Chapter 13: Fluid and Electrolytes: Balance and Disturbance Prep U

Early signs of hypervolemia include thirst. moist breath sounds. a decrease in blood pressure. increased breathing effort and weight gain.

increased breathing effort and weight gain.

A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? 0.45% NaCl 5% NaCl 0.9% NaCl Lactated Ringer solution

0.45% NaCl

The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? 0.9% sodium chloride 0.45% sodium chloride 5% glucose in water 5% glucose in normal saline solution

0.45% sodium chloride

The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client's serum sodium value would be 125 mEq/L (125 mmol/L) 145 mEq/L (145 mmol/L) 135 mEq/L (135 mmol/L) 155 mEq/L (155 mmol/L)

155 mEq/L (155 mmol/L)

A patient is admitted with severe vomiting for 24 hours as well as weakness and "feeling exhausted." The nurse observes flat T waves and ST-segment depression on the electrocardiogram. Which potassium level does the nurse observe when the laboratory studies are complete? 3.5 mEq/L 2.5 mEq/L 5.5 mEq/L 4.5 mEq/L

2.5 mEq/L

Which is the most common cause of symptomatic hypomagnesemia? Sedentary lifestyle Intravenous drug use Burns Alcoholism

Alcoholism

A patient complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patient's laboratory work has returned? Phosphorus Calcium Magnesium Potassium

Calcium

Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism? Hypertension Jaundice Slow pulse Chest pain

Chest pain

A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following? Altered blood urea nitrogen (BUN) value Metabolic alkalosis Respiratory acidosis Extracellular fluid volume deficit

Extracellular fluid volume deficit

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? Extreme anxiety Myasthenia gravis Type 1 diabetes mellitus Opioid overdose

Extreme anxiety

An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? Hypernatremia Hypokalemia Hyperkalemia Hypophosphatemia

Hypokalemia

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? Instruct the client to breathe into a paper bag. Administer ordered supplemental oxygen. Administer an ordered decongestant. Offer the client fluids frequently.

Instruct the client to breathe into a paper bag. The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered PaCO2 level.

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? Half-normal saline solution 5% dextrose and normal saline solution Lactated Ringer's solution 10% dextrose in water

Lactated Ringer's solution

The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? Pancreas and stomach Lungs and kidney Kidney and liver Heart and lungs

Lungs and kidney

The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? Metabolic alkalosis Metabolic acidosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis

The nurse is adding the intake and output results for a client diagnosed with dehydration. The nurse notes a 24-hour intake of 1500 mL/day between oral fluids and intravenous solutions. The output total is calculated as 2800 mL/day from urine output, emesis, and Hemovac drainage. Which nursing action is best to maintain an acceptable fluid balance? Encourage oral fluids. Offer a prescribed antiemetic medication. Suggest a fluid restriction. Remove the Hemovac.

Offer a prescribed antiemetic medication.

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Respiratory alkalosis

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Respiratory acidosis

Respiratory alkalosis

Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)? Three ounces of sliced ham, beets, and a salad A frozen, packaged low-fat dinner with a side salad Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad Tomato juice, low-fat cottage cheese, and three slices of bacon

Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad

Which of the following may be the first sign of respiratory acidosis in anesthetized patients? Mental cloudiness Dull headache Increased pulse Ventricular fibrillation

Ventricular fibrillation

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. sodium 137 mEq/L (137 mmol/L)potassium 4.6 mEq/L (4.6 mmol/L)chloride 94 mEq/L (94 mmol/L)calcium 12.9 mg/dL (3.2 mmol/L) What laboratory value is of highest concern to the nurse? chloride 94 mEq/L (94 mmol/L) calcium 12.9 mg/dL (3.2 mmol/L) potassium 4.6 mEq/L (4.6 mmol/L) sodium 137 mEq/L (137 mmol/L)

calcium 12.9 mg/dL (3.2 mmol/L)

A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the client has a history of alcohol abuse. malignancy is causing the electrolyte imbalance. client may be developing hyperaldosteronism. client's diet is lacking in calcium-rich food products.

malignancy is causing the electrolyte imbalance.

A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance? metabolic acidosis respiratory alkalosis respiratory acidosis metabolic alkalosis

metabolic alkalosis

The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L

pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? PaCO2 less than 35 mm Hg pH 7.26 Serum bicarbonate of 28 mEq/L Serum bicarbonate of 21 mEq/L

Serum bicarbonate of 28 mEq/L

What does the nurse recognize as one of the best indicators of the patient's renal function? Serum creatinine Urine osmolality Blood urea nitrogen Specific gravity

Serum creatinine

A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators? Sodium level of 150 mEq/L Potassium level of 6 mEq/L Potassium level of 3.8 mEq/L Sodium level of 137 mEq/L

Sodium level of 150 mEq/L

The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance? A 72-year-old with a total knee repair A 7-year-old with a fracture tibia A 65-year-old with a myocardial infarction A 52-year-old with diarrhea

A 52-year-old with diarrhea

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance? Hypercalcemia Hypokalemia Hyperkalemia Hypocalcemia

Hypercalcemia

Which is a correct route of administration for potassium? IV (intravenous) push Subcutaneous Oral Intramuscular

Oral

The calcium concentration in the blood is regulated by which mechanism? Androgens Adrenal gland Parathyroid hormone (PTH) Thyroid hormone (TH)

Parathyroid hormone (PTH)

A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching? flank pain polyuria hypertension tingling sensation in the fingers

tingling sensation in the fingers

A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status? edema intake and output vital signs weight

weight

The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching? "A good breakfast for me will include milk and a couple of bananas." "I will take a potassium supplement daily as prescribed." "I will be sure to buy frozen vegetables when I grocery shop." "I can use laxatives and enemas but only once a week."

"I can use laxatives and enemas but only once a week."

The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? 1500 ml 1 L 500 ml 1250 ml

1 L

The nurse should assess the patient for signs of lethargy, increasing intracranial pressure, and seizures when the serum sodium reaches what level? 145 mEq/L 160 mEq/L 130 mEq/L 115 mEq/L

115 mEq/L

The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. Suction the client's airway. Administer IV bicarbonate. Document presenting signs and symptoms. Maintain intake and output records. Compare ABG findings with previous results.

Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms.

The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? Confusion Nausea Headache Hallucinations

Confusion

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? Confusion and seizures Tetany and increased blood urea nitrogen (BUN) levels Flaccidity and thirst Sunken eyeballs and spasticity

Confusion and seizures

A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply. Drink water as an inexpensive way to meet fluid needs. Drink caffeinated beverages to retain fluid. Respond to thirst Drink carbonated beverages to help balance fluid volume. Drink at least eight glasses of fluid each day.

Drink at least eight glasses of fluid each day. Drink water as an inexpensive way to meet fluid needs. Respond to thirst

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? Subnormal temperature Elevated blood pressure Rapid respiration Low heart rate

Elevated blood pressure

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration? Low urine specific gravity Elevated hematocrit level Abnormal potassium level Low white blood count

Elevated hematocrit level

Oral intake is controlled by the thirst center, located in which of the following cerebral areas? Cerebellum Thalamus Hypothalamus Brainstem

Hypothalamus

Your client's lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap? Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Respiratory acidosis

Metabolic acidosis

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? Chloride Potassium CO2 Sodium

Potassium

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? Blood pressure Respirations Pulse Temperature

Pulse

A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition? dehydration hypervolemia hypercalcemia hyperkalemia

dehydration

A client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment? respiratory rate neuromuscular function bowel sounds electrocardiogram (ECG) results

electrocardiogram (ECG) results

A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed? metolazone spironolactone hydrochlorothiazide furosemide

furosemide

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. K+ pH Na+ Glucose PaCO2 HCO3

pH PaCO2 HCO3