Chapter 10: Fluid and Electrolytes
The nurse is caring for a pt in metabolic alkalosis. The pt has an NG tube to low intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the medication orders?
A. Cimetidine
A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. Which factors contribute to this phenomenon? Select all that apply.
A. Decreased kidney mass D. Decreased renal blood flow E. Decreased excretion of potassium
20. The nurse is providing care for a client with chronic obstructive pulmonary disease. When describing the process of respiration, the nurse explains to a newly licensed nurse how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing which process?
A. Diffusion
The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem?
A. Diminished deep tendon reflexes
The nurse is caring for a client who is to receive IV daunorubicin, a chemotherapeutic agent. The nurse starts the infusion and checks the insertion site as per protocol. During the most recent check, the nurse observes that the IV has infiltrated so the nurse stops the infusion. What is the nurse's priority concern with this infiltration?
A. Extravasation of the medication
19. The nurse is evaluating a newly admitted client's laboratory results, which include several values that are outside of reference ranges. Which of the following alterations would cause the release of antidiuretic hormone (ADH)?
A. Increased serum sodium
34. The nurse is providing discharge education to a client who had hypophosphatemia while in the hospital. The client has a diet prescribed that is high in phosphate. Which foods should the nurse teach this client to include in the diet? Select all that apply.
A. Milk B. Beef C. Poultry E. Liver
A client has questioned the nurse's administration of intravenous (IV) normal saline, asking, "Wouldn't sterile water be a more appropriate choice than saltwater?" Under what circumstances would the nurse administer electrolyte-free water intravenously?
A. Never, because it rapidly enters red blood cells, causing them to rupture
The nurse is caring for a client who has been involved in a motor vehicle accident. The client's labs indicate a minimally elevated serum creatinine level. The nurse should further assess which body system for signs of injury?
A. Renal
A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 24 mm Hg. Which condition does the ABG reflect?
A. Respiratory acidosis
You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle accident. You and your colleague note that the patient's labs indicate minimally elevated serum creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older adults?
A. Substantially reduced renal function
The community health nurse is performing a home visit to an 80-year-old client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused at times and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response?
B. "Limiting your fluids can create imbalances that can result in confusion, so let's try adjusting the timing of your fluids."
A client with hypokalemia is to receive intravenous (IV) potassium replacement. Which action should the nurse take when administering potassium intravenously? Select all that apply.
B. Assess blood urea nitrogen (BUN) and serum creatinine prior to potassium administration D. Follow the facility policy for infusion of potassium. E. Report a reduced urinary output to the health care provider.
The physician has ordered a peripheral IV to be inserted before the patient goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter?
B. Consider potential effects on the patients mobility when selecting a site.
The nurse caring for a client post colon resection is assessing the client on the second postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and is infusing at 125 ml/hr. The pt reports pain at the incision site rate a 3/10. During your initial shift assessment, the pt complains of cramps in the legs and a tingling sensation in her feet. Your assessment indicates (DTRs) and you suspect the pt has hypokalemia. What other sign or symptom would you expect this patient to exhibit?
B. Dilute urine
The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in the lips and fingers. The client also reports an intermittent spasm in the wrist and hand and exhibits increased muscle tone. Which electrolyte imbalance should the nurse first suspect?
B. Hypocalcemia
The nurse is caring for a client with a diagnosis of pancreatitis. The client was admitted from a homeless shelter and is a vague historian. The client appears malnourished and on day 3 of the client's admission, total parenteral nutrition (TPN) has been started. Why should the nurse start the infusion of TPN slowly?
B. Malnourished clients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.
A nurse in the neurologic ICU has received a prescription to infuse a hypertonic solution into a client with increased intracranial pressure. This solution will increase the number of dissolved particles in the client's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described with which of the following terms?
B. Osmosis and osmolality
The nurse caring for a client post colon resection is assessing the client on the second postoperative day. The nasogastric tube remains patent and is draining moderate amounts of greenish fluid. Which assessment finding would suggest that the client's potassium level is too low?
B. Paresthesias
A client with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the client is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance?
B. Respiratory alkalosis
A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?
B. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.
The nurse is preparing to insert a peripheral IV catheter into a patient who will require antibiotics. How should the nurse always start the process of insertion?
C. Ask the patient about allergies to latex or iodine.
A nurse educator is reviewing peripheral IV insertion with a group of noice nurses. How should these nurses be encouraged to deal with excess hair at the intended site?
C. Clip the hair in the area.
One day after a client is admitted to the medical unit, the nurse determines that the client is oliguric. The nurse notifies the acute-care nurse practitioner who prescribes a fluid challenge of 200 mL of normal saline solution over 15 minutes. This intervention will help to achieve what goal?
C. Distinguish reduced renal blood flow from decreased renal function.
A client with hypertension has been prescribed hydrochlorothiazide. What nursing action will best reduce the client's risk for electrolyte disturbances?
C. Ensure the client has sufficient potassium intake.
The nurse in the medical intensive care unit is caring for a client who is in respiratory acidosis due to inadequate ventilation. Which diagnosis could the client have that could cause inadequate ventilation?
C. Guillain-Barré syndrome
The nurse is called to a client's room by a family member who voices concern about the client's status. On assessment, the nurse finds the client tachypneic, lethargic, weak, and exhibiting a diminished cognitive ability. The nurse also identifies 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this client's signs and symptoms?
C. Hyperchloremia
The nurse is assessing the client for the presence of a Chvostek sign. Which electrolyte imbalance would a positive Chvostek sign indicate?
C. Hypocalcemia
The nurse is performing an admission assessment on a 79-year-old client newly admitted for end-stage liver disease. What principle should guide the nurse's assessment of the client's skin turgor?
C. Inelastic skin turgor is a normal part of aging.
While assessing a client's peripheral IV site, the nurse observes edema and coolness around the insertion site. How should the nurse document this observation?
C. Infiltration
The nurse is caring for a client admitted to the medical unit 72 hours ago with pyloric stenosis. A nasogastric tube was placed upon admission, and since that time the client has been on low intermittent suction. Upon review of the morning's blood work, the nurse notices that the client's potassium is below reference range. The nurse should assess for signs and symptoms of what imbalance?
C. Metabolic alkalosis
11. A nurse, who is orienting a newly licensed nurse, is planning care for a nephrology client. The nurse states, "A client with kidney disease partially loses the ability to regulate changes in pH." What is the cause of this partial inability?
C. The kidneys reabsorb and regenerate bicarbonate to maintain a stable pH.
The nurse is caring for a client who has a peripheral IV in place for fluid replacement. When caring for the client's IV site, the nurse should:
C. ensure that the tubing is firmly anchored to the client's skin.
36. A client's most recent laboratory results show a slight decrease in potassium. The health care provider has opted to forgo drug therapy but has suggested increasing the client's dietary intake of potassium. What should the nurse recommend?
D. Bananas
Baroreceptors in the left atrium and in the carotid and aortic arches respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect?
D. Decrease in glomerular filtration
Diagnostic testing has been prescribed to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill client. What health problem often precedes normal anion gap acidosis?
D. Excessive administration of chloride
The nurse is caring for a client who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion. The plan of care includes assessment of specific gravity every four hours. The results of this test will allow the nurse to assess which aspect of the client's health?
D. Fluid volume status
When planning the care of a client with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur?
D. Hydrostatic pressure resulting from the pumping action of the heart
The nurse is caring for a client who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. The client reports a new onset of weakness with abdominal pain, and further assessment suggests that the client likely has a fluid volume deficit. The nurse should recognize that this client may be experiencing which electrolyte imbalance?
D. Hypercalcemia
The nurse is working on a burn unit and an acutely ill client is exhibiting signs and symptoms of third spacing. Based on this change in status, the nurse should expect the client to exhibit signs and symptoms of which imbalance?
D. Hypovolemia
The emergency-room nurse is caring for a trauma client who has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How should the nurse interpret these results?
D. Metabolic acidosis with compensatory respiratory alkalosis
The ICU nurse is caring for a pt who experienced trauma in a workplace accident. The pt is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH: 7.28, paCO2: 50 mm Hg, HCO3- 23 mEq/L. The nurse should recognize the likelihood of what acid base disorder?
D. Mixed acid-base disorder
The intensive care unit nurse is caring for a client who experienced trauma in a workplace accident. The client is reporting dyspnea because of abdominal pain. An arterial blood gas test reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3- 20 mEq/L. The nurse should recognize the likelihood of which acid-base disorder(s)?
D. Respiratory acidosis and metabolic acidosis
The nurse is caring for a client with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis?
D. Shallow respirations
A client comes into the emergency department (ED) by ambulance with a hip fracture after slipping and falling while at home. The client is alert and oriented but anxious and reports thirst. The client's pupils are equal and reactive to light and accommodation, and the heart rate is elevated. An indwelling urinary catheter is inserted, and 40 mL of urine is present. What is the nurse's most likely explanation for the client's urinary output?
D. The client is having a sympathetic reaction, which has stimulated the renin- angiotensin-aldosterone system, which results in diminished urine output.
A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurse's preceptor is going over the patient's lab reports with the nurse. The nurse takes note that the patient's PaCo2 has been between 56 and 65 mmHg for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurse's best response?
D. Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.