Lilley Ch. 29 Fluid & Electrolytes Q&A

The nurse is assessing a patient who has symptoms of anorexia, lethargy, and confusion and finds the patient's potassium level to be 3 mEq/L. What question will the nurse ask the patient before initiating the treatment? - "Do you have a history of ulcers?" - "Do you have a history of jaundice?" - "Do you have a history of brain injury?" - "Do you have a history of morning sickness?"

"Do you have a history of ulcers?" Hypokalemia is caused by the loss of potassium and becomes evident by symptoms such as anorexia, lethargy, and confusion. The nurse should find out about a history of ulcer or gastrointestinal bleeding in the patient before initiating oral potassium supplements, because this drug may worsen abdominal ulcers.

A patient who has just undergone surgery exhibits tachycardia and a hemoglobin level of 9 g/100 mL. Which fluid therapy will the nurse expect to administer? - 50 mL of 5% albumin - 450 mL of whole blood - 100 mL of fresh frozen plasma - 250 mL of packed red blood cells

250 mL of packed red blood cells The nurse should administer the red blood cells (RBCs) to increase the patient's oxygen-carrying capacity. The patient has anemia, so this therapy should help alleviate tachycardia because, in this case, tachycardia is a result of sympathetic nervous system (SNS) activation in response to hypoxemia. As the tissues receive more oxygenated blood from the infusion of additional hemoglobin, the SNS stimulation should subside, and improved tissue oxygenation should help improve healing. The patient needs hemoglobin, so albumin and plasma are improper therapy because they do not provide hemoglobin. Whole blood can help replenish hemoglobin, but because whole blood contains more fluid than RBCs, it increases the risk of fluid volume overload and is not indicated.

How much volume of 0.9% sodium chloride is required to raise the plasma volume by 1 L? - 1 L - 0.5 L - 5 to 6 L - 1.5 to 2 L

5 to 6 L To raise the plasma volume by 1 L, 5 to 6 L of 0.9% sodium chloride are required. One liter of 5% colloid solution is required to raise the plasma volume by 1 L. To raise the plasma volume by 1 L, 0.5 L of 25% colloid solution is required. To raise the volume of the plasma by 1 L, 1.5 to 2 L of 3% saline solution must be used.

A patient is prescribed a sodium polystyrene sulfonate enema. The nurse is reviewing the patient's laboratory reports. What will the nurse expect the patient's potassium level to be? - 3.5 mEq/L - 4.2 mEq/L - 2.3 mEq/L - 5.9 mEq/L

5.9 mEq/L Sodium polystyrene sulfonate is given to patients with hyperkalemia.

Which fluid is administered to reduce the risk of deep vein thrombosis? - Colloids - Whole blood - Sodium supplements - Potassium supplements

Colloids Colloids are the intravenous fluids that increase the colloidal osmotic pressure and also increase the fluid flow from the interstitial compartment to the plasma compartment. They can be used as a prophylactic measure for preventing deep vein thrombosis. Whole blood contains all the components of the blood but is not as effective as colloids for treating deep vein thrombosis. Sodium ions are most abundant in the extracellular fluid and are necessary for the optimal functioning of the body. Sodium has no effect on clotting or plasma volume. Potassium supplements have no effect on the clotting mechanism of the blood.

What laboratory reports will the nurse review before administering albumin to a patient? - Glucose levels - Thyroxin levels - Vitamin K levels - Hemoglobin levels

Hemoglobin levels Albumin is contraindicated in patients with severe anemia, so the nurse should check the patient's hemoglobin levels before administering albumin.

Sodium polystyrene sulfonate is used to treat which condition?

Hyperkalemia Sodium polystyrene sulfonate is an ion-exchange resin that contains sodium ions, which are exchanged with the potassium ions in the body.

A patient who was injured in a motor vehicle accident has hypovolemic shock due to excess blood loss. The laboratory reports show that the patient has anemia. What will the nurse expect the provider to order? - Albumin - Normal saline - Packed red blood cells - Plasma protein fraction

Packed red blood cells The patient has hypovolemic shock due to excess blood loss and is anemic. Therefore, administration of red blood cells would help to restore the blood volume as well as increase oxygen-carrying capacity. Albumin is also contraindicated in patients with hypovolemic shock, because it increases the blood volume but cannot restore oxygen-carrying capacity. Normal saline is contraindicated in patients with hypovolemic shock, because it is not effective in restoring oxygen-carrying capacity. A plasma protein fraction is indicated for patients with acute loss of blood due to gastric bleeding.

Which patient condition is a contraindication for the administration of dextran? - Anemia - Liver failure - Osteoporosis - Renal insufficiency

Renal insufficiency In patients with renal insufficiency, dextran administration is contraindicated, because the dextran tends to increase fluid volume, which may not be excreted by the impaired kidneys. Dextran doesn't affect hemoglobin levels; hence, it is not contraindicated in anemic patients. The function of the liver is not affected by dextran administration. The use of dextran does not affect bone function or structure; hence, it is not contraindicated in osteoporosis.

Which product is preferred in patients with extreme blood loss of over 25%? - Whole blood - Fresh frozen plasma (FFP) - Plasma protein fraction (PPF) - Packed red blood cells (PRBCs)

Whole blood Whole blood is more beneficial in patients who undergo extreme blood loss of over 25% because whole blood also contains plasma, which is the chief fluid volume of the blood. FFP is given to patients who show demonstrated deficiency of clotting factor. PPF is used to manage acute bleeding. PRBCs are used to increase the oxygen-carrying capacity in patients.

A patient reports severe thirst and fever. The nurse finds that the patient's blood pressure is 140/95 mm Hg. What will the nurse ask the patient before administering 5% dextrose intravenously? - "When did you urinate last?" - "Do you have any pain in your abdomen?" - "Do you have chest pain or shortness of breath?" - "Do you have disturbances in your acid-base balance?"

"When did you urinate last?" Severe thirst, high body temperature, and high blood pressure are the symptoms of hypernatremia. The treatment includes dietary restrictions, the use of diuretics, or intravenous administration of dextrose. But before prescribing 5% dextrose, the primary health care provider should ask the patient about urine output. A decreased urine output is observed in patients with hypernatremia. Abdominal pain is associated with hyponatremia. Chest pain and shortness of breath can occur due to hypervolemia. Acid-base imbalance is observed in patients when crystalloids or colloids are administered.

An older adult reports a feeling of irregular heartbeat, muscle weakness, and paresthesia. What question will the nurse ask the patient? - "Have you been taking potassium supplements?" - "Have you been drinking more fluids than normal?" - "Have you been having normal bowel movements?" - "Have you been performing excessive physical exercise?"

"Have you been taking potassium supplements?" When the patient reports an irregular heartbeat and muscle weakness, the nurse may suspect ventricular fibrillation caused by hyperkalemia, or elevated potassium levels in the blood. Hyperkalemia may be caused by a kidney problem, but it also can be caused by potassium supplements. Consumption of excess fluids may help the kidneys process the excessive potassium and return the body to normal levels. Potassium is excreted through the kidneys, not through bowel movements. Physical exercise does not increase the level of potassium; in fact, it helps to maintain the electrolyte balance.

A patient has received an infusion of packed red blood cells. Which assessment findings indicate an improvement in the patient's health status? Select all that apply. - Increased energy - Increased urine output - Decreased urine output - Increased oxygen saturation - Blood glucose levels within normal limits

- Increased energy - Increased oxygen saturation Blood products are the only fluids that carry oxygen, because they contain hemoglobin. Patients will begin to show improved energy and increasing tolerance for activities of daily living as a result of treatments with blood products. Pulse oximeter readings will also show improvement. An increase or decrease in the urine output is not a direct outcome of packed red blood cell infusion. The blood glucose levels are evaluated in the case of diabetes.

Which can cause hyperkalemia? Select all that apply. - Trauma - Infections - Loop diuretic use - Metabolic acidosis - Hyperaldosteronism

- Trauma - Infections - Metabolic acidosis Hyperkalemia is caused by several conditions, like trauma, infections, and metabolic acidosis. Loop diuretic use and hyperaldosteronism are not related to increased serum levels of potassium. Instead, they are responsible for decreased serum levels of potassium (hypokalemia).

Which concentration of saline may cause hemolysis of red blood cells? - 5% of sodium chloride - 0.9% of sodium chloride - 0.25% of sodium chloride - 0.45% of sodium chloride

0.25% of sodium chloride A 0.25% sodium chloride solution is hypotonic and may cause hemolysis of red blood cells. A 5% sodium chloride solution is hypertonic and is contraindicated in patients with hypernatremia or hyperchloremia. A 0.9% sodium chloride solution is considered normal saline. 0.45% sodium chloride solution is also hypotonic but does not cause hemolysis of red blood cells.

A patient with severe burns has been vomiting and feeling dizzy when standing up. The nurse assesses a blood pressure of 80/50 mm Hg and a pulse of 100 beats/min. Which intravenous fluid will the nurse expect to administer to the patient? - Dextran 70 - 5% albumin - 0.9% normal saline - Fresh frozen plasma

0.9% normal saline Vomiting and dizziness, along with hypotension, are the symptoms of hyponatremia. Because the patient's blood pressure is low and there is no increase in pulse rate, the nurse should understand that the patient has hyponatremia caused by burns. To restore the sodium concentration in the patient, 0.9% normal saline should be administered intravenously. Administering dextran 70 cannot restore the patient's condition. It should be administered along with 0.9% normal saline. Administering 5% albumin would increase the blood volume but would not treat the hypotension caused by low sodium levels. Fresh frozen plasma is administered to patients during hemorrhagic shock to restore the blood volume.

A patient has experienced a slow blood loss of about 20%. Which solution is administered to treat the patient? - Hetastarch - Dextran 70 - 5% dextrose in water - Fresh frozen plasma (FFP)

5% dextrose in water Administration of crystalloids is suggested to manage a slow blood loss of about 20%. Therefore, 5% dextrose in water should be administered to the patient, because it is a crystalloid solution.

Which nursing intervention will the nurse implement when administering an intravenous potassium supplement? - Administer the potassium as a bolus over 10 minutes. - Apply ice packs to the site of intravenous administration. - Administer the diluted medication using an intravenous pump. - Teach the patient and family signs and symptoms of hypokalemia.

Administer the diluted medication using an intravenous pump. A rapid infusion of potassium can cause cardiac dysrhythmias. Therefore, an intravenous infusion pump must always be used. Potassium is always diluted when administered to the patient and never given in the form of bolus. Ice packs are applied to any site of intravenous administration to reduce irritation and burning. Teaching the patient and family signs and symptoms of hypokalemia is not an immediate concern in this case.

What is the priority nursing intervention when administering intravenous potassium replacement to a patient? - Administer the medication in a diluted form. - Administer potassium as a bolus over 10 minutes. - Apply heat to the site of intravenous administration. - Teach the patient and family the signs and symptoms of hypokalemia.

Administer the medication in a diluted form. Intravenous dosage forms of potassium must always be given in a diluted form. There is no use or place for undiluted potassium because undiluted potassium is associated with cardiac arrest. Potassium should not be administered as a bolus or pushed. Heat will not aid the infusion. Unless the patient is prone to constant hypokalemia, teaching the signs and symptoms is not a priority.

A primary health care provider orders potassium supplements for a patient who is lethargic and dehydrated. After assessing the laboratory reports, the nurse finds the patient's potassium levels are 4 mEq/L. For what does the nurse monitor in the patient? - Complaints of nausea - A decrease in hemoglobin - Complaints of chest discomfort - A decrease in white blood cells (WBC)

Complaints of chest discomfort Normal potassium levels range from 3.5 to 5.0 mEq/L. Therefore, a potassium level of 4 mEq/L indicates normal potassium concentration. When administered extra potassium supplements, the patient may develop symptoms of hyperkalemia; therefore, the nurse should monitor the patient for chest discomfort caused by irregular cardiac activity due to hyperkalemia. Hypokalemia may cause nausea, but hyperkalemia does not manifest as nausea. A decrease in hemoglobin causes anemia and is evident by hemoglobin levels. A decrease in WBC is observed with infections but is not caused by administering potassium.

A patient has been ordered to receive a unit of packed red blood cells. What is the highest priority nursing action prior to initiating the infusion of the blood product? - Confirm the identity of the patient. - Verify that a small-bore IV is in place. - Collect the blood product from the blood bank. - Verify that the permit for infusion was witnessed.

Confirm the identity of the patient. Although all of the actions listed are important, the highest-priority action is confirmation of the identity of the patient. Failure to do this is a major safety violation. Because blood types can vary individually, patient identification is the highest physiologic safety priority. A large bore IV is needed versus small bore for blood administration. If the patient is not correctly identified and blood type verified first, there is no need to obtain the blood from the blood bank. The permit is important for legal purposes; but physiological safety is the priority.

A patient is prescribed oral sodium polystyrene sulfonate. On assessing the patient's medical history, the nurse finds that the patient has gastric ulcers. What will the nurse advise the patient in order to prevent adverse effects of the therapy?

Contact the primary health care provider. The patient is advised to contact the primary health care provider, because oral sodium polystyrene sulfonate may cause gastrointestinal irritation. The patient has pre-existing gastric ulcers, and the drug can increase their severity.

Which food will the nurse recommend for a patient who has hypokalemia? - Lean turkey - Beef bouillon - Mashed potatoes - Cream of broccoli soup

Cream of broccoli soup Hypokalemia indicates a low potassium level. Broccoli soup will help decrease hypokalemia in the patient, because broccoli is high in potassium. Lean turkey, beef bouillon, and mashed potatoes are protein-rich foods, recommended for patients with a protein deficiency.

The nurse is caring for a patient who has lost 20% of blood rapidly. What should be the fluid of choice to control the blood loss? - Dextran 40 - Normal saline - Fresh frozen plasma (FFP) - Cryoprecipitate and plasma protein fraction (PPF)

Cryoprecipitate and plasma protein fraction (PPF) When there is a 20% rapid blood loss, cryoprecipitate and PPF are given. If there is 20% slow blood loss, crystalloids are administered. Dextran 40 and other nonprotein plasma expanders are given when there is a slow blood loss of 20% to 50%. Normal saline is a crystalloid and is administered when there is a slow blood loss of 20%. FFP is given when there is a deficiency of clotting factor levels.

What should be the fluid of choice for a patient who has lost 30% of his or her blood slowly as a result of internal hemorrhage? - Dextran 70 - Whole blood - 3% (hypertonic) saline - Packed red blood cells (PRBCs)

Dextran 70 When there is a slow blood loss of 20% to 50%, nonprotein plasma expanders such as dextran 70 are administered. Whole blood is administered in extreme cases when there is a blood loss of over 50%. A solution of 3% saline is administered when there is a slow blood loss of 20% or less. PRBCs are used in patients with a blood loss of over 50%, in patients with anemia, or in patients with substantial hemoglobin deficit.

A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. What will the nurse do first? - Reassure the patient that this is an expected reaction. - Discontinue the infusion and notify the Rapid Response Team. - Decrease the infusion rate, and reassess the patient in 15 minutes. - Notify the health care provider while a peer monitors the blood transfusion.

Discontinue the infusion and notify the Rapid Response Team. These are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis; therefore, the blood transfusion should be stopped immediately, and emergency action should be taken. This is not an expected reaction. The nursing intervention should be immediate, and the infusion should be stopped completely.

The nurse is administering whole blood to a patient who experienced severe blood loss and who also has an underlying coagulation disorder. What will the nurse expect to administer to this patient? - Intravenous heparin - Fresh frozen plasma - Lactated Ringer's solution - Hetastarch along with whole blood

Fresh frozen plasma Fresh frozen plasma is not used often, except in patients who have severe blood loss or underlying coagulation disorders. Heparin is an anticoagulant which could worsen this patient's condition of severe blood loss. Blood products are given with lactated Ringer's solution, but this is not effective in controlling bleeding. Hetastarch is given when the patient shows a slow loss of blood. It is not effective in controlling the bleeding.

A patient is found to have low levels of clotting factors. Which treatment will the provider order for this patient? - Dextran 70 - Conivaptan - Fresh frozen plasma (FFP) - Packed red blood cells (PRBCs)

Fresh frozen plasma (FFP) Administration of FFP is useful to treat the patient with low levels of clotting factors, because it increases clotting factors and promotes the clotting function. Dextran 70 is used in colloid replacement therapy and does not increase clotting factor levels. Conivaptan is a vaptan used to treat hyponatremia but it is not used in cases of clotting factor deficiency. PRBCs are useful for patients suffering from anemia but does not help increase clotting factor levels.

A patient with severe trauma has received 5000 mL normal saline intravenously. The patient now has peripheral edema but remains hypotensive. Which agent will help in correction of the fluid balance? - 3% saline - Hetastarch - Lactose-free milk - Packed red cells (PRCs)

Hetastarch The patient needs to increase intravascular fluid volume. Hetastarch is a colloid, which will increase osmotic pull from the extravascular spaces to the intravascular area. The use of 3% saline is not preferred because of the risk of hypernatremia. PRCs are red blood cell replacements, not volume expanders. Lactose-free milk is used to induce sleep.

The nurse has administered normal saline to a patient who experienced blood loss. Before administering frozen plasma to the patient, what information will the nurse gather? - History of seizure - History of brain injury - History of osteoporosis - History of thyroid problems

History of osteoporosis Patients with osteoporosis are prescribed calcium supplements, which interact with blood products. Hence, the nurse reviews the drug history of the patient with osteoporosis to prevent potential drug interaction. Antiepileptic drugs are not contraindicated with blood products. However, phenytoin may get precipitated if the intravenous form is administered with dextrose. Neither the patient's history of brain injury nor thyroid drugs are related to the administration of frozen plasma.

A patient is experiencing nausea, cardiac dysrhythmias, and shortness of breath. Which electrolyte alteration does the nurse suspect in the patient? - Hypokalemia - Hyponatremia - Hypercalcemia - Acute dehydration

Hypokalemia The early symptoms of hypokalemia include anorexia, hypotension, lethargy, mental confusion, nausea, and muscle weakness. Late symptoms include neuropathies, paralytic ileus, and cardiac dysrhythmias, in which case the patient may feel palpitations or shortness of breath. Hyponatremia is a condition resulting from sodium loss. It is indicated by lethargy, hypotension, stomach cramps, vomiting, diarrhea, and seizures. Hypercalcemia is indicated by early signs like constipation, headache, increased thirst, dry mouth, and a metallic taste in the mouth. Acute dehydration is indicated by a decrease in urinary output.

The nurse is assessing an 80-year-old patient and finds that the patient has muscle weakness, anorexia, lethargy, and nausea. What will the nurse expect the provider to order? - Increasing the patient's potassium levels with dietary supplements - Increasing the patient's potassium levels with intravenous potassium acetate - Increasing the patient's potassium levels with intravenous potassium chloride - Increasing the patient's potassium levels with a potassium exchange resin enema

Increasing the patient's potassium levels with dietary supplements The patient shows signs of mild hypokalemia, which can be treated by eating a potassium-rich diet. Intravenous administration of potassium acetate and potassium chloride is preferred if the patient has severe hypokalemia. An enema of potassium exchange resin can be administered if the patient has hyperkalemia.

A patient is prescribed an isotonic intravenous fluid. Which intravenous fluid is most likely to be ordered by the health care provider? - 3% NaCl - 0.25% NaCl - Normal saline - 0.45% NaCl/D5W

Normal saline Of the fluids listed, the only one that is isotonic is normal saline. 3% NaCl is considered to be a hypertonic solution; 0.25% NaCl and 0.45% NaCl/D5W are considered to be hypotonic solutions.

A patient is admitted to the hospital after experiencing confusion, weakness, and loss of appetite. The patient's blood pressure is 90/60 mm Hg, and the serum blood pH shows acidity. What drug does the nurse expect to administer? - Conivaptan - Potassium acetate - Potassium chloride - Sodium bicarbonate

Potassium acetate From the caregiver's report, the nurse should understand that the patient is confused, lethargic, and anorexic. The blood pressure shows that the patient is hypotensive and has an acidic pH. These are the symptoms of hypokalemia; therefore, the nurse should expect a potassium supplement in the prescription. Potassium acetate is a potassium supplement; the potassium is used to restore the electrolyte balance, and acetate is used to raise the pH of the blood. Conivaptan is prescribed to hospitalized patients with hyponatremia. Potassium chloride can be useful in restoring potassium levels but cannot raise the pH of the blood. Sodium bicarbonate is prescribed to restore sodium levels in patients with hyponatremia.

The nurse is caring for a patient who has severe diarrhea and who is being treated aggressively with crystalloid solutions. What effects will the nurse monitor for in the patient? - Reduced eyesight - Reduced urinary output - Reduced respiratory rate - Reduced salivary secretions

Reduced respiratory rate Aggressive infusion of crystalloids may cause pulmonary edema, which in turn causes reduced respiratory rate. Eyesight or vision is not affected by administering crystalloids. Diarrhea may cause lowered urinary output, which can be managed by administering crystalloids. Reduced salivary production is a symptom of severe vomiting and is not observed when crystalloids are given.

A patient with hypokalemia is ordered to receive an intravenous (IV) dose of potassium chloride (KCl) 15 mEq in 250 mL of 0.9% saline to infuse over 1 hour. What action will the nurse take prior to starting the infusion? - Place an ice pack over the IV site. - Review the electrocardiogram (ECG). - Ensure that the IV cannula is securely taped. - Review the previous 24-hour intake and output.

Review the electrocardiogram (ECG). Potassium infusions are used to treat patients with severe hypokalemia. The most concentrated solutions used are 60 mEq/L, with a rate not more than 40 mEq/hour. Hence, cardiac monitoring is indicated when concentrated potassium chloride is administered intravenously. An ice pack is placed over the IV site to relieve the burning after or during the therapy. The IV cannula is used for the implementation of antineoplastic drugs. The nurse needs to assess the serum potassium concentrations to evaluate for toxicity, not the 24-hour intake and output.

The nurse is caring for a patient who has diarrhea and vomiting. During a review of the patient's medical history, the nurse finds that the patient is taking phenytoin for seizures. What crystalloid mix will be ineffective in this patient? - Saline mixed with lactose - Saline mixed with sodium - Saline mixed with dextrose - Saline mixed with potassium

Saline mixed with dextrose In the presence of dextrose, phenytoin gets precipitated, which may cause the phenytoin to be ineffective. Therefore, the primary health care provider will not prescribe dextrose. Lactose is a sugar molecule found in milk that does not react with phenytoin. Therefore, lactose can also be prescribed by the primary health care provider. Neither sodium nor potassium precipitates phenytoin. Therefore, sodium or potassium can be prescribed to a patient on phenytoin.

Which drug is used to treat hyperkalemia? - Potassium - Conivaptan - Sodium chloride - Sodium polystyrene sulfonate

Sodium polystyrene sulfonate Sodium polystyrene sulfonate is also known as potassium exchange resin and is used to treat hyperkalemia. Potassium is contraindicated in patients with hyperkalemia. Conivaptan is a nonpeptide dual arginine vasopressin (AVP) V1A and V2 receptor antagonist. It is administered in patients with low serum sodium levels at normal water volume. Sodium chloride is used as a replacement electrolyte for the treatment or prevention of sodium loss.

Which drug should not be given with sodium polystyrene sulfonate? - Sorbitol - Phenytoin - Amphotericin B - Quinupristin and dalfopristin

Sorbitol Sorbitol taken concurrently with sodium polystyrene sulfonate should be avoided because this combination is implicated in intestinal colonic necrosis, a condition that may be fatal. Phenytoin, amphotericin B, and quinupristin and dalfopristin do not affect the administration of sodium polystyrene sulfonate. Phenytoin interacts with dextrose and results in precipitation. Amphotericin B interacts with potassium replacement products. Quinupristin and dalfopristin is an antibiotic combination that interacts with sodium.

The health care provider has ordered 5% dextrose in water as a maintenance fluid for the patient. The nurse is assessing the patient at the beginning of the shift and observes the fluid hanging to be 5% dextrose in normal saline (D5NS). Which is the highest priority nursing action? - Stop the infusion. - Complete an occurrence report. - Find out which nurse hung the D5NS. - Notify the health care provider of the error.

Stop the infusion. The patient's safety is always the primary concern; the fluid should be stopped and the correct fluid hung before other measures are taken, such as notifying the health care provider. The patient should be treated first before completing any paperwork such as an occurrence report and before investigating which nurse hung the incorrect solution.

Which aspect of a patient's history is a contraindication for administering sodium polystyrene sulfonate? - The patient takes phenytoin. - The patient has hypernatremia. - The patient has Addison's disease. - The patient takes quinupristin and dalfopristin.

The patient has Addison's disease. Sodium polystyrene sulfonate is a potassium exchange resin that is used in the treatment of hyperkalemia. Potassium replacement products are contraindicated in patients with Addison's disease. Phenytoin interacts with dextrose and results in precipitation. Hypernatremia is not related to the administration of sodium polystyrene sulfonate. Sodium replacement products are contraindicated in patients with hypernatremia. Phenytoin, and quinupristin and dalfopristin, do not interact with potassium elimination products. Quinupristin and dalfopristin is an antibiotic that interacts with sodium but not potassium.

The nurse is instructed to administer 1 L of 25% albumin to a patient who has hypoproteinemia. What will the nurse infer from such an instruction? - The patient requires 4 L of total plasma volume. - The patient requires 1 L of total plasma volume. - The patient requires 2 L of total plasma volume. - The patient requires 0.5 L of total plasma volume.

The patient requires 2 L of total plasma volume. Hypoproteinemia is reduced levels of total proteins. The prescribed treatment, 25% albumin, is a hypertonic colloid solution, which is used to raise the protein levels by expanding blood plasma volume. To raise the plasma volume by 1 L, 0.5 L of 25% colloid is administered. Therefore, the nurse has to administer 1 L (2 × 0.5 L) of 25% albumin, as the patient is 2 L (2 × 1 L) short of total plasma volume. If the patient is 4 L short of total plasma volume, 2 L of 25% albumin must be administered. If the patient is 1 L short of total plasma volume, 0.5 L of 25% albumin must be administered. If the patient is 0.5 L short of total plasma volume, 0.25 L of 25% albumin must be administered.

Which assessment finding in an adult patient requires immediate nursing action? - PaO2 level of 92 mm Hg - Serum sodium 140 mEq/L - Serum potassium of 3.8 mEq/L - Urinary output of 250 mL in 24 hours

Urinary output of 250 mL in 24 hours The patient requires immediate nursing assistance, because the urinary output should be at least 30 mL/hr. The patient's average urinary output at the moment is 10 mL per hour. Taking the PaO2 level is to check the arterial blood gas. Serum sodium and serum potassium are assessed for judging kidney-related diseases.