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While caring for a patient with metastatic bone cancer, which clinical manifestations would alert the nurse to the possibility of hypercalcemia in this patient (select all that apply.)? a. Weakness b. Paresthesia c. Facial spasms d. Muscle tremors e. Depressed reflexes

a. Weakness e. Depressed reflexes (other 3 choices are symptoms of hypocalcemia) MS

A pt with chronic kidney disease has hyperphosphatemia. What is a commonly associated electrolyte imbalance? a. hypokalemia b. hyponatremia c. hypocalcemia d. hypomagnesemia

c. hypocalcemia (a reciprocal relationship exists between phosphorus and calcium - high phosphate = low calcium) MS workbook

normal sodium values

135 -145 mEq/L

hypercalcemia

serum calcium level higher than 10.5 mg/dL (9.0-10.5 mg/dL)

hypocalcemia

serum calcium level lower than 9.0 mg/dL (9.0-10.5 mg/dL)

hyponatremia

serum sodium level lower than 135 mEq/L (135-145 mEq/L)

hyponatremia symptoms: SALT LOSS

Stupor/coma Anorexia Lethargy Tendon reflexes decreased Limp muscles Orthostatic hypotension Seizures Stomach cramping

hypokalemia: cardiovascular findings (3)

-thready, weak pulse -hypotension -orthostatic hypotension

hypercalcemia: GI findings (4)

- decreased gastric motility, hypoactive bowel sounds - constipation - abdominal distention - nausea, vomiting

hypocalcemia: GI findings (3)

- increased gastric motility, hyperactive bowel sounds - diarrhea - abdominal cramping

hyponatremia: GI findings (4)

- increased gastric motility, hyperactive bowel sounds - nausea, vomiting - diarrhea - abdominal cramping

hypocalcemia: musculoskeletal findings (4)

- tetany -muscle spasms -paresthesias -hyperactive DTRs

hypocalcemia: cardiovascular findings (4)

-bradycardia -hypotension -diminished peripheral pulses -dysrhythmias

hypokalemia: GI findings (4)

-decreased gastric motility, hypoactive or absent bowel sounds -constipation -abdominal distention -nausea, vomiting

hyperkalemia: GI findings (2)

-increased gastric motility, hyperactive bowel sounds -diarrhea

hypercalcemia: cardiovascular findings (4)

-increased heart rate/tachycardia in early phase -bradycardia that can lead to cardiac arrest in late phase -hypertension -bounding peripheral pulses

hypercalcemia: musculoskeletal findings (2)

-muscle weakness -diminished or absent DTRs

medications that cause hyperkalemia (5)

-potassium-sparing diuretics -ACE inhibitors -ARBs -heparin -NSAIDs

hyperkalemia: cardiovascular findings (2)

-slow, irregular pulse -hypotension

hypernatremia: cardiovascular findings (4)

-tachycardia -orthostatic hypotension

hyponatremia: cardiovascular findings (4)

-tachycardia -rapid, thready pulse -hypotension -orthostatic hypotension

A client with a history of cardiac disease is due for a morning dose of furosemide, Which serum potassium level, if noted in the client's laboratory report, should be reported before administering the dose of furosemide? 1. 3.2 mEq/L 2. 3.8 mEq/L 3. 4.2 mEq/L 4. 4.8 mEq/L

1. 3.2 mEq/L -normal K+ = 3.5-5.0 mEq/L -furosemide can cause hypokalemia NCLEX

The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? 1. Twitching 2. Hypoactive bowel sounds 3. Negative Trousseau's sign 4. Hypoactive deep tendon reflexes

1. Twitching (hypocalcemia = ↑ gastric motility, + Trousseau's sign, hyperactive DTRs) NCLEX

Potassium chloride intravenously is prescribed for a client with hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? (Select all that apply) 1. obtain an IV infusion pump 2. monitor urine output during administration 3. prepare the medication for bolus administration 4. monitor the IV site for signs of infiltration or phlebitis 5. ensure that the medication is diluted in the appropriate volume of fluid 6. ensure that the bag is labeled so that it reads the volume of potassium in the solution

1. obtain an IV infusion pump 2. monitor urine output during administration 4. monitor the IV site for signs of infiltration or phlebitis 5. ensure that the medication is diluted in the appropriate volume of fluid 6. ensure that the bag is labeled so that it reads the volume of potassium in the solution NCLEX

normal magnesium values

1.3-2.1 mEq/L MS text: 1.5-2.5 mEq/L

The nurse provides instructions to a client with a low potassium level about food that are high in potassium and tells the client to consume which foods? Select all that apply: 1. Peas 2. Raisins 3. Potatoes 4. Cantaloupe 5. Cauliflower 6. Strawberries

2. Raisins 3. Potatoes 4. Cantaloupe 6. Strawberries NCLEX ch 8

Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. serum calcium: 9.8 mg/dL 2. serum magnesium: 1.0 mEq/L 3. serum potassium: 4.1 mEq/L 4. serum creatinine: 0.9 mg/dL

2. serum magnesium level (normal Mg = 1.3-2.1 mEq/L, everything else is within normal limits) NCLEX ch 57

normal phosphate values

3.0-4.5 mg/dL MS text: 2.4-4.4 mg/dL

normal potassium values

3.5-5.0 mEq/L

normal calcium values

9.0-10.5 mg/dL MS text: 8.6-10.2 mg/dL

hypocalcemia symptoms: CATS

Convulsions Arrhythmias Tetany Spasms and stridor

Which serum potassium result best supports the rationale for administering a stat dose of IV potassium chloride 20 mEq in 200 mL of normal saline over 2 hours? a. 3.1 mEq/L b. 3.9 mEq/L c. 4.6 mEq/L d. 5.3 mEq/L

a. 3.1 mEq/L (normal K+ = 3.5-5.0 mEq/L) MS

You assess four patients. Which patient has greatest risk for hypomagnesemia? a. A 72-year-old with chronic alcoholism b. A 79-year-old with bone cancer c. A 41-year-old with hypernatremia d. A 46-year-old with respiratory acidosis

a. A 72-year-old with chronic alcoholism (chronic alcoholism = high risk for hypomagnesemia) Fundamentals ch 42

A nurse is reviewing the medical record of a client who has hypocalcemia. The nurse should identify which of the following findings as risk factors for the development of this electrolyte imbalance? a. Crohn's disease b. postoperative following appendectomy c. history of bone cancer d. hyperthyroidism

a. Crohn's disease ATI Fundamentals

A nurse is reviewing the laboratory values for a client who has a positive Chvostek's sign. Which of the following laboratory finding should the nurse expect? a. Decreased calcium b. Decreased potassium c. Increased potassium d. Increased calcium

a. Decreased calcium ATI

A nurse is caring for a pt who has a serum potassium 5.4 mEq/L. The nurse should assess for which of the following manifestations? a. ECG changes b. constipation c. polyuria d. paresthesia

a. ECG changes -normal K+ = 3.5-5.0 mEq/L -other 3 choices are symptoms of hypokalemia ATI

Your patient has severe hypercalcemia. What are your priority nursing interventions? (Select all that apply.) a. Fall prevention interventions b. Teaching regarding sodium restriction c. Encouraging increased fluid intake d. Monitoring for constipation e. Explaining how to take daily weights

a. Fall prevention interventions c. Encouraging increased fluid intake d. Monitoring for constipation (hypercalcemia causes lethargy, which increases fall risk) Fundamentals ch 42

Your patient has hypokalemia with stable cardiac function. What are your priority nursing interventions? (Select all that apply.) a. Fall prevention interventions b. Teaching regarding sodium restriction c. Encouraging increased fluid intake d. Monitoring for constipation e. Explaining how to take daily weights

a. Fall prevention interventions d. Monitoring for constipation (hypokalemia causes weakness, which increases fall risk) Fundamentals ch 42

You are caring for a patient admitted with diabetes mellitus, malnutrition, and a massive GI bleed. In analyzing the morning lab results, the nurse understands that a potassium level of 5.5 mEq/L could be caused by which factors in this patient (select all that apply.)? a. The potassium level may be increased if the patient has nephropathy. b. The patient has been eating excessive amounts of foods that increase potassium levels. c. The patient may be excreting extra sodium and retaining potassium secondary to malnutrition. d. There may be excess potassium being released into the blood as a result of massive blood transfusion. e. The potassium level may be increased because of dehydration that accompanies high blood glucose levels.

a. The potassium level may be increased if the patient has nephropathy. d. There may be excess potassium being released into the blood as a result of massive blood transfusion. e. The potassium level may be increased because of dehydration that accompanies high blood glucose levels. MS ch 16

What assessment do you make before hanging an intravenous (IV) fluid that contains potassium? a. Urine output b. Arterial blood gases c. Fullness of neck veins d. Level of consciousness

a. Urine output Fundamentals ch 42

It is especially important for the nurse to assess for which clinical manifestation(s) in a patient who has just undergone a total thyroidectomy? (Select all that apply) a. confusion b. weight gain c. depressed reflexes d. circumoral numbness e. positive Chvostek's sign

a. confusion d. circumoral numbness e. positive Chvostek's sign (symptoms of hypocalcemia) MS ch 16

A nurse is planning care for a client who has hypernatremia. Which of the following actions should the nurse anticipate including in the plan of care? a. infuse hypotonic IV fluids b. implement a fluid restriction c. increase sodium intake d. administer sodium polystyrene sulfonate

a. infuse hypotonic IV fluids ATI Fundamentals

A nurse is caring for a client who has laboratory findings of serum sodium level 133 mEq/L and serum potassium level 3.4 mEq/L. Which of the following treatments can result in these laboratory findings? a. three tap water enemas b. 0.9% sodium chloride solution IV at 50 mL/hr c. 5% dextrose with 0.45% sodium chloride with 20 mEq of K+ IV at 80 mL/hr d. antibiotic therapy

a. three tap water enemas (tap water is hypotonic and can result in decrease Na+ and K+) ATI

Which patient do you plan to teach regarding water restriction? a. A 23-year-old with extracellular fluid volume (ECV) deficit b. A 34-year-old with hyponatremia c. A 47-year-old with hypercalcemia d. A 69-year-old with metabolic acidosis

b. A 34-year-old with hyponatremia (water restriction is the most common therapy for hyponatremia) Fundamentals ch 42

You are caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. Which classification of medications should you withhold until consulting with the health care provider? a. Antibiotics b. Loop diuretics c. Bronchodilators d. Antihypertensives

b. Loop diuretics -K+ is low (normal K+ = 3.5-5.0 mEq/L) -loop diuretics = hypokalemia MS

While performing patient teaching regarding hypercalcemia, which statements are appropriate (select all that apply.)? a. Have patient restrict fluid intake to less than 2000 mL/day. b. Renal calculi may occur as a complication of hypercalcemia. c. Weight-bearing exercises can help keep calcium in the bones. d. The patient should increase daily fluid intake to 3000 to 4000 mL. e. Any heartburn can be managed with an as needed calcium-containing antacid.

b. Renal calculi may occur as a complication of hypercalcemia. c. Weight-bearing exercises can help keep calcium in the bones. d. The patient should increase daily fluid intake to 3000 to 4000 mL. MS

While performing patient teaching regarding hypercalcemia, which statements are appropriate? (select all that apply) a. Have patient restrict fluid intake to less than 2000 mL/day. b. Renal calculi may occur as a complication of hypercalcemia. c. Weight-bearing exercises can help keep calcium in the bones. d. The patient should increase daily fluid intake to 3000 to 4000 mL. e. Any heartburn can be managed with an as needed calcium-containing antacid.

b. Renal calculi may occur as a complication of hypercalcemia. c. Weight-bearing exercises can help keep calcium in the bones. d. The patient should increase daily fluid intake to 3000 to 4000 mL. MS ch 16

The nurse expects the long-term treatment of a pt with hyperphosphatemia secondary to renal failure will include: a. fluid restriction b. calcium supplements c. magnesium supplements d. increased intake of dairy products

b. calcium supplements MS ch 16

A nurse is collecting data from a client who has hypercalcemia as a result of long-term glucocorticoids. Which of the following findings should the nurse expect? (Select all that apply) a. hyperreflexia b. confusion c. positive Chvostek's sign d. bone pain e. nausea and vomiting

b. confusion d. bone pain e. nausea and vomiting ATI Fundamentals

A nurse is caring for a pt who has an NG tube attached to low intermittent suctioning. The nurse should monitor for which of the following electrolyte imbalances? a. hypercalcemia b. hyponatremia c. hyperphosphatemia d. hyperkalemia

b. hyponatremia (nasogastric losses are isotonic and contain sodium) ATI

A pt is taking diuretic drugs. Which fluid or electrolyte imbalance can occur in his pt? (Select all that apply) a. hyperkalemia b. hyponatremia c. hypocalcemia d. hypotonic fluid loss e. hypertonic fluid loss

b. hyponatremia c. hypocalcemia MS workbook

The nurse is caring for a 76-yr-old woman admitted to the medical unit with hypernatremia and dehydration after prolonged fever. The best beverage to offer the patient is a. malted milk. b. orange juice. c. tomato juice. d. hot chocolate.

b. orange juice. (least amount of sodium) MS ch 16

What patient would be at greatest risk for the potential development of hypermagnesmia? a. 83-year-old man with lung cancer and hypertension b. 65-year-old women with hypertension taking beta-adrenergic blockers c. 42-year-old women with systemic lupus erythematosus and renal failure d. 50-year-old man with benign prostatic hyperplasia and a urinary tract infection

c. 42-year-old women with systemic lupus erythematosus and renal failure MS ch 16

A nurse receives a laboratory report for a client indicating a potassium level of 5.2 mEq/L. When notifying the provider, the nurse should anticipate which of the following actions? a. Starting an IV infusion of 0.9% sodium chloride b. Consulting with dietitian to increase intake of potassium c. Initiating continuous cardiac monitoring d. Preparing the client for gastric lavage

c. Initiating continuous cardiac monitoring (hyperkalemia = risk of dysrhythmias) ATI Fund

You receive a physician's order to change a patient's IV from D5½ NS with 40 mEq KCl/L to D5NS with 20 mEq KCl/L. Which serum laboratory values on this same patient best support the rationale for this IV order change? a. Sodium, 136 mEq/L; potassium, 3.6 mEq/L b. Sodium, 145 mEq/L; potassium, 4.8 mEq/L c. Sodium, 135 mEq/L; potassium, 4.5 mEq/L d. Sodium, 144 mEq/L; potassium, 3.7 mEq/L

c. Sodium, 135 mEq/L; potassium, 4.5 mEq/L (The normal range for serum sodium is 135 to 145 mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L. The change in the IV order decreases the amount of potassium and increases the amount of sodium. Therefore, for this order to be appropriate, the potassium level must be near the high end and the sodium level near the low end of their respective ranges.) MS ch 16

A 50-yr-old woman with hypertension has a serum potassium level that has acutely risen to 6.2 mEq/L. Which type of order, if written by the health care provider, should the nurse question? a. Limit foods high in potassium b. Calcium gluconate IV piggyback c. Spironolactone (Aldactone) daily d. Administer intravenous insulin and glucose

c. Spironolactone (Aldactone) daily -normal K+ = 3.5-5.0 mEq/L -spironolactone is a potassium-sparing diuretic, can cause/worsen hyperkalemia MS

A nurse is assessing a client who has hyperkalemia. Which of the following conditions is associated with this electrolyte imbalance? a. heart failure b. Cushing's syndrome c. diabetic ketoacidosis d. thyroidectomy

c. diabetic ketoacidosis ATI

A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication? a. seizures b. paralysis c. dysrhythmias d. acute kidney injury

c. dysrhythmias MS workbook

A nurse is assessing a client for Chovstek's sign. Which of the following techniques should the nurse use to perform this test? a. apply a BP cuff to the pt's arm b. place the stethoscope bell over the pt's carotid artery c. tap lightly on the pt's cheek d. ask the pt to lower her chin to her chest

c. tap lightly on the pt's cheek ATI

The nurse should be alert for which manifestations in a pt receiving a loop diuretic? a. restlessness and agitation b. paresthesias and irritability c. weak, irregular pulse and poor muscle tone d. increased blood pressure and muscle spasms

c. weak, irregular pulse and poor muscle tone (loop diuretics can cause hypokalemia) MS workbook

A nurse is providing education for a client who has severe hypomagnesemia due to alcohol use disorder. The client is to receive magnesium sulfate. Which of the following information should the nurse include in the teaching? a. "You will receive magnesium in a series of intramuscular injections." b. "You should receive a prescription for a thiazide diuretic to take with the magnesium." c. "You should eliminate whole grains from your diet until your magnesium level increases." d. "You will have your deep tendon reflexes monitored while you are receiving magnesium."

d. "You will have your deep tendon reflexes monitored while you are receiving magnesium." (assessment of DTRs helps identify hypermagnesmia that can occur during IV administration of magnesium sulfate) ATI Fund

When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs? a. Diaphoresis b. Constipation c. Blurred vision d. Muscle weakness

d. Muscle weakness Pharm workbook

You are caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would you identify as an adverse effect related to this therapy? a. Sodium falling to 138 mEq/L b. Potassium rising to 4.1 mEq/L c. Magnesium rising to 2.9 mg/dL d. Phosphorus falling to 2.1 mg/dL

d. Phosphorus falling to 2.1 mg/dL (calcium has an inverse relationship with phosphorus) MS ch 16

In a pt with a positive Chvostek's sign, the nurse would anticipate the IV administration of which medication? a. calcitonin b. vitamin D c. loop diuretics d. calcium gluconate

d. calcium gluconate (positive Chvostek's sign = hypocalcemia) MS workbook

In a pt with sodium imbalances, the primary clinical manifestations are related to alterations in which body system? a. kidneys b. cardiovascular system c. musculoskeletal system d. central nervous system

d. central nervous system (confusion is 1st symptom) MS workbook

Which pt is at risk for hypernatremia? a. has a deficiency of aldosterone b. has prolonged vomiting and diarrhea c. receives excessive IV 5% dextrose solution d. has impaired consciousness and decreased thirst sensitivity

d. has impaired consciousness and decreased thirst sensitivity MS workbook

When monitoring a patient for hypokalemia related to diuretic use, the nurse looks for which possible symptoms? a. nausea, vomiting, and anorexia b. diarrhea and abdominal pain c. orthostatic hypotension d. muscle weakness and lethargy

d. muscle weakness and lethargy Pharm workbook

hypermagnesemia

serum magnesium level higher than 2.5 mEq/L (1.3-2.1 mEq/L, 1.5-2.5 mEq/L MS text)

hypomagnesemia

serum magnesium level lower than 1.3 mEq/L (1.3-2.1 mEq/L, 1.5-2.5 mEq/L MS text)

hyperphosphatemia

serum phosphate level greater than 4.5 mg/dL (3.0-4.5 mg/dL, 2.4-4.4 mg/dL MS text)

hypophosphatemia

serum phosphate level lower than 3.0 mg/dL (3.0-4.5 mg/dL, 2.4-4.4 mg/dL MS text)

hyperkalemia

serum potassium level higher than 5.0 mEq/L (3.5-5.0 mEq/L)

hypokalemia

serum potassium level lower than 3.5 mEq/L (3.5-5.0 mEq/L)

hypernatremia

serum sodium level higher than 145 mEq/L (135-145 mEq/L)