Chapter 39

The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?

Sodium

When caring for patients with disorders of sodium balance, the nurse asks the provider which of the following findings are consistent with hypernatremia?

Sodium 158 mEq/L and serum osmolality of 320 mOsm/kg

Of the following clients, which would be at highest risk for developing hyperkalemia?

A male admitted for acute renal failure following a drug overdose

A patient presents to the emergency room with symptoms of generalized muscle weakness, dyspnea, muscle cramps, vomiting, and diarrhea. Based on these symptoms, the nurse anticipates which of the following types of monitoring will be required?

Cardiac monitoring

Which of the following assessments should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L?

Cardiac monitoring looking for prolonged PR interval and flattening of the T wave

When caring for a patient with hyperkalemia, the nurse prioritizes assessment of which of the following body systems?

Cardiovascular

In a person with fluid volume deficit, there is a dehydration of brain and nerve cells. What can occur if fluid volume deficit is corrected too rapidly?

Cerebral edema occurs with potentially severe neurologic impairment.

Which of the following is an anion?

Chloride

A nurse observes peaked, narrow T waves on the electrocardiogram of a patient suffering from renal failure. The nurse suspects that the client is experiencing which of the following conditions?

Hyperkalemia

The nurse is caring for a patient who is 1 day postoperative for a thyroidectomy. The patient complains of tingling of the hands and feet and around his mouth. The nurse suspects these symptoms are a manifestation of which electrolyte disturbance?

Hypocalcemia

A nurse is caring for a patient whose serum potassium level is 2.6 mEq/L. The nurse anticipates which of the following interventions will be prescribed?

IV infusion of 10 mEq potassium chloride in 100-mL normal saline solution over 1 hour times three doses

The edema of venous thrombosis (thrombophlebitis) is related to which of the following?

Increased capillary pressure

A nurse is caring for a patient 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 of the following problems could the patient be diagnosed with?

Syndrome of inappropriate antidiuretic hormone (ADH)

Which of the following best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?

mEq/L

When caring for the client with a hyperkalemia, the nurse recognizes the body should respond in which of these ways?

secrete potassium in the distal tubules for excretion

The nurse is caring for a client with isotonic fluid volume deficit. The nurse would anticipate the client to manifest: Select all that apply.

• Decreased urine output • Hypotension • Tachycardia and weak pulse • Increased hematocrit and BUN

A client is brought to the emergency department semicomatose and a blood glucose reading of 673. He is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29 and HCO3− level 19 mEq/dL; PCO2 level 32 mm Hg. The nurse should anticipate that which of the following orders may correct this diabetic ketosis?

Initiating an insulin IV infusion along with fluid replacement

Which of the following interventions is a priority for the nurse when caring for a patient with hypokalemia?

Initiating cardiac monitoring

A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL. While performing an assessment, the nurse should focus on which of the following clinical manifestations associated with this calcium level?

Intermittent muscle spasms and complaints of numbness around her mouth

Lymph fluid arises directly from which one of the following spaces?

Interstitial

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37. The nurse suspects the client may be experiencing:

Metabolic alkalosis

Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?

Parathyroid hormone

The nurse suspects a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes which of these abnormal laboratory results is consistent with this problem?

Potassium level of 2.8 mEq/L

In isotonic fluid volume deficit, changes in total body water are accompanied by:

Proportionate losses of sodium

When caring for the client with hyponatremia secondary to SIADH, which of these alterations does the nurse anticipate?

decreased serum osmolarity

The nurse teaches the client with hyperparathyroidism he is at risk for which of these?

developing kidney stones

The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as:

9.0 to 10.5 mg/dL

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

0.9% NaCl

Body weight consists of which of the following percentages of body water?

60%

A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the following pathophysiologic processes contributes to this third spacing?

Abnormal increase in transcellular fluid volume

Which of the following combinations of ions are most likely to bind, forming molecules?

Anion and cation

The most reliable method for measuring body water or fluid volume increase is by assessing:

Body weight change

The nurse is caring for a patient who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which of the following best describe this process?

Diffusion

The nurse is caring for a patient with a tumor obstructing the lymphatic system. For which of the following consequences does the nurse assess?

Fluid accumulating in the interstitial spaces distal to the tumor

There are two types of diabetes insipidus (DI): neurogenic and nephrogenic. In nephrogenic DI, there is an inability of the kidney to concentrate urine and to conserve free water. Nephrogenic DI can be either genetic or acquired. What are the causes of nephrogenic DI?

Lithium and hypokalemia

The nurse is administering the medications to a patient on the cardiac unit. Giving which of the following medications causes the nurse to be alert for hypokalemia?

Loop diuretic

When caring for a patient with diabetes insipidus (DI), the nurse plans to evaluate which of the following laboratory studies?

Measurement of antidiuretic hormone (ADH) and plasma/urine osmolality

The nurse is administering a unit of packed red blood cells to a patient and piggybacks the unit of blood through a solution of 0.9% NaCl. Blood cells placed in a solution of 0.9% saline will do which of the following?

Neither shrink nor swell

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:

Osmosis

Pressure generated as water moves across a membrane is also known as which of the following?

Osmotic pressure

A nurse caring for a client with a diagnosis of diabetes insipidus (DI) should prioritize the close monitoring of which of the following electrolyte levels?

Weight gain