Fluids/ Electrolytes
Which length of time is the maximum that the nurse would allow an IV bag of solution to infuse?
24 hours After this time there is increased risk for contamination of the solution and the bag should be changed
A client with HF weighed 175 lb (79.4 kg) yesterday, and todays weight is 181 lb (82.1 kg). How many milliliters of fluid has the client retained?
2700 mL One liter of fluid equals 1000 mL Each liter of fluid is 1 kg of weight
In which components of the nephron unit does furosemide decrease fluid reabsorption?
Loop of henle Distal tubules Proximal tubules "loop diuretic" inhibits sodium and chloride reabsorption from these areas
The nurse receives an order to prepare a solution for administering a cleansing edema for an adolescent client. Which is the volume of solution that would be prepared?
500-750 mL Infants: 150-250 mL Toddler: 250-350 mL School-age: 300-500 mL
At 10:00 AM the nurse hangs a 1000 mL bag of 5% dextrose in water with 20 mEq of potassium chloride to be administered at 80 mL/hr. At noon the health care provider prescribes a stat infusion of an intravenous antibiotic at 100 mL to be administered via piggyback over 1 hour. How much longer than expected will it take the primary bag to empty if the nurse interrupts the primary infusion for infusion of the antibiotic?
60 minutes An infusion of 1000 mL at 80 mL should take 12.5 hours.
One liter of 5% dextrose solution contains 50 grams of sugar. The nurse calculates that 3 L solution/day will supply approximately how many kilocalories?
600 Carbs provide 4 kcal/ g
Which percentage of total body water is found in a premature newborn?
85% Full-term: 70-80%
The nurse gave the client the prescribed sodium polystyrene sulfonate. Which assessment finding indicates that the medication has been effective?
A decrease in serum potassium level Treats hyperkalemia Binds with potassium in GI system and often causes diarrhea
The nurse is administering serum albumin IV to a client with ascites. In response to this therapy, which client problem would the nurse expect to decrease?
Abdominal girth An increased serum albumin level increases the osmotic effect and pulls fluid back into the intravascular compartment. This will increase renal flow and urine output, with a resulting decrease in abdominal girth.
When ammonia is excreted by healthy kidneys, which mechanism is usually maintained?
Acid-base balance of the body
Which is the most probable cause for Conn syndrome in an adult client?
Adrenal adenoma Conn syndrome is primary hyperaldosteronism. Excessive secretion of aldosterone by the adrenal glands due to adrenal adenoma results in Conn syndrome.
Which gland is affected in aldosteronoma?
Adrenal cortex aldosteronoma is an aldosterone-secreting adenoma of the adrenal cortex.
A client with lymphosarcoma is receiving allopurinol and methotrexate. The nurse can help the client prevent complications related to uric acid nephropathy by administering which medication in relation to which changes in fluid intake?
Allopurinol and encouraging increased fluid intake
The diagnostic reports of a client who underwent a hypophysectomy indicate an ICP of 30 mm Hg. Which action made by the client is responsible for the reported ICP?
Bending over at the waist Client without a pituitary gland should avoid bending at the waste because this position increases the ICP
Which nursing assessment findings are consistent with fluid volume overload from high-flow intravenous fluid replacement therapy?
Bounding pulse, presence of dependent edema, neck vein distention in the upright position
A client is admitted for dehydration, and an intravenous infusion of normal saline is started at 125 mL/hr. One hour later, the client begins screaming, "I can't breathe!" How would the nurse respond?
Elevate the head of the client's bed and obtain vital signs This will facilitate breathing by decreasing the pressure against the diaphragm
A pregnant client with severe preeclampsia is receiving IV magnesium sulfate. Which item would the nurse keep at the bedside in case of magnesium sulfate toxicity?
Calcium gluconate The antagonist of magnesium sulfate
Which collecting structure is located at the end of the renal papilla?
Calyx cup-like structure that collects urine and is located at the end of each papilla
The nurse administers a parenteral preparation of potassium slowly to avoid which complication?
Cardiac Arrest
Which statement regarding calcitonin is correct?
Its actions are opposite to that of parathyroid hormone Calcitonin reduces serum calcium levels Parathyroid hormone increases serum calcium levels Calcitonin is secreted by parafollicular cells of the thyroid gland. It decreases calcium and phosphorous by decreasing bone resorption
Which finding during peritoneal dialysis would the nurse act on as a sign of infection?
Cloudy return of dialysate it should be cultured for confirmation
Which component of the clients nephron acts as a receptor site for the ADH to regulate water balance?
Collecting ducts - they regulate water balance and act as a receptor site for ADh
The nurse assesses a client's IV site. Which clinical finding leads the nurse to conclude that the IV has infiltrated, rather than caused inflammation?
Coolness When an IV infiltrates, the IV solution entering the interstitial space is at room temperature, whereas body temperature is approximately 98.6 F; therefore the client's skin will feel cool to the touch at the site of an IV infiltration
Thick mucous gland secretions, elevated sweat electrolytes, meconium ileus (impacted stool in newborn), and difficulty maintaining and gaining weight are associated with which autosomal recessive disorder?
Cystic Fibrosis
Which medication can cause diabetes insipidus?
Demeclocycline This medication decreases the production of antidiuretic hormone by the kidneys
Which relationship between a client's burned body surface and fluid loss would the nurse consider when evaluation fluid loss in a client with burns?
Directly Proportional
A 2-year-old child is admitted with gastroenteritis and dehydration. IV fluids are prescribed. Which is the most appropriate site for the first intravenous insertion?
Dorsal hand
Which part of the kidney produces the hormone bradykinin?
Juxtaglomerular cells of the arterioles this hormone increases blood flow and vascular permeability
Which hormone aids in regulating intestinal calcium and phosphorous absorption?
Glucocorticoids
Which action is characteristic of the hormone vasopressin?
Helps produce concentrated urine action: makes the distal convoluted tubule and collecting duct permeable to water so as to maximize reabsorption and produce concentrated urine
Which symptom indicates a client with inhalation anthrax is in the fulminant stage?
Hematemesis Disease has 2 stages: prodromal and fulminant symptoms of prodromal are fever, dry cough, and mild chest pain.
The nurse would assess for which electrolyte imbalance during the first 48 hours after a client has sustained a thermal injury?
Hyperkalemia and hyponatremia Massive amounts of potassium are released from injured cells into the extracellular fluid compartment Large amounts of sodium are lost in edema
A client is receiving furosemide to relieve edema. The nurse will monitor the client for which adverse effect?
Hypokalemia Causes depletion of sodium and potassium
IV fluids and insulin are prescribed to treat a client's diabetic ketoacidosis. The client develops peripheral paresthesias and shortness of breath. The cardiac monitor shows the appearance of a U wave. Which complication would the nurse suspect?
Hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor
In which category of fluids would the nurse classify an IV solution of 0.45% sodium chloride?
Hypotonic
A client is scheduled to receive total parenteral nutrition. To administer TPN, which piece of equipment is important for the nurse to obtain?
Infusion pump Hypertonic solution should be administered in an infusion pump for continuous and uniform infusion to prevent hyperosmolar diuresis or fluctuations in glucose
Which rationale would lead the nurse to question an order for a tap water enema for a 6-month-old infant with suspected Hirschsprung disease?
It could cause fluid and electrolyte imbalance Tap water enemas are hypotonic and are contraindicated; they may cause increased absorption of fluid through the bowel and may upset the balance of fluid in the body
A client takes furosemide and digoxin for heart failure. Why would the nurse advice the client to drink a glass of orange juice every day?
Maintaining potassium levels Digoxin toxicity can occur in the presence of HYPOkalemia
Which clinical finding would the nurse associated with hypokalemia?
Muscle weakness
A client hospitalized for uncontrolled hypertension and CP was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.6 mEq/L. Which action will the nurse take next?
Notify the HCP that the potassium level is below normal
Which assessment finding in a client signifies a mild form of hypocalcemia?
Numbness around the mouth Seizures, hand spasms, and severe muscle cramps are associated with severe hypocalcemia
Which lab value may indicate hyperfunction of the adrenal gland in a client?
Potassium: 2.9 mEq/ L It may indicate the presence of adrenal gland hyperfunction in the client
In which parts of the kidney are glucose and amino acids reabsorbed?
Proximal tubule Glucose, amino acids, electrolytes, and bicarbonate are reabsorbed in the proximal tubules Distal tubules: water and bicarb are reabsorbed Sodium and chloride are reabsorbed in the ascending limb, and water in the descending limb, of the loop of henle water is reabsorbed in the presence of Adh in the collecting duct
The nurse assesses bilateral +4 peripheral edema while assessing a client with heart failure and peripheral vascular disease. Which is the pathophysiological reason for the excessive edema?
Shift of fluid into the interstitial spaces
Which electrolyte deficiency triggers the secretion of renin?
Sodium Low sodium causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells.
A client receiving a hemodialysis treatment asks the nurse which substances are being removed. Which substance can the nurse report is being removed during hemodialysis?
Sodium passes through the semipermeable membrane during hemodialysis
The client with a permanent sigmoid colostomy has colostomy irrigation prescribed and inquires as to why they are prescribed. Why response would the nurse use?
The irrigations help establish an elimination schedule
A client with chronic kidney disease selects treatment using continuous ambulatory peritoneal dialysis (CAPD). Which statement indicates the client understands the purpose of this therapy?
The treatment uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion