Incorrect PrepU- Exam 3 Ch 13 Fluid and Electrolytes: Balance and Disturbance

Oncotic pressure refers to the a) number of dissolved particles contained in a unit of fluid. b) osmotic pressure exerted by proteins. c) amount of pressure needed to stop the flow of water by osmosis. d) excretion of substances such as glucose through increased urine output.

Osmotic pressure exerted by proteins. Explanation: Oncotic pressure is a pulling pressure exerted by proteins, such as albumin. Osmolality refers to the number of dissolved particles contained in a unit of fluid. Osmotic diuresis occurs when the urine output increases due to excretion of substances such as glucose. Osmotic pressure is the amount of pressure needed to stop the flow of water by osmosis.

A 77-year-old retired male client visits your general practice office twice monthly to maintain control of his congestive heart failure. He measures his weight daily and phones it to your office for his medical record. In a 24-hour period, how much fluid is this client retaining if his weight increases by 2 lb? a) 500 ml b) 1250 ml c) 1 L d) 1500 ml

1L Explanation: A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.

A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond? a) Renin-angiotensin-aldosterone system b) Bicarbonate-carbonic acid buffer system c) Sodium-potassium pump d) ADH-ANP buffer system

A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond? You selected: Bicarbonate-carbonic acid buffer system Correct Explanation: The major chemical regulator of plasma pH is the bicarbonate-carbonic acid buffer system. Therefore options A and C are incorrect. Option D does not exist, it is only a distractor for this question.

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) Hyperkalemia b) Hypercalcemia c) Hypokalemia d) Hypocalcemia

Hypercalcemia Explanation: The normal reference range for serum calcium is 9 to 11 mg/dl. A serum calcium level of 12 mg/dl clearly indicates hypercalcemia. The client's other laboratory findings are within their normal ranges, so the client doesn't have hypernatremia, hypochloremia, or hypokalemia.

The nurse is instructing a patient with recurrent hyperkalemia about following a potassium-restricted diet. Which of the following patient statements indicates the need for additional instruction? a) "I will not salt my food, instead I'll use salt substitute." b) "Bananas have a lot of potassium in them, I'll stop buying them." c) "I'll drink cranberry juice with my breakfast instead of coffee." d) "I need to check if my cola beverage has potassium in it."

"I will not salt my food, instead I'll use salt substitute." Explanation: The patient should avoid salt substitutes. The nurse must caution patients to use salt substitutes sparingly if they are taking other supplementary forms of potassium or potassium-conserving diuretics. Potassium-rich foods to be avoided include many fruits and vegetables, legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, and cocoa. Conversely, foods with minimal potassium content include butter, margarine, cranberry juice or sauce, ginger ale, gumdrops or jellybeans, hard candy, root beer, sugar, and honey. Labels of cola beverages must be checked carefully because some are high in potassium and some are not.

In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours? a) 1,200 b) 400 c) 600 d) 800

800 Explanation: In patients with normal or excess fluid volume, hyponatremia is usually treated effectively by restricting fluid. However, if neurologic symptoms are severe (e.g., seizures, delirium, coma), or in patients with traumatic brain injury, it may be necessary to administer small volumes of a hypertonic sodium solution with the goal of alleviating cerebral edema (see Chapter 66). Incorrect use of these fluids is extremely dangerous, because 1 L of 3% sodium chloride solution contains 513 mEq of sodium and 1 L of 5% sodium chloride solution contains 855 mEq of sodium. The recommendation for hypertonic saline administration in patients with craniocerebral trauma is 3% saline between 0.10 to 1.0 mL/kg of body weight per hour (March, Criddle, Madden et al., 2010).

The nurse is caring for a patient with a metabolic acidosis (pH 7.25). Which of the following values is useful to the nurse in determining whether the cause of the acidosis is due to acid gain or to bicarbonate loss? a) Serum sodium level b) PaCO2 c) Bicarbonate level d) Anion gap

Anion gap Explanation: Metabolic acidosis is a common clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration. It can be produced by a gain of hydrogen ion or a loss of bicarbonate. It can be divided clinically into two forms, according to the values of the serum anion gap: high anion gap acidosis and normal anion gap acidosis. A patient diagnosed with metabolic acidosis is determined to have normal anion gap metabolic acidosis if the anion gap is within this normal range. An anion gap greater than 16 mEq (16 mmol/L) (the normal value for an anion gap is 8-12 mEq/L (8-12 mmol/L) without potassium in the equation. If potassium is included in the equation, the normal value for the anion gap is 12-16 mEq/L (12-16 mmol/L) and suggests an excessive accumulation of unmeasured anions and would indicate high anion gap metabolic acidosis as the type. An anion gap occurs because not all electrolytes are measured. More anions are left unmeasured than cations. A low or negative anion gap may be attributed to hypoproteinemia. Disorders that cause a decreased or negative anion gap are less common compared to those related to an increased or high anion gap.

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? a) Sunken eyeballs and spasticity b) Confusion and seizures c) Flaccidity and thirst d) Tetany and increased blood urea nitrogen (BUN) levels

Question 4: (see full question) Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? You selected: Confusion and seizures Correct Explanation: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication

A patient with cancer is being treated on the oncology unit for bilateral breast cancer. The patient is undergoing chemotherapy. The nurse notes the patient's serum calcium level is 12.3 mg/ dL. Given this laboratory finding, the nurse should suspect which of the following statements? a) The patient may be developing hyperaldosteronism. b) The patient has a history of alcohol abuse. c) The patient's diet is lacking in calcium-rich food products. d) The patient's malignancy is causing the electrolyte imbalance.

The patient's malignancy is causing the electrolyte imbalance. Explanation: The patient's laboratory findings indicate hypercalcemia. Hypercalcemia is defined as a calcium level greater than 10.2 mg/dL (2.6 mmol/L).The most common causes of hypercalcemia are malignancies and hyperparathyroidism. Malignant tumors can produce hypercalcemia by a variety of mechanisms. The patient's calcium level is elevated; there is no indication that the patient's diet is lacking in calcium-rich food products. Hyperaldosteronism is not associated with a calcium imbalance. Alcohol abuse is associated with hypocalcemia.

A patient is diagnosed with hypocalcemia. The nurse advises the patient and his family to immediately report the most characteristic manifestation. What is the most characteristic manifestation? a) Dyspnea and laryngospasm b) Tingling or twitching sensation in the fingers c) Hyperactive bowel sounds. d) Confusion and depression

Tingling or twitching sensation in the fingers Explanation: All the choices are signs and symptoms of hypocalcemia, but tetany is the most characteristic manifestation that occurs when the calcium level is less than 4.4 mg/dL.

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? a) 275-300 mOsm/kg b) >408 mOsm/kg c) 350-544 mOsm/kg d) <136 mOsm/kg

patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? You selected: 275-300 mOsm/kg Correct Explanation: In healthy adults, normal serum osmolality is 270 to 300 mOsm/kg (

A 54-year-old male patient is admitted to the hospital with a case of severe dehydration. The nurse reviews the patient's laboratory results. Which of the following results are consistent with the diagnosis? Select all that apply. a) Hematocrit level of 48% b) Serum sodium of 148 mEq/L c) Serum osmolality of 310 mOsm/kg d) Blood urea nitrogen (BUN) of 23 mg/dL e) Urine specific gravity of 1.03 f) Serum glucose of 90 mg/dL

• Blood urea nitrogen (BUN) of 23 mg/dL • Serum osmolality of 310 mOsm/kg • Serum sodium of 148 mEq/L • Urine specific gravity of 1.03 Explanation: Severe dehydration is associated with an increased BUN (N = 10 to 20 mg/dL), serum osmolality (N = 275 to 300 mOsm/kg), serum sodium (N = 135 to 145 mEq/L) and urine specific gravity (N = 1.01 to 1.025). Glucose and hematocrit levels would also be elevated but are within normal range for this question.

A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The nurse expects that the compensatory mechanisms associated with hypovolemia would cause what clinical manifestations? (Select all that apply.) a) Oliguria b) Hypertension c) Tachycardia d) Tachypnea e) Bradycardia

- Oliguria • Tachycardia • Tachypnea Explanation: Hypovolemia, or fluid volume deficit, is indicated by decreased, not increased, blood pressure (hypotension), oliguria, tachycardia (not bradycardia), and tachypnea.

A volume-depleted patient would present with which of the following diagnostic lab results? a) BUN-to-creatinine ratio of 24:1 b) Urinary output of 1.2 L/24 hours c) Capillary refill time of 3 seconds d) Urine specific gravity of 1.02

BUN-to-creatinine ratio of 24:1 Explanation: A BUN-to-serum creatinine concentration ratio greater than 20:1 is indicative of volume depletion. The other results are within normal range.

A patient complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patient's laboratory work has returned? a) Potassium b) Phosphorus c) Calcium d) Magnesium

Calcium Explanation: Calcium deficit is associated with the following symptoms: numbness and tingling of the fingers, toes, and circumoral region; positive Trousseau's sign and Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, decreased prothrombin, diarrhea, and hypotension. Electrocardiogram findings associated with hypocalcemia include prolonged QT interval and lengthened ST.

Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism? a) Chest pain b) Jaundice c) Slow pulse d) Hypertension

Chest pain Explanation: Manifestations of air embolism include dyspnea and cyanosis; hypotension; weak, rapid pulse; loss of consciousness; and chest, shoulder, and low back pain. Jaundice is not associated with air embolism.

The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? a) Pancreas and stomach b) Kidney and liver c) Lungs and kidney d) Heart and lungs

Correct response: Lungs and kidney Explanation: The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.

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

Correct response: Serum potassium level of 3 mEq/L Explanation: A serum potassium level of 3 mEq/L is below normal, indicating hypokalemia. Because hypokalemia may cause cardiac arrhythmias and asystole, it's the most significant finding. In a client with a potential fluid volume imbalance, such as from vomiting, the other options are expected but none are as life-threatening as hypokalemia. A BUN level of 29 mg/dl indicates slight dehydration. A serum sodium level of 132 mEq/L is slightly below normal but not life-threatening. A urine specific gravity of 1.025 is normal.

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

Dehydration Explanation: The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.

The nurse is caring for a patient with a serum potassium level of 6.0 mEq/L. The patient is ordered to receive oral sodium polystyrene sulfonate (Kayexelate) and furosemide (Lasix). What other orders should the nurse anticipate giving? a) Increase the rate of the IV lactated Ringer's solution. b) Change the lactated Ringer's solution to 2.5% dextrose. c) Discontinue the IV lactated Ringer's solution. d) Change the lactated Ringer's solution to 3% saline.

Discontinue the IV lactated Ringer's solution. Explanation: The lactated Ringer's IV fluid is contributing to both the fluid volume excess and the hyperkalemia. In addition to the volume of IV fluids contributing to the fluid volume excess, lactated Ringer's contains more sodium than daily requirements and excess sodium worsens fluid volume excess. Lactated Ringer's also contains potassium, which would worsen the hyperkalemia.

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration? a) Abnormal potassium level b) Low white blood count c) Elevated hematocrit level d) Low urine specific gravity

Elevated hematocrit level Explanation: When hemoconcentration occurs due to a hypovolemic state, a high ratio of blood components in relation to watery plasma occurs, thus causing an elevated hematocrit level. A high white blood cell count and urine specific gravity is also noted. Other causes of an abnormal potassium level may be present.

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) Hypercalcemia b) Hypermagnesemia c) Hyponatremia d) Hyperkalemia

Hypercalcemia Explanation: More than 99% of the body's calcium is found in the skeletal system. Hypercalcemia (greater than 10.2 mg/dL) can be a dangerous imbalance. The client presents with anorexia, nausea and vomiting, constipation, abdominal pain, bone pain, and confusion.

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? a) Increases arterial pH b) Provides long-term pH regulation c) Decreases arterial pH d) No effect

Increases arterial pH Explanation: Respiratory alkalosis is always caused by hyperventilation, which is a decrease in plasma carbonic acid concentration. The pH is elevated above normal as a result of a low PaCO2.

When caring for a patient who has risk factors for fluid and electrolyte imbalances, which of the following assessment findings is the highest priority for the nurse to follow up? a) Irregular heart rate b) Blood pressure 96/53 mm Hg c) Weight loss of 4 lb d) Mild confusion

Irregular heart rate Explanation: Irregular heart rate may indicate a potentially life-threatening cardiac dysrhythmia. Potassium, magnesium, and calcium imbalances may cause dysrhythmias. Weight loss is a good indicator of the amount of fluid lost, but following up on potential cardiac dysrhythmias is a higher priority. Confusion may occur with dehydration and hyponatremia, but following up on potential cardiac dysrhythmias is a higher priority. The blood pressure is slightly lower than normal but is not life threatening. Following up on potential cardiac dysrhythmias is a higher priority.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? a) Abdominal pain or diarrhea b) Hallucinations or tinnitus c) Light-headedness or paresthesia d) Nausea or vomiting

Light-headedness or paresthesia Explanation: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance

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

Parathyroid hormone (PTH) Explanation: The serum calcium level is controlled by PTH and calcitonin. The thyroid hormone, adrenal gland, or androgens do not regulate the calcium level in the blood.

Which of the following electrolytes is a major cation in body fluid? a) Phosphate b) Chloride c) Potassium d) Bicarbonate

Potassium Explanation: Potassium is a major cation that affects cardiac muscle functioning. Chloride is an anion. Bicarbonate is an anion. Phosphate is an anion.

A nurse is caring for a patient with acute renal failure and hypernatremia. Which of the following actions can be delegated to the nursing assistant? a) Monitor for signs and symptoms of dehydration. b) Assess the patient's daily weights for trends. c) Provide oral care every 2-3 hours. d) Teach the patient about increased fluid intake.

Provide oral care every 2-3 hours. Explanation: Providing oral care for the patient every 23 hours is within the scope of practice of a nursing assistant. The other actions should be completed by the registered nurse.

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) Blood urea nitrogen (BUN) level of 29 mg/dl c) Serum potassium level of 3 mEq/L d) Serum sodium level of 132 mEq/L

Serum potassium level of 3 mEq/L Explanation: A serum potassium level of 3 mEq/L is below normal, indicating hypokalemia. Because hypokalemia may cause cardiac arrhythmias and asystole, it's the most significant finding. In a client with a potential fluid volume imbalance, such as from vomiting, the other options are expected but none are as life-threatening as hypokalemia. A BUN level of 29 mg/dl indicates slight dehydration. A serum sodium level of 132 mEq/L is slightly below normal but not life-threatening. A urine specific gravity of 1.025 is normal.

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

Serum sodium level of 124 mEq/L Explanation: In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing hyponatremia, as indicated by a serum sodium level of 124 mEq/L. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. A hematocrit of 52% and a BUN level of 8.6 mg/dl are elevated. Typically, the hematocrit and BUN level decrease.

Which of the following is a factor affecting an increase in urine osmolality? a) Alkalosis b) Fluid volume excess c) Myocardial infarction d) Syndrome of inappropriate antidiuretic hormone release (SIADH)

Syndrome of inappropriate antidiuretic hormone release (SIADH) Explanation: Factors increasing urine osmolality include SIADH, fluid volume deficit, acidosis, and congestive heart failure. Myocardial infarction typically is not a factor that increases urine osmolality.

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? a) Carbonic acid b) PaO2 c) Bicarbonate d) PO2

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? You selected: Bicarbonate Correct Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. PaO2 and PO2 are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG.

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? You selected: Metabolic alkalosis Correct Explanation: Metabolic alkalosis results in increased plasma pH because of an accumulated base bicarbonate or decreased hydrogen ion concentration. Factors that increase base bicarbonate include excessive oral or parenteral use of bicarbonate-containing drugs, a rapid decrease in extracellular fluid volume and loss of hydrogen and chloride ions as with gastric suctioning. Acidotic states are from excess carbonic acid and hydrogen ions in the system. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary.

Which of the following statements accurately reflects a rule of thumb upon which the nurse may rely in assessing the patient's fluid balance? a) Minimal intake of 2 liters per day b) Minimal intake of 1.5 liters per day c) Minimal urine output of 10 mL per hour d) Minimal urine output of 50 mL per hour

When food and fluids are withheld, IV fluids (3L per day) are usually prescribed. Minimal urine output may be less than 50 mL per hour. Minimal urine output must exceed 10 mL per hour. Minimal intake, as a rule of thumb, is less than 2 liters per day.

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) hypokalemia. c) hypernatremia. d) hyperkalemia.

hyperkalemia. Explanation: Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. Administering glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

Which of the following arterial blood gas (ABG) results would the nurse anticipate for a patient with a 3-day history of vomiting? a) pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 b) pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15 c) pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 d) pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34

pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 Explanation: The patient's ABG would likely demonstrate metabolic alkalosis. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of H+. A common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis where only gastric fluid is lost. The other results do not represent metabolic alkalosis.

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

• Distended neck veins • Crackles in the lung fields • Shortness of breath Explanation: Clinical manifestations of FVE include distended neck veins, crackles in the lung fields, shortness of breath, increased blood pressure, and tachycardia.