ELECTROLYTE IMBALANCES
A patient taking diuretics reports muscle cramps and weakness. Which electrolyte is likely low?
Potassium (Hypokalemia)
pH 7.30, CO₂ 50
Is this acidosis or alkalosis?
Acidosis
Who should you see first?
A. Pain 7/10
B. Oxygen saturation 88%
C. Waiting for discharge papers
D. Needs dressing change
B — low oxygen saturation
Before giving insulin, the nurse must check what lab value?
Blood glucose.
Normal oxygen saturation range?
About 95–100% (or patient baseline).
A diabetic patient is shaky and sweaty. What should you check first?
Blood glucose
A patient with kidney failure has peaked T waves on ECG. Which electrolyte is too high?
Potassium (Hyperkalemia)
pH 7.50, CO₂ 30
Is this respiratory or metabolic?
Respiratory alkalosis
What is the FIRST action when a patient becomes suddenly short of breath?
Assess airway and breathing (apply oxygen if needed).
A patient on opioids becomes difficult to arouse with RR 8/min. Priority action?
Stop opioid and administer naloxone.
High Fowler’s position helps improve what?
Lung expansion/breathing.
Why are incentive spirometers used after surgery?
Prevent pneumonia and atelectasis.
A sodium level of 124 mmol/L puts the patient at risk for what serious complication?
Seizures (the imbalance causes water to shift from the blood into brain cells, leading to cerebral edema)
An ABG shows:
pH: 7.28
PaCO₂: 52
HCO₃: 24
Is this respiratory or metabolic, and what is a likely cause?
Respiratory acidosis — likely caused by hypoventilation (e.g., COPD exacerbation, opioid sedation, respiratory depression).
Which task can be delegated to a care aide?
Assisting a stable patient with bathing or ambulation.
A patient taking digoxin should have which electrolyte monitored closely?
Potassium.
A COPD patient suddenly becomes drowsy after high-flow oxygen. Why?
Loss of hypoxic respiratory drive → CO₂ retention.
A trauma patient becomes restless, tachycardic, and normotensive. What stage of shock is this?
Compensatory (early) shock.
Which electrolyte imbalance causes numbness around the mouth and muscle twitching?
Hypocalcemia
An ABG shows:
pH: 7.47
PaCO₂: 38
HCO₃: 30
What imbalance is present and what assessment question should the nurse ask?
Metabolic alkalosis — ask about vomiting, NG suction, or excessive antacid use.
You receive shift report on four patients. Which requires immediate reassessment?
A. K⁺ 3.4 receiving replacement
B. Na⁺ 140 stable
C. New restlessness after head injury
D. Controlled atrial fibrillation
C — neurological deterioration may indicate increased ICP.
A patient becomes dizzy after a new blood pressure medication. What is the priority teaching?
Change positions slowly (prevent orthostatic hypotension).
Which finding shows respiratory distress?
Use of accessory muscles.
A patient with heart failure gains 2 kg in 2 days. What does this suggest?
Fluid retention.
A patient has excessive vomiting for 3 days. Which electrolyte imbalance is most likely?
Hypokalemia (loss of potassium through GI losses)
pH 7.48
PaCO₂ 32
HCO₃ 24
interpret the values. What is the likely clinical cause?
Respiratory alkalosis — hyperventilation (anxiety, pain, PE).
A postoperative patient has:
HR 120
Pale skin
Restlessness
What should the nurse suspect?
Possible shock or bleeding.
A patient taking warfarin starts antibiotics and develops bruising. Explain why.
Antibiotics reduce vitamin K–producing gut flora therefore increase anticoagulation effect.
A patient suddenly develops chest pain and shortness of breath after surgery. What complication is suspected?
Pulmonary embolism.
A patient becomes suddenly confused and restless. What should the nurse do first?
Assess oxygenation and vital signs.