Fluid and Electrolytes

The doctor orders an isotonic fluid for a patient. Which of the following is not an isotonic fluid? A) 0.9% Normal saline B) LRS C) 0.45% Saline D) 5% Dex in 0.225% Saline

C) 0.45% Saline

Which condition could lead to cell lysis, if not properly monitored? A) Isotonicity B) Hypertonicity C) Hypotonicity D) None of the above

C) Hypotonicity

When the cell presents with the same concentration on the inside and outside with no shifting of fluids this called? A) Hypotonic B) Hypertonic C) Isotonic D) Osmosis

C) Isotonic

The nurse is reading the HCPs progress notes in the client's record and sees that the HCP has documented "insensible fluid loss of approximately 800 mL/daily." Which client is at risk for this loss? A) The client with a draining wound B) The client with a urinary catheter C) The client with a fast respiratory rate D) The client with an nasogastric tube to low suction

C) The client with a fast respiratory rate Rationale: Sensible losses are those that the person is aware of such as those that occur through wound drainage, GI tract losses, and urination. Insensible losses may occur without the person's awareness. Insensible losses occur daily through the skin and the lungs.

Which solution below is NOT a hypertonic solution? A) 5% Dex in 0.9% Saline B) 5% Saline C) 5% Dex in LRS D) 0.33% Saline (1/3 NS)

D) 0.33% saline (1/3 NS)

A patient is being admitted with dehydration due to nausea and vomiting. Which fluid would you expect the patient to be started on? A) 5% Dex in 0.9% Saline B) 0.33% Saline (1/3 NS) C) 0.225% Saline D) 0.9% Normal Saline

D) 0.9% Normal Saline

The nurse who is caring for a client with kidney failure notes that the client is dyspneic and crackles are heard when listening to the breath sounds in the lungs. Which additional sign/symptom should the nurse expect to note in this client? A) Rapid weight loss B) Flat hand and neck veins C) A weak and thready pulse D) An increase in BP

D) An increase in BP Rationale: Impaired cardiac or kidney function can result in fluid volume excess. Findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated BP, bounding pulse, an elevated central venous pressure, weight gain, edema, neck and hand vein distention, an altered LOC and a decreased hematocrit level.

The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign/symptom would be an indication of this electrolyte imbalance? A) Twitching B) Positive Trousseau's sign C) Hyperactive bowel sounds D) Generalized muscle weakness

D) Generalized muscle weakness Rationale: Generalized muscle weakness is seen in clients with hypercalcemia. Twitching, positive Trousseau's sign, and hyperactive bowel sounds are signs of hypocalcemia.

__________ solutions cause cell dehydration and help increase fluid in the extracellular space? A) Hypotonic B) Osmosis C) Isotonic D) Hypertonic

D) Hypertonic solutions

____________ fluids remove water from the extracellular space into the intracellular space A) Hypotonic B) Hypertonic C) Isotonic D) Colloids

A) Hypotonic

Which patient below would not be a candidate for a hypotonic solution? A) Patient with increased intracranial pressure B) Patient with Diabetic Ketoacidosis C) Patient experiencing hyperosmolar hyperglycemia D) All of the options are correct

A) Patient with Diabetic Ketoacidosis

The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at risk for fluid volume deficit? A) Client with cirrhosis B) Client with an ileostomy C) Client with heart failure D) Client with decreased kidney function

B) Client with ileostomy Rationale: Causes of fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient IV fluid replacement, draining fistulas, and ileostomy. A client with cirrhosis, heart failure, or decreased kidney function is at risk for fluid volume excess.

Which of the following is not a hypertonic fluid? A) 3% Saline B) D5W C) 10% Dextrose in water (D10W) D) 5% Dextrose in Lactated Ringers (5DLR)

B) D5W

What type of fluid would a patient with severe hyponatremia most likely be started on? A) Hypotonic B) Hypertonic C) Isotonic D) Colloid

B) Hypertonic

When administering a hypertonic solution the nurse should closely watch for? A) Signs of dehydration B) Pulmonary Edema C) Fluid volume deficient D) Increased lactate level

B) Pulmonary edema

A patient with cerebral edema would most likely be ordered what type of solution? A) 3% Saline B) 0.9% Normal Saline C) Lactated Ringers D) 0.225% Normal Saline

A) 3% Saline Rationale: A patient with cerebral edema would be ordered a hypertonic solution to decrease brain swelling. the solution would remove water from the brain cells back into the intravascular system to be excreted. 3% saline is the only hypertonic option.

The nurse is caring for a client with hyperparathyroidism and notes that the client's calcium level is 13. Which prescribed medication should the nurse plan to assist in administering to the client? A) Calcitonin B) Calcium chloride C) Calcium gluconate D) Large doses of vitamin D

A) Calcitonin Rationale: The client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as as result f acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

*Possible exam question* The nurse is caring for a client who has been taking diuretics on a long-term basis. Which finding should the nurse expect to note as a result of this long-term use? A) Gurgling respirations B) Increased BP C) Decreased hematocrit level D) Increased specific gravity of the urine

D) Increased specific gravity of the urine Rationale: Clients taking diuretics on a long-term basis are at risk for fluid volume deficit. Findings of fluid volume deficit include increased respiration and heart rate, decreased central venous pressure, weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, dark-colored and odorous urine, and increased hematocrit level and an altered LOC. Gurgling respiration, increased BP , and decreased hematocrit as a result of hemodilution are seen in a client with fluid volume excess.

The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is a the least likely risk for the development of third-spacing? A) The client with sepsis B) The client with cirrhosis C) The client with kidney failure D) The client with diabetes mellitus

D) The client with diabetes mellitus Rationale: Fluid that shifts into the interstitial space and remains there is referred to as third-space fluid. Common sites for third-spacing include the abdomen, pleural cavity, peritoneal cavity, and pericardial sac. Third-space fluid is physiologically useless because it doesn't circulate to provide nutrients for the cells. Risk factors include liver or kidney disease, major trauma, burns, sepsis, wound healing, major surgery, malignancy, malabsorption syndrome, malnutrition, alcoholism, and older age.

The nurse reviews electrolyte values and notes a sodium level of 130. The nurse expects that this sodium level would be noted in a client with which condition? A) The client with watery diarrhea B) The client with diabetes insipidus C) The client with an inadequate daily water intake D) The client with the syndrome of inappropriate secretion of antidiuretic hormone

D) The client with the syndrome of inappropriate secretion of antidiuretic hormone Rationale: Hyponatremia is a sodium level less than 135. Hyponatremia can occur secondary to syndrome of inappropriate secretion of ADH. The client with an inadequate daily water intake, watery diarrhea, or diabetes insipidus is at risk for hypernatremia

True/False?: Isotonic fluids cause shifting of water from the extracellular space to the intracellular space

False Rationale: Hypotonic fluids cause shifting of water from the extracellular space to the intracellular space (not isotonic)

Key term: Hypertonic

Higher outflow of water from inside of the cell to the outside of the cell (Cell shrinks)

True/False?: D5W solutions are sometimes considered a hypotonic solution as well as an isotonic solution because after the body metabolizes the dextrose, the solution acts as a hypotonic solution

True Rationale: D5W is classified as an isotonic fluid but after administration the body metabolizes the dextrose and the fluid left over is a hypotonic solution

Key term: Hypotonic

higher inflow of water from outside of the cell to the inside of the cell (Cell swells)