Fluid Imbalance Worksheet

The community health nurse is performing a home visit to an 80-year-old client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused at times and has dry mucous membranes. When asked about fluid intake, the client 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 that can result in confusion, so let's try adjusting the timing of your fluids." C. "It is normal to be a little confused following surgery, and it is safe not to urinate at night." D. "Confusion and bladder issues are a normal consequence of aging, so I am not too concerned."

"Limiting your fluids can create imbalances that can result in confusion, so let's try adjusting the timing of your fluids."

A client with hypokalemia is to receive intravenous (IV) potassium replacement. Which action should the nurse take when administering potassium intravenously? Select all that apply. A. Administer potassium by IV push. B. Assess blood urea nitrogen (BUN) and serum creatinine prior to potassium administration. C. Monitor complete blood count during potassium infusion. D. Follow the facility policy for infusion of potassium. E. Report a reduced urinary output to the health care provider.

Assess blood urea nitrogen (BUN) and serum creatinine prior to potassium administration. Follow the facility policy for infusion of potassium. Report a reduced urinary output to the health care provider.

19. A client's most recent laboratory results show a slight decrease in potassium. The health care provider has opted to forgo drug therapy but has suggested increasing the client's dietary intake of potassium. What should the nurse recommend? A. Apples B. Fish C. Rice D. Bananas

Bananas

14. A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. Which factors contribute to this phenomenon? Select all that apply. A. Decreased kidney mass B. Increased conservation of sodium C. Increased total body water D. Decreased renal blood flow E. Decreased excretion of potassium

Decreased kidney mass Decreased renal blood flow Decreased excretion of potassium

The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem? A. Diminished deep tendon reflexes B. Tachycardia C. Cool, clammy skin D. Acute flank pain

Diminished deep tendon reflexes

8. A client with hypertension has been prescribed hydrochlorothiazide. What nursing action will best reduce the client's risk for electrolyte disturbances? A. Maintain a low-sodium diet. B. Encourage the use of over-the-counter calcium supplements. C. Ensure the client has sufficient potassium intake. D. Encourage fluid intake.

Ensure the client has sufficient potassium intake

The nurse is caring for a client who is to receive IV daunorubicin, a chemotherapeutic agent. The nurse starts the infusion and checks the insertion site as per protocol. During the most recent check, the nurse observes that the IV has infiltrated so the nurse stops the infusion. What is the nurse's priority concern with this infiltration? A. Extravasation of the medication B. Discomfort to the client C. Blanching at the site D. Hypersensitivity reaction to the medication

Extravasation of the medication

The nurse is caring for a client who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion. The plan of care includes assessment of specific gravity every four hours. The results of this test will allow the nurse to assess which aspect of the client's health? A. Nutritional status B. Potassium balance C. Calcium balance D. Fluid volume status

Fluid volume status

The nurse is caring for a client who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. The client reports a new onset of weakness with abdominal pain, and further assessment suggests that the client likely has a fluid volume deficit. The nurse should recognize that this client may be experiencing which electrolyte imbalance? A. Hypernatremia B. Hypomagnesemia C. Hypophosphatemia D. Hypercalcemia

Hypercalcemia

15. The nurse is called to a client's room by a family member who voices concern about the client's status. On assessment, the nurse finds the client tachypneic, lethargic, weak, and exhibiting a diminished cognitive ability. The nurse also identifies 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this client's signs and symptoms? A. Hypocalcemia B. Hyponatremia C. Hyperchloremia D. Hypophosphatemia

Hyperchloremia

20. The nurse is assessing the client for the presence of a Chvostek sign. Which electrolyte imbalance would a positive Chvostek sign indicate? A. Hypermagnesemia B. Hyponatremia C. Hypocalcemia D. Hyperkalemia

Hypocalcemia

5. The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in the lips and fingers. The client also reports an intermittent spasm in the wrist and hand and exhibits increased muscle tone. Which electrolyte imbalance should the nurse first suspect? A. Hypophosphatemia B. Hypocalcemia C. Hypermagnesemia D. Hyperkalemia

Hypocalcemia

3. The nurse is working on a burn unit and an acutely ill client is exhibiting signs and symptoms of third spacing. Based on this change in status, the nurse should expect the client to exhibit signs and symptoms of which imbalance? A. Metabolic alkalosis B. Hypermagnesemia C. Hypercalcemia D. Hypovolemia

Hypovolemia

16. The nurse is caring for a client with a diagnosis of pancreatitis. The client was admitted from a homeless shelter and is a vague historian. The client appears malnourished and on day 3 of the client's admission, total parenteral nutrition (TPN) has been started. Why should the nurse start the infusion of TPN slowly? A. Clients receiving TPN are at risk for hypercalcemia if calories are started too rapidly. B. Malnourished clients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively. C. Malnourished clients who receive fluids too rapidly are at risk for hypernatremia. D. Clients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to accumulate.

Malnourished clients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.

17. The nurse is providing discharge education to a client who had hypophosphatemia while in the hospital. The client has a diet prescribed that is high in phosphate. Which foods should the nurse teach this client to include in the diet? Select all that apply. A. Milk B. Beef C. Potatoes D. Green vegetables E. Liver

Milk Beef Liver

13. A client has questioned the nurse's administration of intravenous (IV) normal saline, asking, "Wouldn't sterile water be a more appropriate choice than saltwater?" Under what circumstances would the nurse administer electrolyte-free water intravenously? A. Never, because it rapidly enters red blood cells, causing them to rupture. B. When the client is severely dehydrated, resulting in neurologic signs and symptoms C. When the client is in excess of calcium and/or magnesium ions D. When a client's fluid volume deficit is due to acute or chronic kidney disease

Never, because it rapidly enters red blood cells, causing them to rupture

. The nurse caring for a client post colon resection is assessing the client on the second postoperative day. The nasogastric tube remains patent and is draining moderate amounts of greenish fluid. Which assessment finding would suggest that the client's potassium level is too low? A. Diarrhea B. Paresthesias C. Increased muscle tone D. Joint pain

Paresthesias

The nurse is caring for a client who has been involved in a motor vehicle accident. The client's labs indicate a minimally elevated serum creatinine level. The nurse should further assess which body system for signs of injury? A. Renal B. Cardiac C. Pulmonary D. Nervous

Renal

18. The nurse is caring for a client with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis? A. Hypertension B. Kussmaul respirations C. Increased DTRs D. Shallow respirations

Shallow respirations

A client comes into the emergency department (ED) by ambulance with a hip fracture after slipping and falling while at home. The client is alert and oriented but anxious and reports thirst. The client's pupils are equal and reactive to light and accommodation, and the heart rate is elevated. An indwelling urinary catheter is inserted, and 40 mL of urine is present. What is the nurse's most likely explanation for the client's urinary output? A. The client urinated prior to arrival to the ED and will probably not need to have the urinary catheter kept in place. B. The client likely has a traumatic brain injury, lacks antidiuretic hormone, and needs vasopressin. C. The client is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide, which results in decreased urine output. D. The client is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system, which results in diminished urine output.

The client is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system, which results in diminished urine output.