NURS 470 Final: Advanced Concepts in Fluids and Lytes

Older adult clients are predisposed to develop fluid volume deficit for which reasons? (Select all that apply.)

Decreased muscle mass

Decreased fat stores

Alterations in nutrition

Alterations in thirst

Diminished renal function

A, C, D, E

What is the major function of tissue gel in the interstitial compartment?

Shift fluid out of capillaries

Provide a source of electrolytes

Distribute fluid evenly

Dispose of cellular waste products

C

Which statement is correct regarding low serum osmolality?

It reflects fluid volume deficit.

It reflects fluid volume excess.

It is associated with dehydration.

It is associated with hypernatremia.

B

Capillary hydrostatic pressure is the pressure exerted by which element?

Plasma proteins in the capillaries

Fluid in the interstitial spaces

Plasma proteins in the interstitial spaces

Fluid moving through the capillaries

D

What is the primary regulator of water intake?

Nervous system

Endocrine system

Renal system

Hypothalamus

D

Which substance, released by the adrenal cortex, is known as the salt-regulating hormone?

ACTH

ADH

Aldosterone

Renin

C

When the hypothalamus senses a change in serum osmolality, it stimulates the posterior pituitary to release which substance?

Renin

Testosterone

ADH

ACTH

C

How is angiotensin II best characterized?

Diuretic

Vasoconstrictor

Thirst trigger

Sodium waster

B

Elevated temperature can cause fluid volume deficit through which process? (Select all that apply.)

Diaphoresis

Tachypnea

Vasoconstriction

Diarrhea

Increased metabolic rate

A, B, E

During a physical assessment, it is noted that the client has pitting edema around the ankles, with 4 mm indentation that disappears within 10 seconds. How should this be documented?

1+ pitting edema

2+ pitting edema

3+ pitting edema

4+ pitting edema

B

What is the normal BUN-to-Cr ratio?

1:1

1:5

5:1

10:1

D

An increased anion gap reflects which condition?

Increased serum osmolality

Increased renal excretion of sodium

Decreased excretion or increased production of acids

Inability of the kidneys to concentrate urine

C

Chloride levels closely follow the levels of which other electrolyte?

K+

Na+

Ca++

Mg++

B

Calcium is absorbed in the intestines under the influence of which nutrient?

Phosphorus

Vitamin D

Sodium

Vitamin C

B

What is one cause of hyperkalemia?

Renal failure

Diuretics

Metabolic acidosis

Severe diarrhea

A

Magnesium plays a role in which physiologic functions? (Select all that apply.)

Na+ and K+ transport

Nerve cell conduction

Fluid regulation

Energy transfer

Carbohydrate metabolism

A, B, C, E

Which statement is correct regarding the use of the physical assessment in diagnosing electrolyte abnormalities?

Physical assessment findings can point to a specific electrolyte problem.

Physical assessment provides important clues to the presence of a general electrolyte problem.

Most signs and symptoms of electrolyte problems are highly specific to each electrolyte.

There is little correlation between physical signs and symptoms and electrolyte levels.

B

Which vital signs are most important to monitor in clients with potential or actual electrolyte abnormalities? (Select all that apply.)

Temperature

Blood pressure

Respiratory rate

Heart rate

Heart rhythm

B, D, E

Hypokalemia and hyponatremia have which neurologic effects?

Confusion and lethargy

Irritability and coma

Disorientation and seizures

Hallucinations and tetany

A

Urinary sodium is helpful in assessing which condition?

Chronic pancreatitis

Acute renal failure

Alcohol intoxication

Gastrointestinal bleeding

B

A client is severely dyspneic and is extremely weak. The physical exam reveals 3+ pitting generalized edema. This client's edema is an example of fluid located in which space?

Intracellular

Intravascular

Interstitial

Transcellular

Answer:

3. Interstitial

Rationale:

3. Edema is defined as an excess accumulation of fluid in interstitial spaces. Pitting edema develops when the accumulation of fluid exceeds what can be absorbed by interstitial gel.

A client who has cirrhosis from chronic alcohol abuse presents with a tightly distended abdomen and shortness of breath. Assuming that this distention is from ascites, the nurse conducts an assessment looking for which condition?

Third spacing

Heart failure

Edema

Peritonitis

Answer:

1. Third spacing

Rationale:

1. Third spacing is defined as abnormal fluid shifts from the intravascular compartment into a "third" space, usually a serous cavity, such as the pericardial or pleural sac and the peritoneal cavity.

A client is bleeding from a deep laceration. On admission, the client's blood pressure was 118/62 mm Hg, pulse was 118/min, RR 26/min, and temperature 97.8°F. Current blood pressure is 90/56. The nurse expects which assessment finding based on baroreceptor response to this drop in blood pressure?

Increased urine output due to renal vasodilation

Decreased heart rate due to decreased sympathetic nervous system response

Less potassium excreted by the kidney due to ACTH suppression

Cool, clammy extremities due to peripheral vasoconstriction

Answer:

4. Cool, clammy extremities due to peripheral vasoconstriction

Rationale:

4. When the baroreceptors sense a decrease in arterial blood pressure, they send a signal to the autonomic nervous system. The sympathetic nervous system responds to the signal by causing peripheral vasoconstriction, which causes cool, clammy extremities.

A client has 3+ generalized edema and has had a urine output of 25 mL/hr for the past 2 hours. The most current serum osmolality is 315 mOsm/kg. Based on these data, the nurse would suspect which condition?

Renal failure

Cerebral vascular accident

Suppressed ADH release

Intravascular fluid deficit

Answer:

4. Intravascular fluid deficit

Rationale:

4. Normal serum osmolality is 280-300 mOsm/kg. A high serum osmolality suggests fluid volume deficit or hemoconcentration, meaning there is less fluid than solute in the serum.

A client's serum osmolality is 320 mOsm/kg. The nurse would relate which assessment findings to this condition? (Select all that apply.)

The lab result reports that serum sodium is elevated.

The client is thirsty.

The client is unconscious.

The client's temperature is low.

The client's face is round and swollen.

Answer:

1. The client is thirsty.

Rationale:

1. The thirst response is triggered by increased serum osmolality and hypernatremia.

A client's urinalysis reveals alkaline urine. Which assessment questions should the nurse ask? (Select all that apply.)

"Do you drink wine?"

"How much water do you drink daily?"

"Have you had symptoms of a urinary tract infection?"

"Do you follow a vegetarian diet?"

"Do you have diabetes?"

Answer:

3. "Do you follow a vegetarian diet?"

Rationale: A vegetarian diet may result in alkaline urine.

A client's serum potassium level is approaching 7 mEq/L. The nurse would be most concerned about changes in which body system?

Cardiovascular

Respiratory

Neurologic

Renal

Answer:

1. Cardiovascular

Rationale:

1. Abnormal serum potassium levels can produce potentially lethal cardiac conduction abnormalities that can result in cardiac arrest.

A client's lab work reveals these electrolyte levels: sodium 133 mEq/L; chloride 110 mEq/L; calcium 8.6 mg/dL; potassium 4 mEq/L; magnesium 1.7 mEq/L; and phosphate 1.8 mEq/L. Which results would the nurse report as abnormal? (Select all that apply.)

Sodium

Chloride

Calcium

Potassium

Magnesium and phosphate

Answer:

1. Sodium

Rationale:

1. This is a low sodium level.

A client's electrolyte measurement reveals hypophosphatemia and hypocalcemia. To which client situation would the nurse attribute those imbalances? (Select all that apply.)

The client states, "Where am I? How did I get here?"

The client's family reports marked increase in irritability over the last week.

Paramedics report the client had a seizure enroute to the hospital.

The nursing home report states the client has had diarrhea for the last 3 days.

The client vomited soon after breakfast.

Answer:

2. The patient's family reports marked increase in irritability over the last week.

Rationale:

2. Irritability is associated with both these imbalances.

A client has urine electrolytes ordered. The nurse should prepare for which procedure?

Obtaining a sterile voided specimen

Collecting urine for 24 hours

Catheterizing the client for a sterile specimen

Obtaining a standard clean-catch specimen

Answer:

2. Collecting urine for 24 hours

Rationale:

2. A 24-hour urine specimen collection is generally necessary to measure urine electrolytes.

Which statement is correct regarding HHS?

It has a high mortality rate.

It is most common in type 1 diabetes.

It causes severe fluid volume overload.

Death occurs from severe metabolic acidosis.

A

Common precipitating events causing HHS include which conditions?

Hemodialysis

Infection

Loop diuretic therapy

High fat diet

B

HHS does not cause ketosis for what reason?

Lipolysis does not occur.

Protein catabolism is occurring.

High glucagon levels prevent it.

Hyperglycemia is not sufficiently severe.

A

Which statement regarding the differences between DKA and HHS is correct?

The onset of HHS is faster.

Dehydration is less severe in HHS.

Hyperosmolality is more severe in HHS.

Mental status changes more rapidly in HHS.

C

Which intervention has priority in the management of the client with a hyperglycemic crisis?

Correct acidosis

Fluid resuscitation

Initiating insulin therapy

Normalization of serum glucose

B

Protocols typically recommend initial fluid replacement using which IV fluids? (Select all that apply.)

5% dextrose, 0.45% normal saline

Lactated Ringer's solution

0.9% normal saline

0.45% normal saline

5% dextrose in water

C, D

Which serum electrolyte is the primary focus when managing hyperglycemic crises?

Potassium

Sodium

Chloride

Magnesium

A

During a hyperglycemic crisis, ADA recommended insulin therapy consists of which of the following?

Slow-acting insulin

Short-acting insulin

Medium-acting insulin

Long-acting insulin

B

Continuous low-dose IV insulin therapy is the treatment of choice for hyperglycemic crises for which reason?

It reduces acidosis.

It is easy to titrate.

It is long acting.

It stabilizes sodium levels.

B

The recommendation by AACE and ADA for intensive insulin therapy is to control glucose levels between which parameters?

80-110 mg/dL

100-140 mg/dL

140-180 mg/dL

180-200 mg/dL

C

The major complication of intensive insulin therapy is which of the following?

Severe hypoglycemia

Cerebral edema

Thromboembolism

Stroke

A

Adjusted or sliding-scale insulin therapy is primarily used for which purpose?

As an alternative therapy during an HHS episode

To control glucose levels in type 1 diabetics during surgical procedures

As an alternative therapy during a DKA episode

To temporarily treat stress hyperglycemia in type 2 diabetes

D

Which set of laboratory results best reflects diabetic ketoacidosis?

pH 7.28, HCO3 34 mEq/L, blood glucose 70 mg/dL

pH 7.18, HCO3 13 mEq/L, blood glucose 100 mg/dL

pH 7.26, HCO3 14 mEq/L, blood glucose 450 mg/dL

pH 7.38, HCO3 24 mEq/L, blood glucose 620 mg/dL

C

Ketosis results from the mobilization of which component?

Amino acids

Glucagon

Glucose

Fatty acids

D

A high anion gap acidosis is consistent with which problem?

Diarrhea

High intake of chloride

Starvation

High intake of sodium

C

What is a common precipitating factor for development of diabetic ketoacidosis?

Infection

Decreased exercise

A stress-free lifestyle

Food-insulin balance

A