Chapter 8: Fluid and Electrolyte Management + Chapter 44: Diabetic Emergencies Questions & Answers

The nurse is screening patients for their risk of developing hyperkalemia. The nurse should consider the patient with which disorder at greatest risk? A. End-stage renal disease B. Diabetic mellitus C. Partial thickness burns D. Receiving a loop diuretic

Answer: A. End-stage renal disease Rationale: End-stage renal patients are not able to excrete potassium through the renal system, increasing the risk for developing hyperkalemia.

Upon assessment, a patient has Trousseau and Chvostek signs. Which electrolyte abnormality does this indicate? A. Hypocalcemia B. Hypercalcemia C. Hyperkalemia D. Hypokalemia

Answer: A. Hypocalcemia Rationale: Trousseau and Chvostek signs indicate low calcium, or hypocalcemia. They are not associated with hypercalcemia or with an imbalance of potassium.

A patient is ordered potassium replacement for a potassium level of 3.2 mEq/dL. What is the best way to administer this medication? A. Crushed and added to applesauce B. Whole pill by mouth C. Intravenous push D. Subcutaneous

Answer: B. Whole pill by mouth Rationale: Potassium can be given whole by mouth or via intravenous infusion. It should never be pushed or crushed, and it is not available subcutaneously.

The nurse has received a report on assigned patients and receives the following laboratory results. Place the patients in the order they should be seen by the nurse. A. Patient with heart failure receiving furosemide (Lasix) with a serum potassium level of 5.5 mEq/L B. Patient who had a total abdominal hysterectomy with a hemoglobin of 11.8 g/dL and hematocrit of 36.2% C. A postoperative patient receiving D5W with a serum sodium level of 125 mEq/L

Answer: C, A, B Rationale: The patient with a low serum sodium level, normal range 135 to 145 mEq/L, is at risk for developing neurological symptoms including seizures; a serum potassium level of 5.5 mEq/L is elevated, placing the patient at risk for cardiac dysrhythmias; the hemoglobin and hematocrit are low—female normal ranges 12 to 16 gm/38 to 46%.

The nurse has just received a report on assigned patients. Which patient should be assessed first? A. A patient with abdominal pain who has drained 400 mL from her nasogastric tube over 6 hours B. A patient postoperative total hip replacement 2 hours ago with 600-mL urine output C. A patient receiving an IV infusion of 0.9% NS at 125 mL/hr who is now complaining of a cough D. A patient complaining of leg cramps after receiving furosemide (Lasix) for peripheral edema

Answer: C. A patient receiving an IV infusion of 0.9% NS at 125 mL/hr who is now complaining of a cough Rationale: Development of a cough in a patient receiving intravenous fluid can indicate the development of fluid volume excess.

A patient has a sodium level of 124 mEq/dL. Which assessment finding is expected? A. Cardiac arrhythmias B. Pressured speech C. Confusion D. Petechiae

Answer: C. Confusion Rationale: When the sodium level is outside of normal limits, look for neurologic side effects, such as lethargy, confusion, dizziness, or seizures. Cardiac arrhythmias, pressured speech, and petechiae would not be expected.

What is the difference between crystalloids and colloids? A. Crystalloids are thicker and more viscous, and colloids are clear fluids. B. Crystalloids are used to correct sodium levels, and colloids are used to correct potassium levels. C. Crystalloids are clear fluids, and colloids are thicker and more viscous. D. Crystalloids are used to correct potassium levels, and colloids are used to correct sodium levels.

Answer: C. Crystalloids are clear fluids, and colloids are thicker and more viscous. Rationale: Crystalloids are crystal clear intravenous fluids while colloids are more viscous, such as albumin and blood products. Neither product completely addresses electrolyte abnormalities or adds electrolytes to the blood.

The nurse monitors for which clinical manifestations in the patient diagnosed with hyponatremia? A. Irregular heart rate, leg cramps, confusion B. Weakness, tachycardia, tingling of the skin C. Headache, nausea, change in level of consciousness D. Bradycardia, hypotension, muscle weakness

Answer: C. Headache, nausea, change in level of consciousness Rationale: Headache, nausea, and changes in level of consciousness occur secondary to the shift of fluid into the cells of the brain, increasing intracranial pressure.

The nurse should intervene immediately if a patient has which blood glucose level? A.200 mg/dL B.152 mg/dL C.80 mg/dL D.40 mg/dL

Answer: D. 40 mg/dL Rationale: As the brain can only use glucose for its metabolic functions, a glucose of 40 requires immediate treatment to avoid potential irreversible CNS dysfunction.

A patient has been admitted to the critical unit with a serum magnesium level of 0.9 mEq/L. The nurse closely monitors the patient for which potential complication of this magnesium level? A. Agitation and restlessness B. Hypotension and bradycardia C. Deep, rapid respirations D. Seizure and ventricular fibrillation

Answer: D. Seizure and ventricular fibrillation Rationale: Patients with low magnesium levels are at risk for seizure and ventricular fibrillation. Agitation and restlessness are seen with hypernatremia. Hypotension and bradycardia are associated with high magnesium levels, and deep, rapid respirations are observed with patients with hypochloremia.

The nurse correlates which laboratory values as a diagnostic for DKA? (Select all that apply.) A.Serum bicarbonate of 18 mEq/L B.Negative anion gap C.Serum glucose of 350 mg/dL D.Positive anion gap E.Arterial pH of 7.36

Answer:A, C, and D A.Serum bicarbonate of 18 mEq/L C.Serum glucose of 350 mg/dL D.Positive anion gap Rationale: In diabetic ketoacidosis, there is inadequate insulin for cells to obtain adequate glucose for normal metabolism. The body attempts to obtain energy by the rapid breakdown of fat stores, releasing fatty acids from adipose tissues. The liver converts the fatty acids into ketone bodies, which can serve as an energy source in the absence of glucose. The ketone bodies, however, have a low pH, resulting in a metabolic acidosis, a low serum bicarbonate, and a positive anion gap. The absence of insulin also results in an increased release of hormones such as glucagon and cortisol in response to inadequate glucose transport into the cells. This leads to gluconeogenesis and glycogenolysis, resulting in severe hyperglycemia.

Pediatric Vitals: 0-12

HR - 100 to 160 RR 0-6mo - 30 to 60 6-12 mo - 24-30 BP 0-6mo - 65-95 /45-60 6-12mo - 80-100 / 55-65

Which intravenous (IV) solution is expected for a patient with cerebral edema? A. Normal saline B. ½ normal saline C. D5 normal saline D. 3% saline

Rationale: Hypertonic solutions such as 3% saline pull water from in the cell into the extracellular fluid. These are useful in cases of severe hyponatremia and severe edema, specifically cerebral edema.