Med-Surg: Adaptive Quizzing: Chapter 11

A patient has a serum magnesium level of 1.2 mEq/L. Which instruction by the nurse is appropriate?

"Notify me if you have diarrhea"

The nurse is performing discharge dietary teaching for a patient with hyperkalemia. Which statement does the nurse include in the teaching?

"You may eat apples, strawberries, and peaches."

A patient with severe hypokalemia is prescribed parenteral administration of potassium. How does the nurse administer potassium to the patient?

1 mEq of potassium to 10 mL intravenous soluton

Which patient is at greatest risk for hypernatremia?

17-year-old with a serum blood glucose of 189 mg/dL

A patient with hyperkalemia is being treated with drugs to improve the condition. Which potassium level indicates that therapy is effective?

4.6 mEq/L

A patient with mild hypokalemia caused by diuretic use is discharged home. The home health nurse delegates which of these interventions to the home health aide?

Measurement of the patient's urine output

When administering 20 mEq potassium chloride intravenously (IV), which is the priority intervention?

Administer at a rate of 10 mEq/hr. The maximum recommended infusion rate is 5 to 10 mEq/hr to avoid potentially lethal cardiac dysrhythmias. Monitoring for pain at the IV infusion site, assessing respiratory rate and depth, and placing the patient on a heart monitor are all appropriate options, but because a rapid rate of administration could have lethal effects, it has the greatest priority.

Which nursing interventions are consistent with safe administration of intravenous (IV) potassium to a patient with hypokalemia? Select all that apply.

Evaluate the heart rate and regularity. Establish and evaluate the patency of a large vein. Obtain an IV controller device (pump). Plan to assess the respiratory rate and oxygen saturation every hour.

Which laboratory value requires a priority response by the nurse to notify the primary health care provider?

Magnesium 4.2 mEq/L

When planning care for a patient with hypercalcemia, which intervention does the nurse consider?

Monitor cardiac rhythm for changes.

Which foods will the nurse teach a patient with hyperkalemia to avoid? Select all that apply.

Oranges Broccoli Dairy products

The health care provider writes orders for a patient who is admitted with a serum potassium (K) level of 6.9 mEq/L. What does the nurse implement first?

Place the patient on a cardiac monitor.

Which written order does the nurse clarify with the provider when caring for a patient with a serum sodium level of 149 mEq/L?

Place the patient on nothing by mouth (NPO) status. Ensuring adequate water intake is an important nutritional therapy in the treatment of hypernatremia; the nurse should ask for clarification of the NPO order. The other orders are appropriate in the management of patients with hypernatremia.

Which nursing action is recommended when providing care to a patient with hypokalemia?

Question the continued administration of bumetanide. Bumetanide is a loop diuretic, which contributes to potassium loss and should be questioned. The Joint Commission has mandated that all concentrated electrolytes be mixed by a pharmacist and that vials of KCl should not be available in patient care areas. A large vein with high blood flow should be accessed to avoid phlebitis; it is recommended that the hand be avoided. Oral potassium supplements should be given with or following a snack or meal to avoid nausea.

Which fruit will the nurse remove from the dietary tray of a patient with high potassium levels?

kiwi

What is the major cause of death in patients diagnosed with hypokalemia?

respiratory insufficiency

Laboratory results for a patient with a large draining abdominal wound show a serum sodium decrease from 138 mEq/L to 131 mEq/L. What is the nurse's first action?

Assess the patient's respiratory status. Hyponatremia may present with neuromuscular changes including muscle weakness of the legs, arms, and respiratory muscles. The nurse should assess the respiratory effectiveness of a patient with hyponatremia as a priority. Obtaining assessment data is important when calling the provider in addition to reporting the laboratory result. Establishing IV access and assessing for orthostatic hypotension are important but are lower-priority interventions.

Which electrolyte imbalance does the nurse anticipate in association with a serum magnesium reading of 1.1 mEq/L?

Calcium 7.8 Hypocalcemia often occurs with hypomagnesemia. A calcium level of 7.8 mg/dL is low. A sodium level of 149 mEq/L is slightly elevated, but not related to the low magnesium level. A phosphorus level of 2.6 mg/dL is slightly low, but not related to hypomagnesemia. A potassium level of 5.7 is elevated, but not related to low magnesium levels.

A patient's electrocardiogram (ECG) demonstrates a heart rate of 52 beats/minute and prolonged PR interval with widened QRS complex, and the patient is also hypotensive. Which laboratory results are consistent with these findings?

Hyperkalemia, hypercalcemia, hypermagnesemia

The nurse is reviewing lab values for a patient recently admitted to the medical-surgical unit. Which lab result is severely abnormal? Sodium, 137 mEq/L Chloride, 107 mEq/L Potassium, 3.5 mEq/L Magnesium, 6.2 mEq/L

Magnesium, 6.2 mEq/L

The nurse instructs an older adult patient to increase intake of dietary potassium when the patient is prescribed which classification of drugs?

high- ceiling (loop) diuretics

The nurse is caring for a patient who is receiving intravenous (IV) magnesium sulfate. Which assessment parameter is critical?

hourly deep tendon reflexes (DTRs)

A patient is brought to the emergency department with symptoms of diarrhea, chest discomfort, and paresthesia. The patient has a heart rate of 60 beats per minute. The electrocardiogram (ECG) of the patient shows missed P waves, tall T waves, prolonged PR intervals, and wide QRS complexes. Which laboratory finding would be consistent with the patient's condition?

Serum potassium levels above 5.0 mEq/L

Which hormone regulates fluid and electrolyte balance by preventing water and sodium loss?

aldosterone

A patient's morning laboratory results show a serum ionized calcium of 2.85 mmol/L. For what sign must the nurse assess?

blood clotting Hypercalcemia allows blood clots to form more easily, especially in the lower legs and pelvic region. The nurse should assess for signs of blood clotting associated with the elevated serum calcium. Increased peristalsis and muscle spasms are associated with hypocalcemia. Tachycardia can occur initially with mild hypercalcemia, but bradycardia is associated with severe hypercalcemia.

Which drug therapies might be used to manage symptoms of hypocalcemia?

calcium chloride A more in depth explanation has been asked by the professors

Hyponatremia most affects the cells of which body systems? Select all that apply.

cerebral, cardiovascular, neuromuscular

When treating a patient for hyponatremia, which type of drug must be altered to decrease sodium loss?

diuretics

A patient who recently experienced an anterior neck injury reports frequent and painful muscle spasms in the calf during sleep. Which condition does the nurse suspect in the patient?

hypocalcemia

Positive Trousseau's and Chvostek's signs are consistent with which electrolyte imbalance?

hypocalcemia

When assessing the laboratory results of a patient who has hypomagnesemia, for which additional electrolyte imbalance should the nurse monitor?

hypocalcemia

Which electrolyte imbalance should be anticipated and monitored in a patient with hyperphosphatemia?

hypocalcemia

A patient with Crohn's disease reports numbness, tingling, and painful muscle contractions. After assessing the deep tendon reflexes of the patient, which intervention does the nurse perform next?

intravenous administration of magnesium sulfate

The nurse is reviewing lab values for a patient recently admitted to the medical-surgical unit. Which lab result is severely abnormal?

magnesium, 6.2 mEq/L

A patient is admitted to the nursing unit with a diagnosis of hypokalemia. Which assessment does the nurse complete first?

obtaining a pulse oximetry reading

An electrocardiogram (ECG) is ordered for a patient who was placed on intravenous (IV) fluids containing potassium. Which ECG finding is consistent with hyperkalemia?

prolonged PR intervals

A patient is admitted with hypokalemia and skeletal muscle weakness. Which assessment does the nurse perform first?

respirations Respiratory changes are likely because of weakness of the muscles needed for breathing. Skeletal muscle weakness results in shallow respirations. Thus respiratory status should be assessed first in any patient who might have hypokalemia. Blood pressure and pulse will be altered in this patient, but they are not the priority assessment. Temperature is not a priority assessment for the patient with hypokalemia.

Which are common symptoms of hypokalemia? Select all that apply.

shallow respirations; weak, thready pulse; musculoskeletal weakness

Which electrolyte deficiency results in decreased depolarization in the excitable cells and increased cellular swelling?

sodium

Which electrolyte excess results in irritability and severe cellular dehydration?

sodium

A 90-year-old patient with hypermagnesemia is seen in the emergency department (ED). The ED nurse prepares the patient for admission to which inpatient unit?

telemetry/cardiac stepdown

The nurse is planning care for a patient with hypocalcemia. Which nursing action is appropriate to delegate to unlicensed assistive personnel (UAP)?

transferring the patient from the bed to a stretcher using a lift sheet