Where Did the Fluid Go?!
Which patient requires immediate intervention?
A) Mild dehydration
B) Peripheral edema
C) Fluid overload with confusion
D) Dry mucous membranes
What is C: fluid overload with confusion?
Rationale:
Neuro changes = severe imbalance affecting brain
A patient with hypovolemia is prescribed Lactated Ringer’s. What is the expected effect?
What is increased intravascular volume?
Rationale:
Isotonic fluids expand circulating volume.
A patient with hyperkalemia is at highest risk for what complication?
What is cardiac arrest?
Rationale:
Hyperkalemia disrupts cardiac conduction.
Which lab values indicate fluid volume deficit?
A) Low Hgb/Hct
B) High Hgb/Hct
C) Low sodium
D) Low potassium
Answer:
What is B: high Hgb and Hct?
Rationale:
Fluid loss concentrates blood components.
What is the purpose of a type and crossmatch?
Answer:
What is to ensure compatibility?
Rationale:
Prevents transfusion reactions.
A patient with vomiting and diarrhea presents with tachycardia and decreased urine output. What is the priority nursing diagnosis?
What is fluid volume deficit?
Rationale:
Fluid loss → decreased circulating volume → poor perfusion (tachycardia, low urine output).
Which IV fluid situation is most dangerous?
A) NS in dehydration
B) D5W in hypernatremia
C) 0.45% NS in head injury
D) LR in hypovolemia
What is C: 0.45% NS in head injury?
Rationale:
Hypotonic fluid → increases brain swelling → ↑ ICP.
A patient with hypocalcemia develops facial twitching when tapped. What is this sign?
What is Chvostek’s sign?
Rationale:
Low calcium → increased neuromuscular excitability.
A dehydrated patient has elevated hemoglobin and hematocrit. What is the cause?
What is hemoconcentration?
Rationale:
Less plasma → more concentrated blood.
A patient develops chills and back pain during transfusion. What is the FIRST action?
What is stop the transfusion?
Rationale:
Prevents further reaction.
A patient with heart failure develops pulmonary edema and crackles. What pathophysiologic problem is occurring?
What is impaired gas exchange due to fluid volume excess?
Rationale:
Fluid backs up into lungs → impaired oxygen exchange.
A patient receives 3% saline. What is its primary action?
What is pulling fluid out of cells into the bloodstream?
Rationale:
Hypertonic → shrinks cells → protects brain in severe hyponatremia.
A patient is receiving a loop diuretic. What electrolyte imbalance is expected?
What is hypokalemia?
Rationale:
Loop diuretics waste potassium.
A patient has sodium of 128 and confusion. What is the priority concern?
What is risk for seizures?
Rationale:
Sodium affects brain → seizure risk.
Which situation is most unsafe?
A) NS with blood
B) Two-nurse check
C) D5W with blood
D) Monitoring vitals
What is C: D5W with blood?
Rationale:
Only NS is compatible with blood.
A patient with severe burns develops third spacing and has edema, hypotension, and decreased urine output. Which intervention does the nurse anticipate as the priority?
What is administering isotonic IV fluids (e.g., normal saline or Lactated Ringer’s)?
Third spacing causes fluid to shift out of the vascular space → decreased intravascular volume and poor perfusion. The priority is restoring circulating volume with isotonic fluids to maintain blood pressure and organ perfusion.
A patient receiving IV fluids develops bounding pulses and hypertension. What is the priority action?
What is slow or stop the IV infusion?
Rationale:
Signs of fluid overload → stop worsening condition.
A patient presents with muscle weakness and dysrhythmias. Which electrolyte imbalance is most likely?
What is potassium imbalance?
Rationale:
Potassium controls cardiac rhythm + muscle function.
A patient has potassium of 6.2. What ECG change is expected?
What is peaked T waves?
Rationale:
Classic hyperkalemia ECG finding.
A patient is B negative. Which blood types can they receive?
Answer:
What are B- and O-?
Rationale:
Must match ABO and Rh.
A patient with fluid overload has stable vitals. Which new finding indicates the condition is worsening?
What is new crackles or decreased oxygen saturation?
Rationale:
Lung involvement = progression → higher risk.
A patient with a head injury is prescribed IV fluids. Which order should the nurse question?
What is 0.45% NS (hypotonic fluid)?
Rationale:
Worsens cerebral edema.
Which patient is highest priority?
A) Mg 1.9
B) Ca 8.4
C) K 6.0
D) Na 136
What is C: K 6.0 ?
Rationale:
Life-threatening arrhythmia risk.
A patient has albumin of 2.8. What clinical finding is expected?
What is edema?
Rationale:
Low oncotic pressure → fluid leaks into tissues.
A patient needs increased oxygen-carrying capacity. Which blood product is indicated?
What are packed red blood cells (PRBCs)?
Rationale:
PRBCs increase oxygen delivery.