CH 8 Fluids and Electrolytes

The nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL (3.25 mmol/L). Which prescribed medication should the nurse plan to assist in administering to the client? 1. Calcitonin 2. Calcium chloride 3. Calcium gluconate 4. Large doses of vitamin D

1 Rationale: The normal serum calcium level is 9 to 10.5 mg/dL (2.2.5-2.75 mmol/L). This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration. Test-Taking Strategy: Focus on the subject, serum calcium level of 13 mg/dL (3.25 mmol/L). Recalling the normal serum calcium level will assist you with determining that the client is experiencing hypercalcemia. With this knowledge, you can easily eliminate calcium chloride and calcium gluconate, because you would not administer medication that adds calcium to the body. Remembering that excessive vitamin D is a causative factor of hypercalcemia will assist you with eliminating that option.

Magnesium normal level

1.3 mEq/L to 2.1 mEq/L (0.65-1.05 mmol/L) Common Food Sources Avocados Canned white tuna fish Cauliflower Oatmeal Green leafy vegetables, such as spinach and broccoli Milk Wheat bran Peanut butter, almonds Peas Pork, beef, chicken, soybeans Potatoes Raisins Yogurt

Sodium normal value

135 mEq/L to 145 mEq/L (135-145 mmol/L) Common Food Sources Bacon, hot dogs, lunch meats Butter, cheese Canned foods Ketchup, mustard Milk Processed foods Snack foods Soy sauce Table salt

The nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse should tell the client that which food item is least likely to contain calcium? 1. Milk 2. Butter 3. Spinach 4. Collard greens

2 Rationale: Butter comes from milk fat and does not contain significant amounts of calcium. Milk, spinach, and collard greens are calcium-containing foods and should be avoided by the client on a calcium-restricted diet. Test-Taking Strategy: Note the subject, the item that is lowest in calcium. Milk can be easily eliminated first. Eliminate spinach and collard greens next, because they are comparable or alike.

The nurse is reading the primary health care provider's (PHCP's) progress notes in the client's record and sees that the PHCP has documented "insensible fluid loss of approximately 800 mL daily." Which client is at risk for this loss? 1. The client with a draining wound 2. The client with a urinary catheter 3. The client with a fast respiratory rate 4. The client with a nasogastric tube to low suction

3 Rationale: Sensible losses are those that the person is aware of, such as those that occur through wound drainage, gastrointestinal (GI) tract losses, and urination. Insensible losses may occur without the person's awareness. Insensible losses occur daily through the skin and the lungs. Test-Taking Strategy: Focus on the subject, insensible fluid loss. Note that wound drainage, urinary output, and gastric secretions are comparable or alike in that they represent visible losses. These types of losses can be measured for accurate output. Fluid loss through a fast respiratory rate cannot be accurately measured, only approximated

Phosphorus normal value

3.0 mg/dL to 4.5 mg/dL (0.97-1.45 mmol/L) Common Food Sources Dairy products Fish Organ meats Nuts Pork, beef, chicken Whole-grain breads and cereals

Potassium normal value

3.5 mEq/L to 5.0 mEq/L (3.5-5.0 mmol/L) Common Food Sources Avocados, bananas, cantaloupe, oranges, strawberries Tomatoes Carrots, mushrooms, spinach Fish, pork, beef, veal Potatoes Raisins

The nurse reviews a client's electrolyte results and notes a potassium level of 5.5 mEq/L (5.5 mmol/L). The nurse understands that a potassium value at this level would be noted with which condition? 1. Diarrhea 2. Traumatic burn 3. Cushing's syndrome 4. Overuse of laxatives

4 Rationale: A serum potassium level of 5.4 mEq/L is indicative of hyperkalemia. Cardiac changes include a wide, flat P wave; a prolonged PR interval; a widened QRS complex; and narrow, peaked T waves. Test-Taking Strategy: Focus on the subject, potassium level of 5.4 mEq/L (5.4 mmol/L). Determine next that this condition is a hyperkalemic one. From this point, it is necessary to know the cardiac changes that are expected when hyperkalemia exists

The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at the least likely risk for the development of third-spacing? 1. The client with sepsis 2. The client with cirrhosis 3. The client with kidney failure 4. The client with diabetes mellitus

4 Rationale: Fluid that shifts into the interstitial space and remains there is referred to as third-space fluid. Common sites for third-spacing include the abdomen, pleural cavity, peritoneal cavity, and pericardial sac. Third-space fluid is physiologically useless because it does not circulate to provide nutrients for the cells. Risk factors include liver or kidney disease, major trauma, burns, sepsis, wound healing, major surgery, malignancy, malabsorption syndrome, malnutrition, alcoholism, and older age. Test-Taking Strategy: Note the subject, the client least likely to develop third-spacing. Eliminate cirrhosis and kidney failure first, because it is likely that fluid balance disturbances will occur with these conditions. From the remaining options, sepsis is the option that is the most acute and therefore the most similar to cirrhosis and kidney failure.

Calcium normal level

9 mg/dL to 10.5 mg/dL (2.25-2.75 mmol/L) Common Food Sources Cheese Collard greens Kale Milk and soy milk Rhubarb Sardines Tofu Yogurt

The nurse reviews the client's serum calcium level and notes that the level is 8.0 mg/dL (2.0 mmol/L). The nurse understands that which condition would cause this serum calcium level? 1. Prolonged bed rest 2. Adrenal insufficiency 3. Hyperparathyroidism 4. Excessive ingestion of vitamin D

1 Rationale: The normal serum calcium level is 9 to 10.5 mg/dL (2.25-2.75 mmol/L). A client with a serum calcium level of 8.0 mg/dL (2.0 mmol/L) is experiencing hypocalcemia. The excessive ingestion of vitamin D, adrenal insufficiency, and hyperparathyroidism are causative factors associated with hypercalcemia. Although immobilization can initially cause hypercalcemia, the long-term effect of prolonged bed rest is hypocalcemia. Test-Taking Strategy: Focus on the subject, serum calcium level of 8.0 mg/dL (2.0 mmol/L). Knowledge regarding the normal serum calcium level will assist you with determining that the client is experiencing hypocalcemia. This should help you to eliminate excessive ingestion of vitamin D. Recalling the causative factors associated with hypocalcemia is necessary to select the correct option from those remaining. Remember that the long-term effect of prolonged bed rest is hypocalcemia.

The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at risk for fluid volume deficit? 1. The client with cirrhosis 2. The client with a ileostomy 3. The client with heart failure 4. The client with decreased kidney function

2 Rationale: Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, ileostomy, and ileostomy. A client with cirrhosis, heart failure (HF), or decreased kidney function is at risk for fluid volume excess. Test-Taking Strategy: Focus on the subject, fluid volume deficit. Read the question carefully, and note that it asks for the client who is at risk for a deficit. Read each option, and think about the fluid imbalance that can occur in each client. Clients with cirrhosis, HF, and decreased kidney function all retain fluid. The only condition that can cause a fluid volume deficit is the condition noted in the correct option.

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 Rationale: Generalized muscle weakness is seen in clients with hypercalcemia. Twitching, positive Trousseau's sign, and hyperactive bowel sounds are signs of hypocalcemia. Test-Taking Strategy: Recall the signs/symptoms of hypocalcemia and hypercalcemia. Note that twitching, positive Trousseau's sign, and hyperactive bowel sounds are comparable or alike, because they all reflect a hyperactivity of body systems. The option that is different is muscle weakness.

The nurse who is caring for a client with kidney failure notes that the client is dyspneic and crackles are heard when listening to breath sounds in the lungs. Which additional sign/symptom should the nurse expect to note in this client? 1. Rapid weight loss 2. Flat hand and neck veins 3. A weak and thready pulse 4. An increase in blood pressure

4 Rationale: Impaired cardiac or kidney function can result in fluid volume excess. Findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, an elevated blood pressure, a bounding pulse, an elevated central venous pressure, weight gain, edema, neck and hand vein distention, an altered level of consciousness, and a decreased hematocrit level. Test-Taking Strategy: Note that rapid weight loss; flat hand and neck veins; and weak, thready pulse are comparable or alike in that they all relate to a decrease in fluid volume. The correct option is the only option that reflects an increase in fluid volume.

The nurse reviews a client's electrolyte results and notes that the potassium level is 5.4 mEq/L (5.4 mmol/L). What should the nurse look for on the cardiac monitor as a result of this laboratory value? 1. ST elevation 2. Peaked P waves 3. Prominent U waves 4. Narrow, peaked T waves

4 Rationale: A serum potassium level of 5.4 mEq/L is indicative of hyperkalemia. Cardiac changes include a wide, flat P wave; a prolonged PR interval; a widened QRS complex; and narrow, peaked T waves. Test-Taking Strategy: Focus on the subject, potassium level of 5.4 mEq/L (5.4 mmol/L). Determine next that this condition is a hyperkalemic one. From this point, it is necessary to know the cardiac changes that are expected when hyperkalemia exists

The nurse is caring for a client who has been taking diuretics on a long-term basis. Which finding should 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 Rationale: Clients taking diuretics on a long-term basis are at risk for fluid volume deficit. Findings of fluid volume deficit include increased respiration and heart rate, decreased central venous pressure, weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, dark-colored and odorous urine, an increased hematocrit level, and an altered level of consciousness. Gurgling respirations, increased blood pressure, and decreased hematocrit as a result of hemodilution are seen in a client with fluid volume excess. Test-Taking Strategy: Focus on the subject, long-term use of diuretics, and realize that this can lead to a fluid volume deficit. Eliminate gurgling respiration and increased blood pressure first because they would be noted in clients with fluid volume excess. Next, remember that the specific gravity of urine is increased in a client with a fluid volume deficit.

The nurse reviews electrolyte values and notes a sodium level of 130 mEq/L (130 mmol/L). The nurse expects that this sodium level would be noted in a client with which condition? 1. The client with watery diarrhea 2. The client with diabetes insipidus 3. The client with an inadequate daily water intake 4. The client with the syndrome of inappropriate secretion of antidiuretic hormone

4 Rationale: Hyponatremia is a serum sodium level less than 135 mEq/L (135 mmol/L). Hyponatremia can occur secondary to syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The client with an inadequate daily water intake, watery diarrhea, or diabetes insipidus is at risk for hypernatremia. Test-Taking Strategy: Focus on the subject, sodium level of 130 mEq/L (130 mmol/L), and determine that this represents hyponatremia. Knowledge regarding the normal sodium level and the causes of hyponatremia is required to answer the question. Remember that hyponatremia can occur secondary to SIADH.

The nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. Which additional sign/symptom should the nurse expect to note in this client if hyponatremia is present? 1. Intense thirst 2. Slow bounding pulse 3. Dry mucous membranes 4. Postural blood pressure changes

4 Rationale: Postural blood pressure changes occur in the client with hyponatremia. Intense thirst and dry mucous membranes are seen in clients with hypernatremia. A slow, bounding pulse is not indicative of hyponatremia. In a client with hyponatremia, a rapid, thready pulse is noted. Test-Taking Strategy: Focus on the subject, hyponatremia, and note the information in the question. Eliminate intense thirst and dry mucous membranes first, because they are comparable or alike (a client with dry mucous membranes is likely to have intense thirst). From the remaining options, it is necessary to recall the signs of hyponatremia.

The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at risk for a potassium deficit? 1. The client with Addison's disease 2. The client with metabolic acidosis 3. The client with intestinal obstruction 4. The client receiving nasogastric suction

4 Rationale: Potassium-rich gastrointestinal (GI) fluids are lost through GI suction, which places the client at risk for hypokalemia. The client with intestinal obstruction, Addison's disease, and metabolic acidosis is at risk for hyperkalemia. Test-Taking Strategy: Focus on the subject, potassium deficit (hypokalemia). Read the question carefully, and note that it asks for the client who is at risk for hypokalemia. Read each option, and think about the electrolyte loss that can occur with each condition. Nasogastric suction not only results in a loss of body fluid, but also of electrolytes.

The nurse is caring for a client with a diagnosis of hyperparathyroidism. Laboratory studies are performed and the serum calcium level is 12.0 mg/dL (3.0 mmol/L). Based on this laboratory value, the nurse should 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 client that the laboratory result is normal.

2 Rationale: The normal serum calcium level ranges from 9 to 10.5 mg/dL (2.25-2.75 mmol/L). The client is experiencing hypercalcemia and the nurse would inform the registered nurse of the laboratory value. Because the client is experiencing hypercalcemia, the remaining options are incorrect actions. Test-Taking Strategy: Focus on the laboratory value in the question to determine that the client is experiencing hypercalcemia. Note that options 1 and 3 are comparable or alike and indicate that no action would be taken to report the abnormal value. From the remaining options, eliminate option 4 because the value is elevated