Iggy Chapter 13: Fluid & Electrolytes

An older adult client is admitted with dehydration. Which nursing assessment data identify that the client is at risk for falling?

A. Dry oral mucous membranes

B. Orthostatic blood pressure changes

C. Pulse rate of 72 beats/min and bounding

D. Serum potassium level of 4.0 mEq/L

B. Orthostatic blood pressure changes

A client has a low serum potassium level and is ordered a dose of parenteral potassium chloride (KCl). How does a nurse safely administer KCl to the client?

A. Administers 5 mEq intramuscularly

B. Dilutes 200 mEq in 1 liter of normal saline and infuses at 100 mL/hr

C. Infuses 10 mEq over a 1-hour period

D. Pushes 5 mEq through a central access line

C. Infuses 10 mEq over a 1-hour period

A client is being monitored for daily weights. The night nurse asks the nursing assistant for the morning weight, and the assistant replies, "She was sleeping so well, I didn't want to wake her to get her weight." How does the nurse respond?

A. "Fast thinking! She really needs to rest after the night she had."

B. "Get the information now, or I'll report you for not doing your job."

C. "Never mind—I will do it myself."

D. "Weigh her now. We need her weight daily, at the same time."

D. "Weigh her now. We need her weight daily, at the same time."

The nurse instructs an older adult client to increase intake of dietary potassium when the client is prescribed which classification of drugs?

A. Alpha antagonists

B. Beta blockers

C. Corticosteroids

D. High-ceiling (loop) diuretics

D. High-ceiling (loop) diuretics

The nurse is instructing a client who is being discharged with a diagnosis of congestive heart failure (CHF). Which client statement indicates a correct understanding of CHF?

A. "I can gain 2 pounds of water a day without risk."

B. "I should call my provider if I gain more than 1 pound a week."

C. "Weighing myself daily can determine if my caloric intake is adequate."

D. "Weighing myself daily can reveal increased fluid retention."

D. "Weighing myself daily can reveal increased fluid retention."

Which client is at GREATEST risk for hypernatremia?

A. A 17-year-old with a serum blood glucose of 189 mg/dL

B. A 30-year-old on a low-salt diet

C. A 42-year-old receiving hypotonic fluids

D. A 54-year-old who is sweating profusely

D. A 54-year-old who is sweating profusely

As adults age, which common physiologic change is likely to alter their hydration status?

A. Adrenal gland growth

B. Decreased muscle mass

C. Increased thirst mechanism

D. Poor skin turgor

B. Decreased muscle mass

The nurse is reviewing serum electrolytes and blood chemistry for a newly admitted client. Which result causes the GREATEST concern?

A. Glucose: 97 mg/dL

B. Magnesium: 2.1 mEq/L

C. Potassium: 5.9 mEq/L

D. Sodium: 143 mEq/L

C. Potassium: 5.9 mEq/L

A client with hyperkalemia is being treated with drugs to improve the condition. Which potassium level indicates that therapy is effective?

A. 7.6 mEq/L

B. 5.6 mEq/L

C. 4.6 mEq/L

D. 2.6 mEq/L

C. 4.6 mEq/L

A client is admitted with hypokalemia and skeletal muscle weakness. Which assessment does the nurse perform FIRST?

A. Blood pressure

B. Pulse

C. Respirations

D. Temperature

C. Respirations

A client develops fluid overload while in the intensive care unit. Which nursing intervention does the nurse perform FIRST?

A. Draws blood for laboratory tests

B. Elevates the head of the bed

C. Places the extremities in a dependent position

D. Puts the client in a side-lying position

B. Elevates the head of the bed

The nurse is assessing a client with hyponatremia. Which finding requires IMMEDIATE action?

A. Diminished bowel sounds

B. Heightened acuity

C. Muscular weakness

D. Urine output of 35 mL/hr

C. Muscular weakness

The nurse is teaching a group of unlicensed assistive personnel (UAP) about fluid intake principles for older adults. What does the nurse tell them?

A. "Be careful not to overload them with too many oral fluids."

B. "Offer fluids that they prefer frequently and on a regular schedule."

C. "Restrict their fluids in the evening hours if they are incontinent."

D. "Wake them every 2 hours during the night with a drink."

B. "Offer fluids that they prefer frequently and on a regular schedule."

The nurse is caring for a client who is receiving intravenous (IV) magnesium sulfate. Which assessment parameter is CRITICAL?

A. Monitoring 24-hour urine output

B. Asking the client about feeling depressed

C. Hourly deep tendon reflexes (DTRs)

D. Monitoring of serum calcium levels

C. Hourly deep tendon reflexes (DTRs)

The charge nurse on a medical-surgical unit is completing assignments for the day shift. Which client is assigned to the LPN/LVN?

A. A 44-year-old with congestive heart failure (CHF) who has gained 3 pounds since the previous day

B. A 58-year-old with chronic renal failure (CRF) who has a serum potassium level of 6 mEq/L

C. A 76-year-old with poor skin turgor who has a serum osmolarity of 300 mOsm/L

D. An 80-year-old with 3+ peripheral edema and crackles throughout the posterior chest

C. A 76-year-old with poor skin turgor who has a serum osmolarity of 300 mOsm/L

The client is a 69-year-old woman with uncontrolled diabetes, polyuria, and a blood pressure of 86/46 mm Hg. Which staff member is assigned to care for her?

A. LPN/LVN who has floated from the hospital's long-term care unit

B. LPN/LVN who frequently administers medications to multiple clients

C. RN who has floated from the intensive care unit

D. RN who usually works as a diabetes educator

C. RN who has floated from the intensive care unit

The nurse is planning care for a 72-year-old resident of a long-term care facility who has a history of dehydration. Which action does the nurse delegate to unlicensed assistive personnel (UAP)?

A. Assessing oral mucosa for dryness

B. Choosing appropriate oral fluids

C. Monitoring skin turgor for tenting

D. Offering fluids to drink every hour

D. Offering fluids to drink every hour

Which newly written prescription does the nurse administer first?

A. Intravenous normal saline to a client with a serum sodium of 132 mEq/L

B. Oral calcium supplements to a client with severe osteoporosis

C. Oral phosphorus supplements to a client with acute hypophosphatemia

D. Oral potassium chloride to a client whose serum potassium is 3 mEq/L

D. Oral potassium chloride to a client whose serum potassium is 3 mEq/L

The health care provider writes orders for a client who is admitted with a serum potassium level of 6.9 mEq/L. What does the nurse implement FIRST?

A. Administer sodium polystyrene sulfonate (Kayexalate) orally.

B. Ensure that a potassium-restricted diet is ordered.

C. Place the client on a cardiac monitor.

D. Teach the client about foods that are high in potassium.

C. Place the client on a cardiac monitor.

The nurse manager of the medical-surgical unit assigns which client to the LPN/LVN?

A. A 44-year-old admitted with dehydration who has a heart rate of 126 beats/min

B. A 54-year-old just admitted with hyperkalemia who takes a potassium-sparing diuretic at home

C. A 64-year-old admitted yesterday with heart failure who still has dependent pedal edema

D. A 74-year-old who has just been admitted with severe nausea, vomiting, and diarrhea

C. A 64-year-old admitted yesterday with heart failure who still has dependent pedal edema

The RN is caring for a client admitted with dehydration who requires a blood transfusion. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)?

A. Inserting a small-gauge needle for intravenous (IV) access

B. Evaluating a headache that develops during the transfusion

C. Explaining to the client the purpose of the blood transfusion

D. Obtaining baseline vital signs before blood administration

D. Obtaining baseline vital signs before blood administration

The RN is caring for a client who is severely dehydrated. Which nursing action can be delegated to unlicensed assistive personnel (UAP)?

A. Consulting with a health care provider about a client's laboratory results

B. Infusing 500 mL of normal saline over 60 minutes

C. Monitoring IV fluid to maintain the drip rate at 75 mL/hr

D. Providing oral care every 1 to 2 hours

D. Providing oral care every 1 to 2 hours

After receiving change-of-shift report, which client does the RN assess FIRST?

A. A 26-year-old with nausea and vomiting who complains of dizziness when standing

B. A 36-year-old with a nasogastric (NG) tube who has dry oral mucosa and is complaining of thirst

C. A 46-year-old receiving intravenous (IV) diuretics whose blood pressure is 95/52 mm Hg

D. A 56-year-old with normal saline infusing at 150 mL/hr whose hourly urine output has been averaging 75 mL

AC. A 46-year-old receiving intravenous (IV) diuretics whose blood pressure is 95/52 mm Hg

The RN is assessing a 70-year-old client admitted to the unit with severe dehydration. Which finding requires IMMEDIATE intervention by the nurse?

A. Client behavior that changes from anxious and restless to lethargic and confused

B. Deep furrows on the surface of the tongue

C. Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched

D. Urine output of 950 mL for the past 24 hours

A. Client behavior that changes from anxious and restless to lethargic and confused

The nurse manager of a medical-surgical unit is completing assignments for the day shift staff. The client with which electrolyte laboratory value is assigned to the LPN/LVN?

A. Calcium level of 9.5 mg/dL

B. Magnesium level of 4.1 mEq/L

C. Potassium level of 6.0 mEq/L

D. Sodium level of 120 mEq/L

A. Calcium level of 9.5 mg/dL

A 90-year-old client with hypermagnesemia is seen in the emergency department (ED). The ED nurse prepares the client for admission to which inpatient unit?

A. Dialysis/home care

B. Geriatric/rehabilitation

C. Medical-surgical

D. Telemetry/cardiac stepdown

D. Telemetry/cardiac stepdown

A client with mild hypokalemia caused by diuretic use is discharged home. The home health nurse delegates which of these interventions to the home health aide?

A. Assessment of muscle tone and strength

B. Education about potassium-rich foods

C. Instruction on the proper use of drugs

D. Measurement of the client's urine output

D. Measurement of the client's urine output

The nurse is planning care for a client with hypocalcemia. Which nursing action is appropriate to delegate to unlicensed assistive personnel (UAP)?

A. Collaborating with the dietitian to provide calcium-rich foods for the client

B. Evaluating the client's laboratory results

C. Implementing seizure precautions for the client

D. Transferring the client from the bed to a stretcher using a lift sheet

D. Transferring the client from the bed to a stretcher using a lift sheet

A client is admitted to the nursing unit with a diagnosis of hypokalemia. Which assessment does the nurse complete First?

A. Auscultating bowel sounds

B. Checking deep tendon reflexes (DTRs)

C. Determining the level of consciousness (LOC)

D. Obtaining a pulse oximetry reading

D. Obtaining a pulse oximetry reading

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure. Laboratory results include a potassium level of 7.0 mEq/L. Which medication does the nurse anticipate administering?

A. Insulin (regular insulin) and dextrose (D20W)

B. Loperamide (Imodium)

C. Sodium polystyrene sulfonate (Kayexalate)

D. Supplemental potassium

A. Insulin (regular insulin) and dextrose (D20W).

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure. Her laboratory results include a potassium level of 7.0 mEq/L. What is the Primary goal of drug therapy for this client?

A. Decreasing cardiac contractility and slowing the heart rate

B. Elevating serum potassium levels to a safe range

C. Maintaining proper diuresis and urine output

D. Restoring fluid balance by controlling the causes of dehydration

D. Restoring fluid balance by controlling the causes of dehydration

A 68-year-old man is admitted to the hospital with dehydration. He has a history of atrial fibrillation, congestive heart failure (CHF), and hypertension. His current medications are digoxin (Lanoxin), chlorothiazide (Diuril), and oral potassium supplements. He tells the nurse that he has had flulike symptoms for the past week and has been unable to drink for the past 48 hours. The health care provider requests laboratory specimens to be drawn and an isotonic IV to be started. Which IV fluid does the nurse administer?

A. 0.45% saline

B. 5% dextrose in 0.45% saline

C. 5% dextrose in Ringer's lactate

D. 5% dextrose in water (D5W)

D. 5% dextrose in water (D5W)

A 68-year-old man is admitted to the hospital with dehydration. He has a history of atrial fibrillation, congestive heart failure, and hypertension. His current medications are digoxin (Lanoxin), chlorothiazide (Diuril), and potassium supplements. He tells a nurse that he has had flulike symptoms for the past week and has been unable to drink for the past 48 hours. The nurse starts the client's IV and receives laboratory results, which include a potassium level of 2.7 mEq/L. The physician orders an IV potassium supplement. How does the nurse administer this medication?

A. Added to an IV, not to exceed 20 mEq/hr

B. Added to an IV, not to exceed 30 mEq/hr

C. Rapid IV push, a 25-mEq dose

D. Slow IV push, a 30-mEq dose

A. Added to an IV, not to exceed 20 mEq/hr

A 70-year-old woman is admitted to the hospital with heart failure, shortness of breath, and 3+ pitting edema in her lower extremities. Her current medications are furosemide (Lasix), digoxin (Lanoxin), and an angiotensin-converting enzyme inhibitor (Lotensin). She states that she stopped taking her Lasix because she did not think that it was helping her heart failure. Her health care provider orders furosemide (Lasix) 5 mg IV push. Which client assessment determines that the medication is working?

A. Decreased blood pressure (BP)

B. Increased heart rate

C. Increased urine output

D. Weight gain

C. Increased urine output

A 70-year-old woman is admitted to the hospital with heart failure, shortness of breath, and 3+ pitting edema in her lower extremities. Her medications are furosemide (Lasix), digoxin (Lanoxin), and an angiotensin-converting enzyme inhibitor (Lotensin). She states that she stopped taking her Lasix because she did not think that it was helping her heart failure. Her health care provider orders furosemide (Lasix) 5 mg IV push. Ten hours after receiving the Lasix, the client's potassium (K+) level is 2.5 mEq/L. Knowing all of the client's medications, what problem does the nurse anticipate in this client?

A. Clinical manifestations of digoxin toxicity

B. Increased heart rate and blood pressure (BP)

C. Increased signs of congestive heart failure (CHF)

D. Signs and symptoms of hypernatremia

A. Clinical manifestations of digoxin toxicity

Which situation can cause a client to experience "insensible water loss"? (Select all that apply.)

E. NauseaA. Diarrhea

B. Dry, hot weather

C. Fever

D. Increased respiratory rate

F. Mechanical ventilation

A. Diarrhea

B. Dry, hot weather

C. Fever

D. Increased respiratory rate

F. Mechanical ventilation

Which client is at increased risk for fluid and electrolyte imbalance? (Select all that apply.)

A. A 22-year-old pregnant woman in her third trimester

B. A 24-year-old male athlete

C. A 65-year-old man on diuretics

D. A 47-year-old man traveling to South America in summer

E. A 76-year-old bedridden woman

B. A 24-year-old male athlete

C. A 65-year-old man on diuretics

E. A 76-year-old bedridden woman

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). She is receiving lactated Ringer's solution IV for rehydration. What clinical manifestations does the nurse monitor during rehydration of the client? (Select all that apply.)

A. Blood serum glucose

B. Blood pressure

C. Pulse rate and quality

D. Urinary output

E. Urine specific gravity levels

B. Blood pressure

C. Pulse rate and quality

D. Urinary output

E. Urine specific gravity levels

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). Her laboratory results include a potassium level of 7.0 mEq/L. What does the nurse include in the client's medication teaching? (Select all that apply.)

A. Daily weights are a poor indicator of fluid loss or gain.

B. Diuretics can lead to fluid and electrolyte imbalances.

C. Diuretics increase fluid retention.

D. Laxatives can lead to fluid imbalance.

E. It is important to weigh daily at the same time.

B. Diuretics can lead to fluid and electrolyte imbalances.

D. Laxatives can lead to fluid imbalance.

E. It is important to weigh daily at the same time.

The nurse is teaching a client who is taking a potassium-sparing diuretic about what foods to avoid. Which foods contain high amounts of potassium? (Select all that apply.)

A. Apples

B. Bananas

C. Broccoli

D. Oranges

E. Spinach

B. Bananas

C. Broccoli

D. Oranges

E. Spinach

Which assessment finding indicates to the nurse that fluid resuscitation therapy for the client with isotonic dehydration is effective?

A. Respiratory rate has changed from 16 to 18 breaths/min.

B. Urine specific gravity has increased from 1.040 to 1.050.

C. Neck veins are flat when the client moves to a sitting position.

D. Pulse pressure has changed from 22 mm Hg to 32 mm Hg.

D. Pulse pressure has changed from 22 mm Hg to 32 mm Hg.

Which condition or manifestation in the client with a serum sodium level of 149 mEq/L indicates to the nurse that this electrolyte imbalance may be caused by excessive fluid loss?

A. The client has twitching muscle contractions in the lower extremities.

B. The client's skin is cool and clammy.

C. The urine specific gravity is increased.

D. The hematocrit is 52%.

D. The hematocrit is 52%.

Which question is most important for the nurse to ask the client who has a serum potassium level of 2.9 mEq/L?

A. "Do you use sugar substitutes?"

B. "Do you use diuretics or laxatives?"

C. "Have you had any muscle twitches or cramps, especially at night?

D. "Have you or any member of your family ever been diagnosed with lung disease?"

B. "Do you use diuretics or laxatives?"

Which intervention is most important for the nurse to teach the client who is at continuing risk for hypercalcemia and has normal kidney function?

A. "Report a weight gain of 1 lb or more a day to your health care provider immediately."

B. "Keep track of the number of bowel movements you have each day."

C. "Avoid taking aspirin or any aspirin-containing products."

D. "Be sure to drink at least 2 liters of fluids each day."

D. "Be sure to drink at least 2 liters of fluids each day."