Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance

To calculate the H2CO3 content of the blood, the nurse needs to measure the PCO2 (partial pressure of CO2) by its solubility coefficient. What is the solubility coefficient of CO2?

0.03

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 (2.25 mmol/L to 2.63 mmol/L))

A nurse suspects that a client with a plasma magnesium level of 1.2 mg/dL (0.60 mmol/L) may have which condition in his or her history?

Abuse of alcohol

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

Body weight change

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of which chemical component?

HCO3-

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:

HCO3−

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

Hyperkalemia

Lymph fluid arises directly from which space?

Interstitial

When caring for a client with diabetes insipidus (DI), the nurse plans to evaluate which laboratory study?

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

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

The nurse who is providing care for several clients recognizes which client is at the highest risk for developing an acid-base imbalance?

A client who is being treated for acute kidney injury and who requires dialysis

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

A male admitted for acute renal failure following a drug overdose

The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation?

A pH moves toward the normal range.

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 pathophysiologic process contributes to this third spacing?

Abnormal increase in transcellular fluid volume

A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance?

Administering an antiemetic to treat the client's frequent vomiting

The nurse is caring for a client who has developed hypoxemia and tissue hypoxia. Which of these interventions does the nurse set as a priority intervention?

Administration of supplemental oxygen

A newly admitted client's diagnostic testing indicates metabolic acidosis. What action should the nurse take when working to determine the cause?

Assess the client's blood glucose levels

The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following?

CO2

The nurse caring for a client with respiratory acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory acidosis is improving?

CO2 has decreased

When caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?

Cardiac

When caring for a client with hyperkalemia, the nurse prioritizes assessment of which body system?

Cardiovascular

Which of the following is an anion?

Chloride

The nurse caring for the client with respiratory alkalosis and renal compensation determines that which diagnostic finding is consistent with this disorder?

Decreased PCO2 and HCO3, and increased pH

A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect?

Decreased pH below 7.35

The nurse is caring for a client who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which function best describes this process?

Diffusion

What assessment would a nurse expect when caring for a client with respiratory alkalosis? Select all that apply.

Dyspnea with short periods of apnea Palpitations Decreased urine acidity

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

A nurse is caring for a client with hypoparathyroidism. Which imbalance is a major concern for the client?

Hypocalcemia

The nurse is caring for a client who is 1 day postoperative for a thyroidectomy. The client 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 community health nurse who is attending a marathon recognizes that which types of hypotonic hyponatremia is likely when a client reports muscle weakness, cramping, and general fatigue in spite of adequate water hydration during the run?

Hypovolemic

A nurse is caring for a client whose serum potassium level is 2.6 mEq/L (2.6 mmol/L). The nurse anticipates which intervention will be prescribed?

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

The nurse is caring for a client with acute primary respiratory acidosis. When determining the cause of the acidosis the nurse is aware that which imbalance is most common?

Impaired alveolar ventilation

The nurse is caring for a client with ketoacidosis who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which phenomenon is most likely occurring?

In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.

During the assessment of a client with heart failure, the nurse uses finger pressure to determine if edema is present in the lower extremities. When would the nurse document pitting edema?

Indentation remains after the finger has been removed.

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; HCO3− level 19 mEq/dL (19 mmol/L); PCO2 level 32 mm Hg. The nurse should anticipate that which order may correct this diabetic ketosis?

Initiating an insulin IV infusion along with fluid replacement

A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL (1.98 mmol/L). While performing an assessment, the nurse should focus on which clinical manifestation associated with this calcium level?

Intermittent muscle spasms and reports of numbness around her mouth

The nurse is performing an assessment for a client who is experiencing shortness of breath. The nurse notes a full and bounding pulse, crackles in the lung fields, and jugular vein distention. The nurse recognizes symptoms of which problem?

Isotonic fluid volume excess

A client has been ill for several days and has not had anything to eat, consuming only about 6 oz of water per day. The client has been vomiting and having diarrhea. Which condition is the nurse most concerned about the client developing?

Ketoacidosis

A child accidentally consumes a container of wood alcohol. The ED physician knows that the child is at risk of developing which of the following?

Metabolic acidosis

The nurse is caring for a client who has excessive diarrhea. Which acid-base disturbance does the nurse anticipate uncovering during evaluation of the arterial blood gas?

Metabolic acidosis

The nurse is caring for a client with renal failure experiencing shortness of breath and increased respiratory rate. The arterial blood gas reflects a pH of 7.10 and HCO3 level of 18 mEq/L (18 mmol/L). How does the nurse interpret these findings?

Metabolic acidosis

A client's arterial blood gases indicate normal oxygen levels but increased carbon dioxide levels. The client's vital signs are within normal range except for respiratory rate of 12 breaths/min. While not evident from assessment and diagnostics, the client's kidneys are minimizing both H+ excretion and HCO3- reabsorption. What is this client's most likely diagnosis?

Metabolic alkalosis

The nurse is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for:

Muscle weakness

The nurse is administering a unit of packed red blood cells to a client 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

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

Osmotic pressure

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 is reviewing lab results of a client diagnosed with metabolic acidosis. The most important electrolyte for the nurse to assess would be:

Potassium (K+)

The nurse caring for a bedridden client who has sacral edema plans care to prevent risk from what type of injury?

Pressure ulcers

The nurse is teaching an older adult about adapting to age-related physiologic changes. Which instruction would be inappropriate to teach?

Reduce daily fluid intake.

A client arrives in the emergency department by ambulance with a family member stating, "He took an overdose of sleeping pills and I found him breathing very shallowly." For which type of acid-base disturbance will the nurse anticipate this client will be treated?

Respiratory acidosis

The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes that these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level, are consistent with which diagnosis?

Respiratory acidosis

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

Sodium

When caring for clients with disorders of sodium balance, the nurse know that which finding is consistent with hypernatremia?

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

The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?

Sodium bicarbonate

The nurse is caring for a client with a serum sodium level of 128 mEq/L (128 mmol/L). Which physiologic event is an expected result of this blood value?

Swelling of cells

Which clinical manifestation would lead the nurse to suspect a client has developed fluid volume excess?

Weight gain

A client is admitted to the hospital with fluid volume deficit. The nurse should be aware that compensatory mechanisms will include:

activation of the renin-angiotensin-aldosterone system (RAAS).

A client with a long history of alcohol abuse has been admitted to the emergency department after several of days of heavy drinking. The nurse can best promote the restoration of the client's acid-base balance by:

administering intravenous sodium bicarbonate as prescribed.

As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:

bicarbonate/carbonic acid regulation.

A client who is postoperative day 1 following a total thyroidectomy is reporting "twitchy" muscles and tingling in his fingertips and around his lips. The nurse's assessment reveals a positive Chvostek sign. The nurse should:

prepare to administer IV calcium gluconate, as ordered.

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

proportionate losses of sodium.

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

secrete potassium in the distal tubules for excretion

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

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.

A 26-year-old female with anxiety who has been hyperventilating

The nurse is assessing a client with abnormal blood gas values. Which of these interpretations does the nurse make regarding the client's physiologic status?

The client has abnormalities in his buffer system.

When caring for a client with bipolar disorder who takes lithium, the nurse observes an excess of clear, unconcentrated urine output in a 24-hour period of time as well as an intake of 3L of fluid in the same time frame. Which of these does the nurse recognize is consistent with side effects of this medication?

The client is exhibiting characteristic signs of nephrogenic diabetes insipidus.

A child has been admitted to the emergency department after consuming ethylene glycol in the form of antifreeze. The nurse should prioritize which goal when planning the client's care?

The client will remain free from the effects of metabolic acidosis.

A client presents with signs and symptoms consistent with chronic acidemia. The nurse should prioritize what assessments when addressing the root cause of the client's health problem?

The client's renal function

A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond?

Lactic acidosis

Hypothalamic sensory neurons that promote thirst when stimulated are called:

Osmoreceptors

The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl, a phosphate binder, with meals. How does the nurse explain the rationale for the timing of this medication?

"The medication should be taken at meal time to allow the binding of phosphate."

Which clients are at risk for developing metabolic alkalosis? Select all that apply.

A client with chronic kidney disease taking calcium carbonate A client with gastric suction for a bowel obstruction A client with heart failure receiving furosemide

In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance?

A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg

Which individuals would be considered to be at risk for the development of edema? Select all that apply.

A client with right-sided heart failure and hypothyroidism A client who has suffered extensive burns in a job-related accident A client with hypoalbuminemia secondary to malnutrition and anorexia nervosa

A client with ethylene glycol toxicity is restless, and stating he has flank pain. What intervention should the nurse perform to minimize complications?

Increase IV fluids

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate?

Mechanical ventilation

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

mEq/L