Lilley Chapter 30: Fluids and Electrolytes Flashcards
The nurse is caring for a patient who has peripheral edema and is hypotensive after having received 5 000 mL of normal saline intravenously. The nurse anticipates administering which intravenous (IV) solution to correct the fluid imbalance?
A. Lactated Ringer’s solution
B. 3% saline solution
C. D5W
D. Hetastarch
D. Hetastarch
The patient needs to increase intravascular fluid volume. Hetastarch (an iso-oncotic solution) will enable this because it is a colloid that will increase osmotic pull from the extravascular spaces to the intravascular space. A 3% saline solution is also hypertonic, but its use is not preferred secondary to risk of hypernatremia. D5W and Lactated Ringer’s solution are an isotonic solutions.
When caring for a patient with a serum potassium of 2.8 mmol/L, what is the priority nursing intervention when the nurse is providing IV replacement therapy?
A. Applying ice packs to the site of IV administration.
B. Maintaining an infusion rate at no greater than 20 mmol/hr.
C. Teaching the patient the signs and symptoms of hypokalemia.
D. Administering potassium as a bolus over 10 minutes.
B. Maintaining an infusion rate at no greater than 20 mmol/hr.
Too rapid an infusion of potassium may cause cardiac arrest. Therefore, IV potassium infusion rates should not exceed 20 mmol/hr.
During the IV administration of a hypertonic saline solution to treat a patient with severe hyponatremia, the nurse monitors for which signs and symptoms of hypernatremia?
A. Flushed skin and increased thirst
B. Vomiting and diarrhea
C. Mental confusion and seizures
D. Lethargy and hypotension
A. Flushed skin and increased thirst
Hypertonic saline solutions administered to raise sodium levels may cause hypernatremia. Thus, very close monitoring for signs and symptoms of hypernatremia is needed. Flushed skin and increased thirst are signs and symptoms of hypernatremia. The other conditions listed are signs and symptoms of hyponatremia.
A patient receiving an IV infusion of 1 unit of packed red blood cells suddenly develops shortness of breath, chills, a hot feeling. The nurse’s priority action is to
A. maintain a patent IV line with normal saline.
B. notify the health care provider.
C. check the vital signs.
D. stop the blood transfusion.
D. stop the blood transfusion.
These are symptoms of a blood transfusion reaction. Thus, the nurse’s priority action is to immediately stop the blood transfusion.
The nurse is caring for a patient with renal insufficiency and thrombocytopenia. Along with platelet transfusions, the nurse would expect to administer which blood product to increase deficient clotting factors in this patient?
A. Whole blood
B. Albumin
C. Plasma protein factors
D. Fresh frozen plasma
D. Fresh frozen plasma
Fresh frozen plasma is indicated to increase clotting factors in patients with a known deficiency. Albumin and plasma protein factors do not contain clotting factors. Although whole blood does contain the same ingredients as fresh frozen plasma, the volume that must be administered to give the patient the necessary clotting factors may be contraindicated in a patient with renal insufficiency.
While assessing the patient, the nurse notes edema of the hands and feet at +3 from third spacing. The patient is having signs and symptoms of intravascular dehydration, and the total protein laboratory result is 46 g/L. The nurse anticipates that the health care provider will prescribe which IV solution for this patient?
A. Whole blood
B. Lactated Ringer’s solution
C. Normal saline
D. 5% albumin
D. 5% albumin
If the total protein level falls below 53 g/L, fluid shifts out of blood vessels into the tissues. When this happens, colloid replacement therapy is required to reverse this process by increasing the colloid oncotic pressure. The three preparations that are most commonly used are 5% albumin, dextran 40, and hetastarch. They all have a very rapid onset of action as well as a long duration of action.
While the nurse is providing care to a patient, the health care provider prescribes an IV potassium chloride infusion. The nurse should question the prescription for this IV fluid on the basis of the patient’s history of which condition?
A. Multiple sclerosis
B. Hypertension
C. Cirrhosis of the liver
D. Renal failure
D. Renal failure
Potassium replacement therapy is indicated in the treatment or prevention of potassium depletion in patients with severe renal disease, acute dehydration, untreated Addison’s disease, severe hemolytic disease, conditions involving extensive tissue breakdown (e.g., multiple trauma, severe burns), and hyperkalemia from any cause.
