124 Fluid and Electrolytes

The health care provider is concerned that the client has hypokalemia. During the physical examination, which question should the nurse ask the client?

"Have you been experiencing muscle weakness or leg cramps?"

A nurse is caring for a client who has end stage renal disease (ESRD). Which of the following are expected findings? (all that apply)

*Slurred speech *Bone pain -Tachypena *Pruitus -Hypertension

A client is admitted to the emergency department with possible internal bleeding after being involved in an automobile accident. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?

0.9% NaCl

A client has been diagnosed with a gastrointestinal bleed and the health care provider has ordered a transfusion. At what rate should the nurse administer the client's packed red blood cells?

1 unit over 2 to 3 hours, no longer than 4 hours

A nurse is admitting an infant who has served dehydration from acute gastroenteritis. Which of the following findings should the nurse expect?

13% weight loss

A nurse is caring for a client who has impaired renal function. For which of the following findings should the nurse notify the provider?

175 ml of urine in the past 8 h

A nurse is admitting a 6 month old for dehydration. Which of the following amounts of urinary output should indicate to the nurse that the treatment has corrected the fluid imbalance?

2ml/kg/hr

Frequent vomiting, leading to loss of fluid volume

A 40-year-old man who has had 3 broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated.

Which cellular dysfunction is responsible for the manifestations of cystic fibrosis?

Abnormal chloride channel proteins allow increased sodium and water reabsorption.

Which of the following is the most common cause of symptomatic hypomagnesemia in the United States?

Alcoholism

What knowledge should guide the nurse when caring for a client with a new ileostomy?

Anticipate that emotional stress can increase intestinal peristalsis.

What is the lab test commonly used in the assessment and treatment of acid-base balance?

Arterial blood gas

The nurse is palpating the skin of a 30-year old client and documents that when picked up in a fold, the skin fold slowly returns to normal. What would be the next action of the nurse based on this finding?

Assess the client for dehydration

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/dL

A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit?

Calcium gluconate

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

Check regularly for dependent edema

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema?

Decreased albumin

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

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?

Decreased level of erythropoietin

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

Encourage high fluid intake.

Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to:

Encourage high fluid intake.

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure?

Encouraging fluid intake after dinner

The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which finding does the nurse anticipate?

Excessive urine output

The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?

Fluid accumulating in the interstitial spaces distal to the tumor

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels?

Frequent vomiting, leading to loss of fluid volume

A nurse in a community clinic is assessing an older adult client for manifestations of dehydration. What should they find?

Furrows in the tongue

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

Grasping the skin

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication?

Hypovolemic shock

A preschooler has vomiting, diarrhea, and a potassium level of 3 mEq/L (3 mmol/L). Which prescribed order will the nurse implement first?

I.V. infusion of 500 ml of dextrose 5% in water and half-normal saline solution with 20 mEq (20 mmol/L) of potassium chloride at 100 ml/hr

A fluid volume deficit can be caused by either dehydration or hypovolemia. What is the distinction between the two?

In hypovolemia only blood volume is low.

Which individual with diarrhea for three days is most likely to suffer from fluid and electrolyte imbalance?

Infant

Lymph fluid arises directly from which space?

Interstitial

Which is a characteristic of right-sided heart failure?

Jugular vein distention

Which serum electrolytes findings should the nurse expect to find in an infant with persistent vomiting?

K+, 3.2; Cl-, 92; Na+, 120

A client had an open cholecystectomy (gallbladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?

Monitor the client closely and promote fluid intake.

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.

The nurse is caring for an older adult. What is the primary nursing intervention to increase fluid intake in older adults?

Offer a variety of fluids to the client every hour.

The calcium concentration in the blood is regulated by which mechanism?

Parathyroid hormone (PTH)

Which electrolyte is a major cation in body fluid?

Potassium (K)

A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient?

Potassium levels

What are key roles of the kidneys? (Select all that apply.)

Regulating body fluid volume Maintaining blood pressure Balancing acids/bases

A 77-year-old female hospital client has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which statement best conveys a risk that this woman faces?

She is susceptible to isotonic fluid volume deficit.

When trying to explain to a client on dialysis the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:

Small openings that allow large amounts of smaller molecular substances to filter through the glomeruli.

Which electrolyte filters through the glomerulus and enters the renal tubule?

Sodium

A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with?

Syndrome of inappropriate antidiuretic hormone (SIADH)

A nurse observes an LPN measuring a client's urine output from an indwelling catheter drainage bag. Which observation by the nurse ensures that the client's urine has been measured accurately?

The LPN pours the urine into a graduated measuring container.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case?

They may cause hyperkalemia.

Which assessment finding would lead a nurse to suspect dehydration in a preterm neonate?

Urine output below 1 ml/hour

The nurse is caring for a child on the burn unit weighing 100 lb (45.5 kg) who has second-degree (partial-thickness) burns over 30% of the body. During the beginning shift assessment, which assessment finding is of most concern to the nurse?

Urine output of 15 ml per hour over the last 4 hours

A nurse is assessing four clients for fluid balance. The nurse should identify that which of the following clients is exhibiting manifestations of dehydration?

a client who has a temperature of 39 (102)

A nurse is preparing to administer potassium chloride (KCL) to a client who is receiving diuretic therapy. The nurse reviews the client's serum potassium levels results and discovers the clients potassium level is 3.2 mEq/L. Which of the following actions should the nurse take?

administer the KCL as prescribed

A client is returning from the operating room after inguinal hernia repair. The nurse notes that the client has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?

bibasilar crackles

An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:

blocking the conversion of angiotensin I to angiotensin II.

An osmotic diuretic such as mannitol is given to the client with increased intracranial pressure (ICP) to

dehydrate the brain and reduce cerebral edema.

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert fo

diaphoresis, vomiting, and diarrhea.

A client loses consciousness after strenuous exercise and needs to be admitted to a health care facility. The client is diagnosed with dehydration. The nurse knows that the client needs restoration of:

electrolytes

A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:

hyperkalemia

A client who has just completed running a marathon reports muscle weakness, cramping, and general fatigue despite drinking adequate amounts of water. The nurse suspects which type of hypotonic hyponatremia?

hypovolemic

The nurse is caring for a child with a severe burn. The treatment for this child during the first 48 hours will be most likely be related to:

hypovolemic shock.

A nurse is providing teaching to a group of adult athletes about prevention

impaired motor control

A client has a diagnosis of dehydration. What indicators would the nurse assess to determine an improvement in dehydration? Select all that apply.

increased weight increased blood pressure

A nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?

low serum potassium level

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?

lower extremities

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

A 6-month-old infant is assessed to have 4% volume depletion related to a gastrointestinal illness. What intervention would the nurse recommend to the parents based on the infant's condition?

oral electrolyte replacement solutions, breast milk, or lactose-free formula

The nurse is caring for an older adult client with diarrhea. Which assessment finding requires immediate nursing intervention?

skin turgor response 5 seconds

A nurse is reviewing a client's laboratory test results. Which electrolyte is the major cation controlling a client's extracellular fluid (ECF) osmolality?

sodium

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms o

sodium and potassium abnormalities.

A client's intravenous catheter has become occluded. The nurse knows that the reason for the occlusion is:

thrombosis at the site.

A client with diabetes whose husband recently died reports elevated blood glucose levels. She admits she is barely eating anything; she does not feel hungry. How will the nurse best respond to this client?

"Often with stress, glucose level increases because the body needs more energy."

A client is suffering from the effects of the opportunistic infection, Cr

Hydration

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 nurse in reviewing the laboratory tests from a client who has prerenal acute kidney injury (AKI). Which of the following electrolyte imbalance should the nurse expect?

hyperkalemia

A nurse is discussing laboratory values associated with the renal system with newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the values?

Creatinine is increased in clients that have kidney injury

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

Hypocalcemia

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

Hypokalemia

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

Hypokalemia and hypoglycemia

A 6-month-old infant is brought to the clinic. The mother reports the infant has been lethargic and not eating well. The infant's anterior fontanel is sunken. Which additional information is a priority for the nurse to assess?

Number of wet diapers the in the last 24 hours

A child is brought to the emergency department with a full-thickness burn involving the epidermis, dermis, and underlying subcutaneous tissue, but does not report pain at this time. Which statements by the nurse are correct about this type of burn? Select all that apply.

This is a severe burn and nerve endings have been destroyed. The child must be monitored for signs of fluid shift. Rehabilitation and skin grafting will be necessary.

A nurse is caring for a 3 year old child who was admitted with acute diarrhea and dehydration. WHich of the following findings indicates that the oral rehydration therapy has been effective?

Urine specific gravity 1.015

A nurse is caring for client who is receiving IV fluids to correct dehydration. Which of the following laboratory values should indicate to the nurse that the client is effectively responding to treatment?

Urine specific gravity of 1.020

The nurse is caring for a client receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which will alert the nurse that the client may be experiencing nephrotoxicity?

a decrease in urine output

In an industrial accident, a client who weighs 155 lb (70 kg) sustained full-thickness burns over 40% of their body. The client is in the burn unit receiving fluid resuscitation. Which finding shows that the fluid resuscitation is benefiting the client?

a urine output consistently above 40 ml/hour (40 mL/hour)

A home health nurse is making a home visit to a client who takes a daily diuretic for heart failure. Which of the following manifestations should the nurse identify as indicating the client is hypoclamic?

fatigue

A client who has been taking furosemide has a serum potassium level of 3.2 mEq/L. Which assessment findings by the nurse would confirm an electrolyte imbalance?

muscle weakness and a weak, irregular pulse

Which client has more extracellular fluid?

newborn

The primary extracellular electrolytes are:

sodium, chloride, and bicarbonate.

A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which the following medications outs the client are risk for both hyperkaliemia and hyponatremia?

spironolactone

A nurse is providing teaching for a client who is on a diuretic therapy and has a new prescription for potassium chloride (KCL) 20 mEq extended release PO daily which of the following instructions should the nurse provide about the new prescription?

take the extended release tablets whole