Chapter 17
You are caring for a patient with metastatic bone cancer. Which of the following clinical manifestations would alert you to the possibility of hypercalcemia in this patient? A) Weakness B) Paresthesia C) Facial spasms D) Muscle tremors
A
You receive a physician's order to change a patient's IV from D5½ NS with 40 mEq KCl/L to D5NS with 20 mEq KCl/L. Which of the following serum laboratory values, documented on this same patient, best supports the rationale for this IV order change? A) Sodium 136 mEq/L, potassium 4.5 mEq/L B) Sodium 145 mEq/L, potassium 4.8 mEq/L C) Sodium 135 mEq/L, potassium 3.6 mEq/L D) Sodium 144 mEq/L, potassium 3.7 mEq/L
A
Which of the following nursing interventions is most appropriate when caring for a patient with dehydration? A) Auscultate lung sounds q2hr. B) Monitor daily weight and intake and output. C) Monitor diastolic blood pressure for increases. D) Encourage the patient to reduce sodium intake.
B
You are admitting a patient with complaints of abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. You assess this patient for which of the following anticipated primary acid-base imbalances if the obstruction is high in the intestine? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis
B
You are caring for a patient admitted with a diagnosis of COPD who has the following arterial blood gas results: pH 7.33, PaO2 47 mm Hg, PaCO2 60 mm Hg, HCO3 32 mEq/L, and O2 saturation of 92%. Which of the following is the correct interpretation of these results? A) Fully compensated respiratory alkalosis B) Partially compensated respiratory acidosis C) Normal acid-base balance with hypoxemia D) Normal acid-base balance with hypercapnia
B
You are caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. Which of the following classification of medications should you withhold until consulting with the physician? A) Antibiotics B) Loop diuretics C) Bronchodilators D) Antihypertensives
B
While performing patient teaching regarding hypercalcemia, which of the following statements are appropriate (select all that apply)? A) Have patient restrict fluid intake to less than 2000 ml/day. B) Renal calculi may occur as a complication of hypercalcemia. C) Weight-bearing exercises can help keep calcium in the bones. D) The patient should increase daily fluid intake to 3000 to 4000 ml. E) Treatment of heartburn can best be managed with Tums on a prn basis.
B,C,D
Metabolic alkalosis and vomiting
Because gastric secretions are rich in hydrochloric acid, the patient who is vomiting will lose a significant amount of gastric acid and be at an increased risk for metabolic alkalosis.
When planning care for adult patients, you conclude that which of the following oral intakes is adequate to meet daily fluid needs of a stable patient? A) 500 to 1500 ml B) 1200 to 2200 ml C) 2000 to 3000 ml D) 3000 to 4000 ml
C
You are caring for a patient receiving D5W at a rate of 125 ml/hr. During the 4:00 pm assessment of the patient, you determine that 500 ml is left in the present IV bag. At which of the following times should the nurse anticipate hanging the next bag of D5W? A) 6:00 pm B) 7:00 pm C) 8:00 pm D) 10:00 pm
C
You must prepare the correct IV solution before administration. The order reads for the patient to receive D5½ NS with 40 mEq KCl/L at 125 ml/hr. You must add KCl to the IV because no premixed solutions are available. The unit medication supply has a stock of KCl 3 mEq/ml in multidose vials. Which of the following amounts of KCl should you add to a liter of D5½ NS to obtain the correct solution? A) 10 ml B) 7.5 ml C) 13.3 ml D) 15 ml
C
Calcium and phosphorus
Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa.
During the postoperative caree of a 76-year-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because a. older adults have an impaired thirst mechanism and need reminding to drink fluids b. water accunts for a greater percentage of body weight in the older adult than in younger adults c. older adults are more likely than younger adults to lose extracellular fluid during surgical procedures d. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults
D
When assessing a patient admitted with nausea and vomiting, which of the following findings supports the nursing diagnosis of deficient fluid volume? A) Polyuria B) Decreased pulse C) Difficulty breathing D) General restlessness
D
You are caring for a patient admitted with diabetes mellitus, malnutrition, and massive GI bleed. In analyzing the morning lab results, the nurse understands that a potassium level of 5.5 mEq/L could be caused by which of the following factors in this patient (select all that apply)? A) The potassium level may be increased if the patient has renal nephropathy. B) The patient may be excreting extra sodium and retaining potassium because of malnutrition. C) The potassium level may be increased as a result of dehydration that accompanies high blood glucose levels. D) There may be excess potassium being released into the blood as a result of massive transfusion of stored hemolyzed blood.
a,c,d
A patient is receiving a loop diuretic. The nurse should be alert for which symptoms? a. reslessness and agitation b. paresthesias and irritability c. weak, irregular pulse and poor muscle tone d. increased blood pressure and muscle spasms
c
It is especially importatnt for the nurse to assess for which clinical manifestation(s) in a patient who has just undergone a total thyroidectomy? a. weight gain b. depressed reflexes c. positive Chvostek's sign d. confusion and personality changes
c
The typical fluid replacement for the patient with a fluid volume deficit is a. dextran b. 0.45% saline c. Lactated ringer's d. 5% dextrose in 0.45% saline
c
What patient would be at greatest risk for the potential development of hypermagnesmia? a. 83-year-old man with lung cancer and hypertension b. 65-year-old women with hypertension taking beta-adrenergic blockers c. 42-year-old woment with systemic lupis erythematosus and renal failure d. 50-year-old man with benign prostatic hyperplasia and a urinary tract infection
c
A patient has the following arterial blood gas results: pH 7.52; PaCO2 30 mm Hg; HCO3- 24 mEq/L. The nurse determins that these results indicate
d
The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to a. apply warm moist compresses to the insertion site b. attempt to force 10 mL of normal saline into the device c. place the patient on the left side with head-down position d. instruct the patient to change positions, raise arm, and cough
d
Hyperkalemia may result from
hyperglycemia, renal insufficiency, and/or cell death. Diabetes mellitus, along with the stress of hospitalization and illness, can lead to hyperglycemia. Renal insufficiency is a complication of diabetes. Malnutrition does not cause sodium excretion accompanied by potassium retention; thus it is not a contributing factor to this patient's potassium level. Stored hemolyzed blood can cause hyperkalemia when large amounts are transfused rapidly.
Signs of hypercalcemia are
lethargy, headache, weakness, muscle flaccidity, heart block, anorexia, nausea, and vomiting.
In dehydration, fluid is lost first from
the blood vessels. To compensate, fluid moves out of the interstitial spaces into the blood vessels to restore circulating volume in that compartment. As the interstitial spaces then become volume depleted, fluid moves out of the cells into the interstitial spaces.
If a hypertonic IV solution is administered, the mechanism involved in equalizing the fluid concentration between the ECF and the cells is a. osmosis b. diffusion c. active transport d. facilitated diffusion
a
Implementation of nursing care for the paitnent with hyponatremia incluides a. fluid restriction b. administration of hypotonic fluids c. administration of a cation-exchange resin d. increase water intake for patients on nasogastric suction
a
Phosphorus levels
2.4-4.4 mg/dl
HCO3 levels
22 to 26
PaCO2 levels
38 to 48 mm Hg
Which of the following serum potassium results best supports the rationale for administering a stat dose of potassium chloride 20 mEq in 250 ml of NSS over 2 hours? A) 3.1 mEq/L B) 3.9 mEq/L C) 4.6 mEq/L D) 5.3 mEq/L
A
You are caring for a patient admitted with an exacerbation of asthma. After several treatments, the ABG results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, O2 saturation 99%. You interpret these results as which of the following? A) Within normal limits B) Slight metabolic acidosis C) Slight respiratory acidosis D) Slight respiratory alkalosis
A
When planning care for a patient with dehydration related to nausea and vomiting, the nurse would anticipate which of the following fluid shifts to occur because of the fluid volume deficit? A) Fluid movement from the blood vessels into the cells B) Fluid movement from the interstitial spaces into the cells C) Fluid movement from the blood vessels into interstitial spaces D) Fluid movement from the interstitial space into the blood vessels
D
When planning the care of a patient with dehydration, you would instruct the nursing assistive personnel (NAP) to report which of the following? A) 60 ml urine output in 90 minutes B) 1200 ml urine output in 24 hours C) 300 ml urine output per 8-hour shift D) 20 ml urine output for 2 consecutive hours
D
You are caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which of the following serum laboratory results would you identify 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
You are caring for an elderly patient who is receiving IV fluids postoperatively. During the 8:00 am assessment of this patient, you note that the IV solution, which was ordered to infuse at 125 ml/hr, has infused 950 ml since it was hung at 4:00 am. Which of the following is the priority nursing intervention? A) Notify the physician and complete an incident report. B) Slow the rate to keep vein open until next bag is due at noon. C) Obtain a new bag of IV solution to maintain patency of the site. D) Listen to the patient's lung sounds and assess respiratory status
D
The lungs act as an acid-base buffer by a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load d. decreasing respiratory rate and dpeth when CO2 levels in the blood are low, increasing acid load
a
The nurse anticipates that the patient with hyperphosphatemia secondary to renal failure will require a. calcium supplements b. potassium supplements c. magnesium supplements d. fluid replacement therapy
a
an elderly women was admitted to the medical unit with dehydration. A clinical indication of this problem is a. weight loss b. full bounding pulse c. engorged neck veins d. Kussmal respirations
a
The minimal urine output necessary to maintain kidney function is
The minimal urine output necessary to maintain kidney function is 30 ml/hr
Loop Diuretics and potassium and sodium
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 physician should be consulted for potassium replacement therapy, and the drug should be withheld until the potassium has returned to normal range.
symptoms of hypocalcemia
Paresthesia, facial spasms, and muscle tremors
Restlessness and dehydration
Restlessness is an early cerebral sign that dehydration has progressed to the point where an intracellular fluid shift is occurring. If the dehydration is left untreated, cerebral signs could progress to confusion and later coma.
