Prepu - Chapter 13: Fluid and Electrolytes: Balance and Disturbance

Which is considered an isotonic solution? 3% NaCl 0.45% normal saline 0.9% normal saline Dextran in normal saline

0.9% normal saline

The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume?

-An elevated hematocrit level -electrolyte imbalance

The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? 1250 ml 1500 ml 500 ml 1 L

1 L

A client has chronic hyponatremia, which requires weekly laboratory monitoring to prevent the client lapsing into convulsions or a coma. What is the level of serum sodium at which a client can experience these side effects? 148 mEq/L 114 mEq/L 130 mEq/L 135 mEq/L

114 mEq/L

At which serum sodium concentration might convulsions or coma occur? 145 mEq/L (145 mmol/L) 142 mEq/L (142 mmol/L) 130 mEq/L (130 mmol/L) 140 mEq/L (140 mmol/L)

130 mEq/L (130 mmol/L)

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? 5.5 mEq/L 3.5 mEq/L 2.5 mEq/L 4.5 mEq/L

2.5 mEq/L

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? >408 mOsm/kg 275-300 mOsm/kg <136 mOsm/kg 350-544 mOsm/kg

275-300 mOsm/kg

A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be 7.30 7.50 7.35 7.45

7.50 Explanation: Respiratory alkalosis is always caused by hyperventilation, which causes excessive "blowing off" of CO2

The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance? A 7-year-old with a fracture tibia A 65-year-old with a myocardial infarction A 72-year-old with a total knee repair A 52-year-old with diarrhea

A 52-year-old with diarrhea

Which of the following measurable urine outputs indicates the client is maintaining adequate fluid intake and balance? A patient with a minimal urine output of 10 mL/hour A patient with a minimal urine output of 20 mL/hour A patient with a minimal urine output of 30 mL/hour A patient with a minimal urine output of 50 mL/hour

A patient with a minimal urine output of 30 mL/hour

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? Alkaline Basic Acidic Neutral

Acidic

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

Administer small volumes of a hypertonic solution.

Which is the most common cause of symptomatic hypomagnesemia? Alcoholism Sedentary lifestyle Intravenous drug use Burns

Alcoholism

To evaluate a client for hypoxia, the physician is most likely to order which laboratory test? Total hemoglobin Red blood cell count Sputum culture Arterial blood gas (ABG) analysis

Arterial blood gas (ABG) analysis

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

A client reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the client's laboratory work has returned? Calcium Phosphorus Iron Potassium

Calcium

The nurse is caring for a client with a serum sodium concentration of 113 mEq/L. The nurse should monitor the client for the development of which condition? Confusion Hallucinations Nausea Headache

Confusion

An adult client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargy. The nurse reconciles the client's medication list and notes that salt tablets had been prescribed. What would the nurse do next? Be prepared to administer a lactated Ringer's IV. Be prepared to administer a sodium chloride IV. Consider sodium restriction with discontinuation of salt tablets. Continue to monitor client with another appointment.

Consider sodium restriction with discontinuation of salt tablets.

The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? Cool and pale skin Crackles in the lung fields Distended jugular veins Dark, concentrated urine

Dark, concentrated urine

The nurse is caring for a 72-year-old client who has been admitted to the unit for a fluid volume imbalance. The nurse knows which of the following is the most common fluid imbalance in older adults? Dehydration Fluid volume excess Hypervolemia Hypovolemia

Dehydration

The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L) and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving? Increase the rate of the intravenous lactated Ringer solution. Change the lactated Ringer solution to 2.5% dextrose. Discontinue the intravenous lactated Ringer solution. Change the lactated Ringer solution to 3% saline.

Discontinue the intravenous lactated ringer solution.

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

Distended neck veins Shortness of breath Crackles in the lung fields

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? Subnormal temperature Elevated blood pressure Low heart rate Rapid respiration

Elevated blood pressure

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? Metabolic alkalosis Extracellular fluid volume deficit Respiratory acidosis Altered blood urea nitrogen (BUN) value

Extracellular fluid volume deficit

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? Type 1 diabetes mellitus Extreme anxiety Myasthenia gravis Opioid overdose

Extreme anxiety

Which nerve is implicated in the Chvostek's sign? Hypoglossal Spinal accessory Facial Optic

Facial Explanation: Chvostek's sign consists of twitching of muscles supplied by the facial nerve

The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0mg/dl. The nurse anticipates that the client will also experience which electrolyte imbalance?

Hypocalcemia.

An elderly client takes 40mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? Hyperkalemia Hypokalemia Hypernatremia Hypophosphatemia

Hypokalemia. Explanation: Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium-losing diuretics, such as furosemide, can induce hypokalemia.

Oral intake is controlled by the thirst center, located in which of the following cerebral areas?

Hypothalamus.

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which? Cardiovascular compromise Lung function Summer allergies Insensible fluid loss

Insensible fluid loss.

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

With which condition should the nurse expect that a decrease in serum osmolality will occur? Influenza Uremia Kidney failure Hyperglycemia

Kidney failure

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

Lactated Ringer's saline solution.

The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? Respiratory alkalosis Metabolic acidosis Respiratory acidosis Metabolic alkalosis

Metabolic acidosis

Your client's lab values are sodium 166 mEq/L, potassium 5.0 mEq/L, chloride 115 mEq/L, and bicarbonate 35 mEq/L. What condition is this client likely to have, judging by anion gap? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Explanation: The anion gap is the difference between sodium and potassium cations and the sum of chloride and bicarbonate anions. An anion gap that exceeds 16 mEq/L indicates metabolic acidosis. In this case, the anion gap is (166 + 5) minus (115 + 35), yielding 21 mEq/L, which suggests metabolic acidosis. Anion gap is not used to check for respiratory alkalosis, metabolic alkalosis, or respiratory acidosis.

A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Metabolic alkalosis

a 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium levels are above 145mEq.L. Should the nurse start salt tablets when caring for this client? Yes, this will correct the sodium deficit. No, sodium intake should be restricted. Yes, along with the hypotonic IV. No, start with the sodium chloride IV.

No, sodium intake should be restricted.

The calcium concentration in the blood is regulated by which mechanism?

Parathyroid hormone.

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

Potassium Explanation: Potassium is a major cation that affects cardiac muscle functioning

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? CO2 Sodium Chloride Potassium

Potassium Explanation: The nurse should identify potassium: 2.2 mEq/L as critical because a normal potassium level is 3.5 to 5.0 mEq/L.

The nurse is analyzing the electrocardiographic (ECG) rhythm tracing of a client experiencing hypercalcemia. Which ECG change is typically associated with this electrolyte imbalance? Prolonged PR intervals Elevated ST segments Prolonged QT intervals Peaked T waves

Prolonged PR intervals Explanation: Cardiovascular changes associated with hypercalcemia may include a variety of dysrhythmias (e.g., heart blocks) and shortening of the QT interval and the ST segment. The PR interval is sometimes prolonged.

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? Metabolic alkalosis Metabolic acidosis Respiratory alkalosis Respiratory acidosis

Respiratory alkalosis

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? Respiratory alkalosis Respiratory acidosis Metabolic acidosis Metabolic alkalosis

Respiratory alkalosis

A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply. Drink caffeinated beverages to retain fluid. Drink carbonated beverages to help balance fluid volume. Respond to thirst Drink at least eight glasses of fluid each day. Drink water as an inexpensive way to meet fluid needs.

Respond to thirst Drink at least eight glasses of fluid each day. Drink water as an inexpensive way to meet fluid needs.

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? Serum bicarbonate of 28 mEq/L Serum bicarbonate of 21 mEq/L PaCO2 less than 35 mm Hg pH 7.26

Serum bicarbonate of 28 mEq/L Explanation: Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? Hematocrit of 52% Serum creatinine level of 0.4 mg/dl Serum sodium level of 124 mEq/L Serum blood urea nitrogen (BUN) level of 8.6 mg/dl

Serum sodium level of 124 mEq/L Explanation: In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing hyponatremia.

The nurse is caring for a client diagnosed with hyperchloremia. Which are signs and symptoms of hyperchloremia? Select all that apply. Weakness Lethargy Dehydration Tachypnea Hypotension

Tachypnea Weakness Lethargy

A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis? The client had a liver transplant 2 years ago. The client works in a health insurance office. The client sees the health care provider for a check-up yearly. The client has never traveled outside of the country.

The client had a liver transplant 2 years ago.

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? The lungs have ineffective cilia from years of smoking. The lungs are not able to blow off carbon dioxide. The lungs are unable to breathe in sufficient oxygen. The lungs are unable to exchange oxygen and carbon dioxide.

The lungs are not able to blow off carbon dioxide. Explanation: In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis

Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 grams per day)?

Three ounces of light or dark meat, 1 cup of spaghetti, and a garden salad.

A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching?

Tingling sensation in the fingers.

What does the nurse understand is the primary method by which fluid volume is regulated? Urine excretion Breathing Bowel elimination Perspiration

Urine excretion

Which of the following may be the first sign of respiratory acidosis in anesthetized patients? Dull headache Mental cloudiness Increased pulse Ventricular fibrillation

Ventricular fibrillation

A client with emphysema is at a greater risk for developing which acid-base imbalance? respiratory alkalosis metabolic acidosis metabolic alkalosis chronic respiratory acidosis

chronic respiratory acidosis

A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed? furosemide hydrochlorothiazide spironolactone metolazone

furosemide

Early signs of hypervolemia include a decrease in blood pressure. moist breath sounds. thirst. increased breathing effort and weight gain.

increased breathing effort and weight gain.

Clients diagnosed with hypervolemia should avoid sweet or dry food because it increases the client's desire to consume fluid. can cause dehydration. can lead to weight gain. obstructs water elimination.

increases the client's desire to consume fluid.

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? metabolic alkalosis respiratory acidosis metabolic acidosis respiratory alkalosis

metabolic alkalosis

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

muscle weakness. Explanation: Muscle weakness; bradycardia; nausea; diarrhea; and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? pH 7.48 PaCO 36 HCO 21 mEq/L O saturation 95%

pH 7.48

Which set of arterial blood gas (ABG) results requires further investigation? pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L

pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

The nurse is analyzing the arterial blood gas results of a client diagnosed with severe pneumonia. Which of the following ABG results indicated respiratory acidosis. pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L pH: 7.40, PaCO2: 40 mm Hg, HCO3-: 24 mEq /L pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L

pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L.

A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status? weight vital signs intake and output edema

weight

A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of: 230 mOsm/kg. 210 mOsm/kg. 250 mOsm/kg. 280 mOsm/kg.

280 mOsm/kg. Explanation: Serum osmolality can be estimated by doubling the serum sodium

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

Light-headedness or paresthesia

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant? Provide oral care every 2-3 hours. Teach the client about increased fluid intake. Assess the client's weight daily for trends. Monitor for signs and symptoms of dehydration.

Provide oral care every 2-3 hours.

The nurse is caring for a client diagnosed with bulimia. The client is being related for a serum potassium concentration of 2.9 mEq/L. Which statement made by the client indicated the need for further teaching?

"I can use laxities and enemas but only once a week."

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'll drink cranberry juice with my breakfast instead of coffee." "Bananas have a lot of potassium in them; I'll stop buying them." "I need to check to see whether my cola beverage has potassium in it." "I will not salt my food; instead I'll use salt substitute."

"I will not salt my food; instead I'll use salt substitute."

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? Kidney and liver Pancreas and stomach Heart and lungs Lungs and kidney

Lungs and kidney

Which is the preferred route of administration for potassium? Intramuscular IV (intravenous) push Oral Subcutaneous

Oral

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? Prepare to assist with ventilation. Prepare for gastric lavage. Monitor the client's heart rhythm. Obtain a urine specimen for drug screening.

Prepare to assist with ventilation. Explanation: Respiratory acidosis is associated with hypoventilation

A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance? Presence of Trousseau sign Slurred speech Negative Chvostek sign Muscle weakness

Presence of Trousseau sign Explanation: After radical neck resection, a client is prone to developing hypocalcemia. Hypocalcemia is defined as a serum value <8.6 mg/dL (<2.15 mmol/L). Signs and symptoms of hypocalcemia include Chvostek sign, which consists of muscle twitching enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe, just below the zygomatic arch, is tapped; and a positive Trousseau sign can be elicited by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and metacarpophalangeal joints, and extended interphalangeal joints with fingers together) will occur as ischemia of the ulnar nerve develops. Slurred speech and muscle weakness are signs of hypercalcemia.

A client with hypervolemia asks the nurse by what mechanism the sodium-potassium pump will move the excess body fluid. What is the nurse's best answer? passive osmosis passive elimination active transport free flow

active transport Explanation: Active transport is the physiologic pump maintained by the cell membrane that results in the movement of fluid from an area of lower concentration to one of higher concentration.

The health care provider ordered an IV solution for a dehydrated patient with a head injury. Select the IV solution that the nurse knows would be contraindicated. c. 0.45% NS d. 3% NS b. 5% DW a. 0.9% NaCl

b. 5% DW Explanation: A solution of D5W is an isotonic IV solution that is contraindicated in head injury because it may increase intracranial pressure.

A nurse caring for a patient with metabolic alkalosis knows to assess for the primary, compensatory mechanism of: b. Increased PaCO2. c. Decreased serum HCO3. d. Decreased PaCO2. a. Increased serum HCO3.

b. Increased PaCO2. Explanation: The respiratory system compensates by decreasing ventilation to conserve CO2 and increase the PaCO2.

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

Confusion and seizures

Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15 pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34 pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28

pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28

A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? Lactated Ringer solution 0.45% NaCl 0.9% NaCl 5% NaCl

0.45% NaCl

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

0.45% NaCl

A client was admitted to the hospital after 2 days of Vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition?

Dehydration

A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse? renin-angiotensin-aldosterone system bicarbonate-carbonic acid buffer system sodium-potassium pump ADH-ANP buffer system

bicarbonate-carbonic acid buffer system