Ch. 13 EAQ

which assessment would the nurse make immediately if a patient's serum potassium is reported to be 5.6 mEq/L?

heart rate a normal potassium level is 3.5 to 5.0 mEq/L. cardiovascular changes, specifically bradycardia, heart block, asystole, and ventricular fibrillation, are life-threatening consequences of elevated potassium. the health care provider or Rapid Response Team may need to be notified if changes in heart rate and rhythm are assessed. paresthesia in the arms and feet and increased intestinal motility with diarrhea are lower-priority signs of elevated potassium

the primary health care provider prescribes IV administration of 100 mL of 20% glucose along with 20 units of insulin. which condition would the nurse expect the patient to have?

hyperkalemia hyperkalemia is a condition where serum potassium levels are high. potassium movement into the cells is enhanced by insulin. IV administration of 100 mL 10% to 20% glucose with 10 to 20 units of regular insulin helps decrease serum potassium levels. insulin increases the activity of sodium-potassium pumps, which decreases serum potassium levels temporarily by moving potassium from the extracellular fluid to the cells. this therapy is prescribed as an add-on therapy along with diuretics in a patient with hyperkalemia. conditions such as hyperglycemia, hypernatremia, and hypercalcemia cannot be managed with this insulin and glucose therapy

for which classification of drugs would the nurse instruct a patient to increase intake of dietary potassium?

loop diuretics high-ceiling (loop) diuretics are potassium-depleting drugs. the patient should increase intake of dietary potassium to compensate for this depletion. alpha antagonists, beta blockers, and corticosteroids are not potassium-depleting drugs

which two electrolytes does the nurse suspect based on the following assessment data of a patient?

hypomagnesemia and hypocalcemia hyperactive deep tendon reflexes, numbness and tingling on the hands and feet, painful muscle contractions, weak pulse, depressed affect, and confusion are associated with signs of hypocalcemia and hypomagnesemia. electrolyte imbalances frequently occur concurrently. the patient's nutrition history also indicated nutrient intake that is likely to be insufficient in calcium (i.e., dairy products)

which condition is the major cause of death in patients with hypokalemia?

respiratory insufficiency respiratory changes may occur in patients with hypokalemia because of respiratory muscle weakness resulting in shallow respirations. the respiratory status of a patient with hypokalemia should be assessed at least every 2 hours because respiratory insufficiency is the major cause of death for these patients. a stroke is not a risk factor for hypokalemia. hypokalemia does not cause renal failure; rather, hyperkalemia is caused by renal failure dysrhythmias may occur because of hypokalemia, but they are not the major cause of death in patients with hypokalemia

which intervention would the nurse expect to be prescribed for a patient with hyponatremia?

small-volume IV infusions of 3% normal saline a solution of 3% saline is hypertonic and is given in small volumes to replenish serum sodium; 0.45% saline is hypotonic and will further dilute serum sodium levels. furosemide causes sodium loss in the kidneys and would further contribute to hyponatremia. a 3-g sodium diet restricts sodium intake; the goal of nutritional therapy with hyponatremia is to increase sodium intake

which electrolyte excess results in cellular irritability and severe cellular dehydration?

sodium hypernatremia occurs when serum sodium levels are very high; this condition causes excitable tissues to over respond to stimuli. this leads to irritability and severe cellular dehydration. hypercalcemia, an excess of calcium, decreases the sensitivity of excitable tissues to normal stimuli. hyperphosphatemia (excess phosphate) causes hypocalcemia. hypermagnesemia (excess magnesium) causes hypotension, bradycardia, central nervous system changes, and neuromuscular changes

which electrolyte deficiency results in reduced excitable membrane depolarization and increased cellular swelling?

sodium hyponatremia occurs when sodium levels are low; this condition causes decreased depolarization in excitable cells and increased cellular swelling. low serum calcium levels lead to muscle cramping and cardiac arrhythmias. a potassium deficiency causes cardiac dysrhythmias. a decrease in the level of magnesium may cause increased nerve impulse transmission

which urine laboratory parameter would help in the diagnosis of a patient with dehydration?

specific gravity dehydration can be indicated by urine analysis with specific gravity levels of more than 1.030. urine pH, glucose levels of the urine, and levels of ketone bodies are not used to diagnose dehydration as they do not change dramatically based on fluid volume

which potassium level would indicate that therapy for hyperkalemia was effective?

4.6 mEq/L a potassium level of 4.6 mEq/L is a normal level, indicating that therapy was effective. normal levels are 3.5 to 5.0 mEq/L. a potassium level of 2.6 mEq/L indicated hypokalemia. a potassium level of 5.6 mEq/L indicates hyperkalemia. a potassium level of 7.6 mEq/L indicated severe hyperkalemia

which patient is at high risk for hypernatremia?

54-year-old who is sweating profusely excessive sweating is a common cause of hypernatremia. hyperglycemia, a low-salt diet, and hypotonic fluid administration are common causes of hyponatremia, not hypernatremia

which assessment finding is consistent with hyponatremia?

muscular weakness muscle weakness is seen in patients with hyponatremia and requires prompt assessment of respiratory effectiveness. mild confusion, flat jugular veins, and hyperactive bowel sounds are expected with hyponatremia

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

aldosterone aldosterone stimulates the nephrons to reabsorb sodium and water into the blood, preventing sodium and water loss. NP hormone levels are altered in response to increased blood volume and blood pressure. antidiuretic hormone acts on the collecting ducts of the kidney to normalize the blood osmolarity. thyrotropin is a thyroid-stimulating hormone that is released in response to low levels of the thyroid hormone

a patient receiving insulin and glucose infusion therapy for hyperkalemia now has a serum potassium level of 3.6 mEq/L. which action would the nurse take?

assess the patient's heart rate, rhythm, and respiratory status. the serum potassium is now at the low end of normal range (3.5 to 5.0 mEq/L). the nurse must first assess the patient's response to the infusion and subsequent change in serum potassium (notably a change in respiratory effectiveness and quality and regularity of the heart rate). once assessment data are obtained, the nurse should contact the health care provider, and the infusion may be stopped, but it does not have to occur immediately

which drug might be used to manage symptoms of hypocalcemia?

calcium with vitamin D calcium supplements are given to restore serum calcium levels. vitamin D may be given to improve calcium absorption. potassium, zinc, and vitamin E are not indicated for the management of hypocalcemia

which assessment parameter is useful for identifying magnesium toxicity during IV magnesium administration?

checking deep tendon reflexes (DTRs) the patient who is receiving IV magnesium sulfate should be assessed for signs of toxicity every hour by assessment of DTRs. hypermagnesmia causes depressed or absent DTRs. most patients who have fluid and electrolyte problems will be monitored for intake and output; this will not immediately generate data about problems with magnesium overdose. although administration of magnesium sulfate can cause a drop in calcium levels, this occurs over a period of time and would not be the best way to assess magnesium toxicity. low magnesium levels can cause psychological depression, but assessing this parameter as the levels are restored would not be a method by which to safely assess a safe dose or an overdose

a patient admitted to the hospital is agitated, with a heart rate of 166 beats/min. which electrolyte imbalance would the nurse suspect?

hypernatremia tachycardia and agitation are indicative of hypernatremia. clinical manifestations of hypomagnesemia are seen in the neuromuscular, central nervous and intestinal systems. hypercalcemia manifests with an altered level of consciousness that can range from confusion and lethargy to coma, and severe hypercalcemia depresses electrical conduction, slowing the heart rate. hyperphosphatemia causes few direct problems with body function

which additional electrolyte imbalance would the nurse monitor for a patient who has hypomagnesemia?

hypocalcemia hypocalcemia often occurs with hypomagnesemia, so the nurse would monitor for signs and symptoms of low calcium levels. hypomagnesemia may increase potassium secretion in certain circumstances, leading the health care provider to be aware that replacement of magnesium is crucial before attempting to replace potassium if the patient is deficient in both. hypernatremia and hypophosphatemia are not related to hypomagnesemia

a patient reports painful muscle spasms in the lower legs at rest, a tingling sensation in the hands and lips, and abdominal cramping and diarrhea. which disorder would the nurse suspect?

hypocalcemia the primary symptoms of hypocalcemia are neuromuscular changes, specifically painful muscle cramps, and paresthesia that may spread to the face, progressing to tetany. abdominal cramping and diarrhea may also occur. muscle spasms in lower legs at rest, a tingling sensation in the hands and lips, and abdominal cramping and diarrhea are not primary characteristics of hypernatremia, hypermagnesemia, or hypophosphatemia

which condition is assessed by using Trousseau and Chvostek signs?

hypocalcemia hypocalcemia is a decrease in serum sodium levels and is assessed by testing for Trousseau and Chvostek signs. hypokalemia, hyponatremia, and hypomagnesemia are not assessed by testing for Trousseau and Chvostek signs. hypokalemia is determined by ECG changes. hyponatremia can be detected by assessing a patient's mental status for changes. hypomagnesemia causes muscle weakness

which electrolyte imbalance should be anticipated in a patient with hyperphosphatemia?

hypocalcemia phosphorus and calcium have an inverse or reciprocal relationship. when one is increased, the other is usually decreased. therefore a patient with hyperphosphatemia should be monitored for hypocalcemia. hyperphosphatemia does not cause hypernatremia, hypokalemia, or hypermagnesemia

positive Trousseau and Chvostek signs are consistent with which electrolyte imbalance?

hypocalcemia the Trousseau sign (palmar flexion) and the Chvostek sign (facial twitching) are consistent with acute hypocalcemia. these manifestations are caused by overstimulation of the nerves and muscles. Trousseau and Chvostek signs are not used to assess for potassium imbalances

a 77-year-old woman who has congestive heart failure (CHF) is brought to the emergency department after she has had diarrhea for 3 days. the family tells the nurse that she has not been eating or drinking well but she has been taking her diuretics and other medications. her laboratory results include a potassium level of 3.0 mEq/L. which information would the nurse include in the patient's medication teaching?

laxatives can lead to fluid imbalance, it is important to weigh daily at the same time, diuretics can lead to fluid and electrolyte imbalances a potassium level of 3.0 mEq/L is low; the normal range is 3.5 to 5.0 mEq/L. diuretics decrease fluid retention and increase loss of fluids and thus can lead to fluid and electrolyte imbalances. laxatives are commonly used by older adults and can also lead to fluid imbalance. daily weight recording is a good indicator of fluid retention. patients should be taught to weigh themselves at the same time, in the same clothing, and on the same scale

a patient with Crohn disease reports numbness, tingling, and painful muscle contractions. the patient's deep tendon reflexes are hyperactive. which medication would the nurse expect to administer intravenously?

magnesium sulfate patients with Crohn disease are at a high risk for magnesium imbalance, mainly hypomagnesemia. a decrease in the levels of magnesium may cause increased nerve impulse transmission, causing hyperactive deep tendon reflexes, numbness, tingling, and painful muscle contractions. this condition can be well treated by administering magnesium sulfate intravenously. IV administration of sodium, bicarbonate, or phosphorous is not a suitable intervention

which laboratory value requires the nurse to notify the primary health care provider?

magnesium: 4.2 mEq/L a magnesium level of 4.2 mEq/L is markedly elevated (normal is 1.8 to 2.6 mEq/L). manifestations are not usually apparent until levels exceed 4 mEq/L. patients with severe hypermagnesemia are in danger of cardiac arrest, so a level of 4.2 mEq/L requires prompt attention. a sodium level of 136 mEq/L is normal. a potassium level of 5.0 mEq/L is normal. a calcium level of 9.0 mg/dl is normal

the health care provider writes prescriptions for a patient who is admitted with a serum potassium (K) level of 6.9 mEq/L. which action would the nurse implement first?

place the patient on a cardiac monitor because hyperkalemia can lead to life-threatening bradycardia, the initial action should be to place the patient on a cardiac monitor. administering a potassium-reducing medication, recommending a potassium-restricted diet, and teaching the patient about diet are appropriate but will not immediately decrease the serum potassium level and do not need to be implemented as quickly as monitoring cardiac rhythm

the nurse is reviewing serum electrolytes and blood chemistry for a newly admitted patient. which result is of concern?

potassium: 5.9 mEq/L a potassium value of 5.9 mEq/L is high, and the patient should be assessed further. a glucose value of 97 mg/dl, a magnesium value of 2.1 mEq/L, and a sodium value of 143 mEq/L are normal values

which action would the nurse take when providing care to a patient with hypokalemia?

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

which history and assessment finding may be associated with hypocalcemia?

tingling around the mouth, muscle spasms in the calf at rest, recent blunt trauma to the throat a history of anterior neck injury may be associated with hypocalcemia. symptoms of hypocalcemia include tingling in the lips, and "charley horses" in the calf during rest or sleep. hypocalcemia increases peristalsis and bowel sounds. decreased deep tendon reflexes without paresthesia is a neuromuscular change in hypercalcemia

which situation causes isotonic dehydration?

water and sodium are lost from the body in proportionately equal amounts dehydration may occur with either fluid loss or with both fluid and electrolyte loss. dehydration is termed isotonic dehydration when there is proportionality between the amount of water and electrolyte, such as sodium, lost from the body. hypertonic dehydration occurs when more water than sodium is lost from the body. hypokalemia occurs when a decrease in the circulating blood volume causes poor tissue perfusion. relative dehydration occurs without the actual loss of total body water when fluid shifts from plasma to the interstitial space