Fluid and electrolytes
A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood brain barrier and been transferred from the vascular space into the client's interstitial space. Which of the following diagnoses best captures this pathophysiology? Focal hypoxia Cytotoxic edema Hydrocephalus Vasogenic edema
Vasogenic edema
The infant is listless with sunken fontanels (fontanelles) and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number.
48
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?
Albumin
A physician orders an isotonic IV solution for a client. Which solution should the nurse plan to administer?
Lactated ringer's solution
There are two types of diabetes insipidus (DI): neurogenic and nephrogenic. In nephrogenic DI, there is an inability of the kidney to concentrate urine and to conserve free water. Nephrogenic DI can be either genetic or acquired. What are the causes of nephrogenic DI?
Lithium and hypokalemia
The nurse suspects that a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes that which abnormal laboratory result is consistent with this problem?
Potassium level of 2.8 mEq/L (2.8 mmol/L)
The nurse notes that the dialysate drainage of a client receiving peritoneal dialysis is cloudy. Which action should the nurse take?
Report the finding to the health care provider
A client is being treated for the ingestion of a neurotoxin that interferes with the depolarization phase of action potentials.What physiologic process will be disrupted?
The inflow of sodium ions
A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?
The man may be experiencing nephrotoxic effects of aspirin
To determine the IV drip rate, a nurse must know the drip factor, which is
The number of drops in one milliliter
The pathophysiology instructor will emphasize that the cells of the proximal tubule have a fine, villous structure that increases surface area, allowing for which physiologic function to occur with fluids? Select all that apply.
- Supports active transport processes - Increase in reabsorption
A client with marked oliguria is ordered a test dose of 0.2 g/kg of 15% mannitol solution intravenously over 5 minutes. The client weighs 132 lb (60 kg). How many grams would the nurse administer? Record your answer as a whole number.
12
A client weighing 160.2 pounds (72.7 kg), who has been diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the client loses 1,000 mL of fluid in 24 hours. What weight would be consistent with this amount of fluid loss?
158.0 lbs (71.7 kg)
A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:
280 mOsm/kg
During a period of extreme excess fluid volume, a renal dialysis client may be administered what type of IV solution to shrink the swollen cells by pulling water out of the cell?
3% sodium chloride
A nurse is caring for a client diagnosed with pneumonia, a urinary tract infection, dehydration, and temperature of 101.4°F;(38.6°C;). The health care provider orders 1,000 ml of D5W to infuse over 8 hours. The available drop factor is 20 gtt/ml. The nurse would regulate the intravenous flow rate to deliver how many drops per minute? Round your answer to the nearest whole number.
42
A child is brought to the emergency department after having gastroenteritis. The healthcare provider orders maintenance intravenous infusion based on body weight (i.e., 100 ml/kg/day for the first 10 kg of body weight, 50 ml/kg/day for the next 10 kg of body weight, 20 ml/kg/day for each kilogram above 20 kg of body weight). If the child weighs 18 kg, what is the hourly flow rate in milliliters? Record your response as a whole number.
58
The nurse knows that a client with which glomerular filtration rate (GFR) would be classified as "decreased GFR"?
70 mL/min
The child's ability to perfuse is poor due to inadequate circulation. The physician writes an order for the child to receive 20 ml of normal saline for each kilogram of body weight. The child will receive the normal saline as a bolus through a central intravenous line. The child weighs 78 lb (35.46 kg). Calculate the amount of normal saline the nurse should administer as a bolus. Record your answer using a whole number.
709
In which individuals would a clinician most suspect multiple myeloma as a diagnosis?
A 40-year-old man who has had 3 broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated.
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?
A blood urea nitrogen level of 42 mg/dL
Which client is benefiting from the RAAS mechanism?
A college student admitted to the neuro trauma unit following traumatic brain injury requiring surgery to evacuate a large hematoma
Edema is an excess in the interstitial fluid volume. What mechanisms play a part in the formation of edema? Mark all that apply.
A. Mechanisms that increase capillary permeability.B. Mechanisms that increase capillary filtration pressure.D. Mechanisms that produce obstruction to the flow of lymph.E. Mechanisms that decrease capillary colloidal osmotic pressure.
A child with extensive burns is receiving an intraosseous infusion into the right leg because there is no other site available for iv access. Which action is appropriate for the nurse to implement when caring for the child while receiving fluids and medication by this route?
Assess pulses distal to the site every hour.
A nurse is teaching a client newly prescribed with an ACE inhibitor. Which information is very important to include in the teaching plan?
Avoid salt substitutes and foods high in potassium.
A client with renal insufficiency is admitted to the hospital with pneumonia. The client is being treated with gentamicin. Which laboratory value should be closely monitored?
BUN
A child is recovering from a bout with group A b-hemolytic Streptococcus infection. They return to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed: A. Autosomal recessive polycystic kidney disease B. Adult-onset medullary cystic disease C. Acute post-infectious glomerulonephritis D. Acute nephritic syndrome
C. Acute post-infectious glomerulonephritis
Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?
Confusion and seizures
A client who is taking lithium carbonate is going home on a 3-day pass. What is the best health teaching the nurse should provide for this client?
Continue to maintain normal sodium intake while at home
The nurse is caring for a client with small cell lung carcinoma who has developed SIADH. What should the nurse incorporate into the plan of care? SATA Daily weights Maintenance of fluid restriction Admission of hypotonic IV solutions Restriction of sodium in the diet Frequent repositioning
Daily weights Maintenance of fluid restriction Frequent repositioning
A client with gestational HTN receives magnesium sulfate 50% 4 g in 250mL D5W over 20 minutes. What priority assessment should the nurse perform when administering this drug?
Deep tendon reflexes
A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority?
Deficient fluid volume related to osmotic diuresis
The wound care nurse evaluates a client's wound after being consulted. The client's wound healing has been slow. Upon assessment of the wound, the wound care nurse informs the medical-surgical nurse that the wound healing is being delayed due to the client's state of dehydration and dehydrated tissues in the wound that are crusty. What is another term for localized dehydration in a wound? a.Desiccation b.Maceration c.Necrosis d.Evisceration
Desiccation
A client complains of having bouts of diarrhea. The client wants to know which antidiarrheal would be best to use. Which antidiarrheal does the nurse know will help stimulate water and electrolyte absorption?
Diphenoxylate
The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this client?
Eyes.
The nurse is caring for a 19-month-old child who has been hospitalized with dehydration secondary to nausea and vomiting. The nurse is aware that promethazine will not be used for this client because it can cause what in children under the age of 2?
Fatal respiratory depression
A nurse is preparing a teaching session for a client prescribed an antibacterial for a UTI. Which instruction should the nurse point out in the teaching session?
Increase fluid intake to at least 2000 mL/day.
Electrical burns over a large surface area of a client's body have resulted in hypovolemic shock. Following physical assessment, which findings lead the nurse to believe the client's body is compensating for this fluid loss? Select all that apply.
Increased heart rate The client complaining of extreme thirst Deep, rapid respirations
A nurse is assessing a client who is receiving total parenteral nutrition. Which finding suggests that the client has developed hyperglycemia?
Increased urine output
A client is exhibiting signs of increasing intracranial pressure (ICP). Which intravenous solution (IV) would the nurse anticipate hanging? - Dextrose 5% in water (D5W) - Half-normal saline (0.45% NSS) - One-third normal saline (0.33% NSS) - Lactated Ringer's
Lactated Ringers
A client experiencing vomiting and diarrhea for 2 days has a blood pressure of 88/56, a pulse rate of 122 beats/minute, and a respiratory rate of 28 breaths/minute. The nurse places the client in which position?
Modified Trendelenburg
A client prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client?
Nausea and vomiting
After receiving large doses of an ovulatory stimulant such as menotropins (Pergonal), a client comes in for her office visit. Data collection reveals the following findings: Weight gain of 6 lb (3 kg), ascites, and pedal edema. What should the nurse do next?
Notify health care provider
The nurse at a long-term care facility encourages the older adults to drink even though they may not feel thirsty at the time. Which statement supports the nurse's action?
Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.
Which infant is most likely to have stable blood glucose levels?
One delivered by cesarean birth
Hypothalamic sensory neurons that promote thirst when stimulated are called:
Osmoreceptors
A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which treatment measure is most likely to resolve this health problem?
Placement of a shunt
A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient?
Potassium levels
Which glucocorticoid also exerts some mineralocorticoid effects?
Prednisolone
The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child?
Providing fluids by straw
Parents who bring a 3-week-old neonate to the hospital report that the infant has been "throwing up after every feeding." A nurse notes projectile vomiting while assessing the neonate. X-rays confirm
Pyloric stenosis
One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte?
Sodium
The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop:
Sodium and water retention
Drug related nephropathies involve functional and or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on?
State of hydration
The nurse is assessing laboratory values to identify if medical treatment and nursing interventions have improved kidney function in a client with renal disease. Which laboratory tests will the nurse monitor to determine the functioning status of the kidneys? SATA
Urine albumin Glomerular filtration rate Creatinine clearance Basic metabolic panel (BMP)
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?
Vasoconstriction
The nurse writes a problem-based care plan, citing the client's excess fluid volume. What risk factor does the nurse expect to assess in the client?
acute kidney injury
The nurse is caring for an adolescent client who is in the intensive care unit after a suicide attempt with barbiturate drugs and alcohol. The client is hypotensive with a mean arterial pressure (MAP) below 30 and a urine output that has decreased from 30 mL/hr to 2 mL/hr. Serum creatinine and potassium are both elevated. The parents of the client notice the small amount of urine in the indwelling catheter drainage bag and ask why there is so little. What is the best response by the nurse? a) "The potassium has crystallized in the renal tubules." b) "The body is conserving fluids to dilute the barbiturates." c) "There is not enough blood getting to the kidneys." d) "Alcohol immediately destroys the cells of the kidneys."
c) " There is not enough blood getting to the kidneys"
The nurse is caring for a client during the first 72 hours after thyroidectomy. The nurse should assess for which signs of complications of this surgery?
carpal spasms and facial numbness
The nurse administers desmopressin (DDAVP) to the client to treat diabetes insipidus. What assessment finding would indicate to the nurse that the desmopressin is producing a therapeutic effect?
decreased urine output
An osmotic diuretic such as mannitol is given to the client with increased intracranial pressure (ICP) to
dehydrate the brain and reduce cerebral edema.
A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia?
diuretics
The nurse is caring for a trauma client who presents with total body edema and scant urine output. The nurse should recognize the effects of what endocrine disruption? a.Excessive secretion of antidiuretic hormone b.Insufficient secretion of antidiuretic hormone c.Excessive secretion of androgens d.Acute growth hormone deficiency
excessive secretion of antidiuretic hormone
A nurse is caring for a client in the 13th week of pregnancy who develops hyperemesis gravidarum. The nurse is reviewing the client's laboratory report. Which finding indicates the need for intervention?
ketones in urine
A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about
recent streptococcal infection.
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:
sodium polystyrene sulfonate (Kayexalate)
Dilutional hyponatremia occurs in which disorder?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
The client has been admitted to the emergency department following a traumatic motor vehicle accident. The client is hypotensive due to blood loss. Which of the following stress response hormones will aid in fluid replacement? -Epinephrine -Norepinephrine -Cortisol -Vasopressin
Vasopressin
The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, what is the immediate action the nurse should take?
Weigh the old dialysate
A client is prescribed furosemide to treat hypertension. What education should the nurse provide to the client?
Reduce the amount of sodium in the diet.
A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client? 145 130 125 165
165
A client asks the nurse what may have caused elevation in urinary protein levels (proteinuria) on a urine test. The best response by the nurse would be: -Abnormal glomerular filtration -Urinary tract infection-Poor fluid intake -Decrease in antidiuretic hormone
Abnormal glomerular filtration
A female client is admitted to the hospital with hypoglycemia, nausea, muscle weakness, and depression. What is the most likely cause?
Addisons
The nurse is completing a plan of care for a client with right sided heart failure in order to prevent skin breakdown which interventions would the nurse include? SATA
Administer prescribed diuretics Elevate bilateral legs ad apply heel protectors Maintain client on fluid restriction as ordered
A nurse is providing care to a child with partial and full thickness burns over 26% of the body. In monitoring the child's output the nurse expects an output of 1 to 2 mL/kg/hr. The nurse has emptied 46 ml from the foley catheter for the past hour. The child weighs 62 lb (28 kg). What action should the nurse take?
Document the output and continue to monitor.
A nurse is caring for an older adult client admitted with fever of unknown origin and changes in mental status due to advanced alzheimer disease. The client is receiving bolus tube feedings every 8 hours and IV antibiotics and is experiencing frequent loose stools. Which conditions place the client at risk for developing hypernatremia? SATA
Fever Diarrhea Tube feedings Confusion
While planning care for a client with irritable bowel syndrome, knowing the client has an increased amount of secretions with impaired GI absorption, the priority nursing diagnosis would be:
Fluid volume deficit
A client receiving continuous ambulatory peritoneal dialysis (CAPD) treatments has excessive weight gain in the past 24 hours and tells the nurse excessive amounts of fluids were consumed while out with family. What change in the client's dialysis order will the nurse anticipate once relaying these findings to the health care provider? -Switching the client from 2.5% to a 4.25% dextrose dialysate -Reducing the volume of dialysate from 3 L to 1 L -Increasing the dialysate dwell time from 6 hours to 8 hours -Preparing the client for a hemodialysis treatment
Switching the client from 2.5% to a 4.25% dextrose dialysate
While working in the newborn nursey a nurse is assessing a new admission the nurse notes the infant has an increased distance between his eyes, a very small jaw, and a split uvula. Thinking this infant might have Digeorge syndrome, the nurse should be assessing this infant for which electrolyte imbalance?
Tetany due to hypoglycemia
A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?
The child has had 8 ounces of formula in the past 24 hours.
What would contraindicate the use of indapamide?
Renal disease
Which cellular dysfunction id responsible for the manifestations of cystic fibrosis?
Abnormal chloride channel proteins allow increased sodium and water reabsorption
