Chapter 8: Fluid and Electrolyte Management QUESTIONS

20. The nurse is caring for a patient with a potassium level of 5.9 mEq/L. The healthcare provider prescribes both glucose and insulin for the patient. The patient's spouse asks, "Why is insulin needed?" Which response by the nurse is the most appropriate? "The insulin will help his kidneys excrete the extra potassium." "The insulin is safer than other medications that can lower potassium levels." "The insulin lowers his blood sugar levels, and this is how the extra potassium is excreted." "The insulin will cause his extra potassium to move into his cells, which will lower potassium in the blood."

"The insulin will cause his extra potassium to move into his cells, which will lower potassium in the blood." Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells.

3. The nurse plans care for a hospitalized patient. Which data necessitate the inclusion of interventions to address a fluid volume deficit? 1. Urine output of 30 mL/hour 2. Heart rate of 110 bpm 3. Weight gain of 10 pounds in 3 days 4. Plus-3 edema in bilateral lower extremities

2. Heart rate of 110 bpm An increased heart rate is indicative of a fluid volume deficit.

10. The nurse provides care to a patient whose serum potassium level is 3.2 mEq/L. Which healthcare provider order does the nurse question based on this data? 1. Serum chemistries (basic metabolic panel) every morning 2. Continuous cardiac monitoring 3. 10 mEq KCl (potassium chloride) in 100 mL normal saline slow IVP (intravenouspyelogram) 4. 25 mg spironolactone (Aldactone) by mouth daily

3. 10 mEq KCl (potassium chloride) in 100 mL normal saline slow IVP (intravenouspyelogram) Although this is an appropriate dose of KCl, it is never given by intravenous pyelogram (IVP). The nurse questions this order.

18. The nurse is providing care to a patient who is prescribed furosemide for treatment of congestive heart failure (CHF). The patient's serum potassium level is 3.4 mEq/L. Which food should the nurse encourage the patient to eat based on this data? 1. Peas 2. Iced tea 3. Bananas 4. Baked fish

3. Bananas A potassium level of 3.4 is low, so the client should be encouraged to consume potassium-rich foods. Of the foods listed, the highest in potassium is banana

6. The nurse provides care to a patient who is prescribed 0.45% normal saline (NS) by intravenous (IV) infusion. Which data cause the nurse to question the healthcare provider regarding this IV fluid order? Urine output 40 mL/hour Blood pressure 100/60 mm Hg Respiratory rate 12 breaths/min Serum sodium level of 145 mEq/L

Blood pressure 100/60 mm Hg Hypotonic IV fluid, such as 0.45% normal saline (NS), shifts fluid out of the vessels and into the cells. Because of this fluid shift, hypotension may be worsened. Therefore, the patient's blood pressure causes the nurse to question the healthcare provider about this prescription. This may cause hyponatremia to occur. The patient's serum sodium level is on the high end of normal; therefore, this data does not cause the nurse to question this prescription. A low-serum-sodium level would necessitate the nurse to question this order.

22. The nurse monitors for which clinical manifestations in the patient admitted with hypermagnesemia? Elevated blood pressure Bradycardia Increased deep tendon reflexes Hyperventilation

Bradycardia Cardiac symptoms in hypermagnesemia include hypotension caused by vasodilation and dysrhythmias such as bradycardia, atrial fibrillation, and intraventricular conduction delays exhibited by widening of the QRS complexes. Central nervous system clinical manifestations include drowsiness, lethargy, muscle weakness, loss of deep tendon reflexes, paralysis, and coma. Respiratory signs include a decrease in respiratory rate that can lead to complete respiratory suppression.

14. The nurse is caring for a patient with congestive heart failure who is admitted to the medical- surgical unit with acute hypokalemia. Which prescribed medication may have contributed to the patient's current hypokalemic state? Cortisol Oxycodone Flexeril Nonsteroidal anti-inflammatory drugs (NSAIDs)

Cortisol Excess potassium loss through the kidneys is often caused by such medications as corticosteroids, potassium-wasting (loop) diuretics, amphotericin B, and large doses of some antibiotics. Cortisol is a type of corticosteroid and can cause hypokalemia.

26. The nurse recognizes which clinical manifestations as age-related changes that may impact fluid and electrolyte in the older adult? Select all that apply. Increased salivation Increased urine output Decreased sense of smell Decreased visual acuity Changes in taste sensation

Decreased sense of smell Changes in taste sensation

12. The nurse is providing care to a patient who seeks emergency treatment for headache and nausea. The patient works in a mill without air conditioning. The patient states, "I drink water several times each day, but I seem to sweat more than I am able to replace." Which suggestions does the nurse provide to this patient? Drink juices and carbonated sodas. Eat something salty when drinking water. Eat something sweet when drinking water. Double the amount of water being ingested.

Eat something salty when drinking water. Both salt and water are lost through sweating. When only water is replaced, the individual is at risk for salt depletion. Clinical manifestations include fatigue, weakness, headache, and gastrointestinal symptoms such as loss of appetite and nausea. The patient should be instructed to eat something salty when drinking water to help replace the loss of sodium.

9. The nurse is providing care to an older adult patient who is receiving intravenous (IV) fluids at 150 mL/hour. It is important that the nurse assess for which clinical manifestations that could indicate fluid volume excess in this patient? Flattened neck veins Elevated blood pressure Bradycardia Skin tenting

Elevated blood pressure The blood pressure may increase if fluids are administered too quickly, and older adults may not be able to tolerate the increased fluid. Bradycardia is not associated with fluid volume excess.

24. The nurse is providing care to a patient whose serum calcium levels have increased since a surgical procedure performed 3 days ago. Which intervention does the nurse implement to decrease the risk for the development of hypercalcemia? Monitor vital signs every 8 hours. Encourage ambulation three times a day. Irrigate the Foley catheter one time a day. Recommend turning, coughing, and deep breathing every 2 hours.

Encourage ambulation three times a day. Hypercalcemia can occur from immobility. Encouraging early and frequent ambulation of patients at risk for hypercalcemia, as well as adequate hydration, assists in preventing elevated serum calcium.

25. The nurse recognizes which intervention as the priority in the care of the patient with a serum phosphorus level of 2.0 mg/dL? Decrease fluid intake. Strain all urine for kidney stones. Encourage consumption of milk and yogurt. Discourage consumption of a high-calorie diet.

Encourage consumption of milk and yogurt. A phosphorus level of 2.0 is low, and the patient needs additional dietary phosphorus. Providing phosphorus-rich foods such as milk and yogurt is a good way to provide that additional phosphorus.

29. The nurse correlates which clinical manifestations to the patient at risk for hypovolemic shock? Select all that apply. Blood pressure of 110/70 Heart rate of 146 Urine output of 0 to 10 mL/hour Cool, clammy skin Increased bowel sounds

Heart rate of 146 Urine output of 0 to 10 mL/hour Cool, clammy skin Hypovolemic shock can develop as evidenced by hypotension, tachycardia, and signs of organ hypoperfusion such as cool, clammy skin, oliguria progressing to anuria (lack of urine output), decreased level of consciousness, and tachypnea.

4. In reviewing laboratory results for a female patient suspected of having a fluid imbalance, the nurse correlates which laboratory value with a diagnosis of dehydration? Hemoglobin of 10.5 g/dL Hematocrit 49% Serum potassium 3.8 mEq/L Serum osmolality 230 mOsm/kg

Hematocrit 49% The hematocrit measures the volume of whole blood that is composed of red blood cells. Because the hematocrit is a measure of the volume of cells in relation to plasma, it is affected by changes in plasma volume. The hematocrit increases with severe dehydration. The normal hematocrit value for a female is 36% to 48%.

7. The nurse is caring for a patient who is receiving intravenous fluids postoperatively after cardiac surgery. The nurse correlates the patient's risk for fluid volume excess to which cause? Decreased mobility as a result of surgery and pain Administration of intravenous fluids Decreased levels of aldosterone Increased levels of antidiuretic hormone

Increased levels of antidiuretic hormone Antidiuretic hormone (ADH) and aldosterone levels are commonly increased as a result of the stress response before, during, and immediately after surgery. This increase leads to sodium and water retention.

30. A patient's serum sodium level is 150 mg/dL. Based on this information, which interventions should the nurse plan for this patient? Select all that apply. Elevate the head of the bed. Instruct on a low-sodium diet. Monitor heart rate and rhythm. Administer diuretics as prescribed. Administer potassium supplement as prescribed

Instruct on a low-sodium diet. Administer diuretics as prescribed.

15. A patient is prescribed 20 mEq of potassium chloride because of excessive vomiting. The nurse includes which information in explaining the rationale for this medication? It controls and regulates water balance in the body. It is used in the body to synthesize ingested protein. It is vital in regulating muscle contraction and relaxation. It is needed to maintain skeletal, cardiac, and neuromuscular activity

It is needed to maintain skeletal, cardiac, and neuromuscular activity Potassium is the major cation in intracellular fluids, with only a small amount found in plasma and interstitial fluid. Potassium is a vital electrolyte for skeletal, cardiac, and smooth muscle activity.

19. The nurse is caring for a patient admitted with hypertension and chronic renal failure who receives hemodialysis three times per week. The nurse is assessing the patient's diet and notes the use of salt substitutes. When teaching the patient to avoid salt substitute, which rationale supports this teaching point? They can potentiate hyperkalemia. They may cause the client to retain fluid. They may interfere with the hemodialysis. They may interact with the client's antihypertensive medications.

Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in patients with renal failure, and the use of salt substitutes will worsen hyperkalemia.

28. The nurse is providing care to a patient who is exhibiting clinical manifestations of a fluid and electrolyte deficit. Which of the following orders does the nurse implement to address this disorder? Select all that apply. Administer diuretics Administer antibiotics Place the patient in high-Fowler's position Monitor patient's I&O Initiate intravenous therapy

Monitor patient's I&O Initiate intravenous therapy Place the patient in high-Fowler's position This is correct. There is no indication for a high-Fowler's position. The patient may be placed in the supine position with severe fluid volume deficit.

2. Which assessment data collected by the nurse indicate that an older adult patient is at risk for dehydration? Poor skin turgor Body mass index of 20.5 Blood pressure of 140/98 mm Hg Oral intake of 48 ounces per day

Oral intake of 48 ounces per day A poor intake of water could indicate a loss of the thirst response, which occurs as a normal age-related change. Because the patient only ingests 48 ounces of water each day, this could indicate a reduction in the normal thirst response.

8. The nurse is planning care for the patient with acute renal failure and incorporates the nursing diagnosis of Excess Fluid Volume. Which assessment data support this nursing diagnosis? Wheezing in the lungs Generalized weakness Urine output of 20 mL/hour Pitting edema in the lower extremities

Pitting edema in the lower extremities Urine output of 20 mL/hour is low and is associated with fluid volume deficit. Wheezing in the lungs is an assessment consistent with asthma.

27. The nurse is preparing an educational session for members of a community health center that focuses on ways to maintain fluid balance during the summer months. Which interventions should the nurse recommend? Select all that apply. Drink diet soda. Reduce the intake of coffee and tea. Drink more fluids during hot weather. Drink flat cola or ginger ale if vomiting. Exercise during the hours of 10 a.m. and 2 p.m.

Reduce the intake of coffee and tea. Drink more fluids during hot weather. Drink flat cola or ginger ale if vomiting. This is correct. Actions to prevent fluid volume deficit during the summer months include increasing fluid intake, drinking flat cola or ginger ale if vomiting, and reducing the intake of coffee and tea.

23. The nurse is monitoring laboratory results on assigned patients. The patient with which laboratory has the highest risk of laryngospasm? Serum calcium 7.5 mg/dL Serum magnesium 3.0 mg/dL Serum potassium 5.6 mEq/L Serum phosphorus 1 mg/dL

Serum calcium 7.5 mg/dL Clinical manifestations of hypocalcemia include positive Trousseau's and Chvostek's signs, tetany, and laryngospasm Respiratory signs of hypermagnesemia include a decrease in respiratory rate that can lead to complete respiratory suppression, not laryngospasm.

13. A nurse is reviewing the serum chemistry results on a patient who has a nasogastric tube to low intermittent suction secondary to a gunshot to the abdomen 2 days ago. Which electrolyte value does the nurse correlate to the NG suctioning? Serum chloride of 90 mEq/L Serum sodium of 148 mEq/L Serum potassium of 5.2 mEq/L Serum calcium of 11.3 mg/dL

Serum chloride of 90 mEq/L Serum chloride decreases in patients with severe vomiting, burns, chronic respiratory acidosis, nasogastric suctioning, metabolic alkalosis, and Addison's disease (adrenal cortex insufficiency). The normal range for serum chloride is 97 to 107 mEq/L.

17. In reviewing a patient's laboratory results before administering digoxin, which laboratory result places the patient at greatest risk for digoxin toxicity? Serum sodium 156 mEq/L Serum potassium 3.0 mEq/L Serum phosphorus of 1.5 mg/dL Serum creatinine of 1.6 mg/dL

Serum potassium 3.0 mEq/L Hypokalemia can potentiate the effects of digitalis by increasing blood levels of digoxin, leading to digoxin toxicity. Symptoms of digoxin toxicity include loss of appetite, nausea, vomiting, cardiac dysrhythmias, and visual disturbances.

11. In reviewing laboratory results for a patient presenting to the Emergency Department with changes in level of consciousness, the nurse correlates which value as placing the patient at greatest risk for seizures? Serum calcium of 12 mg/dL Serum potassium of 3.0 mEq/L Serum sodium of 135 mEq/L Serum magnesium of 2.6 mEq/L

Serum sodium of 135 mEq/L Neurological changes such as confusion, muscle twitching, lethargy, and seizures can indicate low sodium levels, especially in older adults. Seizure activity may be observed in patients with hypocalcemia.

31. The nurse educates a patient who is prescribed furosemide (Lasix) for congestive heart failure on foods rich in potassium. Which patient menu choices indicate to the nurse a correct understanding of the information presented? Select all that apply. Pasta Spinach Applesauce A sweet potato Low-fat milk

Spinach A sweet potato Low-fat milk

21. The nurse provides care for a patient who is experiencing hypomagnesemia. Which food choice is best for this patient? A medium-sized banana One medium-sized baked potato Three ounces of cooked halibut A half-cup of cooked black-eyed peas

Three ounces of cooked halibut A medium-sized banana contains 30 mg of magnesium. This is not the best food choice for the patient.A medium-sized baked potato with the skin contains 50 mg of magnesium. This is not the best food choice for the patient. Three ounces of cooked halibut contains 90 mg of magnesium. Of the foods provided, this choice is the most magnesium rich.One-half cup of cooked black-eyed peas contains 45 mg of magnesium. This is not the best food choice for the patient.

5. The nurse is analyzing the intake and output record for a patient being treated for dehydration. The patient weighs 176 lbs and had a 24-hour intake of 2,000 mL and urine output of 1,200 mL. Based on this data, which conclusion by the nurse is the most appropriate? Treatment has not been effective. Treatment needs to include a diuretic. Treatment is effective and should continue. Treatment has been effective and should end.

Treatment is effective and should continue. Urinary output is normally equivalent to the amount of fluids ingested; the usual range is 1,500 to 2,000 mL in 24 hours, or 40 to 80 mL in 1 hour (0.5 mL/kg per hour). Patients whose intake substantially exceeds output are at risk for fluid volume excess; however, the patient is dehydrated. The extra fluid intake is being used to improve body fluid balance. The patient's output is 40 mL/hour, which is within the normal range.

1. A patient presents in the emergency department (ED) with fever, nausea, and vomiting over the past 2 days. The nurse monitors for which laboratory result in this patient? Urine specific gravity of 1.040 Serum potassium of 4.8 mEq/L Serum sodium of 135 mEq/L Urine positive for glucose and ketones

Urine specific gravity of 1.040 The normal range for specific gravity is 1.005 to 1.030. High specific gravity values indicate concentrated urine and can be seen in patients with decreased renal perfusion or dehydration.