FLUID & ELECTROLYTE IMBALANCE

The healthcare provider prescribes a patient a diuretic that inhibits sodium and chloride reabsorption in the ascending loop of Henle. For which class of diuretic should the nurse prepare teaching for this patient? A. Loop B. Osmotic C. Thiazide D. Potassium sparing

A. Loop Loop diuretics inhibit sodium and chloride reabsorption in the ascending loop of Henle. Thiazide diuretics promote the excretion of sodium, chloride, potassium, and water by decreasing absorption in the distal tubule. Potassium-sparing diuretics promote excretion of sodium and water by inhibiting sodium-potassium exchange in the distal tubule. Osmotic diuretics do not inhibit sodium and chloride reabsorption in the ascending loop of Henle.

The nurse is instructing a group of patients on what to expect during pregnancy. Which information should the nurse include about hydration? A. "Low-protein snacks can be helpful in reducing nausea." B. "A woman is most at risk for dehydration during the first trimester." C. "Pregnant women are more likely to experience dehydration due to a decreased sense of thirst." D. "It is very rare for pregnant women to experience dehydration."

B. "A woman is most at risk for dehydration during the first trimester." A pregnant woman is at greatest risk for fluid volume deficit (FVD) during the first trimester due to morning sickness and vomiting. She is also at higher risk for dehydration and FVD due to blood loss should a miscarriage occur. High-protein snacks can help to curb nausea and vomiting associated with pregnancy. Older adults, not pregnant women, are more likely to experience FVD due to a decreased sense of thirst.

The nurse is caring for a patient with hypochloremia. Which dietary change should the nurse recommend to this patient? A. "Take regular calcium supplements." B. "Add salt to your diet." C. "Restrict fluids." D. "Follow a low-sodium diet."

B. "Add salt to your diet." Hypochloremia is a low serum chloride level. Interventions include adding more salt to the diet, addressing the cause of the hypochloremia, and adding chloride to IV fluids (if hospitalized). Reducing sodium intake, adding calcium supplements, or restricting fluids are not recommended for this health problem.

How will you assess Mrs. Suzuki for a fluid imbalance? A. Assess her pedal pulses. B. Assess her urine output. C. Auscultate her lung sounds. D. Auscultate her bowel sounds.

B. Assess her urine output. Measuring Mrs. Suzuki's urine output will provide you with one type of assessment to indicate whether she has a fluid volume imbalance.

A patient with confusion and hyperreflexia has a serum sodium level of 162 mEq/L. The nurse should plan this patient's care based on which health problem? A. Fluid volume deficit B. Hypernatremia C. Fluid volume excess D. Hyponatremia

B. Hypernatremia The normal range of serum sodium level is from 135-145 mEq/L. A high value indicates hypernatremia. Hyponatremia is a low serum sodium level. There is insufficient information to diagnose either FVE or FVD.

Each of your four clients requires dietary adjustments. Which client is paired with the adjustment that is most appropriate for his or her condition? A. Mr. Eddy has a specific gravity of 1.005, and his serum potassium is 2.5 mEq/L. Dietary adjustment: Increase fluid intake. B. Mrs. Suzuki has a serum sodium level of 165 mEq/L, specific gravity 1.045, and serum osmolality of 350 mOsm/kg. Dietary adjustment: Increase fluid intake. C. Mr. Smith's serum calcium level is 14.5 mg/dL, and his X-rays reveal bone erosion and thinning. Dietary adjustment: Restrict fluid intake. D. Ms. Jones has a serum magnesium level of 1.0 mEq/L, and her serum potassium is 4.0 mEq/L. Intervention: Make Ms. Jones NPO. Submit Decision

B. Mrs. Suzuki has a serum sodium level of 165 mEq/L, specific gravity 1.045, and serum osmolality of 350 mOsm/kg. Dietary adjustment: Increase fluid intake. Mrs. Suzuki's sodium, specific gravity, and serum osmolality are all high, which indicates hypernatremia. A more appropriate dietary adjustment would be restricting intake of sodium and caffeine.

A patient on fluid restriction is experiencing severe thirst. Which suggestion should the nurse provide to this patient? A. "Drink a small glass of water." B. "Eat a bowl of soup." C. "Have a piece of watermelon." D. "Chew sugarless gum."

D. "Chew sugarless gum." Patients on fluid-restricted diets must be careful about every ounce of fluid they take in. They can try chewing sugarless gum or sucking on some ice chips if they get thirsty. Drinking extra water is not appropriate because it can precipitate fluid volume excess (FVE). Eating soup or some fruits and vegetables can also be an extra source of fluid.

The nurse provides care to a patient with dehydration. Which assessment finding indicates to the nurse that current interventions are ineffective to improve the patient's hydration status? A. Urine output of 40 mL/hr B. Warm, dry skin C. Weight gain of 1.2 kg D. Blood pressure 88/50 mmHg

D. Blood pressure 88/50 mmHg A blood pressure of 88/50 mmHg indicates hypotension, which is associated with hypovolemia or low fluid volume. A low blood pressure indicates that the patient's status is not improving. Warm and dry skin, a weight gain, and a urine output between 30 to 60 mL/hr indicates the patient's status is improving.

The nurse is caring for a patient with a fluid volume excess (FVE) secondary to heart failure. The nurse should request a collaborative therapy consult for which specialist? A. Exercise physiologist B. Home care nurse C. Social worker D. Dietitian

D. Dietitian Patients with FVE due to heart failure are advised to follow a low-sodium diet, and would benefit from a consultation with a dietitian or nutritionist to discuss the specifics. Social workers, exercise physiologists, and home care nurses are not typically required in the care of a patient with FVE.

The nurse is caring for a patient with severe diarrhea. Which assessment data should indicate to the nurse that additional intervention is required for this patient? A. Blood pressure of 120/74 mmHg B. Heart rate of 72 beats/min C. Urine output of 50 mL/hr D. Elevated hematocrit level

D. Elevated hematocrit level An elevated hematocrit indicates dehydration caused by intravascular volume loss and hemoconcentration. The other data indicate the fluid volume deficit has resolved.

The mother of a 2-month-old infant is concerned that the baby is becoming dehydrated because of the number of wet diapers. Which recommendation should the nurse make to this mother? A. "Continue with breast milk or formula only; it provides all of the hydration that an infant needs." B. "Add a little extra water to the formula to increase fluid levels." C. "Try giving 1-2 cups of water each day to increase hydration levels." D. "Administer 0.5 cup of oral rehydration solution."

A. "Continue with breast milk or formula only; it provides all of the hydration that an infant needs." Breast milk or formula should be the only source of fluids for a young infant. Newborns and young infants are at risk for fluid volume excess (FVE) due to immature kidneys and filtering mechanism. Extra water, even in mixed formula, or oral rehydration solutions are not necessary for an infant.

The nurse provides teaching to a patient with excess fluid volume. Which patient statement indicates the need for further teaching? A. "I should read food labels to note fiber content." B. "I will learn to safely self-administer diuretics after discharge." C. "I will elevate legs and feet when sitting." D. "I should sit in the Fowler position if dyspnea or orthopnea is present."

A. "I should read food labels to note fiber content." For a patient with fluid volume excess, the patient should understand the importance of monitoring fluid intake to stay within fluid restrictions, monitoring weight daily and reporting significant increases to the healthcare provider, and elevating the legs and feet to reduce dependent edema. The patient should read labels on food products for sodium content. Caffeinated drinks produce a diuretic effect and would not need to be reduced.

The nurse reviews information received during hand-off communication about a group of assigned patients. Which patient should the nurse closely monitor for signs of fluid volume deficit? A. A 37-year-old patient with chronic diarrhea B. A 56-year-old patient with kidney failure C. A 63-year-old patient with hypertension D. A 21-year-old patient with acute water intoxication

A. A 37-year-old patient with chronic diarrhea Fluid volume deficit, or dehydration, can occur when excessive amounts of fluids are lost through diarrhea or vomiting. Kidney failure causes water retention, leading to fluid volume excess, not deficit. Water intoxication results from excessive fluid intake and also leads to fluid volume excess. Fluid volume excess, not deficit, can result in hypertension.

The nurse is caring for a patient who was prescribed a loop diuretic. Which patient data indicates a need for further follow-up with the healthcare provider? A. Periorbital edema B. Weight loss of 6 lb C. Normal skin temperature and without edema D. Normal hemoglobin level

A. Periorbital edema Periorbital edema is a strong indicator of fluid volume excess (FVE) and indicates that the diuretic therapy is not effective. A normal hemoglobin level and normal skin without edema are normal findings and indicate a stabilization of fluid balance. A weight loss of 6 lb is an expected finding and indicates the medication is having the desired therapeutic effect.

The nurse reviews the medical record of an older adult patient. Which health problem should the nurse identify that increases the patient's risk for fluid volume excess? A. Renal failure B. Prolonged vomiting C. Severe burns after an accident D. Dysphagia

A. Renal failure Renal failure puts the patient at risk for developing fluid volume excess. Prolonged vomiting, severe burns, and dysphagia are associated with a risk of developing fluid volume deficit, not excess.

A patient with altered renal function has an elevated potassium level. Which prescription should the nurse question before administering to this patient? A. Administration of a diuretic B. Serum electrolytes every 8 hours C. Electrocardiogram every 12 hours D. Administration of insulin and glucose together

A. Administration of a diuretic With normal renal function, diuretics are sometimes used to treat hyperkalemia. However, they cannot be used when a patient has abnormal renal excretion. Routine electrocardiograms (ECGs) and serum electrolytes are important to monitor for worsening hyperkalemia or cardiac dysrhythmias. Administration of insulin and glucose together is a common medication combination for hyperkalemia.

A patient in the 28th week of pregnancy is suspected of developing preeclampsia. Which potential complication should the nurse anticipate when planning care for this patient? A. Heart failure B. Dehydration C. Cirrhosis D. Sodium imbalance

A. Heart failure Preeclampsia during pregnancy puts a woman at risk for fluid volume excess. Without prompt treatment and resolution of the fluid imbalance, the woman is at risk for developing heart failure due to the increased workload associated with pumping excess blood volume. Fluid volume excess is not associated with dehydration, cirrhosis, or sodium imbalance.

Prioritization of care is primary to the concept of clinical reasoning. Which client should be assessed first and is at greatest risk of an adverse event due to an electrolyte imbalance? A. Mr. Eddy, the 70-year-old male client with congestive heart failure B. Mr. Smith, the 65-year-old male client with a diagnosis of multiple myeloma C. Mrs. Suzuki, the 82-year-old female client with dementia D. Ms. Jones, the 35-year-old female client with alcohol dependence Submit Decision

A. Mr. Eddy, the 70-year-old male client with congestive heart failure Mr. Eddy has CHF and is experiencing dyspnea, fatigue, and nausea, putting him at greatest risk for an immediate adverse event due to an electrolyte imbalance. CHF can create fluid volume excess, and loop diuretics used to treat this excess may cause potassium depletion, resulting in ventricular dysrhythmia and heart block.

The nurse is assigned to care for a patient with excess fluid volume. Which intervention in the patient's plan of care should the nurse question? A. Orthostatic hypotension precautions B. Assessing vital signs and response to therapy 2 hours after administration of diuretics C. Performing oral hygiene every 2 hours D. Use of a low-pressure mattress and heel protectors

A. Orthostatic hypotension precautions A patient with a fluid volume excess requires oral hygiene at least every 2 hours and measures to reduce friction or shearing to the skin. The nurse should also administer prescribed diuretics and monitor the patient's response to therapy. Orthostatic hypotension precautions are not appropriate for this patient.

A young child with increasing lethargy and sleepiness is suspected of having a fluid volume deficit. Which microorganism should the nurse suspect is causing this patient's symptoms? A. Rotavirus B. E. coli C. Salmonella D. Shigella

A. Rotavirus One of the primary causes of gastroenteritis in young children is rotavirus. E. coli, Salmonella, and Shigella are not common causes of gastroenteritis and fluid loss in young children.

A patient seeks medical attention for symptoms that are occurring since drinking large amounts of water after running a marathon. Which assessment should the nurse make a priority for this patient? A. Eye accommodation B. Level of consciousness C. Skin turgor D. Reflexes

B. Level of consciousness The patient with water intoxication is experiencing a fluid volume excess and likely low electrolyte levels. Measuring blood pressure, auscultating lung sounds, and assessing level of consciousness are all priority assessments for the nurse to perform. Reflexes and skin turgor are important to evaluate, because they can give information about electrolyte and fluid levels, but they are not the priority assessment. Palpating the area around the eyes, not testing for accommodation, is a priority for this patient.

Which one of your clients is at risk for an electrolyte imbalance based on their medication regimen? A. Ms. Jones B. Mr. Eddy C. Mr. Smith D. Mrs. Suzuki

B. Mr. Eddy Mr. Eddy has CHF, which requires the use of diuretics. Some diuretics, such as loop diuretics, cause potassium depletion. Ms. Jones is alcohol dependent but does not take any medications. Her malnourishment is what predisposes her for electrolyte imbalance. Mr. Smith has multiple myeloma, which is a cancer of the plasma cells. His lenalidomide and NSAIDs do not affect his fluid and electrolyte balance. Mrs. Suzuki has dementia. Medications for dementia do not affect electrolyte and fluid balance.

The nurse observes a new graduate nurse provide care to a patient with an elevated sodium level. For which action performed by the graduate nurse should the nurse preceptor intervene? A. Involved patient in meal planning B. Provided bouillon and crackers for an afternoon snack C. Used an infusion pump for the administration of IV fluids Initiated safety precautions to avoid falls due to dizziness

B. Provided bouillon and crackers for an afternoon snack Administration of bouillon and crackers is not appropriate for the patient's health problem because these food items are high in sodium. Involving the patient in meal planning, teaching the patient to avoid falls secondary to dizziness, and administering IV fluids using an infusion pump are important interventions when caring for a patient with an electrolyte imbalance.

An older adult patient with electrolyte imbalances is concerned about repeated episodes of dehydration. Which physiological change that contributes to electrolyte imbalances in older adult patients should the nurse explain? A. Decreased insensible water loss in warm weather B. Increased need for vitamins and minerals C. Decreased thirst sensation D. Increased renin and aldosterone secretion

C. Decreased thirst sensation Older adult patients often experience a reduced sense of thirst, which makes it more likely for them to become dehydrated, because they may not drink as much water as needed. Older adult patients also tend to lose more insensible water in warm weather. Older adult patients do not have an increased need for vitamins or minerals and may have decreased renin or aldosterone secretion.

At 2:00 a.m., you check on Ms. Jones. She states, "I need to go outside and smoke a cigarette." Which response is most appropriate? A. "You can't worry about smoking right now. You need to get better." B. "I will let the staff know, and you can go outside and smoke." C. "I will call the doctor and see whether we can get you a prescription." D. "I recommend you have your family visit you. If they cannot, we have some magazines you can read."

C. "I will call the doctor and see whether we can get you a prescription." Keeping Ms. Jones on the unit for monitoring is the safest option. She has an electrolyte imbalance that needs to be treated, and she needs to be assessed for her response to the treatment. If her hypomagnesemia gets severe, supraventricular tachycardia and ventricular dysrhythmias could result. Also, telling Ms. Jones that you will alleviate her need for a cigarette by calling the doctor for a smoking cessation aid will provide her with comfort and reassurance that you recognize her needs and are addressing them.

The nurse is caring for a patient with severe diarrhea. Which assessment data should indicate to the nurse that additional intervention is required for this patient? A. Heart rate of 72 beats/min B. Urine output of 50 mL/hr C. Elevated hematocrit level D. Blood pressure of 120/74 mmHg

C. Elevated hematocrit level An elevated hematocrit indicates dehydration caused by intravascular volume loss and hemoconcentration. The other data indicate the fluid volume deficit has resolved.

The nurse is caring for a patient who is experiencing orthostatic hypotension secondary to fluid volume deficit (FVD). Which action by the patient requires immediate follow-up by the nurse? A. Drinking 1500 mL each day B. Sitting in a recliner instead of lying in bed C. Getting out of bed straight to standing D. Weighing themselves every day

C. Getting out of bed straight to standing A patient with a FVD is at risk for orthostatic hypotension, dizziness, and falling. The nurse should teach the patient to get up and transition slowly from lying down to sitting to standing, instead of going straight to standing. Drinking at least 1500 mL each day, sitting in a recliner, and weighing themselves daily are all appropriate interventions for someone suffering from a FVD.

A patient presents with noticeable lower extremity swelling and periorbital edema. Which collaborative thearpy should the nurse anticipate? A. Elevating the head of the bed B. Sodium replacement therapy C. Loop diuretic D. Electrocardiogram

C. Loop diuretic Significant edema and periorbital edema signifies that the patient may be suffering from fluid volume excess (FVE). The nurse should anticipate the healthcare provider ordering a diuretic to help reduce extra fluid. The patient may be placed on a sodium-restricted diet, not given sodium replacement therapy. Performing an electrocardiogram (ECG) is not likely indicated except for a severe imbalance or concurrent electrolyte imbalances. Elevating the head of the bed is an independent nursing intervention, not a healthcare provider order.

It is 2:45 p.m., and you are assessing your clients. Based on the assessment information provided here, which client is paired with the appropriate priority nursing intervention? A. Mrs. Suzuki needs an IV, but she has just consumed a full glass of water. Priority intervention: Start Mrs. Suzuki's IV. B. Ms. Jones appears to be talking loudly at the television, and she is resistant to taking her magnesium supplements. Priority intervention: Get Ms. Jones to take her magnesium now. C. Mr. Eddy's IV shows signs of phlebitis. He is due to receive 40 mEq KCl in 100 mL NS at a rate of 10 mEq/hour via IV pump. Priority intervention: Restart Mr. Eddy's IV at a different site. D. Mr. Smith has deep bone pain and complains that he can't bear weight on his legs. Priority intervention: Administer an analgesic. Submit Decision

C. Mr. Eddy's IV shows signs of phlebitis. He is due to receive 40 mEq KCl in 100 mL NS at a rate of 10 mEq/hour via IV pump. Priority intervention: Restart Mr. Eddy's IV at a different site. Phlebitis is a problem that requires immediate attention. The administration of potassium-containing solutions is irritating to the veins. The IV site must be monitored, and a safe infusion rate must not be exceeded.

A young child has been experiencing vomiting and diarrhea for several days. Which rehydration solution should the nurse recommend to this patient's mother? A. Apple juice B. Diet ginger ale C. Pedialyte D. Water

C. Pedialyte Pedialyte is an oral rehydration solution that contains both fluids and electrolytes in the correct proportions. A child who has been vomiting with diarrhea for several days needs replacement of both fluid and electrolytes. Water does not contain necessary electrolytes. Sugar facilitates sodium reabsorption during rehydration, so diet ginger ale would not help this child. Undiluted apple juice can actually worsen diarrhea, so it must be diluted with water before giving it to a child with diarrhea and/or vomiting.

The nurse is caring for a patient with a fluid volume deficit (FVD). Which nursing intervention addresses the patient's risk for falls secondary to dizziness? A. Monitoring for signs of blood loss B. Recording hourly intake and output C. Teaching patient to change positions slowly and in stages D. Administering whole blood

C. Teaching patient to change positions slowly and in stages FVD can cause orthostatic hypotension, which can lead to dizziness and falls when changing positions. The nurse should teach the patient about how to prevent this from occurring. Recording intake and output are appropriate assessments for a patient with a FVD, but do not specifically address patient safety or falls. Monitoring for signs of blood loss and administering whole blood are interventions targeted toward hemorrhage (cellular regulation) rather than falls.

The nurse is providing discharge teaching for an older adult patient with a new diagnosis of heart failure. Which symptom should the nurse instruct the patient to immediately report to the healthcare provider? A. Urine output of 320 mL in 8 hours B. Dizziness when standing C. Weight gain of 5 lb in a week D. Dry mouth

C. Weight gain of 5 lb in a week A weight gain of 5 lb in a week indicates that the patient is retaining fluid or experiencing fluid volume excess. This can indicate worsening cardiac function. Dry mouth and dizziness when standing are signs of dehydration, not fluid volume excess. Urine output of 320 mL per 8 hours is within the normal range.

A patient with weakness and fatigue has hypotension. The patient reports having run a marathon the day before. Which health problem should the nurse suspect is occurring with this patient? A. Fluid volume excess B. Hypertension C. Hypoglycemia D. Fluid volume deficit

D. Fluid volume deficit Fluid volume deficit is associated with lethargy, tachycardia, weakness, and tachypnea. Fluid volume excess causes rapid weight gain over a short amount of time, bounding pulse, distended neck veins, cough, and shortness of breath. Hypertension and hypoglycemia do not cause these symptoms.

Each of your four clients requires lab testing. Which client is paired with lab results that would be useful in evaluating his or her condition? A. Mrs. Suzuki's serum calcium is 5.0 mEq/L. B. Mr. Smith's BUN is 12 mg/dL and his serum creatinine is 1.2 mg/dL. C. Mr. Eddy's hematocrit is 0.50 SI and his hemoglobin is 15 g/dL. D. Ms. Jones's serum magnesium is 0.9 mEq/L.

D. Ms. Jones's serum magnesium is 0.9 mEq/L. Ms. Jones suffers from chronic alcoholism, which is the most common cause of hypomagnesemia. Also, her muscle twitching and tremor suggest neuromuscular irritability due to an imbalance in her calcium or magnesium levels.

A patient has a serum potassium level of 7.4 mEq/L. Which medication should the nurse anticipate being prescribed for this patient? A. Oral glucose B. Intravenous potassium supplementation C. Corticosteroid D. Oral sodium polystyrene sulfonate

D. Oral sodium polystyrene sulfonate Hyperkalemia is a potassium level above 5.2 mEq/L. Oral sodium polystyrene sulfonate is used to help reduce the potassium level. Further potassium supplementation would only further increase the potassium level. The healthcare provider may prescribe glucose and insulin together, but never glucose alone. Corticosteroids are not used to treat hyperkalemia.

The nurse is planning care for a patient with heart failure (HF). Which physiological change should the nurse identify as causing this patient to be at risk for fluid retention? A. Decrease in antidiuretic hormone and aldosterone B. Impaired renal excretion of potassium C. Low serum osmolality level that stimulates the thirst center D. Retention of water and sodium

D. Retention of water and sodiumFluid volume excess results from conditions that cause retention of water and sodium. Impaired renal excretion of potassium is not related to fluid volume excess. There will be an increase in antidiuretic hormone (ADH) and aldosterone when the stress response is activated with fluid volume excess. An increase in serum osmolality, not a low serum osmolality, stimulates the thirst center, which could affect fluid volume.