HURST QUESTIONS [FLUIDS / ELECTROLYTES]

Standard orders on the nurse's unit include an intravenous infusion of 1000 mL normal saline with 20 mEq (20 mmol) potassium chloride to run at 100 mL per hour. These IV fluids would be appropriate for which client diagnosis? Select all that apply. 1. Addison's crisis 2. Renal insufficiency 3. Abdominal cramping with diarrhea 4. Graves' disease 5. Hypokalemia

3., 4. & 5. Correct: Clients with abdominal cramping with diarrhea, Graves' disease, and hypokalemia are safe to receive normal saline with potassium chloride. 1. Incorrect: Clients with Addison's disease can have hyperkalemia if they experience an Addisonian crisis due to lack of aldosterone. When aldosterone is not secreted, sodium and water is released and potassium levels elevate in response to the hyponatremia. 2. Incorrect: With diminished renal function the client is at risk for sodium and potassium retention.

A client is being treated for fluid volume deficit with D5W, oral hydration, and management of viral symptoms. Which client data would indicate to the nurse that treatment has been successful? Select all that apply. 1. BP 110/70 lying; 100/68 standing. 2. Moist mucous membranes. 3. Skin turgor recoil below clavicle is 3 seconds. 4. Urine specific gravity of 1.033. 5. Serum sodium 152 mEq.

1. & 2. Correct: These BP readings are within normal limits. Moist mucous membranes is a normal, desired finding. 3. Incorrect: Skin recoil delayed for more than 2 seconds indicates severe dehydration. 4. Incorrect: With fluid volume deficit, the specific gravity can be expected to be abnormally high. 5. Incorrect: This indicates hypernatremia, which is the same thing as dehydration.

An elderly, bed-bound client receiving G-tube feedings at home is transported to the emergency department after onset of behavioral changes and hallucinations. Which nursing action is priority while diagnostic testing is underway? 1. Initiate seizure precautions. 2. Monitor for signs of increased intracranial pressure. 3. Orient to time, place, and person. 4. Obtain vital signs q 15 minutes.

1. Correct: Feeding tube clients tend to get dehydrated, especially clients on bed rest, because bed rest induces diuresis! If the client is already having neurological signs, a grand-mal seizure may be next! Better take seizure precautions while awaiting the serum sodium results. 2. Incorrect: When hypernatremia is present, the brain cells shrink because when the body is dehydrated, water is drawn from the cells into the vascular space. 3. Incorrect: Until serum sodium is corrected, the client will be unable to process information regarding time, place, and person. The brain does not like it when the sodium is messed up. 4. Incorrect: While you're taking vital signs, your client is having a seizure! Don't delay care!

A nurse is caring for a client who was admitted with severe dehydration due to excessive vomiting. Which data noted by the nurse validates this diagnosis? Select all that apply. 1. Urine specific gravity -- 1.036. 2. Dry mouth. 3. Bradycardia. 4. Tachypnea. 5. Postural hypotension. 6. Distended neck veins.

1., 2., 4., & 5. Correct: These are signs and symptoms indicating that a client is dehydrated (fluid volume deficit). 3. Incorrect: Bradycardia is not seen with dehydration. 6. Incorrect: The client with fluid volume deficit will have flat neck veins.

What should the nurse monitor for when caring for a client receiving an IV of 1/2 Normal Saline at 100 mL/hr? 1. Hypertension. 2. Fluid volume deficit. 3. Hypernatremia. 4. Pulmonary edema.

2. Correct: 1/2 Normal Saline is a hypotonic solution. Monitor for cellular edema because the fluid is moving out to the cell which could lead to fluid volume deficit and decreased blood pressure. 1. Incorrect: Hypertension can occur with isotonic and hypertonic IV solutions. Hypotension can occur with hypotonic IV solutions such as 1/2 Normal Saline, 3. Incorrect: Hypernatremia can occur with isotonic and hypertonic sodium solutions. 4. Incorrect: This is a nursing alert for hypertonic IV solutions.

What is the primary electrolyte imbalance that the nurse should monitor for in a client who is receiving an insulin infusion? 1. Hypernatremia 2. Hypokalemia 3. Hypocalcemia 4. hypophosphatemia

2. Correct: Insulin causes movement of potassium into the cells, which can lead to a severe reduction in serum potassium if not regulated appropriately. A severe decrease in serum potassium could be fatal. 1. Incorrect: Although insulin has been shown to increase sodium reabsorption in the kidneys, the change is not as rapid and not as life threatening as the change in potassium. 3. Incorrect: A significant change in the calcium level is not anticipated with the insulin infusion. 4. Incorrect: A significant change in the phosphorus level is not anticipated with the insulin infusion.

An elderly, confused client with dehydration is admitted to the medical unit. Which intervention would be appropriate for the RN to delegate to the LPN/LVN? 1. Involve the client in care decision making. 2. Reinforce the teaching plan with the client's family. 3. Maintain fresh fluids at bedside. 4. Evaluate I & O for adequate fluid replacement.

2. Correct: The LPN/LVN can reinforce teaching. 1. Incorrect: The LPN/LVN can involve the client in care decision making. The client is confused and is not capable at this timme to be involved in their plan of care. 3. Incorrect: This can best be accomplished by the unlicensed assistive personnel (UAP), it can be done by LPN/LVN but not best use of resources. 4. Incorrect: Evaluation is a role of the RN, not LPN. LPN can observe and data collect but not assess and evaluate on the NCLEX.

The nurse is caring for a client with Addison's disease that is taking fludrocortisone 0.1mg/day. What assessment data by the nurse would suggest that the client's dose is too high? Select all that apply. 1. Weight loss of 2 lbs (0.907 kg)/24 hours 2. Elevated serum sodium level 3. Bilateral pedal edema 4. Crackles in the lung fields bilaterally 5. Elevated blood pressure

2., 3., 4., & 5. Correct: Now, remember that with Addison's disease the client does not have enough steroids, so we have to ADD steroids. All of these options indicate the client is holding onto fluid, and we would expect the client to hold onto fluid when their steroid dose is too high. 1. Incorrect: We would expect weight gain with this client, and what is the amount of weight gain we worry about? That's right, anything over 2-3 lbs (0.907 - 1.360 kg) in 24 hours.

What is the priority electrolyte imbalance for the nurse to monitor when caring for a client post op thyroidectomy? 1. Hypophosphatemia 2. Hyperphosphatemia 3. Hypocalcemia 4. Hypercalcemia

3. Correct: Why is hypocalcemia the correct answer? Because if they removed the thyroid gland, where are the parathyroids? They could be GONE! No parathyroid glands means no calcium!! 1. Incorrect: Phosphorus is not the priority electrolyte to monitor post thyroidectmy. 2. Incorrect: Phosphorus is not the priority electrolyte to monitor post thyroidectmy. 4. Incorrect: No, the complication from removal of the thyroid is possible injury or removal of parathyroid glands. This produces a disturbance in calcium levels. The calcium levels fall resulting in hypocalcemia.

Standard orders on the nurse's unit include an intravenous infusion of D5 1/4 NS 1000 mL with 20 mEq (20 mmol/L) potassium chloride to run at 100 mL per hour. This IV solution would be appropriate for which clients diagnosis? Select all that apply. 1. Addisonian crisis. 2. Hypertension. 3. Chronic renal failure. 4. Cushing's disease. 5. Hypokalemia.

4. & 5. Correct: Clients with cramping, Cushing's disease, and hypokalemia are safe to receive normal saline with potassium chloride. 1. Incorrect: Clients with Addison's disease can have hyperkalemia if they experience an Addisonian crisis due to lack of aldosterone. When aldosterone is not secreted, sodium and water is released and potassium levels elevate in response to the hyponatremia. 2. Incorrect: Clients with hypertension need a hypotonic solution which will not increase the client's blood pressure. However, the client may or may not have hypokalemia. 3. Incorrect: Clients in chronic renal failure are retaining fluid and potassium. They do not need more potassium.

A client is admitted for treatment of fluid volume excess. The nurse reviews the admitting lab work and the primary healthcare provider's prescriptions. Which prescription would be of concern to the nurse? Labs: Sodium: 138 mEq/L Potassium: 5.4 mEq/L Calcium: 9.0 mg/dL Glucose: 108 mg/dL Prescriptions: - Bedrest. - 2 gm Na+ diet. - Spironolactone 25 mg by mouth once per day. - KCL 20 mEq by mouth twice a day. 1. Bedrest. 2. 2 gm Na+ diet. 3. Spironolactone 25 mg by mouth once per day. 4. KCL 20 mEq by mouth twice a day.

4. Correct: The client has been prescribed spironolactone, a potassium sparing diuretic, so KCL supplement is not necessary. 1. Incorrect: Bed rest induces diuresis, which is good for this client. 2. Incorrect: This client needs to be on a low sodium diet to reduce fluid retention. 3. Incorrect: Spironolactone is a potassium sparing diuretic which can be prescribed for this client.