NCLEX Review: Fluid, Electrolyte and Acid-Base Imbalances

A nurse must discontinue a patient's intravenous infusion. The nurse shuts off the infusion, washes the hands, and dons clean gloves. Place the following steps in the order in which they should be performed. 1. Apply counter-traction to the skin while loosening the tape at the venipuncture site. 2. Apply firm pressure to the site with sterile gauze for two to three minutes. 3. Apply a sterile dressing with tape over the venipuncture site. 4. Withdraw the needle/catheter along the line of insertion. 5. Examine the end of the needle/catheter.

1,4,2,5,3 **5. Examining the end of the needle/ catheter ensures that it is intact and no portion remains in the patient.

A nurse is assessing a patient's fluid status. Which assessments indicate that the patient has a deficient fluid volume? Select all that apply. 1. ____Negative balance of intake and output 2. ____Decreased body temperature 3. ____Increased blood pressure 4. ____Shortness of breath 5. ____Fla t neck veins 6. ____W eight loss

1. A patient has a negative balance of I&O when the output exceeds the intake. This is a characteristic of a deficient fluid volume. 5. Flat neck veins are associated with a deficient fluid volume as a result of the decreased circulating blood volume. 6. Weight loss occurs with a deficient fluid volume; 1 liter of fluid weighs 2.2 pounds.

A nurse assesses a patient for electrolyte imbalances. Which clinical manifestations indicate that the patient may have a potassium deficiency? Select all that apply. 1. ____Ventricular dysrhythmias 2. ____Increased blood pressure 3. ____Muscle weakness 4. ____Chest pain 5. ____Dry hair

1. Potassium is essential to the sodium-potassium pump that regulates muscle contraction. The heart is a major muscle. Hypokalemia can precipitate a weak, irregular pulse and ventricular dysrhythmias. 3. Potassium is an essential component in the sodium-potassium pump, cellular metabolism, and muscle contraction. Responses associated with hypokalemia include muscle weakness, fatigue, lethargy, leg cramps, and depressed deep-tendon reflexes.

EKG changes in hyperkalemia

1. Tall peaked T waves 2. Flat P waves 3. Widened QRS complexes 4. Prolonged PR interval

A nurse is caring for a patient in the emergency department. The patient's ECG tracing is indicated below. For which additional responses should the nurse assess the patient that can be clustered with the results of this ECG tracing? Select all that apply. 1. ____Bradycardia 2. ____Flaccid paralysis 3. ____Increased bowel sounds 4. ____Ventricular dysrhythmias 5. ____Decreased deep tendon reflexes

1. The ECG t racing indicates hyperkalemia (tall, thin T wave; prolonged PR interval, ST-segment depression; widened QRS; and loss of P wave). Bradycardia is associated with hyperkalemia. Potassium, an electrolyte, is part of the sodium-potassium pump that is involved in muscle contraction. The heart is a muscle. 2. The ECG tracing indicates hyperkalemia (tall, thin T wave; prolonged PR interval, ST-segment depression; widened QRS; and loss of P wave). Flaccid paralysis (muscles that lack tone and strength) is associated with hyperkalemia. Potassium, an electrolyte, is part of the sodium-potassium pump that is involved in muscle contraction. 3. The ECG tracing indicates hyperkalemia (tall, thin T wave; prolonged PR interval, ST-segment depression; widened QRS; and loss of P wave). Increased bowel sounds are associated with hyperkalemia because of hyperactivity of gastrointestinal smooth muscle.

When a patient is under extreme stress, there is an increased production of antidiuretic hormone (ADH) and aldosterone. The nurse plans to monitor the patient routinely because an increase in these hormones will cause a decrease in which of the following? 1. Blood pressure 2. Urinary output 3. Body temperature 4. Sweat gland secretions

2. Both hormones are involved with water reabsorption, which conserves fl uid and results in a decreased urinary output. With decreased kidney perfusion, the juxtaglomerular cells of the kidneys release angiotensin II, which stimulates the release of aldosterone from the adrenal cortex. Aldosterone promotes the excretion of potassium and reabsorption of sodium, which results in the passive reabsorption of water. As the concentration of the blood (osmolality) increases, the anterior pituitary releases antidiuretic hormone (ADH). ADH causes the collecting ducts in the kidneys to become more permeable to water, thus promoting its reabsorption into the blood.

A nurse is monitoring a patient who is receiving fluids intravenously. Which clinical manifestations at the insertion site indicate that the IV has infiltrated? Select all that apply. 1. ____Redness 2. ____Swelling 3. ____Firmness 4. ____Coolness 5. ____Inflammation

2. When an IV line moves out of a vein and into subcutaneous tissue, the IV fluid will begin to collect in the interstitial compartment, causing swelling. 4. The intravenous fluid that is infusing is at room temperature, which is cooler than body temperature. Therefore, IV fluid collecting at the site of an infiltration will cause the site to feel cool to the touch. **When the insertion site of an IV is reddened, swollen, warm to the touch, and painful, the patient has phlebitis, not an infiltration of an IV. **When IV fluid flows into the tissue surrounding a vein (infiltration), the area will feel soft and spongy, not hard. **When the area at the insertion site of an IV appears inflamed, the patient has phlebitis, not an infiltration of an IV.

A patient receiving a diuretic is encouraged to increase the intake of potassium. Which foods selected by the patient indicate that the teaching is understood? Select all that apply. 1. ____Pears 2. ____Cabbage 3. ____Cantaloupe 4. ____Fresh salmon 5. ____Chicken liver

3. Cantaloupe is an excellent source of potassium. One cup of cantaloupe contains 427 mg of potassium. 4. Salmon is an excellent source of potassium. Three ounces of salmon contain 305 mg of potassium.

A nurse is caring for a patient who has dependent edema. Which pressure has caused the excess fluid in the interstitial compartment? 1. Oncotic pressure 2. Diffusion pressure 3. Hydrostatic pressure 4. Intraventricular pressure

3. Hydrostatic pressure is the pressure exerted by a fluid within a compartment, such as blood within the vessels. Hydrostatic pressure moves fluid from an area of greater pressure to an area of lesser pressure. Hydrostatic pressure within vessels of the body moves fluid from the intravascular compartment into the interstitial compartment. Interstitial fluid is extracellular fluid that surrounds cells.

A patient exhibits an increasing blood pressure and 2-lb weight gain over 2 days. Which additional clinical manifestation can be clustered with these data? 1. Decrease in heart rate 2. Increase in skin turgor 3. Increase in pulse volume 4. Decrease in pulse pressure

3. With an excess fluid volume the amount of circulating blood volume increases, resulting in full, bounding peripheral pulses. **With an excess fluid volume, the pulse pressure increases, not decreases.

A patient is admitted to the hospital for a fever of unknown origin. The nursing assessment reveals profuse diaphoresis, dry, sticky mucous membranes, weakness, disorientation, and a decreasing level of consciousness. Which electrolyte imbalance does this data support? 1. Hyperkalemia 2. Hypercalcemia 3. Hypernatremia 4. Hypermagnesemia

3. With profuse diaphoresis, the water loss exceeds the sodium loss, resulting in hypernatremia. Excess serum sodium precipitates changes in the musculoskeletal (weakness), neurological (disorientation and decreased level of consciousness), and integumentary (dry, sticky mucous membranes) systems.

A nurse is assessing several patients for fluid and electrolyte imbalances. Which responses are common to both excess fluid volume and deficient fluid volume? Select all that apply. 1. ____Increased pulse amplitude 2. ____Decreased blood pressure 3. ____Difficulty breathing 4. ____Mental confusion 5. ____Muscle weakness

4. Brain cells require a delicate balance of fluids and electrolytes. Too much fluid and too little fluid affect the appropriate balance of electrolytes, particularly sodium and potassium. Fluid and electrolyte imbalances cause cerebral changes such as headache, confusion, combative behavior, unconsciousness, and coma. 5 . Muscle weakness is a musculoskeletal response to both increased fluid volume and decreased fluid volume because the fluid imbalances alter cellular and body metabolism.

The nurse caring for a client who has been receiving intravenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition? 1. Weight loss and poor skin turgor 2. Lung congestion and increased heart rate 3. Decreased hematocrit and increased urine output 4. Increased respirations and increased blood pressure

Answer: 1 Rationale: A fluid volume deficit occurs when the fluid intake is not sufficient to meet the fluid needs of the body. Assessment findings in a client with a fluid volume deficit include increased respirations and heart rate, decreased central venous pressure (CVP), weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, increased hematocrit, and altered level of consciousness. Lung congestion, increased urinary output, and increased blood pressure are all associated with fluid volume excess. Test-Taking Strategy: Focus on the subject, assessment findings in a fluid volume deficit. Think about the pathophysiology for fluid volume deficit and fluid volume excess to answer correctly. Note that options 2, 3, and 4 are comparable or alike and are manifestations associated with fluid volume excess.

The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit? 1. A client with an ileostomy 2. A client with heart failure 3. A client on long-term corticosteroid therapy 4. A client receiving frequent wound irrigations

Answer: 1 Rationale: A fluid volume deficit occurs when the fluid intake is not sufficient to meet the fluid needs of the body. Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy. A client with heart failure or on long-term corticosteroid therapy or a client receiving frequent wound irrigations is most at risk for fluid volume excess.

The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? 1. pH 7.25, Paco2 50 mm Hg (50 mm Hg) 2. pH 7.35, Paco2 40 mm Hg (40 mm Hg) 3. pH 7.50, Paco2 52 mm Hg (52 mm Hg) 4. pH 7.52, Paco2 28 mm Hg (28 mm Hg)

Answer: 1 Rationale: Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis, the pH is decreased and the Paco2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition, and option 4 identifies respiratory alkalosis. Test-Taking Strategy: Focus on the subject, the arterial blood gas results in a client with atelectasis. Remember that in a respiratory imbalance you will find an opposite response between the pH and the Paco2 . Also, remember that the pH is decreased in an acidotic condition. First eliminate option 2 because it reflects a normal blood gas result. Options 3 and 4 identify an elevated pH, indicating an alkalotic condition. The correct option is the only one that reflects an acidotic condition.

The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance? 1. Respiratory acidosis from inadequate ventilation 2. Respiratory alkalosis from anxiety and hyperventilation 3. Metabolic acidosis from calcium loss due to broken bones 4. Metabolic alkalosis from taking analgesics containing base

Answer: 1 Rationale: Respiratory acidosis is most often caused by hypoventilation. The client with broken ribs will have difficulty with breathing adequately and is at risk for hypoventilation and resultant respiratory acidosis. The remaining options are incorrect. Respiratory alkalosis is associated with hyperventilation. There are no data in the question that indicate calcium loss or that the client is taking analgesics containing base products. Test- Taking Strategy: Note the strategic words, most likely. Focus on the data in the question. Think about the location of the ribs to determine that the client will have difficulty breathing adequately. This will assist in directing you to the correct option. Remembering that hypoventilation results in respiratory acidosis will direct you to the correct option.

Potassium chloride intravenously is prescribed for a client with heart failure experiencing hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply. 1. Obtain an intravenous (IV) infusion pump. 2. Monitor urine output during administration. 3. Prepare the medication for bolus administration. 4. Monitor the IV site for signs of infiltration or phlebitis. 5. Ensure that the medication is diluted in the appropriate volume of fluid. 6. Ensure that the bag is labeled so that it reads the volume of potassium in the solution.

Answer: 1, 2, 4, 5, 6 Rationale: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via an infusion pump. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. The nurse should ensure that the potassium is diluted in the appropriate amount of diluent or fluid. The IV bag containing the potassium chloride should always be labeled with the volume of potassium it contains. The IV site is monitored closely, because potassium chloride is irritating to the veins and there is risk of phlebitis. In addition, the nurse should monitor for infiltration. The nurse monitors urinary output during administration and contacts the primary health care provider if the urinary output is less than 30 mL/hr.

The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply. 1. Nausea 2. Confusion 3. Bradypnea 4. Tachycardia 5. Hyperkalemia 6. Lightheadedness

Answer: 1, 2, 4, 6 Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs. Bradypnea describes respirations that are regular but abnormally slow. Hyperkalemia is associated with acidosis.

The nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 2.5 mEq/L (2.5 mmol/L). Which patterns should the nurse watch for on the electrocardiogram (ECG) as a result of the laboratory value? Select all that apply. 1. U waves 2. Absent P waves 3. Inverted T waves 4. Depressed ST segment 5. Widened QRS complex

Answer: 1, 3, 4 Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level lower than 3.5 mEq/L (3.5 mmol/L) indicates hypokalemia. Potassium deficit is an electrolyte imbalance that can be potentially life-threatening. Electrocardiographic changes include shallow, flat, or inverted T waves; ST segment depression; and prominent U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client with atrial fibrillation, junctional rhythms, or ventricular rhythms. A widened QRS complex may be noted in hyperkalemia and in hypermagnesemia.

The nurse reviews a client's record and determines that the client is at risk for developing a potassium deficit if which situation is documented? 1. Sustained tissue damage 2. Requires nasogastric suction 3. Has a history of Addison's disease 4. Uric acid level of 9.4 mg/dL (557 mcmol/L)

Answer: 2 Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client with hyperuricemia are at risk for hyperkalemia. The normal uric acid level for a female is 2.7 to 7.3 mg/dL (160 to 430 mcmol/L) and for a male is 4.0 to 8.5 mg/dL (240 to 501 mcmol/L).

The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1. Sodium level of 145 mEq/L (145 mmol/L) 2. Potassium level of 3.0 mEq/L (3.0 mmol/L) 3. Magnesium level of 1.8 (0.74 mmol/L) 4. Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

Answer: 2 Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Some clinical manifestations of respiratory alkalosis include lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, diarrhea, epigastric pain, and numbness and tingling of the extremities. All three incorrect options identify normal laboratory values. The correct option identifies the presence of hypokalemia.

The nurse reviews a client's record and determines that the client is at risk for developing a potassium deficit if which situation is documented? 1. Sustained tissue damage 2. Requires nasogastric suction 3. Has a history of Addison's disease 4. Uric acid level of 9.4 mg/dL (557 mcmol/L)

Answer: 2 Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client with hyperuricemia are at risk for hyperkalemia. The normal uric acid level for a female is 2.7 to 7.3 mg/dL (160 to 430 mcmol/L) and for a male is 4.0 to 8.5 mg/dL (240 to 501 mcmol/L).

The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Paco2 of 30 mm Hg (30 mm Hg), and HCO3 - of 20 mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition? 1. Metabolic acidosis, compensated 2. Respiratory alkalosis, compensated 3. Metabolic alkalosis, uncompensated 4. Respiratory acidosis, uncompensated

Answer: 2 Rationale: The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Paco2 . In this situation, the pH is at the high end of the normal value and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore, the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred. Test-Taking Strategy: Focus on the data in the question, noting the arterial blood gas results. Remember that in a respiratory imbalance you will find an opposite response between the pH and the Pco2 as indicated in the question. Therefore, you can eliminate the options reflective of a primary metabolic problem. Also, remember that the pH increases in an alkalotic condition and compensation can be evidenced by a normal pH. The correct option reflects a respiratory alkalotic condition and compensation and describes the blood gas values as indicated in the question

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. 1. Respirations that are shallow 2. Respirations that are increased in rate 3. Respirations that are abnormally slow 4. Respirations that are abnormally deep 5. Respirations that cease for several seconds

Answer: 2, 4 Rationale: Kussmaul's respirations are abnormally deep and increased in rate. These occur as a result of the compensatory action by the lungs. In bradypnea, respirations are regular but abnormally slow. Apnea is described as respirations that cease for several seconds.

The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia? 1. Muscle twitches 2. Decreased urinary output 3. Hyperactive bowel sounds 4. Increased specific gravity of the urine

Answer: 3 Rationale: The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). Hyponatremia is evidenced by a serum sodium level lower than 135 mEq/L (135 mmol/L). Hyperactive bowel sounds indicate hyponatremia. The remaining options are signs of hypernatremia. In hyponatremia, muscle weakness, increased urinary output, and decreased specific gravity of the urine would be noted. Test-Taking Strategy: Focus on the data in the question and the subject of the question, signs of hyponatremia. It is necessary to know the signs of hyponatremia to answer correctly. Also, think about the action and effects of sodium on the body to answer correctly. Remember that increased bowel motility and hyperactive bowel sounds indicate hyponatremia.

On review of the clients' medical records, the nurse determines that which client is at risk for fluid volume excess? 1. The client taking diuretics who has tenting of the skin 2. The client with an ileostomy from a recent abdominal surgery 3. The client who requires intermittent gastrointestinal suctioning 4. The client with kidney disease and a 12-year history of diabetes mellitus

Answer: 4 Rationale: A fluid volume excess is also known as overhydration or fluid overload and occurs when fluid intake or fluid retention exceeds the fluid needs of the body. The causes of fluid volume excess include decreased kidney function, heart failure, use of hypotonic fluids to replace isotonic fluid losses, excessive irrigation of wounds and body cavities, and excessive ingestion of sodium. The client taking diuretics, the client with an ileostomy, and the client who requires gastrointestinal suctioning are at risk for fluid volume deficit. Test-Taking Strategy: Focus on the subject, fluid volume excess. Think about the pathophysiology associated with fluid volume excess. Read each option and think about the fluid imbalance that can occur in each. Clients taking diuretics or having ileostomies or gastrointestinal suctioning all lose fluid. The only condition that can cause an excess is the condition noted in the correct option.

Which client is at risk for the development of a potassium level of 5.5 mEq/L (5.5 mmol/L)? 1. The client with colitis 2. The client with Cushing's syndrome 3. The client who has been overusing laxatives 4. The client who has sustained a traumatic burn

Answer: 4 Rationale: The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level higher than 5.0 mEq/L (5.0 mmol/L) indicates hyperkalemia. Clients who experience cellular shifting of potassium in the early stages of massive cell destruction, such as with trauma, burns, sepsis, or metabolic or respiratory acidosis, are at risk for hyperkalemia. The client with Cushing's syndrome or colitis and the client who has been overusing laxatives are at risk for hypokalemia. Test-Taking Strategy: Eliminate the client with colitis and the client overusing laxatives first, because they are comparable or alike, with both reflecting a gastrointestinal loss. From the remaining options, recalling that cell destruction causes potassium shifts will assist in directing you to the correct option. Also, remember that Cushing's syndrome presents a risk for hypokalemia and that Addison's disease presents a risk for hyperkalemia.

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Paco2 is 90 mm Hg (90 mm Hg), and is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition? 1. Metabolic acidosis with compensation 2. Respiratory acidosis with compensation 3. Metabolic acidosis without compensation 4. Respiratory acidosis without compensation

Answer: 4 Rationale: The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis the pH is decreased and the Pco2 is elevated. The normal bicarbonate ) level is 21 to 28 mEq/L (21 to 28 mmol/L). Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. In addition, the pH is not within normal limits. Therefore, the condition is without compensation. The remaining options are incorrect interpretations.

The nurse is caring for a client with Crohn's disease who has a calcium level of 8 mg/dL (2 mmol/L). Which patterns would the nurse watch for on the electrocardiogram? Select all that apply. 1. U waves 2. Widened T wave 3. Prominent U wave 4. Prolonged QT interval 5. Prolonged ST segment

Answer: 4, 5 Rationale: A client with Crohn's disease is at risk for hypocalcemia. The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A serum calcium level lower than 9 mg/dL (2.25 mmol/L) indicates hypocalcemia. Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged QT interval and prolonged ST segment. A shortened ST segment and a widened T wave occur with hypercalcemia. ST depression and prominent U waves occur with hypokalemia. Test-Taking Strategy: Focus on the subject, the electrocardiographic patterns that occur in a client with Crohn's disease who has a calcium level of 8 mg/dL (2 mmol/L). It is necessary to know this client is at risk for hypocalcemia and that a level of 8 mg/dL (2 mmol/L) is low. Then it is necessary to recall the electrocardiographic changes that occur in hypocalcemia. Remember that hypocalcemia causes a prolonged ST segment and prolonged QT interval.

Which acid base imbalance has Kussmaul's respirations?

Metabolic acidosis

Which acid-base imbalance would cause ventilator settings to get too high or too low?

Respiratory Alkalosis (Overventilation) means ventilator settings may be too HIGH. Respiratory Acidosis (Underventilation) means ventilator settings may be too LOW.

EKG changes for hypokalemia

ST depression prominent U waves

What electrolyte imbalance are lactose intolerant clients most at risk for? What are the s/s of this imbalance?

Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.

Which electrolyte imbalance are the following at higher risk for? Cushing's syndrome Hyperaldosteronism Client on diuretics

The client taking corticosteroids and the client with hyperaldosteronism or Cushing's syndrome are at risk for hypernatremia.

The nurse reviews the electrolyte results of a client with chronic kidney disease and notes that the potassium level is 5.7 mEq/L (5.7 mmol/L). Which patterns would the nurse watch for on the cardiac monitor as a result of the laboratory value? Select all that apply. 1. ST depression 2. Prominent U wave 3. Tall peaked T waves 4. Prolonged ST segment 5. Widened QRS complexes

The client with chronic kidney disease is at risk for hyperkalemia. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level greater than 5.0 mEq/L (5.0 mmol/L) indicates hyperkalemia. Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves. ST depression and a prominent U wave occurs in hypokalemia. A prolonged ST segment occurs in hypocalcemia.

High Pressure Alarms are triggered by ↑ resistance to air flow and can be caused by obstructions of three types:

a. Kinked Tube. NRS ACTION: Unkink it b. Water in tubing (caused by condensation). NRS ACTION: Empty it/Remove H2O c. Mucus in airway. NRS ACTION: Turn, C&DB; only use suction if C&DB fails, as a last resort.

Low Pressure Alarms are triggered by ↓ resistance to air flow and can be caused by disconnections of the:

a. Tubing. NRS ACTION: Pay attention to where tubing is...(contamination). If on floor, change out. If on chest, clean with alcohol then put back on

Which acid-base imbalance needs an ambu-bag at bedside?

acidosis because of risk for coma and decreased respirations

Which acid-base imbalance needs suction at bedside?

alkalosis because of risk for seizures and aspirations

EKG changes for hypocalcemia

prolonged QT interval prolonged ST segment

EKG changes for hypercalcemia

shortened ST segment widened T wave

pH is DOWN Potassium is UP what are the s/s?

• Bradycardia • Bradypnea • Hypotension • ↓ lucidity • anorexia • coma • lethargy

pH is UP Potassium is DOWN what are the s/s?

• Tachycardia • Tachypnea • Diarrhea • Tremors • Seizure • Hyperreflexia • Agitated "A SIC WALT" Alkalosis Shallow respirations Irritability Confusion/drowsiness Weakness Arrhythmias Lethargy Thready pulser