Fluid and Electrolyte Yr 2

A client with chronic kidney disease selects treatment using continuous ambulatory peritoneal dialysis (CAPD). Which statement indicates the client understands the purpose of this therapy?

"The treatment uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."

Which information would the nurse include in response to a client's questioning a protein-restricted dietary change required for his or her acute kidney injury?

"This diet supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys."

Which action would the nurse include in the plan of care for a client undergoing a transsphenoidal hypophysectomy? Select all that apply. One, some, or all responses may be correct.

- Assessing for clear nasal drainage - Maintaining strict intake and output - Increasing daily dietary fiber intake - Elevating the head of the bed 30 degrees - Instructing on the use of an incentive spirometer

A client with a history of severe diarrhea for the past 3 days is admitted for dehydration. The nurse anticipates administering which intravenous (IV) solution?

0.9% NS

Hypovolemic shock treatment

1. Control all obvious external bleeding via direct pressure. 2.Handle the patient gently and keep him or her warm. 3. Start oxygen as soon as you suspect shock, and continue it during transport. *give RBC *watch for hypocalcemia

Which nursing intervention would be provided to a client who has undergone unilateral adrenalectomy?

Administer temporary glucocorticoid replacement therapy

Which mechanism of action explains how aluminum hydroxide decreases serum phosphorus?

Binding with phosphorus in the intestine Aluminum hydroxide binds phosphorus in the intestine, preventing its absorption; this decreases serum phosphorus. Promoting excretion of phosphorus, promoting excretion of excessive urinary phosphates, and dissolving stones as they pass through the urinary tract are not actions of this medication.

When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which medication will the nurse expect the health care provider to prescribe?

Ca

After a craniotomy to remove a brain tumor, the client develops the syndrome of inappropriate antidiuretic hormone (SIADH). For which clinical indicators would the nurse monitor the client? Select all that apply. One, some, or all responses may be correct.

D. Increased weight E. Decreased serum sodium F. Decreased level of consciousness

Which nursing intervention would the nurse consider a priority for clients with fluid overload?

Ensuring client safety

A client is diagnosed with Cushing syndrome. The nurse would monitor the client for which cardiovascular complication?

HTN

The nurse administers desmopressin acetate (DDAVP) to a client with diabetes insipidus. Which would the nurse monitor to evaluate the effectiveness of the medication?

I&O

The nurse is reviewing the electronic health record of a client admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication order would the nurse question?

IV NS

Which nursing intervention is appropriate to include in the plan of care for a client with diabetic ketoacidosis (DKA)?

IV of reg insulin A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client's blood glucose.

Which statement explains why metabolic acidosis develops with kidney failure?

Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis.

Which mechanism of action explains how propylthiouracil (PTU) manages hyperthyroidism?

It decreases production of thyroid hormones.

Pt with hx of chronic kidney disease reports dyspnea. 95%, visibly distressed, rr 32. What is priority? -notify RT -O2 cannula -lay bed flat -nebulizer

O2 cannula

AKI stages

Oliguric, diuretic, recovery

An intravenous solution containing potassium inadvertently infused too rapidly. The client is prescribed insulin added to a solution of 10% dextrose in water. Which would the nurse identify as the purpose of the insulin?

Potassium follows insulin and glucose into the cells of the body, thereby raising the intracellular potassium level.

thyroid storm med

Propylthiouracil (PTU) IV Na iodide propanalol

Hydrocortisone is prescribed for a client with Addison's disease. Which response is a therapeutic effect of this medication?

Supports a better response to stress

Which statement explains why total parenteral nutrition (TPN) is infused through a central line rather than a peripheral line?

The large amount of blood helps dilute the concentrated solution Unless diluted by the increased blood flow, the highly concentrated solution can cause injury to the veins. The potential of infection is high with TPN because of the increased glucose levels. The other options are not the primary reason, although the infusion at this site is more secure and promotes free use of the arms and hands.

A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. Which concern about the client would prompt the nurse to notify the primary health care provider?

There is a decreased ability to handle stress despite steroid therapy

Which finding supports the nurse's conclusions that the client is at risk for kidney damage and the health care provider needs to increase the intravenous fluid rate?

Urine output is 25 mL per hour The urine output should be at least 30 mL/hour. Less than 30 mL/hour indicates the need for notifying the health care provider because low urine output indicates volume depletion that may result in renal damage. Pulse pressure of 40 mm Hg is a normal finding. Systolic BP of 120 mm Hg is a normal finding. Blood osmolality of 280 milliosmoles/kg is a normal finding.

Thyroid storm care

VS Q4 ice water Q4 cluster care

A client will be discharged with a peripherally inserted central venous catheter (PICC) for administration of peripheral parenteral nutrition (PPN). Which instruction would be appropriate for the nurse to include in the client's discharge teaching?

arranging for professional help

Priority for change in Na level

assess neuro changes

Acute Kidney Injury

azotemia (high creatinine and BUN) hypermagnesemia acidosis

The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled. Which information would the nurse share with the client?

encourages removal of serum urea by preventing constriction of peritoneal blood vessels

Which clinical manifestations would the nurse expect the client who has chronic kidney disease with hypocalcemia to exhibit? Select all that apply. One, some, or all responses may be correct.

fractures osteomalacia eye calcium deposits Because of calcium loss from the bone, fractures, osteomalacia, and eye calcium deposits occur. Acidosis decreases calcium that binds to albumin, resulting in more ionized calcium (free calcium) in the blood. Lethargy and weakness are associated with hypercalcemia.

Med that inhibits aldosterone

hyperkalemia

In which category of fluids would the nurse classify an intravenous solution of 0.45% sodium chloride?

hypotonic

Pt with hx of kidney disease with acute shoulder pain. What med to question? -digoxen metoprolol -pan cultures -ibuprofen

ibuprofen

Hypercalcemia S/S

increased clotting low deep tendon reflex nausea, vomiting, lethargy, polyuria, thirst, dehydration, stupor, and coma

A client reports vomiting and diarrhea for 3 days. Which clinical indicator is most commonly used to determine whether the client has a fluid deficit?

loss of body weight

Which clinical manifestations will the nurse assess for in a client with a serum potassium level of 6.4 mEq/L (6.4 mmol/L)? Select all that apply. One, some, or all responses may be correct.

muscle weakness irregular heart rhythm hyperactive bowel tones

When a client is admitted with dehydration, which clinical manifestations would the nurse expect to find? Select all that apply. One, some, or all responses may be correct.

oliguria tenting skin turgor hypotension

Which assessment findings are associated with rejection of a kidney transplant? Select all that apply. One, some, or all responses may be correct.

oliguria weight gain fever

what diuretic to avoid in kidney disease

spironolactone

The laboratory reports of a client reveal a total serum calcium level of 8.1 mg/dL (0.45 mmol/L). Identify the correct order of events to correct this client's total serum calcium level.

1. release of parathyroid hormone (PTH) 2. Stimulation of osteoclastic activity 3. Release of calcium into the blood 4. Elevation of serum calcium levels When serum calcium levels lower, parathyroid hormone secretion increases and stimulates bones to promote osteoclastic activity. This activity releases calcium into the blood. PTH then reduces the renal excretion of calcium and facilitates the mineral's absorption from the intestines.

A client is prone to hyponatremia. Which factors would the nurse identify that can precipitate hyponatremia? Select all that apply. One, some, or all responses may be correct.

A. Wound drainage B. Diuretic therapy C. GI suction D. Parenteral infusion of 0.9% sodium chloride E. Inappropriate anti-diuretic hormone (ADH) secretion Wound drainage can result in hyponatremia from loss of sodium ions. Most diuretics interfere with sodium reabsorption in the nephrons and have the side effect of hyponatremia. Gastrointestinal fluids are rich in sodium ions, which are lost by GI suction. With the syndrome of inappropriate antidiuretic hormone (SIADH), high levels of the antidiuretic hormone (ADH) are produced, causing the body to retain water instead of excreting it normally in the urine. Parenteral infusion of 0.9% sodium chloride, an isotonic solution, should be compatible with body fluids; if given in excess, it may lead to hypernatremia.

Which physical assessment findings would the nurse document on a client who is experiencing Cushing triad? Select all that apply. One, some, or all responses may be correct.

Bradycardia Irregular respirations Systolic hypertension Widening pulse pressure

A client with end-stage renal failure begins hemodialysis for the first time. Which prescribed hemodialysis protocol would the nurse implement when the client reports nausea and a headache, and then appears to become confused?

Decrease the rate of the hemodialysis exchange. Headache, nausea, and confusion are signs and symptoms of disequilibrium syndrome, which results from rapid changes in composition of the extracellular fluid; therefore the nurse would decrease the rate of hemodialysis exchange. Although an analgesic may relieve the headache, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Although administering an antiemetic may relieve the nausea, it will not relieve the other adaptations or the cause of disequilibrium syndrome. Discontinuing the procedure is unnecessary; reducing the rate of exchange should reduce the adaptations of disequilibrium syndrome.

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. Which purpose would the nurse include when explaining why this medication is prescribed?

Decreases the size and vascularity of the thyroid gland

Which type of respiratory pattern would the nurse expect in a client with metabolic acidosis?

Kussmaul respirations

Which unique response is associated with diabetic ketoacidosis (DKA) that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Kussmaul respirations

Which hormones are responsible for altered serum calcium concentrations? Select all that apply. One, some, or all responses may be correct.

calcitonin parathyroid stimulating hormone Produced by the thyroid gland, calcitonin decreases the serum calcium concentration if it increases above the normal level. Parathyroid hormones increase and stimulate bones to promote osteoclastic activity and release calcium into the blood in response to low serum calcium levels. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate protein metabolism to maintain the organic matrix of bone. Growth hormone helps increase bone length and determine the amount of bone matrix formed before puberty.

What med to give for dehydration with high Na and high K

calcium gluconate IV

The nurse administers a parenteral preparation of potassium slowly to avoid which complication?

cardiac arrest

A client with severe bleeding due to a motor vehicle accident was admitted to the emergency department. The nurse assessed that the client was unconscious and has hypovolemic shock. Which site(s) would be used to obtain the client's pulse rate? Select all that apply. One, some, or all responses may be correct.

carotid femoral

Interventions for ketoacidosis

check K NS position insulin bolus

Priority - HHS (hyperglycemic hyperosmolar syndrome

fluid replacement

When the clinic nurse is teaching a group of clients with heart failure (HF) about dietary interventions to prevent fluid overload, which topic will be included?

frozen veggies instead of canned

Which intravenous fluid is a hypertonic solution?

5% Dextrose in normal Saline An isotonic solution has the same osmolarity as body fluids. A hypertonic solution has a higher osmolarity than body fluids; it pulls fluid from cells, causing them to shrink and the extracellular space to expand. The hypertonic solution (5% dextrose in normal saline) provides 586 mOsm/kg. Ringer and Lactated Ringer [273 mOsmol/kg] are isotonic, whereas 5% dextrose in water [252 mOsmol/kg]) is slightly hypotonic.

Which total serum calcium level stimulates the release of parathyroid hormone in a client?

8.5 Hypocalcemia stimulates the release of parathyroid hormone. The normal levels of total serum calcium ranges between 9.0 and 10.5 mg/dL (0.5 and 0.58 mmol/L). A serum calcium concentration of 8.5 mg/dL (0.47 mmol/L) suggests hypocalcemia and stimulates parathyroid hormone release. Serum calcium concentrations of 9.0 and 9.5 mg/dL (0.5 and 0.53 mmol/L) are normal findings. A serum calcium concentration of 10.0 mg/dL (0.56 mmol/L) is a normal finding.

During discharge, the nurse is teaching a client who underwent bilateral adrenalectomy about self-management. Which statements given by the client indicate effective learning? Select all that apply. One, some, or all responses may be correct.

B. "I will procure an influenza vaccination yearly."D. "I will visit the hospital frequently for my lifelong hormonal therapy."E. "I will immediately notify my primary health care provider if I have fever."

What to watch for when pt is on levothyroxine post thyroidectomy

chest pain, dyspnea

The nurse is educating a client on postoperative care after a transsphenoidal hypophysectomy. Which action made by the client is incorrect?

coughing to clear secretions

Which clinical manifestation would the nurse expect a client with diabetes insipidus to exhibit?

decrease urine osmolarity

Goal of Desmopressin in DI

decreased output

What to do if TPN not available

infuse 10% dextrose

What action is most appropriate for the nurse to take for a client who began receiving furosemide 2 days ago and has a serum potassium level of 2.8 mEq/L (2.8 mmol/L)?

notify provider

The nurse assesses for hypocalcemia in a postoperative client. Which is one of the initial signs that might be present?

paresthesias Normally, calcium ions block the movement of sodium into cells. When calcium is low, this allows sodium to move freely into cells, creating increased excitability of the nervous system. Initial symptoms are paresthesias. This can lead to tetany if untreated. Headache, pallor, and blurred vision are not signs of hypocalcemia.

Which is the primary reason an intravenous infusion of 5% dextrose with 0.45% sodium chloride and 20 mEq of potassium is prescribed for a client with a nasogastric (NG) tube set to low intermittent suction?

prevent electrolyte imbalance

Which intervention would the nurse do postoperatively to reduce the risk of thyroid storm after a client has undergone subtotal thyroidectomy?

prevent infection at the surgical site

A client develops hyponatremia. Which factors are likely causes of hyponatremia? Select all that apply. One, some, or all responses may be correct.

profuse diaphoresis rapid IV of D5W Common causes of hyponatremia from loss of sodium-rich body fluids include draining wounds, diarrhea, vomiting, and primary adrenal insufficiency. Inappropriate use of sodium-free or hypotonic IV fluids (like D5W) causes hyponatremia from water excess. Because perspiration contains high levels of sodium, this is a cause of hyponatremia. Diabetes insipidus results in inadequate antidiuretic hormone (ADH), causing water loss and hypernatremia. Excess sodium intake can lead to hypernatremia. Removal of the parathyroid glands can lead to hypocalcemia.

Diuretic preferred for HTN

thiazides

high blood osmolarity s/s

thirst

Care of which client admitted with fluid overload would be considered a priority requiring immediate care based on age and condition? 88 yr old with bounding pulse 12 year old, pale with edema in LE

88 yr old with bounding pulse Client A is an older adult who presents with a bounding pulse rate because of fluid overload in the body. Care should be prioritized in this client because the condition of the client indicates increasing fluid overload and needs immediate treatment. Vital signs should be monitored properly to identify other associated risks. Client B has pale skin with pitting edema, so this client should be given second priority for treatment and an oxygen mask or nasal cannula should be provided. Client C can be given medications to relieve the headache resulting from fluid overload. Client D should be given nutritional therapy to treat fluid overload.

Which pt is most likely to experience renal compromise assessed by decreased urine production? -10 yr hx of DM -WBC 12,000 -recent MI -92/46 BP for 12 hours

92/46

Which clinical manifestations would the nurse identify when assessing a client with hypercalcemia? Select all that apply. One, some, or all responses may be correct.

cardiac dysrhythmias hypoactive bowel sounds When the serum calcium level is increased, initially it causes tachycardia; as it progresses, it depresses electrical conduction in the heart, causing bradycardia. Hypercalcemia causes decreased peristalsis identified by constipation and hypoactive or absent bowel sounds. Muscle tremors occur with hypocalcemia, not hypercalcemia. Abdominal cramps occur with hypocalcemia, not hypercalcemia. Increased intestinal peristalsis occurs with hypocalcemia, not hypercalcemia.

The nurse assesses an older adult client with a diagnosis of dehydration. Which finding is an early sign of dehydration?

change in mental status Older adults are sensitive to changes in fluid and electrolyte levels, especially sodium, potassium, and chloride. These changes will manifest as a change in mental status and confusion. It is difficult to assess dehydration in older adults based on sunken eyes, dry skin, and decreased bowel sounds because these can be prominent as general normal findings in the older adult client.

When monitoring a client for hyponatremia, which assessment findings would the nurse consider significant? Select all that apply. One, some, or all responses may be correct.

confusion seizures Cellular swelling and cerebral edema are associated with hyponatremia; as extracellular sodium level decreases, the cellular fluid becomes relatively more concentrated and pulls water into cerebral cells, leading to confusion and seizures. Thirst is a symptom of hypernatremia; it may indicate dehydration. Erythema is not associated with hyponatremia. Diarrhea, not constipation, is associated with hyponatremia.

When receiving hemodialysis, the client may develop hyponatremia. Which clinical findings related to the potential development of hyponatremia would the nurse monitor? Select all that apply. One, some, or all responses may be correct.

diarrhea seizures Sodium is the most abundant cation in the extracellular fluid and functions as part of the sodium/potassium pump. In the presence of a deficit, the client will exhibit confusion, lethargy, diarrhea, and seizures. Spasm of the facial muscles after a tap over the facial nerve (Chvostek sign) indicates hypocalcemia. Cardiac dysrhythmias are associated with increases or decreases in potassium and calcium. An increase in body temperature reflects a possible infection, not an electrolyte imbalance.

A client with a history of chronic kidney disease is hospitalized. Which assessment findings would alert the nurse to suspect kidney insufficiency?

edema and pruritis The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.

Which signs and symptoms would the nurse include when teaching a client about ketoacidosis? Select all that apply. One, some, or all responses may be correct.

excessive thirst fruity scented breath confusion Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased urination, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.

An infant with severe gastroenteritis has a serum potassium of 3 mEq/L. Potassium chloride 20 mEq/L is prescribed to be added to the infant's intravenous (IV) line. Which action would the nurse take next?

find out when the infant last had a wet diaper Potassium chloride is excreted by functioning kidneys; if there is anuria, which is a sign of kidney failure, the potassium should be withheld and the practitioner notified. There is no reason to question the prescription because the laboratory value is below the expected level for an infant, which is 4.1 to 5.3 mEq/L. Potassium is a component of body fluid and will not cause an allergic response. Administering the potassium without confirming adequate kidney function is unsafe because potassium can accumulate and cause lethal cardiac dysrhythmias.

Which nursing intervention is appropriate when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

fluid replacement As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. Oxygen therapy is not necessarily indicated. Carbohydrates will increase the blood glucose level, which is already high. Although dietary instruction may be appropriate later, such instruction is inappropriate during the crisis.

Which hormone aids in regulating intestinal calcium and phosphorous absorption?

glucocorticoids Adrenal glucocorticoids aid in regulating intestinal calcium and phosphorous absorption by increasing or decreasing protein metabolism. Insulin acts together with growth hormone to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion increases in response to decreased serum calcium concentration and stimulates the bones to promote osteoclastic activity.

During the oliguric phase of acute kidney injury, for which abnormal finding would the nurse monitor in the client?

hyperphosphatemia The kidneys retain potassium during the oliguric phase of acute kidney injury; an elevated potassium level is one of the main indicators for placing a client on hemodialysis when he or she is experiencing acute kidney injury. Hypothermia does not occur with acute kidney injury. Serum levels of phosphorus decrease during the oliguric phase of kidney failure. The retained fluids create a hemodilution effect and hyponatremia occurs, not hypernatremia.

A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. Which electrolyte imbalance is causing these clinical findings?

hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Clinical manifestations of hyponatremia include nausea, malaise, and changes in mental status. Clinical manifestations of hyperglycemia include weakness, dry skin, flushing, polyuria, and thirst. Clinical manifestations of hypercalcemia include lethargy, nausea, vomiting, paresthesias, and personality changes.

The nurse is providing postoperative care for a client 1 hour after an adrenalectomy. Maintenance steroid therapy has not begun yet. The nurse would monitor the client for which complication?

hypotension

A client with acute kidney failure reports fatigue and becomes lethargic. Upon reviewing the client's medical record, which finding would the nurse determine is the most likely cause of these clinical manifestations?

increased BUN An increased BUN level, indicating uremia, is toxic to the central nervous system and causes fatigue and lethargy. Hyperkalemia is associated with muscle weakness, irritability, nausea, and diarrhea. Hypernatremia is associated with firm tissue turgor, oliguria, and agitation. Dehydration can cause fatigue, dry skin and mucous membranes, and rapid pulse and respiratory rates.

Which symptoms indicating thyroid storm would the nurse monitor a client for? Select all that apply. One, some, or all responses may be correct.

increased HR increased temp

The nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse will assess for which complications? Select all that apply. One, some, or all responses may be correct.

infection hyperglycemia electrolyte imbalance

Which clinical findings would the nurse expect when assessing a client with chronic kidney failure? Select all that apply. One, some, or all responses may be correct.

lethargy muscle twitching

The nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which new prescription will the nurse question?

mag citrate

Which intervention is the nurse's first priority during postoperative care for a kidney transplant recipient?

maintaining fluid and electrolyte balance

When caring for a client in late hypovolemic shock, which complication will the nurse anticipate?

metabolic acidosis Decreased cellular oxygen caused by poor perfusion increases the conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis. Hyperkalemia will occur because of renal shutdown; hypokalemia can occur in early shock. Respiratory alkalosis can occur in early shock because of rapid, shallow breathing, but in late shock, metabolic or respiratory acidosis occurs. The Pco2 level will increase in profound shock.

The nurse assesses a client who is experiencing profound (late) hypovolemic shock. When monitoring the client's arterial blood gas results, which response would the nurse expect?

metabolic acidosis Decreased oxygen promotes the conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis. Arterial blood gases do not assess serum potassium levels. Hyperkalemia will occur with shock because of renal shutdown. Respiratory alkalosis may occur in early shock because of rapid, shallow breathing, but in late shock metabolic or respiratory acidosis occurs. The carbon dioxide level will be increased in profound shock.

Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis?

monitor for signs of hypoglycemia due to tx During treatment for acidosis, hypoglycemia may develop; careful observation for this complication will be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

Which finding would the nurse expect when assessing a client diagnosed with hypovolemic shock?

oliguria Urine output decreases to less than 20 to 30 mL/hr (oliguria) because of decreased renal perfusion secondary to a decreased circulating blood volume. Crackles are associated with pulmonary edema caused by cardiogenic shock, not hypovolemic shock. Dyspnea may be associated with hypervolemia, not hypovolemia, and also with pulmonary edema and respiratory disorders. Bounding pulse will occur with hypervolemia.

Which hormone regulates blood levels of calcium?

parathyroid hormone Parathyroid hormone (PTH) regulates the blood levels of calcium and phosphorus. LH stimulates the production of sex hormones, promotes the growth of reproductive organs, and also stimulates reproductive processes. TSH stimulates the release of thyroid hormones and the growth and functioning of the thyroid gland. ACTH promotes the growth of the adrenal cortex and stimulates the release of corticosteroids.

Which interventions would the nurse implement in caring for a client with diabetes insipidus (DI) after a head injury? Select all that apply. One, some, or all responses may be correct.

provide adequate fluids within reach assess for change in LOC monitor for constipation, weight loss, hypotension and tachycardia

Non-progressive stage of shock

signs of acidosis, but talking reflex compensatory mechanisms are activated and perfusion of vital organs is maintained

The nurse is assessing a client during the first 24 hours after a burn injury. Which sign indicates to the nurse that fluid replacement therapy is adequate?

slowing of a previously rapid pulse The pulse rate is one indicator of optimum vascular fluid volume; the pulse rate decreases as intravascular volume normalizes. Decreasing CVP readings indicate hypovolemia. Urinary output of 15 to 20 mL/h indicates inadequate kidney perfusion; if fluid replacement is adequate, the urinary output should be more than 30 mL/h. A hematocrit level increasing from 50% to 55% indicates hypovolemia and increased hemoconcentration.

Initial stage of shock

tachycardia

The nurse is notified that the latest potassium level for a client who has acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action would the nurse take?

take vital signs and notify provider

A child undergoing prolonged steroid therapy takes on a cushingoid appearance. The nurse would expect to find which of these manifestations during further assessment? Select all that apply. One, some, or all responses may be correct.

truncal obesity thin extremities

A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, which are priority nursing assessments? Select all that apply. One, some, or all responses may be correct.

urinary output last serum potassium levels patency of the IV access

Which instruction would the nurse include when teaching the client how to perform peritoneal dialysis and the importance of preventing peritonitis? Select all that apply. One, some, or all responses may be correct.

wear mask aseptic technique clean every day wash hands store items in clean dry location

The nurse is admitting a client with severe myxedema coma. Which interventions would the nurse include in the plan of care? Select all that apply. One, some, or all responses may be correct.

Administer intravenous (IV) levothyroxine.Give IV normal saline. Myxedema coma is a major complication of poorly treated hypothyroidism. Interventions include administering IV levothyroxine. This promotes the return to normal thyroid hormone levels. IV normal saline corrects dehydration. Corticosteroids are administered as part of the treatment. Levothyroxine is initiated before obtaining laboratory results because waiting can cause death. The blood pressure should be monitored hourly.