F&E HESI Exit Practice

An older client comes to the emergency department after three days of diarrhea and is admitted to the hospital for rehydration therapy. In addition to sodium, what electrolyte should the nurse be concerned about most when the client's laboratory results are documented? 1 Calcium 2 Chlorides 3 Potassium 4 Phosphates

3 Potassium Potassium, sodium, and bicarbonate are the electrolytes most often lost with diarrhea. With diarrhea, these electrolytes are excreted via the gastrointestinal tract before they can be absorbed. Hypokalemia can cause cardiac dysrhythmias. Serum calcium levels are related to parathyroid function and calcium metabolism. Although the chloride level may be affected by diarrhea, it is not the greatest concern. Phosphate levels are regulated by calcium metabolism and parathormone. Diarrhea = loss of P, Na, and bicarb

A nurse is assessing a client with diabetes insipidus. Which signs indicative of diabetes insipidus should the nurse identify when assessing the client? Select all that apply. 1 Excessive thirst 2 Increased blood glucose 3 Dry mucous membranes 4 Increased blood pressure 5 Decreased serum osmolarity 6 Decreased urine specific gravity

1 Excessive thirst 3 Dry mucous membranes 6 Decreased urine specific gravity As excessive fluid is lost through urination, dehydration triggers the thirst response. As excessive fluid is lost through urination, dehydration occurs, resulting in dry mucous membranes and poor skin turgor. Because water is not being reabsorbed, urine is dilute, resulting in a low specific gravity (less than 1.005). Diabetes insipidus is not a disorder of glucose metabolism; blood glucose levels are not affected. Diabetes mellitus affects glucose metabolism. Loss of fluid may decrease the blood pressure because fluid is lost from the intravascular compartment. As fluid is lost from the intravascular compartment, serum osmolarity increases, not decreases. Dilute urine = low specific gravity Concentrated urine = high specific gravity

Nasogastric (NG) tube irrigations are prescribed for a client after abdominal surgery. The nurse instills 30 mL of saline solution, and 10 mL is returned. How should the nurse proceed? 1 Record 20 mL as intake 2 Increase the amount of suction 3 Reposition the NG tube 4 Irrigate the NG tube more frequently

1 Record 20 mL as intake This 20 mL must be accounted for in the intake and output, either by including it as intake or by subtracting it from the total gastric drainage. High suction may lead to adherence of mucosa to the tube and potential injury. Repositioning the nasogastric tube is unnecessary. Return of 10 mL indicates patency; more frequent irrigations are not indicated.

The nurse is caring for a client after the client's open heart surgery (coronary artery bypass grafting [CABG]). Serosanguineous fluid drains from the client's chest tube. The nurse expects what volume of drainage from the tube during the first 24 hours after the surgery? 1 100 to 300 mL 2 400 to 500 mL 3 750 to 900 mL 4 800 to 1000 mL

2 400 to 500 mL During the first 24 hours after CABG surgery, 500 mL of fluid will accumulate in the intrapleural space because of trauma and the inflammatory response; gradually, this amount will decrease. Between 100 and 300 mL is less than the expected amount of drainage from the chest tube during the first 24 hours after open heart surgery. A volume of 750 mL or more is an excessive amount of drainage from the chest tube during the first 24 hours after open heart surgery; this amount may indicate a complication.

An 11-month-old is admitted with dehydration and a serum sodium level of 120 mEq/L (120 mmol/L). Reporting of which assessment finding to the healthcare provider is a priority? 1 Weight loss of 1.5 kg in 3 days 2 Muscle twitching in all extremities 3 Temperature increase to 100° F (37.8° C) 4 Heart rate increasing from 100 to 120 beats/min

2 Muscle twitching in all extremities The normal sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). A priority symptom of hyponatremia (less than 135 mEq/L (135 mmol/L)) is seizure activity, which may manifest early on as muscle twitching. Although a client may exhibit an increase in temperature or heart rate or a loss of weight as a result of dehydration, none of these is the priority assessment finding. severe hyponatremia => seizure activity

Which laboratory value may indicate hyperfunction of the adrenal gland in a client? 1 Sodium: 143 mEq/L 2 Potassium: 2.9 mEq/L 3 Bicarbonate: 25 mEq/L 4 Total calcium: 10 mg/dL

2 Potassium: 2.9 mEq/L The normal level of potassium is 3.5 to 5.0 mEq/L. The laboratory value of the potassium in the client is 2.9 mEq/L, which is below the normal level. Therefore, it may indicate the presence of adrenal gland hyperfunction in the client. The normal value of sodium is 136 to 145 mEq/L, bicarbonate is 23 to 30 mEq/L, and total calcium is 9 to 10.5 mg/dL. Thus, the laboratory values of sodium (143 mEq/L), bicarbonate (25 mEq/L), and total calcium (10 mg/dL) lie in the normal range, which does not indicate hyperfunction of the adrenal gland in the client.

A client with addisonian crisis exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies. Which responses should the nurse expect the client to exhibit? Select all that apply. 1 Bradycardia 2 Hypertension 3 Hyperkalemia 4 Hyponatremia 5 Postural hypotension

3 Hyperkalemia 4 Hyponatremia 5 Postural hypotension In the presence of hyponatremia, hyperkalemia results. Hyponatremia occurs because of glucocorticoid and mineralocorticoid insufficiency. Hypotension accompanies glucocorticoid and mineralocorticoid insufficiency. Tachycardia, not bradycardia, occurs as a result of severe hypovolemia. Hypotension, not hypertension, occurs because of sodium and water losses that accompany glucocorticoid and mineralocorticoid insufficiency.

For what clinical indicator should a nurse assess a client who is having a gastric lavage? 1 Decreased serum pH 2 Increased serum oxygen level 3 Increased serum bicarbonate level 4 Decreased serum osmotic pressure

3 Increased serum bicarbonate level Gastric lavage causes an excessive loss of gastric fluid, resulting in excessive loss of hydrochloric acid (HCl), which can lead to alkalosis; the HCl is not available to neutralize the sodium bicarbonate (NaHCO3) secreted into the duodenum by the pancreas. The intestinal tract absorbs the excess bicarbonate, and alkalosis results. Gastric lavage will lead to alkalosis, which is associated with increased pH. Gastric lavage will not affect oxygen levels. Gastric lavage may lead to dehydration, which will increase osmotic pressure. HCl gone -> excess bicarb -> bicarb absorbed -> alkalosis/increased pH

Which complications does the nurse expect in the client with a renal disorder who has a blood urea nitrogen (BUN)/creatinine ratio of 28? Select all that apply. 1 Malnutrition 2 Hepatic damage 3 Kidney impairment 4 Fluid volume deficit 5 Obstructive uropathy

4 Fluid volume deficit 5 Obstructive uropathy The normal range of blood urea nitrogen (BUN)/creatinine ratio is 6 to 25. The BUN/creatinine ratio of 28 is a higher value than the normal; the client may have complications like fluid volume deficit and obstructive uropathy. A decrease in BUN levels indicates malnutrition and severe hepatic damage. Increased serum creatinine levels indicate kidney impairment.