NUR 1021 Fluid Electrolyte & Acid-Base Balance (Chapter 41) Questions & Answers - $13.49   Add to cart

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NUR 1021 Fluid Electrolyte & Acid-Base Balance (Chapter 41) Questions & Answers

NUR 1021 Chapter 41 Fluid Electrolyte & Acid-Base Balance Questions & Answers A patient who is comatose is admitted to the hospital with an unknown history. Respirations are deep and rapid. Arterial blood gas levels on admission are pH, 7.20; PaCO2, 21 mm Hg; PaO2, 92 mm Hg; and HCO3-, 8. You interpret these laboratory values to indicate: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis A. Metabolic acidosis The low pH indicates acidosis. The low PaCO2 is caused by the hyperventilation, either from primary respiratory alkalosis (not compatible with the measured pH) or as a compensation for metabolic acidosis. The low HCO3- indicates metabolic acidosis or compensation for respiratory alkalosis (again, not compatible with the measured pH). Thus metabolic acidosis is the correct interpretation. A patient with a cardiac history is taking the diuretic furosemide (Lasix) and is seen in the emergency department for muscle weakness. Which laboratory value do you assess first? A. Serum albumin B. Serum sodium C. Hematocrit D. Serum potassium D. Serum potassium Potassium-wasting diuretics such as furosemide increase potassium urinary output and can cause hypokalemia unless potassium intake also increases. Hypokalemia causes muscle weakness. Which of these patients do you expect will need teaching regarding dietary sodium restriction? A. An 88-year-old with a fractured femur scheduled for surgery B. A 65-year-old recently diagnosed with heart failure C. A 50-year-old recently diagnosed with asthma and diabetes D. A 20-year-old with vomiting and diarrhea from gastroenteritis B. A 65-year-old recently diagnosed with heart failure Heart failure commonly causes extracellular fluid volume (ECV) excess because diminished cardiac output reduces kidney perfusion and activates the renin-angiotensin-aldosterone system, causing the kidneys to retain Na and water. Dietary sodium restriction is important with heart failure because Na holds water in the extracellular fluid, making the ECV excess worse. You teach patients to replace sweat, vomiting, or diarrhea fluid losses with which type of fluid? A. Tap water or bottled water B. Fluid that has sodium (salt) in it C. Fluid that has K and HCO3- in it D. Coffee or tea, whichever they prefer B. Fluid that has sodium (salt) in it Body fluid losses remove sodium-containing fluid from the body and can cause extracellular fluid volume deficit unless both the sodium and the water are replaced. You assess four patients. Which patient is at greatest risk for the development of hypocalcemia? A. 56-year-old with acute kidney renal failure B. 40-year-old with appendicitis C. 28-year-old who has acute pancreatitis D. 65-year-old with hypertension and asthma C. 28-year-old who has acute pancreatitis People who have acute pancreatitis frequently develop hypocalcemia because calcium binds to undigested fat in their feces and is excreted. This is called steatorrhea. This process decreases absorption of dietary calcium and also increases calcium output by preventing resorption of calcium contained in gastrointestinal fluids. Which of the following activities can you delegate to nursing assistive personnel (NAP)? (Select all that apply.) A. Measuring oral intake and urine output B. Preparing intravenous (IV) tubing for routine change C. Reporting an IV container that is low in fluid D. Changing an IV fluid container A. Measuring oral intake and urine output C. Reporting an IV container that is low in fluid The registered nurse cannot delegate working with IV tubing or changing an IV infusion to NAP. Assessment findings consistent with intravenous (IV) fluid infiltration include: (Select all that apply.) A. Edema and pain B. Streak formation C. Pain and erythema D. Pallor and coolness E. Numbness and pain A. Edema and pain D. Pallor and coolness Inadvertent fluid leakage into the interstitial compartment around an IV site can cause swelling, pain from the pressure, pale color, and coolness of the infiltrated area. Which of the following defi ning characteristics is consistent with fluid volume deficit? A. A 1-lb (0.5 kg) weight loss, pale yellow urine B. Engorged neck veins when upright, bradycardia C. Dry mucous membranes, thready pulse, tachycardia D. Bounding radial pulse, fl at neck veins when supine C. Dry mucous membranes, thready pulse, tachycardia The nursing diagnosis fluid volume deficit includes extracellular fluid volume (ECV) deficit, hypernatremia, and clinical dehydration. ECV deficit is characterized by dry mucous membranes, thready pulse, and tachycardia, among other indicators. Weight loss of 1 lb (0.5 kg) in 1 week could indicate fat loss instead of fluid loss. ECV deficit causes dark yellow urine rather than pale yellow, which is normal. Which of the following assessments do you perform routinely when an older adult patient is receiving intravenous 0.9% NaCl? A. Auscultate dependent portions of lungs B. Check color of urine C. Assess muscle strength D. Check skin turgor over sternum or shin A. Auscultate dependent portions of lungs Excessive or too-rapid infusion of 0.9% NaCl (normal saline) causes extracellular fluid volume (ECV) excess with pulmonary vessel congestion and potential pulmonary edema, especially in older adults, who cannot adapt as rapidly to increased vascular volume. Overload of intravenous normal saline eventually increases urine volume if kidneys are functioning but may not change urine color. Assessment of muscle strength is appropriate for potassium imbalances, not ECV imbalances. Skin turgor is not a reliable assessment of ECV deficit in older adults. While receiving a blood transfusion, your patient develops chills, tachycardia, and flushing. What is your priority action? A. Notify a health care provider B. Insert an indwelling catheter C. Alert the blood bank D. Stop the transfusion D. Stop the transfusion Development of chills, tachycardia, and flushing during a blood transfusion is an indication of an acute hemolytic reaction. You stop the transfusion immediately so no more of the incompatible blood reaches the patient. The health care provider's order is 1000 mL 0.9% NaCl with 20 mEq K intravenously over 8 hours. Which assessment finding causes you to clarify the order with the health care provider before hanging this fluid? A. Flat neck veins B. Tachycardia C. Hypotension D. Oliguria D. Oliguria Administration of KCl (increased K intake) to a person who has oliguria (decreased K output) can cause hyperkalemia. Your patient who has diabetic ketoacidosis is breathing rapidly and deeply. Intravenous (IV) fluids and other treatments have just been started. What should you do about this patient's breathing? A. Notify her health care provider that she is hyperventilating B. Provide frequent oral care to keep her mucous membranes moist C. Ask her to breathe slower and help her to calm down and relax D. Assess her for pain and request an order for a sedative B. Provide frequent oral care to keep her mucous membranes moist Hyperventilation is a compensatory mechanism for metabolic acidosis and should be allowed to continue. Rapid breathing can make oral mucous membranes dry and cracked. Your patient had 200 mL of ice chips and 900 mL intravenous (IV) fluid during your shift. Which total intake should you record? A. 700 mL B. 900 mL C. 1000 mL

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