Fluid and Electrolyte Balance

The client comes to the clinic and is prescribed a diuretic. The client asks the nurse, "What does a diuretic do?" What is the best response by the nurse? Select all that apply. "A diuretic will inhibit the reabsorption of sodium." "A diuretic will inhibit vasopressin production." "A diuretic will increase the loss of water." "A diuretic will promote aldosterone production." "A diuretic will increase serum potassium."

"A diuretic will inhibit the reabsorption of sodium." "A diuretic will increase the loss of water." Diuretics prevent sodium reabsorption and the water that follows sodium will also be excreted. Diuretics will not increase serum potassium, promote aldosterone production, or inhibit vasopressin production.

An adolescent has voluntarily been admitted for treatment of a relapse of anorexia nervosa. The client has a current body mass index (BMI) of 13, down from 16 since discharge 5 months ago. The caregivers are eager to begin a feeding regimen immediately. What teaching should the nurse provide to the caregivers? "We have to be sure the client is agreeable to treatment. Until then, we just have to be patient." "I hear that you are concerned about this weight loss. We will start treatment and keep you updated." "I have to establish the baseline weight and vital signs, and then we can discuss feeding options." "Feeding may not begin until we have determined if there are electrolyte imbalances that need correction."

"Feeding may not begin until we have determined if there are electrolyte imbalances that need correction."

A school-age child is admitted to the hospital in vasoocclusive sickle cell crisis. Place the interventions in the order of priority (from first to last) that the nurse should implement them. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1 Start an intravenous infusion. 2 Start oxygen via nasal cannula. 3 Administer morphine for the pain. 4 Draw blood for electrolyte levels and pH balance.

1 Start an intravenous infusion. 2 Start oxygen via nasal cannula. 3 Administer morphine for the pain. 4 Draw blood for electrolyte levels and pH balance. The nurse should first start an intravenous infusion because dehydration increases sickling of cells; maintaining fluid balance is the top priority. The nurse should next start oxygen and then administer morphine for pain. Last, the nurse should obtain a blood sample for laboratory studies.

The health care provider prescribes an intravenous infusion of 5% dextrose in 0.45% saline to be infused at 2 mL/kg per hour in an infant who weighs 9 lb (4.1 kg). How many milliliters per hour of the solution should the nurse infuse? Round to one decimal place. _____ mL per hour.

4.1 kg × 2 mL/kg = 8.2 mL/hour

The nurse was unsuccessful starting a peripheral intravenous line in the right forearm of a client with a history of a left axillary lymph node removal. What should the nurse do next? Ask another nurse to attempt to start a peripheral intravenous line. Notify the health care provider. Set up for placement of a triple-lumen central venous catheter. Try to start the peripheral intravenous line in the left forearm.

Ask another nurse to attempt to start a peripheral intravenous line. Another nurse needs to attempt to start an intravenous line. That nurse may be successful with starting the intravenous line. The nurse should not begin by notifying the health care provider. This action should only be performed if multiple attempts have been made to insert an intravenous line without success. The nurse will not set up for placement of a triple-lumen central venous catheter without notifying the health care provider and getting an order. The client should not have an intravenous line started in the left forearm because of the lymph node removal. The removal of lymph nodes increases the risk of lymphedema, which can lead to an infection.

The nurse is assessing the urine of a client who has had an ileal conduit and notes that there is a moderate amount of mucus in the urine. What should the nurse do next? Change the appliance bag. Notify the health care provider (HCP). Obtain a urine specimen for culture. Encourage a high fluid intake.

Encourage a high fluid intake. Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or to notify the HCP. The mucus is not an indication of an infection, so a urine culture is not necessary.

When administering IV replacement of 5% dextrose in water with potassium chloride, what should the nurse do first? Add potassium chloride to the bag at the bedside. Evaluate laboratory results for electrolytes. Prime tubing using sterile technique. Check the rate for IV push administration.

Evaluate laboratory results for electrolytes. IV solutions are prescribed based upon the fluid and electrolyte status of the client, so laboratory results should be monitored first. Safety recommendations are for standard premixed solutions. If solutions are not premixed, additives are completed by the pharmacy, not at the bedside. Potassium chloride is never given by IV push because this could be fatal. Administration guidelines require no more than 10 mEq (10 mmol/L) of potassium chloride be infused per hour on a general medical-surgical unit. An infusion device or pump is required for safe administration.

A client prescribed propranolol calls the clinic to report a weight gain of 3 lb (1.36 kg) within 2 days, shortness of breath, and swollen ankles. What is the nurse's best action? Have the client come to the clinic in order to assess the lungs. Assess the client's dietary intake for the past 24 hours. Review medication administration with the client. Assess the client's knowledge of expected effects of the drug.

Have the client come to the clinic in order to assess the lungs. The client needs to be assessed for the heart failure, a potential adverse effect of beta blockers. The other answer choices will not rule out the possibility of the development of pulmonary edema.

Which action has the highest priority in the care of a client with chronic renal failure? Apply corticosteroid creams to relieve itching. Achieve pain control with analgesics. Maintain a low-sodium diet. Measure abdominal girth daily.

Maintain a low-sodium diet. It is appropriate for the client to be on a low-sodium diet to help decrease fluid retention. Dry skin and pruritus are common in renal failure. Lotions are used to relieve the dry skin, and antihistamines may be used to control itching; corticosteroids are not used. Pain is not a major problem in chronic renal failure, but analgesics that are excreted by the kidneys must be avoided. It is not necessary to measure abdominal girth daily because ascites is not a clinical problem in renal failure.

The nurse is changing intravenous fluids for a client who has hypokalemia. Place in order the steps the nurse will use to change intravenous fluids. All options must be used. Review the new intravenous order. Begin the intravenous fluids. Document the start of the fluids. Obtain the correct intravenous fluids. Identify client with two methods. Monitor the next potassium level.

Review the new intravenous order. Obtain the correct intravenous fluids. Identify client with two methods. Begin the intravenous fluids. Document the start of the fluids. Monitor the next potassium level. The nurse will review new intravenous order, obtain correct intravenous fluids, identify the client with two methods, and begin the intravenous fluids. Lastly, the nurse will document the start of the fluids and monitor the next potassium level.

Which assessment finding would lead a nurse to suspect dehydration in a preterm neonate? Bulging fontanels Excessive weight gain Urine specific gravity below 1.012 Urine output below 1 ml/hour

Urine output below 1 ml/hour Urine output below 1 ml/hour is a sign of dehydration. Other signs of dehydration include depressed, not bulging, fontanels; excessive weight loss, not gain; decreased skin turgor; dry mucous membranes; and urine specific gravity above, not below, 1.012.

A toddler diagnosed with nephrotic syndrome has a fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child's plan of care? Limit visitors to 2 to 3 hours a day. Maintain strict bed rest. Test urine specific gravity every shift. Weigh the child before breakfast.

Weigh the child before breakfast. The best indicator of fluid balance is weight. Therefore, daily weight measurements help determine fluid losses and gains. Although limiting visitors to 2 to 3 hours per day or maintaining strict bed rest would help to ensure that the child gets adequate rest, this is unrelated to the child's fluid balance. In nephrotic syndrome, urine is tested for protein, not specific gravity.

A 2-month-old infant has been diagnosed with pyloric stenosis. The infant will undergo a pyloromyotomy to remedy the condition. Prior to the surgery, which conditions represent the most danger to the infant? weight loss dehydration electrolyte imbalance metabolic acidosis

electrolyte imbalance Earlier diagnosis of the condition allows intervention before weight loss or dehydration manifest. Metabolic alkalosis (not acidosis) may occur from loss of hydrochloric acid. Electrolyte imbalance can result in cardiac arrhythmias.

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply. numbness aphasia tingling muscle twitching and spasms polyuria polydipsia

numbness tingling muscle twitching and spasms When the parathyroid gland is removed, the body may not produce enough parathyroid hormone to regulate calcium and phosphorous levels. The symptoms of hypocalcemia include peripheral numbness, tingling, and muscle spasms. Aphasia is not a symptom of calcium depletion. Polyuria and polydipsia are symptoms of diabetes mellitus.

When fluids by mouth are appropriate for the infant after surgery to correct intussusception, the nurse most likely would initiate which type of feeding? cereal-thickened formula full-strength formula half-strength formula oral electrolyte solution

oral electrolyte solution

The nurse is developing a plan of care for a neonate who is to undergo gastroschisis surgery. What should be included? Select all that apply. prevention of hypothermia maintenance of fluid and electrolyte balance controlling pre-operative pain prevention of infection providing developmental care

prevention of hypothermia maintenance of fluid and electrolyte balance prevention of infection The major goals for the neonate include preventing hypothermia, maintaining fluid and electrolyte balance, and preventing infection. Pain medication will be needed after surgery but is not typically needed before the procedure. In many cases surgery is done very soon after birth, so while developmental care is important, it should be addressed after the closure of the abdominal wall defect.

A client is admitted with full-thickness burns to 30% of the body, including both legs. After establishing a patent airway, which intervention is a priority? replacing fluid and electrolytes covering the wounds with antibacterial dressings supporting the lower extremities in normal anatomic position evaluating the presence and quality of pulses distal to the burn injury

replacing fluid and electrolytes After establishing a patent airway, fluid resuscitation is critical for the client with a burn injury. The burns will be covered with sterile saline-soaked dressings until the client is stabilized. Positioning to promote normal anatomic alignment is not a priority at this time. There is no reason to suspect that blood flow to the lower extremities is affected, but it might occur if the injury causes circumferential constriction of the legs.