Chapter 16- Electrolyte acid-base imbalance

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? "I can use laxatives and enemas but only once a week." "A good breakfast for me will include milk and a couple of bananas." "I will be sure to buy frozen vegetables when I grocery shop." "I will take a potassium supplement daily as prescribed."

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

A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? Lactated Ringer solution 0.45% NaCl 0.9% NaCl 5% NaCl

0.45% NaCl

x A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? Lactated Ringer solution 0.45% NaCl 0.9% NaCl 5% NaCl

0.45% NaCl

Which solution is hypotonic? Lactated Ringer solution 0.45% NaCl 0.9% NaCl 5% NaCl

0.45% NaCl is hypotonic

The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? 0.45% sodium chloride 0.9% sodium chloride 5% glucose in water 5% glucose in normal saline solution

0.45% sodium chloride

Which is considered an isotonic solution? 0.9% normal saline Dextran in normal saline 0.45% normal saline 3% NaCl

0.9 normal saline is isotonic

x A client has chronic hyponatremia, which requires weekly laboratory monitoring to prevent the client lapsing into convulsions or a coma. What is the level of serum sodium at which a client can experience these side effects? 114 mEq/L 130 mEq/L 135 mEq/L 148 mEq/L

114 mEq/L

At which serum sodium concentration might convulsions or coma occur? 130 mEq/L (130 mmol/L) 145 mEq/L (145 mmol/L) 140 mEq/L (140 mmol/L) 142 mEq/L (142 mmol/L)

130 mEq/L (130 mmol/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? 4.5 mEq/L 5.5 mEq/L 2.5 mEq/L 3.5 mEq/L

2.5 mEq/L

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? <136 mOsm/kg 275-300 mOsm/kg >408 mOsm/kg 350-544 mOsm/kg

275-300 mOsm/kg

Hypomagnesemia is a common yet often overlooked imbalance in acutely and critically ill patients. Which of the following patients is most likely at the highest risk of experiencing low serum magnesium levels? An obese male patient who has a history of atherosclerosis and a previous non-ST wave elevation myocardial infarction A patient who is temporarily receiving total parenteral nutrition (TPN) as a result of complications from gastric bypass surgery A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use A teenage patient who is currently being treated for non-Hodgkin's lymphoma (NHL)

A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? Neutral Alkaline Acidic Basic

Acidic

A client with excess fluid volume and hyponatremia is in a comatose state. What are the nursing considerations concerning fluid replacement? Restrict fluids and salt for 24 hours. Correct the sodium deficit rapidly with salt. Administer small volumes of a hypertonic solution. Monitor the serum sodium for changes hourly.

Administer small volumes of a hypertonic solution.

To evaluate a client for hypoxia, the physician is most likely to order which laboratory test? Red blood cell count Sputum culture Total hemoglobin Arterial blood gas (ABG) analysis

Arterial blood gas (ABG) analysis

Which is an insensible mechanism of fluid loss? Urination Bowel elimination Breathing Nausea

Breathing

A client reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the client's laboratory work has returned? Potassium Phosphorus Calcium Iron

Calcium

The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms. Administer IV bicarbonate. Suction the client's airway.

Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms.

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 Headache Nausea Hallucinations

Confusion

Baroreceptors in the left atrium and in the carotid and aortic arches respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect? Decrease in the release of aldosterone Increase of filtration in the Loop of Henle Decrease in the reabsorption of sodium Decrease in glomerular filtration

Decrease in glomerular filrtation

The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem? Diminished deep tendon reflexes Tachycardia Cool, clammy skin Acute flank pain

Diminished deep tendon reflexes

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. Increase the rate of the intravenous lactated Ringer solution. Change the lactated Ringer solution to 3% saline. Change the lactated Ringer solution to 2.5% dextrose.

Discontinue the intravenous lactated Ringer solution

The nurse is caring for a client who has a peripheral IV in place for fluid replacement. When caring for the client's IV site, the nurse should: ensure that anticoagulants are placed on hold for the duration of IV therapy. replace the IV dressing with a new, clean dressing if it is soiled. ensure that the tubing is firmly anchored to the client's skin. periodically remove hair from 2 cm around the IV site.

Ensure that the tubing is firmly anchored to the client's skin

The nurse is assessing a client for local complications of intravenous therapy. Which are local complications? Select all that apply. Extravasation Infection Hematoma Phlebitis Air embolism

Extravasation Infection Hematoma Phlebitis

Which nerve is implicated in the Chvostek's sign? Facial Hypoglossal Optic Spinal accessory

Facial

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance? Hyperkalemia Hypocalcemia Hypokalemia Hypercalcemia

Hyoercalcemia

The nurse is called to a client's room by a family member who voices concern about the client's status. On assessment, the nurse finds the client tachypneic, lethargic, weak, and exhibiting a diminished cognitive ability. The nurse also identifies 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this client's signs and symptoms? Hypocalcemia Hyponatremia Hyperchloremia Hypophosphatemia

Hyperchloremia

The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in her lips and fingers. She states that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should the nurse first suspect? Hypophosphatemia Hypocalcemia Hypermagnesemia Hyperkalemia

Hypocalcemia

x The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in her lips and fingers. She states that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should the nurse first suspect? Hypophosphatemia Hypocalcemia Hypermagnesemia Hyperkalemia

Hypocalcemia

Oral intake is controlled by the thirst center, located in which of the following cerebral areas? Hypothalamus Cerebellum Brainstem Thalamus

Hypothalamus

The nurse is working on a burns unit and an acutely ill client is exhibiting signs and symptoms of third spacing. Based on this change in status, the nurse should expect the client to exhibit signs and symptoms of what imbalance? Metabolic alkalosis Hypermagnesemia Hypercalcemia Hypovolemia

Hypovolemia

While assessing a client's peripheral IV site, the nurse observes edema around the insertion site. How should the nurse document this complication related to IV therapy? Air emboli Phlebitis Infiltration Fluid overload

Infiltration

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? Administer an ordered decongestant. Instruct the client to breathe into a paper bag. Offer the client fluids frequently. Administer ordered supplemental oxygen.

Instruct the client to breathe into a paper bag.

With which condition should the nurse expect that a decrease in serum osmolality will occur? Influenza Hyperglycemia Kidney failure Uremia

Kidney failure

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? Headache or blurry vision Abdominal pain or diarrhea Hallucinations or tinnitus Light-headedness or paresthesia

Light-headedness or paresthesia

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? Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

Metabolic acidosis

The nurse is caring for a client admitted to the medical unit 72 hours ago with pyloric stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since. Upon review of the morning's blood work, the nurse notices that the client's potassium is below reference range. The nurse should assess for signs and symptoms of what imbalance? Hypercalcemia Metabolic acidosis Metabolic alkalosis Respiratory acidosis

Metabolic acidosis

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis

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? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Metabolic acidosis

Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality? Sodium Potassium Calcium Magnesium

Sodium

A 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 metabolic acidosis respiratory acidosis respiratory alkalosis

Metabolic alkalosis

x A client has questioned the nurse's administration of IV normal saline, asking, "Wouldn't sterile water would be a more appropriate choice than saltwater?" Under what circumstances would the nurse administer electrolyte-free water intravenously? Never, because it rapidly enters red blood cells, causing them to rupture. When the client is severely dehydrated resulting in neurologic signs and symptoms When the client is in excess of calcium and/or magnesium ions When a client's fluid volume deficit is due to acute or chronic kidney disease

Never, because it rapidly enters red blood cells. causing them to rupture.

The calcium concentration in the blood is regulated by which mechanism? Parathyroid hormone (PTH) Thyroid hormone (TH) Adrenal gland Androgens

Parathyroid hormone (PTH)

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? CO2 Sodium Chloride Potassium

Potassium

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? Prepare to assist with ventilation. Monitor the client's heart rhythm. Prepare for gastric lavage. Obtain a urine specimen for drug screening.

Prepare to assist with ventilation

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 Slurred speech Negative Chvostek sign Muscle weakness

Presence of Trousseau sign

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis

Resiratory alkalosis

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect? Respiratory acidosis Metabolic alkalosis Respiratory alkalosis Metabolic acidosis

Respiratory acidosis

A client with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the client is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance? Respiratory acidosis Respiratory alkalosis Increased PaCO2 CNS disturbances

Respiratory alkalosis

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? Serum bicarbonate of 28 mEq/L PaCO2 less than 35 mm Hg Serum bicarbonate of 21 mEq/L pH 7.26

Serum bicarbonate of 28 mEq/L

A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The kidneys react rapidly to compensate for imbalances in the body. The kidneys regulate the bicarbonate level in the intracellular fluid.

The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance

A client comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The client fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurse's most likely explanation for the low urine output? The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place. The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin. The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output. The man is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.

The man is having a sympathetic reaction,which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.

Which condition leads to chronic respiratory acidosis in older adults? Decreased renal function Erratic meal patterns Thoracic skeletal change Overuse of sodium bicarbonate

Thoracic skeletal change

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 Three ounces of sliced ham, beets, and a salad A frozen, packaged low-fat dinner with a side salad Tomato juice, low-fat cottage cheese, and three slices of bacon

Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad

The physician added the condition "hypervolemia" to a client's list of medical ailments. What could put the client at risk for hypervolemia? Select all that apply. altered cardiac function taking prednisone eating large amounts of bananas drinking too much coffee

altered cardiac function taking prednisone

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? 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)

calcium 12.9 mg/dL (3.2 mmol/L)

A client with emphysema is at a greater risk for developing which acid-base imbalance? chronic respiratory acidosis metabolic alkalosis metabolic acidosis respiratory alkalosis

chronic respiratory acidosis

Early signs of hypervolemia include a decrease in blood pressure. thirst. moist breath sounds. increased breathing effort and weight gain.

increased breathing effort and weight gain

Clients diagnosed with hypervolemia should avoid sweet or dry food because it: increases the client's desire to consume fluid. obstructs water elimination. can cause dehydration. can lead to weight gain.

increases the client's desire to consume fluid

You are doing an admission assessment on an elderly patient newly admitted for end-stage liver disease. You must assess the patient's skin turgor. What should you remember when evaluating skin turgor? Overhydration causes the skin to tent. Dehydration causes the skin to appear edematous and spongy. Inelastic skin turgor is a normal part of aging. Normal skin turgor is moist and boggy.

inelastic skin turgor is a normal part of aging

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 malignancy is causing the electrolyte imbalance. client's diet is lacking in calcium-rich food products. client may be developing hyperaldosteronism. client has a history of alcohol abuse.

malignancy is causing the electrolyte imbalance

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 filtration evaporation active transport

osmosis

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. pH PaCO2 HCO3 Glucose Na+ K+

pH PaCO2 HCO3

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? HCO 21 mEq/L pH 7.48 PaCO 36 O saturation 95%

pH 7.48

Which set of arterial blood gas (ABG) results requires further investigation? pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L

pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

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 pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L

pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L

A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: metabolic acidosis. metabolic alkalosis. respiratory acidosis. respiratory alkalosis.

respiratory alkalosis

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 pitting edema anasarca hypovolemia

third-spacing

A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching? tingling sensation in the fingers polyuria flank pain hypertension

tingling sensation in the fingers