Ch 10 F&E's PrepU

Takes high doses of vitamin D Vit D encourages calcium absorption from GI tract

A client seeks medical attention for an acute onset of severe thirst, polyuria, muscle weakness, nausea, and bone pain. Which health history information will the nurse report to the health care provider? 250

increased breathing effort and weight gain. interstitial pulmonary fluid can cause an increased effort to breath and the excess fluid will cause a weight gain

Early signs of hypervolemia include 237

5% DW this isotonic solution turns hypotonic once glucose metabolizes which will cause the brain cells to swell even more

The health care provider ordered an IV solution for a dehydrated patient with a head injury. Select the IV solution that the nurse knows would be contraindicated. 265-266

dehydration not enough water intake will decrease IV volume

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? 232

hypokalemia leg cramps are a symptom of hypokalemia as well as fatigue other S&S's include: hypotension, bradycardia, confusion, decreased DTR, decreased bowel sounds, irregular thready pulse, shallow respirations / diminished breathing

A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypertension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? 243

malignancy is causing the electrolyte imbalance.

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 250-251

provide oral care every 2-3 hours

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant? 237

275-300 mOsm/kg

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? 229 (how does sodium affect osmolality?)

"I will not salt my food; instead I'll use salt substitute."

The nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricted diet. Which statement by the client indicates the need for additional instruction? 245

Jugular vein distention the body is holding more fluids

Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? 241

Alcoholism "chronic alcohol abuse is a major cause of symptomatic hypomagnesemia." the serum mag level should be measured every 2-3 days in patients undergoing alcohol withdraw

Which is the most common cause of symptomatic hypomagnesemia?

Kidney Failure due to excessive retention of water

With which condition should the nurse expect that a decrease in serum osmolality will occur? pg 237

muscle weakness. S&S's: muscle weakness, bradycardia, hypotension, confusion, increased deep tendon reflexes, increase bowel sounds, cramping, resp failure, ST elevation and Peak T wave

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: 247

osmotic pressure exerted by proteins (albumin) nonsoluble substances

Oncotic pressure refers to 227

Discontinue the intravenous lactated Ringer solution. patient already at fluid excess

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? 245

irregular heart rate

When caring for a client who has risk factors for fluid and electrolyte imbalances, which assessment finding is the highest priority for the nurse to follow up? 240

Potassium K+ (positively charged = cation) , important for neuromuscular and cardiac muscle function

Which electrolyte is a major cation in body fluid? 226

confusion and seizures due to lack of ADH in diabetes, urine water content increases. Diabetes contributes to a depletion of extracellular fluid volume. Diabetes can also cause hypernatremia, causing body to hold more water

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? 234

Cerebral edema ADH tells kidneys how much water to conserve. Syndrome of inappropriate ADH can be caused by over secretion of ADH therefor holding too much fluid

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise?

Pulse because K+ plays a major role in cardiac muscle function and hyperkalemia can cause cardiac arrest

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? 247

Administer small volumes of hypertonic solution small amounts of hypertonic solution is all that is needed to correct hyponatremia. Don't want to administer too much because patient is already hypervolemic. hypertonic solutions are indicated for hyponatremic patients experiencing seizures, delirium, and coma

A client with excess fluid volume and hyponatremia is in a comatose state. What are the nursing considerations concerning fluid replacement? 240

Furosemide Loop diuretics, like furosemide, can cause greater loss of water and salt because they block sodium reabsorption in the ascending limb of the Loop of Henle, where 20-30% of Na is typically absorbed.

A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed? 237

Urine pH of 3.0 Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.010 to 1.025, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?

Oliguria, Tachycardia, and Tachypnea

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?

2.5 mEq/L hypokalemia side effects and hyper have some similar side effects and some differentiating. Both Hyper and Hypo can lead to weakness. The similar side effects between the two are: ↓BP, ↓HR, and confusion. The side effects that separates Hypo from Hyper are: Hypoactive(↓) bowel sounds; ↓DTR's (flaccid, paralysis, burning, weakness, tingling, burning, numbness); shallow respirations; ST depression, flat/inverted T wave, and prominent U wave

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? pg 244

Hypocalcemia calcium plays a major role in clotting factors. less Ca means less clotting ability and more bleeding and bruising

The nurse is caring for a client who has been admitted with a possible clotting disorder. The client is complaining of excessive bleeding and bruising without cause. The nurse knows to take extra care to check for signs of bruising or bleeding in what condition? 249

hypocalcemia

The nurse is caring for a client who has been admitted with a possible clotting disorder. The client is complaining of excessive bleeding and bruising without cause. The nurse knows to take extra care to check for signs of bruising or bleeding in what condition? 249

Neurological system Ca plays a major role in transmitting nerve impulses and helps regulate muscle contraction and relaxation, including cardiac muscle. TETANY, the most characteristic manifestation of hypocalcemia (and hypomagnesemia) REFERS TO THE ENTIRE SYSTEM COMPLEX INDUCED BY INCREASED NEURAL EXCITEABILITY. NO CALCIUM MEANS NO NEURON STABILIZATION

The nurse is assigned a client with calcium level of 4.0 mg/dL. Which system assessment would the nurse ask detailed questions? 248-249

"I can use laxatives and enemas but only once a week."

The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching? pg 244

magnesium alcohol prohibits absorption of Mg

The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely? 252