Electrolyte Balance and Imbalance NCLEX QUESTIONS
A patient is receiving a potassium-sparing diuretic. The nurse should assess for which manifestations during this therapy? Select all that apply. Hyperglycemia Anxiety and irritability Tall, peaked T wave on ECG Presence of U wave Abdominal cramping and diarrhea Paresthesias and weakness of lower extremities
Anxiety and irritability Tall, peaked T wave on ECG Abdominal cramping and diarrhea Paresthesias and weakness of lower extremities -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.
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 KClc
a) 5% dextrose in water with 20 mEq of KCl -D5W stands for 5% dextrose in water, which is different than normal saline, half normal saline, or lactated Ringer's.
While taking a patient's blood pressure, a nurse notices that a carpal spasm occurs. What laboratory test should the nurse review after assessing this finding? a) Calcium b) Sodium c) Potassium d) Magnesium
a) Calcium -Trousseau's sign (carpal spasm when blood pressure cuff is inflated for a few minutes) is indicative of hypocalcemia. It does not occur with changes in sodium, potassium, or magnesium levels. The nurse should expect the primary health care provider to prescribe a calcium level be drawn.
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) Decreased calcium levels -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. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.
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) Dysrhythmias -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 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) Hypocalcemia -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.
The nurse is caring for a patient with diabetes mellitus, malnutrition, and massive gastrointestinal (GI) bleeding who is admitted for blood transfusion. In analyzing the morning laboratory results, the nurse understands that a potassium level of 5.5 mEq/L could be caused by which 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. e) The patient has been overeating raisins, baked beans, and salt substitute, which could increase the potassium level.
a) The potassium level may be increased if the patient has renal nephropathy. 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. -Hyperkalemia may result from hyperglycemia, renal insufficiency, or cell death. Diabetes mellitus, along with the stress of hospitalization and illness, can lead to hyperglycemia. Renal insufficiency is a complication of diabetes. Stored hemolyzed blood can cause hyperkalemia when large amounts are transfused rapidly. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. The patient with a massive GI bleed would have a nasogastric (NG) tube and would not be eating.
The nurse is reviewing magnesium levels for a patient. What does the nurse recognize is the importance of assessing this level for a patient? a) It may cause extracellular fluid overload. b) Can affect neuromuscular excitability and contractility. c) It is the most abundant intracellular cation present in the body. d) The patient is at risk for hypotension when the levels decrease.
b) Can affect neuromuscular excitability and contractility. -Alterations in serum magnesium levels profoundly affect neuromuscular excitability and contractility because magnesium directly acts on the myoneural junction. A decrease in blood magnesium levels increases the blood pressure. Magnesium is the second most abundant intracellular cation. The majority of the body's magnesium is present in the bones. Causing extracellular fluid overload, being the most abundant intracellular cation, and the patient being at risk for hypotension are not relevant to this situation. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
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 -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 monitoring a patient with hyperkalemia. Which conditions should the nurse conclude may cause this condition? Select all that apply. a) Alkalosis b) Renal failure c) Low blood volume d) Large urine volume e) Adrenal insufficiency
b) Renal failure e) Adrenal insufficiency -Hyperkalemia is a condition in which there is an abnormal increase of potassium in the blood. Renal failure may cause hyperkalemia, because the kidneys cannot remove potassium from the body. Adrenal insufficiency causes aldosterone deficiency, which leads to the retention of potassium ions and also may result in hyperkalemia. Alkalosis is seen in hypocalcemia. Low blood volume and a large urine volume can result in hypokalemia. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
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) Respiratory alkalosis c) Diabetic ketoacidosis e) Malabsorption syndrome -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.
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 -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.
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 -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.
The nurse is preparing to administer sodium polystyrene sulfonate rectally to a patient with an irregular pulse and weakness of the lower extremities. What laboratory finding does the nurse determine is the reason for this treatment? a) Hypokalemia b) Hypocalcemia c) Hyperkalemia d) Hypercalcemia
c) Hyperkalemia -Irregular pulse and weakness of the lower extremities are generally seen in patients with hyperkalemia. Sodium polystyrene sulfonate binds with potassium in exchange for sodium, thereby reducing hyperkalemia. Hypokalemia can be treated with potassium chloride. Hypocalcemia can be treated with calcium supplements. Hypercalcemia can be treated by administering furosemide.
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) Increased phosphate levels -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.
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) Paresthesias -Signs of hypocalcemia include paresthesias, tetany, and muscle weakness. Bone pain, diminished reflexes, and polyuria are signs of hypercalcemia. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.
The nurse is caring for a patient with a potassium level of 6.2 mEq/dl. What syndrome does the nurse suspect the patient may have? a) Cushing syndrome b) Milk-alkali syndrome c) Tumor lysis syndrome d) Malabsorption syndrome
c) Tumor lysis syndrome -Tumor lysis syndrome causes movement of potassium from the intracellular fluid (ICF) to the extracellular fluid (ECF), resulting in hyperkalemia. Cushing syndrome may cause hypernatremia. Milk-alkali syndrome may cause hypercalcemia. Malabsorption syndrome may cause hypophosphatemia.
A patient is admitted with alcohol abuse. Laboratory data reveals a phosphate level of 1.8 mg/dL. Which assessment finding is consistent with this data? a) Tetany b) Diarrhea c) Weakness d) Seizure activity
c) Weakness -Signs of hypophosphatemia include weakness, confusion, coma, and diminished reflexes. Seizure activity, diarrhea, and tetany are not associated with this electrolyte imbalance
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) 4.5 mEq/L -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.