NRS 306 - PrepU Fluid & Electrolyte Balance

A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings? a) Atropine b) Lidocaine c) Pronestyl d) Cardizem

a) Atropine *Explanation*: The client is demonstrating signs and symptoms of symptomatic sinus bradycardia. Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias. (p. 718)

A nurse is caring for a client after cardiac surgery. Upon assessment, the client appears restless and reports nausea and weakness. The client's ECG reveals peaked T waves. The nurse reviews the client's serum electrolytes, anticipating which abnormality? a) Hyperkalemia b) Hypercalcemia c) Hypomagnesemia d) Hyponatremia

a) Hyperkalemia *Explanation*: Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Hypercalcemia would likely be demonstrated by asystole. Hypomagnesemia would likely be demonstrated by hypotension, lethargy, and vasodilation. Hyponatremia would likely be indicated by weakness, fatigue, and confusion, without changes in T-wave formation.

Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication? a) Hyponatremia b) Hypernatremia c) Oliguria d) Weight loss

a) Hyponatremia *Explanation*: Hyponatremia is a life-threatening complication of unknown cause. When a client ingests an unusually large volume of water, the kidneys' capacity to excrete water is overwhelmed, and serum sodium concentrations rapidly fall below the normal range.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child? a) Lower extremities b) Face c) Presacral region d) Hands

a) Lower extremities *Explanation*: Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities.

A preschool child is admitted to the pediatric unit with acute nephritis. Which electrolyte replacement agent is used as an adjunct to treatment for this condition? a) Magnesium sulfate b) Calcium glubionate c) Potassium chloride d) Sodium lactate

a) Magnesium sulfate *Explanation*: Magnesium sulfate is an electrolyte that's used as an adjunct to treat acute nephritis. It also is used to treat seizures and severe toxemia. Calcium glubionate, potassium chloride, and sodium lactate aren't therapeutic in acute nephritis and, in fact, may worsen the condition.

The nurse is caring for a 5-year-old child who had a hernia repair 1 day ago. The child is vomiting, has a nasogastric (NG) tube to low intermittent suction, and has diarrhea. Which of the following laboratory results would be the immediate priority for the nurse to assess? a) Potassium level b) Calcium level c) Magnesium level d) Chloride level

a) Potassium level *Explanation*: Vomiting, diarrhea, and NG suction are all common causes of hypokalemia.

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? a) Potassium: 5.8 mEq/L b) Sodium: 138 mEq/L c) Magnesium: 2 mEq/L d) Calcium: 10 mg/dL

a) Potassium: 5.8 mEq/L *Explanation*: Normal potassium level is 3.5 to 5.5 mEq/L. Elevated potassium levels can lead to muscle weakness, paresthesias, and cardiac dysrhythmias. p. 271

Fluid and 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) osmosis b) filtration c) evaporation d) active transport

a) osmosis *Explanation*: Osmosis is the movement of water through a semipermeable membrane; one that allows some but not all substances in a solution to pass through from a diluted area to a more concentrated area. Filtration promotes the movement of fluid and some dissolved substances through a semipermeable membrane according to pressure differences. Evaporation is the process of converting water into a vapor. Active transport requires the energy source ATP to drive dissolved chemicals from an area of low concentration to an area of higher concentration; the opposite of passive diffusion.

Sodium retention and potassium excretion are modulated by which hormone? a) Melatonin b) Aldosterone c) Gastrin d) Calcitonin

b) Aldosterone *Explanation*: Aldosterone is released by the adrenal cortex to regulate sodium retention and potassium excretion.

A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way? a) Fluid intake should be double the urine output. b) Fluid intake should be about equal to the urine output. c) Fluid intake should be half the urine output. d) Fluid intake should be inversely proportional to the urine output.

b) Fluid intake should be about equal to the urine output. *Explanation*: Normally, fluid intake is about equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isn't inversely proportional to the urine output.

The nurse is teaching a pregnant client some nonpharmacologic ways to handle common situations encountered during pregnancy. The nurse determines the session is successful when the client correctly chooses which condition that can be minimized if she avoids drinking fluids with her meals? a) Nosebleeds b) Heartburn c) Blood clots d) Constipation

b) Heartburn *Explanation*: Filling the stomach with heavy food and fluid can cause overfill and place pressure on the stomach, increasing gastric reflux. Avoid excess fluids with meals and eat small frequent meals to avoid heartburn. Nosebleeds result from increased estrogen. Blood clots can result from sitting still for too long. Constipation can result from increased progesterone.

A 91-year-old client, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the client about the drug, what major adverse effect should the nurse be sure to mention? a) Hypokalemia b) Hyperkalemia c) Angina d) Hypertension

b) Hyperkalemia *Explanation*: The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.

A physician orders a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance? a) Hypervolemia b) Hypokalemia c) Hyperkalemia d) Hypernatremia

b) Hypokalemia *Explanation*: A loop diuretic removes water and, along with it, sodium and potassium. This may result in hypokalemia, hypovolemia, and hyponatremia.

Which describes difficulty breathing when a client is lying flat? a) Paroxysmal nocturnal dyspnea (PND) b) Orthopnea c) Tachypnea d) Bradypnea

b) Orthopnea *Explanation*: Orthopnea occurs when the client is having difficulty breathing when lying flat. Sudden attacks of dyspnea at night are known as paroxysmal nocturnal dyspnea. Tachypnea is a rapid breathing rate and bradypnea is a slow breathing rate.

A patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together? a) Magnesium level b) Potassium level c) Calcium level d) Sodium level

b) Potassium level *Explanation*: Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor (such as lisinopril) or angiotensin receptor blocker. (p. 890)

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? a) The client is on a low protein diet. b) The client is dehydrated. c) The client has a history of osteoarthritis. d) The client is lactose intolerant.

b) The client is dehydrated *Explanation*: The BUN test measures the amount of urea nitrogen in the blood. Urea, the major nitrogenous end-waste product of metabolism, is formed in the liver. The bloodstream carries urea from the liver to the kidneys for excretion. When the kidneys are diseased, they are unable to excrete urea adequately, and urea begins to accumulate in the blood, causing BUN to rise. Normal BUN is 8 to 25 mg/100 mL. Because other factors, such as high dietary intake of protein, fluid deficit, infection, gout, or excessive breakdown of protein stores, can also elevate BUN, it is not a highly sensitive indicator of impaired renal function

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

c) Monitoring respiratory status for signs and symptoms of pulmonary complications. *Explanation*: Hypervolemia, or fluid volume excess (FVE), refers to an isotonic expansion of the extracellular fluid. Nursing interventions for FVE include measuring intake and output, monitoring weight, assessing breath sounds, monitoring edema, and promoting rest. The most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds are assessed at regular intervals.

The nurse is caring for a 9-month-old child with severe diarrhea that has lasted 3 days. Which of the following would be a priority assessment for the nurse to make? a) Anemia b) Jaundice c) Poor skin turgor d) Hyponatremia

c) Poor skin turgor *Explanation*: Signs of dehydration include poor skin turgor, lack of tearing, and dry mucous membranes.

A client has been taking furosemide for 2 days. The nurse should assess the client for: a) an elevated blood urea nitrogen (BUN) level. b) an elevated potassium level. c) a decreased potassium level. d) an elevated sodium level.

c) a decreased potassium channel *Explanation*: Furosemide is a loop diuretic and inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle. Furosemide promotes sodium diuresis, resulting in a loss of potassium and serious electrolyte imbalances. Furosemide does not affect the BUN level.

When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: a) restricting fluids. b) restricting sodium. c) encouraging fluids. d) restricting potassium.

c) encouraging fluids *Explanation*: The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.

Which symptom is an early indication that the client's serum potassium level is below normal? a) diarrhea b) sticky mucous membranes c) muscle weakness in the legs d) tingling in the fingers

c) muscle weakness in legs *Explanation*: An early indication of hypokalemia is muscle weakness in the legs. Potassium is essential for proper neuromuscular impulse transmission. When neuromuscular impulse transmission is impaired, as in hypokalemia, leg muscles become weak and flabby. If hypokalemia progresses, respiratory muscles become involved and the client becomes apneic. Hypokalemia also causes ECG changes. Diarrhea is common in hyperkalemia. Sticky mucous membranes are common in hypernatremia. Tingling in the fingers and around the mouth occurs in hypocalcemia.

The primary extracellular electrolytes are: a) potassium, phosphate, and sulfate. b) magnesium, sulfate, and carbon. c) sodium, chloride, and bicarbonate. d) phosphorous, calcium, and phosphate.

c) sodium, chloride, and bicarbonate. The primary extracellular electrolytes are sodium, chloride, and bicarbonate.

A nurse is caring for a client with severe burns and receiving fluid resuscitation. Which finding indicates that the client is responding to the fluid resuscitation? a) pulse rate of 112 bpm b) blood pressure of 94/64 mm Hg c) urine output of 30 mL/h d) serum sodium level of 136 mEq/L (136 mmol/L)

c) urine output of 30 mL/h *Explanation*: Ensuring a urine output of 30 to 50 mL/h is the best measure of adequate fluid resuscitation. The heart rate is elevated, but is not an indicator of adequate fluid balance. The blood pressure is low, likely related to the hypervolemia, but urinary output is the more accurate indicator of fluid balance and kidney function. The sodium level is within normal limits.

A nurse is assessing a client with diarrheal disease and determines that the condition has most likely resulted from a parasitic infection. Which of the following would be a potential cause? Select all that apply. a) E.coli b) Salmonella c) Shigella d) Giardia e) Cryptosporidium

d) Giardia e) Cryptosporidium *Explanation*: Parasitic infections associated with diarrhea include Giardia, cryptosporidium, and entamoeba hystolytica. E. coli, salmonella, and shigella are bacterial causes of diarrhea. (pg. 2138)

A client presents to the emergency department, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? a) Metabolic acidosis and hyperkalemia b) Metabolic acidosis and hypokalemia c) Metabolic alkalosis and hyperkalemia d) Metabolic alkalosis and hypokalemia

d) Metabolic alkalosis and hypokalemia *Explanation*: Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia.

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? a) Vital signs b) Oral intake c) Oral mucosa d) Urine output

d) Urine output *Explanation*: An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink: a) twice as much fluid as usual. b) at least 1,000 mL more than usual. c) as much water or juice as possible. d) at least 3,000 mL of fluids daily.

d) at least 3,000 mL of fluids daily *Explanation*: Instructions should be as specific as possible, and the nurse should avoid general statements such as "as much as possible." A specific goal is most useful. A mix of fluids will increase the likelihood of client compliance. It may not be sufficient to tell the client to drink twice as much as or 1 L more than she usually drinks if her intake was inadequate to begin with.

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) bowel sounds c) respiratory rates d) electrocardiogram (ECG) results.

d) electrocardiogram (ECG) results *Explanation*: Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia. (pg. 263)

A client age 80 years, who takes diuretics for management of hypertension, informs the nurse that she takes laxatives daily to promote bowel movements. The nurse assesses the client for possible symptoms of: a) hypocalcemia b) hypothyroidism c) hypoglycemia d) hypokalemia.

d) hypokalemia *Explanation*: The frequent use of laxatives and diuretics promotes the excretion of potassium and magnesium from the body, increasing the risk for fluid and electrolyte deficits. (pg. 1496)