Chapter 7: Electrolyte Imbalances Multiple choice

Question 2 of 5 A registered nurse is teaching a student nurse how to analyze the electrocardiogram of a hyperkalemic client. Assess the statements made by the student nurse and choose the clinical manifestation that can be observed on the electrocardiogram of a hyperkalemic client. "It will show a flattened T wave." "It will show a prominent U wave." "It will show a prolonged PR interval." "It will show wide QRS complexes." "It will show inverted P waves."

"It will show wide QRS complexes."

Symptoms of fluid volume excess

ascites crackles in lung dyspnes caused by pulmonary fluid accumulation edema, ankle or sacral weight gain (2lbs= 1l of fluid)

Question 3 of 5 One sign associated with hypokalemia is __________________. dark-colored urine edema prolonged PR interval on electrocardiogram. weight gain elevated blood pressure

prolonged PR interval on electrocardiogram.

Question 4 of 12 What is the term for the twitch noted when you tapped along Louise's jaw? Bell's palsy Kernig sign Trousseau's sign Chvostek's sign Trigeminal neuralgia

Chvostek's sign is elicited by tapping on the patient's face, in front of the ear and below the cheek bone. Facial twitching constitutes a positive sign.

Symptoms of Fluid volume deficit

Dark urine depressed fontanelles (infant) dry mucous membranes low urine output orthostatic hypotension poor skin turgor thirst weight loss

Question 4 of 5 Hypercalcemia is often associated with _______________. Hyperphosphatemia Hyponatremia Hypophosphatemia Hypernatremia Hypokalemia

Hypophosphatemia

Normal ranges of Electrolytes Sodium Potassium Calcium Phosphorus Magnesium

Sodium- 153-145 mEq/L Potassium- 3.5-5 mEq/L Calcium- 8.7-10mg/dL Phosphorus- 2.5-4.5 mg/dL Magnesium- 1.5-2.5mEq/L

Question 1 of 5 Reduced sodium concentration accompanied by fluid deficit is also known as: hypervolemic hypernatremia. hypervolemic hyponatremia. hypovolemic hypernatremia. hypovolemic hyponatremia. hypernatremia.

hypovolemic hyponatremia.

Question 11 of 12 Which factors may contribute to this imbalance? Select all that apply. Being male Digitalis usage Age Diet, perhaps lacking in nutrients Diuretic usage

Diet, perhaps lacking in nutrients Diuretic usage Diuretic therapy is the most common cause of hypokalemia; it is present in 20% to 50% of patients on nonpotassium-sparing diuretics. Thiazide and loop diuretics increase the loss of potassium ions in the urine. Inadequate potassium intake can also be a frequent cause of hypokalemia. Patients who are NPO, alcoholic, who have undergone bariatric surgery, and who suffer eating disorders are at greatest risk, but it can also be due to a poor nutritional diet.

Question 5 of 5 Fluid volume excess may cause which of the following signs? Select all that apply. Thirst Edema Dark-colored urine Crackles in the lungs Weight loss

Edema Crackles in the lung

Question 2 of 5 What condition may result in "false hyperkalemia"? hypernatremia acidosis hypermagnesemia alkalosis hypercalcemia

acidosis

Question 3 of 12 What other electrolyte imbalance may you also suspect? Hypernatremia Hyperphosphatemia Hyperkalemia Hypernatremia Hypokalemia

Hyperphosphatemia is usually accompanied by hypocalcemia, and many of its symptoms are related to low calcium levels.

Question 6 of 12 How may metabolic acidosis play a role in Frank's condition? Acidosis causes sodium to shift into cells. Acidosis causes calcium to shift out of cells. Acidosis causes potassium to shift out of cells. Acidosis inhibits calcium transporters. Acidosis elevates serum sodium.

Acidosis causes potassium to shift out of cells. Potassium will move from intracellular fluid (ICF) to extracellular fluid (ECF) based on changes in the hydrogen ion (H+) concentration in the bloodstream. During acidosis, extracellular H+ exchanges with intracellular K+. H+ ions enter the cells, while K+ leaves the cells and enters the plasma. The shift in K+ to the plasma appears as hyperkalemia.

Question 4 of 5 A nurse is providing nutritional advice to a client with hypomagnesemia. Which of the following is a risk factor for hypomagnesemia? Athletic endurance events Obesity Alcoholism Kidney failure

Alcoholism

Question 7 of 12 How may Frank's renal issues play a role in the electrolyte imbalance? Increased sodium reabsorption by the kidneys Decreased potassium excretion by the kidneys Increased calcium reabsorption by the kidneys Increased phosphate excretion by the kidneys Decreased sodium filtration by the kidneys

Decreased potassium excretion by the kidneys In acidosis, hydrogen ions enter the cells, causing potassium ions to leave the cells and enter into the plasma. The elevation in plasma potassium concentration can be compounded by poorly functioning kidneys, as the kidneys normally filter excess potassium into the urine.

Question 5 of 12 While working in the emergency room, you are called to help a patient named Frank who believes he is having a heart attack. He states that his heart rate "feels different." He states also that his fingers feel as if they are going numb. The results of a preliminary ECG show wide QRS complexes; tall, peaked T waves; and bradycardia. Blood analysis reveals metabolic acidosis, with elevated ketones. This is most likely due to Frank having type 1 diabetes. Frank is also being managed for diabetic nephropathy and shows decreased renal function. What electrolyte abnormality due would account for Frank's ECG results? Hypernatremia Hyperkalemia Hypokalemia Hypercalcemia Hypophosphatemia

Hyperkalemia Early symptoms of hyperkalemia include numbness or tingling of the extremities, muscle cramping, diarrhea, apathy, and mental confusion. The ECG will show wide QRS complexes and tall, peaked T waves. As the potassium level rises, the ECG will show bradycardia, irregular pulse rate and, ultimately, cardiac arrest

Question 1 of 5 Which of the following statements about sodium imbalances are true? Select all that apply. Hypernatremia may occur with fluid excess or fluid deficit. Hypernatremia causes muscle inflexibility. Hypernatremia may result in increased thirst. Hyponatremia accompanied by fluid excess may result in cell swelling. Hyponatremia only occurs with fluid excess.

Hypernatremia may occur with fluid excess or fluid deficit. Hypernatremia may result in increased thirst. Hyponatremia accompanied by fluid excess may result in cell swelling.

Question 2 of 12 Recall Louise complained about tingling around her mouth and in her fingers and muscle spasms. Based on Louise's symptoms, what electrolyte imbalance do you suspect? Hypokalemia Hyperkalemia Hypocalcemia Hyponatremia

Hypocalcemia The signs and symptoms of hypocalcemia include neuromuscular excitability, which can be demonstrated as paresthesias around the mouth, hands, and feet; muscle spasms of the face, hands, and feet; laryngeal spasm; seizures; and death.

Question 10 of 12 John is a 41-year-old sales manager. A routine ECG on John shows a prolonged PR interval and smaller than normal T waves. When he stands up from bed, he complains of dizziness. His medical history indicates that orthostatic hypotension is a concern. John has been in poor health for some time. He has heart failure and is currently taking digitalis and a diuretic to manage his condition. He admits his diet is poor. He consumes mainly processed, fast foods. Lately, John states he has been experiencing muscle weakness and feels more tired than usual. He is frequently awakened at night with leg cramps. He also complains of difficulty breathing, especially at night. He states that he needs to prop himself up with two to three pillows. What electrolyte imbalance do you suspect? Hypernatremia Hypocalcemia Hyponatremia Hypomagnesemia Hypokalemia

Hypokalemia The two keys pointing to hypokalemia in this case are the abnormalities observed with electrocardiography and the usage of diuretics. Hypokalemia alters the resting membrane potential of cells, causing hyperpolarization. Flattened, smaller T waves appear on ECG's as repolarization is delayed. Hypokalemia may develop with the use of diuretics. For some diuretics, the mechanism of action is a reduction in ion reabsorption, which also reduces water reabsorption, increasing urine output. John's symptoms, such as leg cramps, provide further support that hypokalemia may be present.

Question 5 of 5 Which of the following are incorrectly mismatched? Select all that apply. Acidosis - false hyperkalemia Hypokalemia - prolonged PR intervals Hypocalcemia - hypophosphatemia Hypovolemic hypernatremia - edema Hypervolemic hyponatremia - diluted sodium concentration

Hypokalemia - prolonged PR intervals Hypocalcemia - hypophosphatemia Hypovolemic hypernatremia - edema

Question 8 of 12 Leslie, a 42-year-old woman, was admitted into the emergency room after completing 32 of 50 miles in an ultramarathon. The medical team brought her to ER after noticing her movements were uncoordinated and she was confused about her surroundings. They report that she had difficulty speaking. She complained of nausea but denied vomiting. She was clutching her calf muscle as it contracted in a spasm. ECG results were normal. Blood chemistry values showed a key electrolyte imbalance, and treatment began. After stabilization, she told you that she had been doing "fine" during the race. It had been hotter than she expected, so she had made certain to hydrate and drank a "ton" of water. She did not feel like consuming food or other nutrients during the race. What electrolyte imbalance do you suspect? Hyponatremia Hypercalcemia Hypokalemia Hypermagnesemia Hypophosphatemia

Hyponatremia One of the concerns with an event such as an ultramarathon is keeping fluid and electrolyte levels within the normal range. In Leslie's situation, the fact she drank a "ton" of water without significant electrolyte replacement through food, beverages, or tablets, would lead you to be concerned about diluting plasma concentrations of electrolytes, particularly sodium. Her symptoms, such as confusion and muscle cramps, point to hyponatremia.

Question 9 of 12 Which action contributed to this imbalance? Select all that apply. Increased sweating Being above age 40 Running over 20 miles Increased fluid intake Lack of electrolyte intake

Increased sweating, Increased fluid intake, lack of electrolyte intake Leslie is experiencing hyponatremia because she was over-hydrating without taking in enough food or nutrients during the race, including sodium, which she was sweating out due to the physical exertion experienced during the ultramarathon. This resulted in the sodium in Leslie's system diluting to the point that she began to experience dilutional hyponatremia.

Question 12 of 12 Select the signs and symptoms that are associated with this electrolyte imbalance. Select all that apply. Leg cramps Dyspnea Prolonged PR interval Flattened T waves Orthostatic hypotension

Leg cramps Prolonged PR interval Flattened T waves The major signs and symptoms of hypokalemia include anorexia, nausea, vomiting, sluggish bowel, cardiac arrhythmias, postural hypotension, muscle fatigue, and weakness. Leg cramps are common and, in severe hypokalemia, respiratory muscles can be weakened. On ECG, there is a prolonged PR interval, flattened T wave, and prominent U wave.

Question 3 of 5 Your client's lab results show that the client's serum calcium level is very elevated. What signs and symptoms would the client exhibit? Select all that apply. Dizziness Diarrhea Muscle spasms Muscle weakness Edema

Muscle weakness

Question 1 of 12 Louise recently had thyroid surgery due to a tumor. You are a nurse working at acute care clinic. She comes in to the office today complaining of tingling around her mouth and fingers and small muscle spasms. She is surprised when you ask if you can tap along her cheekbone. When you do this, you note a slight twitch in her facial muscles. Louise wonders if any of this could be related to her surgery. What tissues do you suspect may have been damaged during Louise's surgery? Parathyroid glands Muscles of the jaw Muscles of the eyes Nerves affecting the lips Diaphragm

Parathyroid glands The parathyroid glands are small structures located near the posterior aspect of the thyroid gland. Surgery of the thyroid gland may inadvertently damage the parathyroid glands.