FLUID & ELECTROLYTES

9. A patient receiving a blood transfusion in the ICU has developed relative hypocalcemia. What is the most likely cause for the hypocalcemia? A) Citrate binding to calcium B) Loop diuretics C) Malabsorption syndrome D) Lack of vitamin D

A

13. When calculating the anion gap, the predominant cation is a. sodium. b. potassium. c. chloride. d. bicarbonate.

A

16. What is a continuous venovenous hemodialysis filter permeable to? a. Electrolytes b. Red blood cells c. Protein d. Lipids

A

18. The nurse is caring for a patient who was run over by an automobile. The patient has hematuria on admission to the emergency department. What is the most likely cause of the hematuria? A) Kidney trauma B) Kidney stones C) Prostatic disease D) Toxic damage

A

2. Loss of albumin from the vascular space may result in a. peripheral edema. b. extra heart sounds. c. hypertension. d. hyponatremia.

A

22. The nurse is caring for a patient with renal disease and is monitoring fluid balance. What is the most accurate method for assessing fluid balance? A) Daily weights at same time of day B) Episodic intake and output totals C) Heart rate trends D) Jugular venous volume measurement

A

24. A patient in acute renal failure presents with a potassium level of 6.9 mg/dL. He has had no urine output in the past 4 hours despite urinary catheter insertion and Lasix 40 mg intravenous push. Vital signs are as follows: HR, 76 beats/min; respiratory rate, 18 breaths/min; and BP, 145/96 mm Hg. He is given 100 mL of 50% dextrose in water and 20 U of regular insulin intravenous push. A repeat potassium level 2 hours later shows a potassium level of 4.5 mg/dL. What order would now be expected? a. Sodium Kayexalate 15 g PO b. Nothing; this represents a normal potassium level c. Lasix 40 mg IVP d. 0.9% normal saline at 125 mL/hr

A

6. The most important assessment parameters for evaluating the patients fluid status is to measure a. daily weights. b. urine and serum osmolality. c. intake and output. d. hemoglobin and hematocrit levels.

A

7. An elderly woman in the ICU has an indwelling urinary catheter and is being treated for a myocardial infarction. She is diabetic but is in the habit of having several glasses of orange juice each day. Her lab test results show that her urinary pH is 7.6. The nurse should suspect which of the following factors as the cause of the elevated pH level? A) A urinary tract infection B) Ketoacidosis caused by untreated diabetes C) Consumption of acidic foods D) Dehydration

A

9. The nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patients urine output has been less than 20 mL/hour for the past 2 hours. It is 0200 in the morning. The patients blood pressure is 100/60 mm Hg, and the pulse is 110 beats per minute. Previously, the pulse was 90 beats per minute with a blood pressure of 120/80 mm Hg. The nurse should: a. contact the provider and expect an order for a normal saline bolus. b. wait until 0900 when the provider makes rounds to report the assessment findings. c. continue to evaluate urine output for 2 more hours. d. ignore the urine output, as this is most likely postrenal in origin.

A

2. A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. A diagnosis of renal failure is made. The nurse would expect to see elevated values in the following laboratory results: (Select all that apply). a. BUN. b. creatinine. c. glucose. d. hemoglobin and hematocrit. e. protein.

A, B, D

1. Which of the following conditions is associated between kidney failure and respiratory failure?(Select all that apply.) a. ARDS b. Lower GFR c. Increased urine output d. Decreased urine output e. Decreased blood flow to the kidneys

A, B, D, E

2. To prevent catheter-associated UTI (CAUTI), the nurse should (Select all that apply.) a. insert urinary catheters using aseptic techniques. b. change the urinary catheter daily. c. review the need for the urinary catheter daily and remove promptly. d. flush the urinary catheter q8 hours to maintain patency. e. avoid unnecessary use of indwelling urinary catheters.

A, C, E

1. Which of the following may be present in the patient with significant fluid volume overload?(Select all that apply.) a. S3 or S4 may develop. b. Distention of the hand veins will disappear if the hand is elevated. c. When testing the quality of skin turgor, the skin will not return to the normal position for several seconds. d. Tachycardia with hypotension may be present. e. Dependent edema may be present.

A, E

12. A patient has acute kidney injury (previously known as acute tubular necrosis). The following blood work was noted: complete blood count shows a white blood cell count of 11,000 mm3, a hemoglobin of 8 g/dL, and a hematocrit of 30%. His chemistry panel shows serum potassium, 4.5 mg/dL; serum sodium, 135 mg/dL; serum calcium, 8.5 mg/dL; BUN, 20 mg/dL; and creatinine, 1.5 mg/dL. What laboratory value(s) need(s) to be treated most immediately and why? a. Administration of 5% dextrose in water and insulin because the patient is hyperkalemic and needs this level reduced b. Administration of Epogen to treat anemia c. Administration of a broad-spectrum antibiotic to treat the elevated blood cell count d. Administration of a calcium supplement for low calcium

B

14. A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. A diagnosis of renal failure is made. The patient urinalysis has a specific gravity of 1.040. What could be the potential cause for this value? a. Volume overload b. Volume deficit c. Acidosis d. Urine ketones

B

14. During physical examination of an ambulatory patient, the nurse finds elevated blood pressure, pulmonary crackles that do not clear with cough, jugular venous distention, liver congestion and enlargement, an S3 heart sound, and pitting edema of the feet and lower legs. What is the most likely cause of this group of findings? A) Fluid volume deficit B) Fluid volume excess C) Hyponatremia D) Leukocytosis

B

17. A patient has been on complete bed rest for 3 days. The health care provider has ordered for the patient to sit at the bedside for meals. The patient complains of feeling dizzy and faint while sitting at the bedside. The nurse anticipates that the patient is experiencing a. orthostatic hypertension. b. orthostatic hypotension. c. hypervolemia. d. electrolyte imbalance.

B

2. Which of the following laboratory values is the most help in evaluating a patient for acute renal failure? a. Serum sodium b. Serum creatinine c. Serum potassium d. Urine potassium

B

20. A patient has significantly decreased creatinine clearance and an elevated serum creatinine. What does this value indicate to the nurse? A) Improved renal function B) Kidney damage from disease C) Muscle wasting D) Rhabdomyolysis

B

23. An alert and oriented patient presents with a pulmonary artery wedge pressure of 4 mm Hg and a cardiac index of 0.8. The BUN is 44 mg/dL, creatinine is 3.2 mg/dL, and BP is 88/36 mm Hg. Urine output is 15 mL/hr. Lungs are clear to auscultation with no peripheral edema noted. Which of the following treatments would the physician most likely order? a. Lasix 40 mg intravenous push b. 0.9% normal saline at 125 mL/hr c. Dopamine 15 mg/kg/min d. Transfuse 1 U of packed red blood cells

B

26. Which of the following medications is considered a loop diuretic? a. Acetazolamide (Diamox) b. Furosemide (Lasix) c. Mannitol d. Metolazone (Zaroxolyn)

B

44. The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier. His blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; he has not voided in 8 hours and his bladder is not distended. The nurse anticipates an order for stat administration of: a. a blood transfusion. b. fluid replacement with 0.45% saline. c. infusion of an inotropic agent. d. an antiemetic.

B

8. A patient is severely hyponatremic. What would be the best nursing action? A) Put the patient on dialysis. B) Administer 3% saline. C) Administer 0.33% saline solution. D) Administer 5% dextrose in water.

B

8. Which electrolytes pose the most potential hazard if not within normal limits for a person with renal failure? a. Phosphorous and calcium b. Potassium and calcium c. Magnesium and sodium d. Phosphorous and magnesium

B

10. A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. A diagnosis of renal failure is made. The nurse suspects the main cause of ascites is a. hypervolemia. b. dehydration. c. volume overload. d. liver damage.

C

12. A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. A diagnosis of renal failure is made. The patient weight upon admission was 176 lb. The patients weight the next day is 184 lb. What is the approximate amount of fluid retained with this weight gain? a. 800 mL b. 2200 mL c. 3600 mL d. 8000 mL

C

16. A patient with renal impairment is found to have a positive Chvosteks sign. What additional information should the nurse assess for? A) Hyperkalemia B) Hyponatremia C) Hypocalcemia D) Hypermagnesemia

C

17. A patient has sepsis and is placed on broad-spectrum antibiotics. Her temperature is 37.8C. Her BUN level is elevated. She continues on vasopressor therapy. What other steps should be taken to protect the patient from inadequate organ perfusion? a. Increase net ultrafiltrate of fluid. b. Discontinue vasopressor support. c. Assess the patient for blood loss and hypotension. d. Notify the physician of access pressures.

C

19. What laboratory value is most likely to indicate renal failure? A) Elevated blood urea nitrogen (BUN) B) Low hemoglobin and hematocrit C) Elevated serum creatinine D) Normal urine osmolarity

C

20. What is the dose for low-dose dopamine? a. 1 to 2 mcg/kg/min b. 1 to 2 mg/kg/min c. 2 to 3 mcg/kg/min d. 2 to 3 mg/kg/min

C

21. The patient is receiving maintenance IV fluids, has no active fluid loss site, and has normal renal function. Based on the physiology of fluid volume balance, what IV fluid use does the nurse anticipate? A) Dextrose 5% in water B) 0.9% saline C) 0.45% saline D) 3% saline

C

25. A patient with chronic renal failure receives hemodialysis treatments 3 days a week. Every 2 weeks, the patient requires a transfusion of 1 or 2 U of packed red blood cells. What is the probable reason for this patients frequent transfusion needs? a. Too much blood phlebotomized for tests b. Increased destruction of red blood cells because of the increased toxin levels c. Lack of production of erythropoietin to stimulate red blood cell formation d. Fluid retention causing hemodilution

C

3. Which of the following auscultatory parameters may exist in the presence of hypovolemia? a. Hypertension b. Third or fourth heart sound c. Orthostatic hypotension d. Vascular bruit

C

5. Which of the following IV solutions is contraindicated for patients with kidney or liver disease or in lactic acidosis? a. D5W b. 0.9% NaCl c. Lactated Ringer solution d. 0.45% NaCl

C

6. To assess whether or not an arteriovenous fistula is functioning, what must be done and why? a. Palpate the quality of the pulse distal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow. b. Palpate the quality of the pulse proximal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow. c. Palpate gently over the site of the fistula to determine whether a thrill is present; listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow. d. Palpate over the site of the fistula to determine whether a thrill is present; check whether the extremity is pink and warm.

C

8. A patients lab results include a finding of glucose in the urine (glycosuria). What other lab result should the nurse expect in this patient? A) Decreased ketones in the urine B) Alkaline urinary pH C) Elevated blood glucose D) Decreased urine volume

C

8. As serum osmolality rises, intravascular fluid equilibrium will be maintained by the release of a. ketones. b. glucagon. c. antidiuretic hormone. d. potassium.

C

20. A patient with severe vascular fluid loss from third spacing is being treated with intravenous hypertonic saline in an attempt to pull fluid from the extravascular space to the vascular space. What nursing assessment result is most indicative of a serious complication of the use of intravenous hypertonic saline? A) Increased urine output B) Decreased peripheral edema C) Slightly elevated blood pressure D) Pulmonary adventitious sounds

D

1. Which of the following assessment findings would indicate fluid volume excess? a. Venous filling of the hand veins greater than 5 seconds b. Distended neck veins in the supine position c. Presence of orthostatic hypotension d. Third heart sound

D

10. A patient in the ICU has acute renal failure and is an alcoholic. Which electrolyte imbalance would the nurse most expect to find in this patient? A) Hypokalemia B) Hyperkalemia C) Hypermagnesemia D) Hypomagnesemia

D

4. One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. How do these agents lower potassium? a. They force potassium out of the cells and into the serum, lowering it on a cellular level. b. They promote higher excretion of potassium in the urine. c. They bind with resin in the bowel and are eliminated in the feces. d. They force potassium out of the serum and into the cells, thus causing potassium to lower.

D

5. Differentiating ascites from distortion caused by solid bowel contents in the distended abdomen is accomplished by a. assessing for bowel sounds in four quadrants. b. palpation of the liver margin. c. measuring abdominal girth. d. the presence of a fluid wave.

D