PrepU Fluid & Electrolyte Balance

A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching?

"I will increase my fluid and calcium intake."

When fluid intake is normal, the specific gravity of urine should be

1.010 to 1.025.

A client has chronic hyponatremia, which requires weekly laboratory monitoring to prevent the client lapsing into convulsions or a coma. What is the level of serum sodium at which a client can experience these side effects?

114 mEq/L

A nurse is assisting the physician conducting a cystogram. The client has an intravenous (IV) infusion of D5W at 40 ml/hr. The physician inserts a urinary catheter into the bladder and instills a total of 350 ml of a contrast agent. The nurse empties 500 ml from the urinary catheter drainage bag at the conclusion of the procedure. How many milliliters does the nurse record as urine?

150

A sample consensus formula for fluid replacement recommends that an isotonic solution be administered in the first 24 hours of a burn in the range of 2 to 4 mL/kg/% of burn with 50% of the total given in the first 8 hours postburn. A 176 lb (80 kg) man with a 30% burn should receive a minimum of how much fluid replacement in the first 8 hours?

2,400 mL

A nurse is reviewing a patient's laboratory test results. Which serum albumin level would lead the nurse to suspect that the patient is at risk for pressure ulcers?

2.5 g/mL

The client has the intake and output shown in the accompanying chart for an 8-hour shift. What is the positive fluid balance?

260

A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:

280 mOsm/kg.

What can the nurse include in the plan of care to ensure early intervention along the continuum of shock to improve the client's prognosis? Select all that apply.

Administer intravenous fluids. Monitor for changes in vital signs. identify the cause of shock

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?

Administration of sodium polystyrene sulfonate [Kayexalate])

The nurse is able to identify which condition as uremia?

An excess of urea in the blood

The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student and then asks the student what nursing interventions might cause increased preload. Which response by the student indicates understanding?

Application of antiembolic stockings

A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?

Assess for elevated blood urea nitrogen levels.

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?

Azotemia

A client with a severe electrical burn injury is treated in the burn unit. Which laboratory result would cause the nurse the most concern?

BUN: 28 mg/dL

A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/d

Trousseau's sign is elicited by which of the following?

Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.

Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic?

Check regularly for dependent edema

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?

Chronic diarrhea

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition?

Decreased fluid intake

The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L) and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving?

Discontinue the intravenous lactated Ringer solution.

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC)

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process?

Elevated blood pressure

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:

Encourage high fluid intake

During a routine checkup, a nurse observes the client's skin to be tight and shiny. Which of the following is the correct indication of this sign?

Fluid retention

A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload?

Head of the bed elevated 45 degrees and lower arms supported by pillows

A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion?

Hydrocortisone

The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of:

Hypocalcemia.

The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?

Hypokalemia

When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition?

Inadequate fluid volume

After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply.

Increase hydration. Administer allopurinol. Administer rasburicase.

What is a characteristic of the intrarenal category of acute kidney injury (AKI)?

Increased BUN

What is a characteristic of the intrarenal category of acute renal failure?

Increased BUN

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

Increased urine output

A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following?

Irritation of the medullary vagal centers

A priority nursing intervention for a client with hypervolemia involves which of the following?

Monitoring respiratory status for signs and symptoms of pulmonary complications.

A client with suspected renal dysfunction is scheduled for excretory urography. The nurse reviews his history for conditions that may warrant changes in client preparation. Normally, the client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding calls for the client to be well hydrated?

Multiple myeloma

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?

Oliguria

Which can be used for rehydration therapy for diarrheal disorders?

Oral rehydration salts (ORS)

Which is the most common cause of esophageal varices?

Portal hypertension

Which electrolyte is a major cation in body fluid?

Potassium

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question?

Potassium chloride

The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide?

Potassium level of 3.1

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders?

Potassium: 5.8 mEq/L

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant?

Provide oral care every 2-3 hours.

Which of the following fluid or electrolyte changes occur in the emergent/resuscitative phase?

Reduction in blood volume

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias?

Serum potassium level

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?

Serum potassium level of 5.8 mEq/L

A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms?

Sodium level of 150 mEq/L

What is used to decrease potassium level seen in acute renal failure?

Sodium polystyrene sulfonate

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is:

Specific gravity 1.035

The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium?

Spironolactone

Which is an effect of aging on upper and lower urinary tract function?

Susceptibility to develop hypernatremia

Which of the following is a factor affecting an increase in urine osmolality?

Syndrome of inappropriate antidiuretic hormone release (SIADH)

Dilutional hyponatremia occurs in which disorder?

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Which is a manifestation of right-sided heart failure?

Systemic venous congestion

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

Urine output of 20 ml/hour

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Urine output of 250 ml/24 hours

Which hormone causes the kidneys to reabsorb sodium?

aldosterone

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has?

calcium

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. sodium 137 mEq/L (137 mmol/L)potassium 4.6 mEq/L (4.6 mmol/L)chloride 94 mEq/L (94 mmol/L)calcium 12.9 mg/dL (3.2 mmol/L) What laboratory value is of highest concern to the nurse?

calcium 12.9 mg/dL (3.2 mmol/L)

The nurse is preparing a client for a nuclear scan of the kidneys. Following the procedure, the nurse instructs the client to

drink liberal amounts of fluids.

A client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment?

electrocardiogram (ECG) results

When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of:

encouraging fluids.

Which of the following actions helps the nurse to determine the quality of the skin turgor?

grasping the skin

The nurse cares for a client in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the client's CVP as 9 mm Hg and recognizes that this finding indicates the client is most likely experiencing which condition?

hypervolemia

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?

hypokalemia

An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?

hypokalemia

Clients diagnosed with hypervolemia should avoid sweet or dry food because it

increases the client's desire to consume fluid.

A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding?

jugular venous distention

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

liver

The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?

low-sodium diet

A client diagnosed with heart failure presents with a temperature of 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; and pulse oximeter reading of 89%. Which finding indicates a need for immediate attention?

lung congestion

A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the

malignancy is causing the electrolyte imbalance.

A client has been admitted to the cardiac step-down unit with acute pulmonary edema. Which symptoms would the nurse expect to find during assessment?

moist, gurgling respirations

The term used to describe total urine output less than 0.5 mL/kg/hour is

oliguria

Which glands regulate calcium and phosphorous metabolism?

parathyroid

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?

preload

Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality?

sodium

An 82-year-old client is admitted to the hospital with a diagnosis of pneumonia. The nurse learns that the client lives alone and hasn't been eating or drinking properly. When assessing the client for dehydration, the nurse would expect to find:

tachycardia.

A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting?

third-spacing

A client with a traumatic brain injury has developed increased intracranial pressure resulting in diabetes insipidus. The expected treatment would consist of which of the following?

vasopressin therapy