Chpate 10: Fluid and Electrlytes

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The nurse is caring for a client who was admitted with fluid volume excess (FVE). Which nursing assessments should the nurse include in the ongoing monitoring of the client? Select all that apply.

-Nutritional status and diet

-Blood pressure, heart rate, and rhythm

-Intake and output, urine volume, and color

-Strength testing for muscle wasting

-Skin assessment for edema and turgor

-Blood pressure, heart rate, and rhythm

-Intake and output, urine volume, and color

-Skin assessment for edema and turgor

Explanation:

To assess for FVE the nurse measures blood pressure, heart rate and rhythm, and breath sounds; inspects the skin to look for edema and turgor; and inspects neck veins. Intake and output, daily weight, urine volume and color, dyspnea, and thirst are assessments that will assist the nurse in identifying improvement or worsening of the fluid volume excess. In addition, the nurse will be able to identify potential fluid volume deficit from overtreatment of the fluid volume excess. Treatment of FVE typically involves dietary restriction of sodium.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Hypervolemia, p. 237.

Chapter 10: Fluid and Electrolytes - Page 237

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A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply.

-Drink at least eight glasses of fluid each day.

-Drink caffeinated beverages to retain fluid.

-Drink alcoholic beverages to help balance fluid volume.

-Drink water as an inexpensive way to meet fluid needs.

-Respond to thirst

-Drink at least eight glasses of fluid each day.

-Drink water as an inexpensive way to meet fluid needs.

-Respond to thirst

Explanation:

In addition, the nurse teaches clients who have a potential for hypovolemia and their families to respond to thirst because it is an early indication of reduced fluid volume; consume at least 8 to 10 (8 ounce) glasses of fluid each day and more during hot, humid weather; drink water as an inexpensive means to meet fluid requirements; and avoid beverages with alcohol and caffeine because they increase urination and contribute to fluid deficits.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, FLUID VOLUME DISTURBANCES, p. 236.

Chapter 10: Fluid and Electrolytes - Page 236

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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?

-Yes, this will correct the sodium deficit.

-Yes, along with the hypotonic IV.

-No, start with the sodium chloride IV.

-No, sodium intake should be restricted.

Explanation:

The symptoms and the high level of serum sodium suggest hypernatremia, (excess of sodium). It is necessary to restrict sodium intake. Salt tablets and sodium chloride IV can only worsen this condition but may be required in hyponatremia (sodium deficit). Hypotonic solution IV may be a part of the treatment but not along with the salt tablets.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, ELECTROLYTE IMBALANCES, pp. 241-242.

Chapter 10: Fluid and Electrolytes - Page 241-242

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An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?

-Hyperkalemia

-Hypokalemia

-Hypernatremia

-Hypophosphatemia

-Hypokalemia

Explanation:

Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium-losing diuretics, such as furosemide, can induce hypokalemia. Hyperkalemia refers to increased potassium levels. Loop diuretics can bring about lower sodium levels, not hypernatremia. Furosemide does not affect phosphorus levels.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Hypervolemia, p. 237.

Chapter 10: Fluid and Electrolytes - Page 237

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Which is the most common cause of symptomatic hypomagnesemia?

-Intravenous drug use

-Alcoholism

-Sedentary lifestyle

-Burns

-Alcoholism

Explanation:

Alcoholism is currently the most common cause of symptomatic hypomagnesemia. Intravenous drug use, sedentary lifestyle, and burns are not the most common causes of hypomagnesemia.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Magnesium Imbalances, p. 252.

Chapter 10: Fluid and Electrolytes - Page 252

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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?

-1 L

-500 ml

-1500 ml

-1250 ml

-1 L

Explanation:

A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.

Reference:

Chapter 10: Fluid and Electrolytes - Page 236

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With which condition should the nurse expect that a decrease in serum osmolality will occur?

-Influenza

-Hyperglycemia

-Kidney failure

-Uremia

-Kidney failure

Explanation:

Failure of the kidneys results in multiple fluid and electrolyte abnormalities including fluid volume overload. If renal function is so severely impaired that pharmacologic agents cannot act efficiently, other modalities are considered to remove sodium and fluid from the body.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Hypervolemia, p. 237.

Chapter 10: Fluid and Electrolytes - Page 237

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A patient is admitted with severe vomiting for 24 hours as well as weakness and "feeling exhausted." The nurse observes flat T waves and ST-segment depression on the electrocardiogram. Which potassium level does the nurse observe when the laboratory studies are complete?

-4.5 mEq/L

-5.5 mEq/L

-2.5 mEq/L

-3.5 mEq/L

-2.5 mEq/L

Explanation:

Symptoms of hypokalemia (

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To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply.

-pH

-PaCO2

-HCO3

-Glucose

-Na+

-K+

-pH

-PaCO2

-HCO3

Explanation:

Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate (HCO3). The two types of acid-base imbalances are acidosis and alkalosis.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, ACID-BASE DISTURBANCES, p. 259.

Chapter 10: Fluid and Electrolytes - Page 259

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What does the nurse understand is the primary method by which fluid volume is regulated?

-Urine excretion

-Breathing

-Bowel elimination

-Perspiration

-Urine excretion

Explanation:

Fluid volume is regulated primarily by the excretion of water in the form of urine and the promotion of thirst. Breathing, bowel elimination, and perspiration are methods the body uses to excrete fluid, but they are not the primary regulatory method for fluid volume.

Reference:

Chapter 10: Fluid and Electrolytes - Page 230

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The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance?

-A 7-year-old with a fracture tibia

-A 65-year-old with a myocardial infarction

-A 52-year-old with diarrhea

-A 72-year-old with a total knee repair

-A 52-year-old with diarrhea

Explanation:

Electrolytes are in both intracellular and extracellular water. Electrolyte deficiency occurs from an inadequate intake of food, conditions that deplete water such as nausea and vomiting, or disease processes that cause an excess of electrolyte amounts. The 52-year-old with diarrhea would be the client most likely to have an electrolyte imbalance. The orthopedic client will not likely have an electrolyte imbalance. Myocardial infarction clients will occasionally have electrolyte imbalance, but this is the exception rather than the rule.

Reference:

Chapter 10: Fluid and Electrolytes - Page 239

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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

-Respiratory alkalosis

-Metabolic acidosis

-Metabolic alkalosis

-Metabolic acidosis

Explanation:

Metabolic acidosis is a common clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3 occurs. Respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg.

Reference:

Chapter 10: Fluid and Electrolytes - Page 260

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A client with emphysema is at a greater risk for developing which acid-base imbalance?

-chronic respiratory acidosis

-metabolic alkalosis

-metabolic acidosis

-respiratory alkalosis

-chronic respiratory acidosis

Explanation:

Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is associated with disorders such as emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis.

Reference:

Chapter 10: Fluid and Electrolytes - Page 262

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Which condition leads to chronic respiratory acidosis in older adults?

-Decreased renal function

-Erratic meal patterns

-Thoracic skeletal change

-Overuse of sodium bicarbonate

-Thoracic skeletal change

Explanation:

Poor respiratory exchange as the result of chronic lung disease, inactivity, or thoracic skeletal changes may lead to chronic respiratory acidosis. Decreased renal function in older adults can cause an inability to concentrate urine and is usually associated with fluid and electrolyte imbalance. A poor appetite, erratic meal patterns, inability to prepare nutritious meals, or financial circumstances may influence nutritional status, resulting in imbalances of electrolytes. Overuse of sodium bicarbonate may lead to metabolic alkalosis.

Reference:

Chapter 10: Fluid and Electrolytes - Page 262-263

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Which of the following arterial blood gas results would be consistent with metabolic alkalosis?

-Serum bicarbonate of 28 mEq/L

-PaCO2 less than 35 mm Hg

-Serum bicarbonate of 21 mEq/L

-pH 7.26

-Serum bicarbonate of 28 mEq/L

Explanation:

Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.

Reference:

Chapter 10: Fluid and Electrolytes - Page 262

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The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis?

-pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L

-pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L

-pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L

-pH: 7.40, PaCO2: 40 mm Hg, HCO3-: 24 mEq /L

-pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L

Explanation:

Respiratory acidosis is a clinical disorder in which the pH is less than 7.35-7.40 and the PaCO2 is greater than 40-45 mm Hg and a compensatory increase in the plasma HCO3- occurs. Respiratory acidosis may be either acute or chronic.

The ABG of pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L indicates metabolic acidosis.

The ABGs of pH: 7.50, PaCO2: 30 mm Hg, and HCO3-: 24 mEq/L indicate respiratory alkalosis.

The ABGs of pH 7.40, PaCO2: 40 mm Hg, and HCO3-: 24 mEq/L indicate a normal result/no

Reference:

Chapter 10: Fluid and Electrolytes - Page 263

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At which serum sodium concentration might convulsions or coma occur?

-130 mEq/L (130 mmol/L)

-145 mEq/L (145 mmol/L)

-140 mEq/L (140 mmol/L)

-142 mEq/L (142 mmol/L)

-130 mEq/L (130 mmol/L)

Explanation:

Normal serum concentration level ranges from 135 to 145 mEq/L (135-145 mmol/L). When the level dips below 135 mEq/L (135 mmol/L), hyponatremia occurs. Manifestations of hyponatremia include mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the deficit is severe. Values of 140, 142, and 145 mEq/L (mmol/L) are within the normal range.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Sodium Imbalances, p. 239.

Chapter 10: Fluid and Electrolytes - Page 239

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A client weighing 160.2 pounds (72.7 kg), who has been diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the client loses 1,000 mL of fluid in 24 hours. What weight would be consistent with this amount of fluid loss?

-156.0 lbs (70.8 kg)

-157.0 lbs (71.2 kg)

-158.0 lbs (71.7 kg)

-159.0 lbs (72.1 kg)

-158.0 lbs (71.7 kg)

Explanation:

A loss of 0.5 kg, or 1.1 lb, represents a fluid loss of about 500 mL. Therefore, a loss of 1,000 mL would be equivalent to the loss of 2.2 lbs (1 kg), bringing the client's weight to 158.0 lbs (71.7 kg).

Reference:

Chapter 10: Fluid and Electrolytes - Page 236

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A client has chronic hyponatremia, which requires weekly laboratory monitoring to prevent the client lapsing into convulsions or a coma. What is the level of serum sodium at which a client can experience these side effects?

-114 mEq/L

-130 mEq/L

-135 mEq/L

-148 mEq/L

-114 mEq/L

Explanation:

Hyponatremia occurs when the serum sodium level dips below 135 mEq/L. When serum sodium levels fall below 115mEq/L, mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, personality changes, convulsions, or coma can occur. A serum sodium level of 148 mEq/L would indicate hypernatremia. Normal serum concentration levels range from 135 to 145 mEq/L.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Sodium Imbalances, p. 240.

Chapter 10: Fluid and Electrolytes - Page 240

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A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance?

-metabolic alkalosis

-metabolic acidosis

-respiratory acidosis

-respiratory alkalosis

-metabolic alkalosis

Explanation:

Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The client's regular use of baking soda (sodium bicarbonate) may create a risk for this condition. Metabolic acidosis refers to decreased plasma pH because of increased organic acids (acids other than carbonic acid) or decreased bicarbonate. Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary with expired air.

Reference:

Chapter 10: Fluid and Electrolytes - Page 261

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Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality?

-Sodium

-Potassium

-Calcium

-Magnesium

-Sodium

Explanation:

Sodium is the primary determinant of ECF osmolality. Sodium plays a major role in controlling water distribution throughout the body because it does not easily cross the intracellular wall membrane and because of its abundance and high concentration in the body. Potassium, calcium, and magnesium are not primary determinants of ECF osmolality.

Reference:

Chapter 10: Fluid and Electrolytes - Page 239

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A client reports 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 client's laboratory work has returned?

-Potassium

-Phosphorus

-Calcium

-Iron

-Calcium

Explanation:

Calcium deficit is associated with the following symptoms: numbness and tingling of the fingers, toes, and circumoral region; positive Trousseau's sign and Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, decreased prothrombin, diarrhea, and hypotension. Electrocardiogram findings associated with hypocalcemia include prolonged QT interval and lengthened ST.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Calcium Imbalances, p. 248.

Chapter 10: Fluid and Electrolytes - Page 248

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A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching?

-tingling sensation in the fingers

-polyuria

-flank pain

-hypertension

-tingling sensation in the fingers

Explanation:

Tingling or numbness in the fingers is a symptom of hypocalcemia. Flank pain, polyuria, and hypertension are symptoms of hypercalcemia.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Calcium Imbalances, p. 248.

Chapter 10: Fluid and Electrolytes - Page 248

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Early signs of hypervolemia include

-a decrease in blood pressure.

-thirst.

-moist breath sounds.

-increased breathing effort and weight gain.

Explanation:

Early signs of hypervolemia are weight gain, elevated blood pressure, and increased breathing effort. Eventually, fluid congestion in the lungs leads to moist breath sounds. One of the earliest symptoms of hypovolemia is thirst.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Hypervolemia, p. 237.

Chapter 10: Fluid and Electrolytes - Page 237

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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.

-metabolic alkalosis.

-respiratory acidosis.

-respiratory alkalosis.

Explanation:

This client's above-normal pH value indicates alkalosis. The below-normal PaCO2 value indicates acid loss via hyperventilation; this type of acid loss occurs only in respiratory alkalosis. These ABG values wouldn't occur in metabolic acidosis, respiratory acidosis, or metabolic alkalosis.

Reference:

Chapter 10: Fluid and Electrolytes - Page 263

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A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values.

sodium 137 mEq/L (137 mmol/L)potassium 4.6 mEq/L (4.6 mmol/L)chloride 94 mEq/L (94 mmol/L)calcium 12.9 mg/dL (3.2 mmol/L)

What laboratory value is of highest concern to the nurse?

-sodium 137 mEq/L (137 mmol/L)

-potassium 4.6 mEq/L (4.6 mmol/L)

-chloride 94 mEq/L (94 mmol/L)

-calcium 12.9 mg/dL (3.2 mmol/L)

Explanation:

More than 99% of the body's calcium is found in the skeletal system. Hypercalcemia, or calcium levels exceeding 10.2 mg/dL (2.5 mmol/L), can be a dangerous imbalance. The client presents with anorexia, nausea and vomiting, constipation, abdominal pain, bone pain, and confusion. The listed sodium, potassium, and chloride levels are within normal limits.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Calcium Imbalances, p. 250.

Chapter 10: Fluid and Electrolytes - Page 250

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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?

-Prepare to assist with ventilation.

-Monitor the client's heart rhythm.

-Prepare for gastric lavage.

-Obtain a urine specimen for drug screening.

-Prepare to assist with ventilation.

Explanation:

Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.

Reference:

Chapter 10: Fluid and Electrolytes - Page 263

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A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition?

-dehydration

-hypervolemia

-hypercalcemia

-hyperkalemia

-dehydration

Explanation:

Dehydration results when the volume of body fluid is significantly reduced in both extracellular and intracellular compartments. In dehydration, all fluid compartments have decreased volumes; in hypovolemia, only blood volume is low. The most common fluid imbalance in older adults is dehydration. Hypervolemia is caused by fluid intake that exceeds fluid loss, such as from excessive oral intake or rapid IV infusion of fluid. Early signs of hypervolemia are weight gain, elevated BP, and increased breathing effort. Hypercalcemia occurs when the serum calcium level is higher than normal. Some of its signs include tingling in the extremities and the area around the mouth (circumoral paresthesia) and muscle and abdominal cramps. Hyperkalemia is an excess of potassium in the blood. Symptoms include diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias.

Reference:

Chapter 10: Fluid and Electrolytes - Page 234-236

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-Potassium

-Phosphorus

-Calcium

-Iron

-Calcium

Explanation:

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Calcium Imbalances, p. 248.

Chapter 10: Fluid and Electrolytes - Page 248

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A client with hypervolemia asks the nurse by what mechanism the sodium-potassium pump will move the excess body fluid. What is the nurse's best answer?

-Passive osmosis

-Free flow

-Passive elimination

-Active transport

Explanation:

Active transport is the physiologic pump maintained by the cell membrane that results in the movement of fluid from an area of lower concentration to one of higher concentration. Active transport requires adenosine triphosphate (ATP) for energy. The sodium-potassium pump actively moves sodium against the concentration gradient out of the cell, and fluid follows. Passive osmosis does not require energy for transport. Free flow is the natural transport of water. Passive elimination is a filter process carried out in the kidneys.

Reference:

Chapter 10: Fluid and Electrolytes - Page 228

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A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be?

-275-300 mOsm/kg

Explanation:

In healthy adults, normal serum osmolality is 270 to 300 mOsm/kg (Crawford & Harris, 2011c).

Reference:

Chapter 10: Fluid and Electrolytes - Page 229

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A nurse is monitoring a client being evaluated who has a potassium level of 7 mEq/L (mmol/L). Which electrocardiogram changes will the client display?

-prolonged T waves

-elevated ST segment

-peaked T waves

-shortened PR interval

-peaked T waves

Explanation:

The earliest changes occur when the serum potassium level is 7 mEq/L (mmol/L). Cardiac tracings include peaked and narrow T waves, ST segment depression, and a shortened QT interval.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Potassium Imbalances, p. 246.

Chapter 10: Fluid and Electrolytes - Page 246

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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:

-210 mOsm/kg.

-230 mOsm/kg.

-250 mOsm/kg.

-280 mOsm/kg.

Explanation:

Serum osmolality can be estimated by doubling the serum sodium or using the formula: Na × 2 = glucose/18 + BUN/3. Therefore, the nurse could estimate a serum osmolality of 280 mOsm/kg by doubling the serum sodium value of 140 mEq/L.

Reference:

Chapter 10: Fluid and Electrolytes - Page 229

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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 alkalosis

-Metabolic alkalosis

-Respiratory acidosis

-Metabolic acidosis

-Metabolic alkalosis

Explanation:

A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

Reference:

Chapter 10: Fluid and Electrolytes - Page 262

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The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching?

-"I can use laxatives and enemas but only once a week."

-"A good breakfast for me will include milk and a couple of bananas."

-"I will be sure to buy frozen vegetables when I grocery shop."

-"I will take a potassium supplement daily as prescribed."

-"I can use laxatives and enemas but only once a week."

Explanation:

The client is experiencing hypokalemia, most likely due to the diagnosis of bulimia. Hypokalemia is defined as a serum potassium concentration

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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.

-Offer the client fluids frequently.

-Administer ordered supplemental oxygen.

-Instruct the client to breathe into a paper bag.

Explanation:

The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered PaCO2 level.

Reference:

Chapter 10: Fluid and Electrolytes - Page 263

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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)?

-Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad

-Three ounces of sliced ham, beets, and a salad

-A frozen, packaged low-fat dinner with a side salad

-Tomato juice, low-fat cottage cheese, and three slices of bacon

-Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad

Explanation:

Ham (1,400 mg Na for 3 oz) and bacon (155 mg Na/slice) are high in sodium as is tomato juice (660 mg Na/¾ cup) and low fat cottage cheese (918 mg Na/cup). Packaged meals are high in sodium.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes.

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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?

-Extracellular fluid volume deficit

-Altered blood urea nitrogen (BUN) value

-Metabolic alkalosis

-Respiratory acidosis

-Extracellular fluid volume deficit

Explanation:

Fluid volume deficit (FVD) occurs when the loss extracellular fluid (ECF) volume exceeds the intake of fluid. FVD results from loss of body fluids and occurs more rapidly when coupled with decreased fluid intake. A cause of this loss is hemorrhage.

Reference:

Chapter 10: Fluid and Electrolytes - Page 233-234

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A client seeks medical attention for an acute onset of severe thirst, polyuria, muscle weakness, nausea, and bone pain. Which health history information will the nurse report to the health care provider?

-Ingests alcohol occasionally

-Takes high doses of vitamin D

-Follows a high-fiber eating plan

-Works as a customer service representative

-Takes high doses of vitamin D

Explanation:

Hypercalcemia can affect many organ systems and symptoms occur when the calcium level acutely rises. Hypercalcemia crisis refers to an acute rise in the serum calcium level. Severe thirst and polyuria are often present. Additional findings include muscle weakness, nausea, and bone pain. Excessive ingestion of vitamin D supplements may cause excessive absorption of calcium. Therefore, the nurse would report this finding to the health care provider. The client's symptoms are not associated with occasional alcohol intake, a high-fiber eating plan, or the client's employment status. These findings would not need to be reported.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Calcium Imbalances, p. 250.

Chapter 10: Fluid and Electrolytes - Page 250

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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?

-Kidney and liver

-Heart and lungs

-Lungs and kidney

-Pancreas and stomach

-Lungs and kidney

Explanation:

The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.

Reference:

Chapter 10: Fluid and Electrolytes - Page 259

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-metabolic acidosis.

-metabolic alkalosis.

-respiratory acidosis.

-respiratory alkalosis.

Explanation:

Reference:

Chapter 10: Fluid and Electrolytes - Page 263

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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

Explanation:

A BUN-to-serum creatinine concentration ratio greater than 20:1 is indicative of volume depletion. The other results are within normal range.

Reference:

Chapter 10: Fluid and Electrolytes - Page 233

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A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance?

-Presence of Trousseau sign

-Slurred speech

-Negative Chvostek sign

-Muscle weakness

-Presence of Trousseau sign

Explanation:

After radical neck resection, a client is prone to developing hypocalcemia. Hypocalcemia is defined as a serum value

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A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

-Headache or blurry vision

-Abdominal pain or diarrhea

-Hallucinations or tinnitus

-Light-headedness or paresthesia

Explanation:

The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Headache, blurry vision, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

Reference:

Chapter 10: Fluid and Electrolytes - Page 263

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he nurse is conducting a lecture on the difference between hypovolemia and dehydration. When completing a verbal comparison, which point needs clarified?

-Similar causes are present in both conditions.

-Hypovolemia contains only low blood volume.

-In dehydration, only extracellular is depleted.

-Both conditions result in abnormal laboratory studies.

-In dehydration, only extracellular is depleted.

Explanation:

In clients diagnosed with dehydration, all fluid compartments including the intracellular and extracellular compartment are reduced. The other options are correct. Both states can be from similar disease process such as vomiting, fever, diarrhea and difficulty swallowing and also have abnormal lab work. It is correct that hypovolemia relates to low blood volume.

Reference:

Chapter 10: Fluid and Electrolytes - Page 228

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A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client?

-110 mEq/L

-130 mEq/L

-145 mEq/L

-165 mEq/L

Explanation:

The normal sodium level is 135- 145 mEq/L (135-145 mmol/L). In hypernatremia, the serum sodium level exceeds 145 mEq/L (145 mmol/L) and the serum osmolality exceeds 300 mOsm/kg (300 mmol/L). The urine specific gravity and urine osmolality are increased as the kidneys attempt to conserve water (provided the water loss is from a route other than the kidneys). Body temperature may increase mildly, but it returns to normal after the hypernatremia is corrected.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Sodium Imbalances, p. 242.

Chapter 10: Fluid and Electrolytes - Page 242

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Which of the following measurable urine outputs indicates the client is maintaining adequate fluid intake and balance?

-A patient with a minimal urine output of 50 mL/hour

-A patient with a minimal urine output of 10 mL/hour

-A patient with a minimal urine output of 30 mL/hour

-A patient with a minimal urine output of 20 mL/hour

-A patient with a minimal urine output of 30 mL/hour

Explanation:

A client with minimal urine output of 30 mL/hour provides the nurse with the information that the patient is maintaining proper fluid balance. Less then 30 mL/hour of urine output indicates dehydration and possible poor kidney function.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Systemic Routes of Gains and Losses, p. 229.

Chapter 10: Fluid and Electrolytes - Page 229

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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 alkalosis

-Respiratory acidosis

-Metabolic acidosis

-Metabolic alkalosis

Explanation:

Metabolic alkalosis results in increased plasma pH because of an accumulated base bicarbonate or decreased hydrogen ion concentration. Factors that increase base bicarbonate include excessive oral or parenteral use of bicarbonate-containing drugs, a rapid decrease in extracellular fluid volume and loss of hydrogen and chloride ions as with gastric suctioning. Acidotic states are from excess carbonic acid and hydrogen ions in the system. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary.

Reference:

Chapter 10: Fluid and Electrolytes - Page 261

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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

Explanation:

Indicative of hypervolemia is a bounding pulse and elevated blood pressure due to the excess volume in the system. Respirations are not typically affected unless there is fluid accumulation in the lungs. Temperature is not generally affected.

Reference:

Chapter 10: Fluid and Electrolytes - Page 234

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When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?

-HCO 21 mEq/L

-pH 7.48

-PaCO 36

-O saturation 95%

-pH 7.48

Explanation:

Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma bicarbonate concentration. The HCO value is below normal. The PaCO value and the oxygen saturation level are within a normal range.

Reference:

Chapter 10: Fluid and Electrolytes - Page 262

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The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L) and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving?

-Discontinue the intravenous lactated Ringer solution.

-Increase the rate of the intravenous lactated Ringer solution.

-Change the lactated Ringer solution to 3% saline.

-Change the lactated Ringer solution to 2.5% dextrose.

-Discontinue the intravenous lactated Ringer solution.

Explanation:

The lactated Ringer intravenous (IV) fluid is contributing to both the fluid volume excess and the hyperkalemia. In addition to the volume of IV fluids contributing to the fluid volume excess, lactated Ringer solution contains more sodium than daily requirements, and excess sodium worsens fluid volume excess. Lactated Ringer solution also contains potassium, which would worsen the hyperkalemia.

Reference:

Chapter 10: Fluid and Electrolytes - Page 245

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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?

-Sodium level of 137 mEq/L

-Potassium level of 3.8 mEq/L

-Sodium level of 150 mEq/L

-Potassium level of 6 mEq/L

-Sodium level of 150 mEq/L

Explanation:

Hypernatremia (normal serum sodium is 135 to 145 mEq/L) is consistent with increased fluid loss and dehydration in diabetes insipidus.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Sodium Imbalances, p. 242.

Chapter 10: Fluid and Electrolytes - Page 242

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A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?

-No effect

-Increases arterial pH

-Decreases arterial pH

-Provides long-term pH regulation

-Increases arterial pH

Explanation:

Respiratory alkalosis is always caused by hyperventilation, which is a decrease in plasma carbonic acid concentration. The pH is elevated above normal as a result of a low PaCO2.

Reference:

Chapter 10: Fluid and Electrolytes - Page 259

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Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?

-Confusion and seizures

-Sunken eyeballs and spasticity

-Flaccidity and thirst

-Tetany and increased blood urea nitrogen (BUN) levels

-Confusion and seizures

Explanation:

Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.

Reference:

Chapter 10: Fluid and Electrolytes - Page 234

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The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?

-PaO2

-PO2

-Carbonic acid

-Bicarbonate

Explanation:

Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. PaO2 and PO2 are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG.

Reference:

Chapter 10: Fluid and Electrolytes - Page 260

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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

Explanation:

Dehydration indicates a fluid volume deficit. Dark, concentrated urine indicates a lack of fluid volume. Adding more fluid would dilute the urine. The other options indicate fluid excess.

Reference:

Chapter 10: Fluid and Electrolytes - Page 236

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The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance?

-Metabolic acidosis

-Respiratory acidosis

-Metabolic alkalosis

-Respiratory alkalosis

-Metabolic acidosis

Explanation:

The client is at risk for developing metabolic acidosis. Metabolic acidosis is caused by diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate).

Reference:

Chapter 10: Fluid and Electrolytes - Page 260

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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

Explanation:

Respiratory acidosis is always from inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations. Respiratory acidosis can occur in diseases that impair respiratory muscles such as myasthenia gravis.

Reference:

Chapter 10: Fluid and Electrolytes - Page 262

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The nurse assesses a client who is diagnosed with bulimia nervosa and at risk for alterations in both fluid and electrolyte balance.

Complete the following sentence by choosing from the lists of options.

During the assessment, the nurse focuses on monitoring the client for (hypokalemia-hypervolemia-hypernatremia) as evidenced by (cardiac arrhythmia-peripheral edema-extreme thirst).

hypokalemia & cardiac arrhythmia

Explanation:

Fluid and electrolyte imbalances are common for clients who are diagnosed with eating disorders, including bulimia nervosa.

The client who vomits as a result of purging behavior when diagnosed with bulimia nervosa is at risk for fluid and electrolyte imbalances, including hypokalemia (i.e., low serum potassium level). The client who experiences low serum potassium levels (i.e., hypokalemia) due to a diagnosed eating disorder must be monitored for cardiac arsrhythmia, a potentially life-threatening consequence of this electrolyte imbalance.

The client who is diagnosed with bulimia nervosa is at risk for hypovolemia (e.g., dehydration) and hyponatremia (i.e., low serum sodium level), not hypervolemia or hypernatremia (i.e., elevated serum sodium level). While peripheral edema is a symptom of hypervolemia and extreme thirst is a symptom of hypernatremia, this client is at risk for hypovolemia (e.g., dehydration), which is manifested by dry mucous membranes, and hyponatremia, which is manifested by muscle weakness.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Table 10-7 Potassium Imbalances, p. 243.

Chapter 10: Fluid and Electrolytes - Page 243

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A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?

-Respiratory alkalosis

-Respiratory acidosis

-Metabolic alkalosis

-Metabolic acidosis

Explanation:

This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.

Reference:

Chapter 10: Fluid and Electrolytes - Page 260

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It is important for a nurse to know how to calculate the corrected serum calcium level for a patient when hypocalcemia is seen along with low serum albumin levels. Calculate the corrected serum calcium when the serum calcium is 9 mg/dL and the serum albumin is 3 g/dL.

-9.8 mg/dL

-10.3 mg/dL

-11 mg/dL

-12 mg/dL

-9.8 mg/dL

Explanation:

To calculate corrected serum calcium, subtract the normal serum albumin level of 4 g/dL from the reported albumin level of 3 g/dL, multiply that value (1) by 0.8 (constant factor) and then add that result (0.8 mg) to the reported serum level of 9 mg/dL. Therefore, 9 + 0.8 = 9.8 mg/dL (corrected value). Note: a constant factor of 0.8 is used because, for every decrease in serum albumin of 1 g/dL below 4 g/dL, the total serum calcium level is underestimated by 0.8 mg/dL.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Calcium Imbalances, p. 249.

Chapter 10: Fluid and Electrolytes - Page 249

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A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action?

-Tetanic contractions

-Jugular vein distention

-Weight loss

-Polyuria

-Jugular vein distention

Explanation:

Jugular vein distention requires further action because this finding signals vascular fluid overload. Tetanic contractions aren't associated with this disorder, but weight gain and fluid retention from oliguria are. Polyuria is associated with diabetes insipidus, which occurs with inadequate production of antidiuretic hormone.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Sodium Imbalances, p. 241.

Chapter 10: Fluid and Electrolytes - Page 241

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The nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricted diet. Which statement by the client indicates the need for additional instruction?

-"I will not salt my food; instead I'll use salt substitute."

-"Bananas have a lot of potassium in them; I'll stop buying them."

-"I'll drink cranberry juice with my breakfast instead of coffee."

-"I need to check to see whether my cola beverage has potassium in it."

-"I will not salt my food; instead I'll use salt substitute."

Explanation:

The client should avoid salt substitutes. The nurse must caution clients to use salt substitutes sparingly if they are taking other supplementary forms of potassium or potassium-conserving diuretics. Potassium-rich foods to be avoided include many fruits and vegetables, legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, and cocoa. Conversely, foods with minimal potassium content include butter, margarine, cranberry juice or sauce, ginger ale, gumdrops or jellybeans, hard candy, root beer, sugar, and honey. Labels of cola beverages must be checked carefully because some are high in potassium and some are not.

Reference:

Chapter 10: Fluid and Electrolytes - Page 245

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The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance?

-Hypocalcemia

-Hyperchloremia

-Hypermagnesemia

-Hyponatremia

-Hypocalcemia

Explanation:

The client is experiencing an elevated serum phosphorus concentration. Hyperphosphatemia is defined as a serum phosphorus that exceeds 4.5 mg/dL (1.45 mmol/L). Because of the reciprocal relationship between phosphorus and calcium, a high serum phosphorus concentration tends to cause a low serum calcium concentration.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Calcium Imbalances, p. 248.

Chapter 10: Fluid and Electrolytes - Page 248

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Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by:

-muscle weakness.

-tremors.

-diaphoresis.

-constipation.

-muscle weakness.

Explanation:

Muscle weakness; bradycardia; nausea; diarrhea; and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

Reference:

Chapter 10: Fluid and Electrolytes - Page 247

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Clients diagnosed with hypervolemia should avoid sweet or dry food because it

-obstructs water elimination.

-increases the client's desire to consume fluid.

-can cause dehydration.

-can lead to weight gain.

-increases the client's desire to consume fluid.

Explanation:

The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is rationed and the client is advised to take a limited amount of fluid when thirsty. Sweet or dry food can increase the client's desire to consume fluid. Sweet or dry food does not obstruct water elimination or cause dehydration. Weight regulation is not part of hypervolemia management except to the extent it is achieved on account of fluid reduction.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Hypervolemia, p. 237.

Chapter 10: Fluid and Electrolytes - Page 237

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A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status?

-vital signs

-edema

-intake and output

-weight

Explanation:

Daily weight provides the ability to monitor fluid status. A 2-lb (0.9 kg) weight gain in 24 hours indicates that the client is retaining 1 L of fluid. Also, the loss of weight can indicate a decrease in edema. Vital signs do not always reflect fluid status. Edema could represent a shift of fluid within body spaces and not a change in weight. Intake and output do not account for unexplainable fluid loss.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, hypervolemia, p. 238.

Chapter 10: Fluid and Electrolytes - Page 238

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Which electrolyte is a major anion in body fluid?

-Chloride

-Potassium

-Sodium

-Calcium

-Chloride

Explanation:

Chloride is a major anion found in extracellular fluid. Potassium, sodium, and calcium are cations.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Chloride Imbalances, p. 257.

Chapter 10: Fluid and Electrolytes - Page 257

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The nurse is caring for a 72-year-old client who has been admitted to the unit for a fluid volume imbalance. The nurse knows which of the following is the most common fluid imbalance in older adults?

-Hypovolemia

-Dehydration

-Hypervolemia

-Fluid volume excess

-Dehydration

Explanation:

The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances.

Reference:

Chapter 10: Fluid and Electrolytes - Page 232

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Which of the following is a factor affecting an increase in urine osmolality?

-Syndrome of inappropriate antidiuretic hormone release -(SIADH)

-Alkalosis

-Fluid volume excess

-Myocardial infarction

-Syndrome of inappropriate antidiuretic hormone release -(SIADH)

Explanation:

Factors increasing urine osmolality include SIADH, fluid volume deficit, acidosis, and congestive heart failure. Myocardial infarction typically is not a factor that increases urine osmolality.

Reference:

Chapter 10: Fluid and Electrolytes - Page 229

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A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess:

-Trousseau's sign.

-Homans' sign.

-Hegar's sign.

-Goodell's sign.

-Trousseau's sign.

Explanation:

This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Calcium Imbalances, p. 248.

Chapter 10: Fluid and Electrolytes - Page 248

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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?

-Provide oral care every 2-3 hours.

-Monitor for signs and symptoms of dehydration.

-Teach the client about increased fluid intake.

-Assess the client's weight daily for trends.

-Provide oral care every 2-3 hours.

Explanation:

Providing oral care for the client every 2-3 hours is within the scope of practice of a nursing assistant. The other actions should be completed by the registered nurse.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Hypervolemia, p. 237.

Chapter 10: Fluid and Electrolytes - Page 237

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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

Explanation:

An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also may delay assessing respirations and temperature because these aren't affected by the serum potassium level.

Reference:

Chapter 10: Fluid and Electrolytes - Page 247

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A client with an intravenous infusion is rubbing his arm. The nurse assesses the site and decides to discontinue the current infusion because of concern that the client has developed phlebitis. Which of the following clinical manifestations would the nurse assess with phlebitis? Select all that apply.

-Cool area around the insertion site

-Reddened area along the path of the vein

-Tender area around the insertion site

-Ecchymosis at the insertion site

-Rapid, shallow respirations

-Reddened area along the path of the vein

-Tender area around the insertion site

Explanation:

Phlebitis is inflammation of a vein and is characterized by a reddened, warm area around an insertion site or along the path of a vein. The involved area is also tender and swollen. The nurse assesses infusion sites and determines the proper action to take. If indications lead to suspected phlebitis, the nurse will discontinue the intravenous line and restart with a different vessel.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Nursing Management of the Patient Receiving Intravenous Therapy, p. 267.

Chapter 10: Fluid and Electrolytes - Page 267

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Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply.

-Distended neck veins

-Crackles in the lung fields

-Shortness of breath

-Decreased blood pressure

-Bradycardia

-Distended neck veins

-Crackles in the lung fields

-Shortness of breath

Explanation:

Clinical manifestations of FVE (hypervolemia) include distended neck veins, crackles in the lung fields, shortness of breath, increased blood pressure, and tachycardia.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Hypervolemia, p. 237.

Chapter 10: Fluid and Electrolytes - Page 237

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Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?

-Give medications that promote fluid retention.

-Limit sodium and water intake.

-Assess for dehydration.

-Teach client behaviors that decrease urination.

-Limit sodium and water intake.

Explanation:

Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, hypervolemia, p. 237.

Chapter 10: Fluid and Electrolytes - Page 237

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Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration?

-Abnormal potassium level

-Elevated hematocrit level

-Low white blood count

-Low urine specific gravity

-Elevated hematocrit level

Explanation:

When hemoconcentration occurs due to a hypovolemic state, a high ratio of blood components in relation to watery plasma occurs, thus causing an elevated hematocrit level. A high white blood cell count and urine specific gravity is also noted. Other causes of an abnormal potassium level may be present.

Reference:

Chapter 10: Fluid and Electrolytes - Page 233

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A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH?

-Restricting fluids to 800 ml/day

-Administering vasopressin as ordered

-Elevating the head of the client's bed to 90 degrees

-Restricting sodium intake to 1 gm/day

-Restricting fluids to 800 ml/day

Explanation:

Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day. Vasopressin is administered to clients with diabetes insipidus a condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion, thus worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted.

Reference:

Chapter 10: Fluid and Electrolytes - Page 239-241

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A newly graduated nurse is admitting a client with a long history of emphysema. The nurse learns that the client's PaCO2 has been between 56 and 64 mm Hg for several months. Why should the nurse be cautious administering oxygen?

-The client's calcium will rise dramatically due to pituitary stimulation.

-Oxygen will increase the client's intracranial pressure and create confusion.

-Oxygen may cause the client to hyperventilate and become acidotic.

-Using oxygen may result in the client developing carbon dioxide narcosis and hypoxemia.

Explanation:

When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla, and the use of oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. No information indicates the client's calcium will rise dramatically due to pituitary stimulation. No feedback system that oxygen stimulates would create an increase in the client's intracranial pressure and create confusion. Increasing the oxygen would not stimulate the client to hyperventilate and become acidotic; rather, it would cause hypoventilation and acidosis.

Reference:

Chapter 10: Fluid and Electrolytes - Page 262-263

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Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

-Tetanic contractions

-Jugular vein distention

-Weight loss

-Polyuria

-Jugular vein distention

Explanation:

SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by jugular vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).

Reference:

Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 10: Fluid and Electrolytes, Sodium Imbalances, p. 241.

Chapter 10: Fluid and Electrolytes - Page 241

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An adult client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargy. The nurse reconciles the client's medication list and notes that salt tablets had been prescribed. What would the nurse do next?

-Continue to monitor client with another appointment.

-Be prepared to administer a lactated Ringer's IV.

-Be prepared to administer a sodium chloride IV.

-Consider sodium restriction with discontinuation of salt tablets.

Explanation:

The client's symptoms of feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargy suggest hypernatremia. The client needs to be evaluated with serum blood tests soon; a later appointment will delay treatment. It is necessary to restrict sodium intake. Salt tablets and a sodium chloride IV will only worsen this condition. A Lactated Ringer's IV is a hypertonic IV and is not used with hypernatremia. A hypotonic solution IV may be a part of the treatment, but not along with the salt tablets.

Reference:

Chapter 10: Fluid and Electrolytes - Page 239

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The nurse is caring for a client who has been diagnosed with chronic obstructive pulmonary disease (COPD) and is experiencing respiratory acidosis. The client asks what is making the acidotic state. What does the nurse identify as the result of the disease process that causes the fall in pH?

-The lungs are unable to breathe in sufficient oxygen.

-The lungs are unable to exchange oxygen and carbon dioxide.

-The lungs have ineffective cilia from years of smoking.

-The lungs are not able to regulate carbonic acid levels.

Explanation:

In clients with chronic respiratory acidosis, the client's lungs are not able to regulate carbonic acid levels. The increase in carbonic acid leads to acidosis. In COPD, the client is able to breathe in oxygen, and gas exchange can occur, but the lungs' ability to remove the carbon dioxide from the system is limited. Although individuals with COPD frequently have a history of smoking, ineffective cilia is not the cause of the acidosis.

Reference:

Chapter 10: Fluid and Electrolytes - Page 262