Saunders Fluid & Electrolyte Practice Questions
A nurse reviews a client's laboratory report and notes thatt the client's serum phosphorus level is 2. Which condition most likely caused this serum phosphorus level? 1) Alcoholism 2) Renal insufficiency 3) Hypoparathyroidism 4) Tumor lysis syndrome
Answer: 1 Rational: The normal serum phosphorus level is 2.4-4.4. The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based or magnesium-based antacids. Malnutrition is associated with alcoholism. Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome are causative factors for Hyperphosphatemia.
The nurse provides instructions to a client with a low potassium level about the foods that are high in potassium and tells the client to consume which foods: Select all that apply: 1) Peas 2) Raisins 3) Potatoes 4) Cauliflower 5) Cantaloupe 6) Strawberries
Answer: 2, 3, 5, & 6 Rational: The normal potassium level is 3.5-5. Common food sources of potassium include avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes. Peas and cauliflower are high in magnesium.
A nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.4. Which of the following would the nurse expect to note on the electrocardiogram as a result of the laboratory value? 1) ST depression 2) Inverted T wave 3) Prominent U wave 4) Tall peaked T wave
Answer: 4 Rational: A serum potassium level greater than 5 indicates hyperkalemia. Elecrocardiographic chanes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves.
A nurse caring for a group of clients reviews the electrolytes laboratory results and notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is a highest risk for developing a potassium value at this level? 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 Rational: A serum potassium level higher than 5 mEq/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.
hydrogen ions think
acids
bicarbonate/base think
alkaline
acidosis hyperk or hypok
hyperkalemia
corticosteroid can increase of decrease k+?
decrease- hypokalemia
diabetes insipidus
deficit
increase hct indicates
deficit
A nurse is reading a physician's progress notes in the lcient's record and reads that the physician had documented "insensible fluid loss of approximately 800 mL daily." The nurse interprets that this type of fluid loss can occur through: 1) The skin 2) Urinary output 3) Wound drainage 4) The gastrointestinal tract
Answer: 1 Rational: Sensible losses are those of which the person is aware, such as through wound drainage, gastrointestinal tract losses, and urination. Insensible losses may occur without the person's awareness. Insensible losses occur daily through the skin and lungs.
A nurse caring for a client with hypocalcemia would expect to note which of the following changes on the electrocardiogram? 1) Widened T wave 2) Prominent U wave 3) Prolonged QT interval 4) Shortened ST segment
Answer: 3 Rational: The normal serum calcium level is 8.6 - 10.2. A serum calcium level lower than 8.6 indicates hypocalcemia. Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or QT interval. A shortened ST segment and a widened T wave occur with hypercalcemia. Prominent U waves occur with hypokalemia.
A nurse caring for for a client who has been receiving 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) Lung congestion 2) Decreased hematocrit 3) Increased blood pressure 4) Decreased central venous pressure (CVP)
Answer: 4 Rational: 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 CVP, weigh loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, increased hematocrit, and altered level of consciousness. The normal CVP is between 4 and 11 cm H2O. A client with dehydration (fluid volume deficit) has a low CVP. The assessment findings in options 1, 2, and 3 are seen in a client with fluid volume excess.
A nurse is reviewing laboratory results and notes that a client's serum sodium level is 150 mEq/L. The nurse reports the serum sodium level to the physician and the physician prescribes dietary instructions based on the serum level. Which food item does the nurse instruct the client to avoid. 1) Peas 2) Nuts 3) Cauliflower 4) Processed oat cereals
Answer: 4 Rational: The normal serum sodium level is 135 - 145. a serum sodium level of 150 indicates hypernatremia. Based on this finding, the nurse would instruct the client to avoid food high in sodium. Nuts, cauliflower, and peas are good food sources of phosphorus. Processed food are high in sodium content.
The nurse caring for a group of clients reviews the electrolyte laboratory results and notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is most at risk for the development of a potassium value at this level? a.The client with colitis b.The client with Cushing's syndrome c.The client who has been overusing laxatives d.The client who has sustained a traumatic burn
D A serum potassium level higher than 5.0 mEq/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.
A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for fluid volume deficit? 1) A client with a colostomy 2) A client with congestive heart failure 3) A client on long term corticosteroid therapy 4) A client receiving frequent wound irrigations
Answer: 1 Rational: A fluid volume deficit occurs when the fluid intakes 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 congestive heart failure or on long-term corticosteroid therapy, or a client receiving frequent wound irrigations, is at risk for fluid volume excess.
A nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 3.2 mEq/L. Which of the following would the nurse note on the electrocardiogram as a result of the laboratory value? 1) U waves 2) Absent P waves 3) Elevated T waves 4) Elevated ST segment
Answer: 1 Rational: A serum potassium level lower than 3.5 mEq/L indicates hypokalemia. Potassium deficit is a common electrolyte imbalance and is potentially life-threatening. Electrocardiographic changes include inverted T waves, ST segment depression, and prominent U waves. Absent P waves are not a characteristic of hypokalemia but may be noting in a client with atrial fibrillation (A-fib).
A nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which of the following clinical manifestations would the nurse expected to notes in the client? 1) Twitching 2) Hypoactive bowel sounds 3) Negative Trouseau's sign 4) Hypoactive deep tendon reflexes
Answer: 1 Rational: The normal serum calcium level is 8.6 - 10.2. A serum calcium level lower than 8.6 indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes and a positive Trouseau's or Chvosteck'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.
A nurse is assigned to care for a group of clients. 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 2) The client with renal failure 3) The client with and ileostomy 4) The client who requires gastrointestinal suctioning
Answer: 2 Rational: 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, congestive 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.
A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a sodium level of 130 on one clients laboratory report. The nurse understands that which client is at highest risk for the development of a sodium value at this level? 1) The client with Cushing's syndrome 2) The client who is taking diuretics 3) The client with hyperaldosteronism 4) The client who is taking corticosteroids
Answer: 2 Rational: Hyponatremia is evidenced by a serum sodium level less than 135. Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the client with Cushing's syndrome or hyper aldosteronism are at risk for hypernatremia.
A nurse is preparing to care for a client with potassium deficit. The nurse reviews the client's record and determines that the client was a risk for developing the potassium deficit because the client: 1) Sustained tissue damage 2) Requires nasogastric suctioning 3) Has a history of Addison's disease 4) Is taking a potassium-sparing diuretic
Answer: 2 Rational: The normal serum potassium level is 3.5 mEq/L to 5 mEq/L. A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal section, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client taking a potassium-sparing diuretic are at risk for hyperkalemia.
The nurse is caring for a client with congestive heart failure. On assessment, the nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present? 1) Weight loss 2) Flat neck and hand veins 3) An increase in blood pressure 4) a decreased central venous pressure (CVP)
Answer: 3 Rational: 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. Assessment findings associated with fluid colume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit. Options 1, 2, and 4 identify signs noted in fluid volume deficit.
A nurse is caring for a client with acute congestive 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) Extreme thirst 2) Decreased urinary output 3) Hyperactive bowel sounds 4) Increased specific gravity of the urine
Answer: 3 Rational: Hyponatremia is evidenced by serum sodium level lower than 135. Hyperactive bowel sounds indicated hypernatremia. Options 1, 2, and 4 are signs of hypernatremia. In hyponatremia, increased urinary output and decreased specific gravity of the urine would be noted.
A nursing students needs to administer potassium chloride intravenously as prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium? 1) Obtaining a controlled intravenous (IV) infusion pump 2) Monitoring urine output during administration 3) Preparing the medication for bolus administration 4) Diluting the medication in appropriate amount or normal saline
Answer: 3 Rational: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via an infusion pump or controller. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. Dilution in normal saline is recommended, and dextrose solution is avoided because this types of solution increases intracellular potassium shifting. The IV site is monitored closely because the potassium chloride is irritating to the veins and there is a risk of phlebitis. The nurse monitors urinary output during administration and contacts the physician if the urinary output is less than 30 mL/hr.
Which intravenous solution would be most appropriate for a client who may be experiencing excess fluid volume secondary to heart failure? a.0.9% normal saline b.0.45% normal saline c.Lactated Ringer's solution d. 5% dextrose in 0.9% normal saline
d. because its a hypertonic solution. we want to push out the fluid into the intravasular space
heart failure
excess
increase of na+ intake
excess
alkalosis, what happens to respirations? what is rate and depth
hyperventilation, respiration depth decreased and rate increases
kayexelate hypo or hyper
hypo
in acidosis what happens to respiration? What is rate and depth?
hypoventilation, deep and slow
Severe diarrhea DKA excessive NSAIDs high fat diet anorexia renal failure
metabolic acidosis
severe vomitting NG suctioning diurretics ingestion of sodium bicarbonate hyperaldosteronism blood transfusion
metabolic alkalosis
