Nursing - Fluid & Electrolytes

Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client's nasogastric tube is bright red. What should the nurse do first?

Determine that this is an expected finding

A client has been given a prescription for furosemide (Lasix) 40 mg every day in conjunction with digoxin (Lanoxin). The nurse concludes that potassium supplements are needed also because:

Digoxin toxicity occurs rapidly in the presence of hypokalemia

A client is admitted to the hospital with a diagnosis of acute salmonellosis. What does the nurse expect the health care provider to prescribe?

Electrolytes

The nurse is developing a postprocedure plan of care for a client with a continuous bladder irrigation following a transurethral vaporization of the prostate. What should the nurse include in the plan?

Exclude the amount of irrigant instilled from the output

After surgery for cancer of the pancreas, the client's nutrition and fluid regimen is influenced by the remaining amount of functioning pancreatic tissue. The nurse considers both the exocrine and the endocrine functions of the pancreas and expects that, postoperatively, the client's dietary regimen will be focused on the management of:

Fats and carbohydrates

A client is diagnosed as having kidney failure. During the oliguric phase the nurse should assess the client for:

Hyperkalemia

A client who is suspected of having Cushing syndrome is admitted to the hospital. The nurse plans to monitor this client for:

Hypokalemia

A nurse administers an intravenous solution of 0.45% sodium chloride. In what category of fluids does this solution belong?

Hypotonic

A dehydrated infant with a several-day history of vomiting is admitted to the pediatric unit with the diagnosis of gastroenteritis. The nurse plans to monitor the infant's response to parenteral therapy. What is the best indicator of rehydration?

Increased weight

After administering a loop diuretic, a nurse monitors the client for increased urine output. What principle explains the secondary water loss (diuresis) of a loop diuretic?

Osmosis

A client with a history of alcoholism and cirrhosis is admitted with severe dyspnea as a result of ascites. The nurse concludes that the ascites is most likely the result of increased:

Pressure in the portal vein

A nurse is caring for a client who had a kidney transplant. Which test is most important for determining whether a client's newly transplanted kidney is working effectively?

Serum creatinine

A client's serum albumin value is 2.8 g/dL. Which food selected by the client indicates that the nurse's dietary teaching is successful?

Sliced turkey

While performing a physical assessment of an infant with hypertrophic pyloric stenosis (HPS) the nurse observes visible peristaltic waves. What other sign of HPS should the nurse expect?

Small mass in the right upper quadrant

Potassium supplements are prescribed for a client receiving diuretic therapy. What client statement indicates that the teaching about potassium supplements is understood?

"I will report any abdominal distress."

An 85-year-old client has a serum potassium level of 6.7 mEq/L. Which nursing action is a priority at this time? 1 Monitor for cardiovascular irregularities. 2 Inquire about changes in bowel patterns. 3 Assess client for leg muscle twitching or weakness. 4 Assess client for signs and symptoms of dehydration

1 Monitor for cardiovascular irregularities.

A 3-year-old child is admitted to the burn unit with partial- and full-thickness burns over 30% of the body. For what complication should the nurse assess the child during the first 48 hours? 1 Shock 2 Pneumonia 3 Contractures 4 Hypertension

1 Shock

When the nurse arrives at 8 AM, a client has a 1000-mL bag of D5W hanging, with 450 mL absorbed during the prior shift. The IV infusion is to deliver 100 mL per hour. At 11 AM the health care provider changes the prescription for the intravenous solution to 1000 mL 0.9% sodium chloride to be administered at 75 mL per hour and changes the dietary prescription from nothing by mouth to clear liquids. From 1 PM to the end of the 12-hour shift at 8 PM, the client has 4 ounces of apple juice, a ½ cup of tea, a ½ cup of gelatin, and 6 ounces of water. How many milliliters should the nurse document as the client's total fluid intake for the 12-hour shift? Record your answer using a whole number with no punctuation. ___ mL

1515

A client weighs 210 pounds on admission to the hospital. After two days of diuretic therapy the client weighs 205.5 pounds. The nurse estimates that the amount of fluid the client has lost is: ___ L (Record your answer as a whole number)

2

A nurse administers a parenteral preparation of potassium slowly and cautiously to avoid which complication? 1 Acidosis 2 Cardiac arrest 3 Psychotic-like reactions 4 Edema of the extremities

2 Cardiac arrest

A nurse is caring for a 3-month-old infant who was admitted to the pediatric unit with severe dehydration caused by diarrhea. After fluid and electrolyte balance is restored, Lactobacillus granules (Lactinex) are prescribed. The nurse expects this medication to: 1 Help expel gas. 2 Relieve pain caused by hyperacidity. 3 Recolonize flora in the intestinal tract. 4 Diminish inflammatory mucosal edema

3 Recolonize flora in the intestinal tract.

A man who has 40% of the body surface area burned is admitted to the hospital. Fluid replacement of 7200 mL during the first 24 hours has been prescribed. The nurse calculates that the hourly intravenous (IV) fluid should be: ___ mL/hr (Record your answer using a whole number)

300

A client with stage 4 ovarian cancer is admitted for dehydration. The client is to receive an intravenous bolus of 500 mL D5W for 1 hour, after which the rate is to be changed to 150 mL/hr. The drop factor is 15 gtt/mL. At what rate, in drops per minute, should the nurse regulate the IV after delivery of the 500-mL bolus?

38

A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. What test result should the nurse anticipate? 1 Arterial pH 7.5 2 Hematocrit of 54% 3 Creatinine of 1.2 mg/dL 4 Potassium of 6.3 mEq/L

4 Potassium of 6.3 mEq/L

A client who is dehydrated is to receive an intravenous (IV) solution of normal saline to be infused at 175 mL/hr. The drop factor of the IV set is 15 gtts/mL. At what drop rate should the nurse adjust the flow to provide the prescribed solution? Record your answer using a whole number. ___gtts/min

44

The intake and output of a client over an eight-hour period (from 0800-1600) is as follows: 150 mL urine voided at 0800; 220 mL urine voided at 1200; 235 mL urine voided at 1600; 200 mL gastric tube formula + 50 mL water administered initially and then repeated x 2; IV had 900 mL in the bag at 0800, and 550 mL remains in the bag at 1600. What is the difference between the client's intake and output? Record the answer using a whole number ___ mL

495

Which intravenous fluid should the nurse classify as hypertonic?

5% dextrose in normal saline

A client rescued from a burning building has partial- and full-thickness burns over 40% of the body. Which is the initial physiologic change that the nurse can expect?

An increase in serum potassium

The nurse is preparing to administer an antibiotic that has been newly prescribed. The nurse plans to administer the antibiotic via a secondary line into the primary infusion of 0.9% sodium chloride. Shortly after initiation of the antibiotic piggyback, the client becomes restless and flushed, and the client begins to wheeze. The nurse determines that appropriate first actions will be to stop the antibiotic infusion and:

Assess the client's respiratory status.

A client's laboratory values demonstrate an increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. For what clinical manifestations should the nurse assess this client? Select all that apply.

Cardiac dysrhythmias Hypoactive bowel sounds

The occurrence of which condition would warrant the nurse calling the primary health care provider to discontinue the intravenous (IV) fluids?

Crackles in lungs

A client is waiting for a kidney transplant. What explanation should the nurse include when teaching the client about the transplant? 1 "Production of urine will be delayed after surgery." 2 "You will require immunosuppressive drugs daily for the rest of your life." 3 "Symptoms of rejection include a decrease in temperature and blood pressure." 4 "You will need to modify your program of work and recreation, including sports.

2 "You will require immunosuppressive drugs daily for the rest of your life."

A client admitted for uncontrolled hypertension and chest pain was started on a daily diuretic two days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.7 mEq/L. Which action should the nurse take next? 1 Notify the health care provider that the potassium level is above normal 2 Notify the health care provider that the potassium level is below normal 3 No action is required because the potassium level is within normal limits 4 Hold the client's morning diuretic dose

2 Notify the health care provider that the potassium level is below normal

The primary health care provider prescribes furosemide (Lasix) 80 mg by mouth daily. Before administering the furosemide, it is most important for the nurse to: 1 Assess skin turgor. 2 Weigh the client. 3 Check the potassium lab results. 4 Check the total intake and output for the last 24 hours

3 Check the potassium lab results.

When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction. For what response should the nurse critically assess this client? 1 Edema 2 Belching 3 Fluid deficit 4 Excessive salivation

3 Fluid deficit

An intravenous (IV) solution of 1000 mL 5% dextrose in water is to be infused at 125 mL/hr to correct a client's fluid imbalance. The infusion set delivers 15 drops/mL. To ensure that the solution will infuse over an eight-hour period, at how many drops per minute should the nurse set the rate of flow? Record the answer using a whole number. ___ gtts/min

31

A woman is brought to the emergency department by her husband. He is upset and says, "She fainted in the kitchen. I'm so worried about her, because she's going to kill herself if she keeps this up." A history is obtained from the husband, and the vital signs and physical assessment data are collected by the nurse. What should the nurse do next? 1 Offer her a small sandwich. 2 Auscultate the abdomen for bowel sounds. 3 Administer oxygen by way of nasal cannula. 4 Obtain a blood specimen for serum electrolytes

4 Obtain a blood specimen for serum electrolytes

A nurse is evaluating a client's understanding of peritoneal dialysis. Which information in the client's response indicates an understanding of the purpose of the procedure? 1 Reestablish kidney function 2 Clean the peritoneal membrane 3 Provide fluid for intracellular spaces 4 Remove toxins in addition to other metabolic wastes

4 Remove toxins in addition to other metabolic wastes

A client is rescued from a house fire and arrives at the emergency department one hour after the rescue. The client weighs 132 pounds and is burned over 35% of the body. The nurse expects that the amount of lactated Ringers solution that will be prescribed to be infused in the next eight hours is:

4200 mL

A nurse is caring for a severely dehydrated infant. After adequate kidney function is confirmed, potassium is added to the intravenous rehydration solution. It is to be infused at a rate of 15 mL/kg body weight every 24 hours. The infant weighs 13 lbs. What does the nurse calculate for the infant's intravenous fluid intake per day? Record your answer using one decimal place. ___ mL

88.6

A nurse assesses a client who had a gastric resection. During the first 24 hours after surgery, the nurse expects to identify:

Bloody nasogastric drainage.

A nurse assesses a client's intravenous site. What clinical finding, unique to infiltration, leads the nurse to conclude that the intravenous (IV) site has infiltrated, rather than become inflamed?

Coolness

A school-aged child with acute glomerulonephritis has fluid intake restricted to the previous day's output plus 40 mL. The child's output over the past 24 hours was 140 mL. From 3 pm to 11 pm the child is to receive one third of the total daily fluid permitted. How much fluid should the nurse provide for the evening intake? 1 60 mL 2 70 mL 3 80 mL 4 90 mL

Correct1 60 mL

A client has been admitted with a diagnosis of intractable vomiting and can only tolerate sips of water. The initial blood work shows a sodium level of 122 mEq/L and a potassium level of 3.6 mEq/L. Based on the lab results and symptoms, what is the client experiencing? 1 Hypernatremia 2 Hyponatremia 3 Hyperkalemia 4 Hypokalemia

Correct2 Hyponatremia

A nurse is caring for a 4-week-old infant with hypertrophic pyloric stenosis who has been admitted to the child health unit for corrective surgery. What is the primary objective of preoperative care for this infant?

Correcting fluid and electrolyte imbalances

Which of the following symptoms indicates to the nurse that the client has an inadequate fluid volume? Select all that apply.

Decreased urine Hypotension Dry mucous membranes Poor skin turgor

A client with hepatic cirrhosis develops hepatic encephalopathy. Neomycin sulfate (Mycifradin) is prescribed. The nurse concludes that the purpose of neomycin is to:

Diminish the blood ammonia level

A nurse is caring for a client who experienced serious burns in a fire. Which relationship between a client's burned body surface area and fluid loss should the nurse consider when evaluating fluid loss in a client with burns?

Directly proportional

A nurse is caring for a client who is receiving an intravenous (IV) infusion. What should the nurse do first if the IV infusion infiltrates?

Discontinue the infusion.

An older client who lives alone was found unconscious on the floor at home. The client was admitted to the hospital with the diagnoses of a fractured hip, kidney failure, and dehydration. In the 24 hours since admission, the client received 1500 mL of intravenous fluid and the serum electrolyte value demonstrates hyponatremia. The nurse concludes that the element that most likely contributed to the hyponatremia is:

Fluid intake

A nurse is caring for a client with type 1 diabetes who is experiencing a fluid imbalance. Which fluid shift associated with diabetes should the nurse take into consideration when assessing this client?

Intracellular to intravascular as a result of hyperosmolarity

A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy?

It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion.

A client who has had right upper quadrant pain for several months now experiences clay-colored stools. Laboratory results reveal elevated liver enzymes and a needle biopsy of the liver is scheduled. What should the nurse include in the client's teaching about the procedure?

Lying on the right side after the procedure is required because it will decrease the risk of hemorrhage

When caring for clients who are demonstrating manic behavior, the nurse must constantly reassess these clients' physical needs. What characteristic about these clients makes this particularly important?

May become exhausted from excessive activity

A client with major burns of the head and chest is admitted to the burn unit. Twenty-four hours after the burn, the client is complaining of severe thirst. The average urinary output is 60 mL/hr for the last 10 hours. No bowel sounds are heard. The nurse's best action is to:

Moisten the lips with wet gauze

The nurse is caring for a client who returns from surgery with a catheter that is attached to a portable wound drainage system exiting from the surgical site. The principle underlying the function of a portable drainage system is:

Negative pressure

An older client comes to the emergency department after three days of diarrhea and is admitted to the hospital for rehydration therapy. In addition to sodium, what electrolyte should the nurse be concerned about most when the client's laboratory results are documented?

Potassium

What is the most important test the nurse should check to determine whether a transplanted kidney is functioning?

Serum creatinine level

A client is admitted post motor vehicle crash. The health care provider has diagnosed the presence of pelvic fractures and bilateral femur fractures. The client's blood pressure has fallen from 121/78 to 62/44 mm Hg and the heart rate has risen from 78 to 128 beats/min. The nurse knows that which parenteral replacement fluids is the most appropriate for this client?

Whole blood products

A client with acute kidney failure states, "Why am I twitching and my fingers and toes tingling?" The nurse should respond, "This is caused by:

calcium depletion.