Chapter 12: Fluid Volume and Electrolytes QUESTIONS

Which drug(s) is/are used to treat hyperkalemia? (Select all that apply.)

c. Glucose and insulin d. Kayexalate and sorbitol e. Sodium bicarbonate and calcium gluconate

The patient has a serum potassium level of 3.2 mEq/L and has been prescribed K-Dur. She asks the nurse why she has to take the supplement. What is the nurse's best response?

a. "A low potassium level can be dangerous, and 3.2 mEq/L is considered too low."

The nurse has taught the patient how to take his oral potassium supplement. Which statement by the patient indicates that he requires more education on taking this medication?

a. "I can take this with a few sips of water."

5. The nurse is caring for a patient who has a heart rate of 98 beats per minute and a blood pressure of 82/58 mm Hg. The patient is lethargic, is complaining of muscle weakness, and has had gastroenteritis for several days. Based on this patient's vital signs, which sodium value would the nurse expect?

a. 126 mEq/L ANS: A Patients who are hyponatremic will have tachycardia and hypotension along with lethargy and muscle weakness. (The normal range for serum sodium is 135 to 145 mEq/L; a serum sodium level of 126 mEq/L would be considered hyponatremic.)

The patient has a serum potassium level of 6.1 mEq/L. What clinical manifestation(s) should the nurse expect to assess in this patient? (Select all that apply.)

a. Abdominal cramps d. Paresthesias of face e. Tachycardia and later bradycardia

4. The nurse is caring for a patient who weighs 75 kg. The patient has intravenous (IV) fluids infusing at a rate of 50 mL/h and has consumed 100 mL of fluids orally in the past 24 hours. Which action will the nurse take?

a. Contact the provider to ask about increasing the I.V rate to 90 mL/h. ANS: A The recommended daily fluid intake for adults is 30 to 40 mL/kg/day. This patient should have a minimum of 2250 mL/day and is currently receiving 1200 mL IV plus 100 mL orally for a total of 1300 mL. (Increasing the I.V rate to 90 mL/h would give the patient 2160 mL. If the patient continues to take oral fluids, the amount of 2250 mL can be met. A rate of 150 mL/h would give the patient 3600 mL/day, which exceeds the recommended amount. Since this patient is not taking fluids well and is not receiving adequate I.V fluids, encouraging an increased fluid intake is not indicated. Even if the patient drank 250 mL of water every 8 hours, the amount would not be sufficient.)

13. The nurse is caring for a patient who is receiving oral potassium chloride supplements. The nurse notes that the patient has a heart rate of 120 beats per minute and has had a urine output of 200 mL in the past 12 hours. The patient reports abdominal cramping. Which action will the nurse take?

a. Contact the provider to request an order for serum electrolytes. ANS: A Oliguria, tachycardia, and abdominal cramping are signs of hyperkalemia, so the nurse should request an order for serum electrolytes. (This patient should increase fluid intake. The patient is not exhibiting signs of hyperchloremia; the patient is showing signs of hyperkalemia, and an increased potassium dose is not indicated.)

17. The nurse is caring for a patient who is receiving isotonic intravenous (IV) fluids at an infusion rate of 125 mL/h. The nurse performs an assessment and notes a heart rate of 102 beats per minute, a blood pressure of 160/85 mm Hg, and crackles auscultated in both lungs. Which action will the nurse take?

a. Decrease the I.V fluid rate and notify the provider. ANS: A The patient shows signs of fluid volume excess, so the nurse should slow the I.V fluid rate and notify the provider. (Increasing the rate would compound the problem. Colloidal and hypertonic fluids would pull more fluids into the intravascular space and compound the problem.)

20. The nurse is caring for a patient who will receive 10% calcium gluconate to treat a serum potassium level of 5.9 mEq/L. The nurse performs a drug history prior to beginning the infusion. Which drug taken by the patient would cause concern?

a. Digitalis ANS: A Calcium gluconate is given to treat hyperkalemia in order to decrease irritability of the myocardium. When administered to a patient taking digitalis, it can cause digitalis toxicity. (The other drugs may affect potassium levels but are not a cause for concern with calcium gluconate.)

21. A patient is admitted with orthopnea, cough, pulmonary crackles, and peripheral edema. The patient's urine specific gravity is 1.002. The nurse will expect this patient's provider to order which treatment?

a. Diuretics ANS: A This patient has signs of fluid volume excess. Diuretics are prescribed to reduce fluid overload.

7. The nurse is caring for a newly admitted patient who has severe gastroenteritis. The patient's electrolytes reveal a serum sodium level of 140 mEq/L and a serum potassium level of 3.5 mEq/L. The nurse receives an order for intravenous 5% dextrose and normal saline with 20 mEq/L potassium chloride to infuse at 125 mL/h. Which action is necessary prior to administering this fluid?

a. Evaluate the patient's urine output. ANS: A (If the patient is receiving potassium and the urine output is <25 mL/h or <600 mL/d, potassium accumulation may occur. Patients with a low urine output should not receive IV potassium. Arterial blood gases are not necessary prior to IV potassium administration. Potassium should never be given as a bolus. Patients should be put on a potassium-enriched diet when foods are tolerated.)

19. The nurse is performing an assessment on a patient brought to the emergency department for treatment for dehydration. The nurse assesses a respiratory rate of 26 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 86/50 mm Hg, and a temperature of 39.5° C. The patient becomes dizzy when transferred from the wheelchair to a bed. The nurse notes cool, clammy skin. Which diagnosis does the nurse suspect?

a. Fluid volume deficit (FVD) ANS: A Patients with FVD will exhibit elevated temperature, tachycardia, tachypnea, hypotension, orthostatic hypotension, and cool, clammy skin. Patients with FVE will have bounding pulses, elevated blood pressure, dyspnea, and crackles. Mild ECF deficit causes thirst. Renal failure generally leads to FVE.

The patient has had diarrhea for several days and has a serum calcium (HYPOcalcemia) level of 3.6 mEq/L. What clinical manifestations will the nurse expect to see in this patient? (Select all that apply.)

a. Hyperactive deep tendon reflexes b. Irritability e. Tetany

Magnesium deficiencies are frequently associated with which other electrolyte imbalance?

a. Hypocalcemia

The patient has pancreatitis. The nurse knows he is at risk for which electrolyte abnormality?

a. Hypocalcemia

2. A patient is suspected of having severe hypocalcemia. While waiting for the patient's serum electrolyte results, the nurse will assess for which symptoms? (Select all that apply.)

a. Laryngeal spasms e. Numbness of fingers f. Twitching of the mouth Patients who have hypocalcemia will exhibit laryngeal spasms, numbness of fingers, and twitching of the mouth. The other symptoms are not characteristic of hypocalcemia.

The patient has been started on a potassium supplement. What should be included in the teaching plan for this patient? (Select all that apply.)

a. List the signs and symptoms of both hypokalemia and hyperkalemia b. Regular testing of serum potassium levels is required. d. The medication must be taken on a full stomach or with a glass of water e. The patient should sit up for 30 minutes after taking the medication.

Which body fluid has a similar composition to lactated Ringer's I.V solution?

a. Plasma

14. A patient asks the nurse about taking calcium supplements to avoid hypocalcemia. The nurse will suggest that the patient follow which instruction?

a. Take a calcium and vitamin D combination supplement. ANS: A Vitamin D enhances the absorption of calcium in the body. (Calcium and phosphorus have an inverse relationship—an increased level of one mineral decreases the level of the other. Antacids can contain magnesium, which can promote calcium loss. Aspirin can alter vitamin D levels and interfere with calcium absorption.)

A patient is receiving high molecular-weight dextran after an explosion. What is the purpose of this fluid?

a. Temporarily restore circulating volume

11. The nurse is caring for a patient whose serum sodium level is 140 mEq/L and serum potassium level is 5.4 mEq/L. The nurse will contact the patient's provider to discuss an order for

a. a low-potassium diet. ANS: A Mild hyperkalemia may be treated with dietary restriction of potassium-rich foods. The patient's sodium level is normal, so sodium bicarbonate is not indicated. (Kayexalate is used for severe hyperkalemia. Salt substitutes contain potassium and would only compound the hyperkalemia.)

What is the normal range for serum osmolality?

b. 275 to 295 mOsm/kg

Calcium is distributed intercellularly and intracellularly in what proportions?

b. 50% : 50%

1. The nurse is caring for a patient who will receive intravenous calcium gluconate. Which nursing actions are appropriate when giving this solution? (Select all that apply.)

b. Assessing for Trousseau and Chvostek signs e. Monitoring the patient's electrocardiogram (ECG) f. Reporting a serum calcium level of >2.5 mEq/L (Trousseau and Chvostek signs indicate hypocalcemia, and patients receiving calcium should be monitored closely for signs of calcium imbalance. Hypercalcemia can cause ECG changes. A serum calcium level greater than 2.5 mEq/L indicates hypercalcemia and therefore should be reported. Calcium does not require infusion through a central line and should not be given as a rapid IV bolus. Calcium should not be added to a solution containing bicarbonate, because rapid precipitation occurs.)

A patient is prescribed 2 L of I.V fluids: 1000 mL D5 W followed by 1000 mL of D5 these fluids classified as?

b. Crystalloids

The nurse is teaching the patient about calcium absorption and includes the health teaching that vitamin D is needed for calcium absorption. Where in the body is calcium absorbed?

b. G.I tract

18. The nurse is preparing to administer digoxin to a patient who is newly admitted to the intensive care unit. The nurse reviews the patient's admission electrolytes and notes a serum potassium level of 2.9 mEq/L. Which action by the nurse is correct?

b. Hold the digoxin dose and notify the provider of the patient's lab values. ANS: B Hypokalemia can cause digoxin toxicity, so the nurse should hold the dose and notify the provider. Potassium should never be given as an I.V bolus. Oral supplements are not used when hypokalemia is severe.

A patient with severe head trauma is receiving 3% saline. It has an osmolality of 900 mOsm/kg. This is considered to be what type of solution?

b. Hypertonic

The patient is in the hospital overnight after having surgery and the nurse has received an order to start an I.V of D5 ½ NS. What type of fluid is D5 1/2 NS?

b. Hypertonic

How is the majority of potassium excreted?

b. Kidneys

A patient has been receiving I.V potassium supplements. The nurse notices that the patient's heart rate is now 116 beats/minute. What other symptom(s) might the nurse expect to see if the patient is becoming hyperkalemic? (Select all that apply.)

b. Nausea c. Numbness in extremities

16. The nurse is administering intravenous fluids to a patient who is dehydrated. On the second day of care, the patient's weight is increased by 2.25 pounds. The nurse would expect that the patient's fluid intake has

b. exceeded urine output by 1 L. ANS: B A weight gain of 1 kg, or 2.2 to 2.5 lb, is equivalent to 1 L of fluid.

22. The nurse is caring for a patient who is ordered to take nothing by mouth (NPO).The patient weighs 65 kg. What volume of intravenous fluid should this patient receive in 24 hours?

c. 2520 mL ANS: C Fluid maintenance needs for the NPO patient are calculated as 4 mL/kg/h for the first 10 kg of weight, 2 mL/kg/h for the second 10 kg of weight, and 1 mL/kg/h for every kg of weight thereafter. This patient's fluid needs are (First) 10 kg X 4 mL + (second) 10 kg X 2 mL + (the rest) 45 kg X 1 mL = 105 mL/h The 24-hour total is 105 mL/h X 24 h = 2,520 mL.

The patient has the following lab results: Na+ 150 mEq/L, K+ 4.2 mEq/L, Cl-100 mEq/L, Mg2+ 1.8 mg/dL, PO4 1.9, Ca 2.2 mEq/L abnormality is present?

c. Hypernatremia

1. A patient's serum osmolality is 305 mOsm/kg. Which term describes this patient's body fluid osmolality?

c. Hyperosmolar ANS: C Normal osmolality is 275 to 295 mOsm/kg. This patient is therefore hyper-osmolar.

9. A patient has a serum potassium level of 2.7 mEq/L. The patient's provider has determined that the patient will need 200 mEq of potassium to replace serum losses. How will the nurse caring for this patient expect to administer the potassium?

c. In an intravenous solution at a rate of 10 mEq/h ANS: C Potassium chloride should be given intravenously when hypokalemia is severe, so this patient should receive I.V potassium chloride. (Potassium should never be given as a bolus and should be administered slowly. The maximum infusion rate for adults with a serum potassium level GREATER than 2.5 mEq/L is 10 mEq/h or 200 mEq/24 hours.)

6. The nurse is caring for a patient who has had severe vomiting. The patient's serum sodium level is 130 mEq/L. The nurse will expect the patient's provider to order which treatment?

c. Intravenous normal saline 0.9% ANS: C Patients with hyponatremia may be treated with oral sodium supplements if the patient is able or if the deficit is mild. This patient is vomiting and would not be able to take supplements easily. (For a serum level between 125 and 135 mEq/L, normal saline may increase sodium content in vascular fluid. Hypertonic saline is used for severe hyponatremia with a serum sodium <120 mEq/L. Diuretics would further deplete sodium and fluid volume in a patient already likely to be dehydrated from severe vomiting.)

What is the term used to describe the body fluid when the serum osmolality is 285 mOsm/kg?

c. Isoosmolar

The patient is taking Slow-K. She is also taking hydrochlorothiazide (HCTZ) 50 mg daily to control her hypertension. The patient's serum potassium level is 2.8 mEq/L. What clinical manifestations would the nurse expect to see in this patient?

c. Muscle weakness d. Nausea

12. The provider has ordered Kayexalate and sorbitol to be administered to a patient. The nurse caring for this patient would expect which serum electrolyte values prior to administration of this therapy?

c. Sodium 135 mEq/L and potassium 6.9 mEq/L ANS: C Severe hyperkalemia, with a potassium level of 6.9 mEq/L, requires aggressive treatment with Kayexalate and sorbitol to increase the body's excretion of potassium. (The normal range for serum potassium is 3.5 to 5.5 mEq/L, so patients with the other potassium levels would not be treated aggressively or would need potassium supplementation.)

A patient has been receiving I.V potassium therapy and the nurse notices that the site has become erythematous and edematous. What is the nurse's best action?

d. Discontinue the I.V and restart in another site.

10. A patient is taking a thiazide diuretic and reports anorexia and fatigue. The nurse suspects which electrolyte imbalance in this patient?

d. Hypokalemia ANS: D Thiazide diuretics cause the body to lose potassium. Patients who take thiazide diuretics should be monitored for hypokalemia.

The patient has been diagnosed with hypokalemia and will be admitted to the hospital for I.V potassium replacement. What is the nurse's best action when preparing to give this medication?

d. Obtain an I.V pump and pump tubing since this drip must be controlled.

15. The nurse is caring for a newly admitted patient who will receive digoxin to treat a cardiac dysrhythmia. The patient takes hydrochlorothiazide (HydroDIURIL) and reports regular use of over-the-counter laxatives. Before administering the first dose of digoxin, the nurse will review the patient's electrolytes with careful attention to the levels of which electrolytes?

d. Potassium and magnesium ANS: D Hypomagnesemia, like hypokalemia, enhances the action of digitalis and causes digitalis toxicity. Laxatives and diuretics can deplete both of these electrolytes.

The patient presents to the hospital and is found to be hyperkalemic. What will the nurse anticipate administering?

d. Sodium bicarbonate (systemically lowers potassium because of the inverse relationship between sodium & potassium)

3. A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion?

d. Stabilization of heart rate and blood pressure ANS: D 6% Dextran 75 is a high-molecular-weight colloidal solution and is used to treat shock from hemorrhage, burns, or trauma. (Colloids are plasma expanders, and the end result is an improvement in heart rate [decreased] and blood pressure [increased]. Plasma expanders will result in an increase in urine output. Blood oxygenation is not affected, and colloids do not increase the amount of interstitial fluid.)

8. A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/h. The nurse assuming care for the patient reviews the patient's serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?

d. Stop the intravenous fluids and notify the provider of the assessment findings. ANS: D The patient's potassium level is within normal limits, but the urine output is decreased, so the patient should not be receiving I.V potassium. (The nurse should stop the I.V and report the findings to the provider. The patient does not need an increase in potassium. The patient needs more fluids but not with potassium.)

2. A patient is admitted after experiencing vomiting and diarrhea for several days. The provider orders intravenous lactated Ringer's solution. The nurse understands that this fluid is given for which purpose?

d. To replace water and electrolytes ANS: D Lactated Ringer's solution is an isotonic solution and is used to replace water and electrolytes and is often used to replace G.I losses. (Hypotonic fluids increase interstitial and intracellular hydration. Colloidal solutions are used to maintain plasma volume over time. Hypertonic solutions pull water from the interstitial space into the extracellular fluid.)