Fluids and electrolytes Flashcards
(33 cards)
A patient is experiencing a fluid imbalance caused by excessive blood loss. Which fluid should the nurse expect to be prescribed for this patient?
A. Colloid
B. Crystalloid
C. Electrolytes
D. Oral fluids
A. Colloid - Fluids are replaced in an attempt to put back what is lost, so blood loss is replaced with blood transfusions, albumins, or other large-molecule protein solutions (colloids). Fluids lost secondary to excessive diuresis, perspiration, inadequate intake, or insensible water losses are replaced by using crystalloids.
The nurse is teaching a patient about maintenance of fluid and electrolyte balance. Which patient statement indicates an understanding of the modifiable risk factor with the most direct effect on calcium balance?
A. “I need to manage my stress level to help keep a good calcium level.”
B. “I should maintain adequate fluid intake for better calcium balance.”
C. “I need to take my diuretic medication as directed to maintain the appropriate calcium level.”
D. “I should exercise to help me to maintain an appropriate calcium balance.”
D. “I should exercise to help me to maintain an appropriate calcium balance.” - Regular weight-bearing exercise helps maintain calcium balance. Stress, fluid intake, and diuretics can all affect fluid and electrolyte balance in a general way, but they do not specifically target calcium.
A nurse is unable to secure an intravenous access site due to severe dehydration.
Which prescription should the nurse expect to replace this patient’s fluid deficit?
A. “Administer fluids via hypodermoclysis.”
B. “Administer sodium supplements.”
C. “Administer oral fluid replacement.”
D. “Administer diuretics.”
A. “Administer fluids via hypodermoclysis.” - When IV access is problematic, fluids can be administered subcutaneously, using a method called hypodermoclysis. Diuretics are used to treat fluid volume excess, not dehydration. Oral fluid replacement is ordered for mild dehydration, not severe dehydration. Fluid replacement, not sodium supplements, would be anticipated. Fluids are replaced gradually, particularly in older adults, to prevent too-rapid rehydration of the cells. In general, fluid deficits are replaced at a rate of approximately 30–50% of the deficit per 24 hours.
A patient has a severe fluid deficit caused by hypovolemia. Which fluid should the nurse expect to be prescribed for this patient?
A. Colloid
B. Oral water
C. Ice chips
D. Crystalloid
D. Crystalloid - Fluids are replaced in an attempt to put back what is lost, so blood loss is replaced with blood transfusions, albumins, or other large-molecule protein solutions (colloids). Fluids lost secondary to excessive diuresis, perspiration, inadequate intake, or insensible water losses are replaced by using crystalloids.
The nurse is caring for a patient who exhibits manifestations of fluid volume overload. Which body mechanism should the nurse anticipate will be activated to assist in the regulation of body fluids?
A. Secretion of thyroxine from the thyroid gland
B. Suppression of norepinephrine from the adrenal gland
C. Suppression of antidiuretic hormone from the posterior pituitary gland
D. Secretion of growth hormone from the anterior pituitary gland
C. Suppression of antidiuretic hormone from the posterior pituitary gland - Antidiuretic hormone (ADH) regulates water excretion from the kidneys. With fluid volume overload, decreased blood osmolality leads to suppression of ADH, causing distal tubules to become less permeable to water. This leads to decreased reabsorption of water into blood and an increase in urine output as serum osmolality returns to normal.
A nurse is assessing a patient with fluid volume overload. Which mechanism should the nurse understand assists in the regulation of body fluids?
A. Release of cortisol from the adrenal gland
B. Renin-angiotensin-aldosterone pathway
C. Suppression of epinephrine from the adrenal gland
D. Erythropoietin release from the kidney
B. Renin-angiotensin-aldosterone pathway - The renin-angiotensin-aldosterone pathway is one of the mechanisms used to maintain fluid balance in the body. Cortisol and epinephrine are stress hormones that are not related to the maintenance of body fluids. Erythropoiesis is the process to stimulate red blood cell production. This process would be stimulated to increase oxygenation but not to maintain the balance of body fluids.
The nurse is providing discharge instructions to a patient with fluid volume excess who is prescribed furosemide. Which patient statement should the nurse identify as indicative of a need for additional instruction?
A. “I will weigh myself weekly and notify my healthcare provider if I gain more than 1 pound.”
B. “I will eat a banana every day.”
C. “I will wear shoes that fit well and will not walk barefoot.”
D. “It is important to change positions frequently.”
A. “I will weigh myself weekly and notify my healthcare provider if I gain more than 1 pound.” - Daily, not weekly, weight is important after discharge to monitor for fluid volume excess. Eating foods rich in potassium, wearing shoes that fit well and not walking barefoot, and changing positions frequently are all responses that indicate understanding of the discharge instructions provided by the nurse.
The nurse is teaching a patient about oral fluid volume replacement.
Which fluid should the patient be advised to avoid?
A. Water
B. Milk
C. Juice
D. Coffee
D. Coffee - Coffee contains caffeine, which exerts a diuretic effect. Water, milk, and juice are acceptable forms of oral fluid replacement and will not exert a diuretic effect.
The nurse is performing an assessment on a patient who has had nothing by mouth since the previous evening.
Which manifestation related to the patient’s fluid restriction should be of concern to the nurse?
A. Edema
B. Increased blood pressure
C. Dry mucous membranes
D. Bounding pulse
C. Dry mucous membranes - Oral fluid restriction can cause dehydration. The nurse should monitor for manifestations of dehydration such as dry mucous membranes, increased hematocrit, and tenting skin. Edema, increased blood pressure, and bounding pulse are manifestations of fluid volume excess, not deficit.
The nurse prepares to assess patients arriving at the clinic for routine prenatal care. Which factor should the nurse identify that contributes to fluid and electrolyte imbalances in pregnant patients?
A. Decreased thirst mechanism
B. Increased vascular volume
C. Hyperemesis gravidarum
D. Decreased kidney function
C. Hyperemesis gravidarum - Hyperemesis gravidarum can cause fluid and electrolyte imbalances. It is a disorder that involves an extreme amount of vomiting during pregnancy. Increased intravascular volume is expected during pregnancy. Decreased kidney function and decreased thirst mechanism are not causes of fluid imbalance in pregnant women.
A patient with fluid volume excess has hypokalemia. Which collaborative therapy should the nurse expect to implement for this patient?
A. Oral fluid solution
B. Heparin
C. Isotonic electrolyte solution
D. Diuretic
D. Diuretic - Diuretics are used to remove excess fluid. A specific diuretic that does not remove potassium will be prescribed. Oral fluids, isotonic electrolyte solutions, and heparin are not appropriate for this patient’s health problem.
The nurse is teaching older adult patients how to prevent fluid volume deficit. Which information should the nurse include?
A. “Avoid extreme temperatures.”
B. “Decrease fluid intake.”
C. “Increase sodium in the diet.”
D. “Take diuretics daily.”
A. “Avoid extreme temperatures.” - Exposure to extreme temperatures such as heat can cause the patient to sweat and experience insensible fluid loss. Decreasing the amount of fluid intake and taking diuretics will cause fluid loss. Increasing sodium in the diet will cause fluid volume excess.
A patient is prescribed daily weights. Which information should the nurse recall as the purpose of daily weights to evaluate fluid balance?
A. Though blood pressure is always a better indicator of fluid imbalance, daily weight is a good adjunct measure.
B. A gain or loss of 5–8% of body weight can represent fluid imbalance.
C. Daily weights are only required for patients taking cardiac medications.
D. Daily weights will not reflect fluid imbalance unless greater than 20% of body weight is affected.
B. A gain or loss of 5–8% of body weight can represent fluid imbalance. - A change in weight of 5–8% (gain or loss) can represent fluid imbalance. A change in body weight greater than 20% would be problematic and more serious than fluid imbalance. Blood pressure can represent alterations in fluid imbalance, but it is not always the best indicator of changes in fluid status. Daily weights are required in many patients, regardless of the medications taken.
A patient’s urine specific gravity is elevated at 1.045. Which explanation should the nurse identify as the reason for this value?
A. The concentration of the solute in the urine is increased and could indicate fluid volume excess.
B. The concentration of the solute in the urine is decreased and could indicate fluid volume excess.
C. The concentration of solute in the urine is elevated and could indicate fluid volume deficit.
D. The concentration of the solute in the urine is decreased and could indicate fluid volume deficit.
D. The concentration of the solute in the urine is decreased and could indicate fluid volume deficit. - Specific gravity is an indicator of urine concentration that can be performed quickly and easily by nursing personnel. Normal specific gravity ranges from 1.005 to 1.030 (usually 1.015–1.024). When the concentration of solutes in the urine is high, the specific gravity rises; in very dilute urine with few solutes, it is abnormally low.
The nurse recalls that sodium and potassium are major electrolyte components in the intracellular and extracellular fluid. Which function should the nurse identify that these electrolytes share?
A. Transmitting electrical impulses and muscle contraction
B. Forming bones and teeth
C. Regulating acid–base balance
D. Maintaining blood volume
A. Transmitting electrical impulses and muscle contraction - Sodium and potassium are involved in the transmission of electrical impulses and muscle contraction. Calcium and phosphate are involved in the formation of bones and teeth. Potassium, along with chloride and bicarbonate, is involved in regulating acid–base balances, but sodium is not. Sodium, along with chloride, maintains blood volume, but potassium does not.
A patient is experiencing signs of a decrease in extravascular volume.
Which should the nurse expect the patient to experience in response to this drop in volume?
A. Increasing kidney function
B. Decreasing secretion of insulin
C. Stimulation of the thirst center
D. Stimulation of thyroid function
C. Stimulation of the thirst center - In order to temporarily respond to decreased extracellular volume, the hypothalamus will be stimulated to initiate thirst. Increasing kidney function would cause more fluid volume loss. Decreased secretion of insulin and stimulation of thyroid function would not decrease extracellular fluid volume.
The nurse is documenting a patient’s fluid output. Which fluid should the nurse include in this calculation?
A. Liquid feces
B. Parenteral fluids
C. Irrigants
D. Tube feeding
A. Liquid feces - Liquid feces is considered output. Parenteral fluids, irrigants, and tube feedings are considered input.
A patient with severe heat exhaustion asks what type of fluid is in the intravenous infusion. Which response should the nurse provide?
A. “I’m giving you a solution that has proteins in it. It will help replace the fluid you lost.”
B. “I’m giving you a solution that is a lot like the fluid outside your cells. It will replace the fluid you lost.”
C. “I’m giving you a solution that is a lot like your blood. It will replace the fluid you lost.”
D. “I’m giving you a solution with a drug that will keep you from losing water.”
B. “I’m giving you a solution that is a lot like the fluid outside your cells. It will replace the fluid you lost.” - Crystalloid solutions are given intravenously to patients like this who have lost fluids from excessive sweating, inadequate intake, or insensible water loss. Crystalloid solutions mimic the body’s extracellular fluid and replace lost fluids. Colloid solutions resemble blood more closely, because they contain proteins and other large molecules, and are given in cases of excessive blood loss. Crystalloid solutions do not contain a drug that causes a person to retain water.
The nurse is reviewing laboratory values for a patient with hyperthyroidism. Which component of the urinalysis should the nurse use to help determine the patient’s fluid status?
A. Nitrites
B. Glucose
C. Urine specific gravity
D. Ketones
C. Urine specific gravity - Specific gravity is an indicator of urine concentration that can be performed quickly and easily by nursing personnel. Normal specific gravity ranges from 1.005 to 1.030 (usually 1.015–1.024). When the concentration of solutes in the urine is high, the specific gravity rises. In very dilute urine with few solutes, it is abnormally low. Ketones are found in the urine when the body is breaking down fats to have an alternate form of energy. Nitrites found in the urine are usually related to an infection. Glucose found in the urine can indicate elevated blood sugar.
The nurse is teaching a patient taking a loop diuretic about prevention of fluid volume excess. Which should the nurse include in this teaching session?
A. “You should perform daily weights.”
B. “You will need to increase the dose of the medication.”
C. “You can eat a banana each day.”
D. “You should decrease fluid intake.”
A. “You should perform daily weights.” - Daily weights are the best indicator of fluid imbalance. The patient should not increase the amount of diuretic medication because that can cause fluid volume deficit. Bananas provide a source of potassium for the patient and bear no impact on fluid balance. Decreasing fluid intake could promote a fluid volume deficit and would be incorrect advice.
The nurse is reviewing the medication record of a patient admitted with dehydration. Which medication type should cause the nurse concern?
A. Nonsteroidal anti-inflammatory drug
B. Antibiotic
C. Antipsychotic
D. Selective serotonin reuptake inhibitor
C. Antipsychotic - Patients with dehydration are likely to develop electrolyte imbalances as the body attempts to compensate for the lost fluid. Individuals taking antipsychotic agents are often at risk for alterations in fluid intake due to the effect on thirst mechanisms. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics are not associated with fluid or electrolyte imbalances and do not affect fluid balance.
A patient had the following during the previous shift: emesis 75 mL, urine output 725 mL, water 240 mL, IV fluids 650 mL, and IV medication 100 mL. Which intake and output values should the nurse document for this patient?
A. Intake 950 mL, output 840 mL
B. Intake 940 mL, output 850 mL
C. Intake 890 mL, output 900 mL
D. Intake 990 mL, output 800 mL
D. Intake 990 mL, output 800 mL - Output consists of urine and emesis and this totals 800 mL for this patient. IV fluids, IV medication, and water are counted as intake and this totals 990 mL for this patient. Accurate intake and output is important to determine if the amount of intake is proportional to the amount of output, because this is objective and can be measured. This must be considered when looking at insensible fluid losses, as well.
The nurse is assessing a patient with a fluid volume deficit. Which finding should the nurse expect in this patient?
A. BP 92/56 mmHg, P 134 beats/min, R 22 breaths/min
B. BP 124/63 mmHg, P 56 beats/min, R 16 breaths/min
C. BP 90/54 mmHg, P 68 beats/min, R 18 breaths/min
D. BP 155/100 mmHg, P 144 beats/min, R 24 breaths/min
A. BP 92/56 mmHg, P 134 beats/min, R 22 breaths/min - When a patient experiences a deficiency in fluid volume, the body’s vital signs will try to compensate for the decreased volume to maintain perfusion. Typical changes that are seen with fluid volume deficit include decreased blood pressure, increased heart rate, and increased respiration, along with decreased urine output. Vital signs of BP 92/56 mmHg, P 134 beats/min, and R 22 breaths/min would be consistent with these typical changes.
The nurse prepares an educational program for colleagues about intracellular and extracellular fluid compartments. Which solutes or electrolytes that are predominantly found within the intracellular and extracellular fluids, should the nurse explain help with transmitting nerve impulses and contracting muscles?
A. Chloride and phosphate
B. Sodium and potassium
C. Calcium and bicarbonate
D. Albumin and magnesium
B. Sodium and potassium - Sodium and potassium are found in both intracellular and extracellular fluid and are involved in transmitting nerve impulses and contracting muscles. Albumin is a protein found in cellular fluid but plays no role in transmitting nerve impulses or contracting muscles. Magnesium is involved with relaxing muscle contractions. Calcium and phosphate are involved in teeth and bone formation. Phosphate is involved with nerve function but does not transmit nerve impulses. Chloride and bicarbonate are involved with acid–base balance.
