EAQ 1 - Fluid and Electrolytes

Which electrolyte deficiency triggers the secretion of renin? a. Sodium b. Calcium c. Chloride d. Potassium

a Low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells. Deficiencies of calcium, chloride, and potassium do not stimulate the secretion of renin.

Which hormone regulates blood levels of calcium? a. Parathyroid hormone b. Luteinizing hormone c. Thyroid-stimulating hormone d. Adrenocorticotropic hormone

a PTH regulates the blood levels of calcium and phosphorus. LH stimulates the production of sex hormones, promotes the growth of reproductive organs, and also stimulates reproductive processes. TSH stimulates the release of thyroid hormones and the growth and function of the thyroid gland. ACTH promotes the growth of the adrenal cortex and stimulates the release of corticosteroids.

In which component of the nephron does furosemide decrease fluid reabsorption? Select all that apply. a. Glomerulus b. Loop of Henle c. Distal tubules d. Proximal tubules e. Bowman capsule (BC)

b, c, d Furosemide, known as a "loop diuretic," inhibits sodium and chloride reabsorption from the ascending loop of Henle, proximal tubules, and distal tubules. The glomerulus is the site of glomerular filtration. The BC is the site of the collection of glomerular filtrate and contains the glomerulus.

Which hormonal deficiency causes diabetes insipidus in a client? a. Prolactin b. Thyrotropin c. Luteinizing hormone d. ADH

d ADH deficiency causes diabetes insipidus. Decreased levels of prolactin may cause decreased amounts of milk secretion after birth. Decreased levels of thyrotropin cause hypothyroidism, weight gain, and lethargy. Luteinizing hormone deficiency cause menstrual abnormalities, decreased libido, and breast atrophy.

Which dietary restriction will the nurse expect to be included in the plan for a client with left ventricular failure? a. Sodium b. Calcium c. Potassium d. Magnesium

a Restriction of sodium reduces the amount of water retention, thus reducing cardiac workload. Calcium is restricted in individuals who develop renal calculi. Potassium is not restricted, especially if a diuretic is prescribed, because diuresis facilitates the loss of potassium in the urine. Magnesium is not restricted.

Which action will the nurse take first when caring for a client reporting chest pain, difficulty breathing, and feeling cold twenty minutes after an infusion of packed red blood cells begins? a. Stop the transfusion. b. Notify the HCP. c. Provide several warm blankets. d. Assess vital signs.

a The client is experiencing an anaphylactic reaction and the infusion should be stopped immediately to prevent worsening problems. The vital signs should be assessed because they will need to be provided to the HCP, who should be notified next. Providing blankets is not essential and may be done after essential actions are taken if they are needed.

Which cation regulates intracellular osmolarity? a. Sodium b. Potassium c. Calcium d. Calcitonin

b A decrease in serum potassium causes a decrease in the cell wall pressure gradient and results in water moving out of the cell. Besides intracellular osmolarity regulation, potassium also regulates metabolic activities, transmission and conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction. Sodium is the most abundant extracellular cation that regulates serum osmolarity as well as nerve impulse transmission and acid-base balance. Calcium is an extracellular cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac conduction, transmission of nerve impulses, and muscle contraction. Calcitonin is a hormone secreted by the thyroid gland and works opposite of parathormone to reduce serum calcium and keep calcium in the bones. Calcitonin does not have a direct effect on intracellular osmolarity.

Which action is the function of ADH? a. Reduces blood volume b. Decreases water loss in urine c. Increases urine output d. Initiates the thirst mechanism

b ADH is released by the posterior pituitary gland. It is released mainly in response to either a decrease in blood volume or an increased concentration of sodium or other substances in the plasma. ADH acts to decrease the production of urine by increasing the reabsorption of water by renal tubules. A decrease in ADH would case reduced blood fluid volume; decreased ability of the kidneys to reabsorb water, resulting in increased urine output; and an increase in the thirst mechanism.

Which complication would a nurse try to avoid by slowly administering a parenteral preparation of potassium? a. Metabolic acidosis b. Cardiac arrest c. Seizure activity d. Respiratory depression

b Too rapid an administration can cause hyperkalemia, which contributes to a long refractory period in the cardiac cycle, resulting in cardiac dysrhythmias and arrest. Although acidosis can cause hyperkalemia, hyperkalemia will not lead to acidosis. Hyperkalemia causes muscle flaccidity and weakness, not seizures. Respiratory depression can occur with too rapid IV magnesium administration, not potassium administration.

How would the nurse respond to a client admitted for dehydration who has an IV infusion of NS is started at 125 mL/hr and one hour later begins screaming, "I can't breathe!"? a. Discontinue the IV and notify the HCP. b. Elevate the head of the client's bed and obtain vital signs. c. Assess the client for allergies and change the IV to an intermittent lock. d. Contact the HCP to request a prescription for a sedative.

b Verbalization indicates that the client is breathing; elevating the HOB facilitates breathing by decreasing pressure against the diaphragm. Vital signs reflect the current status of the client. Discontinuing the IV access line is unsafe because IV medications may need to be administered and restarting the IV will cause unnecessary discomfort and expense; more information is needed before calling the HCP. No info is available to support changing the IV to an intermittent lock. Not enough info is available to support requesting a prescription for a sedative; further assessment is required.

Which clinical finding leads the nurse to conclude that an IV has infiltrated rather than caused inflammation? a. Pain b. Coolness c. Localized swelling d. Cessation in flow of solution

b When an IV infiltrates, the IV solution entering the interstitial space is at room temperature (75 F, 23.9 C), whereas body temperature is approximately 98.6 F (37 C); therefore the client's skin will feel cool to the touch at the site of an IV infiltration. The site of an inflammation will feel warm to the touch because of vasodilation and hyperemia. Pain may occur with both an inflammation and an infiltration. The pain of an inflammation is related to the pressure of edema on nerve endings. The pain of an infiltration is related to the IV solution in the interstitial compartment pressing on nerve endings. An increase in interstitial fluid occurs with both an inflammation and an infiltration. With an inflammation there is increased vascular permeability at the site; fluid, proteins, and leukocytes then move from the intravascular compartment into the interstitial compartment. With an infiltration the IV solution enters the interstitial compartment rather than an intravascular compartment. A cessation inflow of solution occurs with both an inflammation and an infiltration. An inflammation in the vein at the insertion site may narrow the lumen of the vessel, interfering with the flow of solution. An infiltration will cause excess fluid in the interstitial compartment to the extent that it will not accommodate more solution, interfering with the flow of solution.

Which hormone aids in regulating intestinal calcium and phosphorous absorption? a. Insulin b. Thyroxine c. Glucocorticoids d. Parathyroid hormone

c Adrenal glucocorticoids aid in regulating intestinal calcium and phosphorous absorption by increasing or decreasing protein metabolism. Insulin acts together with growth hormone to build and maintain healthy bone tissues. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion increases in response to decreased serum calcium concentration and stimulates the bones to promote osteoclastic activity.

Which client problem would the nurse expect to decrease in response to the administration of serum albumin intravenously to a client with ascites? a. Confusion b. Urinary output c. Abdominal girth d. Serum ammonia level

c 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. Confusion will not be impacted. Urinary output therapy will increase blood volume and blood flow to the kidney, thereby increasing urinary output. Albumin therapy has no effect on blood ammonia levels. An increased, not decreased, blood ammonia level causes hepatic encephalopathy.

In which category of fluids would the nurse classify an IV solution of 0.45% NaCl? a. Isotonic b. Isomeric c. Hypotonic d. Hypertonic

c Hypotonic solutions are less concentrated than body fluids. Isotonic solutions are those that cause no change in the cellular volume or pressure because their concentration is equivalent to that of body fluid. Isomeric relates to two compounds that possess the same molecular formula but that differ in their properties or in the position of atoms in the molecules (isomers). Hypertonic solutions contain more than 0.85 g of solute in each 100 mL.

Which action will the nurse take in a client hospitalized for uncontrolled hypertension and chest pain on a daily diuretic for 2 days whose potassium level this morning is 2.7 mEq/L (2.7 mmol/L)? a. Send another blood sample to the lab to retest the serum potassium level. b. Notify the HCP that the potassium level is above normal. c. Notify the HCP that the potassium level is below normal. d. No action is required because the potassium level is within normal limits.

c The HCP should be notified immediately because the client's potassium is below normal. The normal potassium level range is 3.5 mEq/L to 5.0 mEq/L. Clients on diuretic therapy require close monitoring of their electrolytes because some can cause hypokalemia, whereas others spare potassium, which can cause hyperkalemia. Retesting the serum potassium level is unnecessary and will delay the treatment required by the client.

Which gland is affected in aldosteronoma? a. Kidney cortex b. Thyroid gland c. Pituitary gland d. Adrenal cortext

d An aldosteronoma is an aldosterone-secreting adenoma of the adrenal cortex. An aldosteronoma is not a tumor of the kidney cortex. An aldosteronoma is not a tumor of the thyroid gland. An aldosteronoma is not a tumor of the pituitary gland.

At 10:00 AM the nurse hangs a 1000-mL bag of 5% dextrose in water with 20 mEq of potassium chloride to be administered at 80 mL/hr. At noon the HCP prescribes a stat infusion of an IV antibiotic of 100 mL to be administered via piggyback over 1 hour. How much longer than expected will it take the primary bag to empty if the nurse interrupts the primary infusion for infusion of the antibiotic? a. 15 min b. 30 min c. 45 min d. 60 min

d An infusion of 1000 mL at 80 mL should take 12.5 hours. Because the primary infusion is interrupted for an hour while the antibiotic is infused, the primary bag will run an hour longer than if it were running uninterrupted. Minutes that are less than an hour or incorrect calculations.

Which volume of solution would be prepared when the nurse receives an order to prepare a solution for administering a cleansing enema for an adolescent client? a. 150 to 250 mL b. 250 to 350 mL c. 300 to 500 mL d. 500 to 750 mL

d In adolescents, the volume of solution required is 500 to 750 mL. The nurse would prepare 150 to 250 mL of warmed solution for infants. The nurse would prepare 250 to 350 mL of warmed solution for administering a cleansing enema in a toddler. In school-age children, the volume of warmed solution is 300 to 500 mL.

Which blood type must a person have to be a universal recipient? a. A b. B c. O d. AB

d Type AB blood has both A and B antigens on its RBCs and no antibodies against either antigen in their plasma. Clients with type AB blood can receive packed RBCs of any ABO blood type. Blood types A, B, and O are not universal recipients because each has antibodies against another blood type. People with type O blood are called "universal donors."

Place the following nursing actions in the correct order for a client with esophageal varices prescribed a blood transfusion. a. Verify the blood product with another nurse against the client's ID bracelet. b. Establish IV access with IV normal saline. c. Monitor the client's vital signs and status according to agency policy. d. Check the client's vital signs.

d, b, a, c Baseline vital signs should be obtained immediately before administering the blood product for future comparison purposes. Before obtaining the blood, it is important to have IV access because if there is difficulty establishing an IV after blood is obtained, the blood cannot be returned to the blood bank. Two licensed nurses would confirm the verifying data between the client and the blood product. The nurse would remain with and monitor the client's vital signs during the first 15 minutes of administration of the blood product and then follow the institution's protocol to monitor for a transfusion reaction or fluid overload.