Fluid and electrolyte bonus quiz

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

Potassium

What clinical indicators should the nurse expect a client with hyperkalemia to exhibit? Select all that apply. 1. Tetany 2. Seizures 3. Confusion 4. Weakness 5. Dysrhythmias

3. Confusion 4. Weakness 5. Dysrhythmias Tetany is caused by hypocalcemia. Seizures caused by electrolyte imbalances are associated with low calcium or sodium levels. Because of potassium's role in the sodium/potassium pump, hyperkalemia will cause confusion, weakness, and cardiac dysrhythmias.

An older adult client states, "I walk 2 miles [3.2 km] a day for exercise, but now that the weather is hot, I am worried about becoming dehydrated." What should the clinic nurse teach the client? 1. "Drink fruit juices if you start to feel dehydrated" 2. "Thirst is a good guide to use to determine fluid intake" 3. "Fluids should be increased if urine is getting darker" 4. "Water should be consumed when the skin becomes dry"

Fluids should be increased if urine gets darker

The nurse finds that a client with a urinary disorder has very pale-yellow-colored urine. What is the significance of this abnormal finding? 1. It indicates dilute urine 2. It indicates blood in the urine 3. it indicates concentrated urine 4. It indicates presence of myoglobin

It indicates dilute urine Dilute urine tends to appear very pale-yellow in color. Dark-red or brown color urine indicates the presence of blood in the urine. Dark-amber color urine indicates concentrated urine. Red color urine may indicate the presence of myoglobin.

Which electrolyte deficiency triggers the secretion of renin? 1. Sodium 2. Calcium 3. Chloride 4. Potassium

Sodium 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.

A client presents with gastric pain, vomiting, dehydration, weakness, lethargy, and shallow respirations. Laboratory results indicate metabolic alkalosis. The diagnosis of gastric ulcer has been made. What is the primary nursing concern? 1. chronic pain 2. risk for injury 3. electrolyte imbalance 4. inadequate gas exchange

electrolyte imbalance

A client with anorexia nervosa is admitted to the critical care unit following a period of prolonged starvation. What signs or symptoms indicate to the nurse that the client may have hypokalemia? Select all that apply. 1. Muscle weakness 2. Metabolic alkalosis 3. Cardiac dysrhythmias 4. Respiratory rate of 24 or higher 5. Serum potassium of 5.5 mEq/L (5.5 mmol/L)

1. Muscle weakness 3. Cardiac dysrhythmias Potassium is a component of the sodium-potassium pump that is essential for cellular functioning, especially muscle contraction; a deficiency of either potassium or sodium results in weakness. Potassium is important for muscle contraction; the heart is a muscle, and hypokalemia causes dysrhythmias. Decreased functioning of respiratory muscles may result in respiratory acidosis, not metabolic alkalosis. A serum potassium level of 5.5 mEq/L (5.5 mmol/L) is within the upper range of normal. A low respiratory rate, not a rapid one, would be expected because of the weakened respiratory muscles.

A client who experienced extensive burns is receiving intravenous fluids to replace fluid loss. The nurse should monitor for which initial sign of fluid overload? 1. Crackles in the lungs 2. Decreased heart rate 3. Decreased blood pressure 4. Cyanosis

Crackles in the lungs Crackles, or rales, in the lungs are an early sign of pulmonary congestion and edema caused by fluid overload. Clients with fluid overload will usually demonstrate an increased heart rate and increased blood pressure. A decreased heart rate and decreased blood pressure and cyanosis in a client with fluid overload would be very late and fatal signs.

What is the action of vasopressin? 1. Promotes sodium reabsorption 2. Reabsorbs water into the capillaries 3. Promotes tubular secretion of sodium 4. Stimulates bone marrow to make RBC's

Reabsorbs water into the capillaries Vasopressin is also known as an antidiuretic hormone (ADH). It helps in the reabsorption of water into the capillaries. Aldosterone promotes sodium reabsorption. Natriuretic hormones promote tubular secretion of sodium. Erythropoietin stimulates bone marrow to make red blood cells (RBCs).

A client with the diagnosis of Cushing syndrome has the following laboratory results: Na+ (sodium) 149 mEq/L (149 mmol/L); K + (potassium) 3.2 mEq/L (3.2 mmol/L); Hb (hemoglobin) 17 g/dL (170 mmol/L); and glucose 90 mg/dL (5 mmol/L). What should the nurse teach the client? Select all that apply. 1. Avoid foods high in salt 2. restrict your fluid intake 3. eat foods high in potassium 4. limit your carbohydrate intake 5. continue your regular diet as before

1. avoids foods high in salt 3. eat foods high in potassium

A client with Crohn disease is admitted to the hospital with abdominal pain, fever, poor skin turgor, and diarrhea, with 10 stools in the past 24 hours. Which signs are evidence that the client most likely is dehydrated? Select all that apply. 1. Moist skin 2. Sunken eyes 3. decreased apical pulse 4. dry mucous membranes 5. increased blood pressure

2. sunken eyes 4. dry mucous membranes Sunken eyes and loss of skin turgor occur because of decreased intracellular and interstitial fluid associated with dehydration. Dry mucous membranes occur because of decreased intracellular and interstitial fluid associated with dehydration. The skin will be dry, not moist, with dehydration. The first sign of dehydration usually is tachycardia. The blood pressure will decrease, not increase, because of hypovolemia.

The client is receiving high-flow intravenous (IV) fluid replacement therapy. Which nursing assessment findings are consistent with fluid volume overload? Select all that apply. 1. Pulse quality 2. Pulse pressure 3. Bounding pulse 4. Presence of dependent edema 5. Neck vein distention in the upright position

3. Bounding pulse 4. Presence of dependent edema 5. Distended neck veins in the upright position Bounding pulse, presence of dependent edema, and neck vein distention in the upright position are all indicators of fluid overload, which should be reported by the nurse. Pulse quality and pulse pressure are indicators to monitor the client's response to fluid therapy.

A client's laboratory report indicates hyperkalemia. Which responses should the nurse expect the client to exhibit? Select all that apply. 1. Anorexia 2. Vomiting 3. Constipation 4. Muscle weakness 5. Irregular heart rate

2. Vomiting 4. Muscle weakness 5. Irregular heart rate Bouts of nausea and vomiting are common with hyperkalemia. Because of potassium's role in the sodium-potassium pump, an increase in potassium interferes with muscle contractions; it results in muscle weakness and areflexia. An increase in potassium can cause muscle twitching. The heart is a muscle, and hyperkalemia can cause palpitations and cardiac dysrhythmias. On an ECG tracing the T wave will be peaked with hyperkalemia. Anorexia occurs with hypokalemia, not hyperkalemia. Diarrhea, not constipation, occurs with hyperkalemia.

A client with a history of severe diarrhea for the past 3 days is admitted for dehydration. The nurse anticipates that which intravenous (IV) solution will be prescribed initially? 1. 3% sodium chloride 2. 0.9% sodium chloride 3. 5% dextrose and 0.9% sodium chloride 4. 5% dextrose and lactated ringer solution

0.9% sodium chloride An IV solution of 0.9% sodium chloride is the most appropriate initial IV fluid for this client because it is an isotonic solution that will act as a volume expander to quickly replace volume losses and promote physiological stabilization. Three percent sodium chloride is a high-concentration (hypertonic) electrolyte solution; it would only be used in a client with hyponatremia and must be closely monitored during infusion. Five percent dextrose and 0.9% sodium chloride and 5% dextrose and lactated Ringer solution may be appropriate fluids to infuse after 0.9% sodium chloride.

The nurse is choosing the gauge size for a peripheral catheter to administer saline to an infant. What size of gauge would be most appropriate for this nursing priority? 1. 18 gauge 2. 20 gauge 3. 24 gauge 4. 14 gauge

24 gauge A 24-26 gauge size is appropriate for transfusion and administration of saline in an infant. An 18 gauge is the preferred size for surgery for an adult. A 20 gauge size is adequate for all therapies related to an adult client. A 14 gauge is the preferred size for trauma and surgical clients requiring rapid fluid resuscitation in an adult client.

A client who has been taking digoxin for 20 years is hospitalized. The client exhibits signs of dehydration, and laboratory results identify the presence of hypokalemia. The nurse should monitor the client for which clinical finding indicating digoxin toxicity? 1. Constipation 2. Decreased urination 3. Cardiac dysrhythmias 4. Metallic taste in the mouth

Cardiac Dysrhythmias The development of cardiac dysrhythmias is often a sign of digoxin toxicity. Constipation is not a sign of toxicity; gastrointestinal signs and symptoms of toxicity include anorexia, nausea, vomiting, and diarrhea. Decreased urination is not a sign of toxicity. The client will have a decrease in urination because of dehydration. Digoxin does not cause a metallic taste in the mouth.

While caring for a client who sustained a severe head injury in a motor vehicle accident, the nurse observes that the client is constantly passing urine and is dehydrated. What does the nurse suspect as the cause for the client's condition? 1. Decreased secretion of aldosterone 2. Decreased secretion of antidiuretic hormone 3. Decreased secretion of parathyroid hormone 4. Decreased secretion of atrial natriuretic peptide

Decreased secretion of antidiuretic hormone The client sustained a head injury in the accident; therefore the nurse suspects that the cause of constant water loss through urine could be because of decreased antidiuretic hormone. Diabetes insipidus is a complication of traumatic brain injury where the posterior pituitary does not secrete antidiuretic hormone. In the absence of antidiuretic hormone, water is not reabsorbed from the tubules in the nephron and, therefore, gets eliminated as urine. Aldosterone is secreted by the adrenal cortex and mainly controls sodium-potassium levels. Parathyroid hormone helps regulate serum calcium levels in the body and is secreted by the parathyroid glands located in the neck. Atrial natriuretic peptide is secreted by the myocyte cells in the right atrium and work in opposition to aldosterone, causing increased urine output.

Which medication requires the nurse to monitor the client for signs of hyperkalemia? 1. Furosemide 2. Metolazone 3. Spironolactone 4. Hydrochlorothiazide

Spironolactone Spironolactone is a potassium-sparing diuretic; hyperkalemia is an adverse effect. Furosemide, metolazone, and hydrochlorothiazide generally cause hypokalemia.

The client's serum sodium is 123 mEq/L (123 mmol/L). Which prescription should the nurse question? 1. provide pretzels as a snack daily 2, restrict fluid intake to 1000 ml per day 3. assess neurological status every 2 hours 4. administer intravenous fluid of one half normal saline at 125 ml/hr

administer iv fluid of one half normal saline at 125 ml/hr

Following a major abdominal surgery, a client has a nasogastric tube attached to continuous low suction. The nurse caring for the client postoperatively monitors the client for what signs of hypokalemia? Select all that apply. 1. Short term irritability 2. Dysrhythmias 3. Muscle weakness 4. Abdominal cramps 5. Acidosis

1. Short term irritability 2. Dysrhythmias 3. Muscle weakness Dysrhythmias are a sign of potassium depletion in cardiac muscles. Other cardiovascular effects include irregular, rapid, weak pulse; decreased blood pressure; flattened and inverted T waves; prominent U waves; depressed ST segments; peaked P waves; and prolonged QT intervals. Muscle weakness is a symptom of potassium depletion in skeletal muscles; potassium facilitates the conduction of nerve impulses and muscle activity. Neurologic changes from hypokalemia include altered mental status; the patient may have short-term irritability and anxiety followed by lethargy that progresses to acute confusion and coma as hypokalemia worsens.Abdominal cramps, as a result of heightened neuromuscular activity, is a symptom of hyperkalemia. In acidosis (metabolic), over half of the excess hydrogen ions are buffered in the cells. Electroneutrality is sustained partly by the passage of intracellular potassium into the extracellular fluid. Thus, metabolic acidosis results in a plasma potassium concentration that is elevated in relation to total body stores causing hyperkalemia.

A client's laboratory report indicates the presence of hypokalemia. For which clinical manifestations associated with hypokalemia should the nurse assess the client? Select all that apply. 1. Thirst 2. Anorexia 3. Leg cramps 4. Rapid, thread pulse 5. Dry mucous membranes

2. Anorexia 3. Leg cramps The gastrointestinal manifestations associated with hypokalemia are caused by decreased neuromuscular irritability of the gastrointestinal tract; this results in anorexia, nausea, vomiting, and decreased Peristalsis [1] [2]. Because of potassium's role in the sodium-potassium pump, hypokalemia results in altered neuromuscular functioning, which precipitates leg cramps. Thirst is associated with hypernatremia. Rapid, thready pulse is associated with dehydration and hyponatremia. Dry mucous membranes are associated with hypernatremia.

A client is admitted with severe diarrhea that resulted in hypokalemia. The nurse should monitor for what clinical manifestations of the electrolyte deficiency? Select all that apply. 1. Diplopia 2. Skin rash 3. Leg cramps 4. Tachycardia 5. Muscle weakness

3. Leg cramps 5. Muscle weakness Leg cramps occur with hypokalemia because of potassium deficit. Muscle weakness occurs with hypokalemia because of the alteration in the sodium potassium pump mechanism. Diplopia does not indicate an electrolyte deficit. A skin rash does not indicate an electrolyte deficit. Tachycardia is not associated with hypokalemia; bradycardia is.

A child who reports shortness of breath, wheezing, and coughing is found to have pulmonary edema and is prescribed furosemide. Which nursing interventions would be beneficial to the client? Select all that apply. 1. Administering the drug on an empty stomach 2. Checking the child's weight every day 3. Calculating the dose of drug as carefully as possible 4. Exposing the child to sunlight for increasing periods 5. Assessing the child regularly to help prevent electrolyte loss

2. Checking the child's weight every day 3. Calculating the dose of drug as carefully as possible 5. Assessing the child regularly to help prevent electrolyte loss The child's weight should be checked and recorded daily to aid in the assessment of therapeutic and adverse effects. Pediatric doses should be calculated carefully to prevent an accidental overdose. Pediatric clients are at greater risk of electrolyte loss; therefore, they require closer and more cautious assessment to help prevent hypertension and stroke. Furosemide may cause stomach upset if it is taken on an empty stomach; the child should be given the drug with food to help prevent gastric upset. A child taking diuretics should not be exposed to sunlight for long periods because this action may precipitate fluid volume loss and heatstroke.

Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? 1. Providing oxygen 2. Encouraging carbohydrates 3. Administering fluid replacement 4. Teaching facts about dietary principles

Administering fluid replacement As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. Oxygen therapy is not necessarily indicated. Carbohydrates will increase the blood glucose level, which is already high. Although dietary instruction may be appropriate later, such instruction is inappropriate during the crisis.

A nurse is caring for an elderly client with dementia who has developed dehydration as a result of vomiting and diarrhea. Which assessment best reflects the fluid balance of this client?

Blood lab results Blood lab results provide objective data about fluid and electrolyte status, as well as about hemoglobin and hematocrit.

Which component of the client's nephron acts as a receptor site for the antidiuretic hormone and regulates water balance? 1. Collecting Ducts 2. Bowman's Capsule 3. Distal Convoluted tubule 4. Proximal Convoluted tubule

Collecting Ducts The collecting ducts regulate water balance and act as a receptor site for antidiuretic hormone. The Bowman's capsule collects glomerular filtrate and funnels it into the tubule. The distal convoluted tubule acts as a site for additional water and electrolyte reabsorption. The proximal convoluted tubule is the site for reabsorption of sodium, chloride, water, and urea.

The nurse assesses an elderly client with a diagnosis of dehydration and recognizes which finding as an early sign of dehydration? 1. Sunken eyes 2. dry, flaky skin 3. change in mental status 4. decreased bowel sounds

change in mental status

The nurse reviews a medical record and is concerned that the client may develop hyperkalemia. Which disease increases the risk of hyperkalemia? 1. Crohn disease 2. Cushing disease 3. End stage renal disease 4. Gastroesophageal reflux disease

End stage renal disease One of the kidneys' functions is to eliminate potassium from the body; diseases of the kidneys often interfere with this function, and hyperkalemia may develop, necessitating dialysis. Clients with Crohn disease have diarrhea, resulting in potassium loss. Clients with Cushing disease will retain sodium and excrete potassium. Clients with gastroesophageal reflux disease are prone to vomiting that may lead to sodium and chloride loss with minimal loss of potassium.

The nurse cares for a client with bipolar disorder who is receiving drug therapy. The laboratory report reveals that the client's serum sodium level is 132 mEq/L (132 mmol/L). Which drug might have led to this condition? 1. Lithium 2. Bupropion 3. Fluoxetine 4. Nortriptyline

Fluoxetine A serum sodium level of 132mEq/L (132 mmol/L) indicates hyponatremia. Fluoxetine is a serotonin reuptake inhibitor that may lead to hyponatremia. Lithium is a mood stabilizer used to treat bipolar disorder; it does not lead to hyponatremia. Bupropion is an atypical antidepressant that does not cause hyponatremia. Nortriptyline is a tricyclic antidepressant used to treat bipolar disorder that does not lead to hyponatremia.

A client on antidepressant therapy develops hyponatremia. Which drug may be responsible for the client's electrolyte imbalance? 1. Phenelzine 2. Paroxetine 3. Imipramine 4. Amitriptyline

Paroxetine Paroxetine is a selective serotonin reuptake inhibitor; side effects include hyponatremia. Phenelzine is a monoamine oxidase inhibitor; side effects include orthostatic hypotension. Imipramine and amitriptyline are tricyclic antidepressants; side effects associated with these drugs include dry mouth and blurred vision.

A nurse administers an intravenous solution of 0.45% sodium chloride. In what category of fluids does this solution belong? 1. isotonic 2. isomeric 3. hypotonic 4. hypertonic

hypotonic

When monitoring fluids and electrolytes, the nurse recalls that the major cation-regulating intracellular osmolarity is what? 1. Sodium 2. Potassium 3. Calcium 4. Calcitonin

Potassium 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 serum laboratory values in a client with urinary problems may indicate the risk of developing muscle weakness and cardiac arrhythmias? 1. Calcium of 9.5 mg/dL (2.375 mmol/L) 2. Potassium of 7.02 mEq/L (7.02 mmol/L) 3. Bicarbonate of 22.8 mEq/L (22.8 mmol/L) 4. Phosphorus of 4.1 mg/dL (1.3243 mmol/L)

Potassium of 7.02 mEq/L (7.02 mmol/L) The normal level of serum potassium is between 3.5-5.0 mEq/L (3.5 and 5.0 mmol/L). Elevated potassium levels greater than 6 mEq/L (mmol/L) can lead to muscle weakness and cardiac arrhythmias.

A nurse is caring for a client with heart failure. The healthcare provider prescribes a 2-gram sodium diet. What should the nurse include when explaining how a low-salt diet helps achieve a therapeutic outcome? 1. allows excess tissue fluid to be excreted 2. helps to control the vol of food intake and thus weight 3. aids the weakened heart muscle to contract and improves cardiac output 4. assists in reducing potassium accumulation that occurs when sodium intake is high

allows excess tissue fluid to be excreted