Fluid and Electrolytes/ Acid and Base

Hypotonic IV Fluid

(needs more water)-Diluted (osmolarity≺250) ***Osmolarity=outside the body, IV, drink**** Saline 0.45%(1/2 Normal Saline) 5% Dextrose (D5W)

Hypertonic IV Fluid

(over hydrated) Concentrated (Osmolarity ≻375) 3% Saline 10% Dextrose Heart failure no fluid at all ex:hypertonic 310 osmolality Isotonic or hypotonic IV solution Never treat hypo with hypo; and hyper with hyper

Creatinine

0.5-1.2

Digoxin

0.5-2

Hypertonic

1-solution exerts greater osmotic pressure

Hypotonic

1-solution has smaller concentration

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? 1."I should limit my fluids to 1 liter per day." 2. "I should use my treadmill or go for walks daily." 3. "I should follow a moderate-calcium, high-fiber diet." 4. "My alendronate helps to keep calcium from coming out of my bones."

1. "I should limit my fluids to 1 liter per day."

The nurse is caring for a client who needs a hypertonic intravenous (IV) solution. What solutions are hypertonic? Select all that apply. 1. 10% dextrose in water 2. 0.45% sodium chloride 3. 5% dextrose in 0.9% saline 4. 5% dextrose in 0.45% saline 5. 5% dextrose in 0.225% saline 6. 5% dextrose in lactated Ringer's solution

1. 10% dextrose in water 3. 5% dextrose in 0.9% saline 4. 5% dextrose in 0.45% saline 6. 5% dextrose in lactated Ringer's solution

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 (3.2 mmol/L) 2. 3.8 mEq/L (3.8 mmol/L) 3. 4.2 mEq/L (4.2 mmol/L) 4. 4.8 mEq/L (4.8 mmol/L)

1. 3.2 mEq/L (3.2 mmol/L)

A client with a diagnosis of hyperphosphatemia has been treated with dietary management and phosphate binding gels. The client reports to the clinic, and the nurse is reviewing the laboratory results. Which reported serum phosphate level would indicate improvement in the client's condition? 1. 4.0 mg/dL (1.3 mmol/L) 2. 5.2 mg/dL (1.7 mmol/L) 3. 6.0 mg/dL (1.9 mmol/L) 4. 6.5 mg/dL (2.1 mmol/L)

1. 4.0 mg/dL (1.3 mmol/L)

The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit? 1. A client with an ileostomy 2. A client with heart failure 3. A client on long-term corticosteroid therapy 4. A client receiving frequent wound irrigations

1. A client with an ileostomy

A client has developed paroxysmal nocturnal dyspnea. Which medication should the nurse anticipate will be prescribed by the health care provider? 1. Bumetanide 2. Amiodarone 3. Propranolol 4. Streptokinase

1. Bumetanide

The nurse is caring for a client with a serum phosphorus level of 5.0 mg/dL (1.61 mmol/L). What other laboratory value might the nurse expect to note in the medical record? 1. Calcium level of 8 mg/dL (2.0 mmol/L) 2. Calcium level of 11.2 mg/dL (2.8 mmol/L) 3. Potassium level of 2.9 mEq/L (2.9 mmol/L) 4. Potassium level of 5.6 mEq/L (5.6 mmol/L)

1. Calcium level of 8 mg/dL (2.0 mmol/L)

A client with a diagnosis of Addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1. Hypotension 2. Leukocytosis 3. Hyperkalemia 4. Hypercalcemia 5. Hypernatremia

1. Hypotension 3. Hyperkalemia

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high Fowler's. 5. Administer a vasopressin antagonist as prescribed.

1. Initiate an infusion of 3% NaCl. 3. Restrict fluids to 800 mL over 24 hours. 5. Administer a vasopressin antagonist as prescribed.

A client has abnormal amounts of circulating thyronine (T3) and thyroxine (T4). While obtaining the health history, the nurse asks the client about dietary intake. Lack of which dietary element is most likely the cause? 1. Iodine 2. Calcium 3. Phosphorus 4. Magnesium

1. Iodine

A client is hospitalized with a diagnosis of adrenal insufficiency. Which findings does the nurse identify as supportive of this diagnosis? Select all that apply. 1. Irritability 2. Complaints of nausea 3. Sodium level of 128 mEq/L (128 mmol/L) 4. Potassium level of 3.2 mEq/L (3.2 mmol/L) 5. Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

1. Irritability 2. Complaints of nausea 3. Sodium level of 128 mEq/L (128 mmol/L) 5. Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

The nurse provides dietary instructions to a client at risk for hypokalemia about which foods are high in potassium and should be included in the daily diet. The nurse should tell the client that which fruit is highest in potassium? 1. Kiwi 2. Apples 3. Peaches 4. Pineapple

1. Kiwi

The nurse reviews a client's laboratory report and notes that the client's serum phosphorus (phosphate) level is 1.8 mg/dL (0.45 mmol/L). Which condition most likely caused this serum phosphorus level? 1. Malnutrition 2. Renal insufficiency 3. Hypoparathyroidism 4. Tumor lysis syndrome

1. Malnutrition

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions should be included in the care plan for this client? Select all that apply. 1. Monitor daily weight. 2. Monitor intake and output. 3. Assess extremities for edema. 4. Maintain a high-sodium diet. 5. Maintain a low-potassium diet.

1. Monitor daily weight. 2. Monitor intake and output. 3. Assess extremities for edema.

The nurse is developing a plan of care for a client with Addison's disease. The nurse has identified a problem of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor for changes in mentation. 2. Encourage an intake of low-protein foods. 3. Encourage an intake of low-sodium foods. 4. Encourage fluid intake of at least 3000 mL per day. 5. Monitor vital signs, skin turgor, and intake and output.

1. Monitor for changes in mentation. 4. Encourage fluid intake of at least 3000 mL per day. 5. Monitor vital signs, skin turgor, and intake and output.

The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply. 1. Nausea 2. Confusion 3. Bradypnea 4. Tachycardia 5. Hyperkalemia 6. Lightheadedness

1. Nausea 2. Confusion 4. Tachycardia 6. Lightheadedness

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply. 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 3. Put the client on NPO (nothing by mouth) status except for ice chips. 4. Review the client's medications to determine if any contain or retain potassium. 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.

1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 4. Review the client's medications to determine if any contain or retain potassium.

A client with suspected primary hyperparathyroidism is undergoing diagnostic testing. The nurse would assess for which as a manifestation of this disorder? 1. Polyuria 2. Diarrhea 3. Polyphagia 4. Weight gain

1. Polyuria

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply. 1. Polyuria 2. Polydipsia 3. Concentrated urine 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005

1. Polyuria 2. Polydipsia 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. 1. Polyuria 2. Headache 3. Bone pain 4. Nervousness 5. Weight gain

1. Polyuria 3. Bone pain

The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance? 1. Respiratory acidosis from inadequate ventilation 2. Respiratory alkalosis from anxiety and hyperventilation 3. Metabolic acidosis from calcium loss due to broken bones 4. Metabolic alkalosis from taking analgesics containing base products

1. Respiratory acidosis from inadequate ventilation

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? 1. Restrict fluids as prescribed. 2. Care for the arteriovenous fistula. 3. Encourage foods high in potassium. 4. Administer analgesics as prescribed

1. Restrict fluids as prescribed.

A client had a 1000-mL bag of 5% dextrose in 0.9% sodium chloride hung at 1500. The nurse making rounds at 1545 finds that the client is complaining of a pounding headache and is dyspneic, experiencing chills, and apprehensive, with an increased pulse rate. The intravenous (IV) bag has 400 mL remaining. The nurse should take which action first? 1. Slow the IV infusion. 2. Sit the client up in bed. 3. Remove the IV catheter. 4. Call the health care provider (HCP).

1. Slow the IV infusion.

Which client is at risk for the development of a sodium level at 130 mEq/L (130 mmol/L)? 1. The client who is taking diuretics 2. The client with hyperaldosteronism 3. The client with Cushing's syndrome 4. The client who is taking corticosteroids

1. The client who is taking diuretics

A client with an endocrine disorder has experienced recent weight loss and exhibits tachycardia. Based on the clinical manifestations, the nurse should suspect dysfunction of which endocrine gland? 1. Thyroid 2. Pituitary 3. Parathyroid 4. Adrenal cortex

1. Thyroid

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

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

The nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 2.5 mEq/L (2.5 mmol/L). Which patterns should the nurse watch for on the electrocardiogram (ECG) as a result of the laboratory value? Select all that apply. 1. U waves 2. Absent P waves 3. Inverted T waves 4. Depressed ST segment 5. Widened QRS complex

1. U waves 3. Inverted T waves 4. Depressed ST segment

A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge? 1. Weigh self on a daily basis. 2. Sleep with the head of the bed flat. 3. Take a double dose of the diuretic if peripheral edema is noted. 4. Withhold prescribed digoxin if slight respiratory distress occurs.

1. Weigh self on a daily basis.

The nurse caring for a client who has been receiving intravenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition? 1. Weight loss and poor skin turgor 2. Lung congestion and increased heart rate 3. Decreased hematocrit and increased urine output 4. Increased respirations and increased blood pressure

1. Weight loss and poor skin turgor

The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? 1. pH 7.25, Paco2 50 mm Hg (50 mm Hg) 2. pH 7.35, Paco2 40 mm Hg (40 mm Hg) 3. pH 7.50, Paco2 52 mm Hg (52 mm Hg) 4. pH 7.52, Paco2 28 mm Hg (28 mm Hg)

1. pH 7.25, Paco2 50 mm Hg (50 mm Hg)

Urine specific gravity

1.003-1.030

Magnesium

1.5-2.5

BUN

10-20

Hemoglobin

12-18

Sodium

135-145

Platlets

150,000-400,000

Isotonic

2-solutions have same concentration, solutions exert same osmotic pressure

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The registered nurse determines that the new nurse understands that what substance is secreted if which statement is made? 1. "Cortisol will be secreted." 2. "Aldosterone will be secreted." 3. "Additional glucagon will be produced." 4. "Adrenocorticotropic hormone production will increase."

2. "Aldosterone will be secreted."

The nurse is taking a health history for a client with hyperparathyroidism. Which question would elicit information about this client's condition? 1. "Do you have tremors in your hands?" 2. "Are you experiencing pain in your joints?" 3. "Do you notice swelling in your legs at night?" 4. "Have you had problems with diarrhea lately?"

2. "Are you experiencing pain in your joints?"

The nurse teaches the client, who is newly diagnosed with diabetes insipidus, about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. 1. "This medication will turn my urine orange." 2. "I should decrease my oral fluids when I start this medication." 3. "The amount of urine I make should increase if this medicine is working." 4. "I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." 5. "I should report headache and drowsiness to my health care provider since these symptoms could be related to my desmopressin."

2. "I should decrease my oral fluids when I start this medication." 5. "I should report headache and drowsiness to my health care provider since these symptoms could be related to my desmopressin."

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1. "It relieves the headaches." 2. "It increases water reabsorption." 3. "It stimulates the production of aldosterone." 4. "It decreases the production of the antidiuretic hormone."

2. "It increases water reabsorption."

The family of a bedridden client with type 2 diabetes mellitus and chronic kidney disease calls the nurse to report symptoms of headache, polydipsia, and increased lethargy. Which most important question should the nurse ask the family to determine a possible problem? 1. "What is the client's urine output?" 2. "What is the client's capillary blood glucose level?" 3. "Has there been any change in the dietary intake?" 4. "Have you increased the amount of fluids provided?"

2. "What is the client's capillary blood glucose level?"

A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen (BUN) level drops to which value? 1. 3 mg/dL (1.05 mmol/L) 2. 15 mg/dL (5.25 mmol/L) 3. 29 mg/dL (10.15 mmol/L) 4. 35 mg/dL (12.25 mmol/L)

2. 15 mg/dL (5.25 mmol/L)

The nurse is reviewing the results of the electrolyte panel for a client seen in the health care clinic. The nurse determines that the client's potassium level is normal if which value is noted? 1. 2.0 mEq/L (2.0 mmol/L) 2. 4.0 mEq/L (4.0 mmol/L) 3. 5.3 mEq/L (5.3 mmol/L) 4. 6.0 mEq/L (6.0 mmol/L)

2. 4.0 mEq/L (4.0 mmol/L)

A client has returned to the nursing unit after a thyroidectomy. The nurse notes that the client is complaining of tingling sensations around the mouth, fingers, and toes. On the basis of these findings, the nurse should next assess the results of which serum laboratory study? 1. Sodium 2. Calcium 3. Potassium 4. Magnesium

2. Calcium

A client with medullary carcinoma of the thyroid has an excess function of the C cells of the thyroid gland. When reviewing the most recent laboratory results, the nurse should expect which electrolyte abnormality? 1. Sodium 2. Calcium 3. Potassium 4. Magnesium

2. Calcium

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

2. Calcium level

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

2. Metabolic alkalosis

A client's laboratory results indicate the serum calcium is 12 mg/dL (3 mmol/L) and the serum phosphorous is 2.1 mg/dL (0.697 mmol/L). Based on these findings, the nurse suspects imbalance of which hormone? 1. Thyroid hormone 2. Parathyroid hormone 3. Follicle-stimulating hormone 4. Adrenocorticotropic hormone

2. Parathyroid hormone

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which finding on assessment of the client? 1. Unresponsive pupils 2. Positive Trousseau's sign 3. Negative Chvostek's sign 4. Hypoactive bowel sounds

2. Positive Trousseau's sign

A client is being treated for metabolic acidosis with medication therapy and other measures. The nurse should plan to monitor the results of which electrolyte, which could dramatically decline with effective treatment of the acidosis? 1. Sodium 2. Potassium 3. Magnesium 4. Phosphorus

2. Potassium

Spironolactone is prescribed for a client with heart failure. In providing dietary instructions to the client, the nurse identifies the need to avoid foods that are high in which electrolyte? 1. Calcium 2. Potassium 3. Magnesium 4. Phosphorus

2. Potassium

The nurse is preparing to administer furosemide to a client with a diagnosis of heart failure. Which is the most important laboratory test result for the nurse to check before administering this medication? 1. Creatinine level 2. Potassium level 3. Cholesterol level 4. Blood urea nitrogen (BUN)

2. Potassium level

The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1. Sodium level of 145 mEq/L (145 mmol/L) 2. Potassium level of 3.0 mEq/L (3.0 mmol/L) 3. Magnesium level of 1.3 mEq/L (0.65 mmol/L) 4. Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

2. Potassium level of 3.0 mEq/L (3.0 mmol/L)

The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client is at risk for developing the potassium deficit because of which situation? 1. Sustained tissue damage 2. Requires nasogastric suction 3. Has a history of Addison's disease 4. Uric acid level of 9.4 mg/dL (559 mmol/L)

2. Requires nasogastric suction

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. 1. Respirations that are shallow 2. Respirations that are increased in rate 3. Respirations that are abnormally slow 4. Respirations that are abnormally deep 5. Respirations that cease for several seconds

2. Respirations that are increased in rate 4. Respirations that are abnormally deep

The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Paco2 of 30 mm Hg (30 mm Hg), and HCO3- of 20 mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition? 1. Metabolic acidosis, compensated 2. Respiratory alkalosis, compensated 3. Metabolic alkalosis, uncompensated 4. Respiratory acidosis, uncompensated

2. Respiratory alkalosis, compensated

A client with heart failure is scheduled to be discharged to home with digoxin and furosemide as daily prescribed medications. The nurse tells the client to report which finding as an indication that the medications are not having the intended effect? 1. Sudden increase in appetite 2. Weight gain of 2 to 3 lb in a few days 3. Increased urine output during the day 4. Cough accompanied by other signs of respiratory infection

2. Weight gain of 2 to 3 lb in a few days

Phosphorous

2.8-4.5

HC03

22-26

Plasma Osmolality

275-295

The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? 1. "I should avoid contact sports." 2. "I should check my ankles for swelling." 3. "I need to avoid foods high in potassium." 4. "I need to check my blood glucose regularly."

3. "I need to avoid foods high in potassium."

A home health care nurse is visiting an older client at home. Furosemide is prescribed for the client and the nurse teaches the client about the medication. Which statement, if made by the client, indicates the need for further teaching? 1. "I will sit up slowly before standing each morning." 2. "I will take my medication every morning with breakfast." 3. "I need to drink lots of coffee and tea to keep myself healthy." 4. "I will call my health care provider if my ankles swell or my rings get tight."

3. "I need to drink lots of coffee and tea to keep myself healthy."

A nurse has provided dietary instructions to a client with Addison's disease. Which statement made by the client indicates that the client understands instructions? 1. "I will decrease my carbohydrate intake." 2. "High fat intake is essential with this disease." 3. "I will maintain a normal sodium intake in my diet." 4. "I will need to restrict the amount of protein in my diet."

3. "I will maintain a normal sodium intake in my diet."

A new registered nurse (RN) prepares to administer sodium polystyrene sulfonate to a client. Before administering the medication, the nurse reviews the action of the medication with another RN. Which statement by the new RN indicates that the teaching has been effective? 1. "Bicarbonate is exchanged for primarily sodium ions." 2. "Potassium ions are exchanged for primarily sodium ions." 3. "Sodium ions are exchanged for primarily potassium ions." 4. "Sodium ions are exchanged for primarily bicarbonate ions."

3. "Sodium ions are exchanged for primarily potassium ions."

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 mm3 (200 × 109/L) 2. A blood glucose level of 110 mg/dL (6.28 mmol/L) 3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) 4. A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L)

The nurse is caring for a client with hypertension who is receiving torsemide orally daily. Which laboratory test result would indicate to the nurse that the client may be experiencing a side or adverse effect related to the medication? 1. A chloride level of 98 mEq/L (98 mmol/L) 2. A sodium level of 135 mEq/L (135 mmol/L) 3. A potassium level of 3.1 mEq/L (3.1 mmol/L) 4. A blood urea nitrogen (BUN) of 15 mg/dL (5.4 mmol/L)

3. A potassium level of 3.1 mEq/L (3.1 mmol/L)

The nurse is monitoring a child with burns during treatment for burn shock. Which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation? 1. Skin turgor 2. Level of edema at burn site 3. Adequacy of capillary filling 4. Amount of fluid tolerated in 24 hours

3. Adequacy of capillary filling

The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? 1. Weight loss and dry skin 2. Flat neck and hand veins and decreased urinary output 3. An increase in blood pressure and increased respirations 4. Weakness and decreased central venous pressure (CVP)

3. An increase in blood pressure and increased respirations

A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted? 1. The child has no tears. 2. Urine specific gravity is 1.035. 3. Capillary refill is less than 2 seconds. 4. Urine output is less than 1 mL/kg/hour.

3. Capillary refill is less than 2 seconds.

In reviewing the medication records of a group of clients, the nurse determines that which client would be at greatest risk for developing hyperkalemia? 1. Client receiving bumetanide 2. Client receiving furosemide 3. Client receiving spironolactone 4. Client receiving hydrochlorothiazide

3. Client receiving spironolactone

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data should the nurse identify as a possible complication of thyroid surgery? 1. Increased serum sodium level 2. Increased serum glucose level 3. Decreased serum calcium level 4. Decreased serum albumin level

3. Decreased serum calcium level

A nurse needs to maintain food and fluid intake to minimize the risk of dehydration in a client with diabetes mellitus who has gastroenteritis. Which is the appropriate nursing intervention? 1. Offer water only until the client is able to tolerate solid foods. 2. Withhold all fluids until vomiting has ceased for at least 4 hours. 3. Encourage the client to take 8 to 12 oz of fluid every hour while awake. 4. Maintain a clear liquid diet for at least 5 days before advancing to solids.

3. Encourage the client to take 8 to 12 oz of fluid every hour while awake.

A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Which blood component should the nurse expect the health care provider to prescribe? 1. Platelets 2. Granulocytes 3. Fresh-frozen plasma 4. Packed red blood cells

3. Fresh-frozen plasma

A client with a history of lung disease is at risk for developing respiratory acidosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder? 1. Bradycardia and hyperactivity 2. Decreased respiratory rate and depth 3. Headache, restlessness, and confusion 4. Bradypnea, dizziness, and paresthesias

3. Headache, restlessness, and confusion

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 1. Hypernatremia 2. Signs of water deficit 3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone (ADH)

3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone (ADH)

The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia? 1. Muscle twitches 2. Decreased urinary output 3. Hyperactive bowel sounds 4. Increased specific gravity of the urine

3. Hyperactive bowel sounds

A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased blood pressure, bounding pulse, jugular vein distention, and crackles bilaterally. The nurse determines that the client is experiencing which complication of PN therapy 1. Sepsis 2. Air embolism 3. Hypervolemia 4. Hyperglycemia

3. Hypervolemia

The nurse is reading a health care provider's (HCP's) progress notes in the client's record and reads that the HCP has documented "insensible fluid loss of approximately 800 mL daily." The nurse makes a notation that insensible fluid loss occurs through which type of excretion? 1. Urinary output 2. Wound drainage 3. Integumentary output 4. The gastrointestinal tract

3. Integumentary output

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1. Diarrhea 2. Metabolic acidosis 3. Metabolic alkalosis 4. Hyperactive bowel sounds

3. Metabolic alkalosis

A nurse is assessing a client who has had cranial surgery and is at risk for development of diabetes insipidus. The nurse would assess for which signs or symptoms that could indicate development of this complication? 1. Diarrhea 2. Infection 3. Polydipsia 4. Weight gain

3. Polydipsia

A client receiving total parenteral nutrition (TPN) has a history of heart failure. The health care provider (HCP) has prescribed furosemide 40 mg by mouth daily to prevent fluid overload. Which laboratory value should the nurse monitor to identify the presence of an adverse effect of this medication? 1. Sodium 2. Glucose 3. Potassium 4. Magnesium

3. Potassium

Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)? 1. Chloride level of 98 mEq/L (98 mmol/L) 2. Sodium level of 135 mEq/L (135 mmol/L) 3. Potassium level of 6.8 mEq/L 6.8 mmol/L) 4. Magnesium level of 1.6 mEq/L (0.8 mmol/L)

3. Potassium level of 6.8 mEq/L 6.8 mmol/L)

The nurse reviews the arterial blood gas results of an assigned client and notes that the laboratory report indicates a pH of 7.30, Paco2 of 58 mm Hg, Pao2 of 80 mm Hg, and Hco3 of 27 mEq/L (27 mmol/L). The nurse interprets that the client has which acid-base disturbance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

3. Respiratory acidosis

The nurse is caring for a postoperative client who has had an adrenalectomy. What should the nurse check for during the client's focused assessment? 1. Peripheral edema 2. Bilateral exophthalmos 3. Signs and symptoms of hypovolemia 4. Signs and symptoms of hypocalcemia

3. Signs and symptoms of hypovolemia

The nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.7 mEq/L (5.7 mmol/L). Which patterns would the nurse watch for on the cardiac monitor as a result of the laboratory value? Select all that apply. 1. ST depression 2. Prominent U wave 3. Tall peaked T waves 4. Prolonged ST segment 5. Widened QRS complexes

3. Tall peaked T waves 5. Widened QRS complexes

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign or symptom, if noted in the client, would most likely indicate the presence of hypocalcemia? 1. Bradycardia 2. Flaccid paralysis 3. Tingling around the mouth 4. Absence of Chvostek's sign

3. Tingling around the mouth

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1. To treat thyroid storm 2. To prevent cardiac irritability 3. To treat hypocalcemic tetany 4. To stimulate release of parathyroid hormone

3. To treat hypocalcemic tetany

A multidisciplinary health care team is developing a plan of care for a client with hyperparathyroidism. The nurse should include which priority intervention in the plan of care? 1. Describe the use of loperamide. 2. Restrict fluids to 1000 mL per day. 3. Walk down the hall for 15 minutes 3 times a day. 4. Describe the administration of aluminum hydroxide gel.

3. Walk down the hall for 15 minutes 3 times a day.

Albumin

3.5-5

Potassium

3.5-5.0

Paco2

35-45

Hematocrit

37-52

RBC

4-6

After client education about the importance of sunscreen use and active vitamin production via the skin, the nurse determines that the client understands the teaching when which statement is made? 1. "Vitamin B is activated in the outer layer of the skin by the sun." 2. "Vitamin E deficiency occurs from lack of exposure to sunlight." 3. "Vitamin K can be depleted if exposed to excess ultraviolet light." 4. "Vitamin D is activated in the epidermis from ultraviolet light, such as sunlight."

4. "Vitamin D is activated in the epidermis from ultraviolet light, such as sunlight."

The nurse is reviewing the assessment findings for a client who has been taking spironolactone for treatment of hypertension. Which, if noted in the client's record, would indicate that the client is experiencing an adverse effect related to the medication? . Client complaint of dry skin 2. Client complaint of constipation 3. A potassium level of 3.5 mEq/L (3.5 mmol/L) 4. A potassium level of 5.8 mEq/L (5.8 mmol/L)

4. A potassium level of 5.8 mEq/L (5.8 mmol/L)

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? 1. A decreased pH and an increased PaCO2 2. An increased pH and a decreased PaCO2 3. A decreased pH and a decreased HCO3- 4. An increased pH and an increased HCO3-

4. An increased pH and an increased HCO3-

A client has a tumor that is interfering with the function of the hypothalamus. The nurse should monitor for signs and symptoms related to which imbalance? 1. Melatonin excess or deficit 2. Glucocorticoid excess or deficit 3. Mineralocorticoid excess or deficit 4. Antidiuretic hormone (ADH) excess or deficit

4. Antidiuretic hormone (ADH) excess or deficit

After hypophysectomy, a client complains of being thirsty and having to urinate frequently. What is the initial nursing action? 1. Increase fluid intake. 2. Document the complaints. 3. Assess for urinary glucose. 4. Assess urine specific gravity.

4. Assess urine specific gravity.

A health care provider prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? 1. Obtains a weight 2. Takes the temperature 3. Takes the blood pressure 4. Checks the amount of urine output

4. Checks the amount of urine output

A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse should next assess the client for the presence of which condition? 1. Thirst 2. Polyuria 3. Decreased blood pressure 4. Crackles on auscultation of the lungs

4. Crackles on auscultation of the lungs

The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency? 1. Headache 2. Dysphagia 3. Constipation 4. Electrocardiographic changes

4. Electrocardiographic changes

A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would assess for which problem as a manifestation of this disorder? 1. Edema 2. Obesity 3. Hirsutism 4. Hypotension

4. Hypotension

A client has an as needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. Nausea and vomiting

4. Nausea and vomiting

A client with pulmonary edema has been receiving diuretic therapy. The client has a prescription for additional furosemide in the amount of 40 mg intravenous push. Knowing that the client will also be started on digoxin, which laboratory result should the nurse review as the priority? 1. Sodium level 2. Digoxin level 3. Creatinine level 4. Potassium level

4. Potassium level

The nurse is caring for a client with hypocalcemia. Which patterns would the nurse watch for on the electrocardiogram as a result of the laboratory value? Select all that apply. 1. U waves 2. Widened T wave 3. Prominent U wave 4. Prolonged QT interval 5. Prolonged ST segment

4. Prolonged QT interval 5. Prolonged ST segment

The nurse is caring for a postoperative client who has lost a significant amount of blood because of complications during a surgical procedure. Which assessment finding would be indicative of further fluid volume deficit? 1. 4+ edema noted in lower extremities 2. Crackles auscultated from lung bases to apices 3. Blood pressure rises from 116/68 to 118/74 mm Hg 4. Pulse rate increases from 100 beats/min to 136 beats/min

4. Pulse rate increases from 100 beats/min to 136 beats/min

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Paco2 is 90 mm Hg (90 mm Hg), and HCO3- is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition? 1. Metabolic acidosis with compensation 2. Respiratory acidosis with compensation 3. Metabolic acidosis without compensation 4. Respiratory acidosis without compensation

4. Respiratory acidosis without compensation

The nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation? 1. Serum chloride level of 98 mEq/L (98 mmol/L) 2. Serum sodium level of 145 mEq/L (145 mmol/L) 3. Serum calcium level of 10.5 mg/dL (2.75 mmol/L) 4. Serum potassium level of 2.8 mEq/L (2.8 mmol/L)

4. Serum potassium level of 2.8 mEq/L (2.8 mmol/L)

The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are pH = 7.53, Pao2 = 72 mm Hg (72 mm Hg), Paco2 = 32 mmHg (32 mm Hg), and HCO3- = 28 mEq/L (28 mmol/L). Which conclusion about the client should the nurse make? 1. The client has acidotic blood. 2. The client is probably overreacting. 3. The client is fluid volume overloaded. 4. The client is probably hyperventilating.

4. The client is probably hyperventilating.

Which client is at risk for the development of a potassium level of 5.5 mEq/L (5.5 mmol/L)? 1. The client with colitis 2. The client with Cushing's syndrome 3. The client who has been overusing laxatives 4. The client who has sustained a traumatic burn

4. The client who has sustained a traumatic burn

On review of the clients' medical records, the nurse determines that which client is at risk for fluid volume excess? 1. The client taking diuretics and has tenting of the skin 2. The client with an ileostomy from a recent abdominal surgery 3. The client who requires intermittent gastrointestinal suctioning 4. The client with kidney disease and a 12-year history of diabetes mellitus

4. The client with kidney disease and a 12-year history of diabetes mellitus

During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what should the nurse assess next? 1. Serum glucose 2. Blood pressure 3. Respiratory rate 4. Urine specific gravity

4. Urine specific gravity

WBC

5-10

pH

7.35-7.45

Fasting glucose

70-110

Calcium

9-10.5

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

A 72-year-old with chronic alcoholism

Aldosterone

A mineralcortocoid produced by the adrenal cortex that promotes sodium and water reabsorption by the kidneys and potassium excretion in urine.

Anion

A negatively charged ion

Concentration gradient

Across membrane separating high concentration of ion from low concentration of same ion

Renin

An enzyme secreted by the juxtaglomerular cells when blood pressure decreases. Renin onverts angiotensinogen to angiotensin I.

Cardiac (Shut off before fluid volume overload)

Baroreceptors (pressure) in right Atrium=high pressure detecting→Natriuretic peptides>diuretic →ANP,BNP

Fluid movement in capillaries

Capillary=always veins

Which assessment do you interpret as a transfusion reaction? Crackles in dependent parts of lungs High fever, severe hypotension Anxiety, itching, confusion Chills, tachycardia, and flushing

Chills, tachycardia, and flushing

Water

Compartments- intracellular, interstitial(tissues), extracellular, plasma, transcellular (pleura spaces, joints) Movement-Osmotic pressure(pull of the concentration) ↑concentration ↑pull it has; Oncotic pressure(pull); Hydrostatic Pressure (push)

antidiuretic hormone (ADH)

Decreases urine, Ups water reabsorption in renal tubules Production: decreases production of urine Storage/release: postierior lobe of the pituitary gland Purpose: increases BP

Osmotic pressure

Drawing power for water, which depends on the number of molecules in the solution.

Your patient has severe hypercalcemia. What are your priority nursing interventions? Fall prevention interventions Teaching regarding sodium restriction Encouraging increased fluid intake Monitoring for constipation Explaining how to take daily weights

Fall prevention interventions Encouraging increased fluid intake Monitoring for constipation

Your patient has hypokalemia with stable cardiac function. What are your priority nursing interventions? Fall prevention interventions Teaching regarding sodium restriction Encouraging increased fluid intake Monitoring for constipation Hypokalemia causes bilateral skeletal muscle Explaining how to take daily weights .

Fall prevention interventions Monitoring for constipation

Electrolytes

Fluid in body compartments contains mineral salts know technically as electrolytes

Which assessment do you use as a clinical marker of vascular volume in a patient at high risk of extracellular fluid volume (ECV) deficit? Dryness of mucous membranes Presence or absence of edema Fullness of neck veins when supine Fullness of neck veins when upright

Fullness of neck veins when supine

Oral intake

GI-Feces high in potassium,fluids in GI:sodium high Digestive Fluids= 8L/day

Plasma osmolality and fluid osmolarity

IV fluid look for edema, listen to lungs, labs , level of consciousness, kidney function

Oncotic pressure (Pull) power of protein

Made up of Protein (albumin 3.5-5) and Colloid Osmotic pressure which are IV proteins Crystalloids-Salts, sugars, minerals and vitamins S/S low albumin (Lack of protein)- protein seeps out and causes edema or Ascites fluid in peritoneal space (abdomen) Ascites happens in malnourished older people

Diffusion

Movement of molecules from an area of higher concentration to an area of lower concentration.

Fluid spacing

Occurs too much fluid moves from intravascular space (blood vessels) into the interstitial space between cells

Osmolarity

Osmoles of solute per liter of solution

Hydrostatic pressure

Pressure caused by liquid

Osmotic pressure make up

Range:275-295 Plasma Osmolality=concentration pull Plasma Osmolality is made up of glucose, sodium and fluid

Cell and plasma osmolality

Red blood cell in hypotonic solution=Cell blew up like a balloon(swelled cells) Happens in heart failure, low plasma osmolality cells more concentrated Isotonic solution=Cells happy (homeostasis) normal Hypertonic solution=Pulls fluid out of the cell (Cell shrinks), happens in high osmolality, fluid loss, sickness

Hypothalamus

Regulates thirst (Osmoreceptors)- osmolality sensors osmol ↑ too concentrated (Baroreceptors) detect pressure low BP retain fluid 1.First Thirst happens (diminished in elderly) 2.Pituitary→ADH(indirectly affects sodium, anti duiretic hormone, don't release fluid) 3. Kidneys hold water BP ↑

Renal

Renal Tubules - Decision made to hold on or not, urine and electrolytes let go, acid and base Renin- vasoconstriction ▫︎peripherally ▫︎makes blood volume where it needs to be

Your patient is hyperventilating from acute pain and hypoxia. Interventions to manage his pain and oxygenation will decrease his risk of which acid-base imbalance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory alkalosis

Isotonic IV Fluid

Same Osmolarity as normal plasma osmolality(250-375) Components how body processes No effect on the blood cells Expands ECF with out effect on ICF 0.9% Saline(NS) LR lactated ringer (Don't use with ceftriaxone -contains calcium) not for neonates

Homeostasis

State of relative constancy

When you assess pain and redness at a vascular access device (VAD) site, which action do you take first? Apply a warm, moist compress Monitor the patient's blood pressure Aspirate the infusing fluid from the VAD Stop the infusion and discontinue the intravenous infusion

Stop the infusion and discontinue the intravenous infusion

Oncotic pressure

Total influence of the protein on the osmotic activity of plasma fluid.

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

Urine output

Acidosis

a condition that tends to make the blood relatively too acidic

Adrenal cortex

aldosterone-Salt and mineral→Retains sodium (directly)→(Osmosis +) Retains water aldosterone→excretes potassium in urine

Osmolality

expressed in osmoses or millionsmoles per kg of water

Cation

ions that are positively charged

Osmosis

movement of lower concentration to the higher concentration

Active transport

requires ATP to move electrolytes across cell membranes against concentration

Facilitated diffusion

spontaneous passive transport of molecules or ions across a biological membrane via specific transmembrane in Tegal proteins