Ch 40 PrepU Fluid and Electrolytes

A nurse is teaching a client regarding a newly implanted venous access system. Which statement by the nurse is incorrect? "Implanted catheters have a self-sealing port." "The implanted venous access is hidden under the skin." "The catheter will need to be flushed periodically with heparin." "You won't have to endure any more needlesticks."

"You won't have to endure any more needlesticks."

What commonly used intravenous solution is hypotonic? lactated Ringer's 10% dextrose in water 0.9% NaCl 0.45% NaCl

0.45% NaCl

The nurse is administering 1,000 mL 0.9 normal saline over 10 hours (set delivers 60 gtt/1 mL). Using the formula below, the flow rate would be: gtt/min = milliliters per hour x drop factor (gtt/mL) ÷ 60 min/hr 600 gtt/min 160 gtt/min 60 gtt/min 100 gtt/min

100 gtt/min

Total parenteral nutrition is hypertonic. What is the percentage of dextrose in these solutions? 10% dextrose 2.5% dextrose 50% dextrose 5% dextrose

50% dextrose Total parenteral nutrition (TPN) is a hypertonic solution containing 20% to 50% dextrose, proteins, vitamins, and minerals that is administered into the venous system.

A health care provider orders a bolus infusion of 250 mL of normal saline to run over 1 hour. The set delivers 20 gtt/mL. What is the flow rate in gtt/min? 42 gtt/min 167 gtt/min 83 gtt/min 5,000 gtt/min

83

The nurse is planning to discontinue a peripherally inserted central catheter (PICC) for a client who is prescribed warfarin therapy. Which intervention will individualize care for this client? Apply pressure to insertion site for at least 3 minutes. Apply petroleum-based ointment and sterile occlusive dressing. Ask client to perform Valsalva maneuver. Instruct client to remain flat for 30 minutes.

Apply pressure to insertion site for at least 3 minutes.

The nurse is providing care for a client with a peripheral intravenous catheter in situ. What intervention should the nurse implement in the care of this IV? Flush the catheter every six hours with hypertonic solution if the IV is not in constant use. Change the site every three to four days. Insert the largest gauge possible to maximize flow and minimize the risk of occlusion. Clean the insertion site daily using sterile technique.

Change the site every three to four days. Peripheral IV sites should be rotated every 72 to 96 hours, depending on the institutional protocol. IV insertion sites are not cleansed daily, but the site should be assessed per institutional protocol or every nursing shift. Flushes are not necessary every six hours. Hypertonic solution is not used for IV flushes. The smallest gauge that is practical should be inserted in order to minimize trauma.

The nurse is assuming care for a client who is receiving an infusion of packed red blood cells (PRBCs). The PRBCs were hung 4 hours ago, and 100 mL is left to infuse. Which action is most appropriate? Discontinue the infusion and record the volume left in the blood bag. Fully open the roller clamp on the infusion set and infuse the remaining PRBCs as rapidly as possible. Continue to infuse the PRBCs until they are completely infused. Insert a larger gauge IV catheter and transfer the infusion to the new insertion site.

Discontinue the infusion and record the volume left in the blood bag.

The nurse is caring for a client with "hyperkalemia related to decreased renal excretion secondary to potassium-conserving diuretic therapy." What is an appropriate expected outcome? ECG will show no cardiac dysrhythmias within 24 hours after beginning supplemental K+. ECG will show no cardiac dysrhythmias within 48 hours after removing salt substitutes, coffee, tea, and other K+-rich foods from diet. Bowel motility will be restored within 24 hours after eliminating salt substitutes, coffee, tea, and other K+-rich foods from the diet. Bowel motility will be restored within 24 hours after beginning supplemental K+.

ECG will show no cardiac dysrhythmias within 48 hours after removing salt substitutes, coffee, tea, and other K+-rich foods from diet.

A client is to receive a blood transfusion. Immediately after initiating the transfusion, the nurse suspects that the client is experiencing a hemolytic reaction based on which finding? Select all that apply. Low back pain Urticaria Fever Hematuria Facial flushing

Fever Facial flushing Low back pain Hematuria

A nurse is changing a client's peripheral venous access dressing. The nurse finds that the site is bleeding and oozing. Which type of dressing should the nurse use for this client? Sealed IV dressing Transparent semipermeable membrane dressing Occlusive dressing Gauze dressing

Gauze dressing

A nurse is obtaining an arterial blood specimen from a client to assess acid-base status. Which value is expected for a client with normal status? PaCO2: 48 mm Hg (6.38 kPa) pH: 6.45 HCO3: 25 mEq/L (25 mmol/L) SaO2: 89%

HCO3: 25 mEq/L (25 mmol/L)

A client needs an intravenous fluid that will pull fluids into the vascular space. What type of fluid does the nurse prepare to administer as prescribed? Hypotonic Osmolar Isotonic Hypertonic

Hypertonic

When providing chemotherapeutic agents, which catheter is accessed with a non-coring needle? Hickman catheter Groshong catheter Implanted venous access catheter Peripheral central catheter

Implanted venous access catheter

A nurse is assessing clients across the lifespan for fluid and electrolyte balance. Which age group would the nurse identify as having the greatest risk for these imbalances? Adolescents Toddlers School-age children Infants

Infants

A client is admitted to the unit with a diagnosis of intractable vomiting for 3 days. What acid-base imbalance related to the loss of stomach acid does the nurse observe on the arterial blood gas (ABG)? Respiratory alkalosis Metabolic alkalosis Metabolic acidosis Respiratory acidosis

Metabolic alkalosis

An older adult has fluid volume deficit and needs to consume more fluids. Which approach by the nurse demonstrates gerontologic considerations?

Offer small amounts of preferred beverage frequently.

A client has been receiving intravenous (IV) fluids that contain potassium. The IV site is red and there is a red streak along the vein that is painful to the client. What is the priority nursing action? Remove the IV. Slow the rate of IV fluids. Elevate the arm. Apply a warm compress.

Remove the IV.

When caring for a client who is on intravenous therapy, the nurse observes that the client has developed redness, warmth, and discomfort along the vein. Which intervention should the nurse perform for this complication? Apply antiseptic and a dressing. Elevate the client's head. Restart infusion in another vein and apply a warm compress. Position the client on the left side.

Restart infusion in another vein and apply a warm compress.

A nurse is assessing for the presence of edema in a client who is confined to bed and who often lies supine. The nurse would pay particular attention to which area? Sacral area Hands Face Abdomen

Sacral area The nurse should assess the sacral area in the client when determining the presence of edema. Edema is most noticeable in dependent areas of the body. The edema cannot be assessed in the face, hands and abdomen, as these are not dependent areas.

Sodium is the most abundant cation in the extracellular fluid. Which is true regarding sodium? Sodium is not regulated by natriuretic peptides. If sodium is low, it means that there is not enough water. Normal serum sodium levels range from 145 to 155 mEq/L (145 to 155 mmol/L). Sodium is regulated by the renin-angiotensin-aldosterone system.

Sodium is regulated by the renin-angiotensin-aldosterone system.

A nurse is administering a blood transfusion to a client. After 15 minutes, the client reports difficulty breathing. What is the first action by the nurse? Check the client's vital signs. Stop the transfusion and infuse normal saline using the blood tubing. Stop the transfusion and infuse normal saline using a new administration set. Notify the health care provider of the client's response.

Stop the transfusion and infuse normal saline using a new administration set.

What signs of complications and their probable causes may occur when administering an IV solution to a client? Select all that apply. A pounding headache, fainting, rapid pulse rate, increased blood pressure, chills, back pains, and dyspnea occur when an air embolus is present. Engorged neck veins, increased blood pressure, and dyspnea occur when a thrombus is present. Bleeding at the site when the IV is discontinued indicates an infection is present. Swelling, pain, coolness, or pallor at the insertion site may indicate infiltration of the IV. Local or systemic manifestations may indicate an infection is present at the site. Redness, swelling, heat, and pain at the site may indicate phlebitis.

Swelling, pain, coolness, or pallor at the insertion site may indicate infiltration of the IV. Redness, swelling, heat, and pain at the site may indicate phlebitis. Local or systemic manifestations may indicate an infection is present at the site.

The nurse is describing the role of antidiuretic hormone in the regulation of body fluids. What phenomenon takes place when antidiuretic hormone is present? The frequency of voiding increases. Urine becomes more diluted. The client has a decreased sensation of thirst. The renal system retains more water.

The renal system retains more water.

Which statement most accurately describes the process of osmosis? Plasma proteins facilitate the reabsorption of fluids into the capillaries. Water shifts from high-solute areas to areas of lower solute concentration. Solutes pass through semipermeable membranes to areas of lower concentration. Water moves from an area of lower solute concentration to an area of higher solute concentration.

Water moves from an area of lower solute concentration to an area of higher solute concentration.

Which hormone regulates the extracellular concentration of potassium within the human body? testosterone androgen aldosterone progesterone

aldosterone

A client admitted with heart failure requires careful monitoring of his fluid status. Which method will provide the nurse with the best indication of the client's fluid status? output measurements daily BUN and serum creatinine monitoring daily electrolyte monitoring daily weights

daily weights

After surgery, a client is on IV therapy for the next 4 days. How often should the nurse change the IV tubing for this client? every 72 hours every 12 hours every 36 hours every 24 hours

every 72 hours

The nurse is caring for a client who was in a motor vehicle accident and has severe cerebral edema. Which fluid does the nurse anticipate infusing? isotonic hypotonic, followed by isotonic hypertonic hypotonic

hypertonic

A client who is admitted to the health care facility has been diagnosed with cerebral edema. Which intravenous solution needs to be administered to this client? hypertonic solution hypotonic solution colloid solution isotonic solution

hypertonic solution Hypertonic solutions are used in extreme cases when it is necessary to reduce cerebral edema or to expand the circulatory volume rapidly because it is more concentrated than body fluid and draws cellular and interstitial water into the intravascular compartment.

During an assessment of an older adult client, the nurse notes an increase in pulse and respiration rates, and notes that the client has warm skin. The nurse also notes a decrease in the client's blood pressure. Which medical diagnosis may be responsible? hypovolemia edema hypervolemia circulatory overload

hypovolemia The nurse should recognize that hypovolemia, also known as dehydration, may be responsible. Additional indicators of dehydration in older adults include mental status changes; increases in pulse and respiration rates; decrease in blood pressure; dark, concentrated urine with a high specific gravity; dry mucous membranes; warm skin; furrowed tongue; low urine output; hardened stools; and elevated hematocrit, hemoglobin, serum sodium, and blood urea nitrogen (BUN).

A client is diagnosed with metabolic acidosis. The nurse develops a plan of care for this client based on the understanding that the body compensates for this condition by: increasing ventilation through the lungs. decreasing the excretion of H+ ion into the urine. increasing the excretion of HCO3− into the urine. preventing excretion of acids into the urine.

increasing ventilation through the lungs.

The nurse, along with a nursing student, is caring for Mrs. Roper, who was admitted with dehydration. The student asks the nurse where most of the body fluid is located. The nurse should answer with which fluid compartment? extracellular intravascular intracellular interstitial

intracellular