Fluids and Electrolytes

Carlo S. Payabyab, R.N.

1. Nurse Raffa is reading a physician's progress notes in the client's record and reads that the physician has documented "insensible fluid loss of approximately 800 mL daily." Nurse Raffa understands that this type of fluid loss can occur through: 1. the skin 2. urinary output 3. wound drainage 4. the gastrointestinal tract

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skin - Sensible losses are those of which the person is aware such as through wound drainage, GIT losses and urination. Insensible losses may occur without the person's awareness. Options 2,3, and 4 can all be measured accurately. fluid loss through the skin cannot be measured accurately, only approximately.

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Nurse Melvin is assigned to care for a group of clients' medical records. Nurse Melvin determines that which of the client is at risk for deficient fluid volume? 1. a client with congestive heart failure. 2. a client with decreased kidney function 3. a client with colostomy 4. a client receiving wound irrigations.

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a client with colostomy - Among the causes of fluid volume deficit are vomiting, diarrhea, conditions that increase respiration or increased urinary output, insufficient IV replacement, and presence of ileostomy or colostomy. Choices 1,2 and 4 can all lead to fluid volume excess.

3. Nurse Bon is caring for a client with congestive heart failure. On assessment, nurse Bon notes that the client is dyspneic and that crackles are audible upon auscultation. Nurse Bon suspects excess fluid volume. What additional signs would nurse Bon expect to note in this client if excess fluid volume is present? 1. Flat neck and hand veins 2. Weight loss 3. An increase in blood pressure 4. A decrease in Central venous pressure

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3. An increase in blood pressure - assessment findings associated with fluid volume excess include cough, dsypneam crackles, tachypnea, tachycardia, an elevated blood pressure and a bounding pulse, elevated CVP, weight gain, edema, neck and hand distention, altered level of consciousness and decreased hematocrit level. Options 1,2 and 4 are all associated with fluid volume deficit.

4. Nurse Angel is preparing to care for a client with potassium deficit. He reviews the client's records and determines that the client was at risk for developing potassium deficit because the client: 1. Is taking a Aldactone 2.Has history of Addisson's disesae 3. Requires nasogastric suction 4. has renal failure

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Requires nasogastric suctionPotassium-rich gstrointestinal fluids are lost though GI suction, placing the client at risk of Hypokalemia. the client with renal failure or Addison's disease and the client taking aldactone are all at risk of hyperkalemia and not of hypokalemia.

5. Nurse Donnie reviews a client's laboratory report and notes that the potassium level is 3.2 mEq/L. Which of the following would the nurse note on the electrocardiogram as a result of the laboratory value? 1. prolonged St or Qt interval 2. Widened T wave 3. Presence of U waves 4. Shortened ST segment

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3. Presence of U waves - a serum potassium level of less than 3.5 mEq/L indicates hypokalemia. Electrocardiographic changes for hypokalemia include inverted T waves, ST segment depression and prominet U wave. Presence of prolonged ST or QT interval indicates hypocalcemia while presence of widened t wave and shortened st segment indicate hypercalcemia.

6. Nurse Joseph needs to administer potassium chloride intravenously as prescribed to a client with hypokalemia. the nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for the preparation and administration of the potassium? 1. Diluting in appropriate amount of Normal Saline 2. Monitoring urine output during administration 3. Preparing the medication for bolus administration 4. Obtaining a controlled IV infusion pump

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3. Preparing the medication for bolus administration - potassium chloride administered intravenously should always be diluted in IV fluid and infused via a pump or controller. The usual concentration of IV potassium chloride is 20 to 40 mEq/L. Potassium chloride given by IV push/bolus should never be done for it can result into sudden cardiac arrest. Dilution in normal saline is recommended but never with dextrose for this type of solution increases intracellular potassium shifting. the nurse should always monitor urine output during administration. Urine output less than 30ml/hr should be notified to the physician for this may indicate renal impairment.

7. Nurse Dennis reviews the electrolyte results of an assigned client and notes that the potassium level is 5.4 mEq/L. which of the following would the nurse expect to note on the electrocardiogram as a result of the laboratory value? 1. ST depression 2. Prominent U wave 3. Inverted T wave 4. Tall peaked T waves

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Tall peaked T waves - A serum potassium

level greater than 5.1 mEq/L indicates hyperkalemia. Electrocardiographic changes include flat P waves, prolonged PR intervals, widened QRS complexes and tall peaked T waves. Choices 1,2 and 3 all inidcate electrocardiographic changes for a patient with hypokalemia.

8. Nurse Adrian is caring for a client with acute congestive heart failure who is receiving high doses of diuretic on assessment, he notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in this client if hyponatremia were present?
1. Decreased Urinary output 2. Increased specific gravity 3. Hyperactive bowel sounds 4. Dry skin

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3. Hyperactive bowel sounds - the patient is suffering from diluted hyponatremia. options 1,2 and4 are all signs for hypernatremia.

9. A nurse is reviewing client's laboratory report and notes that the serum calcium is 4.0 mg/dL. The nurse understands that which condition most likely caused this serum calcium

1. Renal insufficiency 2. Hyperparathyroidism 3. Prolonged bed rest 4. excessive ingestion of vitamin D

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3. Prolonged bed rest - the normal serum calcium level is 8.6 - 10.0 mg/dl. A client with serum calcium level of 4.0 mg/dl is experiencing hypocalcemia. Hyperparathyroisdism and excessive ingestion of vitamin d can lead to hypercalcemia. Endstage Renal disease, not renal insufficiency, can lead to hypocalcemia. Prolonged bed rest can lead to hypocalcemia. although immobilization can initially lead to hypercalcemia, the long term effect of bed rest is hypocalcemia

10. A nurse reviews a client's laboratory report and notes that the client's serum phosporus level is 2.0 mg/dl. Which condition most likely caused the serum phosporus level?

1. Renal insuiciency 2. Alcoholism 3. Tumor Lysis Syndrome 4. Hypoparathyroism

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Alcoholism the normal phosphorus level is 2.7 to 4.5 mg/dl. the patient is experiencing hypophosphatemia. options 1,3,4 can all lead to hyperphospathemia while alcoholism is greatly associated with malnutrit

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