Electrolyte Mysteries
A patient recently started a thiazide diuretic for hypertension. Today they report muscle cramps and weakness. You note a flattened T wave on their ECG. What imbalance do you suspect?
What is hypokalemia
An 83-year-old client presents to the emergency department with noted poor skin turgor and a weak, thready pulse related to a new onset diagnosis of dehydration. What is the most important initial intervention for the nurse to perform at this time?
What is initiate isotonic IV fluids
Which client should the nurse see first?
A) Patient with mild weakness after starting a thiazide diuretic
B) Patient with new confusion after several days of vomiting
C) Patient with tingling lips after thyroid surgery
Who is the client wiht new confusion after several days of vomiting
You client is being admitted for dehydration from vomiting and will need rapid volume replacement. Which order for IV fluid should the nurse anticipate?
What is 0.9% Normal Saline
You recently started IV fluids on your client as prescribed by your provider. Upon assessment of the client’s IV site, you notice the client has cool skin, swelling, and pallor at the IV site. Which complication related to infusion therapy has the client experienced?
What is infiltration
A marathon runner collapses after drinking large amounts of plain water during the race. They are confused, lethargic, and have a headache. What imbalance is most likely occurring?
What is hyponatremia?
A client with confusion and flushed skin has a history of limited water intake and high-sodium diet. What intervention is most appropriate for the nurse to implement at this time?
What is encourage oral fluid intake or administer hypotonic fluids as ordered
Which patient is the priority?
A) Edema and 2-lb weight gain in 24 hrs
B) Muscle weakness and peaked T waves
C) Dry mucous membranes after diarrhea
Who is the client with muscle weakness and peaked T waves
Intracellular dehydration related to hypernatremia is best treated with which type of IV fluid?
What is Hypotonic IV fluids. What are some appropriate examples? 0.45%, D5W
Your client is receiving a dose of IV antibiotic and calls to the nurse’s station because they feel their IV site does not look right. Upon assessing the client’s IV site, you notice red streaking and tenderness along vein. Which complication related to infusion therapy has the client likely experienced?
What is phlebitis
A 75-year-old male with advanced kidney disease reports feeling weak and notices occasional skipped heartbeats. You observe tall, peaked T waves on their ECG this morning. Which imbalance is the client likely experiencing?
What is hyperkalemia?
A 62-year-old client with leg cramps and K+ suspected to be low is on a loop diuretic. Which intervention takes priority?
What is place the client on cardiac monitoring
The nurse is caring for a client with stage III heart failure and notices crackles in the all right-sided lung fields. The client is also having difficulty breathing and growing anxious. What will be the nurse’s priority at this time?
What is elevate the head of bed and apply supplemental oxygen
A client diagnosed with cerebral edema should not be prescribed which type of IV fluid?
What is hypotonic IV fluids. (E.g., 0.45% NaCl, D5W, etc).
Your client develops sudden shortness of breath (SOB) and crackles after initiation of a rapid IV infusion. Which complication should the nurse suspect the client is experiencing?
What is fluid overload, fluid volume excess
A patient with chronic alcohol use disorder reports tremors, leg cramps, and hyperactive deep tendon reflexes. A positive Chvostek sign is present. Which imbalance fits these clinical manifestations?
What is hypomagnesemia?
A client presents with tremors, tetany, and a positive Trousseau sign is found to have low calcium. Which nursing intervention is most urgent?
What is initiate seizure precautions
Your client is receiving potassium chloride via IV and reports burning at the insertion site. Which of the following should the nurse perform first?
1. Call provider
2. Stop the IV
3. Assess the site
What is stop the infusion
Which type of IV fluid expands vascular volume by staying in the intravascular space?
What are Colloidal solutions (e.g., albumin, dextran, etc.)
You were given report by the off going nurse that the client is receiving vancomycin for treatment of a severe infection. Upon assessing your IV you notice infiltration of the IV. The nurse should anticipate which other complication because of this infiltration?
What is extravasation
A 73 year old female client has sustained multiple fractures from metastatic bone cancer this year. Today, she reports fatigue, constipation, and confusion over the past week. Which imbalance do you suspect?
What is hypercalcemia?
A 31 year-old client developed bradycardia, hypotension, and diminished deep tendon reflexes after receiving magnesium sulfate for preeclampsia. What is the nurse's immediate action?
What is stopping the infusion and notify the provider
A client's BP tumbles to 80/50 after an acute hemorrhage. Which action should the nurse do next?
What is administer a bolus of isotonic fluids
A trauma client is brought into the emergency department after being involved in a multi-vehicle accident and is in hypovolemic shock, they are hypoxic and swiftly need something that expand volume as well as improve oxygen needs. What should the nurse anticipate the provider ordering immediately?
What is Packed Red Blood Cells (PRBCs)
You are a nurse in the Cardiothoracic ICU training a new graduate nurse on the unit. You are providing education to your orientee regarding potential complications of Intravenous Access Devices (IVADs) such as central lines. What are some potential complications a client could experience either during insertion or while receiving therapy via the line?
What are :
Air emboli
Thrombotic emboli
Arrhythmias
Systemic infection
Pneumothorax