Med Surg ATI Fluid, Electrolyte, and Acid-Base

A nurse is caring for a client who has a sodium level of 155 mEq/L. Which of the following IV fluids should the nurse anticipate the provider to prescribe?

0.45% sodium chloride A sodium level of 155 mEq/L is an indication of hypernatremia. The nurse should anticipate a prescription for a hypotonic solution. The 0.45% sodium chloride is a hypotonic solution used to provide free water and treat cellular dehydration, which promotes waste elimination by the kidneys.

A nurse is admitting a client who takes 40 mg furosemide daily for heart failure and has experienced 3 days of vomiting. The nurse suspects hypokalemia. Which of the following medications should the nurse prepare to administer? Sodium polystyrene sulfonate 30g/day? 0.9% sodium chloride with 10 mEq/L of potassium chloride at 100 mL/hr? Bumetanide 8mg/day? 100 mL of dextroe 10% in water with 10 units of insulin?

09% sodium chloride with 10 mEq/L of potassium chloride at 100 mL/hr This IV solution will provide adequate fluid and potassium replacement to offset the losses from vomiting. The typical amount of potassium chloride to administer IV is 5 to 10 mEq/hr, not to exceed 20 mEq/hr. The dilution should be 1 mEq of potassium chloride to 10 mL of 0.9% sodium chloride.

A nurse is providing dietary teaching to a client who has heart failure and is receiving furosemide. Which of the following foods should the nurse recommend as containing the greatest amount of potassium? 1/2 cup chopped celery? 1 cup plain yogurt? One slice whole grain bread? 1/2 cup cooked tofu?

1 cup plain yogurt.

Urine specific gravity reference range?

1.005 to 1.030

he nurse should identify that a client who has dehydration can have a urine specific gravity that is above the expected reference range of

1.010 to 1.025. Fluid volume excess can cause a decrease in urine specific gravity.

BUN reference range?

10 to 20

The nurse should identify that a client who has dehydration can have a BUN that is above the expected reference range of:

10 to 20 mg/dL. Fluid volume excess can cause a decrease in BUN.

The nurse should identify that a client who has dehydration can have a Hgb level that is above the expected reference range of:

12 to 16 g/dl for females or 14 to 18 g/dl for males. Fluid volume excess can cause hemodilution and a decreased hemoglobin level.

Normal sodium level

136 to 145

Sodium reference range?

136 to 145

Expected reference range for Phosphorus?

3 to 4.5 mg/dL

A nurse is planning care for a client who has experienced excessive fluid loss. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) Administer IV fluids to the client evenly over 24 hours? Provide the client with a salt substitute? Assess the client for pitting edema? Encourage the client to rise slowly when standing up? Weigh the client every 8 hours?

Administer IV fluids to the client evenly over 25 hours. Encourage the client to rise slowly when standing up. Weight the client every 8 hours.

A nurse is caring for a client who is receiving furosemide daily. During the morning assessment, the client tells the nurse that he is "feeling weak in the legs." Which of the following actions should the nurse take first. Monitor the client's bowel sounds? Review the client's daily laboratory results? Auscultate the client's lungs? Palpate the client's peripheral pulses?

Auscultate the client's lungs An adverse effect of many diuretics, including furosemide, is hypokalemia. When using the airway, breathing, circulation approach to client care, the nurse should first auscultate the client's lungs to assess for respiratory changes due to weakness of the respiratory muscles.

A nurse is caring for a client who has dehydration and is receiving IV fluids. When assessing for complications, the nurse should recognize which of the following manifestations as a sign of fluid overload?

Bounding peripheral pulses Other manifestations include: increased respiratory rate, increased gastrointestinal motility, and reduced urine specific gravity

A nurse is assessing a client who has a calcium level of 8.1 mg/dL. Which of the following findings is the priority for the nurse to assess? Deep-tendon reflexes? Cardiac Rhythm? Peripheral sensation? Bowel sounds?

Cardiac rhythm When using the airway, breathing, circulation approach to client care, the nurse should first assess the client's cardiac rhythm because this total serum calcium level is below the expected reference range. Hypocalcemia can cause ECG changes, bradycardia, or tachycardia. Deep-tendon reflexes, peripheral sensation, and bowel sounds should be checked as hypocalcemia can cause neuromuscular changes and increased peristalsis but these are not the priority.

A nurse is assessing a client who has respiratory acidosis. Which of the following findings should the nurse expect?

Confusion A client who has respiratory acidosis will experience confusion from a lack of cerebral perfusion. If acidosis is not reversed, the client's level of consciousness will decrease, and coma can occur.

A nurse is a assessing a client who has hyperkalemia. Which of the following findings should the nurse expect?

Decreased muscle strength The nurse should expect the client to experience muscle weakness, fatigue, paresthesia, bradycardia, hypotension, and nausea, abdominal cramps, and diarrhea

True/False Lactated Ringer's is used to treat hypernatremia?

False Lactated Ringer's contains sodium and other electrolytes and is not indicated for hypernatremia.

The nurse is reviewing the laboratory report of a client who has fluid volume excess. Which of the following laboratory values should the nurse expect?

Hct 34% The nurse should identify that a client who has fluid volume excess can have a Hct level that is below the expected reference range of 37% to 47% for females or 42% to 52% for males. Fluid volume excess can cause hemodilution and a decreased hematocrit level.

A nurse is assessing a client who has hypomagnesemia. Which of the following findings should the nurse expect? Hyperactive deep-tendon reflexes? Increased bowel sounds? Drowsiness? Decreased blood pressure?

Hyperactive deep-tendon reflexes Hyperactive deep-tendon reflexes are an expected finding for a client who has hypomagnesemia. Other expected findings include muscle cramps, numbness, and tingling. Hypomagnesemia would also cause decreased bowel sounds, insomnia, and increased blood pressure.

Is Dextrose 5% in 0.9% sodium chloride considered a hypertonic or hypotonic solution?

Hypertonic It should not be used in cases of hypernatremia

Is hypo, or hyperreflexia a manifestation of respiratory acidosis?

Hyporeflexia As acidosis increases, hyperkalemia can occur, causing muscle weakness, flaccid paralysis, and hyporeflexia.

A nurse is teaching nutritional strategies to a client who has a low calcium level and an allergy to milk. Which of the following statements by the client indicates an understanding of the teaching?

I will add broccoli and kale to my diet The nurse should recommend that the client consume broccoli and kale, which are good sources of calcium, as alternatives to dairy products

A nurse is providing teaching to a client who is at risk for developing respiratory acidosis following surgery. Which of the following statements by the client indicates an understanding of the teaching?

I will use the incentive spirometer every hour. Respiratory depression and limited chest expansion are both causes of respiratory acidosis. Using an incentive spirometer will promote adequate chest expansion.

While reviewing a client's laboratory results, a nurse notes a serum calcium level of 8.0 mg/dL. Which of the following actions should the nurse take? Implement seizure precautions? Administer phosphate? Initiate diuretic therapy? Prepare the client for hemodialysis?

Implement seizure precautions The client is at risk for seizures due to low excitation threshold as a result of a decreased calcium level. The nurse should initiate seizure precautions to prevent injury. Administering phosphate can further decrease the client's calcium level. Diuretic therapy can further decrease the client's calcium level. Hemodialysis is administered to treat hypercalcemia, not hypocalcemia.

A nurse is caring for a client who is experiencing respiratory distress as a result of pulmonary edema. Which of the following actions should the nurse take first? Assist with intubation? Initiate high-flow oxygen therapy? Administer a rapid-acting diuretic? Provide cardiac monitoring?

Initiate high-flow oxygen therapy When using the airway, breathing, circulation approach to client care, the nurse should first administer high-flow oxygen therapy by face mask at 5 to 6 L/min to keep the client's oxygen saturation above 90%.

A nurse is assessing a client who has dehydration. Which of the following assessments is the priority?

Mental status The greatest risk to this client is injury from a fall due to a decline in their mental status. Therefore, assessing the client's mental status is the nurse's priority. Through not priority, also check: skin turgor, urine output, and weight

A nurse is providing dietary teaching to a client who has kidney disease. Which of the following food choices should the nurse include in the teaching as containing the lowest amount of magnesium? One large hard boiled egg? 1 cup bran cereal? 1/2 cup almonds? 1 cup cooked spinach?

One large hard boiled egg One large hard-boiled egg contains 5 mg of magnesium. Therefore, the nurse should recommend this food as containing the lowest amount of magnesium. One cup of bran cereal contains 112 mg of magnesium One-half cup of almonds contains 193 mg of magnesium One cup of cooked spinach contains 157 mg of magnesium.

A nurse is planning care for a client who has a potassium level of 3.0 mEq/L. The nurse should plan to monitor the client for which of the following findings?

Orthostatic hypotension The nurse should plan to monitor the client for orthostatic hypotension, which places them at risk for falls. Orthostatic hypotension is a manifestation of hypokalemia. Also monitor for hyporeflexia, weak hand grip strength, weak deep-tendon reflexes, respiratory distress, weak and thready pulse

A nurse is caring for a client who reports difficulty breathing and tingling in both hands. His respiratory rate is 36/min and he appears very restless. Which of the following values should the nurse anticipate to be outside the expected reference range if the client is experiencing respiratory alkalosis?

PaCO2 The nurse should anticipate that a client who has respiratory alkalosis will have a decreased PaCO2 level due to hyperventilation.

In addition to confusion, respiratory acidosis also causes

Pale, cyanotic, dry skin is a manifestation of respiratory acidosis, as ineffective breathing causes a lack of perfusion to the tissues. Facial flushing and warmth are manifestations of metabolic acidosis

A nurse is caring for a client who requires continuous cardiac monitoring. The nurse identifies a prolonged PR interval and a widened QRS complex. Which of the following laboratory values supports this finding? Sodium 152 mEq/L? Chloride 102 mEq/L? Magnesium 1.8 mEq/L? Potassium 6.1 mEq/L?

Potassium 6.1 mEq/L Hyperkalemia, defined as a potassium level above 5.0 mEq/L, can cause a prolonged PR interval, a wide QRS complex, flat or absent P waves, and tall, peaked T waves.

A nurse is assessing a client who is using patient controlled analgesia PCA following a thoracotomy. The client is short of breath, appears restless, and has a respiratory rate of 28/min. The client's ABG results are pH 7.52, PaO2 89 mmhHg, PaCO2 28 mmHg, and HC03- 24 mEq/L. Which of the following actions should the nurse take?

Provide calming interventions The client's respiratory rate is above the expected reference range of 12 to 20/min. The nurse should instruct the client to breathe slowly. Calming the client should decrease the respiratory rate, which will cause the client's carbon dioxide levels to increase to expected levels of 35 to 45 mm Hg and lower the pH to expected levels of 7.35 to 7.45.

A nurse is admitting a client who has status asthmaticus. The client's ABG results are pH 7.32. PaO2 74 mmHg. PaCO2 56 mmHg, and HCO3- 26 mEq/L. The nurse should interpret these laboratory values as which of the following imbalances? Respiratory acidosis? Respiratory alkalosis? Metabolic acidosis? Metabolic alkalosis?

Respiratory acidosis Status asthmaticus causes inadequate gas exchange, resulting in a low pH and PaO2, an elevated PaCO2, and an HCO3- within the expected reference range. These laboratory values indicate respiratory acidosis.

A nurse is reviewing the medical record of a client who has diabetes mellitus and is receiving insulin by continuous IV infusion to treat diabetic ketoacidosis. Which of the following findings should the nurse report to the provider?

Serum potassium 3.0 mEQ/L This serum potassium level is below the expected reference range. Hypokalemia is a serious complication that can occur when a client who has diabetic ketoacidosis is receiving insulin to treat the condition. The nurse should report this finding to the provider.

A nurse is assessing a client who has a phosphorus level of 2.4 mg/dl. Which of the following findings should the nurse expect? Hepatic failure? Abdominal pain? Slow peripheral pulses? Increase in cardiac output?

Slow peripheral pulses from a decrease in cardiac output. This phosphorus level is below the expected reference range. The nurse should expect the client to have slow peripheral pulses. The nurse might also find that the client's pulses are difficult to find and easy to block. Hypophosphatemia also causes weakness of skeletal muscles and rhabdomyolysis

A nurse is assessing a client who is receiving hydrochlorothiazide and notes that the client is confused and lethargic. Which of the following laboratory values should the nurse report to the provider?

Sodium 128 mEq/L and is the likely cause of the client's altered mental status. The nurse should report this finding to the provider and monitor the client for weakened respiratory effort.

A nurse is evaluating a client who is receiving IV fluids to treat dehydration. Which of the following laboratory findings indicates that the fluid therapy has been effective? BUN 26 mg/dL Sodium 142 mEq/L HCT 56% Urine specific gravity 1.035

Sodium 142 mEq/L A sodium level of 142 mEq/L is within the expected reference range of 136 to 145 mEq/L and indicates that the fluid therapy has been effective. A BUN of 26 mg/dL is above the expected reference range of 10 to 20 mg/dL. An elevated BUN is an indication that the client is still dehydrated. This Hct is above the expected reference range of 42 to 52% for males and 37 to 47% for females. An elevated Hct is an indication that the client is still dehydrated. A urine specific gravity of 1.035 is above the expected reference range of 1.005 to 1.030. An elevated urine specific gravity is an indication that the client is still dehydrated.

A nurse is providing teaching to a client who has venous insufficiency of the lower extremities. Which of the following statements by the client indicates and understanding of the teaching?

When I sit down to watch television, I'll be sure to put my feet up." Venous insufficiency makes it difficult for blood flow to return to the heart. Elevating the feet will increase venous return. The client should elevate their feet for at least 20 min several times per day.

A nurse is preparing to administer oral potassium to a client who has a potassium level of 5.5 mEq/L. Which of the following actions should the nurse take first?

Withhold the medication The greatest risk to the client is bradycardia, hypotension, and life-threatening cardiac complications due to hyperkalemia, defined as a potassium level above 5.0 mEq/L. Therefore, the nurse's priority action is to withhold the oral potassium and notify the provider. Although not priority, the nurse should also repeat the potassium level check, administer a hypertonic solution to correct the hyperkalemia, and monitor for paresthesia (numbness and tingling are indications of hyperkalemia)

A nurse is reviewing the ABG results for four clients. Which of the following findings should the nurse identify as metabolic acidosis.

pH 7.26, PaO2 84 mm Hg, PaCO2 38 mm Hg, HCO3- 20 mEq/L A pH below 7.35 is an indication of acidosis. An HCO3- below 22 mEq/L is an indication of metabolic acidosis.

A nurse is caring for a client who requires nasogastric suctioning. Which of the following sets of laboratory results indicates that the client has metabolic alkalosis?

pH 7.51, PaO2 94 mm Hg, PaCO2 36 mm Hg, HCO3- 31 mEq/L An elevated pH and HCO3- with a PaCO2 that is either elevated or within the expected reference range indicates metabolic alkalosis.