Chapter 16 - Electrolyte Balance and Imbalance

For which clinical manifestations would the nurse monitor a patient with a serum calcium level of 11.2 mg/dL? Select all that apply. a) Polyuria b) Hypotension c) Nephrolithiasis d) Chvostek's Sign e) Trousseau's Sign

A - C --> Plasma concentration of calcium greater than 10.2 mg/dL indicates hypercalcemia, which results in increased concentration of calcium in the urine. This impairs sodium and water reabsorption and causes polyuria. Hypercalcemia can cause kidney stones, or nephrolithiasis, because an increased concentration of calcium in the urine deposits crystals in the kidney, which combine to form kidney stones. Hypotension, Chvostek's sign, and Trousseau's sign are clinical manifestations of hypocalcemia.

A patient's potassium level is 2.9 meq/L. Which health care provider order should the nurse expect? a) Continuous ECG monitoring b) Increase digoxin (Lanoxin) to 0.25 mg every day c) Add 20 mEq KCL to the present IV bag hanging and give over four hours d) 40 mEq KCL in 100 cc D5W intravenous piggyback (IVPB) to infuse over 30 minutes

A --> Hypokalemia can cause lethal ventricular rhythms. Therefore continuous cardiac monitoring should be expected. Patients with hypokalemia are at risk for digoxin toxicity. The nurse should watch for signs of digoxin toxicity and question an increase in dosage. KCL infusion must be diluted and given at a rate not to exceed 10 meq/hour. 40 meq KCL in 100 cc of fluid is too concentrated and should be given over at least two hours. To prevent bolusing, KCL should never be added to an IV bag that already is hanging.

To prevent a recurrence of hypocalcemia, the nurse should encourage the patient to increase intake of which of foods? a) Fish b) Lean meat c) Dairy Products d) Potatoes and Starches

C --> Dairy products, including milk, cheese, and yogurt, are rich in calcium and can help correct hypocalcemia. Lean meat, potatoes, and fish may have calcium; however, dairy products have the highest content of calcium of the foods listed.

Upon assessment of laboratory data, the nurse notes a calcium level of 6.4 mg/dL. Which physical assessment finding is consistent with this data? a) Polyuria b) Bone pain c) Paresthesias d) Diminished deep tendon reflexes

C --> Signs of hypocalcemia include paresthesias, tetany, and muscle weakness. Bone pain, diminished reflexes, and polyuria are signs of hypercalcemia.

Which assessment finding is consistent with a phosphate level of 1.8 mg/dL? a) Tetany b) Diarrhea c) Weakness d) Muscle Cramps

C --> Signs of hypophosphatemia include weakness, confusion, coma, and diminished reflexes. Tetany and muscle cramps are manifestations of hyperphosphatemia. Diarrhea is commonly seen with sodium and potassium imbalances.

The nurse is providing education for a patient regarding hypercalcemia. What statements made by the patient would indicate understanding of the education by the nurse? Select all that apply. a) "I can use Tums as needed for heartburn." b) "I will restrict fluid intake to less than 2000 mL/day." c) "i will increase daily fluid intake to 3000 to 4000 mL." d) Renal calculi may occur as a complication of hypercalcemia." e) "weight-bearing exercises can help keep calcium in the bones."

C-D-E --> A daily fluid intake of 3000 to 4000 mL is necessary to enhance calcium excretion and prevent the formation of renal calculi, a potential complication of hypercalcemia. Weight-bearing exercise does enhance bone mineralization. Tums are a calcium-based antacid that should not be used in patients with hypercalcemia.

The nurse is caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would be identified as an adverse effect related to this therapy? a) Sodium falling to 138 mEq/L b) Potassium rising to 4.1 mEq/L c) Magnesium rising to 2.9 mg/dL d) Phosphorus falling to 2.1 mg/dL

D --> Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa. Because hypercalcemia rarely occurs as a result of calcium intake, the patient's phosphorus falling to 2.1 mg/dL (normal 2.4-4.4 mg/dL) may be a result of the phosphate-binding effect of calcium carbonate. Sodium falling, potassium rising, and magnesium rising are not adverse reactions to the treatment.

The nurse is preparing to administer intravenous (IV) potassium chloride (KCl) to a patient. Which action should the nurse perform to ensure the patient's safety? a) Give KCl via IV push. b) Add KCl to the hanging IV bag. c) Give IV KCl in concentrated amounts. d) Invert IV bags containing KCl several times.

D --> Hypokalemia is characterized by a decreased concentration of potassium in the body. Therefore KCl should be administered to maintain normal potassium levels. Inverting the IV bags containing KCl several times ensures even distribution of KCl medication in the bag. The nurse should administer KCl through an infusion pump, not by IV push, to ensure that it is administered at an accurate rate. The nurse should not add KCl to the hanging IV bag because this would result in administering a bolus dose. The nurse will give IV KCl in diluted forms, rather than in concentrated amounts, to ensure the patient's safety.

The patient has a one-time prescription for potassium chloride 20 mEq in 250 mL of normal saline intravenous (IV) to be given immediately. The nurse would seek clarification for this prescription if the patient's more recent potassium level is at what level? a) 1.7 mEq/L b) 2.9 mEq/L c) 3.6 mEq/L d) 4.5 mEq/L

D --> The normal range for serum potassium is 3.5 to 5 mEq/L. The IV prescription provides a substantial amount of potassium, so the patient's potassium level must be low. A level of 4.5 mEq/L would not warrant this medication.

The primary health care provider has prescribed parenteral nutrition for a patient. The nurse administers a 10% dextrose solution with amino acids, electrolytes, vitamins, and trace elements. What does the nurse need to know regarding the 10% dextrose solution? a) It is a hypertonic solution. b) It is used as a plasma expander. c) It expands the extracellular compartment. d) It should be administered only through a central line.

A --> A 10% dextrose solution with amino acids, electrolytes, vitamins, and trace elements is used in parenteral nutrition to provide additional calories. It is a hypertonic solution, which provides free water, expanding both the extracellular and intracellular compartments. Solutions with a dextrose concentration of 10% or more should be administered only through a peripheral line. Solutions with a higher dextrose concentration should be administered through a central line. Hypertonic solutions are not used as plasma expanders because they do not stay in the vascular space.

Which is a priority nursing action when providing care to a patient who is being treated for hypernatremia that developed slowly over several days? a) initiating seizure precautions b) administering prescribed diuretics c) monitoring the patient's weight each day d) restricting the patient's dietary sodium intake

A --> A rapid reduction in the sodium level can cause a rapid shift of water back into the cells, resulting in cerebral edema and neurologic complications. This risk is greatest in a patient who developed hypernatremia over several days or longer. The priority nursing action in this case is to implement seizure precautions due to the risk of neurologic complications. Monitoring the patient's weight each day, restricting dietary sodium intake, and administering prescribed diuretics are all appropriate nursing actions; however, these are not the priority given this patient's risk for neurologic complications.

A patient has a prescription to receive D5W with 20 mEq KCl/L at 100 mL/hour. The nurse should select which solution from the intravenous supply cart? a) 5% dextrose in water with 20 mEq of KCl b) 5% dextrose in 0.9% sodium chloride with 20 mEq of KCl c) 5% dextrose lactated Ringer's solution with 20 mEq of KCl d) 5% dextrose in 0.45% sodium chloride with 20 mEq of KCl

A --> D5W stands for 5% dextrose in water, which is different than normal saline, half normal saline, or lactated Ringer's.

A patient has low levels of parathyroid hormone. What other laboratory finding does the nurse expect in the patient? a) decreased calcium levels b) increased potassium levels c) decreased phosphate levels d) increased magnesium levels

A --> Low levels of parathyroid hormone cause hypocalcemia, or decreased calcium levels, because of reduced renal activity, which limits calcium absorption. The nurse would suspect increased potassium levels with hyperkalemia if the patient had adrenal insufficiency. Hypoparathyroidism causes hyperphosphatemia because of impaired renal phosphate excretion. Hypoparathyroidism can result in magnesium deficiency.

The nurse has been administering magnesium sulphate I.V. to a patient with preeclampsia. When observing signs of toxicity, what medication should the nurse administer to counter the effects of the magnesium? a) Intravenous calcium chloride b) Intravenous magnesium sulfate c) Intravenous potassium chloride d) Intravenous 3% sodium chloride

A --> Magnesium toxicity can be treated by administering intravenous calcium chloride to antagonize the effects of magnesium on the cardiac muscles. Intravenous magnesium sulfate can further increase magnesium toxicity. Intravenous potassium chloride is used to treat hypokalemia, but it does not reverse magnesium toxicity. A solution of 3% intravenous sodium chloride is used to treat hyponatremia.

The nurse is preparing to administer a dose of potassium phosphate. What laboratory finding would indicate that the nurse should withhold the medication? a) Calcium 6.4 mg/dL b) Sodium 133 mEq/L c) Magnesium 1.8 mEq/L d) Potassium 5.2 mEq/L

A --> Phosphorus and calcium have inverse or reciprocal relationships, meaning that when calcium levels are high, phosphorus levels tend to be low. Therefore administration of phosphorus will reduce a patient's already abnormally low calcium level, which can result in life-threatening complications. Potassium phosphate will not have any effect on sodium, magnesium, or potassium levels.

The nurse is caring for a patient and observes with a serum potassium of 2.8 mEq/L. What is the greatest risk for this patient that the nurse should monitor for? a) Dysrhythmias b) Acute renal failure c) Metabolic alkalosis d) Malignant hypertension

A --> Potassium exerts a direct effect on the excitability of cardiac muscle tissue. Therefore an increased or low serum level of potassium can alter cardiac function and heart rhythm, resulting in dysrhythmias. Acute renal failure is not a complication of hypokalemia, but it may be seen with hyperkalemia. Metabolic alkalosis and malignant hypertension are not associated with hypokalemia.

The nurse is reviewing the serum potassium results for a patient. What level best supports the rationale for administering a stat dose of potassium chloride 20 mEq in 250 mL of normal saline over two hours? a) 3.1 mEq/L b) 3.9 mEq/L c) 4.6 mEq/L d) 5.3 mEq/L

A --> The normal range for serum potassium is 3.5 to 5.0 mEq/L. This intravenous (IV) prescription provides a substantial amount of potassium. Thus the patient's potassium level must be low. The only low value shown is 3.1 mEq/L; 3.9 mEq/L, 4.6 mEq/L, and 5.3 mEq/L are not low values.

The nurse assesses the present of Trousseau's sign in a patient that had an inadvertent removal of the parathyroids during a thyroidectomy. What electrolyte disturbance should the nurse check the laboratory studies for? a) Hypocalcemia b) Hypercalcemia c) Hypermagnesemia d) Hyperphosphatemia

A --> Trousseau's sign refers to carpal spasms induced by inflating a blood pressure cuff on the arm. Hypocalcemia can be identified by Trousseau's sign. Hypercalcemia, hypermagnesemia, and hyperphosphatemia cannot be identified by Trousseau's sign.

Which clinical manifestations should the nurse anticipate when providing care to a patient with a diagnosis of hyperkalemia? Select all that apply. a) 1+ deep tendon reflexes b) Rapid and shallow respirations c) Serum blood glucose level of 250 mg/dL d) Numbness and tingling in the hands and feet e) Ventricular fibrillation noted on the electrocardiogram

A-D-E --> Clinical manifestations of hyperkalemia include decreased reflexes, paresthesia, and an irregular pulse. These are manifested in 1+ deep tendon reflexes, numbness and tingling in the hands and feet, and ventricular fibrillation noted on an electrocardiogram, respectively. Rapid and shallow respirations and hyperglycemia (serum blood glucose of 250 mg/dL) would be anticipated when providing care to a patient with hypokalemia, not hyperkalemia.

The nurse suspects which possible conditions in a patient whose serum potassium level is 6.8 mEq/L on admission? Select all that apply. a) The patient is on insulin therapy. b) The patient is taking amiloride daily. c) The patient suffers from renal disease. d) The patient's electrocardiogram reveals flattened T waves. e) The patient's orders will include intravenous fluids with added potassium.

B - C --> Potassium levels greater than 5.0 mEq/mL indicated hyperkalemia. Potassium-sparing diuretics, such as amiloride, increase the potassium levels. The kidneys excrete potassium, so renal disease can also lead to increased potassium levels. Insulin moves potassium into the cell and decreases serum potassium values. Hyperkalemia is manifested on an electrocardiogram as tall, peaked T waves, not flattened T waves. Potassium should not be added to IV fluids if the patient is already suffering from hyperkalemia.

Which clinical manifestation would the nurse expect to see when assessing a client with hypocalcemia? a) Shortened ST segment b) Prolonged QT segment c) Ventricular Dysrhythmias d) Increase Digitalis effects

B --> A prolonged QT segment is a clinical manifestation the nurse should expect to see when assessing a client with hypocalcemia. A shortened ST segment, ventricular dysrhythmias, and increased digitalis effects are anticipated when assessing a client with hypercalcemia.

The nurse is caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. What classification of medications should be withheld until consulting with the health care provider? a) Antibiotics b) Loop Diuretics c) Bronchodilators d) Antihypertensives

B --> Loop diuretics are contraindicated during episodes of hypokalemia because these medications cause the kidneys to excrete sodium and potassium. Thus administration of this type of medication at this time would worsen the hypokalemia, putting the patient at risk for dysrhythmias. The prescribing health care provider should be consulted for potassium replacement therapy, and the drug should be withheld until the potassium has returned to normal range. Antibiotics, bronchodilators, and antihypertensives are not an issue in this case.

The nurse is caring for a patient with hyponatremia associated with heart failure and liver cirrhosis. What drug does the nurse anticipate administering to treat this patient? a) amiloride b) tolvaptan c) kayexalate d) pamidronate

B --> Tolvaptan is used to treat hyponatremia associated with heart failure and liver cirrhosis. It acts by blocking the activity of antidiuretic hormone. Amiloride is a potassium-sparing diuretic that is not effective in treating hyponatremia. Kayexalate is an ion-exchange resin used to treat hyperkalemia. Pamidronate is used to treat hypercalcemia.

The nurse is caring for a group of patients with a variety of diagnoses. Which conditions would cause the nurse to include interventions in the plan of care to address anticipated hypophosphatemia? Select all that apply. a) Renal failure b) Respiratory alkalosis c) Diabetic ketoacidosis d) Tumor lysis syndrome e) Malabsorption syndrome

B-C-E --> The nurse would include interventions to address hypophosphatemia when providing care to patients with respiratory alkalosis, diabetic ketoacidosis, and malabsorption syndrome. The nurse should create a care plan for hyperphosphatemia when providing care to patients with renal failure and tumor lysis syndrome.

A patient is receiving a potassium-sparing diuretic. The nurse should assess for which manifestations during this therapy? Select all that apply. a) Hyperglycemia b) Anxiety and irritability c) Tall, peaked T wave on ECG d) Presence of U wave e) Abdominal cramping and diarrhea f) Paresthesias and weakness of lower extremities

B-C-E-F --> Potassium-sparing diuretics may result in renal retention of potassium (i.e., hyperkalemia). Clinical manifestations of hyperkalemia include irritability, anxiety, abdominal cramping, diarrhea, weakness of lower extremities, paresthesias, and several ECG changes, including tall, peaked T waves. Hyperglycemia and presence of U wave reflect manifestations of hypokalemia.

Which electrolyte imbalance would prompt the nurse to instruct a patient to consume more dairy products in their diet? Select all that apply. a) Hyperkalemia b) Hypocalcemia c) Hypercalcemia d) Hypophosphatemia e) Hyperphosphatemia

B-D --> Hypocalcemia is decreased calcium levels, which can be alleviated by the consumption of dairy products. Hypophosphatemia is decreased levels of phosphates in the body, which also can be alleviated through the consumption of dairy products, because they are rich in phosphates. Patients with hyperkalemia, hypercalcemia, and hyperphosphatemia are instructed to avoid dairy products.

It is especially important for the nurse to assess for which clinical manifestation(s) in a patient with primary hypoparathyroidism? Select all that apply. a) Anorexia b) Easy fatigability c) Depressed reflexes d) Circumoral numbness e) Positive Trousseau's sign

B-D-E --> Primary hypoparathyroidism can result in a lack of parathyroid hormone, leading to hypocalcemia. Manifestations of low serum calcium levels include easy fatigability, depression, anxiety, confusion, numbness and tingling in extremities and the region around the mouth, hyperreflexia, muscle cramps, positive Chvostek's and Trousseau's signs, and others. Anorexia and depressed reflexes are manifestations of hypercalcemia.

The nurse is caring for a patient with sickle cell anemia. What common electrolyte imbalance should the nurse carefully assess the patient for that is commonly associated with this disease? a) Increased calcium levels b) Increased potassium levels c) Increased phosphate levels d) Increased magnesium levels

C --> Sickle cell anemia leads to increased concentration of phosphates in the body, thus causing hyperphosphatemia. Hypercalcemia, or increased calcium levels, is associated with hyperparathyroidism. Hyperkalemia, or increased potassium levels, is associated with tumor-lysis syndrome. Hypermagnesemia, or increased magnesium levels, is associated with diabetic ketoacidosis.

The nurse is caring for a patient that has a nasogastric tube (NGT) on intermittent suction. The patient asks why they cannot have something to drink. What is the best response by the nurse? a) "It will cause sodium retention." b) "It will disrupt the intermittent suction." c) "It will increase nausea and vomiting." d) "It will increase the loss of electrolytes."

D --> Allowing a patient with an NGT to drink water increases the loss of electrolytes. It will not cause sodium retention, but sodium depletion. The free water will pull electrolytes into the stomach and the NGT will suck the fluids and electrolytes out of the stomach. Depending on the patient's condition and amount of water being ingested, it may increase nausea and vomiting. However, this would most likely happen if the suction was not working properly; it is not the primary reason for withholding oral fluids. Oral intake of water would not disrupt the intermittent suction.

The nurse is caring for a patient with a blood sodium level of 170 mEq/L and is experiencing intense thirst, agitation, and decreased alertness. What does the nurse anticipate administering? a) Intravenous furosemide b) Intravenous cation-exchange resin c) Intravenous phosphate-binding agent d) Intravenous 0.45% sodium chloride saline solution

D --> Hypernatremia is a condition in which water shifts out of the cells into the extracellular fluid, resulting in dehydration. Therefore the patient with hypernatremia would experience intense thirst, agitation, and decreased alertness. To reduce dehydration, fluid should be replaced by administering hypotonic intravenous fluids such as 5% dextrose in water or 0.45% sodium chloride saline solution. Administering intravenous furosemide may help treat hypercalcemia. A cation-exchange resin may be administered to treat hyperkalemia. A phosphate-binding agent may be administered to treat hyperphosphatemia.