Fluid and electrolytes Prep-U

The normal serum value for potassium is

3.5 to 5.5 mEq/L.

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?

Extracellular fluid volume deficit

A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action? a) Tetanic contractions b) Weight loss c) Jugular vein distention d) Polyuria

c

An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?

Hypokalemia

Which of the following electrolytes is a major cation in body fluid?

Potassium

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? a) Serum creatinine level of 0.4 mg/dl b) Serum blood urea nitrogen (BUN) level of 8.6 mg/dl c) Serum sodium level of 124 mEq/L d) Hematocrit of 52%

c

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

a

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? a) Potassium b) Chloride c) CO2 d) Sodium

a

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? a) Urine pH of 3.0 b) Absence of protein c) Absence of glucose d) Specific gravity of 1.02

a

Which of the following is a correct route of administration for potassium? a) Oral b) Subcutaneous c) IV (intravenous) push d) Intramuscular

a

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? a) Hypocalcemia b) Hypercalcemia c) Hypokalemia d) Hyperkalemia

b

The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance does a positive Chvostek's sign indicate? a) Hypercalcemia b) Hypocalcemia c) Hyperkalemia d) Hypermagnesemia

b

A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess: a) Goodell's sign. b) Homans' sign. c) Trousseau's sign. d) Hegar's sign.

c

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? a) Altered blood urea nitrogen (BUN) value b) Metabolic alkalosis c) Extracellular fluid volume deficit d) Respiratory acidosis

c

A priority nursing intervention for a client with hypervolemia involves which of the following? a) Encouraging the client to consume sodium-free fluids. b) Establishing I.V. access with a large-bore catheter. c) Monitoring respiratory status for signs and symptoms of pulmonary complications. d) Drawing a blood sample for typing and crossmatching.

c

Below which serum sodium level may convulsions or coma can occur? a) 145 mEq/L b) 140 mEq/L c) 135 mEq/L d) 142 mEq/L

c

A patient's lab results show a slight decrease in potassium. The physician has declined to treat with drug therapy but has suggested increasing potassium through diet. Which of the following would be a good source of potassium? a) Asparagus b) Carrots c) Apples d) Bananas

d

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

d

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

d

Patients diagnosed with hypervolemia should avoid sweet or dry food because: a) It can lead to weight gain. b) It obstructs water elimination. c) It can cause dehydration. d) It increases the client's desire to consume fluid.

d

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? a) Vasodilation b) Increased urine output c) Bradycardia d) Tachycardia

d

Which of the following is the most common cause of symptomatic hypomagnesemia in the United States? a) Loss of gastric acid b) Inflammatory bowel disease c) Intestinal resection d) Alcoholism

d

early signs of hypervolemia include

increased breathing effort and weight gain

In a pre-nursing pathophysiology class the instructor is teaching about the regulation of fluid volume. How is fluid volume primarily regulated? a) Urine excretion b) Breathing c) Bowel elimination d) Perspiration

a

You are caring for a patient admitted with a diagnosis of renal failure. When you review your patient's laboratory reports, you note that the patient's magnesium levels are high. What would be important for you to assess? a) Diminished deep tendon reflexes b) Tachycardia c) Cool, clammy skin d) Increased serum magnesium

a

You are caring for a patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion. Your patient has specific gravities ordered every 4 hours. What does this test detect? a) Fluid volume status b) Nutritional deficit c) Hyperkalemia d) Hypercalcemia

a

You are working on a burn unit. One of your patients is exhibiting signs and symptoms of third spacing, which occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, what would you expect the patient to demonstrate? a) Hypovolemia b) Hypervolemia c) Hypertension d) Bradycardia

a

Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality? a) Sodium b) Potassium c) Calcium d) Magnesium

b

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? a) Assess for dehydration. b) Give medications that promote fluid retention. c) Limit sodium and water intake. d) Teach client behaviors that decrease urination.

c

A 42-year-old client has chronic hyponatremia which requires weekly blood labs to keep him from lapsing into convulsions or a coma. What is the level of serum sodium below which convulsions or coma can occur? a) 145 mEq/L b) 140 mEq/L c) 142 mEq/L d) 135 mEq/L

d

A 57-year-old homeless female with a history of alcohol abuse has been admitted to your hospital unit. She was admitted with signs and symptoms of hypovolemia - minus the weight loss. She exhibits a localized enlargement of her abdomen. What condition could she be presenting? a) Anasarca b) Hypovolemia c) Pitting edema d) Third-spacing

d

A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. Laboratory values are as follows: Na + 147 mEq/L K + 3.0 mEq/L Cl - 112 mEq/L Mg ++ 2.3 mg/dL Ca ++ 1.5 mg/dL Which of the following is consistent with the client's findings? a) Hypophosphatemia b) Hyperchloremia c) Hypernatremia d) Hypokalemia

d

A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: a) hypercalcemia. b) hypernatremia. c) hypokalemia. d) hyperkalemia.

d

You are the nurse caring for a 77-year-old male who fell off his roof. You note that the patient's labs indicate minimally elevated serum creatinine levels. What can this indicate in older adults? a) Substantially reduced renal function b) Reduced respiratory function c) Alterations in ratio of body fluids to muscle mass d) Increased cardiac function

a

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? a) Administering vasopressin as ordered b) Restricting fluids to 800 ml/day c) Restricting sodium intake to 1 gm/day d) Elevating the head of the client's bed to 90 degrees

b

A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her: a) neuromuscular function. b) electrocardiogram (ECG) results. c) bowel sounds. d) respiratory rate.

b

A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? a) Urine specific gravity of 1.025 b) Serum potassium level of 3 mEq/L c) Blood urea nitrogen (BUN) level of 29 mg/dl d) Serum sodium level of 132 mEq/L

b

The home health nurse is visiting an 84-year-old woman living at home and recovering from hip surgery. The nurse notes that the woman seems confused and has poor skin turgor. When asked about her fluid intake, the patient states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response? a) "I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup." b) "Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of you fluids." c) "It is normal to be a little confused following surgery, and it's safe not to urinate a night." d) "Confusion following surgery is common in the elderly due to a loss of sleep."

b

Translocation is a term used to describe the general movement of fluid and chemicals within body fluids. In every client's body, fluid-electrolyte balance is maintained through the process of translocation. What specific process allows water to pass through a membrane from a dilute to a more concentrated area? a) Diffusion b) Osmosis c) Active transport d) Filtration

b

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? a) Hypovolemia b) Dehydration c) Hypervolemia d) Fluid volume excess

b

You are doing an admission assessment on an elderly patient newly admitted for end-stage liver disease. You must assess the patient's skin turgor. What should you remember when evaluating skin turgor? a) Dehydration causes the skin to appear edematous and spongy. b) Inelastic skin turgor is a normal part of aging. c) Overhydration causes the skin to tent. d) Normal skin turgor is moist and boggy.

b

You are the nurse caring for a 65-year-old female patient who is in renal failure. During your shift assessment, the patient complains of tingling in her lips and fingers whenever anyone takes her blood pressure. She tells you that she gets a spasm in her wrist and hand and that it is very painful. What would you suspect? a) Hypophosphatemia b) Hypocalcemia c) Hypermagnesemia d) Hyperkalemia

b

Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply. a) Decreased blood pressure b) Distended neck veins c) Crackles in the lung fields d) Bradycardia e) Shortness of breath

b c e

A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client? a) Yes, this will correct the sodium deficit. b) Yes, along with the hypotonic IV. c) No, sodium intake should be restricted. d) No, start with the sodium chloride IV.

c

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. Na + 130 mEq/L K + 4.6 mEq/L Cl - 94 mEq/L Mg ++ 2.8 mg/dL Ca ++ 13 mg/dL Which of the following alterations is consistent with the client's findings? a) Hyponatremia b) Hyperkalemia c) Hypercalcemia d) Hypermagnesemia

c

The calcium level of the blood is regulated by which mechanism? a) Adrenal gland b) Thyroid hormone (TH) c) Parathyroid hormone (PTH) d) Androgens

c

Which nerve is implicated in the Chvostek's sign? a) Optic b) Spinal accessory c) Facial d) Hypoglossal

c

Which of the following are the insensible mechanisms of fluid loss? a) Bowel elimination b) Nausea c) Breathing d) Urination

c

Which of the following is considered an isotonic solution? a) 0.45% normal saline b) 3% NaCl c) 0.9% normal saline d) Dextran in NS

c

While admitting a new patient to your medical-surgical unit, you note that the patient is oliguric. You notify the acute-care nurse practitioner who orders a fluid challenge of 100 to 200 mL of normal saline solution over 15 minutes. What do you know this intervention will do? a) Help distinguish hyponatremia from hypernatremia b) Help evaluate pituitary gland function c) Help distinguish reduced renal blood flow from decreased renal function d) Help provide an effective treatment for hypertension-induced oliguria

c