1 Nur 360 fluid prep U ch10
A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators?
Sodium level of 150 mEq/L Explanation: Hypernatremia (normal serum sodium is 135 to 145 mEq/L) is consistent with increased fluid loss and dehydration in diabetes insipidus.
Which set of arterial blood gas (ABG) results requires further investigation?
pH 7.49, PaCO2 30 mm Hg, Pa02 89 mm Hg, and HCOz* 18 mEq/L
The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely?
Magnesium
Which solution is hypotonic?
0.45% NaCl Explanation: Half-strength saline is hypotonic. Lactated Ringer solution and normal saline (0,9% NaCi) are tonic. A 5% Nacl solution is hypertonic.
The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer?
0.45% sodium chloride
The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining?
1 L
A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry. swollen tongue; body temperature of 993 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client?
165 mEq/L
A patient is admitted with severe vomiting for 24 hours as well as weakness and "feeling exhausted." The nurse observes flat T waves and ST-segment depression on the electrocardiogram. Which potassium level does the nurse observe when the laboratory studies are complete?
2.5 mEq/L
A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:
280 mOsm/kg Serum osmolality can be estimated by doubling the serum sodium or using the formula: Na × 2 = glucose/18 + BUN/3. Therefore, the nurse could estimate a serum osmolality of 280 mOsm/kg by doubling the serum sodium value of 140 mEq/L.
A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be
7.50 (hyperventilating = resp alkalosis)
A client with hypervolemia asks the nurse by what mechanism the sodium-potassium pump willi move the excess body fluid. What is the nurse's best answer?
Active transport
A client being treated for a chronic illness has a serum potassium level of 2.9 mEq/L (2.9 mmol/L). Which assessment finding(s) will the nurse expect to assess in the client? Select all that apply.
Anorexia Paresthesias Muscle weakness Leg cramps
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?
Bicarbonate - 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.
A client reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chostek's signs. Which decreased laboratory results does the nurse observe when the client's laboratory work has returned?
Calcium
Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism?
Chest Pain - 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.
Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply.
Clinical manifestations of FVE include distended neck veins, crackles in the lung fields, shortness of breath, increased blood pressure, and tachycardia.
The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition?
Confusion
An adult client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargy. The nurse reconciles the client's medication list and notes that salt tablets had been prescribed. What would the nurse do next?
Consider sodium restriction with discontinuation of salt tablets.
The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L) and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving?
Discontinue the intravenous lactated Ringer solution. The lactated Ringer intravenous (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 solution contains more sodium than daily requirements, and excess sodium worsens fluid volume excess. Lactated Ringer solution also contains potassium, which would worsen the hyperkalemia.
The nurse assesses a client who is diagnosed with bulimia nervosa and at risk for alterations in both fluid and electrolyte balance.
During the assessment, the nurse focuses on monitoring the client for hypokalemia as evidence by cardiac arrhythmia
Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration?
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 nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following?
Extracellular fluid volume deficit
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?
Increased arterial pH - 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.
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
Light-headedness or paresthesia
An older adult client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance?
Metabolic alkalosis
Which electrolyte is a major cation in body fluid?
Potassium
A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance?
Presence of Trousseau sign
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (Pa02), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO,), 27 mm Hg; and bicarbonate (HCO3), 24 mEq/L. Based on these values, the nurse suspects:
Respiratory alkalosis
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result?
Serum sodium level of 124 mEq/L
A client with an intravenous infusion is rubbing his arm. The nurse assesses the site and decides to discontinue the current infusion because of concern that the client has developed phlebitis. Which of the following clinical manifestations would the nurse assess with phlebitis? Select all that apply.
Tender area around the insertion site, Reddened area along the path of the vein
A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis?
The client had a liver transplant 2 years ago.
A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting?
Third-spacing
Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)?
Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad
A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. sodium 137 mEq/L (137 mmol/L) potassium 4.6 mEq/L (4.6 mmol/L) chloride 94 mEq/L (94 mmol/L) calcium 12.9 mg/dL (3.2 mmol/L) What laboratory value is of highest concern to the nurse?
calcium 12.9 mg/dL (3.2 mmol/L)
The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition?
confusion
A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition?
dehydration
The nurse is caring for a 72-year-old client who has been admitted to the unit for a fluid volume imbalance. The nurse knows which of the following is the most common fluid imbalance in older adults?
dehydration
The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process?
elevated blood pressure
A client is experiencing edema in the tissue. What type of intravenous fluid would the nurse expect to be prescribed?
hypertonic solution Explanation: A hypertonic solution is used to pull water back in to circulation, as it has more particles than the body's water. If hypertonics are given too rapidly or in large quantities, they may cause an extracellular volume excess and precipitate circulatory overload and dehydration. As a result, these solutions must be given cautiously and usually only when the serum osmolality has decreased to dangerously low levels. Hypertonic solutions exert an osmotic pressure greater than that of the extracellular fluid. The hospitalized client requires treatment for the tissue edema. An 'isotonic solution is the same concentration as the body's water and is used as an intravenous volutie expander. A hypotonic solution has fewer particles than the body's water, thus shifting water from the vascular space to the tissue.
The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance?
hypocalcemia
Oral intake is controlled by the thirst center, located in which of the following cerebral areas?
hypothalamus
Which condition might occur with respiratory acidosis?
increased intracranial pressure
A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action?
jugular vein distention
With which condition should the nurse expect that a decrease in serum osmolality will occur?
kidney failure
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?
lungs and kidney
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3*), 15 mEq/L. These ABG values suggest which disorder?
metabolic acidosis
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for?
metabolic acidosis
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?
osmosis
The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis?
pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L
A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting?
third spacing
