Chapter 16: Caring For Clients With Fluid, Electrolyte, And Acid-Base Imbalances

25 July 2022
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question
Below which serum sodium concentration might convulsions or coma occur? a. 135 mEq/L (135 mmol/L) b. 145 mEq/L (145 mmol/L) c. 140 mEq/L (140 mmol/L) d. 142 mEq/L (142 mmol/L)
answer
a 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.
question
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? a. HCO 21 mEq/L b. pH 7.48 c. PaCO 36 d. O saturation 95%
answer
b 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.
question
Fluid and electrolyte balance is maintained through the process of translocation. What specific process allows water to pass through a membrane from a dilute to a more concentrated area? a. osmosis b. filtration c. evaporation d. active transport
answer
a Osmosis is the movement of water through a semipermeable membrane; one that allows some but not all substances in a solution to pass through from a diluted area to a more concentrated area. Filtration promotes the movement of fluid and some dissolved substances through a semipermeable membrane according to pressure differences. Evaporation is the process of converting water into a vapor. Active transport requires the energy source ATP to drive dissolved chemicals from an area of low concentration to an area of higher concentration; the opposite of passive diffusion.
question
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? a. dehydration b. hypervolemia c. hypercalcemia d. hyperkalemia
answer
a 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.
question
The physician has prescribed a peripheral IV to be inserted before the client goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter? a. Choose a hairless site if available. b. Consider potential effects on the client's mobility when selecting a site. c. Have the client briefly hold his arm over his head before insertion. d. Leave the tourniquet on for at least 3 minutes.
answer
b Ideally, both arms and hands are carefully inspected before choosing a specific venipuncture site that does not interfere with mobility. Instruct the client to hold his arm in a dependent position to increase blood flow. Never leave a tourniquet in place longer than 2 minutes. The site does not necessarily need to be devoid of hair.
question
Which electrolyte is a major cation in body fluid? a. Chloride b. Bicarbonate c. Potassium d. Phosphate
answer
c Potassium is a major cation that affects cardiac muscle functioning. Chloride, bicarbonate, and phosphate are anions.
question
Clients diagnosed with hypervolemia should avoid sweet or dry food because it a. obstructs water elimination. b. increases the client's desire to consume fluid. c. can cause dehydration. d. can lead to weight gain.
answer
b 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.
question
Which is the most common cause of symptomatic hypomagnesemia? a. Intravenous drug use b. Alcoholism c. Sedentary lifestyle d. Burns
answer
b 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.
question
A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? a. Lactated Ringer solution b. 0.45% NaCl c. 0.9% NaCl d. 5% NaCl
answer
b Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to replace cellular fluid because it is hypotonic compared with plasma. Another is to provide free water to excrete body wastes. At times, hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar conditions. Lactated Ringer solution and normal saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic.
question
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? a. Presence of Trousseau sign b. Slurred speech c. Negative Chvostek sign d. Muscle weakness
answer
a After radical neck resection, a client is prone to developing hypocalcemia. Hypocalcemia is defined as a serum value <8.6 mg/dL (<2.15 mmol/L). Signs and symptoms of hypocalcemia include Chvostek sign, which consists of muscle twitching enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe, just below the zygomatic arch, is tapped; and a positive Trousseau sign can be elicited by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and metacarpophalangeal joints, and extended interphalangeal joints with fingers together) will occur as ischemia of the ulnar nerve develops. Slurred speech and muscle weakness are signs of hypercalcemia.
question
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? a. Neutral b. Alkaline c. Acidic d. Basic
answer
c Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.
question
Which is an insensible mechanism of fluid loss? a. Urination b. Bowel elimination c. Breathing d. Nausea
answer
c Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is unnoticeable and immeasurable. Losses from urination and bowel elimination are measurable. Nausea does not result in fluid loss, however if the client would develop emesis ( vomiting) this would be considered loss of body fluids and would need measured.
question
Which is a correct route of administration for potassium? a. Subcutaneous b. Intramuscular c. Oral d. IV (intravenous) push
answer
c Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously.
question
Oral intake is controlled by the thirst center, located in which of the following cerebral areas? a. Hypothalamus b. Cerebellum c. Brainstem d. Thalamus
answer
a Oral intake is controlled by the thirst center located in the hypothalamus. The thirst center is not located in the cerebellum, brainstem, or thalamus.
question
A patient with abnormal sodium losses is receiving a regular diet. How can the nurse supplement the patient's diet to provide 1,600 mg of sodium daily? a. One beef cube and 8 oz of tomato juice b. Four beef cubes and 8 oz of tomato juice c. One beef cube and 16 oz of tomato juice d. One beef cube and 12 oz of tomato juice
answer
a For a patient with abnormal losses of sodium who can consume a general diet, the nurse encourages foods and fluids with high sodium content to control hyponatremia. For example, broth made with one beef cube contains approximately 900 mg of sodium; 8 oz of tomato juice contains approximately 700 mg of sodium. The nurse also needs to be familiar with the sodium content of parenteral fluids (see Table 13-5).
question
Which is considered an isotonic solution? a. 0.9% normal saline b. Dextran in normal saline c. 0.45% normal saline d. 3% NaCl
answer
a An isotonic solution is 0.9% normal saline (NaCl). Dextran in normal saline is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.
question
A patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The patient's ileostomy output has been unexpectedly high in the 2 days since surgery, and the patient's most recent blood work indicates a K+ level of 2.7 mEq/L. This potassium level should prompt the nurse to assess for which of the following physical manifestations? a. Confusion and decreased level of consciousness b. Shortness of breath, rales, and peripheral edema c. Dysphagia, tetany, and emotional lability d. Fatigue, cramps, and weakness
answer
d A serum potassium level of 2.7 mEq/L constitutes hypokalemia. Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias (numbness and tingling), arrhythmias, and increased sensitivity to digitalis. Respiratory symptoms, dysphagia, and tetany are not typically associated with hypokalemia.
question
The nurse is working on a burns unit and an acutely ill client is exhibiting signs and symptoms of third spacing. Based on this change in status, the nurse should expect the client to exhibit signs and symptoms of what imbalance? a. Metabolic alkalosis b. Hypermagnesemia c. Hypercalcemia d. Hypovolemia
answer
d Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators of third-spacing fluid shift. Burns typically cause acidosis, not alkalosis.
question
The nurse is assessing the client for the presence of a Chvostek sign. What electrolyte imbalance would a positive Chvostek sign indicate? a. Hypermagnesemia b. Hyponatremia c. Hypocalcemia d. Hyperkalemia
answer
c You can induce Chvostek sign by tapping the client's facial nerve adjacent to the ear. A brief contraction of the upper lip, nose, or side of the face indicates Chvostek sign. Both hypomagnesemia and hypocalcemia may be tested using the Chvostek sign.
question
A nurse caring for a patient with metabolic alkalosis knows to assess for the primary, compensatory mechanism of: a. Increased serum HCO3. b. Increased PaCO2. c. Decreased serum HCO3. d. Decreased PaCO2.
answer
b The respiratory system compensates by decreasing ventilation to conserve CO2 and increase the PaCO2.
question
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? a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis d. Metabolic acidosis
answer
d 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.
question
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: a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.
answer
d 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
question
Hypomagnesemia is a common yet often overlooked imbalance in acutely and critically ill patients. Which of the following patients is most likely at the highest risk of experiencing low serum magnesium levels? a. An obese male patient who has a history of atherosclerosis and a previous non-ST wave elevation myocardial infarction b. A patient who is temporarily receiving total parenteral nutrition (TPN) as a result of complications from gastric bypass surgery c. A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use d. A teenage patient who is currently being treated for non-Hodgkin's lymphoma (NHL)
answer
c Alcoholism is currently the most common cause of symptomatic hypomagnesemia in the United States. Hypomagnesemia is particularly troublesome during treatment of alcohol withdrawal. Therefore, the serum magnesium level should be routinely measured in patients undergoing withdrawal from alcohol. TPN, heart disease, and lymphoma are not identified as central risk factors for the development of hypomagnesemia.
question
A 54-year-old male patient is admitted to the hospital with a case of severe dehydration. The nurse reviews the patient's laboratory results. Which of the following results are consistent with the diagnosis? Select all that apply. a. Blood urea nitrogen (BUN) of 23 mg/dL b. Serum osmolality of 310 mOsm/kg c. Serum sodium of 148 mEq/L d. Serum glucose of 90 mg/dL e. Urine specific gravity of 1.03 f. Hematocrit level of 48%
answer
a, b, c, e Severe dehydration is associated with an increased BUN (N = 10 to 20 mg/dL), serum osmolality (N = 275 to 300 mOsm/kg), serum sodium (N = 135 to 145 mEq/L) and urine specific gravity (N = 1.01 to 1.025). Glucose and hematocrit levels would also be elevated but are within normal range for this question.
question
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)? a. Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad b. Three ounces of sliced ham, beets, and a salad c. A frozen, packaged low-fat dinner with a side salad d. Tomato juice, low-fat cottage cheese, and three slices of bacon
answer
a 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/ยพ cup) and low fat cottage cheese (918 mg Na/cup). Packaged meals are high in sodium.
question
A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance? a. Hyperkalemia b. Hypocalcemia c. Hypokalemia d. Hypercalcemia
answer
d The normal reference range for serum calcium is 8.6 to 10.2 mg/dl. A serum calcium level of 12 mg/dl clearly indicates hypercalcemia. The client's other laboratory findings are within their normal ranges, so the client doesn't have hypernatremia, hypochloremia, or hypokalemia.
question
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? a. Respiratory alkalosis b. Metabolic alkalosis c. Respiratory acidosis d. Metabolic acidosis
answer
b 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.
question
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? a. 1 L b. 500 ml c. 1500 ml d. 1250 ml
answer
a A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.
question
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? a. pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L b. pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L c. pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L d. pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L
answer
a 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. It 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 7.42, PaCO2: 45 mm Hg, and HCO3-: 22 mEq/L indicate a normal result/no imbalance.
question
The physician added the condition "hypervolemia" to a client's list of medical ailments. What could put the client at risk for hypervolemia? Select all that apply. a. altered cardiac function b. taking prednisone c. eating large amounts of bananas d. drinking too much coffee
answer
a, b Clients at risk for hypervolemia include those who are receiving corticosteroid therapy and those with altered heart function.
question
A client with emphysema is at a greater risk for developing which acid-base imbalance? a. chronic respiratory acidosis b. metabolic alkalosis c. metabolic acidosis d. respiratory alkalosis
answer
a 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.
question
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? a. "I can use laxatives and enemas but only once a week." b. "A good breakfast for me will include milk and a couple of bananas." c. "I will be sure to buy frozen vegetables when I grocery shop." d. "I will take a potassium supplement daily as prescribed."
answer
a The client is experiencing hypokalemia, most likely due to the diagnosis of bulimia. Hypokalemia is defined as a serum potassium concentration <3.5 mEq/L (3.5 mmol/L), and usually indicates a deficit in total potassium stores. Clients diagnosed with bulimia frequently suffer increased potassium loss through self-induced vomiting and misuse of laxatives, diuretics, and enemas; thus, the client should avoid laxatives and enemas. Prevention measures may involve encouraging the client at risk to eat foods rich in potassium (when the diet allows), including fruit juices and bananas, melon, citrus fruits, fresh and frozen vegetables, lean meats, milk, and whole grains. If the hypokalemia is caused by abuse of laxatives or diuretics, client education may help alleviate the problem.
question
A client with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the client is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance? a. Respiratory acidosis b. Respiratory alkalosis c. Increased PaCO2 d. CNS disturbances
answer
b The most common cause of acute respiratory alkalosis is hyperventilation. Extreme anxiety can lead to hyperventilation. Acute respiratory acidosis occurs in emergency situations, such as pulmonary edema, and is exhibited by hypoventilation and decreased PaCO2. CNS disturbances are found in extreme hyponatremia and fluid overload.
question
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? a. Metabolic acidosis b. Respiratory acidosis c. Metabolic alkalosis d. Respiratory alkalosis
answer
d Respiratory alkalosis results from alveolar hyperventilation. It's marked by a decrease in PaCO2 to less than 35 mm Hg and an increase in blood pH over 7.45. Metabolic acidosis is marked by a decrease in HCO3? to less than 22 mEq/L, and a decrease in blood pH to less than 7.35. In respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg. In metabolic alkalosis, the HCO3? is greater than 26 mEq/L and the pH is greater than 7.45.
question
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? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
answer
c 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.
question
While assessing a client's peripheral IV site, the nurse observes edema around the insertion site. How should the nurse document this complication related to IV therapy? a. Air emboli b. Phlebitis c. Infiltration d. Fluid overload
answer
c Infiltration is the administration of nonvesicant solution or medication into the surrounding tissue. This can occur when the IV cannula dislodges or perforates the wall of the vein. Infiltration is characterized by edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness in the area of infiltration, and a significant decrease in the flow rate. Air emboli, phlebitis, and fluid overload are not indications of infiltration.
question
The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in her lips and fingers. She states that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should the nurse first suspect? a. Hypophosphatemia b. Hypocalcemia c. Hypermagnesemia d. Hyperkalemia
answer
b Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence. Signs of hyperkalemia include paresthesias and anxiety.
question
What foods can the nurse recommend for the patient with hypokalemia? a. Fruits such as bananas and apricots b. Green, leafy vegetables c. Milk and yogurt d. Nuts and legumes
answer
a Sources of potassium include fruit juices and bananas, melon, citrus fruits, fresh and frozen vegetables, lean meats, milk, and whole grains (Crawford & Harris, 2011b).
question
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? a. Administer an ordered decongestant. b. Instruct the client to breathe into a paper bag. c. Offer the client fluids frequently. d. Administer ordered supplemental oxygen.
answer
b 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.
question
Early signs of hypervolemia include a. a decrease in blood pressure. b. thirst. c. moist breath sounds. d. increased breathing effort and weight gain.
answer
d 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.
question
The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? a. Confusion b. Headache c. Nausea d. Hallucinations
answer
a Normal serum concentration ranges from 135 to 145 mEq/L (135-145 mmol/L). Hyponatremia exists when the serum concentration decreases below 135 mEq/L (135 mmol/L). When the serum sodium concentration decreases to <115 mEq/L (<115 mmol/L), signs of increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur. General manifestations of hyponatremia include poor skin turgor, dry mucosa, headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic changes, including altered mental status, status epilepticus, and coma, are probably related to cellular swelling and cerebral edema associated with hyponatremia. Hallucinations are associated with increased serum sodium concentrations.
question
A client's most recent laboratory results show a slight decrease in potassium. The physician has opted to forego drug therapy but has suggested increasing the client's dietary intake of potassium. What should the nurse recommend? a. Apples b. Fish c. Rice d. Bananas
answer
d Bananas are high in potassium. Apples, fish, and rice are not high in potassium.
question
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? a. No effect b. Increases arterial pH c. Decreases arterial pH d. Provides long-term pH regulation
answer
b 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.
question
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? a. Extracellular fluid volume deficit b. Altered blood urea nitrogen (BUN) value c. Metabolic alkalosis d. Respiratory acidosis
answer
a 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.
question
The nurse is participating in the care of a client who had a peripherally inserted central catheter (PICC) placed in the right arm. After catheter placement, the nurse should complete which action? a. Send the client for a chest x-ray. b. Administer the prescribed IV fluids. c. Obtain written consent for the procedure. d. Assess the client's blood pressure (BP) on the right arm.
answer
a A chest x-ray is needed to confirm the placement of catheter tip before initiating ordered infusions. Consent should be obtained before, not after, the procedure. No BPs should be taken on the extremity where the catheter is placed.
question
The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem? a. Diminished deep tendon reflexes b. Tachycardia c. Cool, clammy skin d. Acute flank pain
answer
a To gauge a client's magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with hypermagnesemia.
question
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? a. Myasthenia gravis b. Type 1 diabetes mellitus c. Extreme anxiety d. Opioid overdose
answer
c Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul's respirations) don't cause excessive CO2 loss. Myasthenia gravis and opioid overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.
question
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? a. Hypocalcemia b. Hyperchloremia c. Hypermagnesemia d. Hyponatremia
answer
a 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.
question
The nurse is evaluating a newly admitted client's laboratory results, which include several values that are outside of reference ranges. Which of the following alterations would cause the release of antidiuretic hormone (ADH)? a. Increased serum sodium b. Decreased serum potassium c. Decreased hemoglobin d. Increased platelets
answer
a Increased serum sodium causes increased osmotic pressure, increased thirst, and the release of ADH by the posterior pituitary gland. When serum osmolality decreases and thirst and ADH secretions are suppressed, the kidney excretes more water to restore normal osmolality. Levels of potassium, hemoglobin, and platelets do not directly affect ADH release.
question
Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: a. muscle weakness. b. tremors. c. diaphoresis. d. constipation.
answer
a Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.
question
A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis
answer
b Metabolic alkalosis is a clinical disturbance characterized by a high pH and a high plasma biacarbonate concentration. The most common cuase of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and choloride ions. Gastric fluid has an acid pH, and loss of this acidic fluid increases the alkalinity of body fluids.
question
A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. The laboratory values are as follows sodium is 147 mEq/L (mmol/L) potassium is 3.0 mEq/L (mmol/L) chloride is 112 mEq/L (mmol/L) Magnesium is 2.3 mg/dL (0.95mmol/L) What laboratory value is consistent with the client's symptoms? a. Sodium 147 mEq/L (mmol/L) b. Potassium 3.0 mEq/L (mmol/L) c. Chloride is 112 mEq/L (mmol/L) d. Magnesium is 2.3 mg/dL (0.95mmol/L)
answer
b Potassium is the major intracellular electrolyte. Hypokalemia (below 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium deficiency can result in derangements in physiology. Clinical signs include fatigue, anorexia, nausea, vomiting, muscles weakness, leg cramps, decreased bowel motility, and paresthesias. The sodium, chloride and magnesium levels are within normal limits.
question
Which of the following is a function of calcitonin? Select all that apply. a. Reduces bone resorption b. Increases urinary excretion of calcium c. Increases deposition of calcium in bones d. Decreases deposition of phosphorous in bones e. Decreases urinary excretion of phospate
answer
a, b, c Calcitonin reduces bones resorption, increasing deposition of calcium and phosphorous in the bones, and increases urinary excretion of calcium and phosphate.
question
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? a. "I will not salt my food; instead I'll use salt substitute." b. "Bananas have a lot of potassium in them; I'll stop buying them." c. "I'll drink cranberry juice with my breakfast instead of coffee." d. "I need to check to see whether my cola beverage has potassium in it."
answer
a 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.
question
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? a. The client's calcium will rise dramatically due to pituitary stimulation. b. Oxygen will increase the client's intracranial pressure and create confusion. c. Oxygen may cause the client to hyperventilate and become acidotic. d. Using oxygen may result in the client developing carbon dioxide narcosis and hypoxemia.
answer
d 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.
question
A patient with a history of poorly controlled type 1 diabetes has begun displaying the characteristic signs and symptoms of diabetic nephropathy. The patient's nurse recognizes that the patient is at risk of disruptions to fluid balance. What role do the kidneys play in the maintenance of normal fluid balance? a. Secreting or withholding antidiuretic hormone in response to extracellular fluid volume b. Selectively retaining needed substances and excreting waste products c. Synthesizing and releasing angiotensin in cases of fluid volume deficit d. Maintaining the correct concentration of H+ ions in the blood
answer
b Major functions of the kidneys in maintaining normal fluid balance include regulation of extracellular fluid (ECF) volume and osmolality by selective retention and excretion of body fluids and regulation of electrolyte levels in the ECF by selective retention of needed substances and excretion of unneeded substances. Antidiuretic hormone (ADH) is secreted by the pituitary gland, and angiotensin is ultimately derived from the liver, not the kidneys. Concentration of H+ ions contributes the buffer action of the kidneys, not the maintenance of fluid balance.
question
A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be a. 7.50 b. 7.45 c. 7.35 d. 7.30
answer
a The patient is experiencing respiratory alkalosis. Respiratory alkalosis is a clinical condition in which the arterial pH is >7.45 and the PaCO2 is <38 mm Hg. Respiratory alkalosis is always caused by hyperventilation, which causes excessive "blowing off" of CO2 and, hence, a decrease in the plasma carbonic acid concentration. Causes include extreme anxiety, hypoxemia, early phase of salicylate intoxication, gram-negative bacteremia, and inappropriate ventilator settings.
question
The nurse is caring for a client admitted to the medical unit 72 hours ago with pyloric stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since. Upon review of the morning's blood work, the nurse notices that the client's potassium is below reference range. The nurse should assess for signs and symptoms of what imbalance? a. Hypercalcemia b. Metabolic acidosis c. Metabolic alkalosis d. Respiratory acidosis
answer
c Probably the most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric fluid is lost. Vomiting, gastric suction, and pyloric stenosis all remove potassium and can cause hypokalemia. This client would not be at risk for hypercalcemia; hyperparathyroidism and cancer account for almost all cases of hypercalcemia. The nasogastric tube is removing stomach acid and will likely raise pH. Respiratory acidosis is unlikely since no change was reported in the client's respiratory status.
question
A patient is being treated with loop diuretics; gastric suctioning has been initiated. The nurse understands the patient is at risk for developing which of the following electrolyte imbalances? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypomagnesium
answer
a Potassium-losing diuretics, such as the thiazides and loop diuretics, can induce hypokalemia. Gastrointestinal (GI) loss of potassium is another common cause of potassium depletion. Vomiting and gastric suction frequently lead to hypokalemia.
question
The nurse is caring for a client who is to receive IV daunorubicin, a chemotherapeutic agent. The nurse starts the infusion and checks the insertion site as per protocol. During the most recent check, the nurse observes that the IV has infiltrated so the nurse stops the infusion. What is the nurse's priority concern with this infiltration? a. Extravasation of the medication b. Discomfort to the client c. Blanching at the site d. Hypersensitivity reaction to the medication
answer
a Irritating medications, such as chemotherapeutic agents, can cause pain, burning, and redness at the site. Blistering, inflammation, and necrosis of tissues can occur. The extent of tissue damage is determined by the medication concentration, the quantity that extravasated, infusion site location, the tissue response, and the extravasation duration. Extravasation is the priority over the other listed consequences.
question
A patient is admitted with a diagnosis of renal failure. The patient complains of "stomach distress" and describes ingesting several antacid tablets over the past 2 days. Blood pressure is 110/70 mm Hg, face is flushed, and the patient is experiencing generalized weakness. Which is the most likely magnesium level associated with the symptoms the patient is having? a. 11 mEq/L b. 5 mEq/L c. 2 mEq/L d. 1 mEq/L
answer
b Magnesium excess (>2.7 mEq/L) is associated with the following symptoms: flushing, hypotension, muscle weakness, drowsiness, hypoactive reflexes, depressed respirations, and cardiac arrest. The respiratory center is depressed when serum magnesium levels exceed 10 mEq/L (5 mmol/L). This is not present in this patient, so the magnesium level is unlikely to be 11 mEq/L. Coma, atrioventricular heart block, and cardiac arrest can occur when the serum magnesium level is greatly elevated and not treated.
question
Which of the following arterial blood gas results would be consistent with metabolic alkalosis? a. Serum bicarbonate of 28 mEq/L b. PaCO2 less than 35 mm Hg c. Serum bicarbonate of 21 mEq/L d. pH 7.26
answer
a Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.
question
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? a. Hypocalcemia b. Hyperchloremia c. Hypermagnesemia d. Hyponatremia
answer
a 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.
question
A client with hypertension has been prescribed hydrochlorothiazide. What nursing action will best reduce the client's risk for electrolyte disturbances? a. Maintain a low sodium diet. b. Encourage the use of over-the-counter calcium supplements. c. Ensure the client has sufficient potassium intake. d. Encourage fluid intake.
answer
c Diuretics cause potassium loss, and it is important to maintain adequate intake during therapy. Hyponatremia is more of a risk than hypernatremia, so a low-sodium diet does not address the risk for electrolyte disturbances. There is no direct need for extra calcium intake and increased fluid intake does not reduce the client's risk for electrolyte disturbances.
question
A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting? a. third-spacing b. pitting edema c. anasarca d. hypovolemia
answer
a Third-spacing describes the translocation of fluid from the intravascular or intercellular space to tissue compartments, where it becomes trapped and useless. The client manifests signs and symptoms of hypovolemia with the exception of weight loss. There may be signs of localized enlargement of organ cavities (such as the abdomen) if they fill with fluid, a condition referred to as ascites. Pitting edema occurs when indentations remain in the skin after compression. Anascara is another term for generalized edema, or brawny edema, in which the interstitial spaces fill with fluid. Hypovolemia (fluid volume deficit) refers to a low volume of extracellular fluid.
question
A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? a. <136 mOsm/kg b. 275-300 mOsm/kg c. >408 mOsm/kg d. 350-544 mOsm/kg
answer
b In healthy adults, normal serum osmolality is 270 to 300 mOsm/kg (Crawford & Harris, 2011c).
question
A client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment? a. neuromuscular function b. bowel sounds c. respiratory rate d. electrocardiogram (ECG) results
answer
d Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.
question
An average, healthy infant should have what percentage of interstitial body fluid? a. 25% b. 4% c. 10% d. 15%
answer
a Extracellular fluid includes the water between cells (interstitial fluid) and in the plasma (serum) portion of blood (intravascular fluid). The body weight of a healthy infant is 77% water, with the following percentages: 4% intravascular, 25% interstitial, and 48% intracellular.
question
A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypotension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypercalcemia
answer
a Hypokalemia causes fatigue, weakness, anorexia, nausea, vomiting, cardiac dysrhythmias, leg cramps, muscle weakness, and paresthesias. Many diuretics, such as ethacrynic acid (Edecrin), also waste potassium. Symptoms of hyperkalemia include diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias. Signs of hypocalcemia include tingling in the extremities and the area around the mouth and muscle and abdominal cramps. Hypercalcemia causes deep bone pain, constipation, anorexia, nausea, vomiting, polyuria, thirst, pathologic fractures, and mental changes.
question
With which condition should the nurse expect that a decrease in serum osmolality will occur? a. Diabetes insipidus b. Hyperglycemia c. Kidney failure d. Uremia
answer
c 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.
question
The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely? a. Magnesium b. Calcium c. Phosphorus d. Potassium
answer
a Chronic alcohol abuse is a major cause of symptomatic hypomagnesemia in the United States. The serum magnesium concentration should be measured at least every 2 or 3 days in clients undergoing alcohol withdrawal. The serum magnesium concentration may be normal at admission but may decrease as a result of metabolic changes, such as the intracellular shift of magnesium associated with intravenous glucose administration.
question
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? a. Metabolic acidosis b. Respiratory acidosis c. Metabolic alkalosis d. Respiratory alkalosis
answer
a 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).
question
The nurse is caring for a client admitted to the medical unit 72 hours ago with pyloric stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since. Upon review of the morning's blood work, the nurse notices that the client's potassium is below reference range. The nurse should assess for signs and symptoms of what imbalance? a. Hypercalcemia b. Metabolic acidosis c. Metabolic alkalosis d. Respiratory acidosis
answer
c Probably the most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric fluid is lost. Vomiting, gastric suction, and pyloric stenosis all remove potassium and can cause hypokalemia. This client would not be at risk for hypercalcemia; hyperparathyroidism and cancer account for almost all cases of hypercalcemia. The nasogastric tube is removing stomach acid and will likely raise pH. Respiratory acidosis is unlikely since no change was reported in the client's respiratory status.
question
The nurse notes that a patient's urine osmolality is 980 mOsm/kg. What should the nurse assess as a possible cause of this finding? a. Acidosis b. Fluid volume excess c. Diabetes insipidus d. Hyponatremia
answer
a Normal urine osmolality is 200 to 800 mOsm/kg, so 980 mOsm/kg is elevated. Acidosis is a factor that increases urine osmolality. Fluid volume excess, diabetes insipidus, and hyponatremia are all factors that decrease urine osmolality.
question
A patient with a history of poorly controlled type 1 diabetes has begun displaying the characteristic signs and symptoms of diabetic nephropathy. The patient's nurse recognizes that the patient is at risk of disruptions to fluid balance. What role do the kidneys play in the maintenance of normal fluid balance? a. Secreting or withholding antidiuretic hormone in response to extracellular fluid volume b. Selectively retaining needed substances and excreting waste products c. Synthesizing and releasing angiotensin in cases of fluid volume deficit d. Maintaining the correct concentration of H+ ions in the blood
answer
b Major functions of the kidneys in maintaining normal fluid balance include regulation of extracellular fluid (ECF) volume and osmolality by selective retention and excretion of body fluids and regulation of electrolyte levels in the ECF by selective retention of needed substances and excretion of unneeded substances. Antidiuretic hormone (ADH) is secreted by the pituitary gland, and angiotensin is ultimately derived from the liver, not the kidneys. Concentration of H+ ions contributes the buffer action of the kidneys, not the maintenance of fluid balance.
question
Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply. a. Distended neck veins b. Crackles in the lung fields c. Shortness of breath d. Decreased blood pressure e. Bradycardia
answer
a, b, c Clinical manifestations of FVE include distended neck veins, crackles in the lung fields, shortness of breath, increased blood pressure, and tachycardia.
question
The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L). The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving? a. Discontinue the intravenous lactated Ringer solution. b. Increase the rate of the intravenous lactated Ringer solution. c. Change the lactated Ringer solution to 3% saline. d. Change the lactated Ringer solution to 2.5% dextrose.
answer
a 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.
question
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? a. Hypocalcemia b. Hyperchloremia c. Hypermagnesemia d. Hyponatremia
answer
a 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.
question
Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? a. pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 b. pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 c. pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15 d. pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34
answer
a The client's ABG would likely demonstrate metabolic alkalosis. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of H+. A common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis, where only gastric fluid is lost. The other results do not represent metabolic alkalosis.
question
Which is an insensible mechanism of fluid loss? a. Urination b. Bowel elimination c. Breathing d. Nausea
answer
c Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is unnoticeable and immeasurable. Losses from urination and bowel elimination are measurable. Nausea does not result in fluid loss, however if the client would develop emesis ( vomiting) this would be considered loss of body fluids and would need measured.
question
A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypotension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypercalcemia
answer
a Hypokalemia causes fatigue, weakness, anorexia, nausea, vomiting, cardiac dysrhythmias, leg cramps, muscle weakness, and paresthesias. Many diuretics, such as ethacrynic acid (Edecrin), also waste potassium. Symptoms of hyperkalemia include diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias. Signs of hypocalcemia include tingling in the extremities and the area around the mouth and muscle and abdominal cramps. Hypercalcemia causes deep bone pain, constipation, anorexia, nausea, vomiting, polyuria, thirst, pathologic fractures, and mental changes.
question
A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. The laboratory values are as follows: sodium 147 mEq/L (147 mmol/L) potassium 3.0 mEq/L (3.0 mmol/L) chloride 112 mEq/L (112 mmol/L) Magnesium 2.3 mg/dL (0.95 mmol/L) What laboratory value is consistent with the client's symptoms? a. sodium 147 mEq/L (147 mmol/L) b. potassium 3.0 mEq/L (3.0 mmol/L) c. chloride 112 mEq/L (112 mmol/L) d. magnesium 2.3 mg/dL (0.95 mmol/L)
answer
b Potassium is the major intracellular electrolyte. Hypokalemia (potassium levels lower than 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium deficiency can result in derangements in physiology. Clinical signs include fatigue, anorexia, nausea, vomiting, muscles weakness, leg cramps, decreased bowel motility, and paresthesias. The sodium, chloride, and magnesium levels listed are within normal limits.
question
The human body is an intricate mechanism which maintains homeostasis through a multitude of chemical reactions. The measureable chemical levels disclose how well the body is (or is not) functioning. Which of these chemical substances release hydrogen into fluid? a. Acids b. Alkalines c. Bases d. Electrolytes
answer
a Acids are substances that release hydrogen into fluid. The delicate balance of fluid, electrolytes, acids, and bases is ensured by an adequate intake of water and nutrients, physiologic mechanisms that regulate fluid volume, and chemical processes that buffer the blood to keep its pH nearly neutral.
question
You are working on a burn unit. One of your patients is exhibiting signs and symptoms of third spacing, which occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, what would the nurse expect the patient to demonstrate? a. Hypertension b. Bradycardia c. Hypervolemia d. Hypovolemia
answer
d Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Hypertension, bradycardia, and hypervolemia are not indicators of third-spacing fluid shift.
question
Maintaining fluid balance, especially in older adults, can be a challenge. While hypovolemia is to be avoided, there is also an accompanying danger for blood clots and urinary stones. What condition contributes to the possible development of these life-threatening events? a. hemoconcentration b. metabolic acidosis c. metabolic alkalosis d. hemodilution
answer
a Hemoconcentration, a high ratio of blood components in relation to watery plasma, increases the potential for blood clots and urinary stones and compromises the kidney's ability to excrete nitrogen wastes. Metabolic acidosis is a condition that results in decreased plasma pH because of increased organic acids (acids other than carbonic acid) or decreased bicarbonate. Accumulation of acids also may follow renal failure, aspirin (acetylsalicylic acid) over dosage, or profuse diarrhea. Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. Risk factors include excessive oral or parenteral use of bicarbonate-containing drugs or other alkaline salts, a rapid decrease in extracellular fluid volume, and loss of hydrogen and chloride ions through vomiting or other GI conditions. Hemodilution is a reduced ratio of blood components to watery plasma, which causes a low blood cell count and hematocrit level.
question
The oral fluid intake of a febrile 150-lb adult client has been 2600 ml. The nurse concludes that this oral fluid intake: a. has been adequate for the client's weight. b. is below the standard for the client's weight. c. exceeds the standard for the client's weight. d. must be supplemented with IV fluid.
answer
a In healthy adults, oral fluid intake averages about 2500 mL/day; however, it can range between 1800 and 3000 mL/day, with a similar volume of fluid loss. Based on the standard formula for calculating daily fluid intake, this client requires about 2220 ml of oral fluid intake based on the weight of 150 lb.
question
Which electrolyte is a major anion in body fluid? a. Chloride b. Potassium c. Sodium d. Calcium
answer
a Chloride is a major anion found in extracellular fluid. Potassium, sodium, and calcium are cations.
question
Which is considered an isotonic solution? a. 0.9% normal saline b. Dextran in normal saline c. 0.45% normal saline d. 3% NaCl
answer
a An isotonic solution is 0.9% normal saline (NaCl). Dextran in normal saline is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.
question
A nurse in the neurologic ICU has received a prescription to infuse a hypertonic solution into a client with increased intracranial pressure. This solution will increase the number of dissolved particles in the client's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? a. Hydrostatic pressure b. Osmosis and osmolality c. Diffusion d. Active transport
answer
b Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to water pressure. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; the solutes in an intact vascular system are unable to move so diffusion normally should not be taking place. Active transport is the movement of molecules against the concentration gradient and requires adenosine triphosphate (ATP) as an energy source; this process typically takes place at the cellular level and is not involved in vascular volume changes.
question
Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: a. muscle weakness. b. tremors. c. diaphoresis. d. constipation.
answer
a Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.
question
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? a. Myasthenia gravis b. Type 1 diabetes mellitus c. Extreme anxiety d. Opioid overdose
answer
c Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul's respirations) don't cause excessive CO2 loss. Myasthenia gravis and opioid overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.
question
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: a. hypernatremia. b. hypokalemia. c. hyperkalemia. d. hypercalcemia.
answer
c Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. Administering glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.
question
A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? a. Lactated Ringer solution b. 0.45% NaCl c. 0.9% NaCl d. 5% NaCl
answer
b Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to replace cellular fluid because it is hypotonic compared with plasma. Another is to provide free water to excrete body wastes. At times, hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar conditions. Lactated Ringer solution and normal saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic.
question
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. a. Nutritional status and diet b. Blood pressure, heart rate, and rhythm c. Intake and output, urine volume, and color d. Strength testing for muscle wasting e. Skin assessment for edema and turgor
answer
b, c, e 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.
question
What clinical indication of hyperphosphatemia does the nurse assess in a patient? a. Bone pain b. Paresthesia c. Seizures d. Tetany
answer
d Tetany is a symptom of hyperphosphatemia. Bone pain, peresthesia, and seizures are associated with hypophosphatemia.