Fluid Balance and IV Fluids
A nurse is caring for a patient with decreased urine output. Which hormone is responsible for increasing water reabsorption by the kidneys?
What is Antidiuretic hormone (ADH)?
A patient has experienced vomiting and diarrhea for two days. Which assessment finding is consistent with dehydration?
A. Bradycardia
B. Increased urine output
C. Dry mucous membranes
D. Hypertension
C — Dry mucous membranes
Vomiting and diarrhea cause fluid loss and can lead to dehydration. Common assessment findings include dry mucous membranes, thirst, tachycardia, hypotension, dizziness, and decreased urinary output.
A patient's serum sodium level is 130 mEq/L. Which electrolyte imbalance does this indicate?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia
B — Hyponatremia
The lecture identifies the normal sodium range as 136–145 mEq/L. A sodium level of 130 mEq/L indicates hyponatremia. Low sodium levels can affect neurologic functioning.
A patient reports numbness, tingling, and muscle twitching. Which electrolyte imbalance should the nurse suspect?
A. Hypercalcemia
B. Hypocalcemia
C. Hypernatremia
D. Hyperkalemia
B — Hypocalcemia
Hypocalcemia increases neuromuscular excitability. Clinical manifestations include numbness, tingling, muscle twitching, spasms, and tetany.
Which arterial blood pH value is within the normal range?
A. 7.20
B. 7.30
C. 7.40
D. 7.55
C — 7.40
The normal arterial blood pH range is 7.35–7.45. A pH of 7.40 falls within this range. Values below 7.35 indicate acidemia, while values above 7.45 indicate alkalemia.
A nurse is calculating a patient's 24-hour intake. Which item should be included in the total fluid intake?
A. Urine Output
B. Wound Drainage
C. IV Fluids
D. Gastric Suction
What are intravenous fluids?
A patient with dehydration reports dizziness when standing. Which nursing instruction is most appropriate?
A. Stand up quickly to improve circulation
B. Avoid drinking fluids
C. Change positions slowly and request assistance
D. Walk independently despite dizziness
C — Change positions slowly and request assistance
Dehydration can decrease circulating blood volume, resulting in hypotension and dizziness. Changing positions slowly helps reduce the risk of falls and injury.
A nurse is assessing a patient with hyponatremia. Which finding should the nurse expect?
A. Increased alertness
B. Severe thirst as the defining symptom
C. Confusion and lethargy
D. Increased deep tendon reflexes as the defining finding
C — Confusion and lethargy
Hyponatremia can cause neurologic changes, including headache, confusion, and lethargy. These manifestations occur because altered sodium concentrations affect fluid movement and cellular functioning in the central nervous system.
A patient with alcohol use disorder and malnutrition develops hyperactive deep tendon reflexes. Which imbalance should the nurse suspect?
A. Hypermagnesemia
B. Hypomagnesemia
C. Hypernatremia
D. Hypercalcemia
B — Hypomagnesemia
Hypomagnesemia may occur in patients with malnutrition or alcohol use disorder. Manifestations include increased neuromuscular excitability and hyperactive deep tendon reflexes.
A patient with a COPD exacerbation is retaining carbon dioxide. Which acid-base imbalance should the nurse anticipate?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
A — Respiratory acidosis
Respiratory acidosis occurs when the lungs cannot eliminate sufficient carbon dioxide. During a COPD exacerbation, impaired ventilation may cause carbon dioxide retention and increased acidity in the blood.
Which assessment is most useful for monitoring changes in a patient's overall fluid status?
A. Daily weight
B. Pupil response
C. Bowel sounds
D. Skin temperature alone
A — Daily weight
Daily weights are an important indicator of fluid status. Changes in body weight can reflect fluid gains or losses. Weights should be obtained consistently, preferably at the same time each day and using the same scale.
A patient with prolonged fever has tachycardia, hypotension, and decreased urine output. Which nursing intervention is most appropriate?
A. Restrict fluids without an order
B. Monitor vital signs and provide prescribed fluid replacement
C. Encourage strenuous activity
D. Delay reassessment until the next shift
B — Monitor vital signs and provide prescribed fluid replacement
Tachycardia, hypotension, and decreased urinary output suggest dehydration and potentially reduced tissue perfusion. Nursing interventions include monitoring vital signs, laboratory results, intake and output, and administering prescribed oral or IV fluids.
A patient has a serum potassium level of 6.2 mEq/L. Which ECG finding is commonly associated with this imbalance?
A. Peaked T waves
B. Normal ECG in every patient
C. ST elevation as the defining change
D. Flattened T waves as the characteristic finding
A — Peaked T waves
Hyperkalemia can cause characteristic ECG changes, including peaked T waves. Elevated potassium disrupts normal cardiac electrical activity and increases the risk of dangerous dysrhythmias.
A patient with kidney impairment who uses magnesium-containing laxatives develops lethargy, bradycardia, and decreased deep tendon reflexes. This magnesium imbalance is suspected.
What is hypermagnesemia?
A patient experiences prolonged vomiting and nasogastric suctioning. Which acid-base imbalance is most likely?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
D — Metabolic alkalosis
Prolonged vomiting and nasogastric suctioning cause loss of gastric acid. The loss of hydrogen ions increases the relative concentration of base, potentially producing metabolic alkalosis.
This type of IV solution causes water to move out of cells, resulting in cellular shrinkage.
What is a hypertonic solution, such as 3% sodium chloride?
A dehydrated patient may develop these two cardiovascular findings due to decreased circulating fluid volume.
What are tachycardia and hypotension?
A patient with kidney impairment develops hyperkalemia. Which complication is the nurse's greatest concern?
A. Constipation
B. Skin breakdown
C. Cardiac dysrhythmias
D. Urinary incontinence
C — Cardiac dysrhythmias
The primary concern with hyperkalemia is its effect on the heart. Elevated potassium can interfere with electrical conduction and lead to life-threatening dysrhythmias or cardiac arrest.
A patient with prolonged immobility develops weakness, lethargy, and decreased deep tendon reflexes. This calcium imbalance may be present.
What is hypercalcemia?
Prolonged immobility can contribute to hypercalcemia. The lecture also identifies renal failure, bone cancer, and thyroid disorders as associated conditions.
A patient experiencing a panic attack begins hyperventilating. Which acid-base imbalance is most likely?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
B — Respiratory alkalosis
Hyperventilation causes excessive carbon dioxide elimination through the lungs. This decreases carbon dioxide levels and increases blood pH, resulting in respiratory alkalosis.
A nurse is reviewing how hypotonic IV solutions affect body cells. Which response is expected?
A. Cells shrinkB. Cells remain completely unchangedC. Cells swellD. Cells immediately rupture in every case
C — Cells swell
Hypotonic IV solutions have a lower effective concentration of solutes than the intracellular compartment. Water moves into cells through osmosis, causing them to swell.
This term describes decreased urinary output, which may occur in dehydration.
What is oliguria?
A nurse reviews laboratory results for four patients. Which result requires the most urgent follow-up?
A. Sodium 140 mEq/LB. Potassium 4.0 mEq/LC. Potassium 6.8 mEq/LD. Sodium 138 mEq/L
C — Potassium 6.8 mEq/L
A potassium level of 6.8 mEq/L indicates severe hyperkalemia. Because this imbalance can cause fatal cardiac dysrhythmias, it requires urgent assessment and intervention.
The nurse inflates a blood pressure cuff and observes carpal spasm. This is the name of the positive assessment finding.
What is Trousseau's sign?
Trousseau's sign is demonstrated when sustained inflation of a blood pressure cuff produces carpal spasm. This finding is associated with hypocalcemia and increased neuromuscular excitability.
Which IV solution is classified as isotonic?
A. 0.45% sodium chloride
B. 3% sodium chloride
C. 0.9% sodium chloride
D. 0.22% sodium chloride
C — 0.9% sodium chloride
Normal saline (0.9% sodium chloride) is an isotonic solution. Isotonic solutions primarily expand extracellular fluid volume without causing major fluid shifts into or out of cells.