Electrolytes and Fluids
Calcium is present in the serum in what 3 forms?
1. Free or ionized; 2. bound to protein (primarily albumin); and 3. complexed with phosphate, citrate, or carbonate. **The ionized form is the biologically active form.**
What are the two major fluid compartments in the body?
1. intracellular fluid (ICF), or inside the cells, and 2. extracellular fluid (ECF), or outside the cells. ECF is composed of interstitial fluid, plasma, and transcellular fluids.
What is hyPOcalcemia?
A low serum calcium level. (below 8.6 mg/dL)
What is hyPOmagnesemia?
A low serum magnesium level. < 1.5 mEq/L
What is hyPOphosphatemia?
A low serum phosphorus level.
What is hyPOkalemia?
A low serum potassium level.
What does Aldosterone do?
A mineralcorticoid, its secretion causes sodium retention and potassium excretion.
What causes diabetes insipidus?
A reduction in the release of ADH
Which of the following solutions is hypotonic? a) 0.45% NaCl b) 5% NaCl c) 0.9% NaCl d) Lactated Ringer's solution
A) 0.45% NaCl Half-strength saline is hypotonic. Lactated Ringer's solution is isotonic. Normal saline (0.9% NaCl) is isotonic. A solution that is 5% NaCl is hypertonic.
What are symptoms of hyPERnatremia?
Dehydration and any accompanying ECF volume deficit, such as postural hypotension, weakness, and decreased skin turgor.
What are the manifestations of hyPOmagnesemia?
Neuromuscular and CNS hyperirritability
What are the clinical manifestations of hyPERphosphatemia?
Symptoms include neuromuscular irritability, tetany, and calcified deposits in soft tissues.
What occurs in cases of hyPOkalemia?
The incidence of potentially lethal ventricular dysrhythmias is increased in hypokalemia. Skeletal muscle weakness and paralysis, including the respiratory muscles, leading to shallow respirations and respiratory arrest, can occur.
What is the primary organ for regulating fluid and electrolyte balance?
The kidney
What happens with impaired kidneys?
The kidneys cannot maintain fluid and electrolyte balance, resulting in edema and electrolyte imbalances.
What causes hyPERkalemia?
The most common cause is renal failure. Hyperkalemia is also common with massive cell destruction (e.g., burn or crush injury, tumor lysis); rapid transfusion of stored, hemolyzed blood; and catabolic states (e.g., severe infections).
What is first spacing?
The normal distribution of fluid in the ICF and ECF compartments.
What is third spacing?
When fluid accumulates in a portion of the body from which it is not easily exchanged with the rest of the ECF (e.g., burns, blisters).
what does fluid volume DEFICIT result from?
With abnormal loss of body fluids (e.g., diarrhea, fistula drainage, hemorrhage, polyuria), inadequate intake, or a plasma-to-interstitial fluid shift.
What is hyPERnatremia?
An elevated serum sodium that may occur with water loss or sodium gain.
How is ADH secretion stimulated?
An increase in plasma osmolality (concentration) or lowered blood volume.
What are the four pressures acting on body fluids?
(1) capillary hydrostatic pressure, (2) plasma oncotic pressure, (3) interstitial hydrostatic pressure, and (4) interstitial oncotic pressure.
A nursing instructor is reviewing with the class the steps in urine formation. Place in the correct order from first to last the sequence the instructor would present. -Filtrate enters Bowman's capsule -Plasma filtered through glomerulus -Formed urine drains from the collecting tubules, into the renal pelvis, and down each ureter to the bladder -Filtrate moves through tubular system of the nephron and is either reabsorped or excreted
-Plasma filtered through glomerulus -Filtrate enters Bowman's capsule -Filtrate moves through tubular system of the nephron and is either reabsorped or excreted -Formed urine drains from the collecting tubules, into the renal pelvis, and down each ureter to the bladder
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute glomerulonephritis b) Acute renal failure c) Nephrotic syndrome d) Chronic renal failure
A) Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder? a) Anticholinergic agent b) Over-the-counter decongestant c) Tricyclic antidepressants d) Estrogen hormone
A) Anticholinergic agent Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.
The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? a) Catheterize the client immediately after the client voids. b) Check for residual after the client reports the urge to void. c) Set up a routine schedule of every 4 hours to check for residual urine. d) Record the volume of urine obtained.
A) Catheterize the client immediately after the client voids Explanation: To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids.
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? a) Check for thrill or bruit over the access site. b) Warm the solution to body temperature. c) Inspect the catheter insertion site for infection. d) Add the prescribed drug to the dialysate.
A) Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a) Dehydration b) Crackles c) Hypertension d) Hyperkalemia
A) Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of: a) Disturbed body image b) Situational low self esteem c) Anticipatory grieving d) Deficient knowledge: stoma care
A) Disturbed body image The client is exhibiting defining characteristics of disturbed body image.
Which of the following terms is used to refer to inflammation of the renal pelvis? a) Pyelonephritis b) Interstitial nephritis c) Urethritis d) Cystitis
A) Pyleonephritis Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.
Which of the following electrolytes is a major cation in body fluid? a) Potassium b) Bicarbonate c) Chloride d) Phosphate
A) Potassium Potassium is a major cation that affects cardiac muscle functioning. Chloride is an anion. Bicarbonate is an anion. Phosphate is an anion.
Retention of which electrolyte is the most life-threatening effect of renal failure? a) Potassium b) Calcium c) Phosphorous d) Sodium
A) Potassium Retention of potassium is the most life-threatening effect of renal failure.
A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse? a) Renal circulation b) Urine production c) Kidney function d) Kidney structure
A) Renal circulation A renal angiogram (renal arteriogram) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. b) Administer furosemide (Lasix) 20 mg I.V. c) Encourage oral fluids. d) Start hemodialysis after a temporary access is obtained.
A) Start IV fluids with normal saline solution bolus followed by a maintenance dose. Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a) Urine output of 250 ml/24 hours b) Temperature of 100.2° F (37.8° C) c) Serum creatinine level of 1.2 mg/dl d) Blood urea nitrogen (BUN) level of 22 mg/dl
A) Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. a) Vitamin D synthesis b) Secretion of prostaglandins c) Vitamin B production d) Secretion of insulin e) Regulation of blood pressure
A) Vitamin D synthesis B) Secretion of prostaglandins E) Regulation of blood pressure Explanation: Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.
What is hyPERcalcemia?
An elevated serum calcium level. (above 10.2 mg/dL)
What is the most common cause of hyPOkalemia?
Abnormal losses via either the kidneys or the gastrointestinal tract.
What causes potassium to move from the ICF to the ECF?
Acidosis, trauma to cells (as in massive soft tissue damage or in tumor lysis), and exercise.
What is hyPERmagnesemia?
An elevated serum magnesium level. >2.5 mEq/L
What is hyPERphosphatemia?
An elevated serum phosphorus level. It is usually associated with acute or chronic renal failure.
What is hyPERkalemia?
An elevated serum potassium level.
What is second spacing?
An abnormal accumulation of interstitial fluid (i.e., edema).
The nurse is concerned that a patient's arterial blood carbon dioxide level is increasing because this can contribute to the development of which of the following disorders? 1. hyperkalemia 2. hypokalemia 3. hypercalcemia 4. hypocalcemia
Answer: 1 Rationale: A rise in arterial blood carbon dioxide is a diagnostic indicator of acidosis. Acidosis contributes to hyperkalemia because excess hydrogen ions shift into the cells, forcing potassium out into the serum. The nurse should be concerned about the patient developing hyperkalemia. Acidosis does not contribute to the development of the other disorders.
A patient has a serum calcium level of 7.9 mg/dL. Which of the following interventions would be appropriate for this patient? 1. place on seizure precautions 2. strain urine 3. assess for hypertension 4. treat tachycardia
Answer: 1 Rationale: A serum calcium level of less than 8.5 mg/dL is indicative of hypocalcemia. Nursing interventions appropriate for the patient would include monitoring the patient for seizures, signs and symptoms of decreased cardiac output, bradycardia, and ventricular dysrhythmias. Interventions that would not be appropriate for hypocalcemia include straining urine, assessing for hypertension, and treating tachycardia
A patient with fluid volume excess has a hemoglobin level of 9.0 mg/dL. The nurse realizes this laboratory value is due to 1. plasma dilution from excess fluid. 2. undiagnosed bleeding disorder. 3. iron deficiency anemia. 4. chronic anemia.
Answer: 1 Rationale: An altered serum laboratory value, such as a hemoglobin level of 9.0 mg/dl, is the result of plasma dilution from excess extracellular fluid volume. There is not enough information to determine if the patient has an undiagnosed bleeding disorder, iron deficiency anemia, or chronic anemia.
The nurse is assessing a patient diagnosed with hyperphosphatemia. In which of the following medical conditions is this electrolyte imbalance most likely to be seen? 1. chronic renal failure 2. rheumatoid arthritis 3. heart failure 4. chronic obstructive pulmonary disease
Answer: 1 Rationale: Hyperphosphatemia is less commonly seen in the high acuity patient. It is predominantly associated with chronic renal failure even though other causes include hyperthyroidism, hypoparathyroidism, severe catabolic states, and conditions causing hypocalcemia. This electrolyte imbalance is not associated with rheumatoid arthritis, heart failure, or chronic obstructive pulmonary disease
A patient, diagnosed with chronic renal failure, is admitted with hypermagnesemia. Which of the following history data would contribute to this electrolyte imbalance? 1. ingestion of magnesium-containing antacids for epigastric reflux for 3 weeks 2. reduced intake of caffeine-containing fluids 3. recovering from nasal congestion 4. sprained wrist one week ago while carrying heavy groceries up stairs
Answer: 1 Rationale: The patient has chronic renal failure. Even though this abnormality is rare, it can occur with diminished renal excretion as seen in renal dysfunction, or excessive magnesium intake. Consumption of large quantities of magnesium-containing antacids or laxatives can be a source of excessive intake. The history data of ingestion of magnesium-containing antacids for epigastric reflux for 3 weeks is most likely what contributed to this electrolyte imbalance in the patient. The other history data would not have contributed to this imbalance.
A patient is demonstrating upon electrocardiogram a prolonged P-R interval and ST segment depression. The nurse realizes these changes are seen in which of the following electrolyte imbalances? 1. hypokalemia 2. hyperkalemia 3. hypernatremia 4. hypocalcemia
Answer: 2 Rationale: Cardiovascular manifestations of hyperkalemia include prolonged P-R interval; flat or absent P wave; slurring of QRS; tall peaked T wave; and ST segment depression. These same electrocardiogram changes are not seen in hypokalemia, hypernatremia, or hypocalcemia
A patient, being treated for fluid volume excess, is experiencing an elevated blood glucose level. The nurse realizes the diuretic that this patient most likely has been prescribed would be 1. Lasix. 2. Aldactone. 3. hydrochlorothiazide. 4. calcium chloride
Answer: 3 Rationale: Hydrochlorothiazide has hyperglycemia as a major side effect. Lasix and Aldactone do not have hyperglycemia as a major side effect. Calcium chloride is not a diuretic.
A patient has a serum calcium level of 11.0 mg/dL. The nurse realizes that which of the following is contributing to this patient's elevated calcium level? 1. diagnosis of hypoparathyroidism 2. thiazide diuretics and immobility 3. diagnosis of acute pancreatitis 4. low serum magnesium level
Answer: 2 Rationale: Hypercalcemia is seen in patients with malignancies in addition to those who are prescribed thiazide diuretics. It develops from prolonged immobility, hyperparathyroidism and thyrotoxicosis. The diagnosis of hypoparathyroidism and acute pancreatitis are associated with hypocalcemia. A low serum magnesium level is also seen in hypocalcemia.
A patient, with a history of heart failure, is admitted with dehydration, malnutrition, and fatigue. The nurse learns that the patient has been taking multiple doses of a thiazide diuretic. Which of the following electrolyte disorders should be investigated for this patient? 1. hypocalcemia 2. hypophosphatemia 3. hypernatremia 4. hypermagnesemia
Answer: 2 Rationale: Hypophosphatemia is associated with malnourished states and is a relatively common imbalance in the high acuity patient. Other conditions that can cause hypophosphatemia include those disorders that cause hypercalcemia. Thiazide diuretics can cause hypercalcemia. The patient was found to be taking multiple doses of a thiazide diuretic. Therefore, the patient's phosphorus level should be evaluated. Hypophosphatemia is also associated with muscle fatigue, another symptom that the patient is demonstrating. Dehydration, malnutrition, and fatigue are not directly linked to hypocalcemia, hypernatremia, or hypermagnesemia.
A patient is admitted for hypermagnesemia. The nurse realizes that which of the following will be provided to the patient? 1. intravenous fluids of 5% dextrose and 0.45% normal saline 2. calcium 3. maintain on bed rest 4. treatment for tetany
Answer: 2 Rationale: In the patient with the diagnosis of hypermagnesemia, medications containing magnesium should not be given. The first line treatment for elevated magnesium levels is to give calcium. Intravenous fluid infusion of 5% dextrose and 0.45% normal saline is not indicated. The patient does not need to be maintained on bedrest. Tetany is seen in hypomagnesemia and not hypermagnesemia.
A patient is in the intensive care unit experiencing a gastrointestinal hemorrhage. The nurse realizes that the intravenous solution of choice to help this patient would be 1. 0.45% normal saline. 2. 0.9% normal saline. 3. 2.5% dextrose. 4. 5% dextrose and 0.45% normal saline
Answer: 2 Rationale: The patient needs an isotonic solution to expand the blood volume. The appropriate intravenous solution would be 0.9% normal saline. Both 0.45% normal saline and 2.5% dextrose are hypotonic solutions and would not help expand the patient's blood volume. The solution 5% dextrose and 0.45% normal saline is a hypertonic solution and also would not expand the patient's blood volume
The nurse is planning the care of a patient with the risk of developing fluid volume deficit. Which of the following assessment findings would contribute to this risk? 1. loose bowel movement one per day 2. diuretic therapy two doses per day 3. first degree steam burn on forearm 4. temperature 97.6 degrees F
Answer: 2 Rationale: The patient receiving two doses of diuretic therapy per day is at risk for high volumes of urine output which could increase the risk of developing a fluid volume deficit. Other causes of fluid volume deficit include diarrhea and not one loose bowel movement per day. Burns also can cause a fluid volume deficit but it is unlikely that a first degree burn on the forearm will produce these results. Fluid volume deficit is also associated with febrile states. The patient's temperature is below normal and therefore would not add to the risk of a fluid volume deficit.
The nurse is preparing to administer intravenous fluids to a patient diagnosed with hyperphosphatemia. Which of the following solutions would be the most beneficial for this patient? 1. 5% dextrose and water 2. 0.9% normal saline 3. Lactated Ringer's solute 4. 5% dextrose and 0.25% normal saline
Answer: 2 Rationale: Treatment of hyperphosphatemia is directed at lowering serum levels. This is accomplished by either administering agents that bind phosphate in the gastrointestinal tract or administering an intravenous solution with saline since saline promotes the renal excretion of phosphate. The intravenous solution of choice for this patient would be 0.9% normal saline. The other intravenous solutions either do not contain saline or contain saline in insufficient amounts.
The nurse is caring for a patient with a serum sodium level of 149 mEq/L. The nursing diagnoses appropriate for the patient at this time would be 1. risk for imbalanced fluid volume. 2. risk for ineffective cerebral perfusion. 3. risk for injury. 4. anxiety.
Answer: 3 Rationale: A nursing diagnosis appropriate for a patient with hypernatremia is risk for injury because when administering water replacement, the changes in serum sodium can cause rapid fluid shifts in the brain and result in cerebral edema. The patient should be monitored for neurologic deterioration. Risk for imbalanced fluid volume and risk for ineffective cerebral perfusion are nursing diagnoses applicable to the patient with hyponatremia. There is no evidence to suggest the nursing diagnosis of anxiety would be applicable for the patient at this time.
The nurse is preparing intravenous fluids for a patient with hypernatremia. Which of the following types of fluids would be indicated for this patient? 1. 5% dextrose and 0.45% normal saline 2. 10% dextrose in water 3. 0.45% normal saline 4. Lactated Ringer's
Answer: 3 Rationale: To effectively treat hypernatremia, the patient will need to be provided with hypotonic intravenous fluids. The fluid 0.45% normal saline is a hypotonic fluid. The fluids of 5% dextrose and 0.45% normal saline and 10% dextrose in water are hypertonic solutions and would not be used to treat hypernatremia. Lactated Ringer's is an isotonic solution and would not be effective when treating hypernatremia.
The nurse is assessing the effectiveness of fluid replacement therapy in a patient with the nursing diagnosis of fluid volume deficit. Which of the following assessment findings would indicate the therapy is effective? 1. blood pressure 90/48 mm Hg 2. weight loss 1 pound per day 3. mucous membranes dry 4. urine output 40 cc per hour
Answer: 4 Rationale: Evidence of a normal fluid balance would include a urine output of at least 30 cc per hour. The patient is demonstrating a urine output of 40 cc per hour which means the patient is demonstrating effectiveness of fluid replacement therapy. The other assessment findings would indicate that the patient is still under-hydrated or continues to lose fluid volume as evidenced by the weight loss of 1 pound per day. The blood pressure is low and the mucous membranes are dry which both indicate fluid volume deficit.
A patient is receiving several units of packed red blood cells over several days to replace the blood lost during an active gastrointestinal bleed. The nurse realizes that this patient is prone to developing which of the following disorders? 1. hypercalcemia 2. hyponatremia 3. hypernatremia 4. hypocalcemia
Answer: 4 Rationale: Hypocalcemia can be induced by the administration of large amounts of stored blood because stored blood is preserved with citrate. Citrate is added to stored blood as a preservative. When blood is administered, the citrate binds with calcium, which lowers ionized calcium. The administration of blood does not cause hypercalcemia, hyponatremia, or hypernatremia.
The nurse, caring for a patient receiving digoxin, realizes that which of the following electrolytes needs to be monitored for early detection of dysrhythmias? 1. sodium 2. chloride 3. bicarbonate 4. potassium
Answer: 4 Rationale: In patients receiving digoxin therapy, low serum potassium levels can increase the risk for development of dysrhythmias. Although important, the other electrolytes do not provide the same risk for the development of dysrhythmias as potassium.
. A patient comes into the emergency department with complaints of feeling weak, confused, and having abdominal cramps after spending several hours in the hot sun attending a baseball game. The patient's blood pressure is 96/58 mmHg. Which of the following would these signs and symptoms suggest to the nurse? 1. hypernatremia 2. hypocalcemia 3. hypercalcemia 4. hyponatremia
Answer: 4 Rationale: Manifestations of hyponatremia include hypotension, confusion, headache, lethargy, seizures, decreased muscle tone, muscle twitching, tremors, vomiting, diarrhea, and cramping. The patient is complaining of feeling weak and confused with abdominal cramps which are symptoms associated with hyponatremia. The blood pressure of 96/58 mm Hg is another indication of hyponatremia. Manifestations of hypernatremia include hypertension, thirst, nausea, and vomiting. Because the patient was sitting out doors in the hot sun for several hours, the patient mostly likely is experiencing hyponatremia. Neither hypocalcemia nor hypercalcemia has the same manifestations as hyponatremia and it is unlikely that the patient is experiencing either of these electrolyte disorders.
A patient is demonstrating tremors and a positive Chvostek's sign even though the serum calcium level is low normal. Which of the following should the nurse suspect is occurring with this patient? 1. elevated magnesium level 2. low potassium level 3. elevated sodium level 4. low magnesium level
Answer: 4 Rationale: The symptoms associated with a low magnesium level are similar to those seen in a low calcium level. Therefore, the nurse should suspect that the patient is experiencing a low magnesium level since tremors and a positive Chvostek's sign is also seen with a low calcium level. These symptoms are not seen in an elevated magnesium level, low potassium level, or elevated sodium level.
Which of the following is considered an isotonic solution? a) 3% NaCl b) 0.9% normal saline c) Dextran in NS d) 0.45% normal saline
B) 0.9% Normal Saline An isotonic solution is 0.9% normal saline (NaCl). Dextran in NS is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? a) Alkaline b) Acidic c) Basic d) Neutral
B) Acidic Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.
You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? a) Hypovolemia b) Dehydration c) Hypervolemia d) Fluid volume excess
B) Dehydration The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.
A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine? a) Repeated diarrhea b) Excess fluid intake c) Frequent vomiting d) Urine retention
B) Excessive fluid intake Excess fluid intake results in low specific gravity of urine. Excessive fluid intake will result in formation of dilute urine. When the urine is diluted, it results in low specific gravity of urine. Frequent vomiting, repeated diarrhea, and urine retention will result in high specific gravity of urine.
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? a) "Be aware that your urine will be cherry-red for 5 to 7 days." b) "Increase your fluid intake to 2 to 3 L per day." c) "Apply an antibacterial dressing to the incision daily." d) "Take your temperature every 4 hours."
B) Increase your fluid intake to 2 to 3 L per day The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.
Which of the following is a correct route of administration for potassium? a) IV (intravenous) push b) Oral c) Intramuscular d) Subcutaneous
B) Oral Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma? a) Glomerular filtration rate (GFR) b) Renal clearance c) Specific gravity d) Tubular secretion
B) Renal Clearance Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.
A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact? a) The kidneys are situated just above the adrenal glands. b) The left kidney usually is slightly higher than the right one. c) The kidneys lie between the 10th and 12th thoracic vertebrae. d) The average kidney is approximately 5 cm (2?) long and 2 to 3 cm (¾? to 1??) wide.
B) The left kidney usually is slightly higher than the right one The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4??) long, 5 to 5.8 cm (2? to 2¼?) wide, and 2.5 cm (1?) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.
The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with: a) Urethritis b) Ureteral colic c) Interstitial cystitis d) Acute prostatitis
B) Ureteral colic
The nurse observes the color of the client's urine which appears pale blue-green. The nurse obtains a drug history from the client based on the understanding that drugs used by the client may affect which of the following? a) Size of the urinary bladder b) Urinary tract tests c) Urine specific gravity d) Amount of urine produced
B) Urinary tract tests It is important to inquire about drugs because some drugs may affect the outcome of urinary tract tests as well as the color and odor of the urine. Dietary intake may affect urine characteristics as well as urinary tract disorders and their management. Drugs do not directly affect the size of the urinary bladder or the amount of urine produced.
A urinalysis of a urine specimen that is not processed within 1 hour may result in erroneous measurement of a) glucose b) bacteria c) specific gravity d) white blood cells
B) bacteria bacteria in warm urine specimens multiply rapidly, and false or unreliable bacterial counts may occur with old urine. Glucose, specific gravity, and WBCs do not change in urine specimens, but pH becomes more alkaline, RBCs are hemolyzed, and casts may disintegrate.
A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: a) 1 hour. b) 24 hours. c) 1 minute. d) 30 minutes.
C) 1 minute Explanation: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.
Susan Young, a 57-year-old financial officer, has been exhibiting signs and symptoms which lead her urologist to suspect the adequacy of her urinary function. Beginning with the least invasive tests, which of the following would you expect the physician to prescribe to assess kidney function? Choose all correct options. a) Blood urea nitrogen (BUN) level b) Creatinine clearance c) Angiography d) All options are correct
C) Angiography Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.
A client presents at the testing center for an intravenous pyelogram. What question should the nurse ask to ensure the safety of the client? a) "Have you any artificial joints?" b) "Do you have a pacemaker?" c) "Do you have any allergies?" d) "Who has come with you today?"
C) Do you have any allergies? Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.
The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? a) Clean intermittent catheterization b) Suprapubic cystostomy tube c) Permanent drainage with a urethral catheter d) Credé voiding procedure
C) Permanent drainage with a urethral catheter Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones, renal diseases, bladder infections, and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream. Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention. The Credé voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a) History of hyperparathyroidism b) History of osteoporosis c) Recent history of streptococcal infection d) Previous episode of acute pyelonephritis
C) Recent hx of streptococcal infection Explanation: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Impaired urinary elimination b) Toileting self-care deficit c) Risk for infection d) Activity intolerance
C) Risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
A 57-year-old homeless female with a history of alcohol abuse has been admitted to your hospital unit. She was admitted with signs and symptoms of hypovolemia - minus the weight loss. She exhibits a localized enlargement of her abdomen. What condition could she be presenting? a) Hypovolemia b) Pitting edema c) Third-spacing d) Anasarca
C) Third spacing Third-spacing describes the translocation of fluid from the intravascular or intercellular space to tissue compartments, where it becomes trapped and useless. The client manifests signs and symptoms of hypovolemia with the exception of weight loss. There may be signs of localized enlargement of organ cavities (such as the abdomen) if they fill with fluid, a condition referred to as ascites.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a) a decreased serum phosphate level secondary to kidney failure. b) an increased serum calcium level secondary to kidney failure. c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. d) metabolic alkalosis secondary to retention of hydrogen ions.
C) water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.
What are the symptoms of hyPOphosphatemia?
Decreased cardiac output, shallow respirations, irritability, confusion
Which of the following are the insensible mechanisms of fluid loss? a) Bowel elimination b) Urination c) Nausea d) Breathing
D) Breathing Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is unnoticeable and immeasurable. Losses from urination and bowel elimination are measurable.
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a) Therapeutic index b) GI absorption rate c) Liver function studies d) Creatinine clearance
D) Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.
The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? a) Pregnancy b) Diabetes mellitus c) Neuromuscular disorders d) Hypotension
D) Hypotension Hypertension, not hypotension, is a risk factor for kidney disease.
Which type of incontinency refers to the involuntary loss of urine due to medications? a) Overflow b) Urge c) Reflex d) Iatrogenic
D) Iatrogenic Explanation: Iatrogenic incontinence is the involuntary loss of urine due to medications. Reflex incontinence is the involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a) Decreased blood urea nitrogen (BUN) b) Decreased potassium c) Increased serum albumin d) Increased serum creatinine
D) Increased serum creatinine In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a) Increased red blood cell count b) Decreased serum potassium level c) Increased serum calcium level d) Increased serum creatinine level
D) Increased serum creatinine level Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.
Patients diagnosed with hypervolemia should avoid sweet or dry food because: a) It obstructs water elimination. b) It can cause dehydration. c) It can lead to weight gain. d) It increases the client's desire to consume fluid.
D) It increases the client's desire to consume fluid The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed, and the client is advised to take limited amount of fluid when thirsty. Sweet or dry food can increase the client's desire to consume fluid. Sweet or dry food does not obstruct water elimination nor does it cause dehydration. Weight regulation is not part of hypervolemia management except to the extent that it is achieved on account of fluid reduction.
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? a) "The effluent should be allowed to drain by gravity." b) "It is important to use strict aseptic technique." c) "The infusion clamp should be open during infusion." d) "It is appropriate to warm the dialysate in a microwave."
D) It is appropriate to warm the dialysate in a microwave Explanation: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
Which of the following is a characteristic of a normal stoma? a) Painful b) No bleeding when cleansing stoma c) Dry in appearance d) Pink color
D) Pink color Explanation: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Serum sodium level of 135 mEq/L b) Serum potassium level of 4.9 mEq/L c) Temperature of 99.2° F (37.3° C) d) Urine output of 20 ml/hour
D) Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a) Perform deep-breathing exercises vigorously. b) Avoid carrying heavy items. c) Auscultate the lungs frequently. d) Wear a mask when performing exchanges.
D) Wear a mask when performing exchanges The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.
What are treatments for hyPERmagnesemia?
Diuretics, calcium gluconate or calcium chloride.
True or False? The primary function of the kidney is to excrete nitogeneous waste products.
False Primary function of kidney is to regulate the volume and composition of extracellular fluids
How is hyPOkalemia treated?
Giving potassium chloride supplements and increasing dietary intake of potassium.
What two forces drive water movement?
Hydrostatic pressure and osmotic pressure.
What is given to the hyPERkalemic patient experiencing dangerous cardiac dysrhythmias ?
IV calcium gluconate.
What is treatment for hyPOnatremia?
If from water excess, fluid restriction is often the only treatment. If fluid loss is the cause, replacement with sodium-containing solutions is indicated.
What are the manifestations of hyPERmagnesemia?
Initial clinical manifestations include lethargy, drowsiness, and nausea and vomiting. With rising levels, deep tendon reflexes are lost, followed by somnolence, then respiratory and cardiac arrest.
What is the function of phosphorus?
It is a primary anion in the ICF and is essential to the function of muscle, red blood cells, and the nervous system.
What are manifestations of hyPOcalcemia?
It is characterized by increased muscle excitability resulting in tetany.
What is the function of Magnesium?
It is important for cardiac function and is a coenzyme in the metabolism of carbohydrates and proteins.
What is the cause of hyPOphosphatemia?
It is most commonly seen in a patient who is malnourished or has a malabsorption syndrome.
What is the importance of potassium?
It is the major ICF cation and is the major factor in the resting membrane potential of nerve and muscle cells. Potassium is critical for many cellular and metabolic functions, and disruptions cause a number of clinical problems.
How is hyPERnatremia treated?
It is treated by cause. In water deficits, volume is replaced. In sodium excess, dilution is accomplished with sodium-free IV fluids.
What is the usual cause of hyPERphoshatemia?
It is usually associated with acute or chronic renal failure.
What is the cause of hyPERmagnesemia?
It usually occurs only with an increase in magnesium intake accompanied by renal insufficiency or failure.
What is hyPOnatremia?
Low serum sodium level.
What is the cause of hyPOmagnesemia?
Malnutrition, alcoholism, diarrhea, vomiting
How is hyPERphosphatemia treated?
Management is aimed at the underlying cause (treatment of the renal failure).
What are the manifestations of hyPERkalemia?
Manifestations include cramping leg pain, followed by weakness or paralysis of skeletal muscles.
What are the manifestations of HyPERcalcemia?
Manifestations include decreased memory, confusion, disorientation, fatigue, muscle weakness, constipation, cardiac dysrhythmias, and renal calculi.
What does fluid volume EXCESS result from?
May result from excessive intake of fluids, abnormal retention of fluids (e.g., heart failure, renal failure), or interstitial-to-plasma fluid shift.
How is hyPOphosphatemia treated?
Oral or IV phosphorus.
What is the treatment for hyPOmagnesemia?
Oral supplements. NUTS and NANNERS!!
What is oncotic pressure?
Osmotic pressure exerted by colloids in solution.
What is the major colloid in the vascular system that contributes to total oncotic pressure?
Protein
What are three processes of movement of water and electrolytes between ECF and ICF?
Simple diffusion, facilitated diffusion, and active transport.
What happens to older adults' kidney functions?
Structural changes to the kidney and a decrease in the renal blood flow lead to a decrease in the glomerular filtration rate, decreased creatinine clearance, the loss of the ability to concentrate urine and conserve water, and narrowed limits for the excretion of water, sodium, potassium, and hydrogen ions.
What is osmotic pressure?
The amount of pressure required to stop the osmotic flow of water.
What is hydrostatic pressure?
The force within a fluid compartment and is the major force that pushes water out of the vascular system at the capillary level.
What is homeostasis?
The state of equilibrium in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival.
What is the main mechanism for fluid balance?
The thirst mechanism
What does the measure of osmolality indicate?
The water balance of the body.
What happens to patients on digoxin?
They experience increased digoxin toxicity if their serum potassium level is low.
What are the goals of treatment in fluid imbalances ?
To correct the UNDERLYING CAUSE and to restore fluid and electrolyte balance.
What are the functions of calcium?
Transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth and bone, and muscle contractions.
How is hyPOcalcemia treated?
Treated with oral or IV calcium supplements.
What is the treatment of HyPERcalcemia?
Treatment is promotion of excretion of calcium in urine by administration of a loop diuretic and hydration of the patient with isotonic saline infusions.
True or False? GFR is primarily dependent on adequate blood flow and adequate hydrostatic pressure.
True
True or False? Increased permeability in the glomerulus causes loss of proteins into the urine.
True
True or False? Prostaglandin synthesis by the kidneys causes vasodilation and increased renal blood flow.
True
True or False? Water is the primary substance reabsorbed in the collecting duct?
True
What are the two main causes of HyPERcalcemia?
Two thirds are hyperparathyroidism and one third are caused by malignancy, especially from breast or lung cancer, and multiple myeloma.
What causes hyPOcalcemia?
Usually caused by a decrease in the production of parathyroid hormone.
What are common causes of hyPOnatremia?
Water excess from inappropriate use of sodium-free or hypotonic IV fluids.
What is the primary component of the body?
Water, accounting for approximately 60% of the body weight in the adult.
A patient who has had neck surgery including thyroidectomy is observed carefully for_____.
____signs of hyPOcalcemia.
All patients with hyPERkalemia should be ___
___monitored electrocardiographically to detect potentially fatal dysrhythmias and to monitor the effects of therapy.
Which of the following urine specific gravity values would indicate to the nurse that the patient is receiving excessive IV fluid therapy? a) 1.002 b) 1.010 c) 1.025 d) 1.030
a) 1.002 A urine specific gravity of 1.002 is low, indicating dluite urine and the excretion of excess fluid. Fluid overload, diuretics, or lack of ADH can cause dilute urine. Normal urine specific gravity indicates concentrated urine that would be seen in dehydration.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Weight loss b) Fever c) Absence of pain d) Diuresis
b) Fever Fever is an indicator of infection or transplant rejection.
During physical assessment of the urinary system, the nurse a) auscultates the lower abdominal quadrants for fluid sounds b) palpates an empty bladder at the level of the symphysis pubis c) percusses the kidney with a firm blow at the posterior costovertebral angle d) positions the patient prone to palpate the kidneys with a posterior approach
c) percusses the kidney with a firm blow at the posterior costovertebral angle To assess for kidney tenderness, the nurse strikes the fist of one hand over the dorsum of the other hand at the posterior costovertebral angle. The upper abdominal quadrants and costovertebral angles are auscultated for vascular bruits in the renal vessels and aorta, and an empty bladder is not palpable. The kidneys are palpated through the abdomen, with the patient supine.
What are symptoms of hyPOnatremia?
rapid pulse, shallow breathing, confusion, headache, seizures, increased urine output, hyperactive bowel.