalosis (not compatible with the measured pH) or as a compensation for metabolic acidosis. The low HCO 3- indicates metabolic acidosis or compensation for respiratory alkalosis (again, not compatible with the measured pH). Thus metabolic acidosis is the correct interpretation.

The nurse is caring for a patient who has an accumulation of fluids in the pleural cavity. The nurse understands that this fluid is transcellular fluid secreted by epithelial cells. Which bodily fluids are examples of transcellular fluids? Select all that apply. Serum Plasma Peritoneal fluid Synovial fluid Cerebrospinal fluid

Peritoneal fluid Synovial fluid Cerebrospinal fluid Transcellular fluids are secreted by epithelial cells. Fluid collection between the two layers of the peritoneum is an example of transcellular fluid. Fluid collection in the synovial space of a joint is secreted by the epithelial cells and is also an example of transcellular fluid. Cerebrospinal fluid is colorless fluid present in the brain and spinal cord and is an example of transcellular fluid. Serum and plasma are constituents of intravascular fluid, which is a part of extracellular fluids.

A nurse is examining a patient with hypocalcemia. Which clinical findings would the nurse watch for during the assessment? Select all that apply. Abdominal distension Positive Chvostek sign Positive Trousseau sign Muscle twitching and cramping Bilateral muscle weakness in quadriceps

Positive Chvostek sign Positive Trousseau sign Muscle twitching and cramping Hypocalcemia occurs due to low serum calcium level. It increases neuromuscular excitability and can cause a positive Chvostek sign. Chvostek sign refers to the contraction of facial muscles when a facial nerve is tapped. Trousseau sign refers to the carpal spasm in response to hypoxia. This sign is positive in hypocalcemia. In addition, muscle twitching and cramping can be noted. Abdominal distention is noted in cases of hypokalemia along with muscle weakness. Bilateral muscle weakness in the quadriceps is noted in the case of imbalances of serum potassium levels.

A patient with a cardiac history is taking the diuretic furosemide and is seen in the emergency department for muscle weakness. Which laboratory value does the nurse assess first? Serum albumin Serum sodium Hematocrit Serum potassium

Potassium-wasting diuretics such as furosemide increase potassium urinary output and can cause hypokalemia unless potassium intake also increases. Hypokalemia causes muscle weakness. Abnormal serum albumin, serum sodium, and hematocrit levels do not cause muscle weakness.

Which clinical manifestations does the nurse find in a patient with hypomagnesemia? Select all that apply. Seizures Hypotension Heart block Mood swings Tachyarrhythmias

Seizures Mood swings Tachyarrhythmias Hypomagnesemia is indicated by a serum magnesium level below 1.3 mEq/L. Magnesium is an important cation in the body that plays a major role in energy metabolism. Therefore its deficiency may cause neurologic disorders such as seizure. Hypomagnesemia affects brain function, which in turn can cause mood swings. Hypomagnesemia also alters cardiovascular function and can lead to tachyarrhythmia (an abnormally high heart rate). Hypophosphatemia and hypermagnesemia can lead to hypotension. Hypermagnesemia can lead to heart block.

Which precautions should the nurse follow to prevent speed shock during the intravenous (IV) administration of medications? Select all that apply. Refrain from inserting IV catheters over the joints. Stop the infusion immediately if sudden onset of dizziness occurs. Do not use electronic pumps for the infusion. Monitor the gravity flow set closely during administration. Follow the recommended infusion rate of medication.

Stop the infusion immediately if sudden onset of dizziness occurs. Monitor the gravity flow set closely during administration. Follow the recommended infusion rate of medication. Speed shock occurs when medication is administered too quickly. Sudden onset of dizziness, headache, facial flushing, and irregular heartbeat can occur as a result of speed shock; therefore the nurse stops the medication administration if dizziness occurs. If the medication needs to be infused via a gravity flow set, the nurse closely monitors the administration to prevent too rapid of an infusion. The nurse also follows the recommended infusion rates to ensure safe administration. The nurse refrains from inserting an IV catheter over the joints to prevent catheter embolism because insertion over a joint can weaken the catheter. Electronic devices can be used for administration because they effectively regulate the administration of medication at controlled rates.

After reviewing a patient's arterial blood gas reports, the nurse concludes that the patient has metabolic acidosis. Which assessment findings led the nurse to reach this conclusion? pH 7.25, PaCO 2 of 40 mm Hg, HCO 3 of 17 mEq/L pH 7.50, PaCO 2 of 28 mm Hg, HCO 3 of 23 mEq/L pH 7.40, PaCO 2 of 40 mm Hg, HCO 3 of 23 mEq/L pH 7.25, PaCO 2 of 55 mm Hg, HCO 3 of 24 mEq/L

pH 7.25, PaCO 2 of 40 mm Hg, HCO 3 of 17 mEq/L If the PaCO 2 level is normal (35 to 45 mm Hg) and the HCO 3 level is abnormal, it indicates that the patient has a metabolic disorder. A pH level of 7.25, a PaCO 2 level of 40 mm Hg, and an HCO 3 level of 17 mEq/L indicate acidosis. Therefore the nurse concludes that the patient has metabolic acidosis. The normal pH range is 7.35 to 7.45. A pH that falls below 7.35 indicates acidosis, and a pH above 7.45 indicates alkalosis. Normal HCO 3 levels are between 22 and 26 mEq/L. A pH of 7.50, a PaCO 2 level of 28 mm Hg, and an HCO 3 level of 23 mEq/L indicate respiratory alkalosis. A pH of 7.40, a PaCO 2 level of 40 mm Hg, and an HCO 3 level of 23 mEq/L indicate that the patient's arterial blood gas levels are normal. A pH of 7.25, a PaCO 2 level of 55 mm Hg, and an HCO 3 level of 24 mEq/L indicate respiratory acidosis.