Nsg1 Wk.3 Prep U Ch.4 (Flash Cards Exam-1)

A patient with a diagnosis of thyroid cancer is postoperative day 1 following a total thyroidectomy in which her parathyroid gland was also removed. When assessing for related electrolyte imbalances, what question should the nurse ask the patient? "Are you feeling any tingling in your hands or around your mouth?" "How thirsty are you feeling right now?" "Do you feel like you're having heart palpitations where your heart feels like it skips a beat?" "How would you rate your energy level right now?"

"Are you feeling any tingling in your hands or around your mouth?" Explanation: Removal of the parathyroid can precipitate hypocalcemia, which often results in tetany. Arrhythmias, increased thirst, and fatigue are not common assessment findings associated with low serum calcium.

The nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricted diet. Which statement by the client indicates the need for additional instruction? "I need to check to see whether my cola beverage has potassium in it." "Bananas have a lot of potassium in them; I'll stop buying them." "I'll drink cranberry juice with my breakfast instead of coffee." "I will not salt my food; instead I'll use salt substitute."

"I will not salt my food; instead I'll use salt substitute." Explanation: The client should avoid salt substitutes. The nurse must caution clients to use salt substitutes sparingly if they are taking other supplementary forms of potassium or potassium-conserving diuretics. Potassium-rich foods to be avoided include many fruits and vegetables, legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, and cocoa. Conversely, foods with minimal potassium content include butter, margarine, cranberry juice or sauce, ginger ale, gumdrops or jellybeans, hard candy, root beer, sugar, and honey. Labels of cola beverages must be checked carefully because some are high in potassium and some are not.

Which solution is hypotonic? 0.9% NaCl 0.45% NaCl 5% NaCl Lactated Ringer solution

0.45% NaCl Explanation: Half-strength saline is hypotonic. Lactated Ringer solution and normal saline (0.9% NaCl) are isotonic. A 5% NaCl solution is hypertonic.

A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client? 165 mEq/L 110 mEq/L 145 mEq/L 130 mEq/L

165 mEq/L Explanation: The normal sodium level is 135- 145 mEq/L (135-145 mmol/L). In hypernatremia, the serum sodium level exceeds 145 mEq/L (145 mmol/L) and the serum osmolality exceeds 300 mOsm/kg (300 mmol/L). The urine specific gravity and urine osmolality are increased as the kidneys attempt to conserve water (provided the water loss is from a route other than the kidneys). Body temperature may increase mildly, but it returns to normal after the hypernatremia is corrected.

A patient is admitted with severe vomiting for 24 hours as well as weakness and "feeling exhausted." The nurse observes flat T waves and ST-segment depression on the electrocardiogram. Which potassium level does the nurse observe when the laboratory studies are complete? 2.5 mEq/L 5.5 mEq/L 4.5 mEq/L 3.5 mEq/L

2.5 mEq/L Explanation: Symptoms of hypokalemia (<3.0 mEq/L) include fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, paresthesias, leg cramps, hypotension, ileus, abdominal distention, and hypoactive reflexes. Electrocardiogram findings associated with hypokalemia include flattened T waves, prominent U waves, ST depression, and prolonged PR interval.

As part of a large hospital's IV team, two nurses are responsible for inserting peripherally inserted central catheters (PICCs) at the bedside for patients who require this form of venous access. Which of the following patients would most likely require a PICC? An elderly man who has been admitted from the community with a fluid volume deficit A woman who has just been ordered total parenteral nutrition (TPN) A woman who recently suffered a pelvic fracture in a motor vehicle accident A man whose hypocalcemia requires a stat infusion of calcium gluconate

A woman who has just been ordered total parenteral nutrition (TPN) Explanation: Parenteral nutrition is a common indication for the use of a PICC. The other patients' needs are more likely to be met with a peripheral IV, although a PICC is not contraindicated.

A client with excess fluid volume and hyponatremia is in a comatose state. What are the nursing considerations concerning fluid replacement? Administer small volumes of a hypertonic solution. Restrict fluids and salt for 24 hours. Monitor the serum sodium for changes hourly. Correct the sodium deficit rapidly with salt.

Administer small volumes of a hypertonic solution. Explanation: In clients with normal or excess fluid volume, hyponatremia is usually treated effectively by restricting fluid with clients who are not neurologically impaired. When the serum sodium concentration is overcorrected (exceeding 140 mEq/L) too rapidly or in the presence of hypoxia or anoxia, the client can develop neurological symptoms. However, if neurologic symptoms are severe (e.g., seizures, delirium, coma), or if the client has traumatic brain injury, it may be necessary to administer small volumes of a hypertonic sodium solution with the goal of alleviating cerebral edema. Incorrect use of these fluids is extremely dangerous, because 1 L of 3% sodium chloride solution contains 513 mEq (mmol/L) of sodium and 1 L of 5% sodium chloride solution contains 855 mEq (mmol/L) of sodium. The recommendation for hypertonic saline administration in clients with craniocerebral trauma is between 0.10 to 1.0 mL of 3% saline per kilogram of body weight per hour.

The nurse is caring for a patient with a metabolic acidosis (pH 7.25). Which of the following values is useful to the nurse in determining whether the cause of the acidosis is due to acid gain or to bicarbonate loss? Bicarbonate level Serum sodium level PaCO2 Anion gap

Anion gap Explanation: Metabolic acidosis is a common clinical disturbance characterized by a low pH (increased H+concentration) and a low plasma bicarbonate concentration. It can be produced by a gain of hydrogen ion or a loss of bicarbonate. It can be divided clinically into two forms, according to the values of the serum anion gap: high anion gap acidosis and normal anion gap acidosis. A patient diagnosed with metabolic acidosis is determined to have normal anion gap metabolic acidosis if the anion gap is within this normal range. An anion gap greater than 16 mEq (16 mmol/L) (the normal value for an anion gap is 8-12 mEq/L (8-12 mmol/L) without potassium in the equation. If potassium is included in the equation, the normal value for the anion gap is 12-16 mEq/L (12-16 mmol/L) and suggests an excessive accumulation of unmeasured anions and would indicate high anion gap metabolic acidosis as the type. An anion gap occurs because not all electrolytes are measured. More anions are left unmeasured than cations. A low or negative anion gap may be attributed to hypoproteinemia. Disorders that cause a decreased or negative anion gap are less common compared to those related to an increased or high anion gap.

The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? PO2 PaO2 Bicarbonate Carbonic acid

Bicarbonate Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. PaO2and PO2 are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG.

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? Bicarbonate PaO2 Carbonic acid PO2

Bicarbonate Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. PaO2and PO2 are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG.

A nurse who provides care on the oncology unit of the hospital is aware of the high incidence of hypercalcemia among patient with cancer. What factors contribute to this fact? Select all that apply. Bone demineralization Secretion of parathyroid hormone (PTH)-related protein by tumors Use of chemotherapeutic agents Use of artificial nutrition and hydration Consequences of immobility

Bone demineralization Secretion of parathyroid hormone (PTH)-related protein by tumors Consequences of immobility Explanation: Hypercalcemia in patients with advanced cancer is associated with increased osteoclast activity resulting in bone demineralization and/or tumor-produced factors that affect bone resorption and/or tubular calcium reabsorption. Tumor cells can secrete PTH-related protein resulting in increased serum calcium. Bone mineral is also lost during immobilization, and sometimes this causes elevation of total (and especially ionized) calcium in the bloodstream. Artificial nutrition and chemotherapy are not noted to contribute to elevated calcium levels.

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? Confusion and seizures Flaccidity and thirst Tetany and increased blood urea nitrogen (BUN) levels Sunken eyeballs and spasticity

Confusion and seizures Explanation: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? Confusion and seizures Sunken eyeballs and spasticity Flaccidity and thirst Tetany and increased blood urea nitrogen (BUN) levels

Confusion and seizures Explanation: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? Sunken eyeballs and spasticity Flaccidity and thirst Tetany and increased blood urea nitrogen (BUN) levels Confusion and seizures

Confusion and seizures Explanation: Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.

Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply. Bradycardia Crackles in the lung fields Distended neck veins Shortness of breath Decreased blood pressure

Distended neck veins Crackles in the lung fields Shortness of breath Explanation: Clinical manifestations of FVE (hypervolemia) include distended neck veins, crackles in the lung fields, shortness of breath, increased blood pressure, and tachycardia.

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration? Low urine specific gravity Elevated hematocrit level Abnormal potassium level Low white blood count

Elevated hematocrit level Explanation: When hemoconcentration occurs due to a hypovolemic state, a high ratio of blood components in relation to watery plasma occurs, thus causing an elevated hematocrit level. A high white blood cell count and urine specific gravity is also noted. Other causes of an abnormal potassium level may be present.

A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for: Dehydration. Hyponatremia. Acidosis. Hyperglycemia.

Explanation: Decreased serum sodium is a factor associated with decreased serum osmolality. Dehydration and hyperglycemia are associated with increased serum osmolality; acidosis is associated with increased urine osmolality.

A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following? Altered blood urea nitrogen (BUN) value Respiratory acidosis Metabolic alkalosis Extracellular fluid volume deficit

Extracellular fluid volume deficit Explanation: Fluid volume deficit (FVD) occurs when the loss extracellular fluid (ECF) volume exceeds the intake of fluid. FVD results from loss of body fluids and occurs more rapidly when coupled with decreased fluid intake. A cause of this loss is hemorrhage.

The nurse is conducting a lecture on the difference between hypovolemia and dehydration. When completing a verbal comparison, which point needs clarified? Hypovolemia contains only low blood volume. In dehydration, only extracellular is depleted. Similar causes are present in both conditions. Both conditions result in abnormal laboratory studies.

In dehydration, only extracellular is depleted. Explanation: In clients diagnosed with dehydration, all fluid compartments including the intracellular and extracellular compartment are reduced. The other options are correct. Both states can be from similar disease process such as vomiting, fever, diarrhea and difficulty swallowing and also have abnormal lab work. It is correct that hypovolemia relates to low blood volume.

A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action? Tetanic contractions Polyuria Weight loss Jugular vein distention

Jugular vein distention Explanation: Jugular vein distention requires further action because this finding signals vascular fluid overload. Tetanic contractions aren't associated with this disorder, but weight gain and fluid retention from oliguria are. Polyuria is associated with diabetes insipidus, which occurs with inadequate production of antidiuretic hormone.

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? 10% dextrose in water 5% dextrose and normal saline solution Lactated Ringer's solution Half-normal saline solution

Lactated Ringer's solution Explanation: Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L, is isotonic. The nurse shouldn't give half-normal saline solution because it's hypotonic, with an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L) also would be incorrect because these solutions are hypertonic.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? Headache or blurry vision Hallucinations or tinnitus Abdominal pain or diarrhea Light-headedness or paresthesia

Light-headedness or paresthesia Explanation: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Headache, blurry vision, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? Light-headedness or paresthesia Hallucinations or tinnitus Abdominal pain or diarrhea Headache or blurry vision

Light-headedness or paresthesia Explanation: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Headache, blurry vision, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? Heart and lungs Lungs and kidney Kidney and liver Pancreas and stomach

Lungs and kidney Explanation: The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis

Metabolic acidosis Explanation: The client is at risk for developing metabolic acidosis. Metabolic acidosis is caused by diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate).

A 43-year-old patient with a history of alcohol abuse has been admitted to an acute medical unit with complications resulting from liver failure. Upon assessment, the patient's abdomen is distended, firm to touch, and nontender. The nurse recognizes that the patient has excess fluid in his peritoneal space (ascites), a problem that results from the disruption of normal movement of water and electrolytes. What process is primarily responsible for maintaining fluid balance along a concentration gradient? Osmosis Hydrostatic pressure Active transport Filtration

Osmosis Explanation: The movement of water caused by a concentration gradient is known as osmosis. A lack of albumin, as in cases of liver failure, results in a disruption in osmotic function. Filtration is a result of hydrostatic pressure, and hydrostatic pressure itself is not a result of a concentration gradient. Active transport implies that energy must be expended for the movement to occur against a concentration gradient.

Which electrolyte is a major cation in body fluid? Phosphate Bicarbonate Potassium Chloride

Potassium Explanation: Potassium is a major cation that affects cardiac muscle functioning. Chloride, bicarbonate, and phosphate are anions.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? Pulse Temperature Respirations Blood pressure

Pulse Explanation: An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also may delay assessing respirations and temperature because these aren't affected by the serum potassium level.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? Respirations Temperature Blood pressure Pulse

Pulse Explanation: An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also may delay assessing respirations and temperature because these aren't affected by the serum potassium level.

A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Explanation: Respiratory acidosis is always from inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations. Respiratory acidosis can occur in diseases that impair respiratory muscles such as myasthenia gravis.

A patient with a history of poorly controlled type 1 diabetes has begun displaying the characteristic signs and symptoms of diabetic nephropathy. The patient's nurse recognizes that the patient is at risk of disruptions to fluid balance. What role do the kidneys play in the maintenance of normal fluid balance? Maintaining the correct concentration of H+ ions in the blood Secreting or withholding antidiuretic hormone in response to extracellular fluid volume Synthesizing and releasing angiotensin in cases of fluid volume deficit Selectively retaining needed substances and excreting waste products

Selectively retaining needed substances and excreting waste products Explanation: Major functions of the kidneys in maintaining normal fluid balance include regulation of extracellular fluid (ECF) volume and osmolality by selective retention and excretion of body fluids and regulation of electrolyte levels in the ECF by selective retention of needed substances and excretion of unneeded substances. Antidiuretic hormone (ADH) is secreted by the pituitary gland, and angiotensin is ultimately derived from the liver, not the kidneys. Concentration of H+ ions contributes the buffer action of the kidneys, not the maintenance of fluid balance.

An elderly patient has developed Clostridium difficile-related diarrhea and been subsequently diagnosed with fluid volume deficit (FVD). The nurse providing care for this patient should anticipate: A decreased level of blood urea nitrogen (BUN) The administration of a hypertonic IV solution The administration of hypotonic or isotonic IV solution An increased level of serum potassium

The administration of hypotonic or isotonic IV solution Explanation: FVD necessitates the administration of isotonic IV solutions (in hypotensive patients) or hypotonic solutions (in normotensive patients). FVD is associated with increased levels of BUN and hypokalemia, especially in patients whose losses are due to vomiting or diarrhea.

As the ICU nurse caring for a patient with multiple trauma from an ATV accident you draw arterial blood gases (ABGs) every 4 hours. What are you primarily assessing in this patient with the ABGs? The patient's electrolyte balance The patient's intracellular buffer systems The bicarbonate-carbonic acid buffer system The patient's fluid balance

The bicarbonate-carbonic acid buffer system Explanation: The body's major extracellular buffer system is the bicarbonate-carbonic acid buffer system, which is assessed when arterial blood gases are measured. ABGs do not assess intracellular buffer systems, electrolyte status, or fluid balance.

A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance? respiratory acidosis metabolic alkalosis respiratory alkalosis metabolic acidosis

metabolic alkalosis Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The client's regular use of baking soda (sodium bicarbonate) may create a risk for this condition. Metabolic acidosis refers to decreased plasma pH because of increased organic acids (acids other than carbonic acid) or decreased bicarbonate. Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary with expired air.

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: constipation. muscle weakness. tremors. diaphoresis.

muscle weakness. Explanation: Muscle weakness; bradycardia; nausea; diarrhea; and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

Oncotic pressure refers to the number of dissolved particles contained in a unit of fluid. excretion of substances such as glucose through increased urine output. osmotic pressure exerted by proteins. amount of pressure needed to stop the flow of water by osmosis.

osmotic pressure exerted by proteins. Explanation: Oncotic pressure is a pulling pressure exerted by proteins such as albumin. Osmolality refers to the number of dissolved particles contained in a unit of fluid. Osmotic diuresis occurs when urine output increases as a result of excretion of substances such as glucose. Osmotic pressure is the amount of pressure needed to stop the flow of water by osmosis.

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. PaCO2 HCO3 Glucose pH K+ Na+

pH PaCO2 HCO3 Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate (HCO3). The two types of acid-base imbalances are acidosis and alkalosis.

A nurse is monitoring a client being evaluated who has a potassium level of 7 mEq/L (mmol/L). Which electrocardiogram changes will the client display? elevated ST segment shortened PR interval prolonged T waves peaked T waves

peaked T waves Explanation: The earliest changes occur when the serum potassium level is 7 mEq/L (mmol/L). Cardiac tracings include peaked and narrow T waves, ST segment depression, and a shortened QT interval.

A nurse is monitoring a client being evaluated who has a potassium level of 7 mEq/L (mmol/L). Which electrocardiogram changes will the client display? shortened PR interval peaked T waves elevated ST segment prolonged T waves

peaked T waves Explanation: The earliest changes occur when the serum potassium level is 7 mEq/L (mmol/L). Cardiac tracings include peaked and narrow T waves, ST segment depression, and a shortened QT interval.