N181 - Fluid & Electrolyte Balance
The nurse is developing a plan of care for a client with Meniere's disease and identifies a nursing diagnosis of excess fluid volume related to fluid retention in the inner ear. Which intervention would be most appropriate to include in the plan of care?
Limit foods that are high in sodium.
A client has experienced hypovolemic shock and is being treated with 2 liters of lactated Ringer's solution. It is now most important for the nurse to assess
Lung sounds
The nurse is caring for a client following a motor vehicle incident with head trauma suspected of diabetes insipidus. Which nursing intervention is appropriate?
Measure and record urinary output.
A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced?
Renal impairment
A client with neurologic infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which is an important nursing action for this client?
Restricting fluid intake and hydration
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids
The preferred preparation for treating hypothyroidism includes which of the following?
Levothyroxine (Synthroid)
The health care provider is concerned that the client has hypokalemia. During the physical examination, which question should the nurse ask the client?
"Have you been experiencing muscle weakness or leg cramps?"
The nurse is completing intake and output totals for the shift ending at 3:00 p.m. At 8:00 a.m., the child drank one 8-ounce carton of milk and ate a 3-ounce bowl of Jell-O. At 9:15 am. the child had a formed stool and voided 228 mL. At 10:45, the child drank one 12-ounce can of soda. For lunch at 12:20 p.m., the child finished ½ of an 8-ounce bowl of cream of chicken soup, one package of crackers, a red 6-ounce popsicle, and a bag of Cheetos. At 1:10 p.m., the child voided 288 mL of clear urine. At 2:35 p.m., the child vomited 105 mL of reddish-orange semi-digested food. What would be the total intake for this child for this shift? Record your answer using a whole number.
990
The nurse is evaluating the laboratory values of a client whose nursing diagnosis is "risk for impaired skin integrity." Which of the following values places the client at greatest risk?
Albumin, 1.5 g/dL
Diabetes insipidusis a disorder of the posterior pituitary resulting in deficient secretion of which hormone?
Antidiuretic hormone
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?
Dehydration
A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected?
Dental erosion and chronic edema
A nurse notes that a client's I.V. insertion site is red, swollen, and warm to the touch. Which action should the nurse take first?
Discontinue the I.V. infusion.
A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:
Encourage fluid intake, if possible, to dilute the urine.
Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day.
Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels?
Frequent vomiting, leading to loss of fluid volume
Which medication is categorized as a loop diuretic?
Furosemide
Which term describes the percentage of blood volume that consists of erythrocytes?
Hematocrit
A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?
Hemoglobin level
The nurse is admitting a patient with severe diarrhea. What is the most important element of assessment for this patient?
Hydration status
A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing?
Hyperkalemia
Immediately after a burn injury, electrolytes need to be evaluated for a major indicator of massive cell destruction, which is:
Hyperkalemia
A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address?
Hypocalcemia
Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication?
Hyponatremia
A nurse is caring for an infant who is in critical condition. The nurse notes that the child weighs 11 lb (5 kg) and has had a blood loss of 100 mL. Assessment reveals a decreased urine output, mild tachycardia, and restlessness. Which of the following should be the priority action for the nurse to take?
IV administration of lactated Ringer's
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected?
On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.
Hypothalamic sensory neurons that promote thirst when stimulated are called:
Osmoreceptors
Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:
Osmosis
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema, weight gain
Which is a potassium-sparing diuretic used in the treatment of heart failure?
Spironolactone
A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action?
Stop the infusion.
A client's BUN test results are significantly elevated. When reviewing the client's history, which finding is consistent with BUN elevation other than renal compromise?
The client is dehydrated.
The nurse is teaching a group of nursing students about the mechanism of action of common diuretics. What best reflects the mechanism of these drugs?
They block the reabsorption of sodium and chloride in the nephron.
Which is a classic sign of cardiogenic shock?
Tissue hypoperfusion
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
Urine output of 20 ml/hour
The nurse is assigned to care for a patient in the oliguric phase of kidney failure. When does the nurse understand that oliguria is said to be present?
When the urine output is less than 30 mL/h
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication?
With food
Which of these clients in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?
a client who is pale and diaphoretic with a heart rate of 115 beats/minute
Potassium is needed for neural, muscle, and:
cardiac function.
The nurse prepares a client for a barium enema. The nurse should place the client on which diet prior to the procedure?
clear liquids day before
A client with gestational hypertension receives magnesium sulfate 50% 4 g in 250 mL D5W over 20 minutes. What priority assessment should the nurse perform when administering this drug?
deep tendon reflexes
In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for:
dehydration
Mineralocorticoids directly affect:
electrolyte levels.
A client loses consciousness after strenuous exercise and needs to be admitted to a health care facility. The client is diagnosed with dehydration. The nurse knows that the client needs restoration of:
electrolytes
The nurse starts an intravenous (IV) line on a client with edema. The order reads 500 mL bolus of D5LR over 30 min. The nurse knows that this IV fluid will cause water to move out of the cell because it is which type of fluid?
hypertonic
Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into the intravascular compartment?
hypertonic
The nurse is caring for a child with a severe burn. The treatment for this child during the first 48 hours will be most likely be related to:
hypovolemic shock.
A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation?
lack of free water intake
Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?
mEq/L
A client must receive a blood transfusion of packed red blood cells (RBCs) for severe anemia. What I.V. fluid should the nurse use to prime the tubing before hanging this blood product?
normal saline solution as this is considered an isotonic solution
The term used to describe total urine output less than 0.5 mL/kg/hr is
oliguria.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
urine output of 250 ml/24 hours
The nurse observes that a postsurgical client has hemorrhaged and is in hypovolemic shock. Which nursing intervention will manage and minimize hemorrhage and shock?
Reinforcing dressings or applying pressure if bleeding is frank
A client has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit the nurse will be assessing the client for syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment would alert the clinic nurse that the client may be developing this complication?
Report of decreased urine output, no edema noted in ankles, increasing headache
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose?
patellar reflex
The nurse is aware of the importance of potassium and sodium for normal physiologic functions of a client. The rapid movement of potassium and sodium in actions is known as:
primary active transport.
A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the
malignancy is causing the electrolyte imbalance.
A client has been admitted with severe burns. Lactated Ringer's has been ordered to infuse via a pump. Why is this solution being used?
to prevent signs of hypovolemic shock and restore circulation
The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client's serum sodium value would be
155 mEq/L (155 mmol/L)
