Pharmacology Chapter 29, Fluids and Electrolytes

4 The patient had 20% blood loss due to trauma, so the patient has to be transfused with blood products to restore the volume of the blood lost. Cryoprecipitate and PPF are used to manage acute bleeding of 20% blood loss rapidly or over 50% slowly. Therefore, administration of 1 unit of cryoprecipitate and 1 unit of PPF would be most useful to treat the patient. Hetastarch and dextran 70 are nonprotein plasma expanders, which are administered in cases of 20% to 50% slow blood loss and not for acute bleeding with 20% blood loss. Administration of 1 unit of FFP and 1 unit of platelets is useful in cases of over 80% blood loss but not for 20% blood loss.

A patient has acute blood loss of about 20% as the result of a motor vehicle accident. Which will the nurse expect to administer? 1 500 mL of hetastarch 2 500 mL of dextran 70 3 1 unit of fresh frozen plasma (FFP) and 1 unit of platelets 4 1 unit of cryoprecipitate and 1 unit of plasma protein fraction (PPF)

4 Sodium polystyrene sulfonate is given to patients with hyperkalemia. The normal range of serum potassium level is 3.5 to 5 mEq/L; therefore, the nurse would find the serum potassium level of the patient to be 5.9 mEq/L. A serum potassium level of 3.5 mEq/L is considered in the normal range, so the enema would not be required. A serum potassium level of 4.2 mEq/L is considered a normal level of potassium in the blood. A serum potassium level of 2.3 mEq/L is considered a low potassium level. If sodium polystyrene sulfonate were administered to a patient with hypokalemia, the potassium level would decrease further.

A patient is prescribed a sodium polystyrene sulfonate enema. The nurse is reviewing the patient's laboratory reports. What will the nurse expect the patient's potassium level to be? 1 3.5 mEq/L 2 4.2 mEq/L 3 2.3 mEq/L 4 5.9 mEq/L

4 The nurse should administer the red blood cells (RBCs) to increase the patient's oxygen-carrying capacity. The patient has anemia, so this therapy should help alleviate tachycardia because, in this case, tachycardia is a result of sympathetic nervous system (SNS) activation in response to hypoxemia. As the tissues receive more oxygenated blood from the infusion of additional hemoglobin, the SNS stimulation should subside, and improved tissue oxygenation should help improve healing. The patient needs hemoglobin, so albumin and plasma are improper therapy because they do not provide hemoglobin. Whole blood can help replenish hemoglobin, but because whole blood contains more fluid than RBCs, it increases the risk of fluid volume overload and is not indicated.

A patient who has just undergone surgery exhibits tachycardia and a hemoglobin level of 9 g/100 mL. Which fluid therapy will the nurse expect to administer? 1 50 mL of 5% albumin 2 450 mL of whole blood 3 100 mL of fresh frozen plasma 4 250 mL of packed red blood cells

3 The patient has hypovolemic shock due to excess blood loss and is anemic. Therefore, administration of red blood cells would help to restore the blood volume as well as increase oxygen-carrying capacity. Albumin is also contraindicated in patients with hypovolemic shock, because it increases the blood volume but cannot restore oxygen-carrying capacity. Normal saline is contraindicated in patients with hypovolemic shock, because it is not effective in restoring oxygen-carrying capacity. A plasma protein fraction is indicated for patients with acute loss of blood due to gastric bleeding.

A patient who was injured in a motor vehicle accident has hypovolemic shock due to excess blood loss. The laboratory reports show that the patient has anemia. What will the nurse expect the provider to order? 1 Albumin 2 Normal saline 3 Packed red blood cells 4 Plasma protein fraction

4 Reduced urine output is called oliguria. It is a symptom associated with diarrhea. Crystalloids can be used to manage specific fluid and electrolyte balance and to increase urinary output. Therefore, the nurse would expect the primary health care provider to prescribe lactated Ringer solution, which is a crystalloid. Dextran, acetazolamide, and sodium bicarbonate are not crystalloids and do not increase urinary output. Dextran is a solution of glucose that is used to maintain colloid oncotic pressure. Acetazolamide and sodium bicarbonate are the diuretics that are used to maintain acid-base balance in the body.

A patient with diarrhea has reduced urine output. What will the nurse expect the primary health care provider to prescribe? 1 Dextran 2 Acetazolamide 3 Sodium bicarbonate 4 Lactated Ringer solution

2 Potassium infusions are used to treat patients with severe hypokalemia. The most concentrated solutions used are 60 mEq/L, with a rate not more than 40 mEq/hour. Hence, cardiac monitoring is indicated when concentrated potassium chloride is administered intravenously. An ice pack is placed over the IV site to relieve the burning after or during the therapy. The IV cannula is used for the implementation of antineoplastic drugs. The nurse needs to assess the serum potassium concentrations to evaluate for toxicity, not the 24-hour intake and output.

A patient with hypokalemia is ordered to receive an intravenous (IV) dose of potassium chloride (KCl) 15 mEq in 250 mL of 0.9% saline to infuse over 1 hour. What action will the nurse take prior to starting the infusion? 1 Place an ice pack over the IV site. 2 Review the electrocardiogram (ECG). 3 Ensure that the IV cannula is securely taped. 4 Review the previous 24-hour intake and output.

1 When the patient reports an irregular heartbeat and muscle weakness, the nurse may suspect ventricular fibrillation caused by hyperkalemia, or elevated potassium levels in the blood. Hyperkalemia may be caused by a kidney problem, but it also can be caused by potassium supplements. Consumption of excess fluids may help the kidneys process the excessive potassium and return the body to normal levels. Potassium is excreted through the kidneys, not through bowel movements. Physical exercise does not increase the level of potassium; in fact, it helps to maintain the electrolyte balance.

An older adult reports a feeling of irregular heartbeat, muscle weakness, and mild confusion. What question will the nurse ask the patient? 1 "Have you been taking potassium supplements?" 2 "Have you been drinking more fluids than normal?" 3 "Have you been having normal bowel movements?" 4 "Have you been performing excessive physical exercise?"

2 Of the fluids listed, the only hypotonic one is 0.25% NaCl. The intravenous fluid 3% NaCl is hypertonic; normal saline and lactated Ringer solution are isotonic.

Based on the condition of the patient, a hypotonic intravenous fluid will be ordered. Which intravenous fluid is most likely to be ordered by the health care provider? 1 3% NaCl 2 0.25% NaCl 3 Normal saline 4 Lactated Ringer

4 An overdose of hypertonic saline leads to sodium excess, which may cause red, flushed skin and increased thirst. Vomiting, diarrhea, lethargy, and hypotension are direct adverse effects of hyponatremia. Confusion and seizures are the symptoms of hypokalemia.

For what signs and symptoms of overdose does the nurse monitor after administering a hypertonic saline solution to a patient who has severe hyponatremia? 1 Vomiting and diarrhea 2 Confusion and seizures 3 Lethargy and hypotension 4 Flushed skin and increased thirst

1, 2, 4 Hypernatremia is the condition of increased sodium, above 145 mEq/L. The nurse has to assess for symptoms like edema, hypertension, and reddish, flushed skin. Paralytic ileus and cardiac dysrhythmias are not symptoms of hypernatremia. They are symptoms associated with late hypokalemia.

For which symptoms does the nurse assess in a patient with hypernatremia? Select all that apply. 1 Edema 2 Hypertension 3 Paralytic ileus 4 Reddish, flushed skin 5 Cardiac dysrhythmias

3 To raise the plasma volume by 1 L, 5 to 6 L of 0.9% sodium chloride are required. One liter of 5% colloid solution is required to raise the plasma volume by 1 L. To raise the plasma volume by 1 L, 0.5 L of 25% colloid solution is required. To raise the volume of the plasma by 1 L, 1.5 to 2 L of 3% saline solution must be used.

How much volume of 0.9% sodium chloride is required to raise the plasma volume by 1 L? 1. 1 L 2. 0.5 L 3. 5 to 6 L 4. 1.5 to 2 L

3 Patients with osteoporosis are prescribed calcium supplements, which interact with blood products. Hence, the nurse reviews the drug history of the patient with osteoporosis to prevent potential drug interaction. Antiepileptic drugs are not contraindicated with blood products. However, phenytoin may get precipitated if the intravenous form is administered with dextrose. Neither the patient's history of brain injury nor thyroid drugs are related to the administration of frozen plasma.

The nurse has administered normal saline to a patient who experienced blood loss. Before administering frozen plasma to the patient, what information will the nurse gather? 1 History of seizure 2 History of brain injury 3 History of osteoporosis 4 History of thyroid problems

4 The nurse should be alert to signs of hypernatremia when administering hypertonic saline solutions. Flushed skin, increased thirst, elevated temperature, and decreased urinary output are signs and symptoms of hypernatremia. However these signs are not as high a priority as decreased level of consciousness and confusion, which are signs of severe hypernatremia

The nurse is administering hypertonic saline solution to treat a patient with severe hyponatremia. Which nursing action is the priority? 1 Monitor temperature 2 Monitor urinary output 3 Administer antiemetic 4 Assess level of consciousness

3 A protein concentration of 4 g/dL signifies a lowered protein concentration in the body that increases fluid concentrations in the tissue, causing edema. Swelling in the lower extremities or legs indicates an edematous condition. Hepatomegaly, or increased liver size, is seen in hepatic infections, which cause elevation in hepatic enzymes but may not directly affect the protein concentration. Severe diarrhea will reduce the sodium and water concentrations in the body but not the protein concentration. Hypovolemic shock is due to loss of blood and is a fatal condition that is treated by administering blood products.

The nurse is assessing a patient whose protein level is 4 g/dL. Which symptom may be present in this patient as a result of this protein level? 1 Hepatomegaly 2 Severe diarrhea 3 Swelling in the legs 4 Hypovolemic shock

1 The patient shows signs of mild hypokalemia, which can be treated by eating a potassium-rich diet. Intravenous administration of potassium acetate and potassium chloride is preferred if the patient has severe hypokalemia. An enema of potassium exchange resin can be administered if the patient has hyperkalemia.vb

The nurse is assessing an 80-year-old patient and finds that the patient has muscle weakness, anorexia, lethargy, and nausea. What will the nurse expect the provider to order? 1 Increasing the patient's potassium levels with dietary supplements 2 Increasing the patient's potassium levels with intravenous potassium acetate 3 Increasing the patient's potassium levels with intravenous potassium chloride 4 Increasing the patient's potassium levels with a potassium exchange resin enema

2 FFP is used to increase the clotting factor in patients who show demonstrated deficiency in clotting factor. Hetastarch is used as a nonprotein plasma expander to increase the blood volume in patients with decreased blood levels. PPF is used to manage acute bleeding. PRBCs are used to increase the oxygen-carrying capacity in patients with anemia, in patients with hemoglobin deficit, and in patients with blood loss up to 25%.

The nurse is caring for a patient who has a deficiency in clotting factor. Which product is used in such a patient? 1 Hetastarch 2 Fresh frozen plasma (FFP) 3 Plasma protein fraction (PPF) 4 Packed red blood cells (PRBCs)

4 When there is a 20% rapid blood loss, cryoprecipitate and PPF are given. If there is 20% slow blood loss, crystalloids are administered. Dextran 40 and other nonprotein plasma expanders are given when there is a slow blood loss of 20% to 50%. Normal saline is a crystalloid and is administered when there is a slow blood loss of 20%. FFP is given when there is a deficiency of clotting factor levels.

The nurse is caring for a patient who has lost 20% of blood rapidly. What should be the fluid of choice to control the blood loss? 1 Dextran 40 2 Normal saline 3 Fresh frozen plasma (FFP) 4 Cryoprecipitate and plasma protein fraction (PPF)

3 Hypoproteinemia is reduced levels of total proteins. The prescribed treatment, 25% albumin, is a hypertonic colloid solution, which is used to raise the protein levels by expanding blood plasma volume. To raise the plasma volume by 1 L, 0.5 L of 25% colloid is administered. Therefore, the nurse has to administer 1 L (2 × 0.5 L) of 25% albumin, as the patient is 2 L (2 × 1 L) short of total plasma volume. If the patient is 4 L short of total plasma volume, 2 L of 25% albumin must be administered. If the patient is 1 L short of total plasma volume, 0.5 L of 25% albumin must be administered. If the patient is 0.5 L short of total plasma volume, 0.25 L of 25% albumin must be administered.

The nurse is instructed to administer 1 L of 25% albumin to a patient who has hypoproteinemia. What will the nurse infer from such an instruction? 1 The patient requires 4 L of total plasma volume. 2 The patient requires 1 L of total plasma volume. 3 The patient requires 2 L of total plasma volume. 4 The patient requires 0.5 L of total plasma volume.

2, 5 When the nurse observes the patient rubbing the chest and unable to breathe, the nurse should conclude that the patient has shortness of breath and chest pain. It is caused by an increase in fluid volume from the albumin infusion. The nurse should immediately provide artificial ventilation to the patient to reduce shortness of breath and then administer spironolactone. The latter is a diuretic, which decreases fluid volume by increasing urine output. Acetazolamide is also a diuretic, but it is not as effective as spironolactone in diuresis and is normally used to correct metabolic acid-base disturbances. Oral rehydration fluid is administered to patients who are dehydrated. Administration of sodium bicarbonate further reduces the urine output by increasing sodium levels.

The nurse walks into the emergency room, where a patient has been receiving intravenous albumin for the past hour. The nurse observes that the patient is rubbing the chest and is unable to take complete breaths. What interventions will the nurse expect to perform? Select all that apply. 1 Administer acetazolamide as prescribed. 2 Administer spironolactone as prescribed. 3 Provide oral rehydration fluid to the patient. 4 Administer sodium bicarbonate as prescribed. 5 Prepare to administer artificial ventilation to the patient.

1, 2, 3 A rapid increase in heart rate and irregular electrocardiograph are found in patients with elevated potassium levels, or hyperkalemia. The nurse should immediately administer calcium carbonate and stop the IV infusion of potassium chloride. Calcium carbonate reduces the toxic effects associated with increased levels of potassium by causing a rapid intracellular shift of potassium ions, and it reduces the serum potassium levels. Sodium polystyrene sulfonate is administered after calcium carbonate to eliminate the excess serum levels of potassium from the body. Sodium bicarbonate should be administered alone, without insulin. Insulin is administered along with dextrose solution to lower glucose levels. Continuation of the potassium chloride infusion would result in cardiac arrest and eventually cause death.

The primary health care provider orders an intravenous (IV) potassium infusion for a patient who has undergone heart surgery. During the infusion, the nurse notes an irregular electrocardiograph associated with a rapid increase in heart rate. What are the priority nursing interventions? Select all that apply. 1 Administer calcium carbonate as prescribed. 2 Stop the intravenous infusion of potassium chloride. 3 Administer sodium polystyrene sulfonate as prescribed. 4 Administer sodium bicarbonate with insulin as prescribed. 5 Continue with the intravenous infusion of potassium chloride.

1 Before administering intravenous fluids with potassium, the nurse should assess the patient's urinary output to know if there is any electrolyte imbalance. The kidneys compensate for any electrolyte imbalance by retaining electrolytes. A higher urinary output indicates loss of potassium, and the nurse will administer potassium supplements as prescribed. Change in blood pressure can be due to multiple factors and is not necessarily due to potassium levels in the body. A saliva sample will also provide information about infection but not potassium levels. A stool sample will provide information about the infection but not about potassium levels.

The primary health care provider orders intravenous fluids containing potassium for a patient who has gastroenteritis and dehydration. Which nursing action is correct before administering the intravenous fluid? 1 Assess the patient's urinary output. 2 Check the patient's blood pressure. 3 Take a saliva sample from the patient. 4 Obtain a stool sample from the patient.

1 Intravenous dosage forms of potassium must always be given in a diluted form. There is no use or place for undiluted potassium because undiluted potassium is associated with cardiac arrest. Potassium should not be administered as a bolus or pushed. Heat will not aid the infusion. Unless the patient is prone to constant hypokalemia, teaching the signs and symptoms is not a priority.

What is the priority nursing intervention when administering intravenous potassium replacement to a patient? 1 Administer the medication in a diluted form. 2 Administer potassium as a bolus over 10 minutes. 3 Apply heat to the site of intravenous administration. 4 Teach the patient and family the signs and symptoms of hypokalemia

4 Albumin is contraindicated in patients with severe anemia, so the nurse should check the patient's hemoglobin levels before administering albumin. Variation in the patient's glucose levels or thyroxin levels causes diabetes and thyroid dysfunction. Therefore, these are not contraindications for administering albumin. Vitamin K levels play an important role in the clotting mechanism. Its levels do not affect the administration of albumin.

What laboratory reports will the nurse review before administering albumin to a patient? 1 Glucose levels 2 Thyroxin levels 3 Vitamin K levels 4 Hemoglobin level

4 A percentage of 0.45% sodium chloride in the solution is considered half-normal. A percentage of 3% sodium chloride is considered hypertonic saline. A percentage of 0.9% sodium chloride is considered normal. A percentage of 0.25% sodium chloride is considered quarter-normal.

What percentage of sodium chloride is considered half-normal? 1 3% sodium chloride 2 0.9% sodium chloride 3 0.25% sodium chloride 4 0.45% sodium chloride

4 The patient requires immediate nursing assistance, because the urinary output should be at least 30 mL/hr. The patient's average urinary output at the moment is 10 mL per hour. Taking the PaO2 level is to check the arterial blood gas. Serum sodium and serum potassium are assessed for judging kidney-related diseases.

Which assessment finding in an adult patient requires immediate nursing action? 1 PaO2 level of 92 mm Hg 2 Serum sodium 140 mEq/L 3 Serum potassium of 3.8 mEq/L 4 Urinary output of 250 mL in 24 hours

1 Sorbitol taken concurrently with sodium polystyrene sulfonate should be avoided because this combination is implicated in intestinal colonic necrosis, a condition that may be fatal. Phenytoin, amphotericin B, and quinupristin and dalfopristin do not affect the administration of sodium polystyrene sulfonate. Phenytoin interacts with dextrose and results in precipitation. Amphotericin B interacts with potassium replacement products. Quinupristin and dalfopristin is an antibiotic combination that interacts with sodium.

Which drug should not be given with sodium polystyrene sulfonate? 1 Sorbitol 2 Phenytoin 3 Amphotericin B 4 Quinupristin and dalfopristin

4 Hypokalemia indicates a low potassium level. Broccoli soup will help decrease hypokalemia in the patient, because broccoli is high in potassium. Lean turkey, beef bouillon, and mashed potatoes are protein-rich foods, recommended for patients with a protein deficiency.

Which food will the nurse recommend for a patient who has hypokalemia? 1 Lean turkey 2 Beef bouillon 3 Mashed potatoes 4 Cream of broccoli soup

2 When a patient has lost about 15% of the blood slowly, crystalloids are the fluid of choice. Dextran is a nonprotein plasma expander and is given to patients who have lost about 20% to 50% of blood slowly. Whole blood is given to patients who have lost over 50% of blood slowly or 20% of blood rapidly. PPF is given to control acute bleeding in patients.

Which is the fluid of choice in a patient who has lost 15% of blood volume slowly? 1 Dextran 2 Crystalloids 3 Whole blood 4 Plasma protein fraction (PPF)

3 The patient is at high risk for cardiac dysrhythmias caused by a low potassium level. Oxygen and IV fluids are not a priority; sodium polystyrene sulfonate is used for hyperkalemia, not hypokalemia.

Which is the priority intervention when the nurse is assessing a patient with a potassium level of 3.2 mEq/L? 1 Apply oxygen. 2 Start IV fluids. 3 Attach leads for cardiac monitoring. 4 Administer sodium polystyrene sulfonate.

4 In patients with renal insufficiency, dextran administration is contraindicated, because the dextran tends to increase fluid volume, which may not be excreted by the impaired kidneys. Dextran doesn't affect hemoglobin levels; hence, it is not contraindicated in anemic patients. The function of the liver is not affected by dextran administration. The use of dextran does not affect bone function or structure; hence, it is not contraindicated in osteoporosis.

Which patient condition is a contraindication for the administration of dextran? 1 Anemia 2 Liver failure 3 Osteoporosis 4 Renal insufficiency