Week 4: Fluid and Electrolyte
Fluid and electrolyte imbalance
while palpating the skin of a client, the nurse observes pitting edema on the dorsum of the foot. What could the reason for this condition?
Fluid and electrolyte balance
A nurse is caring for a client who is having diarrhea. To prevent an adverse outcome, the nurse should most closely monitor what client date or assessment finding?
Hypotension
Which is the clinical manifestation occurs in a client with vasopressin deficiency?
Serum potassium level
Before a client has a cardiac catheterization, an electrocardiogram (ECG) is preformed, and hypokalemia is suspected. The nurse expects that the diagnosis will be confirmed by which diagnostic test?
33 drops per minute
The patient has a prescription for lactated ringers IV at a rate of 200mL/hour. An IV pump is not available. The IV tube has a drop factor of 10 drops/mL. The nurse will administer the lactated ringers solution at ___ drops per minute?
Paresthesias
Upon assessment of laboratory data, the nurse notes a calcium level of 6.4mg/dL. which physical assessment finding is consistent with this data?
Calyx
What is the cup-like structure that collects a clients urine and is located at the end of each papilla?
Tolvaptan is used to treat hyponatremia associated with heart failure and liver cirrhosis. It acts by blocking the activity of antidiuretic hormone
The nurse is caring for a patient with hyponatremia associated with hearth failure and liver cirrhosis. What drug does the nurse anticipate administering to treat this patient?
Insulin infusion For severe hyperphosphatemia, hemodialysis or an insulin and glucose infusion can decrease levels rapidly. Fluid restriction, calcium supplements, and diuretic therapy are not treatment options for hyperphosphatemia.
The nurse is caring for a patient with severe hyperphosphatemia. What type of treatment does the nurse anticipate administering to this patient?
End stage renal disease
The nurse reviews a medical record and is concerned that the client may develop hyperkalemia. Which disease increases the risk of hyperkalemia?
25% albumin solution After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be used as a volume expander.
The patient was admitted for a paracentesis to remove ascites fluid. Five liters of fluid was removed. What IV solution may be used to pull fluid into the intravascular space after the paracentesis?
Adrenal cortex
A client is admitted for hypertension, and serum electrolyte studies have yielded abnormal results. The scheduled workup included a scan for an aldosteronoma. What gland is affected in aldosteronoma?
-Renal Failure -Adrenal Insufficiency Hyperkalemia is a condition in which there is an abnormal increase of potassium in the blood. Renal failure may cause hyperkalemia, because the kidneys cannot remove potassium from the body. Adrenal insufficiency causes aldosterone deficiency, which leads to the retention of potassium ions and also may result in hyperkalemia.
The nurse is monitoring a patient with hyperkalemia. Which conditions may be associated with this electrolyte imbalance?
Sodium 136mEq/L, Potassium 4.5mEq/L
The nurse receives a health care providers prescription to change the patient IV from D5 1/2 NS with 40mEq KCl/L to D5 NS with 20mEq KCl/L. Which serum laboratory value on this same patient best supports the rationale for this IV prescription change?
Administer furosemide
A patient with a tumor of the adrenal glands reports feeling unusually sleepy. After receiving the prescription from the health care provider, which nursing action is most appropriate considering the fact that the patient is at risk of hypernatremia due to primary aldosteronism?
Hyperkalemia Irregular pulse and weakness of the lower extremities are generally seen in patients with hyperkalemia.
The nurse is preparing to administer sodium polystyrene sulfonate rectally to a patient with an irregular pulse and weakness of the lower extremities. What laboratory finding does the nurse determine is the reason for this treatment?
"I should provide fluids only when the patient feels thirsty." Mental status alterations are a common problem in old age and may lead to decreased ability to express thirst and obtain fluids.
The nurse is teaching a caregiver for an older adult patient with dementia about fluid balance maintenance at home. Which statement made by the caregiver indicates that he or she requires further education?
Chlorhexidine-based solutions such as chlorhexidine gluconate have been shown to be more effective at killing bacteria than povidone-alcohol or isopropyl alcohol solutions. Therefore chlorhexidine-based solutions should be used to cleanse around the central venous access device.
The nurse is preparing to cleanse the skin around a central venous access device. Which solution would the nurse select as the most effective means of killing harmful bacteria?
625mL
The nurse is preparing to documant output for a patient at the end of the shift. The patient has had 500mL of urine output, vomited 100mL of clear liquid, and 25mL of wound drainage was removed via a wound vacuum device. What does the nurse record as the total output for this shift? Record your answer as the whole number in mL.
1+
The nurse is preparing to document skin assessment findings for a patient being treated for renal failure. Assessment findings include cool, taut skin over the sternum with a 2mm indentation when pressing with a thumb over the sternum. How does the nurse document the grade of the edema?
-"I will increase daily fluid intake to 3000 to 4000 mL." -"Renal calculi may occur as a complication of hypercalcemia." -"Weight-bearing exercises can help keep calcium in the bones."
The nurse is providing education for a patient regarding hypercalcemia. What statement made by the patient would indicate understanding of the education by the nurse?
Observe the client for increasing confusion.
The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. What nursing intervention is the priority?
1.4 mg/dL Alcohol withdrawal can result in hypophosphatemia. Phosphate levels of less than 2.4 mg/dL indicate hypophosphatemia
Which phosphate level would the nurse be likely to find in the patient who has alcohol withdrawal symptoms?
It indicated dilute urine
The nurse finds that a client with a urinary disorder has very pale-yellow- colored urine. What is the significance of this abnormal finding?
Daily weighing
The nurse is assessing the fluid balance of a patient being treated for heart failure. Which indicator is the best measure of fluid volume status?
Shock
A 3-year-old child is admitted to the burn unit with partial and full thickness burns over 30% of the body. For what complication should the nurse assess the child during the first 48 hours?
In the first 8 hours 4200 mL should be infused. According to the Parkland (Baxter) formula, one half of the total daily amount of fluid should be administered in the first 8 hours. Because the client weighs 60 kg (132 pounds ÷ 2.2 kg = 60 kg), the calculation is 60 kg × 4 mL/kg × 35% burns = 8400 mL per day; half of this amount should be infused within the first 8 hours.
A client is rescued from a house fire and arrives at the emergency department 1 hour after the rescue. The client weighs 132 pounds (60kg) and is burned over 35% of the body. The nurse expects that the amount of lactated ringer solution that will be prescribed to be finished in the next 8 hours is what?
An increased serum albumin level increases the osmotic effect and pulls fluid back into the intravascular compartment. This will increase renal flow and urine output, with a resulting decrease in abdominal girth.
A nurse is administering serum albumin intravenously to a client with ascites. In response to this therapy what does the nurse expect to decrease?
Low calcium
A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information?
Ketones as a result of rapid fat breakdown, causing acidosis
A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition?
Accelerated bone demineralization
A nurse writes a goal of preventing renal calculi in a care plan for a client with paraplegia. Which information most likely caused the nurse to write this goal?
Oral input = output
A patient has been treated for dehydration. What outcome does the nurse determine demonstrates effectiveness of the treatment regimen?
Weakness Signs of hypophosphatemia include weakness, confusion, coma, and diminished reflexes
A patient is admitted with alcohol, abuse. Laboratory data reveals a phosphate level of 1.8 mg/dL. Which assessment finding is consistent with this data?
Dyspnea Excess extracellular volume may result from fluid retention during Cushing syndrome. This shift of fluid into the interstitial spaces leads to blockage of air spaces (pulmonary edema) resulting in dyspnea, crackles, and peripheral edema. Dry mouth, weight loss, and restlessness are the common manifestations resulting from extracellular fluid depletion.
A patient is diagnosed with Cushing syndrome. What manifestation does the nurse anticipate while assessing this patient?
Adrenal Cortical The adrenal-cortical system secretes glucocorticoids and mineralocorticoids to regulate water and electrolyte balance. Glucocorticoids have an anti-inflammatory effect and increase serum glucose levels.
In the regulation of water balance, which system has a primarily anti-inflammatory effect and increases serum glucose levels?
8mL
The IV prescription reads "D5.45 normal saline (NS) with 40mEq KCl/L at 125mL/hour" the nurse needs to add the KCl to the IV because no premixed solutions are available. The units medication supply has a stock of KCl 5mEq/mL in multidose vials. The nurse would need to draw up ______ mL to add to the IV solution?
65-year-old homeless woman with a history of chronic alcoholism Causes of hypomagnesemia include chronic alcoholism, diarrhea, vomiting, malabsorption syndromes, prolonged malnutrition, and nasogastric (NG) suction
The charge nurse is reviewing the electrolyte laboratory study results for the units assigned patients. Which patient would be at greatest risk for the potential development of hypomagnesemia?
Hypocalcemia Trousseau's sign refers to carpal spasms induced by inflating a blood pressure cuff on the arm. Hypocalcemia can be identified by Trousseau's sign. Hypercalcemia, hypermagnesemia, and hyperphosphatemia cannot be identified by Trousseau's sign.
The nurse assesses the present of Trousseau's sign is a patient that had an inadvertent removal of the parathyroids during a thyroidectomy. What electrolyte disturbance should the nurse check the laboratory studies for?
0.9% sodium chloride An isotonic fluid such as 0.9% sodium chloride is used to rapidly replace fluid volume. The solutions 0.45% sodium chloride, 5% dextrose in 0.25% saline, and 5% dextrose in 0.9% saline are all hypertonic solutions that are not used to rapidly increase fluid volume.
The emergency room nurse is caring for a patient with severe fluid volume deficit, who presented after several days of diarrhea secondary to C. difficile infection. Which IV fluid does the nurse anticipate will be used to rapidly replace the fluid volume?
Shift to fluid into the interstitial spaces
The nurse assesses bilateral +4 peripheral edema while assessing a client with heart failure and peripheral vascular disease. What is the pathophysiological reason for the excessive edema?
It is a hypertonic solution A 10% dextrose solution with amino acids, electrolytes, vitamins, and trace elements is used in parenteral nutrition to provide additional calories. It is a hypertonic solution, which provides free water, expanding both the extracellular and intracellular compartments.
The primary health care provider has prescribed parenteral nutrition for a patient. The nurse administers a 10% dextrose solution with amino acids, electrolytes, vitamins, and trace elements. What does the nurse need to know regarding the 10% dextrose solution?
Adrenal adenoma
What is the most probable cause for Conn's syndrome in an adult client?
General restlessness Restlessness is an early cerebral sign that dehydration has progressed to the point where an intracellular fluid shift is occurring. If the dehydration is left untreated, cerebral signs could progress to confusion and later coma.
When assessing a patient admitted with nausea and vomiting, which finding supports a determination of deficient fluid volume?
Fluid movement from the interstitial spaces into the blood vessels. In dehydration, fluid is lost first from the blood vessels. To compensate, fluid moves out of the interstitial spaces into the blood vessels to restore circulating volume in that compartment.
When planning care for a patient with dehydration related to nausea and vomiting, the nurse would anticipate which fluid shift to occur because of the fluid volume deficit?
The normal level of potassium is 3.5 to 5.0 mEq/L. The laboratory value of the potassium in the client is 2.9 mEq/L, which is below the normal level. Therefore, it may indicate the presence of adrenal gland hyperfunction in the client.
Which laboratory value may indicate hyperfunction of the adrenal gland in a client?
congestive heart failure (CHF)
Which medical diagnosis would cause the nurse to include nursing interventions appropriate for hyponatremia in the plan of care?
Calcium
Which nutrient deficiency in the pregnant adolescent may result in decreased birth weight as a consequence of low bone mineral density in the fetus?
"It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."
A student is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy?
Patients with deficient fluid volume experience decreased tissue perfusion and hypoxia resulting in an increased respiratory rate.
The nurse is completing an assessment of a patient with hearth failure who is being treated for accidental overdose of diuretics. For which potential respiratory issue should the nurse monitor the patient?
Phosphorus falling to 2.1 mg/dL Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa. Because hypercalcemia rarely occurs as a result of calcium intake, the patient's phosphorus falling to 2.1 mg/dL (normal 2.4-4.4 mg/dL) may be a result of the phosphate-binding effect of calcium carbonate.
The nurse is caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would be identified as an adverse effect related to this therapy?
Tumor Lysis Syndrome (TLS) Tumor lysis syndrome causes movement of potassium from the intracellular fluid (ICF) to the extracellular fluid (ECF), resulting in hyperkalemia.
The nurse is caring for a patient with a potassium level of 6.2 mEq/dl. What syndrome does the nurse suspect the patient may have?
Isotonic
Which term is used to describe the fact that extracellular fluid and intracellular fluid have the same osmolality?
