EAQ Ch 29, Fluids and Electrolytes

2 (Although all of the actions listed are important, the highest priority one is confirmation of the identity of the patient. Failure to do this is a major safety violation. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action)

A patient has been ordered to receive a unit of packed red blood cells. What is the highest priority nursing action prior to initiating the infusion of the blood product? 1 Verify that a large bore IV is in place. 2 Confirm the identity of the patient. 3 Collect the blood product from the blood bank. 4 Verify that the permit for infusion was witnessed

1 (Of the fluids listed, the only one that is isotonic is normal saline. 3% NaCl is considered to be a hypertonic solution; 0.45% NaCl/D5W and 0.25% NaCl are considered to be hypotonic solutions.)

A patient is ordered an isotonic intravenous fluid. Which intravenous fluid is most likely to be ordered by the health care provider? 1 Normal saline 2 3% NaCl 3 0.45% NaCl/D5W 4 0.25% NaCl

3 (These are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis; therefore the blood transfusion should be stopped immediately and emergency action should be taken. This is not an expected reaction. The nursing intervention should be immediate and the infusion should be stopped completely. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.)

A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. What will the nurse do first? 1 Reassure the patient that this is an expected reaction. 2 Notify the health care provider while a peer monitors the blood transfusion. 3 Discontinue the infusion and notify the Rapid Response Team. 4 Decrease the infusion rate and reassess the patient in 15 minutes.

4 (Little or no appetite (anorexia), low blood pressure (hypotension), confusion, and lethargy are the symptoms of early hypokalemia. Consuming large amounts of licorice may result in hypokalemia (low serum potassium levels). Therefore, the nurse should suggest that the patient eat a diet rich in potassium, including foods such as fruits, juices, vegetables, fish, and meat. Daily intake of milk is suggested to patients who have reduced calcium levels but not in cases of hypokalemia. Salt is a rich source of sodium and not potassium; therefore reducing the intake of salt does not help the patient. Lemon juice (citrus) is a rich source of vitamin C but not potassium. So, consuming lemon juice is not effective in preventing hypokalemia.)

A patient reports reduced appetite, lethargy, and confusion. The patient has low blood pressure. On interacting with the patient, the nurse finds that the patient consumes licorice regularly. What advice given by the nurse is accurate? 1 Make a habit of drinking milk daily. 2 Restrict your intake of salty foods. 3 Consume a glass of lemon juice daily. 4 Consume fruits, juices, vegetables, and meat regularly.

hyponatremia (atitesting.com)

Hypertonic solutions are infused to treat patients who have severe _______.

hypokalemia

Little or no appetite (anorexia), low blood pressure (hypotension), confusion, and lethargy are the symptoms of early _________.

375 (atitesting.com)

Solutions with an electrolyte content of ___ mEq/L or more are considered hypertonic.

4 (Of the intravenous solutions listed, the only one that is compatible with blood products is saline.)

The nurse is preparing to administer a transfusion of a blood product. What is the most appropriate intravenous fluid to hang as a maintenance infusion? 1 Lactated Ringer's 2 5% dextrose and water 3 Ringer's solution 4 Normal saline

volume expanders (volume expander)

What drug class is dextran in?

4 (0.45% sodium chloride in the solution is considered half-normal. 3% sodium chloride is considered hypertonic saline. 0.9% of sodium chloride is considered normal. 0.25% of sodium chloride in the solution is quarter-normal. )

What percentage of sodium chloride is considered half-normal? 1 3% sodium chloride 2 0.9% sodium chloride 3 0.25% sodium chloride 4 0.45% sodium chloride

4 (The patient requires immediate nursing assistance as the urinary output should be at least 30 mL/hr. The patient's average urinary output at the moment is 10 mL per hour. PaO2 level is to check the arterial blood gas. Serum sodium and serum potassium are assessed for judging kidney-related diseases)

Which assessment finding in an adult patient requires immediate nursing action? 1 PaO2 level of 92 mm Hg 2 Serum sodium 140 mEq/L 3 Serum potassium 3.8 mEq/L 4 Urinary output 250 mL in 24 hours

3 (Packed red blood cells are useful in anemic patients to increase oxygen-carrying capacity. Plasma protein fraction provides clotting factors and is used in cases of acute bleeding to arrest the bleeding. It doesn't help increase oxygen-carrying capacity. Fresh frozen plasma is useful for patients with low levels of clotting factors. It doesn't increase the oxygen-carrying capacity of the blood. Cryoprecipitate is useful for arresting acute bleeding and for facilitating quick clotting.)

Which blood product is administered to anemic patients? 1 Plasma protein fraction 2 Fresh frozen plasma 3 Packed red blood cells 4 Cryoprecipitate

4 (To increase the oxygen-carrying capacity in patients, PRBCs are given. Albumin is given to increase the blood volume through colloid oncotic pressure. FFP is given to increase the clotting factor levels in patients with a demonstrated deficiency. PPF is given to manage acute bleeding.)

Which fluid is given to increase the oxygen-carrying capacity in patients? 1 5% albumin 2 Fresh frozen plasma (FFP) 3 Plasma protein fraction (PPF) 4 Packed red blood cells (PRCBs)

2 (A rapid infusion of potassium can cause cardiac dysrhythmias. Therefore, an intravenous infusion pump must always be used. Potassium is always diluted when administered to the patient and never given in the form of bolus. Ice packs are applied to any site of intravenous administration to reduce irritation and burning. Teaching the patient and family signs and symptoms of hypokalemia is not an immediate concern in this case.)

Which nursing intervention will the nurse implement when administering intravenous potassium supplement? 1 Administer the potassium as a bolus over 10 minutes. 2 Administer the diluted medication using an intravenous pump. 3 Apply ice packs to the site of intravenous administration. 4 Teach the patient and family signs and symptoms of hypokalemia

1 (In patients with renal insufficiency, dextran administration is contraindicated because the dextran tends to increase fluid volume, which may not be excreted by the impaired kidneys. The function of the liver is not affected by dextran administration. The use of dextran does not affect bone function or structure; hence it is not contraindicated in osteoporosis. Dextran doesn't affect hemoglobin levels; hence it is not contraindicated in anemic patients.)

Which patient condition is a contraindication for the administration of dextran? 1 Renal insufficiency 2 Liver failure 3 Osteoporosis 4 Anemia

3 (Albumin is responsible for 70% of the colloidal osmotic pressure. Globulin is a plasma protein, which has a lesser contribution to the colloidal osmotic pressure. Fibrinogen is not the chief contributing protein for the colloidal osmotic pressure, as it causes a much lower amount of pressure on the blood vessel wall. Fibronectin is an extracellular matrix protein that is not responsible for causing colloidal osmotic pressure.)

Which protein is responsible for 70% of the colloidal osmotic pressure? 1 Globulin 2 Fibrinogen 3 Albumin 4 Fibronectin

fresh frozen plasma

___ ___ ___ (blood product) is/are useful for patients with low levels of clotting factors. It doesn't increase the oxygen-carrying capacity of the blood.

plasma protein fraction

___ ___ ___ (blood product) provide(s) clotting factors and is used in cases of acute bleeding to arrest the bleeding. It doesn't help increase oxygen-carrying capacity.