Ch. 13 - F&E
The nurse is instructing a patient with recurrent hyperkalemia about following a potassium-restricted diet. Which of the following patient statements indicates the need for additional instruction?
"I will not salt my food, instead I'll use salt substitute."
A client's potassium level is elevated. The nurse is reviewing the ECG tracing. Identify the area on the tracing where the nurse would expect to see peaks.
(The earliest change that can be seen are peaked, narrow T waves on the ECG)
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?
2.0 mEq/L
The nurse should assess the patient for signs of lethargy, increasing intracranial pressure, and seizures when the serum sodium reaches what level?
115 mEq/L
A 42-year-old client has chronic hypo natremia, which requires weekly blood labs to keep him from lapsing into convulsions or a coma. What is the level of serum sodium below which convulsions or coma can occur?
135 mEq/L
A patient is admitted with a diagnosis of renal failure. The patient complains of "stomach distress" and describes ingesting several antacid tablets over the past 2 days. Blood pressure is 110/70 mm Hg, face is flushed, and the patient is experiencing generalized weakness. Which is the most likely magnesium level associated with the symptoms the patient is having?
5 mEq/L
What percentage of potassium that is excreted daily, leaves the body by way of the kidneys?
80%
In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours?
800
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?
Acidic
The nurse notes that a patient's urine osmolality is 980 mOsm/kg. What should the nurse assess as a possible cause of this finding?
Acidosis Rationale: Normal urine osmolality is 200 to 800. Acidosis is a factor that increases osmolality. FVE, DI, and hypoNa are all factors that decrease.
What is one process by which dissolved chemicals from one area of the body to another?
Active transport
Which of the following is the most common cause of symptomatic hypomagnesemia?
Alcoholism
The nurse is caring for a patient with hypernatremia. What complication of hypernatremia should the nurse continuously monitor for?
Cerebral edema
Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism?
Chest pain
Which of the following electrolytes is a major anion in body fluid?
Chloride
The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration?
Dark, concentrated urine
A 73-year-old male client was admitted to your hospital unit after 2days of vomiting and diarrhea. His wife became alarmed when he demonstrated confusion and elevated temperature and reported "dry mouth."You suspect the client is experiencing which of the following conditions?
Dehydration
The nurse is caring for a patient with a serum potassium level of 6.0 mEq/L. The patient is ordered to receive oral sodium polystyrene sulfonate (Kayexelate) and furosemide (Lasix). What other orders should the nurse anticipate giving?
Discontinue the IV lactated Ringer's solution
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:
ECG results
Hypokalemia can cause which of the following symptoms to occur?
Excessive thirst Rationale: HypoK can lead to an inability of the kidneys to concentrate urine, causing dilute urine and excessive thirst
Which of the following is a factor affecting an increase in serum osmolality?
Free water loss
Which of the following is a factor that increases blood urea nitrogen (BUN)?
GI bleeding
You are caring for a new client on your unit who is third-spacing fluid. You know to assess for what type of edema?
Generalized
A patient with mild fluid volume excess is prescribed a diuretic that blocks sodium reabsorption in the distal tubule. Which diuretic does the nurse anticipate administering to this patient?
HydroDiuril Rationale: Lasix, Bumex, Demadex can cause a greate loss of both water and sodium because they block Na reabsorption in the ascending limb of Henle's loop.
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
Hyperkalemia
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
Which of the following electrolyte imbalances occur with adrenal insufficiency?
Hyperkalemia
You are caring for a client who has been admitted with a possible clotting disorder. The client is complaining of excessive bleeding and bruising without cause. You know that you should take extra care to check for signs of bruising or bleeding in what condition?
Hypocalcemia
During his annual physical exam, your 72-year-old male client complains of muscle cramps in his calves and that he feels "tired a lot." He is taking ethacrynic acid (Edecrin) for his hypotension. Your client will be evaluated for which of the following electrolyte imbalance based on his symptoms?
Hypokalemia
Which of the following conditions does the nurse need to confirm when he or she taps the facial nerve of a client who has dysphagia?
Hypomagnesemia
A patient with a magnesium level of 2.6 mEq/L is being treated on a medical-surgical unit. Which of the following treatments should the nurse anticipate will be used?
IV furosemide (Lasix)
Which of the following may occur with respiratory acidosis?
Increased intracranial pressure
When caring for a patient who has risk factors for fluid and electrolyte imbalances, which of the following assessment findings is the highest priority for the nurse to follow up?
Irregular heart rate
The nurse is caring for a patient undergoing alcohol withdrawal. Which of the following serum laboratory values should the nurse monitor most closely?
Magnesium
Your clients lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap?
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 Rationale: Metabolic acidosis is a common clinical disturbance characterized by a low pH and a low plasma bicarbonate concentration
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur?
Metabolic alkalosis
Which of the following statements accurately reflects a rule of thumb upon which the nurse may rely in assessing the patient's fluid balance?
Minimal intake pf 1.5 liters per day
A priority nursing intervention for a client with hypervolemia involves which of the following?
Monitoring resp. status for s/s of pulmonary complications
The nurse is assigned a client with calcium level of 4.0 mg/dL. Which system assessment would the nurse ask detailed questions?
Neurological system Rationale: Tetany, seizures, and spasms
A client is experiencing edema in the tissue. The nurse is correct in anticipating which tonicity of intravenous fluid?
No IV solution Rationale: A hypertonic solution is used to pull water back in to circulation as a hypertonic solution has more particles than the body's water. An isotonic solution is the same concentration as the body's water and is used as an intravenous volume 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 adding the intake and output results for a client diagnosed with dehydration. The nurse notes a 24-hour intake of 1500 mL/day between oral fluids and intravenous solutions. The output total is calculated as 2800 mL/day from urine output, emesis, and Hemovac drainage. Which nursing action is best to maintain an acceptable fluid balance?
Offer a prescribed antiemetic medication
A patient with abnormal sodium losses is receiving a regular diet. How can the nurse supplement the patient's diet to provide 1,600 mg of sodium daily?
One beef cube and 8 ox of tomato juice
The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders?
Potassium: 5.8 mEq/L
A patient is being treated in the ICU 24 hours after having a radical neck dissection completed. The patient's serum calcium level is 7.6 mg/dL. Which of the following physical examination findings is consistent with this electrolyte imbalance?
Presence of Trousseau's sign
The nurse is analyzing the electrocardiographic (ECG) rhythm tracing of a patient experiencing hypercalcemia. Which of the following ECG changes is typically associated with this electrolyte imbalance?
Prolonged PR intervals
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?
Respiratory acidosis
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L Rationale: Normal range is 21-26
What does the nurse recognize as one of the indicators of the patient's renal function?
Serum creatinine
A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant?
Serum potassium level of 3 mEq/L
Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality?
Sodium
Which conditions leads to chronic respiratory acidosis in older adults?
Thoracic skeletal change
A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:
Trousseau's sign
A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?
Urine pH of 3.0
Which of the following may be the first sign of respiratory acidosis in anesthetized patients?
Ventricular fibrilation
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
pH 7.25 PaCO2 50 mm Hg
The nurse is caring for a patient who was admitted with fluid volume excess (FVE). Which of the following nursing assessments should the nurse include in the ongoing monitoring of the patient? Select all that apply.
• Blood pressure, heart rate, and rhythm • Intake and output, urine volume, and color • Skin assessment for edema and turgor
In which of the following medical conditions would administering IV normal saline solution be inappropriate? Select all that apply.
• Heart failure • Pulmonary edema • Renal impairment
What laboratory findings does the nurse determine are consistent with hypovolemia in a female patient? (Select all that apply.)
• Hematocrit level of >47% • Urine specific gravity of 1.027 • Urine osmolality of >450 mOsm/kg
Which of the following is a function of calcitonin? Select all that apply.
• Increases deposition of calcium in bones • Reduces bone resorption • Increases urinary excretion of calcium
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? (Select all that apply.)
• Oliguria • Tachycardia • Tachypnea
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.
• Reddended area along the path of the vein • Tender area around the insertion site
The nurse is caring for a patient diagnosed with hyperchloremia. Signs and symptoms of hyperchloremia include which of the following? Select all that apply.
• Tachypnea • Weakness • Lethargy
