Chapter 13 Fluid and Electrolytes: Balance and Disturbance

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? A.) Discontinue the intravenous lactated Ringer solution. B.) Increase the rate of the intravenous lactated Ringer solution. C.) Change the lactated Ringer solution to 3% saline. D.) Change the lactated Ringer solution to 2.5% dextrose.

ANswer: A.) Discontinue the intravenous lactated Ringer solution.

The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? A.) 1 L B.) 500 ml C.) 1500 ml D.) 1250 ml

Answer: A.) 1 L

Which electrolyte is a major cation in body fluid? A.) Chloride B.) Bicarbonate C.) Potassium D.) Phosphate

Answer: C.) Potassium

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? A.) Headache or blurry vision B.) Abdominal pain or diarrhea C.) Hallucinations or tinnitus D.) Light-headedness or paresthesia

Answer: D.) Light-headedness or paresthesia Rationale: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Headache, blurry vision, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? A.) Metabolic acidosis B.) Metabolic alkalosis C.) Respiratory acidosis D.) Respiratory alkalosis

Answer: D.) Respiratory alkalosis

The calcium concentration in the blood is regulated by which mechanism? A.) Parathyroid hormone (PTH) B.) Thyroid hormone (TH) C.) Adrenal gland D.) Androgens

Answer: A.) Parathyroid hormone (PTH)

The nurse is caring for a client diagnosed with hyperchloremia. Which are signs and symptoms of hyperchloremia? Select all that apply. - Tachypnea - Weakness - Lethargy - Dehydration - Hypotension

Answer: - Tachypnea - Weakness - Lethargy Rationale: The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive ability; and hypertension occur. If untreated, hyperchloremia can lead to a decrease in cardiac output, dysrhythmias, and coma. A high chloride concentration is accompanied by a high sodium concentration and fluid retention.

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which? A.) Lung function B.) Summer allergies C.) Cardiovascular compromise D.) Insensible fluid loss

Answer: D.) Insensible fluid loss Rationale: Due to the high heat and humidity, geriatric clients are at a high risk for insensible fluid loss through perspiration and vapor in the exhaled air. These losses are noted as unnoticeable and unmeasurable. Those with respiratory deficits and allergies may be only able to be outside for a limited period. Those with cardiovascular compromise may need to alternate outdoor activities with indoor rest.

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? A.) 114 mEq/L B.) 130 mEq/L C.) 135 mEq/L D.) 148 mEq/L

Answer: A.) 114 mEq/L

The health care provider ordered an IV solution for a dehydrated patient with a head injury. Select the IV solution that the nurse knows would be contraindicated. A.) 0.9% NaCl B.) 5% DW C.) 0.45% NS D.) 3% NS

Answer: B.) 5% DW Rationale: A solution of D5W is an isotonic IV solution that is contraindicated in head injury because it may increase intracranial pressure.

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? A.) No effect B.) Increases arterial pH C.) Decreases arterial pH D.) Provides long-term pH regulation

Answer: B.) Increases arterial pH

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? A.) Potassium: 5.8 mEq/L B.) Sodium: 138 mEq/L C.) Magnesium:2 mEq/L D.) Calcium: 10 mg/dL

Answer: A.) Potassium: 5.8 mEq/L

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? A.) CO2 B.) Sodium C.) Chloride D.) Potassium

Answer: D.) Potassium

A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply. - Drink at least eight glasses of fluid each day. - Drink caffeinated beverages to retain fluid. - Drink carbonated beverages to help balance fluid volume. - Drink water as an inexpensive way to meet fluid needs. - Respond to thirst

Answer: - Drink at least eight glasses of fluid each day. - Drink water as an inexpensive way to meet fluid needs. - Respond to thirst

The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? A.) 0.45% sodium chloride B.) 0.9% sodium chloride C.) 5% glucose in water D.) 5% glucose in normal saline solution

Answer: A.) 0.45% sodium chloride

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: A.) 210 mOsm/kg. B.) 230 mOsm/kg. C.) 250 mOsm/kg. D.) 280 mOsm/kg.

Answer: D.) 280 mOsm/kg. Rationale: Serum osmolality can be estimated by doubling the serum sodium or using the formula: Na × 2 = glucose/18 + BUN/3. Therefore, the nurse could estimate a serum osmolality of 280 mOsm/kg by doubling the serum sodium value of 140 mEq/L.

A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypertension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? A.) hypokalemia B.) hyperkalemia C.) hypocalcemia D.) hypercalcemia

ANswer: A.) hypokalemia Rationale: Hypokalemia causes fatigue, weakness, anorexia, nausea, vomiting, cardiac dysrhythmias, leg cramps, muscle weakness, and paresthesias. Many diuretics, such as ethacrynic acid (Edecrin), also waste potassium. Symptoms of hyperkalemia include diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias. Signs of hypocalcemia include tingling in the extremities and the area around the mouth and muscle and abdominal cramps. Hypercalcemia causes deep bone pain, constipation, anorexia, nausea, vomiting, polyuria, thirst, pathologic fractures, and mental changes.

The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client's serum sodium value would be A.) 155 mEq/L (155 mmol/L) B.) 145 mEq/L (145 mmol/L) C.) 135 mEq/L (135 mmol/L) D.) 125 mEq/L (125 mmol/L)

Answer: A.) 155 mEq/L (155 mmol/L) Rationale: The client is experiencing signs and symptoms (S/S) of hypernatremia. Hypernatremia is a serum sodium concentration >145 mEq/L (>145 mmol/L). A cause of hypernatremia is near drowning in seawater (which contains a sodium concentration of approximately 500 mEq/L). S/S of hypernatremia include thirst, elevated body temperature, swollen and dry tongue and sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, simple partial or tonic-clonic seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia, elevated pulse, and elevated blood pressure.

Which of the following is the most common cause of symptomatic hypomagnesemia in the United States? A.) Alcoholism B.) Intestinal resection C.) Inflammatory bowel disease D.) Loss of gastric acid

Answer: A.) Alcoholism Rationale: Alcoholism is currently the most common cause of symptomatic hypomagnesemia in the United States. Any disruption in small bowel function, as in intestinal resection or inflammatory bowel disease, can lead to hypomagnesemia.

The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? A.) Confusion B.) Headache C.) Nausea D.) Hallucinations

Answer: A.) Confusion Rationale: Normal serum concentration ranges from 135 to 145 mEq/L (135-145 mmol/L). Hyponatremia exists when the serum concentration decreases below 135 mEq/L (135 mmol/L). When the serum sodium concentration decreases to <115 mEq/L (<115 mmol/L), signs of increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur. General manifestations of hyponatremia include poor skin turgor, dry mucosa, headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic changes, including altered mental status, status epilepticus, and coma, are probably related to cellular swelling and cerebral edema associated with hyponatremia. Hallucinations are associated with increased serum sodium concentrations.

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? A.) Confusion and seizures B.) Sunken eyeballs and spasticity C.) Flaccidity and thirst D.) Tetany and increased blood urea nitrogen (BUN) levels

Answer: A.) Confusion and seizures Rationale: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? A.) Serum sodium level of 124 mEq/L B.) Serum creatinine level of 0.4 mg/dl C.) Hematocrit of 52% D.) Serum blood urea nitrogen (BUN) level of 8.6 mg/dl

Answer: A.) Serum sodium level of 124 mEq/L Rationale: In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing hyponatremia, as indicated by a serum sodium level of 124 mEq/L. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. A hematocrit of 52% and a BUN level of 8.6 mg/dl are elevated. Typically, the hematocrit and BUN level decrease.

Which medication does the nurse anticipate administering to antagonize the effects of potassium on the heart for a patient in severe metabolic acidosis? A.) Sodium bicarbonate B.) Magnesium sulfate C.) Furosemide D.) Calcium gluconate

Answer: A.) Sodium bicarbonate Rationale: 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.

A client with emphysema is at a greater risk for developing which acid-base imbalance? A.) chronic respiratory acidosis B.) metabolic alkalosis C.) metabolic acidosis D.) respiratory alkalosis

Answer: A.) chronic respiratory acidosis

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 A.) malignancy is causing the electrolyte imbalance. B.) client's diet is lacking in calcium-rich food products. C.) client may be developing hyperaldosteronism. D.) client has a history of alcohol abuse.

Answer: A.) malignancy is causing the electrolyte imbalance.

A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance? A.) metabolic alkalosis B.) metabolic acidosis C.) respiratory acidosis D.) respiratory alkalosis

Answer: A.) metabolic alkalosis

Fluid and 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? A.) osmosis B.) filtration C.) evaporation D.) active transport

Answer: A.) osmosis Rationale: Osmosis is the movement of water through a semipermeable membrane; one that allows some but not all substances in a solution to pass through from a diluted area to a more concentrated area. Filtration promotes the movement of fluid and some dissolved substances through a semipermeable membrane according to pressure differences. Evaporation is the process of converting water into a vapor. Active transport requires the energy source ATP to drive dissolved chemicals from an area of low concentration to an area of higher concentration; the opposite of passive diffusion.

Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? A.) pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 B.) pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 C.) pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15 D.) pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34

Answer: A.) pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28

The nurse is caring for a 72-year-old client who has been admitted to the unit for a fluid volume imbalance. The nurse knows which of the following is the most common fluid imbalance in older adults? A.) Hypovolemia B.) Dehydration C.) Hypervolemia D.) Fluid volume excess

Answer: B.) Dehydration Rationale: The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances.

An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? A.) Hyperkalemia B.) Hypokalemia C.) Hypernatremia D.) Hypophosphatemia

Answer: B.) Hypokalemia

Which could be a potential cause of respiratory acidosis? A.) Vomiting B.) Hypoventilation C.) Diarrhea D.) Hyperventilation

Answer: B.) Hypoventilation

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? A.) Administer an ordered decongestant. B.) Instruct the client to breathe into a paper bag. C.) Offer the client fluids frequently. D.) Administer ordered supplemental oxygen.

Answer: B.) Instruct the client to breathe into a paper bag.

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? A.) Respiratory alkalosis B.) Metabolic alkalosis C.) Respiratory acidosis D.) Metabolic acidosis

Answer: B.) Metabolic alkalosis

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? A.) Specific gravity of 1.02 B.) Urine pH of 3.0 C.) Absence of protein D.) Absence of glucose

Answer: B.) Urine pH of 3.0 Rationale: Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.010 to 1.025, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? A.) HCO 21 mEq/L B.) pH 7.48 C.) PaCO 36 D.) O saturation 95%

Answer: B.) pH 7.48

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? A.) Neutral B.) Alkaline C.) Acidic D.) Basic

Answer: C.) Acidic

A client with excess fluid volume and hyponatremia is in a comatose state. What are the nursing considerations concerning fluid replacement? A.) Restrict fluids and salt for 24 hours. B.) Correct the sodium deficit rapidly with salt. C.) Administer small volumes of a hypertonic solution. D.) Monitor the serum sodium for changes hourly.

Answer: C.) Administer small volumes of a hypertonic solution. Rationale: In clients with normal or excess fluid volume, hyponatremia is usually treated effectively by restricting fluid with clients who are not neurologically impaired. When the serum sodium concentration is overcorrected (exceeding 140 mEq/L) too rapidly or in the presence of hypoxia or anoxia, the client can develop neurological symptoms. However, if neurologic symptoms are severe (e.g., seizures, delirium, coma), or if the client has traumatic brain injury, it may be necessary to administer small volumes of a hypertonic sodium solution with the goal of alleviating cerebral edema. Incorrect use of these fluids is extremely dangerous, because 1 L of 3% sodium chloride solution contains 513 mEq (mmol/L) of sodium and 1 L of 5% sodium chloride solution contains 855 mEq (mmol/L) of sodium. The recommendation for hypertonic saline administration in clients with craniocerebral trauma is between 0.10 to 1.0 mL of 3% saline per kilogram of body weight per hour.

A client reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the client's laboratory work has returned? A.) Potassium B.) Phosphorus C.) Calcium D.) Iron

Answer: C.) Calcium

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? A.) Myasthenia gravis B.) Type 1 diabetes mellitus C.) Extreme anxiety D.) Opioid overdose

Answer: C.) Extreme anxiety

The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? A.) Respiratory acidosis B.) Respiratory alkalosis C.) Metabolic acidosis D.) Metabolic alkalosis

Answer: C.) Metabolic acidosis

A priority nursing intervention for a client with hypervolemia involves which of the following? A.) Establishing I.V. access with a large-bore catheter. B.) Drawing a blood sample for typing and crossmatching. C.) Monitoring respiratory status for signs and symptoms of pulmonary complications. D.) Encouraging the client to consume sodium-free fluids.

Answer: C.) Monitoring respiratory status for signs and symptoms of pulmonary complications. rationale: Hypervolemia, or fluid volume excess (FVE), refers to an isotonic expansion of the extracellular fluid. Nursing interventions for FVE include measuring intake and output, monitoring weight, assessing breath sounds, monitoring edema, and promoting rest. The most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds are assessed at regular intervals.

Which is a correct route of administration for potassium? A.) Subcutaneous B.) Intramuscular C.) Oral D.) IV (intravenous) push

Answer: C.) Oral Rationale: 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.

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? A.) Metabolic acidosis B.) Respiratory acidosis C.) Metabolic alkalosis D.) Respiratory alkalosis

Answer: D.) Respiratory alkalosis

What clinical indication of hyperphosphatemia does the nurse assess in a patient? A.) Bone pain B.) Paresthesia C.) Seizures D.) Tetany

Answer: D.) Tetany Rationale: Tetany is a symptom of hyperphosphatemia. Bone pain, paresthesia, and seizures are associated with hypophosphatemia.

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? A.) neuromuscular function B.) bowel sounds C.) respiratory rate D.) electrocardiogram (ECG) results

Answer: D.) electrocardiogram (ECG) results

Early signs of hypervolemia include A.) a decrease in blood pressure. B.) thirst. C.) moist breath sounds. D.) increased breathing effort and weight gain.

Answer: D.) increased breathing effort and weight gain. Rationale: Early signs of hypervolemia are weight gain, elevated blood pressure, and increased breathing effort. Eventually, fluid congestion in the lungs leads to moist breath sounds. One of the earliest symptoms of hypovolemia is thirst.

A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: A.) metabolic acidosis. B.) metabolic alkalosis. C.) respiratory acidosis. D.) respiratory alkalosis.

Answer: D.) respiratory alkalosis.