Nursing Jeopardy

Fluid and Electrolyte Balance

100

A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. Laboratory values are as follows: Na + 147 mEq/L K + 3.0 mEq/L Cl - 112 mEq/L Mg ++ 2.3 mg/dL Ca ++ 1.5 mg/dL Which of the following is consistent with the client's findings? a. Hypernatremia b. Hyperchloremia c. Hypomagnesia d. Hypokalemia

Hypokalemia Potassium is the major intracellular electrolyte. Hypokalemia (below 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium deficiency can result in derangements in physiology. Clinical signs include fatigue, anorexia, nausea, vomiting, muscles weakness, leg cramps, decreased bowel motility, and paresthesias.

200

Which laboratory result does the nurse identify as a direct result of the client’s hypovolemic status with hemoconcentration? a. Low urine specific gravity b. elevated hematocrit level c. High white blood cell count d. Hyperkalemia

Elevated hematocrit level When hemoconcentration occurs due to a hypovolemic state, a high ratio of blood components in relation to watery plasma occurs, thus causing an elevated hematocrit level. A high white blood cell count and urine specific gravity is also noted. Other causes of an abnormal potassium level may be present.

300

A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? a. Metabolic Acidosis b. Respiratory Alkalosis c. Metabolic Alkalosis d. Respiratory Acidosis

Respiratory Acidosis Respiratory acidosis is always from inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations. Respiratory acidosis can occur in diseases that impair respiratory muscles such as myasthenia gravis.

400

Which of the following clients could be at risk for developing hypernatremia? a. 60-year-old with lung cancer and inappropriate ADH syndrome b. 39-year-old with diarrhea and vomiting c. 62-year-old with congestive heart failure taking lasix d. 50-year-old with pneumonia, diaphoresis, and high fevers

d. 50-year-old with pneumonia, diaphoresis, and high fevers

500

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). She is receiving lactated Ringer's solution IV for rehydration. What clinical manifestations does the nurse monitor during rehydration of the client? (Select all that apply.) A. Blood serum glucose B. Blood pressure C. Pulse rate and quality D. Urinary output E. Urine specific gravity levels

B,C,D,E The two most important areas to monitor during rehydration are pulse rate and quality and urine output; however, decreasing specific gravity of urine is also an indication of rehydration. Blood pressure is also important to monitor during rehydration. Blood glucose changes do not have a direct relation to a client's rehydration status.

What does the Nurse DO??

100

What amount of fluid per kg/day should the NUR encourage the patient to drink for wound healing? a. 100-120 mL b. 20-25 mL c. 30-35 mL d. 15-20 mL

c. 30-35 mL

200

The patient has hypomagnesemia. The nurse knows to also look for which other imbalance? a. Hypocalcemia b. Hypokalemia c. Hyperphosphetemia d. Hyperchloremia

Hypocalcemia

300

A bedridden client has a calcium level of 13. What is the most appropriate nursing action? a. Provide passive ROM exercises and encourage fluid intake b. Teach the client to increase intake of whole grains and nuts c Place a tracheostomy tray at the bedside d. Administer calcium gluconate IM as ordered

a. Provide passive ROM exercises and encourage fluid intake

400

A patient with hypotension is in the emergency department being evaluated. The patients sodium level has come back at 146 mmol/L. What interventions by the nurse would be most appropriate in caring for this patient with hypernatremia? Select all that apply. a. Administer hypertonic solution by IV as ordered b. Perform neurological assessments at least every 4 hours c. Limit oral intake of sodium d. Encourage the patient to use incentive spirometry e. Provide pain medication as ordered prn

B, C, E

500

You are caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. Which classification of medications should you withhold until consulting with the physician? a. Antibiotics b. Loop diuretics c. Bronchodilators d. Antihypertensives

B. Loop diuretics

It's always K+

100

For which electrolyte imbalance would hypertension be considered a possible sign? a. Hypokalemia b. Hypomagnesemia c. Hyponatremia d. Hyperchloremia

b. Hypomagnesemia

200

The nurse caring for a group of clients reviews the electrolyte laboratory results and notes a sodium level of 130 mEq/L on one client’s laboratory report. The nurse understands that which client is at highest risk for the development of a sodium value at this level? 1. The client who is taking diuretics 2. The client with hyperaldosteronism 3. The client with Cushing’s syndrome 4. The client who is taking corticosteroids

1 Rationale: Hyponatremia is evidenced by a serum sodium level less than 135 mEq/L. Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the client with hyperaldosteronism or Cushing’s syndrome are at risk for hypernatremia.

300

Which situation can cause a client to experience "insensible water loss"? (Select all that apply.) A. Diarrhea B. Dry, hot weather C. Fever D. Increased respiratory rate E. Nausea F. Mechanical ventilation

A,B,C,D,F Insensible water loss occurs through the intestinal tract as diarrhea. It can be caused and/or influenced by dry, hot weather. Insensible water loss occurs through the skin, and it is increased by the presence of fever. It occurs through the lungs (increased rate of respirations), and is increased in clients who are mechanically ventilated. Nausea with no accompanying vomiting would not cause insensible water loss.

400

You are caring for a patient admitted with diabetes mellitus, malnutrition, and massive GI bleed. In analyzing the morning lab results, the nurse understands that a potassium level of 5.5 mEq/L could be caused by which factors in this patient (select all that apply)? A. The potassium level may be increased if the patient has renal nephropathy. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The potassium level may be increased as a result of dehydration that accompanies high blood glucose levels. D. There may be excess potassium being released into the blood as a result of massive transfusion of stored hemolyzed blood. E. The patient has been overeating raisins, baked beans, and salt substitute that increase the potassium level.

C, D Hyperkalemia may result from hyperglycemia, renal insufficiency, and/or cell death. Diabetes mellitus, along with the stress of hospitalization and illness, can lead to hyperglycemia. Renal insufficiency is a complication of diabetes. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient's potassium level. Stored hemolyzed blood can cause hyperkalemia when large amounts are transfused rapidly. The patient with a massive GI bleed would have an NG tube and not be eating.

500

The patient has a serum phospate level of 4.7 mg/dL. Which interdisciplinary treatments would the nurse expect for this patient? (Select all that apply) A. IV normal saline B. Calcium containing antacids C. IV potassium phosphate D. Encouraging milk intake E. Increasing vitamin D intake

A, B

Nursing Critical Thinking

100

The nurse is planning care for a pt with fluid volume overload & hyponatremia. Which of the following should be included in this pt's plan of care? 1. Restrict fluids. 2. Administer intravenous fluids. 3. Provide Kayexalate. 4. Administer intravenous normal saline with furosemide.

Answer: 1 Rationale 1: The nursing care for a pt with hyponatremia is dependent on the cause. Restriction of fluids to 1,000 mL/day is usually implemented to assist sodium increase & to prevent the sodium level from dropping further due to dilution. Rationale 2: The administration of intravenous fluids would be indicated in fluid volume deficit & hypernatremia. Rationale 3: Kayexalate is used in pts with hyperkalemia. Rationale 4: The administration of normal saline with furosemide is used to increase calcium secretio

200

The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse 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 a client with hyponatremia? 1. Muscle twitches 2. Decreased urinary output 3. Hyperactive bowel sounds 4. Increased specific gravity of the urine

3 Rationale: Hyponatremia is evidenced by a serum sodium level lower than 135 mEq/L. Hyperactive bowel sounds indicate hyponatremia. The remaining options are signs of hypernatremia. In hyponatremia, muscle weakness, increased urinary output, and decreased specific gravity of the urine would be noted.

300

A pt, experiencing multisystem fluid volume deficit, has the symptoms of tachycardia, pale, cool skin, & decreased urine output. The nurse realizes these findings are most likely a direct result of which of the following? 1. the body's natural compensatory mechanisms 2. pharmacological effects of a diuretic 3. effects of rapidly infused intravenous fluids 4. cardiac failure

1. Rationale 1: The internal vasoconstrictive compensatory reactions within the body are responsible for the symptoms exhibited. The body naturally attempts to conserve fluid internally specifically for the brain & heart. Rationale 2: A diuretic would cause further fluid loss, & is contraindicated. Rationale 3: Rapidly infused intravenous fluids would not cause a decrease in urine output. Rationale 4: The manifestations reported are not indicative of cardiac failure in this pt.

400

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure. Her laboratory results include a potassium level of 7.0 mEq/L. What is the primary goal of drug therapy for this client? A. Decreasing cardiac contractility and slowing the heart rate B. Elevating serum potassium levels to a safe range C. Maintaining proper diuresis and urine output D. Restoring fluid balance by controlling the causes of dehydration

D Drug therapy for dehydration is directed at restoring fluid balance and controlling the causes of dehydration. Hyperkalemia (serum potassium level of 7.0) will slow the cardiac rate and cause decreased contractility of the heart. Serum potassium levels are already critically high, so should not be elevated further. Excessive diuretic use is what has caused this client's problems. What she needs now is to have electrolyte balance restored; for potassium, that is 3.5 to 5.0 mEq/L.

500

A 70-year-old woman is admitted to the hospital with heart failure, shortness of breath, and 3+ pitting edema in her lower extremities. Her medications are furosemide (Lasix), digoxin (Lanoxin), and an angiotensin-converting enzyme inhibitor (Lotensin). She states that she stopped taking her Lasix because she did not think that it was helping her heart failure. Her health care provider orders furosemide (Lasix) 5 mg IV push. Ten hours after receiving the Lasix, the client's potassium (K+) level is 2.5 mEq/L. Knowing all of the client's medications, what problem does the nurse anticipate in this client? A. Clinical manifestations of digoxin toxicity B. Increased heart rate and blood pressure (BP) C. Increased signs of congestive heart failure (CHF) D. Signs and symptoms of hypernatremia

A Hypokalemia increases the sensitivity of cardiac muscle to digoxin and may result in digoxin toxicity, even when the digoxin level is within the therapeutic range. Heart rate and BP would be more likely to decrease with the medications that the client is receiving coupled with her low potassium level. Use of a diuretic tends to decrease the signs of CHF. High serum sodium levels would not be expected in this scenario.

ABGs

100

The nurse is caring for a pt diagnosed with renal failure. Which of the following does the nurse recognize as compensation for the acid-base disturbance found in pts with renal failure? 1. The pt breathes rapidly to eliminate carbon dioxide. 2. The pt will retain bicarbonate in excess of normal. 3. The pH will decrease from the present value. 4. The pt's oxygen saturation level will improve.

Answer: 1 Rationale 1: In metabolic acidosis compensation is accomplished through increased ventilation or "blowing off" C02. This raises the pH by eliminating the volatile respiratory acid & compensates for the acidosis. Rationale 2: Because compensation must be performed by the system other than the affected system, the pt cannot retain bicarbonate; the manifestation of metabolic acidosis of renal failure is a lower than normal bicarbonate value. Rationale 3: Metabolic acidosis of renal failure causes a low pH; this is the manifestation of the disease process, not the compensation. Rationale 4: Oxygenation disturbance is not part of the acid-base status of the pt with renal failure.

200

A pt's blood gases show a pH greater of 7.53 & bicarbonate level of 36 mEq/L. The nurse realizes that the acid-base disorder this pt is demonstrating is which of the following? 1. respiratory acidosis 2. metabolic acidosis 3. respiratory alkalosis 4. metabolic alkalosis

Answer: 4 Rationale 1& 2: Respiratory acidosis & metabolic acidosis are both consistent with pH less than 7.35. Rationale 3: Respiratory alkalosis is associated with a pH greater than 7.45 & a PaCO2 of less than 35 mmHG. It is caused by respiratory related conditions. Rationale 4: Arterial blood gases (ABGs) show a pH greater than 7.45 & bicarbonate level greater than 26 mEq/L when the pt is in metabolic alkalosis.

300

The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial intervention to correct this problem? 1. Encourage the pt to breathe in & out slowly into a paper bag. 2. Immediately administer oxygen via a mask & monitor oxygen saturation. 3. Prepare to start an intravenous fluid bolus using isotonic fluids. 4. Anticipate the administration of intravenous sodium bicarbonate.

Answer: 1 Rationale 1: This pt is exhibiting signs of hyperventilation that is confirmed with the blood gas results of respiratory alkalosis. Breathing into a paper bag will help the pt to retain carbon dioxide & lower oxygen levels to normal, correcting the cause of the problem. Rationale 2: The oxygen levels are high, so oxygen is not indicated, & would exacerbate the problem if given. Intravenous fluids would not be the initial intervention. Rationale 3: Not enough information is given to determine the need for intravenous fluids. Rationale 4: Bicarbonate would be contraindicated as the pH is already high

400

An elderly postoperative pt is demonstrating lethargy, confusion, & a resp rate of 8 per minute. The nurse sees that the last dose of pain medication administered via a pt controlled anesthesia (PCA) pump was within 30 minutes. Which of the following acid-base disorders might this pt be experiencing? 1. respiratory acidosis 2. metabolic acidosis 3. respiratory alkalosis 4. metabolic alkalosis

Answer: 1 Rationale 1: Acute respiratory acidosis occurs due to a sudden failure of ventilation. Overdoses of narcotic or sedative medications can lead to this condition. Rationale 2: The pt condition being described is respiratory not metabolic in nature. Rationale 3: Acute respiratory acidosis occurs due to a sudden failure of ventilation. Overdoses of narcotic or sedative medications can lead to this condition. Rationale 4: Acute respiratory acidosis occurs due to a sudden failure of ventilation. Overdoses of narcotic or sedative medications can lead to this condition. The pt condition being described is respiratory not metabolic in nature.

500

The pt, newly diagnosed with diabetes mellitus, is admitted to the emergency department with nausea, vomiting, & abdominal pain. ABG results reveal a pH of 7.2 & a bicarbonate level of 20 mEq/L. Which other assessment findings would the nurse anticipate in this pt? Select all that apply. 1. tachycardia 2. weakness 3. dysrhythmias 4. Kussmaul's respirations 5. cold, clammy skin

Answer: 2,3,4 Rationale: Further assessment findings of this condition are weakness, bradycardia, dysrhythmias, general malaise, decreased level of consciousness, warm flushed skin, & Kussmaul's respirations. Rationale: These ABG results, coupled with the pt's recent diagnosis of diabetes mellitus & history of vomiting would lead the nurse to suspect metabolic acidosis. Further assessment findings of this condition are weakness, bradycardia, dysrhythmias, general malaise, decreased level of consciousness, warm flushed skin, & Kussmaul's respirations.