Chapter 8: Fluid and Electrolyte Management

12. The nurse is providing care to a patient who seeks emergency treatment for headache and nausea. The patient works in a mill without air conditioning. The patient states, "I drink water several times each day, but I seem to sweat more than I am able to replace." Which suggestions does the nurse provide to this patient? 1. Drink juices and carbonated sodas. 2. Eat something salty when drinking water. 3. Eat something sweet when drinking water. 4. Double the amount of water being ingested.

12. ANS: 2 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 5. Describing the pathophysiology, clinical presentations, and management of dehydration, hypovolemia, and hypervolemia Chapter page reference: 124 - 125 Heading: Electrolyte Disorders/Hyponatremia: Medical Management Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 Juices and carbonated sodas will not help to replace the loss of sodium. 2 Both salt and water are lost through sweating. When only water is replaced, the individual is at risk for salt depletion. Clinical manifestations include fatigue, weakness, headache, and gastrointestinal symptoms such as loss of appetite and nausea. The patient should be instructed to eat something salty when drinking water to help replace the loss of sodium. 3 Eating something sweet will not help replace the loss of sodium. 4 Doubling the amount of water being ingested could lead to hyponatremia and further manifestations.

13. A nurse is reviewing the serum chemistry results on a patient who has a nasogastric tube to low intermittent suction secondary to a gunshot to the abdomen 2 days ago. Which electrolyte value does the nurse correlate to the NG suctioning? 1. Serum chloride of 90 mEq/L 2. Serum sodium of 148 mEq/L 3. Serum potassium of 5.2 mEq/L 4. Serum calcium of 11.3 mg/dL

13. ANS: 1 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations related to disorders in chloride. Chapter page reference: 127 Heading: Electrolyte Disorders /Hypochloremia Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis Concept: Fluid and Electrolyte Balance Difficulty: Difficult Feedback 1 Serum chloride decreases in patients with severe vomiting, burns, chronic respiratory acidosis, nasogastric suctioning, metabolic alkalosis, and Addison's disease (adrenal cortex insufficiency). The normal range for serum chloride is 97 to 107 mEq/L. 2 Serum sodium does not increase secondary to nasogastric suctioning. The normal range for serum sodium is 135 to 145 mEq/L 3 Serum potassium usually decreases with nasogastric suctioning. This value is high because the normal range of serum potassium is 3.5 to 5.0 mEq/L. 4 Serum calcium levels are not impacted by nasogastric suctioning. The normal range for serum calcium is 8.2 to 10.2 mg/dL.

1. A patient presents in the emergency department (ED) with fever, nausea, and vomiting over the past 2 days. The nurse monitors for which laboratory result in this patient? 1. Urine specific gravity of 1.040 2. Serum potassium of 4.8 mEq/L 3. Serum sodium of 135 mEq/L 4. Urine positive for glucose and ketones

1. ANS: 1 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 3. Explaining the significance of osmolality, osmolarity, blood urea nitrogen (BUN), creatinine, and urine specific gravity related to fluid and electrolyte status Chapter page reference: 115 - 116 Heading: Fluid and Electrolyte Regulation/Indicators of Fluid Status Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 The normal range for specific gravity is 1.005 to 1.030. High specific gravity values indicate concentrated urine and can be seen in patients with decreased renal perfusion or dehydration. 2 Serum potassium is not related to fluid volume status and this is a normal value. The normal range is 3.5 to 5.0 mEq/L. 3 Serum sodium is elevated with fluid loss and this value is low. The normal range is 135 to 145 mEq/L. 4 Urine that is positive for glucose and ketones is observed in patients with diabetes mellitus.

10. The nurse provides care to a patient whose serum potassium level is 3.2 mEq/L. Which healthcare provider order does the nurse question based on this data? 1. Serum chemistries (basic metabolic panel) every morning 2. Continuous cardiac monitoring 3. 10 mEq KCl (potassium chloride) in 100 mL normal saline slow IVP (intravenous pyelogram) 4. 25 mg spironolactone (Aldactone) by mouth daily

10. ANS: 3 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations related to disorders in: Potassium Balance Chapter page reference: 122 - 123 Heading: Electrolyte Disorders/Potassium/Table 8.7 Common Electrolyte Disturbances Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 A chemistry panel/basic metabolic panel is prescribed to monitor kidney status, electrolyte and acid-base balance, and blood glucose level. This is an appropriate order for the patient who is experiencing hypokalemia. 2 Potassium imbalances cause electrocardiogram changes; therefore, continuous cardiac monitoring is an appropriate prescription for this patient. 3 Although this is an appropriate dose of KCl, it is never given by intravenous pyelogram (IVP). The nurse questions this order. 4 A potassium-sparing diuretic, such as spironolactone, is an appropriate prescription for the patient experiencing hypokalemia.

11. In reviewing laboratory results for a patient presenting to the Emergency Department with changes in level of consciousness, the nurse correlates which value as placing the patient at greatest risk for seizures? 1. Serum calcium of 12 mg/dL 2. Serum potassium of 3.0 mEq/L 3. Serum sodium of 135 mEq/L 4. Serum magnesium of 2.6 mEq/L

11. ANS: 3 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations related to disorders in sodium balance Chapter page reference: 124 Heading: Electrolyte Disorders /Hyponatremia: Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Fluid and Electrolyte Balance Difficulty: Difficult Feedback 1 Hypercalcemia presents with anorexia, nausea, vomiting, lethargy, non-specific joint and muscle aches, and confusion. Seizure activity may be observed in patients with hypocalcemia. 2 Patients with hypokalemia may experience weakness, lethargy, hyporeflexia, nausea/vomiting, constipation, abdominal cramping and electrocardiographic (ECG) changes (ST depression). 3 Neurological changes such as confusion, muscle twitching, lethargy, and seizures can indicate low sodium levels, especially in older adults. 4 Patients with hypermagnesemia may present with hypotension, bradycardia, drowsiness, lethargy, muscle weakness, and loss of deep tendon reflexes.

14. The nurse is caring for a patient with congestive heart failure who is admitted to the medical-surgical unit with acute hypokalemia. Which prescribed medication may have contributed to the patient's current hypokalemic state? 1. Cortisol 2. Oxycodone 3. Flexeril 4. Nonsteroidal anti-inflammatory drugs (NSAIDs)

14. ANS: 1 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations related to disorders in: Potassium balance Chapter page reference: 128 - 129 Heading: Electrolyte Disorders /Hypokalemia Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1 Excess potassium loss through the kidneys is often caused by such medications as corticosteroids, potassium-wasting (loop) diuretics, amphotericin B, and large doses of some antibiotics. Cortisol is a type of corticosteroid and can cause hypokalemia. 2 NSAIDs, narcotics, and muscle relaxers would not bring about potassium loss to cause hypokalemia. 3 NSAIDs, narcotics, and muscle relaxers would not bring about potassium loss to cause hypokalemia. 4 NSAIDs, narcotics, and muscle relaxers would not bring about potassium loss to cause hypokalemia.

15. A patient is prescribed 20 mEq of potassium chloride because of excessive vomiting. The nurse includes which information in explaining the rationale for this medication? 1. It controls and regulates water balance in the body. 2. It is used in the body to synthesize ingested protein. 3. It is vital in regulating muscle contraction and relaxation. 4. It is needed to maintain skeletal, cardiac, and neuromuscular activity.

15. ANS: 4 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 130 Heading: Electrolyte Disorders /Hypokalemia: Nursing Management Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Pharmacological and Parental Therapies Cognitive Level: Comprehension [Understanding] Concept: Medication Difficulty: Moderate Feedback 1 Sodium controls and regulates water balance in the body. 2 Magnesium is used in the body to synthesize ingested protein. 3 Calcium is vital in regulating muscle contraction and relaxation. 4 Potassium is the major cation in intracellular fluids, with only a small amount found in plasma and interstitial fluid. Potassium is a vital electrolyte for skeletal, cardiac, and smooth muscle activity.

16. The nurse is caring for a patient with congestive heart failure who is admitted to the medical-surgical unit with acute hypokalemia. Which prescribed medication may have contributed to the patient's current hypokalemic state? 1. Cortisol 2. Oxycodone 3. Flexeril 4. Nonsteroidal anti-inflammatory drugs (NSAIDs)

16. ANS: 1 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations related to disorders in: Potassium balance Chapter page reference: 8-40-8-41 Heading: Hypokalemia Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological and Parental Therapies Cognitive Level: Comprehension [Understanding] Concept: Medication Difficulty: Easy Feedback 1 Excess potassium loss through the kidneys is often caused by such medications as corticosteroids, potassium-wasting (loop) diuretics, amphotericin B, and large doses of some antibiotics. Cortisol is a type of corticosteroid and can cause hypokalemia. 2 NSAIDs, narcotics, and muscle relaxers would not bring about potassium loss to cause hypokalemia. 3 NSAIDs, narcotics, and muscle relaxers would not bring about potassium loss to cause hypokalemia. 4 NSAIDs, narcotics, and muscle relaxers would not bring about potassium loss to cause hypokalemia.

17. In reviewing a patient's laboratory results before administering digoxin, which laboratory result places the patient at greatest risk for digoxin toxicity? 1. Serum sodium 156 mEq/L 2. Serum potassium 3.0 mEq/L 3. Serum phosphorus of 1.5 mg/dL 4. Serum creatinine of 1.6 mg/dL

17. ANS: 2 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 130 Heading: Electrolyte Disorders /Hypokalemia: Nursing Management Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Fluid and Electrolyte Balance Difficulty: Difficult Feedback 1 Hypernatremia does not increase the risk of digoxin toxicity. 2 Hypokalemia can potentiate the effects of digitalis by increasing blood levels of digoxin, leading to digoxin toxicity. Symptoms of digoxin toxicity include loss of appetite, nausea, vomiting, cardiac dysrhythmias, and visual disturbances. 3 Hypophosphatemia does increase the risk of digoxin toxicity. 4 Elevations of blood urea nitrogen (BUN) and creatinine indicate decreased renal function, which can result in decreased potassium excretion and hyperkalemia. There is no risk of digoxin toxicity with elevated creatinine levels.

18. The nurse is providing care to a patient who is prescribed furosemide for treatment of congestive heart failure (CHF). The patient's serum potassium level is 3.4 mEq/L. Which food should the nurse encourage the patient to eat based on this data? 1. Peas 2. Iced tea 3. Bananas 4. Baked fish

18. ANS: 3 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 130 Heading: Electrolyte Disorders/Hypokalemia// Nursing Management Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 Peas are not a potassium-rich food, which is currently needed based on the patient's serum potassium level. 2 Iced tea is not a potassium-rich food, which is currently needed based on the patient's serum potassium level. 3 A potassium level of 3.4 is low, so the client should be encouraged to consume potassium-rich foods. Of the foods listed, the highest in potassium is banana. 4 Baked fish is not a potassium-rich food, which is currently needed based on the patient's serum potassium level.

19. The nurse is caring for a patient admitted with hypertension and chronic renal failure who receives hemodialysis three times per week. The nurse is assessing the patient's diet and notes the use of salt substitutes. When teaching the patient to avoid salt substitute, which rationale supports this teaching point? 1. They can potentiate hyperkalemia. 2. They may cause the client to retain fluid. 3. They may interfere with the hemodialysis. 4. They may interact with the client's antihypertensive medications.

19. ANS: 1 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 5. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 130 Heading: Electrolyte Disorders /Hyperkalemia Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Basic Care and Comfort Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in patients with renal failure, and the use of salt substitutes will worsen hyperkalemia. 2 Increases in weight do need to be reported to the healthcare provider as a possible indication of fluid volume excess, but this is not the reason why salt substitute is to be avoided. 3 Salt substitutes do not impact hemodialysis. 4 The control of hypertension is essential in the management of a client with kidney disease, but salt substitute is not known to interact with antihypertensive medications.

2. Which assessment data collected by the nurse indicate that an older adult patient is at risk for dehydration? 1. Poor skin turgor 2. Body mass index of 20.5 3. Blood pressure of 140/98 mm Hg 4. Oral intake of 48 ounces per day

2. ANS: 4 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 4. Discussing changes in fluid and electrolyte balance associated with aging Chapter page reference: 116 Heading: Fluid and Electrolyte Regulation/Age-Related Changes Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 Skin turgor is a poor indicator of fluid balance in an older adult patient. 2 A body mass index within normal limits would not contribute to dehydration. A body mass index associated with overweight or obesity could be associated with dehydration, because fat cells contain little or no water. 3 An elevated blood pressure could indicate fluid volume overload or sodium sensitivity. 4 A poor intake of water could indicate a loss of the thirst response, which occurs as a normal age-related change. Because the patient only ingests 48 ounces of water each day, this could indicate a reduction in the normal thirst response.

20. The nurse is caring for a patient with a potassium level of 5.9 mEq/L. The healthcare provider prescribes both glucose and insulin for the patient. The patient's spouse asks, "Why is insulin needed?" Which response by the nurse is the most appropriate? 1. "The insulin will help his kidneys excrete the extra potassium." 2. "The insulin is safer than other medications that can lower potassium levels." 3. "The insulin lowers his blood sugar levels, and this is how the extra potassium is excreted." 4. "The insulin will cause his extra potassium to move into his cells, which will lower potassium in the blood."

20. ANS: 4 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 131 - 132 Heading: Electrolyte Disorders /Hyperkalemia: Medical Management Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1 Insulin does not promote renal excretion of potassium. 2 Giving insulin to decrease serum potassium levels is not considered a safer method than other medications that can be used. 3 Serum potassium is lowered by entering the cells; this is not controlled by serum glucose. 4 Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells.

21. The nurse provides care for a patient who is experiencing hypomagnesemia. Which food choice is best for this patient? 1. A medium-sized banana 2. One medium-sized baked potato 3. Three ounces of cooked halibut 4. A half-cup of cooked black-eyed peas

21. ANS: 3 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 133 Heading: Electrolyte Disorders/Hypomagnesemia/Nursing Management/ Box 8.3 Food Sources for Magnesium Integrated Processes: Nursing Process: Nursing Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analysis [Analyzing] Concept: Nutrition Difficulty: Moderate Feedback 1 A medium-sized banana contains 30 mg of magnesium. This is not the best food choice for the patient. 2 A medium-sized baked potato with the skin contains 50 mg of magnesium. This is not the best food choice for the patient. 3 Three ounces of cooked halibut contains 90 mg of magnesium. Of the foods provided, this choice is the most magnesium rich. 4 One-half cup of cooked black-eyed peas contains 45 mg of magnesium. This is not the best food choice for the patient.

22. The nurse monitors for which clinical manifestations in the patient admitted with hypermagnesemia? 1. Elevated blood pressure 2. Bradycardia 3. Increased deep tendon reflexes 4. Hyperventilation

22. ANS: 2 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations related to disorders in magnesium. Chapter page reference: 134 Heading: Electrolyte Disorders /Hypermagnesemia: Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 Cardiac symptoms in hypermagnesemia include hypotension caused by vasodilation and dysrhythmias such as bradycardia, atrial fibrillation, and intraventricular conduction delays exhibited by widening of the QRS complexes. 2 Cardiac symptoms in hypermagnesemia include hypotension caused by vasodilation and dysrhythmias such as bradycardia, atrial fibrillation, and intraventricular conduction delays exhibited by widening of the QRS complexes. 3 Central nervous system clinical manifestations include drowsiness, lethargy, muscle weakness, loss of deep tendon reflexes, paralysis, and coma. 4 Respiratory signs include a decrease in respiratory rate that can lead to complete respiratory suppression.

23. The nurse is monitoring laboratory results on assigned patients. The patient with which laboratory has the highest risk of laryngospasm? 1. Serum calcium 7.5 mg/dL 2. Serum magnesium 3.0 mg/dL 3. Serum potassium 5.6 mEq/L 4. Serum phosphorus 1 mg/dL

23. ANS: 1 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations related to disorders in calcium Chapter page reference: 135 Heading: Electrolyte Disorders /Hypocalcemia: Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Fluid and Electrolyte Balance Difficulty: Difficult Feedback 1 Clinical manifestations of hypocalcemia include positive Trousseau's and Chvostek's signs, tetany, and laryngospasm. 2 Respiratory signs of hypermagnesemia include a decrease in respiratory rate that can lead to complete respiratory suppression, not laryngospasm. 3 Clinical manifestations of hyperkalemia include generalized fatigue, muscle cramps, palpitations, paresthesia, and weakness. 4 Clinical manifestations include alterations in neurological, cardiac, and musculoskeletal function. The most common manifestation of hypophosphatemia is skeletal or smooth muscle weakness, including respiratory insufficiency from diaphragmatic dysfunction. Laryngospasm is not associated with hypophosphatemia.

24. The nurse is providing care to a patient whose serum calcium levels have increased since a surgical procedure performed 3 days ago. Which intervention does the nurse implement to decrease the risk for the development of hypercalcemia? 1. Monitor vital signs every 8 hours. 2. Encourage ambulation three times a day. 3. Irrigate the Foley catheter one time a day. 4. Recommend turning, coughing, and deep breathing every 2 hours

24. ANS: 2 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 136 Heading: Electrolyte Disorders /Hypercalcemia Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 This intervention has no effect on the development of hypercalcemia. Patients with hypercalcemia may develop bradycardia. 2 Hypercalcemia can occur from immobility. Encouraging early and frequent ambulation of patients at risk for hypercalcemia, as well as adequate hydration, assists in preventing elevated serum calcium. 3 This intervention is not related to the risk for the development of hypercalcemia. 4 This intervention is not related to decreasing the risk for the development of hypercalcemia but is routine post-operative nursing care.

25. The nurse recognizes which intervention as the priority in the care of the patient with a serum phosphorus level of 2.0 mg/dL? 1. Decrease fluid intake. 2. Strain all urine for kidney stones. 3. Encourage consumption of milk and yogurt. 4. Discourage consumption of a high-calorie diet.

25. ANS: 3 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 137 Heading: Electrolyte Disorders /Hypophosphatemia Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive Level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 Fluid intake does not directly impact phosphorus levels. 2 Decreased phosphorus levels are not associated with renal calculi. 3 A phosphorus level of 2.0 is low, and the patient needs additional dietary phosphorus. Providing phosphorus-rich foods such as milk and yogurt is a good way to provide that additional phosphorus. 4 Caloric consumption is not associated with phosphorus levels.

26. The nurse recognizes which clinical manifestations as age-related changes that may impact fluid and electrolyte in the older adult? Select all that apply. 1. Increased salivation 2. Increased urine output 3. Decreased sense of smell 4. Decreased visual acuity 5. Changes in taste sensation

26. ANS: 3, 4, 5 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 4. Discussing changes in fluid and electrolyte balance associated with aging Chapter page reference: 116 Heading: Fluid an Electrolyte Regulation/Age-Related Changes Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 This is incorrect. Alterations in smell also affect taste, impacting oral intake, especially fluids, of older adults. This would lead to dry mucous membranes. 2 This is incorrect. Alterations in smell also affect taste, impacting oral intake, especially fluids, of older adults. These patients typically have decreased urine output secondary to decreased fluid intake. 3 This is correct. With aging, there is a decrease in taste, smell, and thirst, which can impact fluid and electrolyte balance because it affects intake of fluids and food. With aging, there is a decline in olfactory function as a result of the decrease in olfactory fibers and receptors. Loss of these fibers and receptors results in a decrease in olfactory function and the ability to discriminate smells. 4 This is correct. Loss of olfactory fibers and receptors results in a decrease in olfactory function and the ability to discriminate smells. Alterations in smell also affect taste, impacting oral intake, especially fluids, of older adults. 5 This is correct. Alterations in smell also affect taste, impacting oral intake, especially fluids, of older adults.

27. The nurse is preparing an educational session for members of a community health center that focuses on ways to maintain fluid balance during the summer months. Which interventions should the nurse recommend? Select all that apply. 1. Drink diet soda. 2. Reduce the intake of coffee and tea. 3. Drink more fluids during hot weather. 4. Drink flat cola or ginger ale if vomiting. 5. Exercise during the hours of 10 a.m. and 2 p.m.

27. ANS: 2, 3, 4 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 117 - 118 Heading: Fluid Imbalances/Hypovolemia: Medical Management Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 This is incorrect. Diet soda often contains caffeine. 2 This is correct. Actions to prevent fluid volume deficit during the summer months include increasing fluid intake, drinking flat cola or ginger ale if vomiting, and reducing the intake of coffee and tea. 3 This is correct. Actions to prevent fluid volume deficit during the summer months include increasing fluid intake, drinking flat cola or ginger ale if vomiting, and reducing the intake of coffee and tea. 4 This is correct. Actions to prevent fluid volume deficit during the summer months include increasing fluid intake, drinking flat cola or ginger ale if vomiting, and reducing the intake of coffee and tea. 5 This is incorrect. Exercising between the hours of 10 a.m. and 2 p.m., considered the hottest time of the day, should be avoided.

28. The nurse is providing care to a patient who is exhibiting clinical manifestations of a fluid and electrolyte deficit. Which of the following orders does the nurse implement to address this disorder? Select all that apply. 1. Administer diuretics 2. Administer antibiotics 3. Place the patient in high-Fowler's position 4. Monitor patient's I&O 5. Initiate intravenous therapy

28. ANS: 3, 4, 5 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 5. Describing the pathophysiology, clinical presentations, and management of dehydration, hypovolemia, and hypervolemia Chapter page reference: 117 - 118 Heading: Fluid Imbalances /Hypovolemia: Medical Management Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 This is incorrect. Diuretics may be ordered to reduce fluid volume excess. 2 This is incorrect. Antibiotics are not used for fluid and electrolyte imbalance. 3 This is correct. There is no indication for a high-Fowler's position. The patient may be placed in the supine position with severe fluid volume deficit. 4 This is correct. Monitoring patient's intake and output (I&O) is one of several ways to assess the patient's fluid status. 5 This is correct. Intravenous fluids may be ordered for the patient with a fluid volume deficit if replacement oral fluids cannot be taken in sufficient quantity.

29. The nurse correlates which clinical manifestations to the patient at risk for hypovolemic shock? Select all that apply. 1. Blood pressure of 110/70 2. Heart rate of 146 3. Urine output of 0 to 10 mL/hour 4. Cool, clammy skin 5. Increased bowel sounds

29. ANS: 2, 3, 4 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 4. Discussing changes in fluid and electrolyte balance associated with aging Chapter page reference: 118 Heading: Fluid Imbalances/ Hypovolemia: Fluid Volume Deficit—Complications Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Assessment Difficulty: Difficult Feedback 1 This is incorrect. This blood pressure is within normal limits. Hypovolemic shock is manifested by hypotension, tachycardia, and signs of organ hypoperfusion. 2 This is correct. The heart rate is increased. Complications of fluid volume deficit occur with losses of large amounts of fluid volume. Hypovolemic shock can develop as evidenced by hypotension, tachycardia, and signs of organ hypoperfusion such as cool, clammy skin, oliguria progressing to anuria (lack of urine output), decreased level of consciousness, and tachypnea. 3 This is correct. Complications of fluid volume deficit occur with losses of large amounts of fluid volume. Hypovolemic shock can develop as evidenced by hypotension, tachycardia, and signs of organ hypoperfusion such as cool, clammy skin, oliguria progressing to anuria (lack of urine output), decreased level of consciousness, and tachypnea. 4 This is correct. Complications of fluid volume deficit occur with losses of large amounts of fluid volume. Hypovolemic shock can develop as evidenced by hypotension, tachycardia, and signs of organ hypoperfusion such as cool, clammy skin, oliguria progressing to anuria (lack of urine output), decreased level of consciousness, and tachypnea. 5 This is incorrect. Bowel sounds decrease in hypovolemic shock as a result of decreased perfusion of the gastrointestinal tract.

3. The nurse plans care for a hospitalized patient. Which data necessitate the inclusion of interventions to address a fluid volume deficit? 1. Urine output of 30 mL/hour 2. Heart rate of 110 bpm 3. Weight gain of 10 pounds in 3 days 4. Plus-3 edema in bilateral lower extremities

3. ANS: 2 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: Reviewing basic concepts related to fluid and electrolyte balance Chapter page reference: 117 Heading: Fluid Imbalances/Hypovolemia: Fluid Volume Deficit/Clinical Manifestations Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 Expected urine output for an adult patient is 30 mL/hour. A decreased urine output would necessitate interventions to address a fluid volume deficit. 2 An increased heart rate is indicative of a fluid volume deficit. 3 Weight loss, not weight gain, supports the inclusion of interventions to address a fluid volume deficit. 4 Dependent edema supports the inclusion of interventions to address fluid volume excess, not a fluid volume deficit.

30. A patient's serum sodium level is 150 mg/dL. Based on this information, which interventions should the nurse plan for this patient? Select all that apply. 1. Elevate the head of the bed. 2. Instruct on a low-sodium diet. 3. Monitor heart rate and rhythm. 4. Administer diuretics as prescribed. 5. Administer potassium supplement as prescribed.

30. ANS: 2, 4 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations related to disorders in: Sodium balance Chapter page reference: 126 - 127 Heading: Electrolyte Disorders/Hypernatremia: Medical Management Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 This is incorrect. Elevating the head of the bed would be appropriate if the patient were demonstrating signs of fluid volume overload. This is not known at this time and would not be a routine intervention with an elevated sodium level. 2 This is correct. For an elevated sodium level, the electrolyte will need to be restricted, in the form of a low-sodium diet. 3 This is incorrect. Monitoring of heart rate and rhythm would be more appropriate with a potassium imbalance. 4 This is correct. Diuretics will remove excess fluid being held in the body because of the extra sodium. 5 This is incorrect. A potassium imbalance is not associated with a sodium imbalance. More information is needed before this intervention would be planned or implemented.

31. The nurse educates a patient who is prescribed furosemide (Lasix) for congestive heart failure on foods rich in potassium. Which patient menu choices indicate to the nurse a correct understanding of the information presented? Select all that apply. 1. Pasta 2. Spinach 3. Applesauce 4. A sweet potato 5. Low-fat milk

31. ANS: 2, 4, 5 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 120 Heading: Potassium/Table 8.2 - Potassium Content of Common Foods Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Basic Care and Comfort Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Difficult Feedback 1 This is incorrect. Pasta is a low-potassium food; therefore, this choice indicates a need for additional teaching regarding foods rich in potassium. 2 This is correct. Spinach contains 839 mg of potassium in 1 cup cooked; therefore, this choice indicates a correct understanding of the information presented. 3 This is incorrect. Applesauce is a low-potassium food; therefore, this choice indicates a need for additional teaching regarding foods rich in potassium. 4 This is correct. A sweet potato contains 475 mg potassium in 1/2 cup cooked; therefore, this choice indicates a correct understanding of the information presented. 5 This is correct. Low-fat milk contains 407 mg of potassium in 1 cup; therefore, this choice indicates a correct understanding of the information presented.

4. In reviewing laboratory results for a female patient suspected of having a fluid imbalance, the nurse correlates which laboratory value with a diagnosis of dehydration? 1. Hemoglobin of 10.5 g/dL 2. Hematocrit 49% 3. Serum potassium 3.8 mEq/L 4. Serum osmolality 230 mOsm/kg

4. ANS: 2 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 5. Describing the pathophysiology, clinical presentations, and management of dehydration, hypovolemia, and hypervolemia Chapter page reference: 117 Heading: Hypovolemia: Fluid Volume Deficit/ Laboratory Values Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 A normal hemoglobin value for a female is 11.7 to 15.5 g/dL. The hemoglobin is not directly affected by fluid volume status. 2 The hematocrit measures the volume of whole blood that is composed of red blood cells. Because the hematocrit is a measure of the volume of cells in relation to plasma, it is affected by changes in plasma volume. The hematocrit increases with severe dehydration. The normal hematocrit value for a female is 36% to 48%. 3 Serum potassium is not an electrolyte used to determine an alteration in fluid balance. Serum sodium values usually change related to fluid volume changes. 4 Serum osmolality is a measure of the solute concentration of the blood and is used to evaluate fluid balance. Normal values are 275 to 295 mOsm/kg. An increase in serum osmolality indicates a fluid volume deficit; a decrease reflects fluid volume excess.

5. The nurse is analyzing the intake and output record for a patient being treated for dehydration. The patient weighs 176 lbs and had a 24-hour intake of 2,000 mL and urine output of 1,200 mL. Based on this data, which conclusion by the nurse is the most appropriate? 1. Treatment has not been effective. 2. Treatment needs to include a diuretic. 3. Treatment is effective and should continue. 4. Treatment has been effective and should end.

5. ANS: 3 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 7. Explaining nursing considerations related to patients with fluid and electrolyte disorders Chapter page reference: 117 - 118 Heading: Hypovolemia: Fluid Volume Deficit/ Medical Management Integrated Processes: Nursing Process: Evaluation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Difficult Feedback 1 Treatment has been effective. 2 A diuretic is not needed because the patient is being treated for dehydration. 3 Urinary output is normally equivalent to the amount of fluids ingested; the usual range is 1,500 to 2,000 mL in 24 hours, or 40 to 80 mL in 1 hour (0.5 mL/kg per hour). Patients whose intake substantially exceeds output are at risk for fluid volume excess; however, the patient is dehydrated. The extra fluid intake is being used to improve body fluid balance. The patient's output is 40 mL/hour, which is within the normal range. 4 Treatment has been effective; however, it should continue until the intake and output are more balanced. Ending treatment now could further jeopardize this client's fluid balance.

6. The nurse provides care to a patient who is prescribed 0.45% normal saline (NS) by intravenous (IV) infusion. Which data cause the nurse to question the healthcare provider regarding this IV fluid order? 1. Urine output 40 mL/hour 2. Blood pressure 100/60 mm Hg 3. Respiratory rate 12 breaths/min 4. Serum sodium level of 145 mEq/L

6. ANS: 2 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 6. Correlating laboratory data and clinical manifestations of sodium balance. Chapter page reference: 119 Heading: Hypovolemia: Fluid Volume Deficit /Medical Management Table 8.4 Common IV Fluids: Crystalloids and Colloids Integrated Processes: NP Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 This urine output is within normal limits; therefore, there is no reason to question the intravenous (IV) prescription based on this data. 2 Hypotonic IV fluid, such as 0.45% normal saline (NS), shifts fluid out of the vessels and into the cells. Because of this fluid shift, hypotension may be worsened. Therefore, the patient's blood pressure causes the nurse to question the healthcare provider about this prescription. 3 A respiratory rate of 12 breaths/min is within normal limits; therefore, there is no reason to question the IV prescription based on this data. 4 Hypotonic IV fluid, such as 0.45% NS, shifts fluid out of the vessels and into the cells. This may cause hyponatremia to occur. The patient's serum sodium level is on the high end of normal; therefore, this data does not cause the nurse to question this prescription. A low-serum-sodium level would necessitate the nurse to question this order.

7. The nurse is caring for a patient who is receiving intravenous fluids postoperatively after cardiac surgery. The nurse correlates the patient's risk for fluid volume excess to which cause? 1. Decreased mobility as a result of surgery and pain 2. Administration of intravenous fluids 3. Decreased levels of aldosterone 4. Increased levels of antidiuretic hormone

7. ANS: 4 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 2. Describing the role of endocrine, renal, and respiratory systems in the regulation of fluid and electrolyte balance Chapter page reference: 120 Heading: Hypervolemia: Fluid Volume Excess/Causes Integrated Processes: NP Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 Fluid volume excess is not caused by inactivity. 2 It is unlikely that the fluid volume excess experienced by the patient is caused by intravenous fluids. 3 Aldosterone secretion is increased in stressful conditions like surgery. 4 Antidiuretic hormone (ADH) and aldosterone levels are commonly increased as a result of the stress response before, during, and immediately after surgery. This increase leads to sodium and water retention.

8. The nurse is planning care for the patient with acute renal failure and incorporates the nursing diagnosis of Excess Fluid Volume. Which assessment data support this nursing diagnosis? 1. Wheezing in the lungs 2. Generalized weakness 3. Urine output of 20 mL/hour 4. Pitting edema in the lower extremities

8. ANS: 4 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 2, Describing the role of endocrine, renal, and respiratory systems in the regulation of fluid and electrolyte balance Chapter page reference: 120 Heading: Hypervolemia: Fluid Volume Excess/Clinical Manifestations Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 Wheezing in the lungs is an assessment consistent with asthma. 2 Generalized weakness is not typically observed in patients with fluid volume excess. 3 Urine output of 20 mL/hour is low and is associated with fluid volume deficit. 4 The patient in acute renal failure will likely be edematous, as the kidneys are not producing urine.

9. The nurse is providing care to an older adult patient who is receiving intravenous (IV) fluids at 150 mL/hour. It is important that the nurse assess for which clinical manifestations that could indicate fluid volume excess in this patient? 1. Flattened neck veins 2. Elevated blood pressure 3. Bradycardia 4. Skin tenting

9. ANS: 2 Chapter number and title: 8, Fluid and Electrolyte Management Chapter learning objective: 4. Discussing changes in fluid and electrolyte balance associated with aging Chapter page reference: 120 Heading: Hypervolemia: Fluid Volume Excess/Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 Flat neck veins are indicative of fluid volume deficit/hypovolemia 2 The blood pressure may increase if fluids are administered too quickly, and older adults may not be able to tolerate the increased fluid. 3 Bradycardia is not associated with fluid volume excess. 4 Skin tenting is associated with fluid volume deficit. Assessing skin turgor may not be as effective in the older adult because of loss of skin elasticity associated with aging.