Evolve - Chapter 29 (Fluid and Electrolytes)
The nurse is assessing a patient who has symptoms of anorexia, lethargy, and confusion, and finds the patient's potassium level to be 3 mEq/L. What question will the nurse ask the patient before initiating the treatment? 1. "Do you have a history of ulcers?" 2. "Do you have a history of jaundice?" 3. "Do you have a history of brain injury?" 4. "Do you have a history of morning sickness?"
1. "Do you have a history of ulcers?" Rationale: Hyponatremia is caused by the loss of sodium and is evident by symptoms such as anorexia, lethargy, and confusion. The nurse should find out about the history of ulcer or gastrointestinal bleeding in the patient before initiating oral potassium supplements, as this drug may worsen abdominal ulcers. Jaundice is caused due to bile duct obstruction, which is unrelated to potassium intake. Brain injury or trauma is also irrelevant when prescribing potassium supplements. Morning sickness is a feeling of nausea soon after waking up in the morning. Potassium intake is unrelated to morning sickness.
The primary health care provider orders an intravenous (IV) potassium infusion for a patient who has undergone heart surgery. During the infusion, the nurse notes an irregular electrocardiograph associated with a rapid increase in heart rate. What are the priority nursing interventions? Select all that apply. 1. Administer calcium carbonate (Jarcal) as prescribed. 2. Stop the intravenous infusion of potassium chloride (Epiklor). 3. Administer sodium polystyrene sulfonate (Kayexalate) as prescribed. 4. Continue with the intravenous infusion of potassium chloride (Epiklor). 5. Administer sodium bicarbonate (Neut) with insulin (Humulin R) as prescribed.
1. Administer calcium carbonate (Jarcal) as prescribed. 2. Stop the intravenous infusion of potassium chloride (Epiklor). 3. Administer sodium polystyrene sulfonate (Kayexalate) as prescribed. Rationale: A rapid increase in heart rate and irregular electrocardiograph are found in patients with elevated potassium levels, or hyperkalemia. The nurse should immediately administer calcium carbonate (Jarcal) and stop the IV infusion of potassium chloride (Epiklor). Calcium carbonate (Jarcal) reduces the toxic effects associated with increased levels of potassium, by causing a rapid intracellular shift of potassium ions, and reduces the serum potassium levels. Sodium polystyrene sulfonate (Kayexalate) is administered after calcium carbonate (Jarcal) to eliminate the excess serum levels of potassium from the body. Continuation of the potassium chloride (Epiklor) infusion would result in cardiac arrest and eventually cause death. Sodium bicarbonate (Neut) should be administered alone, without insulin. Insulin is administered along with dextrose solution to lower glucose levels.
Which fluid is administered to reduce the risk of deep vein thrombosis? 1. Colloids 2. Whole blood 3. Potassium supplements 4. Sodium supplements
1. Colloids Rationale: Colloids are the intravenous fluids that increase the colloidal osmotic pressure and also increase the fluid flow from the interstitial compartment to the plasma compartment. They can be used as a prophylactic measure for preventing deep vein thrombosis. Whole blood contains all the components of the blood but is not as effective as colloids for treating deep vein thrombosis. Potassium supplements have no effect on the clotting mechanism of the blood. Sodium ions are most abundant in the extracellular fluid, which is necessary for the optimal functioning of the body. Sodium has no effect on clotting or plasma volume.
Which food will the nurse recommend for a patient who has hypokalemia? 1. Cream of broccoli soup 2. Lean turkey 3. Mashed potatoes 4. Beef bouillon
1. Cream of broccoli soup Rationale: Hypokalemia indicates a low potassium level. Broccoli soup will help decrease hypokalemia in the patient as broccoli is high in potassium. Lean turkey, mashed potatoes, and beef bouillon are protein-rich foods, recommended for patients with a protein deficiency.
What should be the fluid of choice for a patient who has lost 30% of blood slowly as a result of internal hemorrhage? 1. Dextran 70 2. Whole blood 3. 3% (hypertonic) saline 4. Packed red blood cells (PRBCs)
1. Dextran 70 Rationale: When there is a slow blood loss of 20% to 50%, then nonprotein plasma expanders such as dextran 70 are administered. Whole blood is administered in extreme cases when there is a blood loss of over 50%. A solution of 3% saline is administered when there is a slow blood loss of 20% or less. PRBCs are used when there is a blood loss of over 50%, in patients with anemia, or in patients with substantial hemoglobin deficit.
Which symptoms does the nurse assess in a patient with hypernatremia? Select all that apply. 1. Edema 2. Hypertension 3. Paralytic ileus 4. Reddish, flushed skin 5. Cardiac dysrhythmias
1. Edema 2. Hypertension 4. Reddish, flushed skin Rationale: Hypernatremia is the condition of increased sodium, above 145 mEq/L. The nurse has to assess for symptoms like edema, hypertension, and reddish, flushed skin. Paralytic ileus and cardiac dysrhythmias are not symptoms of hypernatremia. They are symptoms associated with late hypokalemia.
A patient has received an infusion of packed red blood cells. Which assessment findings indicate an improvement in the patient's health status? Select all that apply. 1. Increased oxygen saturation 2. Blood glucose levels within normal limits 3. Increased energy 4. Decreased urine output 5. Increased urine output
1. Increased oxygen saturation 3. Increased energy Rationale: Blood products are the only fluids that carry oxygen, because they contain hemoglobin. Patients will begin to show improved energy and increasing tolerance for activities of daily living as a result of treatments with blood products. Pulse oximeter readings will also show improved readings. The blood glucose levels are evaluated in case of diabetes. A decrease or increase in the urine output is not a direct outcome of packed red blood cell infusion.
The nurse is assessing an 80-year-old patient and finds that the patient has muscle weakness, anorexia, lethargy, and nausea. What will the nurse expect the provider to order? 1. Increasing the patient's potassium levels with dietary supplements 2. Increasing the patient's potassium levels with a potassium exchange resin enema 3. Increasing the patient's potassium levels with intravenous potassium acetate 4. Increasing the patient's potassium levels with intravenous potassium chloride
1. Increasing the patient's potassium levels with dietary supplements Rationale: The patient shows signs of mild hypokalemia, which can be treated by eating a potassium-rich diet. An enema of potassium exchange resin can be administered if the patient has hyperkalemia. Intravenous administration of potassium acetate and potassium chloride is preferred if the patient has severe hypokalemia.
A patient is ordered an isotonic intravenous fluid. Which intravenous fluid is most likely to be ordered by the health care provider? 1. Normal saline 2. 3% NaCl 3. 0.45% NaCl/D5W 4. 0.25% NaCl
1. Normal saline Rationale: Of the fluids listed, the only one that is isotonic is normal saline. 3% NaCl is considered to be a hypertonic solution; 0.45% NaCl/D5W and 0.25% NaCl are considered to be hypotonic solutions.
Which patient condition is a contraindication for the administration of dextran? 1. Renal insufficiency 2. Liver failure 3. Osteoporosis 4. Anemia
1. Renal insufficiency Rationale: In patients with renal insufficiency, dextran administration is contraindicated because the dextran tends to increase fluid volume, which may not be excreted by the impaired kidneys. The function of the liver is not affected by dextran administration. The use of dextran does not affect bone function or structure; hence it is not contraindicated in osteoporosis. Dextran doesn't affect hemoglobin levels; hence it is not contraindicated in anemic patients.
Which can cause hyperkalemia? Select all that apply. 1. Trauma 2. Infections 3. Loop diuretic use 4. Metabolic acidosis 5. Hyperaldosteronism
1. Trauma 2. Infections 4. Metabolic acidosis Rationale: Hyperkalemia is caused by several conditions, like trauma, infections, and metabolic acidosis. Loop diuretic use and hyperaldosteronism are not related to increased serum levels of potassium. Instead, they are responsible for decreased serum levels of potassium (hypokalemia).
Which product is preferred in patients with extreme blood loss of over 25%? 1. Whole blood 2. Fresh frozen plasma (FFP) 3. Plasma protein fraction (PPF) 4. Packed red blood cells (PRBCs)
1. Whole blood Rationale: Whole blood is more beneficial in patients who undergo extreme blood loss of over 25% because whole blood also contains plasma, which is the chief fluid volume of the blood. FFP is given to patients who show demonstrated deficiency of clotting factor. PPF is used to manage acute bleeding. PRBCs are used to increase the oxygen-carrying capacity in patients.
An elderly patient reports a feeling of irregular heartbeat, muscle weakness, and mild confusion. What question will the nurse ask the patient? 1. "Have you been taking potassium supplements?" 2. "Have you been performing excessive physical exercise?" 3. "Have you been having normal bowel movements?" 4. "Have you been drinking more fluids than normal?"
1."Have you been taking potassium supplements?" Rationale: When the patient reports an irregular heartbeat and muscle weakness, the nurse may suspect ventricular fibrillation caused by hyperkalemia, or elevated potassium levels in the blood. Hyperkalemia may be caused by a kidney problem, but also by potassium supplements. Physical exercise does not increase the level of potassium; in fact it helps to maintain the electrolyte balance. Bowel movements would be assessed to understand the extent of electrolyte loss in a patient due with dehydration, but not necessarily for hyperkalemia. Consumption of excess fluids may help the kidneys process the excessive potassium and return the body to normal levels.
Which nursing intervention will the nurse implement when administering intravenous potassium supplement? 1. Administer the potassium as a bolus over 10 minutes. 2. Administer the diluted medication using an intravenous pump. 3. Apply ice packs to the site of intravenous administration. 4. Teach the patient and family signs and symptoms of hypokalemia.
2. Administer the diluted medication using an intravenous pump. Rationale: A rapid infusion of potassium can cause cardiac dysrhythmias. Therefore, an intravenous infusion pump must always be used. Potassium is always diluted when administered to the patient and never given in the form of bolus. Ice packs are applied to any site of intravenous administration to reduce irritation and burning. Teaching the patient and family signs and symptoms of hypokalemia is not an immediate concern in this case.
The nurse is administering hypertonic saline solution to treat a patient with severe hyponatremia. Which nursing intervention is the priority? 1. Monitor urinary output. 2. Assess skin for flushing and assess increased thirst. 3. Monitor temperature. 4. Administer antiemetic for vomiting.
2. Assess skin for flushing and assess increased thirst. Rationale: Flushed skin and increased thirst are signs and symptoms of hypernatremia. Urine output will be assessed, but it is not a priority. Temperature and vomiting are not a concern. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.
A patient has been ordered to receive a unit of packed red blood cells. What is the highest priority nursing action prior to initiating the infusion of the blood product? 1. Verify that a large bore IV is in place. 2. Confirm the identity of the patient. 3. Collect the blood product from the blood bank. 4. Verify that the permit for infusion was witnessed.
2. Confirm the identity of the patient. Rationale: Although all of the actions listed are important, the highest priority one is confirmation of the identity of the patient. Failure to do this is a major safety violation.
A patient is prescribed oral sodium polystyrene sulfonate (Kayexalate). On assessing the patient's medical history, the nurse finds that the patient has gastric ulcers. What will the nurse advise the patient to prevent adverse effects of the therapy? 1. Take the medication with food 2. Contact the primary health care provider 3. Eat foods rich in potassium 4. Discontinue the medication
2. Contact primary health care provider Rationale: The patient is advised to contact the primary health care provider because oral sodium polystyrene sulfonate (Kayexalate) may cause gastrointestinal irritation. The patient has pre-existing gastric ulcers, and the drug can increase their severity. Taking the medication with food does not reduce the gastrointestinal irritation. It is evident that the patient is hyperkalemic. Hence, it is not advisable to take potassium supplements. The hyperkalemia may worsen if the medication is discontinued.
Which is the fluid of choice in a patient who has lost 15% of blood volume slowly? 1. Dextran 2. Crystalloids 3. Whole blood 4. Plasma protein fraction (PPF)
2. Crystalloids Rationale: When a patient has lost about 15% of the blood slowly, crystalloids are the fluid of choice. Dextran is a nonprotein plasma expander and is given to patients who have lost about 20% to 50% of blood slowly. Whole blood is given to patients who have lost over 50% of blood slowly or 20% of blood rapidly. PPF is given to control acute bleeding in patients.
The nurse is administering whole blood to a patient who experienced severe blood loss who has an underlying coagulation disorder. What will the nurse expect to administer to this patient? 1. Intravenous heparin 2. Fresh frozen plasma 3. Lactated Ringer's solution 4. Hetastarch along with whole blood
2. Fresh frozen plasma Rationale: Fresh frozen plasma is not used often, except in patients who have severe blood loss or underlying coagulation disorders. Blood products are given with lactated Ringer's solution, but this is not effective in controlling bleeding. Hetastarch is given when the patient shows a slow loss of blood. It is not effective in controlling the bleeding.
The nurse is caring for a patient who has a deficiency in clotting factor. Which product is used in such a patient? 1. Hetastarch 2. Fresh frozen plasma (FFP) 3. Plasma protein fraction (PPF) 4. Packed red blood cells (PRBCs)
2. Fresh frozen plasma (FFP) Rationale: FFP is used to increase the clotting factor in patients who show demonstrated deficiency in clotting factor. Hetastarch is used as a nonprotein plasma expander to increase the blood volume in patients with decreased blood levels. PPF is used to manage acute bleeding. PRBCs are used to increase the oxygen-carrying capacity in patients with anemia, in patients with hemoglobin deficit, and in patients with blood loss up to 25%.
Sodium polystyrene sulfonate (Kayexalate) is used to treat which condition? 1. Hypokalemia 2. Hyperkalemia 3. Hyponatremia 4. Hypernatremia
2. Hyperkalemia Rationale: Sodium polystyrene sulfonate (Kayexalate) is an ion exchange resin containing sodium ions, which are exchanged with the potassium ions in the body. It is useful in the treatment of hyperkalemia. It is not applicable for patients with hypokalemia because it doesn't increase the concentration of potassium ions in the body. Sodium polystyrene sulfonate is not useful for treating low levels of sodium because, though the potassium ions are exchanged for the sodium ions in the resin, it is not sufficient for an intracellular increase in sodium. Hyponatremia and hypernatremia are not treated with sodium polystyrene sulfonate (Kayexalate) resin as it exchanges sodium ions for the potassium ions in the body. It has no effect on the sodium ions of the body.
A patient is admitted to the hospital after experiencing confusion, weakness, and loss of appetite The patient's blood pressure is 90/60 mm Hg, and the serum blood pH shows acidity. What drug does the nurse expect to administer? 1. Conivaptan (Vaprisol) 2. Potassium acetate (Tri-K) 3. Sodium bicarbonate (Neut) 4. Potassium chloride (Epiklor)
2. Potassium acetate (Tri-K) Rationale: From the caregiver's report, the nurse should understand that the patient is confused, lethargic, and anorexic. The blood pressure shows that the patient is hypotensive and has an acidic pH. These are the symptoms of hypokalemia. So, the nurse should expect a potassium supplement in the prescription. Potassium acetate (Tri-K) is a potassium supplement; the potassium is used to restore the electrolyte balance, and acetate is used to raise the pH of the blood. Conivaptan (Vaprisol) is prescribed to hospitalized patients with hyponatremia. Sodium bicarbonate (Neut) is prescribed to restore sodium levels in patients with hyponatremia. Potassium chloride (Epiklor) can be useful in restoring potassium levels but cannot raise the pH of the blood.
The nurse observes accumulation of fluid in a patient's feet along with high body temperature in a patient receiving sodium polystyrene sulfonate (Kayexalate) to treat hyperkalemia. What will the nurse expect to perform to reduce the swelling? Select all that apply. 1. Restrict the patient's intake of excess fluids. 2. Restrict the patient's intake of food containing excess salt. 3. Administer 5% dextrose intravenously as prescribed. 4. Administer normal saline intravenously as prescribed. 5. Administer sodium bicarbonate (Neut) intravenously as prescribed.
2. Restrict the patient's intake of food containing excess salt. 3. Administer 5% dextrose intravenously as prescribed. Rationale: Edema and high body temperature are the symptoms of hypernatremia. It is caused by the administration of sodium polystyrene sulfonate (Kayexalate), which leads to accumulation of sodium in the body. The nurse will restrict any further intake of salt through food. In order to dilute the concentration of sodium and increase its excretion, the nurse administers 5% dextrose. Fluid intake should be encouraged to increase the urine output. Normal saline will further increase the symptoms, as it contains sodium and causes edema. Sodium bicarbonate (Neut) also increases the accumulation of fluids in the interstitial spaces.
A patient with hypokalemia is ordered to receive an intravenous (IV) dose of potassium chloride (KCl) 15 mEq in 250 mL of 0.9% saline to infuse over 1 hour. What action will the nurse take prior to starting the infusion? 1. Ensure that the IV cannula is securely taped. 2. Review the electrocardiogram (ECG). 3. Review the previous 24-hour intake and output. 4. Place an ice pack over the IV site.
2. Review the electrocardiogram (ECG). Rationale: Potassium infusions are used to treat patients with severe hypokalemia. The most concentrated solutions used are 60 mEq/L, with a rate not more than 40 mEq/hour. Hence, cardiac monitoring is indicated when concentrated potassium chloride is administered intravenously. The IV cannula is used for the implementation of antineoplastic drugs. The nurse needs to assess the serum potassium concentrations to evaluate for toxicity and not the 24-hour intake and output. An ice pack is placed over the IV site to relieve the burning after or during the therapy.
Which aspect of a patient's history is a contraindication for administering sodium polystyrene sulfonate (Kayexalate)? 1. The patient has hypernatremia. 2. The patient has Addison's disease. 3. The patient takes phenytoin (Dilantin). 4. The patient takes quinupristin and dalfopristin (Synercid).
2. The patient has Addison's disease. Rationale: Sodium polystyrene sulfonate (Kayexalate) is a potassium exchange resin that is used in the treatment of hyperkalemia. Potassium replacement products are contraindicated in patients with Addison's disease. Hypernatremia is not related to the administration of sodium polystyrene sulfonate (Kayexalate). Phenytoin (Dilantin), and quinupristin and dalfopristin (Synercid), do not interact with potassium replacement products. Sodium replacement products are contraindicated in patients with hypernatremia. Phenytoin (Dilantin) interacts with dextrose and results in precipitation. Quinupristin and dalfopristin (Synercid) is an antibiotic that interacts with sodium but not potassium.
Which concentration of saline may cause hemolysis of red blood cells? 1. 5% of sodium chloride 2. 0.9% of sodium chloride 3. 0.25% of sodium chloride 4. 0.45% of sodium chloride
3. 0.25% of sodium chloride Rationale: 0.25% sodium chloride solution is hypotonic and may cause hemolysis of red blood cells. 5% sodium chloride is hypertonic and is contraindicated in patients with hypernatremia or hyperchloremia. 0.9% sodium chloride solution is considered normal saline. 0.45% sodium chloride solution is also hypotonic solution but does not cause hemolysis of red blood cells.
Which concentration of saline may cause hemolysis of red blood cells? 1. 5% of sodium chloride 2. 0.9% of sodium chloride 3. 0.25% of sodium chloride 4. 0.45% of sodium chloride
3. 0.25% of sodium chloride Rationale: 0.25% sodium chloride solution is hypotonic and may cause hemolysis of red blood cells. 5% sodium chloride is hypertonic and is contraindicated in patients with hypernatremia or hyperchloremia. 0.9% sodium chloride solution is considered normal saline. 0.45% sodium chloride solution is also hypotonic solution but does not cause hemolysis of red blood cells.
The nurse is caring for a patient with heart failure who needs expansion of blood volume. Which solution can be given to increase the blood volume? 1. 5% albumin solution 2. Solution of dextran 40 3. 0.9% sodium chloride 4. 0.25% sodium chloride
3. 0.9% sodium chloride Rationale: The patient's blood volume has to be increased and the patient has heart failure. Sodium chloride is a physiologic electrolyte and has no hypersensitivity reactions. A solution of 0.9% of sodium chloride is considered normal and can be administered to the patient. A 5% albumin solution cannot be given to the patient because the patient has heart failure. Albumin is contraindicated in patients with heart failure. A solution of dextran 40 also cannot be given to the patient because it is contraindicated in patients with heart failure, renal insufficiency, and extreme dehydration. A solution of 0.25% sodium chloride can be used to restore the blood volume. But as the solution of 0.25% sodium chloride is hypotonic, it may cause hemolysis of red blood cells and it is not advisable to take the risk in the case of a patient with heart failure.
A patient has experienced a slow blood loss of about 20%. Which solution is administered to treat the patient? 1. Dextran 70 2. Hetastarch 3. 5% dextrose in water 4. Fresh frozen plasma (FFP)
3. 5% dextrose in water Rationale: Administration of crystalloids is suggested to manage a slow blood loss of about 20%. Therefore, 5% dextrose in water should be administered to the patient, as it is a crystalloid solution. Dextran 70, Hetastarch, and FFP are not used to treat slow blood loss of 20%. Hetastarch and Dextran 70 are nonprotein plasma expanders, which are administered in cases of slow bleeding causing a loss of 20 to 50% of blood volume. FFP is used to manage bleeding resulting in 20% rapid loss or a slow loss of over 50% of the total blood volume.
Which protein is responsible for 70% of the colloidal osmotic pressure? 1. Globulin 2. Fibrinogen 3. Albumin 4. Fibronectin
3. Albumin Rationale: Albumin is responsible for 70% of the colloidal osmotic pressure. Globulin is a plasma protein, which has a lesser contribution to the colloidal osmotic pressure. Fibrinogen is not the chief contributing protein for the colloidal osmotic pressure, as it causes a much lower amount of pressure on the blood vessel wall. Fibronectin is an extracellular matrix protein that is not responsible for causing colloidal osmotic pressure.
On reviewing a patient's laboratory reports, the nurse finds that the patient has a total protein level of 4.5 g/dL. What will the nurse expect the primary health care provider to prescribe? 1. Tolvaptan (Samsca) 2. Conivaptan (Vaprisol) 3. Albumin (Albuminar-20) 4. Sodium polystyrene sulfonate (Kayexalate)
3. Albumin (Albuminar-20) Rationale: The normal total protein level in the body is 7.4 g/dL. If the level falls below 5.3 g/dL, then colloid replacement therapy is suggested to the patient. The total level of protein in the patient is 4.5 g/dL (below 5.3g/dL). Therefore, the nurse would expect the primary health care provider to prescribe albumin (Albuminar-20), a natural protein. Tolvaptan (Samsca), conivaptan (Vaprisol), and sodium polystyrene sulfonate (Kayexalate) are not used to restore the patient's protein level. Tolvaptan (Samsca) and conivaptan (Vaprisol) are nonpeptide dual arginine vasopressins used to restore sodium levels in the body. Sodium polystyrene sulfonate (Kayexalate) is used to restore potassium levels in the body.
The primary health care provider orders intravenous fluids containing potassium for a patient who has gastroenteritis and dehydration. Which nursing action is correct before administering the intravenous fluid? 1. Obtain a stool sample from the patient. 2. Take a saliva sample from the patient. 3. Assess the patient's urinary output. 4. Check the patient's blood pressure.
3. Assess the patient's urinary output. Rationale: Before administering intravenous fluids with potassium, the nurse should assess the patient's urinary output to know if there is any electrolyte imbalance. The kidneys compensate for any electrolyte imbalance by retaining electrolytes. A higher urinary output indicates loss of potassium, and the nurse will administer potassium supplements as prescribed. A stool sample will provide information about the infection but not about potassium levels. A saliva sample will also provide information about infection but not potassium levels. Change in blood pressure can be due to multiple factors and is not necessarily due to potassium levels in the body.
A patient is found to have low levels of clotting factors. Which treatment will the provider order for this patient? 1. Dextran 70 2. Conivaptan (Vaprisol) 3. Fresh frozen plasma (FFP) 4. Packed red blood cells (PRBCs)
3. Fresh frozen plasma (FFP) Rationale: Administration of FFP is useful to treat the patient with low levels of clotting factors, as it increases clotting factors and promotes the clotting function. Dextran 70 is used in colloid replacement therapy and does not increase clotting factor levels. PRBCs are useful for patients suffering from anemia but may not help increase clotting factor levels. Conivaptan (Vaprisol) is a vaptan used to treat hyponatremia but not used in cases of clotting factor deficiency.
A patient with severe trauma has received 5000 mL normal saline intravenously. The patient now has peripheral edema, but remains hypotensive. Which agent will help in correction of the fluid balance? 1. Lactose-free milk 2. 3% saline 3. Hetastarch (Hespan) 4. Packed Red Cells (PRCs)
3. Hetastarch (Hespan) Rationale: The patient needs to increase intravascular fluid volume. Hetastarch is a colloid, which will increase osmotic pull from the extravascular spaces to the intravascular area. Lactose-free milk is used to induce sleep. The use of 3% saline is not preferred because of the risk of hypernatremia. PRCs are used to replace red blood cells and not as volume expanders.
Which blood product is administered to anemic patients? 1. Plasma protein fraction 2. Fresh frozen plasma 3. Packed red blood cells 4. Cryoprecipitate
3. Packed red blood cells Rationale: Packed red blood cells are useful in anemic patients to increase oxygen-carrying capacity. Plasma protein fraction provides clotting factors and is used in cases of acute bleeding to arrest the bleeding. It doesn't help increase oxygen-carrying capacity. Fresh frozen plasma is useful for patients with low levels of clotting factors. It doesn't increase the oxygen-carrying capacity of the blood. Cryoprecipitate is useful for arresting acute bleeding and for facilitating quick clotting.
A patient who was injured in a motor vehicle accident has hypovolemic shock due to excess blood loss. The laboratory reports show that the patient has anemia. What will the nurse expect the provider to order? 1. Normal saline 2. Albumin (Albuminar-20) 3. Packed red blood cells 4. Plasma protein fraction (Plasmanate)
3. Packed red blood cells Rationale: The patient has hypovolemic shock due to excess blood loss and is anemic. Therefore, administration of red blood cells would help to restore the blood volume as well as increase oxygen-carrying capacity. Normal saline is contraindicated in patients with hypovolemic shock as it is not effective in restoring oxygen-carrying capacity. Albumin (Albuminar-20) is also contraindicated in patients with hypovolemic shock, as it increases the blood volume but cannot restore oxygen-carrying capacity. Plasma protein fraction (Plasmanate) is indicated for patients with acute loss of blood due to gastric bleeding.
The nurse is caring for a patient who has diarrhea and vomiting. During a review of the patient's medical history, the nurse finds that the patient is taking phenytoin (Dilantin) for seizures. What crystalloid mix will be ineffective in this patient? 1. Saline mixed with sodium 2. Saline mixed with lactose 3. Saline mixed with dextrose 4. Saline mixed with potassium
3. Saline mixed with dextrose Rationale: In the presence of dextrose, phenytoin (Dilantin) gets precipitated, which may cause the phenytoin (Dilantin) to be ineffective. Therefore, the primary health care provider will not prescribe dextrose. Neither sodium nor potassium precipitates phenytoin (Dilantin). Therefore, sodium or potassium can be prescribed to a patient on phenytoin (Dilantin). Lactose is a sugar molecule found in milk which does not react with phenytoin (Dilantin). Therefore, lactose can also be prescribed by the primary health care provider.
The health care provider has ordered 5% dextrose in water as a maintenance fluid for the patient. The nurse is assessing the patient at the beginning of the shift and observes the fluid hanging to be 50% dextrose in water (D50W). Which is the highest priority nursing action? 1. Notify the health care provider of the error. 2. Find out which nurse hung the D50W. 3. Stop the infusion. 4. Complete an incident report.
3. Stop the infusion. Rationale: The patient's safety is always the primary concern; the fluid should be stopped and the correct fluid hung before other measures are taken such as notifying the health care provider. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.
The nurse is instructed to administer 1 L of 25% albumin to a patient who has hypoproteinemia. What will the nurse infer from such an instruction? 1. The patient requires 4 L of total plasma volume. 2. The patient requires 1 L of total plasma volume. 3. The patient requires 2 L of total plasma volume. 4. The patient requires 0.5 L of total plasma volume.
3. The patient requires 2 L of total plasma volume. Rationale: Hypoproteinemia is reduced levels of total proteins. The prescribed treatment, 25% albumin, is a hypertonic colloid solution, which is used to raise the protein levels by expanding blood plasma volume. To raise the plasma volume by 1 L, 0.5 L of 25% colloid is administered. Therefore, the nurse has to administer 1 L (2 × 0.5 L) of 25% albumin, as the patient is 2 L (2 × 1 L) short of total plasma volume. If the patient is 0.5 L short of total plasma volume, then 0.25 L of 25% albumin must be administered. If the patient is 1 L short of total plasma volume, then 0.5 L of 25% albumin must be administered. If the patient is 4 L short of total plasma volume, then 2 L of 25% albumin must be administered.
A patient reports severe thirst and fever. The nurse finds that the patient's blood pressure is 140/95 mm Hg. What will the nurse ask the patient before administering 5% dextrose intravenously? 1. "Do you have any pain in your abdomen?" 2. "Do you have disturbances in your acid-base balance?" 3. "Do you have chest pain or shortness of breath?" 4. "When did you urinate last?"
4. "When did you urinate last?" Rationale: Severe thirst, high body temperature, and high blood pressure are the symptoms of hypernatremia. The treatment includes dietary restrictions, the use of diuretics, or intravenous administration of dextrose. But before prescribing 5% dextrose, the primary health care provider should ask the patient about urine output. A decreased urine output is observed in patients with hypernatremia. Abdominal pain is associated with hyponatremia. Acid-base imbalance is observed in patients when crystalloids or colloids are administered. Chest pain and shortness of breath can occur due to hypervolemia.
Which solution may have other electrolytes added without causing the fluid to be hypertonic? 1. 3% NaCl 2. 6% NaCl 3. 0.9% NaCl 4. 0.25% NaCl
4. 0.25% NaCl Rationale: 0.25% sodium chloride is hypotonic. Rapid administration of hypertonic saline that is 3% or 6% NaCl is avoided in order to prevent osmotic demyelination syndrome 0.9% NaCl is already isotonic; adding electrolytes will cause it to be hypertonic.
Based on the condition of the patient, a hypotonic intravenous fluid will be ordered. Which intravenous fluid is most likely to be ordered by the health care provider? 1. Normal saline 2. 3% NaCl 3. Lactated Ringers 4. 0.25% NaCl
4. 0.25% NaCl Rationale: Of the fluids listed, the only one that is hypotonic is 0.25% NaCl. Normal saline and lactated Ringer's are isotonic; 3% NaCl is hypertonic.
What percentage of sodium chloride is considered half-normal? 1. 3% sodium chloride 2. 0.9% sodium chloride 3. 0.25% sodium chloride 4. 0.45% sodium chloride
4. 0.45% sodium chloride Rationale: 0.45% sodium chloride in the solution is considered half-normal. 3% sodium chloride is considered hypertonic saline. 0.9% of sodium chloride is considered normal. 0.25% of sodium chloride in the solution is quarter-normal.
A patient has acute blood loss of about 20% as the result of a motor vehicle accident. Which will the nurse expect to administer? 1. 500 mL of hetastarch 2. 500 mL of dextran 70 3. 1 unit of fresh frozen plasma (FFP) and 1 unit of platelets 4. 1 unit of cryoprecipitate and 1 unit of plasma protein fraction (PPF)
4. 1 unit of cryoprecipitate and 1 unit of plasma protein fraction (PPF) Rationale: The patient had 20% blood loss due to trauma. So, the patient has to be transfused with blood products to restore the volume of the blood lost. Cryoprecipitate and PPF are used to manage acute bleeding of 20% blood loss rapidly or over 50% slowly. Therefore, administration of 1 unit of cryoprecipitate and 1 unit of PPF would be most useful to treat the patient. Hetastarch and dextran 70 are nonprotein plasma expanders, which are administered in cases of 20 to 50% slow blood loss and not for acute bleeding with 20% blood loss. Administration of 1 unit of FFP and 1 unit of platelets is useful in case of over 80% blood loss but not for 20% blood loss.
A patient who has just undergone surgery exhibits tachycardia and a hemoglobin level of 10 g/100 mL. Which fluid therapy will the nurse expect to administer? 1. 450 mL of whole blood 2. 50 mL of 5% albumin 3. 100 mL of fresh frozen plasma 4. 250 mL of packed red blood cells
4. 250 mL of packed red blood cells Rationale: The nurse should administer the red blood cells (RBCs) to increase the patient's oxygen-carrying capacity. The patient has anemia, so this therapy should help alleviate tachycardia because, in this case, tachycardia is a result of sympathetic nervous system (SNS) activation in response to hypoxemia. As the tissues receive more oxygenated blood from the infusion of additional hemoglobin, the SNS stimulation should subside, and improved tissue oxygenation should help improve healing. The patient needs hemoglobin, so albumin and plasma are improper therapy because they do not provide hemoglobin. Whole blood can help replenish hemoglobin, but because whole blood contains more fluid than RBCs, it increases the risk of fluid volume overload and is not indicated.
A primary health care provider orders potassium supplements for a patient who is lethargic and dehydrated. After assessing the laboratory reports, the nurse finds the patient's potassium levels are 4 mEq/L. What does the nurse monitor in the patient? 1. A decrease in hemoglobin 2. Complaints of nausea 3. A decrease in white blood cells (WBC) 4. Complaints of chest discomfort
4. Complaints of chest discomfort Rationale: Normal potassium levels range from 3.5 to 5.0 mEq/L. Therefore, a potassium level of 4 mEq/L indicates normal potassium concentration. When administered extra potassium supplements, the patient may develop symptoms of hyperkalemia. So, the nurse should monitor the patient for chest discomfort caused by irregular cardiac activity due to hyperkalemia. A decrease in hemoglobin causes anemia and is evident by hemoglobin levels. Hypokalemia may cause nausea, but hyperkalemia does not manifest as nausea. A decrease in WBC is observed with infections but is not caused by administering potassium.
The nurse is caring for a patient who has lost 20% of blood rapidly. What should be the fluid of choice to control the blood loss? 1. Dextran 40 2. Normal saline 3. Fresh frozen plasma (FFP) 4. Cryoprecipitate and plasma fraction (PPF)
4. Cryoprecipitate and plasma fraction (PPF) Rationale: When there is a 20% rapid blood loss, then cryoprecipitate and PPF are given. If there is 20% slow blood loss, then crystalloids are administered. Dextran 40 and other nonprotein plasma expanders are given when there is a slow blood loss of 20% to 50%. Normal saline is a crystalloid and is administered when there is a slow blood loss of 20%. FFP is given when there is a deficiency of clotting factor levels.
The nurse is caring for a patient who has lost 20% of blood rapidly. What should be the fluid of choice to control the blood loss? 1. Dextran 40 2. Normal saline 3. Fresh frozen plasma (FFP) 4. Cryoprecipitate and plasma protein fraction (PPF)
4. Cryoprecipitate and plasma protein fraction (PPF) Rationale: When there is a 20% rapid blood loss, then cryoprecipitate and PPF are given. If there is 20% slow blood loss, then crystalloids are administered. Dextran 40 and other nonprotein plasma expanders are given when there is a slow blood loss of 20% to 50%. Normal saline is a crystalloid and is administered when there is a slow blood loss of 20%. FFP is given when there is a deficiency of clotting factor levels.
The nurse has administered normal saline to a patient who experienced blood loss. Before administering frozen plasma to the patient, what information will the nurse gather? 1. History of seizure 2. History of thyroid problems 3. History of brain injury 4. History of osteoporosis
4. History of osteoporosis Rationale: Patients with osteoporosis are prescribed calcium supplements, which interact with blood products. Hence, the nurse reviews the drug history of the patient with osteoporosis to prevent potential drug interaction. Anti-epileptic drugs are not contraindicated with blood products. However, phenytoin (Dilantin) may get precipitated if the intravenous form is administered with dextrose. Neither thyroid drugs nor the patient's history of brain injury are related to the administration of frozen plasma.
The nurse is preparing to administer a transfusion of a blood product. What is the most appropriate intravenous fluid to hang as a maintenance infusion? 1. Lactated Ringers 2. 5% dextrose and water 3. Ringer's solution 4. Normal saline
4. Normal saline Rationale: Of the intravenous solutions listed, the only one that is compatible with blood products is saline.
Which fluid is given to increase the oxygen-carrying capacity in patients? 1. 5% albumin 2. Fresh frozen plasma (FFP) 3. Plasma protein fraction (PPF) 4. Packed red blood cells (PRCBs)
4. Packed red blood cells (PRCBs) Rationale: To increase the oxygen-carrying capacity in patients, PRBCs are given. Albumin is given to increase the blood volume through colloid oncotic pressure. FFP is given to increase the clotting factor levels in patients with a demonstrated deficiency. PPF is given to manage acute bleeding.
The nurse is assessing a patient's laboratory reports and finds that the serum pH as less than 7. Which drug may be contraindicated in this patient? 1. Laxatives 2. Loop diuretics 3. Sodium bicarbonate 4. Potassium-sparing diuretics
4. Potassium-sparing diuretics Rationale: The pH level of less than 7 indicates metabolic acidosis, which is treated by administering bicarbonates. Metabolic acidosis causes an increase in potassium concentration; hence, patients with metabolic acidosis are not administered potassium-sparing diuretics, as they cause hyperkalemia. Laxatives are not contraindicated in patients with metabolic acidosis, as they do not cause hyperkalemia. Loop diuretics are preferred to induce dieresis in patients with metabolic acidosis, and sodium carbonate is one effective drug used to treat acidosis. It does not cause hyperkalemia.
The nurse is assessing a patient whose protein level is 4 g/dl. Which symptom may be present in this patient as a result of this protein level? 1. Hepatomegaly 2. Severe diarrhea 3. Hypovolemic shock 4. Swelling in the legs
4. Swelling in the legs Rationale: A protein concentration of 4 g/dl signifies a lowered protein concentration in the body that increases fluid concentrations in the tissue, causing edema. Swelling in the lower extremities or legs indicates an edematous condition. Hepatomegaly, or increased liver size, is seen in hepatic infections, which cause elevation in hepatic enzymes but may not directly affect the protein concentration. Severe diarrhea will reduce the sodium and water concentrations in the body but not the protein concentration. Hypovolemic shock is due to loss of blood and is a fatal condition which is treated by administering blood products.
The primary health care provider prescribes a loop diuretic to a patient to treat hypertension. The medication history shows that the patient is taking a mineralocorticoid to treat Addison's disease. In the follow-up visit, the patient reports, "I was unable to walk even small distances, and I don't feel like eating." What does the nurse expect the provider to order? Select all that apply. 1. A lowered dose of loop diuretics 2. A lowered dose of mineralocorticoids 3. Intravenous (IV) calcium carbonate (Jarcal) 4. Intravenous sodium bicarbonate (Neut) 5. Intravenous potassium chloride (Epiklor) 6. Intravenous potassium phosphate (Neutra-Phos-K)
5. Intravenous potassium chloride (Epiklor) 6. Intravenous potassium phosphate (Neutra-Phos-K) Rationale: When the patient reports, "I am unable to walk even small distances, and I don't feel like having food," the nurse should understand that the patient has muscle weakness and anorexia. These are the symptoms associated with hypokalemia. As the patient is taking mineralocorticoids and loop diuretics concurrently, it results in excessive elimination of serum potassium and causes hypokalemia. The nurse should expect potassium supplements such as potassium chloride (Epiklor) or potassium phosphate (Neutra-Phos-K) in the prescription, which can restore potassium levels. Decreasing the dose of loop diuretic will affect the patient's blood pressure. Decreasing the dose of mineralocorticoids will exacerbate the symptoms of Addison's disease. Intravenous administration of calcium carbonate (Jarcal) and sodium bicarbonate (Neut) is recommended in case of hyperkalemia.
