Prep U Chapter 13
A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? <136 mOsm/kg 275-300 mOsm/kg >408 mOsm/kg 350-544 mOsm/kg
275-300 mOsm/kg
A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of: 280 mOsm/kg. 210 mOsm/kg. 230 mOsm/kg. 250 mOsm/kg.
280 mOsm/kg
The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? 1500 ml 1250 ml 500 ml 1 L
1 L
Which solution is hypotonic? Lactated Ringer solution 0.45% NaCl 5% NaCl 0.9% NaCl
0.45% NaCl
The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? 5% glucose in normal saline solution 0.9% sodium chloride 0.45% sodium chloride 5% glucose in water
0.45% sodium chloride
Which is considered an isotonic solution? 0.9% normal saline Dextran in normal saline 3% NaCl 0.45% normal saline
0.9% normal saline
A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be 7.30 7.35 7.45 7.50
7.50
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? Alkaline Acidic Basic Neutral
Acidic
Which is the most common cause of symptomatic hypomagnesemia? Alcoholism Burns Sedentary lifestyle Intravenous drug use
Alcoholism
The nurse has been assigned to care for various clients. Which client is at the highest risk for a fluid and electrolyte imbalance? An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide. A 45-year-old client who had a laparoscopic appendectomy 24 hours ago and is being advanced to a regular diet. A 79-year-old client admitted with a diagnosis of pneumonia. A 66-year-old client who had an open cholecystectomy with a T-tube placed that is draining 125 mL of bile per shift.
An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide.
A patient complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patient's laboratory work has returned? Calcium Potassium Phosphorus Magnesium
Calcium
A volume-depleted patient would present with which of the following diagnostic lab results? BUN-to-creatinine ratio of 24:1 Urinary output of 1.2 L/24 hours Urine specific gravity of 1.02 Capillary refill time of 3 seconds
BUN-to-creatinine ratio of 24:1
A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond? Renin-angiotensin-aldosterone system Bicarbonate-carbonic acid buffer system Sodium-potassium pump ADH-ANP buffer system
Bicarbonate-carbonic acid buffer system
Which is an insensible mechanism of fluid loss? Breathing Urination Bowel elimination Nausea
Breathing
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? Hypovolemic shock Severe hyperkalemia Cerebral edema Tetany
Cerebral edema
Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism? Slow pulse Chest pain Hypertension Jaundice
Chest pain
The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? Headache Confusion Hallucinations Nausea
Confusion
Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? Sunken eyeballs and spasticity Flaccidity and thirst Tetany and increased blood urea nitrogen (BUN) levels Confusion and seizures
Confusion and seizures
The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? Cool and pale skin Crackles in the lung fields Distended jugular veins Dark, concentrated urine
Dark, concentrated urine
You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? Hypovolemia Dehydration Hypervolemia Fluid volume excess
Dehydration
The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L). The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving? Increase the rate of the intravenous lactated Ringer solution. Change the lactated Ringer solution to 2.5% dextrose. Discontinue the intravenous lactated Ringer solution. Change the lactated Ringer solution to 3% saline.
Discontinue the intravenous lactated Ringer solution.
The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? Low heart rate Elevated blood pressure Rapid respiration Subnormal temperature
Elevated blood pressure
Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration? Elevated hematocrit level Abnormal potassium level Low white blood count Low urine specific gravity
Elevated hematocrit level
A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following? Respiratory acidosis Extracellular fluid volume deficit Altered blood urea nitrogen (BUN) value Metabolic alkalosis
Extracellular fluid volume deficit
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? Type 1 diabetes mellitus Opioid overdose Myasthenia gravis Extreme anxiety
Extreme anxiety
What foods can the nurse recommend for the patient with hypokalemia? Green, leafy vegetables Nuts and legumes Fruits such as bananas and apricots Milk and yogurt
Fruits such as bananas and apricots
A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. Na + 130 mEq/L K + 4.6 mEq/L Cl - 94 mEq/L Mg ++ 2.8 mg/dL Ca ++ 13 mg/dL Which of the following alterations is consistent with the client's findings? Hypermagnesemia Hyponatremia Hypercalcemia Hyperkalemia
Hypercalcemia
A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance? Hyperkalemia Hypercalcemia Hypokalemia Hypocalcemia
Hypercalcemia
A client is experiencing edema in the tissue. The nurse is correct in anticipating which tonicity of intravenous fluid? No intravenous solution Hypotonic solution Isotonic fluid Hypertonic solution
Hypertonic solution
A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. Laboratory values are as follows: Na + 147 mEq/L K + 3.0 mEq/L Cl - 112 mEq/L Mg ++ 2.3 mg/dL Ca ++ 1.5 mg/dL Which of the following is consistent with the client's findings? Hyperchloremia Hypophosphatemia Hypernatremia Hypokalemia
Hypokalemia
An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? Hypokalemia Hypophosphatemia Hypernatremia Hyperkalemia
Hypokalemia
Which could be a potential cause of respiratory acidosis? Diarrhea Hypoventilation Vomiting Hyperventilation
Hypoventilation
Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? Administer an ordered decongestant. Instruct the client to breathe into a paper bag. Administer ordered supplemental oxygen. Offer the client fluids frequently.
Instruct the client to breathe into a paper bag.
The nurse is caring for a geriatric client in the home setting. Due to geriatric changes decreasing thirst, the nurse is likely to see a decrease in which fluid location which contains the most body water? Extracellular fluid Interstitial fluid Intravascular fluid Intracellular fluid
Intracellular fluid
A client with a magnesium concentration of 2.6 mEq/L (1.3 mmol/L) is being treated on a medical-surgical unit. Which treatment should the nurse anticipate will be used? Fluid restriction Oral magnesium oxide Dialysis Intravenous furosemide
Intravenous furosemide
A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action? Polyuria Weight loss Tetanic contractions Jugular vein distention
Jugular vein distention
Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? Polyuria Jugular vein distention Tetanic contractions Weight loss
Jugular vein distention
The nurse monitors a patient who is being evaluated for hyperkalemia. She is aware that ECG changes and serum potassium levels are diagnostic. Which of the following are the earliest changes that the nurse should report? K+ = 8 mEq/L; shortened PR interval K+ = 6 mEq/L; elevated ST segment K+ = 5 mEq/L; prolonged T waves K+ = 7 mEq/L; peaked T waves
K+ = 7 mEq/L; peaked T waves
With which condition should the nurse expect that a decrease in serum osmolality will occur? Diabetes insipidus Uremia Hyperglycemia Kidney failure
Kidney failure
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? Abdominal pain or diarrhea Nausea or vomiting Hallucinations or tinnitus Light-headedness or paresthesia
Light-headedness or paresthesia
Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? Assess for dehydration. Give medications that promote fluid retention. Limit sodium and water intake. Teach client behaviors that decrease urination.
Limit sodium and water intake.
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? Pancreas and stomach Lungs and kidney Heart and lungs Kidney and liver
Lungs and kidney
The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. Administer IV bicarbonate. Maintain intake and output records. Compare ABG findings with previous results. Suction the client's airway. Document presenting signs and symptoms.
Maintain intake and output records. Compare ABG findings with previous results. Document presenting signs and symptoms.
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? Respiratory acidosis Metabolic acidosis Metabolic alkalosis Respiratory alkalosis
Metabolic acidosis
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis
Metabolic acidosis
A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
Metabolic alkalosis
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? Respiratory acidosis Respiratory alkalosis Metabolic alkalosis Metabolic acidosis
Metabolic alkalosis
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? Respiratory alkalosis Metabolic acidosis Respiratory acidosis Metabolic alkalosis
Metabolic alkalosis
A 64-year-old client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and is lethargic. Serum sodium level is above 145 mEq/l (145 mmol/L). Should the nurse start salt tablets when caring for this client? Yes, along with the hypotonic IV. Yes, this will correct the sodium deficit. No, sodium intake should be restricted. No, start with the sodium chloride IV.
No, sodium intake should be restricted.
A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client? No, sodium intake should be restricted. Yes, along with the hypotonic IV. No, start with the sodium chloride IV. Yes, this will correct the sodium deficit.
No, sodium intake should be restricted.
Which electrolyte is a major cation in body fluid? Potassium Phosphate Chloride Bicarbonate
Potassium
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? Monitor the client's heart rhythm. Prepare to assist with ventilation. Obtain a urine specimen for drug screening. Prepare for gastric lavage.
Prepare to assist with ventilation.
A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant? Teach the client about increased fluid intake. Assess the client's weight daily for trends. Monitor for signs and symptoms of dehydration. Provide oral care every 2-3 hours.
Provide oral care every 2-3 hours.
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? Blood pressure Respirations Temperature Pulse
Pulse
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Respiratory acidosis
A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators? Potassium level of 3.8 mEq/L Potassium level of 6 mEq/L Sodium level of 150 mEq/L Sodium level of 137 mEq/L
Sodium level of 150 mEq/L
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? Metabolic alkalosis Respiratory alkalosis Respiratory acidosis Metabolic acidosis
Respiratory alkalosis
A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? Respiratory acidosis Metabolic acidosis Metabolic alkalosis Respiratory alkalosis
Respiratory alkalosis
The nurse is participating in the care of a client who had a peripherally inserted central catheter (PICC) placed in the right arm. After catheter placement, the nurse should complete which action? Administer the prescribed IV fluids. Obtain written consent for the procedure. Send the client for a chest x-ray. Assess the client's blood pressure (BP) on the right arm.
Send the client for a chest x-ray.
Which of the following arterial blood gas results would be consistent with metabolic alkalosis? pH 7.26 Serum bicarbonate of 28 mEq/L pH 7.30 Serum bicarbonate of 21 mEq/L
Serum bicarbonate of 28 mEq/L
A 54-year-old male patient is admitted to the hospital with a case of severe dehydration. The nurse reviews the patient's laboratory results. Which of the following results are consistent with the diagnosis? Select all that apply. Serum glucose of 90 mg/dL Serum osmolality of 310 mOsm/kg Urine specific gravity of 1.03 Hematocrit level of 48% Blood urea nitrogen (BUN) of 23 mg/dL Serum sodium of 148 mEq/L
Serum osmolality of 310 mOsm/kg Urine specific gravity of 1.03 Blood urea nitrogen (BUN) of 23 mg/dL Serum sodium of 148 mEq/L
A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? Serum sodium level of 132 mEq/L Blood urea nitrogen (BUN) level of 29 mg/dl Urine specific gravity of 1.025 Serum potassium level of 3 mEq/L
Serum potassium level of 3 mEq/L
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? Serum blood urea nitrogen (BUN) level of 8.6 mg/dl Hematocrit of 52% Serum sodium level of 124 mEq/L Serum creatinine level of 0.4 mg/dl
Serum sodium level of 124 mEq/L
Which medication does the nurse anticipate administering to antagonize the effects of potassium on the heart for a patient in severe metabolic acidosis? Calcium gluconate Magnesium sulfate Sodium bicarbonate Furosemide (Lasix)
Sodium bicarbonate
Which of the following is a factor affecting an increase in urine osmolality? Myocardial infarction Syndrome of inappropriate antidiuretic hormone release (SIADH) Fluid volume excess Alkalosis
Syndrome of inappropriate antidiuretic hormone release (SIADH)
A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis? The client sees his physician for a check-up yearly. The client has never traveled outside of the country. The client had a liver transplant 2 years ago. The client works in a health care insurance office.
The client had a liver transplant 2 years ago.
The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? The lungs are unable to exchange oxygen and carbon dioxide. The lungs are not able to blow off carbon dioxide. The lungs have ineffective cilia from years of smoking. The lungs are unable to breathe in sufficient oxygen.
The lungs are not able to blow off carbon dioxide.
Which of the following may be the first sign of respiratory acidosis in anesthetized patients? Ventricular fibrillation Increased pulse Dull headache Mental cloudiness
Ventricular fibrillation
Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)? Tomato juice, low-fat cottage cheese, and three slices of bacon Three ounces of sliced ham, beets, and a salad Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad A frozen, packaged low-fat dinner with a side salad
Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad
A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? Absence of protein Specific gravity of 1.02 Absence of glucose Urine pH of 3.0
Urine pH of 3.0
A client with emphysema is at a greater risk for developing which acid-base imbalance? chronic respiratory acidosis respiratory alkalosis metabolic acidosis metabolic alkalosis
chronic respiratory acidosis
A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her: neuromuscular function. electrocardiogram (ECG) results. bowel sounds. respiratory rate.
electrocardiogram (ECG)
A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypotension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? hypokalemia hypercalcemia hyperkalemia hypocalcemia
hypokalemia
Early signs of hypervolemia include moist breath sounds. thirst. a decrease in blood pressure. increased breathing effort and weight gain.
increased breathing effort and weight gain.
A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the client may be developing hyperaldosteronism. client has a history of alcohol abuse. malignancy is causing the electrolyte imbalance. client's diet is lacking in calcium-rich food products.
malignancy is causing the electrolyte imbalance.
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? PaCO 36 HCO 21 mEq/L O saturation 95% pH 7.48
pH 7.48
Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15 pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34
pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: metabolic acidosis. respiratory alkalosis. respiratory acidosis. metabolic alkalosis.
respiratory alkalosis.
A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting? anasarca third-spacing hypovolemia pitting edema
third-spacing
