Med Surg Test 2
The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer?
0.45% sodium chloride Explanation: Half-strength saline (0.45% sodium chloride) solution is frequently used as an IV hypotonic solution. 5% dextrose in water or normal saline is a hypertonic solution.
Creatinine normal
0.7-1.4 mg/dL
Urine specific gravity normal range
1.010 to 1.025
BUN normal
10 to 20 mg/dL
Below which serum sodium level may convulsions or coma can occur?
135 mEq/L
A patient who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue and a body temperature of 99.3°F. The urine specific gravity is 1.020. What is the most likely serum sodium value for this patient?
155 mEq/L
Extracellular water
20% body weight
Intracellular water
40% body weight
Which of the following is the most common cause of symptomatic hypomagnesemia?
Alcoholism
Hypervolemia
An isotonic expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF Manifests with edema, distended neck veins, crackles, tachycardia; increased blood pressure Treatments include diuresis and fluid and sodium restriction. Nursing care: Daily weights Assessment of edema
A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond?
Bicarbonate-carbonic acid buffer system
Which of the following are the insensible mechanisms of fluid loss?
Breathing
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?
Cerebral edema
Patients diagnosed with hypervolemia should avoid sweet or dry food because:
It increases the client's desire to consume fluid.
Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism?
Chest pain
Lawrence Wilkins, a 73-year-old male, was admitted to your hospital unit after two days of vomiting and diarrhea. His wife became alarmed when he demonstrated confusion, elevated temperature and reported "dry mouth". From what condition would you suspect Lawrence may be suffering?
Dehydration
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?
Dehydration
You are caring for a client with severe hypokalemia. The physician has ordered IV potassium to be administered at 10 mEq/hr. The client complains of burning along their vein. What should you do?
Dilute the infusion
The nurse is caring for a client who is exhibiting symptoms of tachypnea and circumoral paresthesias. What should be the nurse's first course of action?
Find and correct the cause of tachypnea.
Which of the following is a factor affecting an increase in serum osmolality?
Free Water Loss
What foods can the nurse recommend for the patient with hypokalemia?
Fruits such as bananas and apricots
You are caring for a new client on your unit who is third-spacing fluid. You know to assess for what type of edema?
Generalized
A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance?
Hypercalcemia Explanation: The normal reference range for serum calcium is 9 to 11 mg/dl. A serum calcium level of 12 mg/dl clearly indicates hypercalcemia. The client's other laboratory findings are within their normal ranges, so the client doesn't have hypernatremia, hypochloremia, or hypokalemia
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?
Hyperkalemia Explanation: Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia
An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?
Hypokalemia
Oral intake is controlled by the thirst center, located in which of the following cerebral areas?
Hypothalamus
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?
Increases arterial pH Explanation: Respiratory alkalosis is always caused by hyperventilation, which is a decrease in plasma carbonic acid concentration. The pH is elevated above normal as a result of a low PaCO2.
Hypokalemia
K+ level of <3.5 mEq/L from active losses of potassium or insufficient intake Cardiac, respiratory, and muscular manifestations Treatment is oral or IV replacement therapy Nursing treatment focuses on assessment of cardiac and motor signs and symptoms
With which condition should the nurse expect that a decrease in serum osmolality will occur?
Kidney failure
A nursing instructor is teaching her class about burns. The instructor relates the following scenario: A nurse is caring for a severely burned client who now has elevated hematocrit and blood cell counts. What consequences should the nurse expect in this client?
Kidney stones and blood clots Severe burn injury may cause high fluid loss leading to hypovolemia. Elevated hematocrit levels and blood cell counts indicate hemoconcentration, which means a high ratio of blood components in relation to watery plasma. This increases the potential for blood clots and urinary stones. In hypovolemia, the heart rate tends to be high as the heart tries to compensate for the drop in the circulatory volume. Serum electrolyte levels tend to remain normal because they are depleted in proportion to the water loss. CVP is usually below 4 cm H2O.
A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer?
Lactated Ringer's solution.
Hyponatremia
Less than 135 mEq/L Caused by active losses or by dilutional hyponatremia Clinical manifestations depend on the cause, magnitude, and speed of the deficit May necessitate fluid restriction or sodium replacement Nurse must monitor: Fluid I&O Daily body weight Central nervous system changes
Hematocrit normal
Males: 42%-52% Females: 35%-47%
A priority nursing intervention for a client with hypervolemia involves which of the following?
Monitoring respiratory status for signs and symptoms of pulmonary complications
Hypernatremia
Na+ exceeding 145 mEq/L caused by a gain of sodium in excess of water or by a loss of water Clinical manifestations are primarily neurologic Treatment is usually a hypotonic electrolyte solution Nursing care focuses on prevention and on close monitoring of fluid I&O
A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client?
No, sodium intake should be restricted.
Hypovolemia
Occurs when loss of ECF volume exceeds the intake of fluid Multiple systemic signs and symptoms Treatment usually consists of isotonic or hypotonic IV solution Nursing care: Monitor fluid balance Perform frequent vital signs Assess skin turgor
Russell Thompkins, a 77-year-old retired male, visits your general practice office twice monthly to maintain control of his congestive heart failure. He measures his weight daily and phones it to your office for his medical record. In a 24-hour period, how much fluid is Russell retaining if his weight increases by two pounds?
One liter Explanation: A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.
Which of the following is a correct route of administration for potassium?
Oral Explanation: Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously
Homeostasis
Organs involved in homeostasis include the kidneys, lungs, heart, adrenal glands, parathyroid glands, and pituitary gland
An ICU nurse has orders to infuse a hypertonic solution. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. What term is described by this process?
Osmosis
Translocation is a term used to describe the general movement of fluid and chemicals within body fluids. In every client's body, fluid-electrolyte balance is maintained through the process of translocation. What specific process allows water to pass through a membrane from a dilute to a more concentrated area?
Osmosis
Oncotic pressure refers to the
Osmotic pressure exerted by proteins
The calcium level of the blood is regulated by which mechanism?
Parathyroid hormone (PTH)
Which of the following electrolytes is a major cation in body fluid?
Potassium
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?
Prepare to assist with ventilation
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?
Respiratory Alkalosis
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?
Respiratory acidosis
What does the nurse recognize as one of the indicators of the patient's renal function?
Serum Creatinine
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L
Which medication does the nurse anticipate administering to antagonize the effects of potassium on the heart for a patient in severe metabolic acidosis?
Sodium bicarbonate Explanation: IV administration of sodium bicarbonate may be necessary in severe metabolic acidosis to alkalinize the plasma, shift potassium into the cells, and furnish sodium to antagonize the cardiac effects of potassium
You notify the physician that your client is third-spacing fluid. What orders would you expect the physician to give you?
Start IV fluids and blood products
To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?
Tachycardia
Tonicity
The ability of all the solutes to cause an osmotic driving force that promotes water movement from one compartment to another
Osmolality
The concentration of fluid that affects the movement of water between fluid compartments by osmosis
Osmosis
The movement of water caused by a concentration gradient
Diffusion
The natural tendency of a substance to move from an area of higher concentration to one of lower concentration
A 57-year-old homeless female with a history of alcohol abuse has been admitted to your hospital unit. She was admitted with signs and symptoms of hypovolemia - minus the weight loss. She exhibits a localized enlargement of her abdomen. What condition could she be presenting?
Third Spacing
True/False: A patient who is experiencing hypovolemia is likely to have a weak, rapid pulse and hypotension.
True
A client is brought in by ambulance in a nauseous and confused state and demonstrating carpopedal spasm. Initial arterial blood gases show increased pH and HCO3 and normal PaCO2 levels. Breathing is slow and shallow. As the nurse caring for this client, you know that potassium salt should be a part of the treatment for this client when?
When hypokalemia is present
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
pH 7.48
In which of the following medical conditions would administering IV normal saline solution be inappropriate?
• Heart failure • Pulmonary edema • Renal impairment
