NUR 170 Med-Surg Exam 1 Questions and Answers|Latest Update with complete solution

Section 1: Fluid and Electrolytes 1. You are the R.N. caring for a 65-year-old woman admitted after 3 days of vomiting, stomach pain, and poor oral intake. Her weight decreased from 153 lb to 141 lb. She has dry skin and mucous membranes, T 99.5 F, pulse 110, respirations 32, BP 94/66, and urine output of 150 mL in 12 hours. Labs: K+ 3.4, Hct 57%, urine specific gravity 1.038, Na+ 151, Hgb 19, BUN 28. Analyze her fluid-volume status and identify priority interventions. Answer: Severe hypovolemia (fluid-volume deficit) with dehydration and hypernatremia. • Assess airway, breathing, circulation, mental status, and perfusion. • Notify the provider; establish or maintain IV access. • Administer prescribed isotonic IV fluid. • Strict intake/output, daily weights, frequent vital signs, and fall precautions. • Treat vomiting and monitor for dysrhythmias. Rationale: Vomiting and poor intake caused major water and volume loss. The 12-lb weight loss, hypotension, tachycardia, oliguria, dry membranes, and concentrated urine indicate reduced circulating volume. Elevated hemoglobin, hematocrit, sodium, BUN, and urine specific gravity reflect hemoconcentration. The immediate priority is restoring perfusion with prescribed isotonic fluid, usually 0.9% normal saline, while monitoring vital signs, mental status, urine output, electrolytes, renal function, and cardiac rhythm. Replace potassium only as prescribed and after adequate urine output is confirmed. 2. What are common causes of hypervolemia? What signs and symptoms would you expect in a patient who is volume overloaded? Answer: Common causes include heart failure, kidney failure, cirrhosis, excessive IV fluids or sodium, corticosteroids, and excess aldosterone. Findings include rapid weight gain, edema, jugular venous distention, bounding pulses, hypertension, crackles, dyspnea, orthopnea, ascites, and diluted laboratory values. Rationale: Excess intravascular volume raises hydrostatic pressure, forcing fluid into tissues and the lungs. This produces peripheral edema and pulmonary congestion. Daily weights and respiratory assessment are especially important because pulmonary edema can become life-threatening. 3. When assessing a client's hydration status, what is the best indicator of fluid losses or gains? Answer: Daily weight measured at the same time, on the same scale, in similar clothing, preferably after voiding. Rationale: Approximately 1 kg (2.2 lb) of weight change represents about 1 liter of fluid. Daily weight is more sensitive than edema, skin turgor, or intake/output alone. 2 4. Compare and contrast the signs and symptoms of sodium imbalances. What precautions should be implemented? Answer: Both hyponatremia and hypernatremia can cause neurological changes. Hyponatremia may cause headache, confusion, lethargy, nausea, weakness, seizures, and coma. Hypernatremia may cause intense thirst, dry mucous membranes, restlessness, irritability, twitching, hyperreflexia, seizures, and coma. Rationale: Sodium controls water movement across cell membranes, including brain cells. Low sodium can cause cerebral swelling; high sodium can cause cellular dehydration. Use seizure and fall precautions when indicated, perform frequent neurological checks, monitor fluid balance and sodium, and correct sodium gradually to avoid serious neurological injury. 5. Compare and contrast the signs and symptoms of potassium imbalances. What precautions should be implemented? Answer: Hypokalemia commonly causes weakness, cramps, constipation or ileus, shallow respirations, weak irregular pulse, flattened T waves, ST depression, and U waves. Hyperkalemia may cause weakness, paresthesia, diarrhea, bradycardia, tall peaked T waves, widened QRS, ventricular dysrhythmias, and cardiac arrest. Rationale: Potassium directly affects cardiac, skeletal, and smooth-muscle electrical activity. Place patients with significant abnormalities on cardiac monitoring, assess respiratory and muscle function, and monitor renal function. Never give potassium by IV push. Verify adequate urine output before potassium replacement and use an infusion pump. 6. Discuss signs and symptoms of hypocalcemia. Answer: Perioral numbness, tingling of the fingers or toes, muscle cramps, tetany, hyperreflexia, positive Chvostek and Trousseau signs, seizures, laryngospasm or stridor, abdominal cramping, and prolonged QT interval. Rationale: Low calcium increases neuromuscular excitability. Severe hypocalcemia can obstruct the airway or cause seizures and dysrhythmias. Use seizure precautions, monitor cardiac rhythm and airway status, keep suction available, and administer calcium as prescribed.