Electrolytes Sherpath

The emergency room nurse is caring for a patient with a severe fluid volume deficit who presented after several days of diarrhea secondary to C. difficile infection. Which intravenous (IV) fluid does the nurse anticipate will be used to rapidly replace the fluid volume? 0.9% sodium chloride 0.45% sodium chloride 5% dextrose in 0.9% sodium chloride 5% dextrose in 0.25% sodium chloride

0.9% sodium chloride

Which clinical manifestations should the nurse anticipate when providing care to a patient with a diagnosis of hyperkalemia? Select all that apply. 1+ deep tendon reflexes Rapid and shallow respirations Serum blood glucose level of 250 mg/dL Numbness and tingling in the hands and feet Ventricular fibrillation noted on the electrocardiogram

1+ deep tendon reflexes Numbness and tingling in the hands and feet Ventricular fibrillation noted on the electrocardiogram

The nurse is reviewing the serum potassium results for a patient. What level best supports the rationale for administering a stat dose of potassium chloride 20 mEq in 250 mL of normal saline over two hours? 3.1 mEq/L 3.9 mEq/L 4.6 mEq/L 5.3 mEq/L

3.1 mEq/L

normal potassium levels

3.5-5.0 mEq/L

Which phosphate level would the nurse be likely to find in the patient who has alcohol withdrawal symptoms? 1.4 mg/dL 2.4 mg/dL 3.8 mg/dL 4.8 mg/dL

1.4 mg/dL

normal phosphate levels

2.5-4.5 mg/dL

The nurse is providing education for a patient regarding hypercalcemia. What statements made by the patient would indicate understanding of the education by the nurse? Select all that apply. "I can use Tums as needed for heartburn." "I will restrict fluid intake to less than 2000 mL/day." "I will increase daily fluid intake to 3000 to 4000 mL." "Renal calculi may occur as a complication of hypercalcemia." "Weight-bearing exercises can help keep calcium in the bones."

"I will increase daily fluid intake to 3000 to 4000 mL." "Renal calculi may occur as a complication of hypercalcemia." "Weight-bearing exercises can help keep calcium in the bones."

The nurse is caring for a patient that has a nasogastric tube (NGT) on intermittent suction. The patient asks why they cannot have something to drink. What is the best response by the nurse? "It will cause sodium retention." "It will disrupt the intermittent suction." "It will increase nausea and vomiting." "It will increase the loss of electrolytes."

"It will increase the loss of electrolytes." -The free water will pull electrolytes into the stomach and the NGT will suck the fluids and electrolytes out of the stomach

Milk-alkali Syndrome (Burnett's syndrome)

- caused by ingestion of calcium (often milk) along with absorbable antacids (like calcium carbohydrate). -Characterized by hypercalcemia, hyperphosphatemia, alkalosis, and progressive renal failure

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? 1.7 mEq/L 2.9 mEq/L 3.6 mEq/L 4.5 mEq/L

4.5 mEq/L

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?

5% dextrose in water with 20 mEq of KCl

The charge nurse is reviewing the electrolyte laboratory study results for the unit's assigned patients. Which patient would be at greatest risk for the potential development of hypomagnesemia? 83-year-old man with lung cancer and hypertension 65-year-old homeless woman with a history of chronic alcoholism 32-year-old pregnant woman who has been treated for eclampsia 63-year-old man with benign prostatic hyperplasia (BPH) and a urinary tract infection (UTI)

65-year-old homeless woman with a history of chronic alcoholism

The intravenous (IV) prescription reads "D5.45 normal saline (NS) with 40 mEq KCl/L at 125 mL/hour." The nurse needs to add KCl to the IV because no premixed solutions are available. The unit's medication supply has a stock of KCl 5 mEq/mL in multidose vials. The nurse would need to draw up __ milliliters to add to the IV solution? Record your answer using a whole number.

8

Calcium normal range

8.5-10.5 mg/dL

Diabetic Ketoacidosis (DKA)

A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available. -Hypermagnesemia

The nurse finds that the patient with renal disease is irritable and has an irregular pulse. ECG changes suggest severe hyperkalemia. What is the first nursing action? Stop all sources of dietary potassium Administer intravenous calcium gluconate Administer ion-exchange resins Administer intravenous insulin with glucose

Administer intravenous calcium gluconate

A decrease in blood magnesium levels increases...

BP

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?

Calcium

The nurse is preparing to administer a dose of potassium phosphate. What laboratory finding would indicate that the nurse should withhold the medication? Calcium 6.4 mg/dL Sodium 133 mEq/L Magnesium 1.8 mEq/L Potassium 5.2 mEq/L

Calcium 6.4 mg/dL

The nurse is reviewing magnesium levels for a patient. What does the nurse recognize is the importance of assessing this level for a patient? It may cause extracellular fluid overload. Can affect neuromuscular excitability and contractility. It is the most abundant intracellular cation present in the body. The patient is at risk for hypotension when the levels decrease.

Can affect neuromuscular excitability and contractility.

A patient with cancer is found to have a serum phosphate level of 5.4 mg/dL. What does the nurse determine is the probable reason for the increase in phosphate levels in this patient? Chemotherapy Insulin therapy Total parenteral nutrition Phosphate-binding antacids

Chemotherapy Chemotherapy drugs increase the patient's phosphate levels

Which medical diagnosis would cause the nurse to include nursing interventions appropriate for hyponatremia in the plan of care? Diabetes insipidus Cushing syndrome Congestive heart failure Uncontrolled diabetes mellitus

Congestive heart failure (the rest are for hypernatremia)

A patient's potassium level is 2.9 meq/L. Which health care provider order should the nurse expect? Continuous ECG monitoring Increase digoxin (Lanoxin) to 0.25 mg every day Add 20 meq KCL to the present IV bag hanging and give over four hours 40 meq KCL in 100 cc D5W intravenous piggyback (IVPB) to infuse over 30 minutes

Continuous ECG monitoring

A patient's ECG tracing has a short QT interval and a high peaked T wave. Which prescription should the nurse question? D5W with 20 meq KCL to run at 125 mL/hr Sodium polystyrene sulfonate 30 grams by mouth 10 units regular insulin IVP and one-half ampule D50W IVP 2 grams calcium gluconate intravenous (IV) administered over two minutes

D5W with 20 meq KCL to run at 125 mL/hr

To prevent a recurrence of hypocalcemia, the nurse should encourage the patient to increase intake of which of foods? Fish Lean meat Dairy products Potatoes and starches

Dairy products

A patient has low levels of parathyroid hormone. What other laboratory finding does the nurse expect in the patient? Decreased calcium levels Increased potassium levels Decreased phosphate levels Increased magnesium levels

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 is caring for a patient with kidney failure who is experiencing severe hyperphosphatemia. Which treatment does the nurse anticipate for this patient to correct the electrolyte imbalance? Dialysis Fluid restriction Potassium supplementation Loop diuretic therapy

Dialysis -For severe hyperphosphatemia, hemodialysis can decrease levels rapidly

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? Dysrhythmias Acute renal failure Metabolic alkalosis Malignant hypertension

Dysrhythmias

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?

Hypocalcemia

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? Increased calcium levels Increased potassium levels Increased phosphate levels Increased magnesium levels

Increased phosphate levels

Which is a priority nursing action when providing care to a patient who is being treated for hypernatremia that developed slowly over several days? Initiating seizure precautions Administering prescribed diuretics Monitoring the patient's weight each day Restricting the patient's dietary sodium intake

Initiating seizure precautions

The nurse is preparing to administer intravenous (IV) potassium chloride (KCl) to a patient. Which action should the nurse perform to ensure the patient's safety? Give KCl via IV push. Add KCl to the hanging IV bag. Give IV KCl in concentrated amounts. Invert IV bags containing KCl several times.

Invert IV bags containing KCl several times.

The primary health care provider has prescribed parenteral nutrition for a patient. The nurse administers a 10% dextrose solution with amino acids, electrolytes, vitamins, and trace elements. What does the nurse need to know regarding the 10% dextrose solution? It is a hypertonic solution. It is used as a plasma expander. It expands the extracellular compartment. It should be administered only through a central line.

It is a hypertonic solution.

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? Antibiotics Loop diuretics Bronchodilators Antihypertensives

Loop diuretics

The nurse is caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would be identified as an adverse effect related to this therapy? Sodium falling to 138 mEq/L Potassium rising to 4.1 mEq/L Magnesium rising to 2.9 mg/dL Phosphorus falling to 2.1 mg/dL

Phosphorus falling to 2.1 mg/dL -Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa. Because hypercalcemia rarely occurs as a result of calcium intake, the patient's phosphorus falling to 2.1 mg/dL (normal 2.4-4.4 mg/dL) may be a result of the phosphate-binding effect of calcium carbonate.

The nurse is monitoring a patient with hyperkalemia. Which conditions may be associated with this electrolyte imbalance? Select all that apply. Alkalosis Renal failure Low blood volume Large urine volume Adrenal insufficiency

Renal failure Adrenal insufficiency -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

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. Renal failure Respiratory alkalosis Diabetic ketoacidosis Tumor lysis syndrome Malabsorption syndrome

Respiratory alkalosis Diabetic ketoacidosis Malabsorption syndrome

An older adult patient is admitted with pneumonia. Why would it be important for the nurse to closely monitor fluid and electrolyte balance in this patient? Older adults are at an increased risk of impaired renal function. Older adults have an impaired level of consciousness and need to be reminded to drink fluids. Older adults are more likely than younger adults to lose extracellular fluid during severe illnesses. Small losses of fluid are more significant because body water accounts for only about 50% of body weight in older adults.

Small losses of fluid are more significant because body water accounts for only about 50% of body weight in older adults.

The nurse receives a health care provider's prescription to change a patient's intravenous (IV) from D 5 ½ normal saline (NS) with 40 mEq KCl/L to D 5 NS with 20 mEq KCl/L. Which serum laboratory value on this same patient best supports the rationale for this IV prescription change? Sodium 136 mEq/L, potassium 4.5 mEq/L Sodium 145 mEq/L, potassium 4.8 mEq/L Sodium 135 mEq/L, potassium 3.6 mEq/L Sodium 144 mEq/L, potassium 3.7 mEq/L

Sodium 136 mEq/L, potassium 4.5 mEq/L -The normal range for serum sodium is 135 to 145 mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L. The change in the IV prescription decreases the amount of potassium and increases the amount of sodium. For this prescription to be appropriate, the potassium level must be near the high end and the sodium level near the low end of their respective ranges.

A patient sustains multiple injuries in a motor vehicle accident and is hypovolemic due to hemorrhage. Blood transfusions are given to replace the lost blood. The nurse finds that the patient has now developed laryngeal stridor, dysphagia, and numbness and tingling around the mouth. What could be the reason for these new manifestations? The patient has developed anemia. The patient has developed hypocalcemia. The patient has developed fluid overload. The patient has developed a hemolytic reaction.

The patient has developed hypocalcemia.

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. The potassium level may be increased if the patient has renal nephropathy. The patient may be excreting extra sodium and retaining potassium because of malnutrition. The potassium level may be increased as a result of dehydration that accompanies high blood glucose levels. There may be excess potassium being released into the blood as a result of massive transfusion of stored hemolyzed blood. The patient has been overeating raisins, baked beans, and salt substitute, which could increase the potassium level.

The potassium level may be increased if the patient has renal nephropathy. The potassium level may be increased as a result of dehydration that accompanies high blood glucose levels. There may be excess potassium being released into the blood as a result of massive transfusion of stored hemolyzed blood.

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? Amiloride Tolvaptan Kayexalate Pamidronate

Tolvaptan

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? Cushing syndrome Milk-alkali syndrome Tumor lysis syndrome Malabsorption syndrome

Tumor lysis syndrome

sickle cell anemia

a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape -leads to increased concentration of phosphates in the body, thus causing hyperphosphatemia

Pamidronate (Aredia)

bone resorption inhibitor used to treat hypercalcemia

Trosseau's sign

carpal spasm when bp cuff inflated

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol -can cause hypernatremia

Tumor Lysis Syndrome (TLS)

causes movement of potassium from the intracellular fluid (ICF) to the extracellular fluid (ECF), resulting in hyperkalemia.

A rapid reduction in the sodium level can cause a rapid shift of water back into the cells, resulting in...

cerebral edema and neurologic complications.

Causes of hypomagnesemia include...

chronic alcoholism, diarrhea, vomiting, malabsorption syndromes, prolonged malnutrition, and nasogastric (NG) suction

adrenal insufficiency

condition in which the adrenal glands underproduce necessary hormones -The nurse would suspect increased potassium levels

Clinical manifestations of hyperkalemia include...

decreased reflexes, paresthesia, and an irregular pulse

Hypoparathyroidism

deficient production of parathyroid hormone -causes hyperphosphatemia because of impaired renal phosphate excretion -can result in magnesium deficiency.

Potassium exerts a direct effect on the...

excitability of cardiac muscle tissue

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?

hyperkalemia

Hypercalcemia, or increased calcium levels, is associated with...

hyperparathyroidism

5% dextrose in 0.9% sodium chloride is...

hypertonic

Loop diuretics are contraindicated during episodes of...

hypokalemia because these medications cause the kidneys to excrete sodium and potassium.

Congestive heart failure increases the patient's risk for developing...

hyponatremia

Alcohol withdrawal can result in....

hypophosphatemia

Allowing a patient with an NGT to drink water causes:

increased loss of electrolytes sodium depletion

5% dextrose in 0.25% sodium chloride is...

isotonic

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? Polyuria Bone pain Paresthesias Diminished deep tendon reflexes

paresthesias

Amiloride (Midamor)

potassium-sparing diuretic

Which clinical manifestation would the nurse expect to see when assessing a client with hypocalcemia? Shortened ST segment Prolonged QT segment Ventricular dysrhythmias Increased digitalis effects

prolonged QT segment -the rest occur in hypercalcemia

isotonic fluid is used to...

rapidly replace fluid volume

Acute of this disease, is not a complication of hypokalemia, but it may be seen with hyperkalemia.

renal failure

Alterations in serum magnesium levels profoundly affect neuromuscular excitability and contractility because magnesium directly acts on...

the myoneural junction

myoneural junction

the point at which the motor nerve contacts a muscle fiber

eclampsia

true toxemia of pregnancy characterized by high blood pressure, albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma

Tolvaptan (Samsca)

used to treat hyponatremia associated with heart failure and liver cirrhosis. It acts by blocking the activity of antidiuretic hormone

Which assessment finding is consistent with a phosphate level of 1.8 mg/dL? Tetany Diarrhea Weakness Muscle cramps

weakness, confusion, coma, and diminished reflexes