EAQs Chapter 16 Fluid and Electrolytes Flashcards Preview

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Flashcards in EAQs Chapter 16 Fluid and Electrolytes Deck (189)
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1

The nurse is reviewing magnesium levels for a patient. What does the nurse recognize is the importance of assessing this level for a patient?

It may cause extracellular fluid overload.
Can affect neuromuscular excitability and contractility.
It is the most abundant intracellular cation present in the body.
The patient is at risk for hypotension when the levels decrease.

Can affect neuromuscular excitability and contractility.

Alterations in serum magnesium levels profoundly affect neuromuscular excitability and contractility because magnesium directly acts on the myoneural junction. A decrease in blood magnesium levels increases the blood pressure. Magnesium is the second most abundant intracellular cation. The majority of the body’s magnesium is present in the bones. Causing extracellular fluid overload, being the most abundant intracellular cation, and the patient being at risk for hypotension are not relevant to this situation.

2

The nurse is caring for a patient with severe hyperphosphatemia. What type of treatment does the nurse anticipate administering to this patient?

Insulin infusion
Fluid restriction
Calcium supplements
Loop diuretic therapy

Insulin infusion

For severe hyperphosphatemia, hemodialysis or an insulin and glucose infusion can decrease levels rapidly. Fluid restriction, calcium supplements, and diuretic therapy are not treatment options for hyperphosphatemia.

3

The nurse is monitoring a patient with hyperkalemia. Which conditions should the nurse conclude may cause this condition? Select all that apply.

Alkalosis
Renal failure
Low blood volume
Large urine volume
Adrenal insufficiency

Renal failure
Adrenal insufficiency

Hyperkalemia is a condition in which there is an abnormal increase of potassium in the blood. Renal failure may cause hyperkalemia, because the kidneys cannot remove potassium from the body. Adrenal insufficiency causes aldosterone deficiency, which leads to the retention of potassium ions and also may result in hyperkalemia. Alkalosis is seen in hypocalcemia. Low blood volume and a large urine volume can result in hypokalemia.

4

The nurse is reviewing the serum potassium results for a patient. What level best supports the rationale for administering a stat dose of potassium chloride 20 mEq in 250 mL of normal saline over two hours?

3.1 mEq/L
3.9 mEq/L
4.6 mEq/L
5.3 mEq/L

3.1 mEq/L

The normal range for serum potassium is 3.5 to 5.0 mEq/L. This intravenous (IV) prescription provides a substantial amount of potassium. Thus the patient's potassium level must be low. The only low value shown is 3.1 mEq/L; 3.9 mEq/L, 4.6 mEq/L, and 5.3 mEq/L are not low values.

5

A patient's ECG tracing has a short QT interval and a high peaked T wave. Which prescription should the nurse question?

D5W with 20 meq KCL to run at 125 mL/hr
Sodium polystyrene sulfonate 30 grams by mouth
10 units regular insulin IVP and one-half ampule D50W IVP
2 grams calcium gluconate intravenous (IV) administered over two minutes

D5W with 20 meq KCL to run at 125 mL/hr

A short QT interval and a high peaked T wave are indicative of hyperkalemia. The prudent nurse should question any prescription that could increase the potassium level in the patient. IV insulin with D50W and calcium gluconate are given to force the potassium back into the cells, temporarily correcting the hyperkalemia. Polystyrene sulfonate binds with potassium in the gastrointestinal (GI) tract and excretes it via feces.

6

The nurse is providing care to a patient with hypocalcemia. Which clinical manifestation should the nurse anticipate for this patient?

Shortened ST segment
Prolonged QT segment
Ventricular dysrhythmia
Increased digitalis effect

Prolonged QT segment

A prolonged QT segment is a clinical manifestation the nurse would anticipate when providing care to a patient with hypocalcemia. A shortened ST segment, ventricular dysrhythmia, and increased digitalis effects are anticipated when providing care to a patient with hypercalcemia.

7

The nurse finds that the patient with renal disease is irritable and has an irregular pulse. ECG changes suggest severe hyperkalemia. What is the first nursing action?

Stop all sources of dietary potassium
Administer intravenous calcium gluconate
Administer ion-exchange resins
Administer intravenous insulin with glucose

Administer intravenous calcium gluconate

In the case of severe hyperkalemia, manifested by irritation, irregular pulse, and changes in ECG findings, the nurse should act immediately to prevent cardiac arrest. The nurse should administer intravenous calcium gluconate to reverse the membrane potential effects of extracellular fluid (ECF) potassium. Administering ion-exchange resins (to increase elimination of potassium) and intravenous insulin with glucose (to force potassium from ECF to intracellular fluid [ICF]) can be done once the patient is stable. Stopping all sources of dietary potassium is an important measure when hyperkalemia is mild.

8

The nurse is caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would be identified as an adverse effect related to this therapy?

Sodium falling to 138 mEq/L
Potassium rising to 4.1 mEq/L
Magnesium rising to 2.9 mg/dL
Phosphorus falling to 2.1 mg/dL

Phosphorus falling to 2.1 mg/dL

Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa. Because hypercalcemia rarely occurs as a result of calcium intake, the patient's phosphorus falling to 2.1 mg/dL (normal 2.4-4.4 mg/dL) may be a result of the phosphate-binding effect of calcium carbonate. Sodium falling, potassium rising, and magnesium rising are not adverse reactions to the treatment.

9

A patient with cancer is found to have a serum phosphate level of 5.4 mg/dL. What does the nurse determine is the probable reason for the increase in phosphate levels in this patient?

Chemotherapy
Insulin therapy
Total parenteral nutrition
Phosphate-binding antacids

Chemotherapy

Phosphate levels greater than 4.4 mg/dL indicate hyperphosphatemia. Chemotherapy drugs increase the patient’s phosphate levels. Insulin therapy decreases the phosphate levels to less than 2.4 mg/dL. Patients with total parenteral nutrition have decreased phosphate levels. Phosphate-binding antacids remove phosphates from the body, resulting in hypophosphatemia.

10

An older adult patient is admitted with pneumonia. Why would it be important for the nurse to closely monitor fluid and electrolyte balance in this patient?

Older adults are at an increased risk of impaired renal function.

Older adults have an impaired level of consciousness and need to be reminded to drink fluids.

Older adults are more likely than younger adults to lose extracellular fluid during severe illnesses.

Small losses of fluid are more significant because body water accounts for only about 50% of body weight in older adults.

Small losses of fluid are more significant because body water accounts for only about 50% of body weight in older adults.

Older adults, with less muscle mass and more fat content, have less body water than younger adults. In the older adult, body water content averages 45% to 55% of body weight, leaving them at a higher risk for fluid-related problems than young adults. Renal function, level of consciousness, and severe illnesses are not relevant in this instance.

11

The nurse is administering regular insulin intravenously to a patient with moderate hyperkalemia. Which additional intravenous medication will the nurse administer to the patient?

Glucose
Furosemide
Pamidronate
Calcium gluconate

Glucose

While administering regular insulin intravenously to a hyperkalemic patient to help force potassium from extracellular fluid to intracellular fluid, the nurse also administers glucose to prevent hypoglycemia. Furosemide is administered if the patient has hypermagnesemia. Pamidronate is administered if the patient has hypercalcemia. Calcium gluconate is administered to treat hypocalcemia.

12

The nurse is caring for a patient with sickle cell anemia. What common electrolyte imbalance should the nurse carefully assess the patient for that is commonly associated with this disease?

Increased calcium levels
Increased potassium levels
Increased phosphate levels
Increased magnesium levels

Increased phosphate levels

Sickle cell anemia leads to increased concentration of phosphates in the body, thus causing hyperphosphatemia. Hypercalcemia, or increased calcium levels, is associated with hyperparathyroidism. Hyperkalemia, or increased potassium levels, is associated with tumor-lysis syndrome. Hypermagnesemia, or increased magnesium levels, is associated with diabetic ketoacidosis.

13

A patient sustains multiple injuries in a motor vehicle accident and is hypovolemic due to hemorrhage. Blood transfusions are given to replace the lost blood. The nurse finds that the patient has now developed laryngeal stridor, dysphagia, and numbness and tingling around the mouth. What could be the reason for these new manifestations?

The patient has developed anemia.
The patient has developed hypocalcemia.
The patient has developed fluid overload.
The patient has developed a hemolytic reaction.

The patient has developed hypocalcemia.

Laryngeal stridor, dysphagia, and numbness and tingling around the mouth after multiple blood transfusions can be attributed to hypocalcemia. Blood and blood products have citrate in them, which can bind with calcium in the body and make it unavailable. Multiple blood transfusions have thus caused hypocalcemia. This usually manifests as laryngeal stridor, dysphagia, and numbness and tingling around the mouth. Such symptoms are not caused by fluid overload, which manifests as edema. Anemia can be the result of hemorrhage but does not present with laryngeal stridor and dysphagia. There are chances of hemolytic reactions, because the patient is receiving multiple transfusions. However, a hemolytic reaction manifests as severe anaphylaxis, so the patient is not having a hemolytic reaction.

14

The nurse is caring for a patient and observes with a serum potassium of 2.8 mEq/L. What is the greatest risk for this patient that the nurse should monitor for?

Dysrhythmias
Acute renal failure
Metabolic alkalosis
Malignant hypertension

Dysrhythmias

Potassium exerts a direct effect on the excitability of cardiac muscle tissue. Therefore an increased or low serum level of potassium can alter cardiac function and heart rhythm, resulting in dysrhythmias. Acute renal failure is not a complication of hypokalemia, but it may be seen with hyperkalemia. Metabolic alkalosis and malignant hypertension are not associated with hypokalemia.

15

The nurse is caring for a patient that has a nasogastric tube (NGT) on intermittent suction. The patient asks why they cannot have something to drink. What is the best response by the nurse?

"It will cause sodium retention."
"It will disrupt the intermittent suction."
"It will increase nausea and vomiting."
"It will increase the loss of electrolytes."

"It will increase the loss of electrolytes."

Allowing a patient with an NGT to drink water increases the loss of electrolytes. It will not cause sodium retention, but sodium depletion. The free water will pull electrolytes into the stomach and the NGT will suck the fluids and electrolytes out of the stomach. Depending on the patient's condition and amount of water being ingested, it may increase nausea and vomiting. However, this would most likely happen if the suction was not working properly; it is not the primary reason for withholding oral fluids. Oral intake of water would not disrupt the intermittent suction.

16

The nurse receives a health care provider's prescription to change a patient's intravenous (IV) from D 5 ½ normal saline (NS) with 40 mEq KCl/L to D5 NS with 20 mEq KCl/L. Which serum laboratory value on this same patient best supports the rationale for this IV prescription change?

Sodium 136 mEq/L, potassium 4.5 mEq/L
Sodium 145 mEq/L, potassium 4.8 mEq/L
Sodium 135 mEq/L, potassium 3.6 mEq/L
Sodium 144 mEq/L, potassium 3.7 mEq/L

Sodium 136 mEq/L, potassium 4.5 mEq/L

The normal range for serum sodium is 135 to 145 mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L. The change in the IV prescription decreases the amount of potassium and increases the amount of sodium. For this prescription to be appropriate, the potassium level must be near the high end and the sodium level near the low end of their respective ranges.

17

The nurse is caring for a group of patients with a variety of diagnoses. Which conditions would cause the nurse to include interventions in the plan of care to address anticipated hypophosphatemia? Select all that apply.

Renal failure
Respiratory alkalosis
Diabetic ketoacidosis
Tumor lysis syndrome
Malabsorption syndrome

Respiratory alkalosis
Diabetic ketoacidosis
Malabsorption syndrome

The nurse would include interventions to address hypophosphatemia when providing care to patients with respiratory alkalosis, diabetic ketoacidosis, and malabsorption syndrome. The nurse should create a care plan for hyperphosphatemia when providing care to patients with renal failure and tumor lysis syndrome.

18

The nurse suspects which possible conditions in a patient whose serum potassium level is 6.8 mEq/L on admission? Select all that apply.

The patient is on insulin therapy.
The patient is taking amiloride daily.
The patient suffers from renal disease.
The patient’s electrocardiogram reveals flattened T waves.
The patient’s orders will include intravenous fluids with added potassium.

The patient is taking amiloride daily.
The patient suffers from renal disease.

Potassium levels greater than 5.0 mEq/mL indicated hyperkalemia. Potassium-sparing diuretics, such as amiloride, increase the potassium levels. Insulin moves potassium into the cell and decreases serum potassium values. The kidneys excrete potassium, so renal disease can lead to increased potassium levels. Hyperkalemia is manifested on an electrocardiogram as tall, peaked T waves. Potassium should not be added to IV fluids if the patient suffers from hyperkalemia.

19

The nurse is preparing to administer intravenous (IV) potassium chloride (KCl) to a patient. Which action should the nurse perform to ensure the patient’s safety?

Give KCl via IV push.
Add KCl to the hanging IV bag.
Give IV KCl in concentrated amounts.
Invert IV bags containing KCl several times.

Invert IV bags containing KCl several times.

Hypokalemia is characterized by a decreased concentration of potassium in the body. Therefore KCl should be administered to maintain normal potassium levels. Inverting the IV bags containing KCl several times ensures even distribution of KCl medication in the bag. The nurse should administer KCl through an infusion pump, not by IV push, to ensure that it is administered at an accurate rate. The nurse should not add KCl to the hanging IV bag because this would result in administering a bolus dose. The nurse will give IV KCl in diluted forms, rather than in concentrated amounts, to ensure the patient’s safety.

20

The nurse is caring for a patient with a potassium level of 6.2 mEq/dl. What syndrome does the nurse suspect the patient may have?

Cushing syndrome
Milk-alkali syndrome
Tumor lysis syndrome
Malabsorption syndrome

Tumor lysis syndrome

Tumor lysis syndrome causes movement of potassium from the intracellular fluid (ICF) to the extracellular fluid (ECF), resulting in hyperkalemia. Cushing syndrome may cause hypernatremia. Milk-alkali syndrome may cause hypercalcemia. Malabsorption syndrome may cause hypophosphatemia.

21

The patient has a one-time prescription for potassium chloride 20 mEq in 250 mL of normal saline intravenous (IV) to be given immediately. The nurse would seek clarification for this prescription if the patient's more recent potassium level is at what level?

1.7 mEq/L
2.9 mEq/L
3.6 mEq/L
4.5 mEq/L

4.5 mEq/L
The normal range for serum potassium is 3.5 to 5 mEq/L. The IV prescription provides a substantial amount of potassium, so the patient's potassium level must be low. A level of 4.5 mEq/L would not warrant this medication.

22

The nurse is providing care to a patient whose serum potassium level is 5.1 mEq/L. Which change should the nurse make to the plan of care to address this finding?

Monitoring for digitalis toxicity
Adding bananas to the list of approved fruits
Implementing continuous monitoring of urine output
Ensuring that intravenous calcium gluconate is available at all times

Ensuring that intravenous calcium gluconate is available at all times

A patient with hyperkalemia, as indicated by the serum potassium level, is at risk for dysrhythmia. Therefore the nurse should ensure that intravenous calcium gluconate is available at all times. Monitoring for digitalis toxicity, adding bananas to the list of approved fruits, and implementing continuous monitoring of urine output are interventions the nurse should add to the plan of care for a patient who develops hypokalemia, not hyperkalemia.

23

The nurse reviews laboratory findings for a patient with milk-alkali syndrome. What laboratory results are consistent with this diagnosis?

Calcium levels of 7 mg/dL
Calcium levels of 15 mg/dL
Phosphate levels of 2 mg/dL
Phosphate levels of 17 mg/dL

Calcium levels of 15 mg/dL

Milk-alkali syndrome is a condition in which large concentrations of calcium are found in the body. Calcium levels of more than 10.2 mg/dL indicate hypercalcemia. Calcium levels of 7 mg/dL indicate hypocalcemia. Phosphate levels of 2 mg/dL indicate hypophosphatemia. Phosphate levels of 17 mg/dL indicate hyperphosphatemia.

24

The nurse is caring for a patient with a blood sodium level of 170 mEq/L and is experiencing intense thirst, agitation, and decreased alertness. What does the nurse anticipate administering?

Intravenous furosemide
Intravenous cation-exchange resin
Intravenous phosphate-binding agent
Intravenous 0.45% sodium chloride saline solution

Intravenous 0.45% sodium chloride saline solution

Hypernatremia is a condition in which water shifts out of the cells into the extracellular fluid, resulting in dehydration. Therefore the patient with hypernatremia would experience intense thirst, agitation, and decreased alertness. To reduce dehydration, fluid should be replaced by administering hypotonic intravenous fluids such as 5% dextrose in water or 0.45% sodium chloride saline solution. Administering intravenous furosemide may help treat hypercalcemia. A cation-exchange resin may be administered to treat hyperkalemia. A phosphate-binding agent may be administered to treat hyperphosphatemia.

25

Upon assessment of laboratory data, the nurse notes a calcium level of 6.4 mg/dL. Which physical assessment finding is consistent with this data?

Polyuria
Bone pain
Paresthesias
Diminished deep tendon reflexes

Paresthesias

Signs of hypocalcemia include paresthesias, tetany, and muscle weakness. Bone pain, diminished reflexes, and polyuria are signs of hypercalcemia.

26

While reviewing a patient’s laboratory reports, the nurse finds the plasma concentration of calcium to be 11.2 mg/dL. Which clinical manifestations does the nurse anticipate observing? Select all that apply.

Polyuria
Seizures
Nephrolithiasis
Chvostek’s sign
Trousseau’s sign

Polyuria
Nephrolithiasis

Plasma concentration of calcium greater than 10.2 mg/dL indicates hypercalcemia, which results in increased concentration of calcium in the urine. This impairs sodium and water reabsorption and causes polyuria. Hypercalcemia can cause kidney stones, or nephrolithiasis, because an increased concentration of calcium in the urine deposits crystals in the kidney, which combine to form kidney stones. Seizures, Chvostek’s sign, and Trousseau’s sign are clinical manifestations of hypocalcemia.

27

The nurse is caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. What classification of medications should be withheld until consulting with the health care provider?

Antibiotics
Loop diuretics
Bronchodilators
Antihypertensives

Loop diuretics

Loop diuretics are contraindicated during episodes of hypokalemia because these medications cause the kidneys to excrete sodium and potassium. Thus administration of this type of medication at this time would worsen the hypokalemia, putting the patient at risk for dysrhythmias. The prescribing health care provider should be consulted for potassium replacement therapy, and the drug should be withheld until the potassium has returned to normal range. Antibiotics, bronchodilators, and antihypertensives are not an issue in this case.

28

The nurse is preparing to administer a dose of potassium phosphate. What laboratory finding would indicate that the nurse should withhold the medication?

Calcium 6.4 mg/dL
Sodium 133 mEq/L
Magnesium 1.8 mEq/L
Potassium 5.2 mEq/L

Calcium 6.4 mg/dL

Phosphorus and calcium have inverse or reciprocal relationships, meaning that when calcium levels are high, phosphorus levels tend to be low. Therefore administration of phosphorus will reduce a patient's already abnormally low calcium level, which can result in life-threatening complications. Potassium phosphate will not have any effect on sodium, magnesium, or potassium levels.

29

A patient is admitted with alcohol abuse. Laboratory data reveals a phosphate level of 1.8 mg/dL. Which assessment finding is consistent with this data?

Tetany
Diarrhea
Weakness
Seizure activity

Weakness

Signs of hypophosphatemia include weakness, confusion, coma, and diminished reflexes. Seizure activity, diarrhea, and tetany are not associated with this electrolyte imbalance.

30

Which medical diagnosis would cause the nurse to include nursing interventions appropriate for hyponatremia in the plan of care?

Diabetes insipidus
Cushing syndrome
Congestive heart failure
Uncontrolled diabetes mellitus

Congestive heart failure

Congestive heart failure increases the patient’s risk for developing hyponatremia; therefore this diagnosis would cause the nurse to include interventions specific to hyponatremia in the plan of care. Diabetes insipidus, Cushing syndrome, and uncontrolled diabetes mellitus increase the patient’s risk for hypernatremia, not hyponatremia.