Fluid and Electrolyte

1

100

A client is hospitalized with a diagnosis of chronic glomerulonephritis. The client mentions that she likes salty foods. The nurse should warn her to avoid foods containing sodium because: A. reducing sodium promotes urea nitrogen excretion B. reducing sodium improves her glomerular filtration rate C. reducing sodium increases potassium absorption D. reducing sodium decreases edema

D reducing sodium intake reduces fluid retention. Fluid retention increases blood volume, which changes blood vessel permeability and allows plasma to move into interstitial tissue, causing dema. Urea nitrogen excretion can be increased only by improved renal function. Sodium intake doesn’t affect the glomerular filtration rate. Potassium absorption is improved only by increasing the glomerular filtration rate; it isn’t affected by sodium intake.

200

When caring for a client with esophageal varices, the nurse knows that bleeding in this disorder usually stems from: A. esophageal perforation B. pulmonary hypertension C. portal hypertension D. peptic ulcers

C Increased pressure within the portal veins causes them to bulge, leading to rupture and bleeding into the lower esophagus. Bleeding associated with esophageal varices doesn’t stem from esophageal perforation, pulmonary hypertension, or peptic ulcers.

300

The nurse knows that the most abundant cation in the blood is __________.

Sodium

400

A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low intermittent suction for the past 3 days. The patient's respiratory rate has decreased to 12 breaths per minute. The nurse would expect the patient to have which of the following arterial blood gas values?

a.pH 7.78,PaCO2 40 mmHG, HCO2 30 mEq/L b.pH 7.52 PaCO2 48 mmHG. HCO3 28 mEq/L c.pH 7.35, PaCO2 35 mmHg,HCO3 26 mEq/L d.pH 7.35 ,PaCO2 35 mmHg,HCO3 26 mEq/L

2

100

The nurse is assessing a post craniotomy client and finds the urine output from a catheter is 1500 ml for the 1st hour and the same for the2nd hour. The nurse should suspect: a. Cushing’s syndrome b. Diabetes mellitus c. Adrenal crisis d. Diabetes insipid us

: D Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery. Cushing’s syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. Diabetes mellitus is a hyperglycemic state marked by polyuria, polydipsia, and polyphagia. Adrenal crisis is under secretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.

200

A client is hospitalized with a diagnosis of chronic renal failure. An arteriovenous fistula was created in his left arm for hemodialysis. When preparing the client for discharge, the nurse should reinforce which dietary instruction? A. “Be sure to eat meat at every meal. B. “Monitor your fruit intake and eat plenty of bananas C. “Restrict your salt intake. D. “Drink plenty of fluids.”

C In a client with chronic renal failure, unrestricted intake of sodium, protein, potassium, and fluids may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit his intake of sodium, meat (high in Protein), bananas (high in potassium), and fluid because the kidneys can’t secret adequate urine.

300

The nurse receives the patient's most recent blood work results. Which laboratory value is of greatest concern? A. sodium145 meq/L B. calcium 17.5 mg/L C. potassium 3.5 meq/L D. Chloride100 meq/L

ANS: Ca 17.5 mg/L is high

3

100

A client with a serum glucose level of 618mg/dl is admitted to the facility. He’s awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6º F (38.1º C),heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes the highest priority? a. deficient fluid volume related to osmotic diuresis b. decreased cardiac output related to elevated heart rate c. imbalanced nutrition: Less than body requirements related to insulin deficiency d. ineffective thermoregulation related to dehydration

A. A serum glucose level of 618 mg/dl indicates hyperglycemia, which causes polyuria and deficient fluid volume. In this client, tachycardia is more likely to result from deficient fluid volume than from decreased cardiac output because his blood pressure is normal. Although the client’s serum glucose is elevated, food isn’t a priority because fluids and insulin should be administered to lower the serum glucose level. Therefore, a diagnosis of Imbalanced Nutrition: Less then body requirements isn’t appropriate. A temperature of 100.6º F isn’t life threatening, eliminating ineffective thermoregulation as the top priority.

200

A client is chronically short of breath and yet has normal lung ventilation, clear lungs, and an arterial oxygen saturation (SaO2) 96% or better. The client most likely has: A. poor peripheral perfusion B. a possible Hematologic problem C. a psychosomatic disorder D. left-sided heart failure

B SaO2 is the degree to which hemoglobin is saturated with oxygen. It doesn’t indicate the client’s overall Hgb adequacy. Thus, an individual with a subnormal Hgb level could have normal SaO2 and still be short of breath. In this case, the nurse could assume that the client has a Hematologic problem. Poor peripheral perfusion would cause subnormal SaO2. There isn’t enough data to assume that the client’s problem is psychosomatic. If the problem were left-sided heart failure, the client would exhibit

300

The nurse would expect a patient with increased levels of serum calcium to also have ___________.

ANS: phosphate

4

100

Before weaning a client from a ventilator, which assessment parameter is most important for the nurse to review? A. fluid intake for the last 24 hours B. baseline arterial blood gas (ABG) levels C. prior outcomes of weaning D. electrocardiogram (ECG) results

B Before weaning a client from mechanical ventilation, it’s most important to have a baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client’s record, and the nurse can refer to them before the weaning process begins

200

The nurse understands that administering a hypertonic solution to a patient will shift water from the ____________ to the _____________ space

Intracellular, extracellular

300

A 2-year-old child was brought into the emergency department after ingesting several morphine tablets from a bottle in his mother's purse. The nurse knows that the child is at greatest risk for which acid-base imbalance?

ANS: respiratory acidosis