Med_Surg_Chapter_13

Med-Surg Chapter 13: Fluid and Electrolytes Balance and Disturbance Question 4 A 64-year-old client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and is lethargic. Serum sodium level is above 145 mEq/l (145 mmol/L). Should the nurse start salt tablets when caring for this client? • No, sodium intake should be restricted. 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 (HCO –), 24 mEq/L. Based on these values, the nurse suspects: • respiratory alkalosis. 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? • Respiratory alkalosis 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 • 7.50 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? • third-spacing 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? • Metabolic alkalosis 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? • Metabolic acidosis Question A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? • Light-headedness or paresthesia 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 (HCO –) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? • Metabolic alkalosis 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? • Presence of Trousseau sign Question 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 Question A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? • Cerebral edema Question A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? • Serum sodium level of 124 mEq/L Question A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her: • electrocardiogram (ECG) results. Question A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? • 0.45% NaCl Question A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. Na + 130 mEq/L K + 4.6 mEq/L Cl - 94 mEq/L Mg ++ 2.8 mg/dL Ca ++ 13 mg/dL Which of the following alterations is consistent with the client's findings? • Hypercalcemia 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? • hypokalemia 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? • dehydration Question 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 water as an inexpensive way to meet fluid needs. • Respond to thirst Question A client weighing 160 pounds diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the patient loses 1,000 mL of fluid in 24 hours. Choose the weight that would be consistent with this amount of fluid loss. • 158 lbs Question 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. Question A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client’s serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the • malignancy is causing the electrolyte imbalance. Question A client with emphysema is at a greater risk for developing which acid–base imbalance? • chronic respiratory acidosis Question 1 A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? • Serum potassium level of 3 mEq/L Question A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond? • Bicarbonate–carbonic acid buffer system Question 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: • 280 mOsm/kg. Question A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? • Acidic Question A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action? • Jugular vein distention 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? • Respiratory acidosis Question 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. 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? • Hypercalcemia Question 2 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 Question A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis? • The client had a liver transplant 2 years ago. Question A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? • Urine pH of 3.0 Question A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? • Respiratory alkalosis Question A patient complains of 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 patient’s laboratory work has returned? • Calcium Question A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The nurse expects that the compensatory mechanisms associated with hypovolemia would cause what clinical manifestations? (Select all that apply.) • Oliguria • Tachycardia • Tachypnea Question 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 150 mEq/L Question A patient with mild fluid volume excess is prescribed a diuretic that blocks sodium reabsorption in the distal tubule. Which diuretic does the nurse anticipate administering to this patient? • HydroDiuril Question A priority nursing intervention for a client with hypervolemia involves which of the following? • Monitoring respiratory status for signs and symptoms of pulmonary complications. Question An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? • Hypokalemia 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? • Extreme anxiety Question Early signs of hypervolemia include • increased breathing effort and weight gain. Question Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: • muscle weakness. Question Oncotic pressure refers to the • osmotic pressure exerted by proteins. Question The calcium concentration in the blood is regulated by which mechanism? • Parathyroid hormone (PTH) Question 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? • Bicarbonate 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? • pH: 7.20, PaCO2: 65 mm Hg, HCO3–: 26 mEq/L Question The nurse is assessing a client for local complications of intravenous therapy. Which are local complications? Select all that apply. • Extravasation • Hematoma • Phlebitis Question The nurse is assigned a client with calcium level of 4.0 mg/dL. Which system assessment would the nurse ask detailed questions? • Neurological system 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? • Hypocalcemia 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? • “I can use laxatives and enemas but only once a week.” Question The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? • The lungs are not able to blow off carbon dioxide. Question The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? • Elevated blood pressure Question The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely? • Magnesium 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? • Confusion Question The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? • Dark, concentrated urine Question 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? • Lungs and kidney 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? • Metabolic acidosis Question 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? • Metabolic acidosis Question 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 52-year-old with diarrhea Question The nurse is correct to state that a client’s body needs to have adequate nutrition to maintain energy. Which type of transport of dissolved substances requires adenosine triphosphate (ATP)? • Active transport 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? • “I will not salt my food; instead I’ll use salt substitute.” 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? • Send the client for a chest x-ray. Question The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? • Potassium: 5.8 mEq/L 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? • Acidosis Question 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? • Metabolic alkalosis Question The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. • Compare ABG findings with previous results. • Maintain intake and output records. • Document presenting signs and symptoms. Question The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? • 0.45% sodium chloride 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? • 1 L Question To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? • Tachycardia Question 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 Question What foods can the nurse recommend for the patient with hypokalemia? • Fruits such as bananas and apricots Question When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? • pH 7.48 Question Which condition leads to chronic respiratory acidosis in older adults? • Thoracic skeletal change Question Which could be a potential cause of respiratory acidosis? • Hypoventilation Question Which electrolyte is a major anion in body fluid? • Chloride Question Which electrolyte is a major cation in body fluid? • Potassium Question Which factor increases blood urea nitrogen (BUN)? • Gastrointestinal bleeding Question Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? • Confusion and seizures 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? • Instruct the client to breathe into a paper bag. Question Which is a correct route of administration for potassium? • Oral Question 7 Which is an insensible mechanism of fluid loss? • Breathing Question Which is the most common cause of symptomatic hypomagnesemia? • Alcoholism Question Which laboratory result does the nurse identify as a direct result of the client’s hypovolemic status with hemoconcentration? • Elevated hematocrit level Question Which nerve is implicated in the Chvostek’s sign? • Facial Question Which of the following arterial blood gas results would be consistent with metabolic alkalosis? • Serum bicarbonate of 28 mEq/L Question Which of the following electrolyte imbalances occur with adrenal insufficiency? • Hyperkalemia Question 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 Question Which of the following is a factor affecting an increase in urine osmolality? • Syndrome of inappropriate antidiuretic hormone release (SIADH) Question Which of the following is consistent with the client's findings? • Hypokalemia Question 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 Question Which of the following is a factor affecting an increase in serum osmolality? • Free water loss Question Which set of arterial blood gas (ABG) results requires further investigation? • pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3– 18 mEq/L Question Which solution is hypotonic? • 0.45% NaCl Question With which condition should the nurse expect that a decrease in serum osmolality will occur? • Kidney failure Question You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? • Dehydration