Fluid and Electrolytes

A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for a fluid volume deficit? A. A client with a colostomy B. A client with CHF C. A client recieving frequent wound irrigations D. A client on long-term corticosteroids

A. A client with a colostomy

Hypomagnesemia is a common yet often overlooked imbalance in acutely and critically ill patients. Which of the following patients is most likely at the highest risk of experiencing low serum magnesium levels? A. A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use B. A patient who is temporarily receiving total parenteral nutrition (TPN) as a result of complications from gastric bypass surgery C. A teenage patient who is currently being treated for non-Hodgkin's lymphoma (NHL) D. An obese male patient who has a history of atherosclerosis and a previous non-ST wave elevation myocardial infarction

A. A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use Alcoholism is currently the most common cause of symptomatic hypomagnesemia in the United States. Hypomagnesemia is particularly troublesome during treatment of alcohol withdrawal. Therefore, the serum magnesium level should be routinely measured in patients undergoing withdrawal from alcohol. TPN, heart disease, and lymphoma are not identified as central risk factors for the development of hypomagnesemia.

Nursing Actions related to Fluid Volume status are: (Choose all that apply.) A. Closely monitor intake and output. B. Percentage of meal eaten. C. Checking capillary refill. D. Checking pupillary response. E. Taking vital signs. F. Daily weights

A. Closely monitor intake and output. C. Checking capillary refill. E. Taking vital signs. F. Daily weights

The baroreceptors, located in the left atrium, and the carotid and aortic arches respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what? A. Decrease in glomerular filtration B. Increase of filtration in the Loop of Henele C. Decrease in the reabsorption of sodium D. Decrease in the release in aldosterone

A. Decrease in glomerular filtration Sympathetic stimulation constricts renal arterioles; this decreases glomerular filtration, increases the release of aldosterone, and increases sodium and water reabsorption

You are caring for a patient admitted with a diagnosis of renal failure. When you review your patient's laboratory reports, you note that the patient's magnesium levels are high. What would be important for you to assess? A. Diminished deep tendon reflexes B. Increased serum magnesium C. Cool, clammy skin D. Tachycardia

A. Diminished deep tendon reflexes

A patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The patient's ileostomy output has been unexpectedly high in the 2 days since surgery, and the patient's most recent blood work indicates a K+ level of 2.7 mEq/L. This potassium level should prompt the nurse to assess for which of the following physical manifestations? A. Fatigue, cramps and weakness B. SOB, rales and peripheral edema C. Dsypahgia, tetany and emotional liabilty D. Confusion and decreased LOC

A. Fatigue, cramps and weakness A serum potassium level of 2.7 mEq/L constitutes hypokalemia. Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias (numbness and tingling), arrhythmias, and increased sensitivity to digitalis. Respiratory symptoms, dysphagia, and tetany are not typically associated with hypokalemia.

A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; PERRLA is intact. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed and 40 ml of urine is present. What is the nurse's most likely explanation for the urine output? A. He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine outpu. B. The man is in heart failure and is releasing atrial natriuretic peptide that results in decreased urine output. C. The man has a brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin. D. The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.

A. He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output. As the sympathetic nervous system is stimulated, aldosterone is released in response to an increased release of rennin, which decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most likely cause of the lower urine output. The man urinating prior to his arrival to the ED is unlikely; the fall and hip injury would make his ability to urinate difficult. There is no assessment information that indicates he has a head injury or heart failure.

You are caring for a patient on the oncology floor with a diagnosis of metastatic brain cancer. During your assessment, you note the patient complains of abdominal pain and constipation. What electrolyte imbalance would you anticipate? A. Hypercalcemia. B. Hypomagnesemia. C. Hypernatremia. D. Hyperphosphatemia.

A. Hypercalcemia

You are the nurse caring for a 65-year-old female patient who is in renal failure. During your shift assessment, the patient complains of tingling in her hand and fingers whenever anyone takes her blood pressure. What would you suspect? A. Hypocalcemia B. Hyperkalemia C. Hypermagnesemia D. Hypophosphatemia

A. Hypocalcemia

A client involved in a motor vehicle crash (MVC) presents to the emergency department with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates that which IV solution will most likely be prescribed to increase intravascular volume, replace immediate blood loss volume, and increase blood pressure? A. Lactate Ringers (LR) B. 0.45% sodium chloride (1/2 normal saline) C. 0.33% sodium chloride (1/3 NS) D. 0.225% sodium chloride (1/4 NS)

A. Lactate Ringers (LR)

You are an emergency room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results? A. Metabolic acidosis with a compensatory respiratory alkalosis B. Metabolic acidosis with no compensation C. Metabolic alkalosis with a compensatory alkalosis D. Respiratory acidosis with no compensation

A. Metabolic acidosis with a compensatory respiratory alkalosis A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO2 is also low, which causes alkalosis. The bicarb is low, which causes acidosis. The pH bicarb more closely corresponds with a decrease in pH, making the metabolic component the primary problem

The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse goes to attach the distal end of the IV tubing to a needleless device, the exposed tubing drops and hits the top of the medication cart. Which of the following is the appropriate action by the nurse? A. Obtain a new IV tubing B. Wipe the distal end of the tubing with Betadine C. Attach a new needleless device D. Scrub the needleless device with an alcohol swab

A. Obtain new IV tubing

A nursing student needs to administer potassium chloride intravenously as prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium? A. Preparing the medication for bolus administration B. Diluting the medication in appropriate amount of normal saline C. Obtaining a controlled intravenous (IV) infusion pump D. Monitoring urine output during administration

A. Preparing the medication for bolus administration

A patient in the ICU starts complaining of being "short of breath." An arterial blood gas (ABG) is drawn. The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A. Respiratory acidosis

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? A. Serum sodium level of 124 mEq/L B. Serum blood urea nitrogen (BUN) level of 8.6 mg/dl C. Hematocrit of 52% D. Serum creatinine level of 0.4 mg/dl

A. Serum sodium level of 124 mEq/L

You are caring for a patient and the physician has just ordered a urine dip for specific gravity (SG). You find her SG is 1.038. This indicates: A. The patient is dehydrated. B. The patient's intake is adequate. C. The patient should be placed on NPO (nothing by mouth) status. D. The patient is overhydrated

A. The patient is dehydrated

______ is currently the most common cause of symptomatic hypomagnesemia in the United States

Alcoholism

A patient has been admitted to the medical unit from the emergency department with a peripheral IV in situ and normal saline infusing by gravity. How should the nurse best ensure that the patient's ordered solution infuses at the correct rate? Selected Answer: A. Assess the patient often for signs and symptoms of fluid overload. B. Change from gravity infusion to an electronic IV pump. C. Monitor the patient's IV infusion hourly. D. Label the patient's bag of IV solution with a time-calibrated strip of tape.

B. Change from gravity infusion to an electronic IV pump. Monitoring a patient's IV infusion, labeling gravity infusions, and assessing patients for fluid overload are all prudent measures in the care of a patient who is receiving IV fluids by gravity. However, the most accurate way to ensure that a patient's ordered fluid is infusing at the correct rate is to use an electronic IV pump.

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? A. Hypovolemia B. Dehydration C. Fluid volume excess D. Hypervolemia

B. Dehydration

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? A. Hypernatremia B. Hyperkalemia C. Hypercalcemia D. Hyperglycemia

B. Hyperkalemia

The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance does a positive Chvostek's sign indicate? A. Hyperkalemia B. Hypocalcemia C. Hypermagnesemia D. Hypercalcemia

B. Hypocalcemia You can induce Chvostek's sign by tapping the patient's facial nerve adjacent to the ear. A brief contraction of the upper lip, nose, or side of the face indicates Chvostek's sign. Both hypomagnesemia and hypocalcemia may be tested using the Chvostek's sign.

A client has just undergone insertion of a peripherally inserted central venous catheter (PICC) at the bedside. The nurse would be sure to check the results of which of the following before initiating the flow rate of the client's IV solution at 100ml/hr? A. Serum electrolyte levels B. Portable chest x-ray C. Serum osmolality D. Intake and output record

B. Portable chest x-ray

In the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur? A. The number of dissolved particles contaoned in a unit of blood B. The hydrostatic pressure resulting from the pumping action of the heart C. The active transport of H+ ions across the capillary walls D. The pressure of blood in the renal capillary walls

B. The hydostatic pressure from the pumping action of the blood

A nurse is caring for several patients, all of whom require IV medications. Which of the following situations requires an incident report to be filled out A. The patient's central line becomes occluded B. Multiple attempts to start an IV are made by nursing staff C. An IV is started on the same side as a fistula that is used exclusively for dialysis D. The client's central line is tender and there is erythema at the insertion site

C. An IV is started on the same side as a fistula that is used exclusively for dialysis

Two days after surgery, Mr. Webb complains of muscle cramps and tingling in his lips. The nurse will call the physician to share these findings, which are most likely the result of: A. Residual effects of general anesthesia. B. Increasing serum magnesium following surgery. C. Damage to the parathyroid glands during surgery. D. Endotracheal intubation.

C. Damage to the parathyroid glands

You are caring for a patient admitted with a diagnosis of renal failure. When you review your patient's laboratory reports, you note that the patient's magnesium levels are high. What would be important for you to assess? A. Tachycardia B. Cool, clammy skin C. Diminished deep tendon reflexes D. Increased serum magnesium

C. Diminished deep tendon reflexes

You are the nurse caring for a patient who is to receive IV daunorubicin. You start the infusion and check the insertion site as per protocol. This time when you look at the IV site, you note that the IV has infiltrated. You stop the infusion. What is your main concern with this infiltration? A. Blanching at the site B. Discomfort to the patient C. Extravasation of the medication D. Reaction to the medication

C. Extravasation of the medication Medications such as dopamine, calcium preparations, and chemotherapeutic agents can cause pain, burning, and redness at the site. Blistering, inflammation, and necrosis of tissues can occur. The extent of tissue damage is determined by the concentration of the medication, the quantity that extravasated, the location of the infusion site, the tissue response, and the duration of the process of extravasation. With this medication, options A and D are valid concerns but not your main concerns. Blanching at the site would not be a concern.

A client receiving normal saline 0.9% as maintenance fluid should be monitored for: (Choose all that apply.) A. Weight loss. B. Hyponatremia. C. Fluid overload. D. Hyperchloremia. E. Rales on auscultation of the lungs

C. Fluid Overload D. Hyperchloremia E. Rales on ascultation

You are doing an admission assessment on an elderly patient newly admitted for end-stage liver disease. You must assess the patient's skin turgor. What should you remember when evaluating skin turgor? A. Normal skin turgor is moist and boggy. B. Dehydration causes the skin to appear edematous and spongy. C. Inelastic skin turgor is a normal part of aging. D. Overhydration causes the skin to tent.

C. Inelastic skin turgor is a normal part of aging. Inelastic skin turgor is a normal part of aging. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy. Normal skin turgor is dry and firm.

Isotonic IV fluids are fluids with a total osmolality close to that of the ECF. Most IV fluids contain either dextrose or electrolytes in water. When would you infuse electrolyte-free water intravenously? A. When the patient is in an excess of an electrolyte, i.e. hypercalcemia B. When the patient is in a deficit of an electrolyte, i.e. hypocalcemia C. Never, it rapidly enters red blood cells, causing them to rupture. D. When the patient is severely dehydrated

C. Never, it rapidly enters red blood cells, causing them to rupture.

After several diagnostic tests, a client is diagnosed with diabetes insipidus (DI). The nurse performing an assessment on the client knows that which symptom is most indicative of this disorder? A. Weight gain. B. Diarrhea. C. Polydipsia. D. Fatigue.

C. Polydipsia

Disorders, fluids, and medications that may lead to hypernatremia include: (Select all that apply) A. Syndrome of Inappropriate Antidiuretic Hormone (SIADH). B. Hypoaldosteronism. C. Profuse sweating. D. Diabetes insipidus. E. Saline 3%.

C. Profuse Sweating D. Diabetes Insipidus E. Saline 3%

A 22-year-old man with a diagnosis of schizophrenia has been transferred from the psychiatric unit to the medical unit after drinking 5 liters of water over the past hour. Assessment reveals that the patient is oriented to person but not to time or place and that he is drowsy but rousable by touch. When reviewing this patient's most recent blood work, the nurse should pay particular attention to the patient's levels of: A. Phosphate B. Calcium C. Sodium D. BUN

C. Sodium Ingestion of large volumes of free water results in hyponatremia. As such, the patient's sodium levels would be monitored closely.

You are caring for a patient who has been admitted for changes in level in consiousness, muscle twitching, and abnormal speech. The patient was sent for a computed tomography, and cerebral vascular accident (stroke) was ruled out. Serum sodium is noted to be 162 mEq/dL. you note the patient has weak thready pulses, dry mucous membranes, and poor tissue turgor. You as the student nurse anticipate: A. Hypertonic saline 3% at 100 ml/hr B. Spironolactone (Aldactone) C. Sodium restriction and Normal Saline 0.45% at 80ml/hr. D. Furosemide (Lasix) E. Normal saline 0.9% at 100 ml/hr

C. Sodium restriction and Normal Saline 0.45% at 80 ml/hr

An elderly patient has developed Clostridium difficile-related diarrhea and been subsequently diagnosed with fluid volume deficit (FVD). The nurse providing care for this patient should anticipate: A. The administration of a hypertonic IV solution B. A decreased level of blood urea nitrogen (BUN) C. The administration of hypotonic or isotonic IV solution D. An increased level of serum potassium

C. The administration of hypotonic or isotonic IV solution FVD necessitates the administration of isotonic IV solutions (in hypotensive patients) or hypotonic solutions (in normotensive patients). FVD is associated with increased levels of BUN and hypokalemia, especially in patients whose losses are due to vomiting or diarrhea.

The parathyroid glands regulate __________ and phosphate balance by means of the parathyroid hormone (PTH).

Calcium

_________________, the end product of muscle metabolism, is a better indicator of renal function than BUN

Creatinine

Vitamin __________ therapy is instituted to increase calcium from the GI tract.

D

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? A. Hypovolemic shock B. Severe hyperkalemia C. Tetany D. Cerebral edema

D. Cerebral edema

You are working on a burn unit. One of your patients is exhibiting signs and symptoms of third spacing, which occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, what would you expect the patient to demonstrate? A. Hypervolemia B. Hypertension C. Bradycardia D. Hypovolemia

D. Hypovolemia Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Hypertension, bradycardia, and hypervolemia are not indicators of third-spacing fluid shift

A 43-year-old patient with a history of alcohol abuse has been admitted to an acute medical unit with complications resulting from liver failure. Upon assessment, the patient's abdomen is distended, firm to touch, and nontender. The nurse recognizes that the patient has excess fluid in his peritoneal space (ascites), a problem that results from the disruption of normal movement of water and electrolytes. What process is primarily responsible for maintaining fluid balance along a concentration gradient? A. Filtration B. Active transport C. Hydrostatic pressure D. Osmosis

D. Osmosis The movement of water caused by a concentration gradient is known as osmosis. A lack of albumin, as in cases of liver failure, results in a disruption in osmotic function. Filtration is a result of hydrostatic pressure, and hydrostatic pressure itself is not a result of a concentration gradient. Active transport implies that energy must be expended for the movement to occur against a concentration gradient.

Which medication reported by a client during a nursing history could be associated with the development of hypocalcemia? A. Calcitriol. B. Hydrochlorothiazide (HydroDIURIL). C. Calcium Carbonate (TUMS). D. Phenytoin (Dilantin).

D. Phenytoin (Dilantin).

You are caring for a patient with chronic renal failure with a phosphorus level of 6.8. You notice the patient is experiencing muscle twitching and has hyperreflexia. You anticipate the physician orders will include: A. Fluid restriction B. Potassium/Sodium Phosphate (Neutra Phos) C. Sodium polystyrene sulfonate (Kayexelate) D. Sevelamer (Renagel)

D. Sevelamer (Renagel)

A nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.4mEq/L. Which of the following would the nurse expect to note on the electrocardiogram as a result of the laboratory value? A. Prominent U wave B. ST depression C. Inverted T wave D. Tall peaked T waves

D. Tall peaked T waves

A nurse is reading a physician's progres notes in the client's record and reads that the physician has documented "insensible fluid loss of approximately 800ml daily". The nurse interprets that this type of fluid loss can occur through: A. Wound drainage B. Urinary output C. The GI tract D. The skin

D. The skin

A patient's most recent arterial blood gases reveal pH = 7.5; HCO3- = 29 mEq/L, and PaCO2 = 51 mm Hg. What health problem could account for these findings? A. Diabetic ketoacidosis (DKA) B. Atelectasis C. Hyperventilation D. Volume depletion from vomiting

D. Volume depletion from vomiting The patient is in metabolic alkalosis.

Potassium can be administered IV push. True or False

False

In metabolic alkalosis, the respiratory rate increases, causing greater elimination of CO2. True or False

False In metabolic alkalosis, the lungs are going to compensate by retaining CO2 through slower respirations.

Which finding in a client's history would alert the nurse to assess for signs of hypophosphatemia? A. Short-term gastric suction. B. Alcohol abuse. C. Occasional use of aluminum-containing antacids. D. The oliguric phase of acute tubular necrosis.

B. Alcohol Abuse

You are caring for a patient with hypercalcemia. You as the student nurse know that one of the most common causes of hypercalcemia is: A. Alcoholism B. Cancer C. Alkalosis D. Hypoparathyroidism

B. Cancer

You are caring for a patient with hypercalcemia. You as the student nurse know that one of the most common causes of hypercalcemia is: A. Alkalosis B. Cancer C. Alcoholism D. Hypoparathyroidism

B. Cancer

You are caring for a patient who is renal failure. Morning Lab results indicate that the patient's phosphorus level is 7.2 mg/dL. Symptoms you would monitor your patient for include: A. Tetany B. Respiratory depression C. Poor wound healing D. Decreased tissue turgor

A. Tetany

A patient with a diagnosis of thyroid cancer is postoperative day 1 following a total thyroidectomy in which her parathyroid gland was also removed. When assessing for related electrolyte imbalances, what question should the nurse ask the patient? A. "Are you feeling any tingling in your hands or around your mouth?" B. "How thirsty are you feeling right now?" C. "Do you feel like you're having heart palpitations where your heart feels like it skips a beat?" D. "How would you rate your energy level right now?"

A. "Are you feeling any tingling in your hands or around your mouth?" Removal of the parathyroid can precipitate hypocalcemia, which often results in tetany. Arrhythmias, increased thirst, and fatigue are not common assessment findings associated with low serum calcium.

You are caring for a patient who has been admitted for changes in level in consiousness, muscle twitching, and abnormal speech. The patient was sent for a computed tomography, and cerebral vascular accident (stroke) was ruled out. Serum sodium is noted to be 162 mEq/dL. you note the patient has weak thready pulses, dry mucous membranes, and poor tissue turgor. You as the student nurse anticipate: A. Hypertonic saline 3% at 100 ml/hr B. Normal saline 0.9% at 100 ml/hr C. Spironolactone (Aldactone) D. Furosemide (Lasix) E. Sodium restriction and Normal Saline 0.45% at 80 ml/hr.

E. Sodium restriction and Normal Saline 0.45% at 80 ml/hr

Sodium is important in regulating the volume of body fluid, because sodium concentration affects the overall concentration of extracellular fluid. True or False

True

The major waste product of protein metabolism is urea. True or False

True

When the kidneys are functioning normally, the volume of electrolytes excreted per day is equal to the amount ingested. True or False

True