Question 1

Signs and symptoms of extracellular fluid volume excess include

Accepted Answer

Bounding pulse is one of the signs of extracellular fluid volume excess.Tachycardia is one of the signs of extracellular fluid volume deficit.Increased serum sodium concentration is found in hypernatremia.Hematocrit can be decreased with extracellular fluid volume excess.

Question 2

Clinical manifestations of extracellular fluid volume deficit include

Accepted Answer

Clinical manifestations of extracellular fluid volume deficit include weak pulse, low blood pressure, and increased heart rate.Extracellular fluid volume deficit does not cause diarrhea.Confusion, lethargy, coma, and perhaps seizures are associated with osmolality imbalances such as hyponatremia.Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

Question 3

The imbalance that occurs with oliguric renal failure is

Accepted Answer

Oliguric renal failure decreases potassium excretion, which causes hyperkalemia.Oliguric renal failure decreases acid excretion and causes metabolic acidosis (not alkalosis).Oliguric renal failure does not cause hypokalemia or hypophosphatemia.

Question 4

A patient who reports an intestinal fistula also reports feeling "weak and dizzy" when she stands.While taking her blood pressure she becomes temporarily unresponsive but quickly regains consciousness when put into a supine position.What nursing interventions will the nurse implement before calling the physician?

Accepted Answer

Her substantial systolic postural blood pressure decrease with tachycardia and syncope when upright are indicators of ECV deficit and she needs salt and water.Your questions will provide information for her physician regarding the origin of the ECV deficit.She fainted the first time when she sat upright and is likely to faint again, given her upright systolic pressure of 77 mm Hg.She needs salt and water to increase her ECV and sleep quality is not directly related to ECV deficit.Ankle edema is a sign of ECV excess.

Question 5

Clinical manifestations of hyponatremia include

Accepted Answer

Clinical manifestations of hyponatremia include confusion, lethargy, coma, and perhaps seizures, as they are manifestations of CNS dysfunction.Weak pulse, low blood pressure, and increased heart rate are characteristic of clinical dehydration.Hyponatremia does not cause thirst, dry mucous membranes, and diarrhea.Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

Question 6

The person at highest risk for developing hypernatremia is a person who

Accepted Answer

Tube feedings are associated with hypernatremia due to intake of highly concentrated solution that causes the kidneys to excrete extra water to remove the solute load.Absorption of excessive water from daily tap water enemas would cause hyponatremia.Uncontrolled secretion of ADH causes renal retention of water that leads to hyponatremia.An IV solution of 0.9% NaCl (normal saline)is isotonic.

Question 7

A patient, who is 8 months pregnant, has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures.To determine if her infusion rate is too high, you should regularly

Accepted Answer

Hypermagnesemia causes decreased neuromuscular excitability and testing the patellar reflex can detect that.Hypermagnesemia causes decreased, not increased, neuromuscular excitability.If the patellar reflex stays the same, the infusion rate is therapeutic.Watching for seizure activity is a dangerous course of action.Hypermagnesemia can cause respiratory depression and cardiac arrest, so you need to assess for its development.

Question 8

Effects of hypernatremia on the central nervous system typically include

Accepted Answer

Hypernatremia causes osmotic shrinking of brain cells, which manifests as confusion or coma.Hypernatremia does not usually cause central nervous system excitation, insomnia, or hallucinations.

Question 9

A known cause of hypokalemia is

Accepted Answer

Insulin overdose causes hypokalemia by shifting potassium into cells.Oliguric renal failure decreases electrolyte excretion.Pancreatitis causes fat malabsorption, which binds calcium and magnesium, but not potassium, in the gastrointestinal tract.Hyperparathyroidism regulates calcium, not potassium.

Question 10

What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding?

Accepted Answer

Failure to provide adequate water when a patient is receiving tube feedings could result in hypernatremia.The feedings may have too much sodium, or the patient may be receiving too much feeding solution, but most likely the patient is not receiving enough water.Kidney failure is most likely not the cause of hypernatremia in this patient.

Question 11

Which change in a patient's assessment has the greatest urgency?

Accepted Answer

Cardiac dysrhythmias from hyperkalemia need rapid attention to prevent potentially life-threatening consequences and are therefore the highest priority for reporting.Certainly you will want to report this symptomatic hypokalemia, but it is not your most urgent priority, because abdominal distention is not rapidly life threatening and you have another patient with cardiac dysrhythmias, which can be life threatening.Certainly you will want to report this hypocalcemia, but it is not your most urgent priority, because there are no signs and symptoms of hypocalcemia and you have another patient with cardiac dysrhythmias, which can be life threatening.Certainly you will want to report this symptomatic hypercalcemia, but it is not your most urgent priority, because constipation is not rapidly life threatening and you have another patient with cardiac dysrhythmias, which can be life threatening.

Question 12

A patient has a positive Chvostek sign.The nurse interprets this as a sign of

Accepted Answer

Positive Chvostek sign indicates increased neuromuscular excitability, which can be caused by hypocalcemia, hypomagnesemia, or other factors.Hypercalcemia and hypermagnesemia cause decreased neuromuscular excitability and do not cause positive Chvostek sign.Hypokalemia and hyperkalemia cause skeletal muscle weakness and do not cause positive Chvostek sign.

Question 13

The nurse provides teaching regarding dietary intake of potassium to avoid an electrolyte imbalance when a patient

Accepted Answer

Chronic heart failure causes increased secretion of aldosterone, which often causes hypokalemia by increasing renal excretion of potassium; most diuretics used to treat heart failure also increase renal excretion of potassium.Vitamin D and malabsorption of fat decreases absorption of calcium, not potassium.Chronic oliguric renal failure causes decreased excretion of potassium.An anorexic patient with chronic oliguric renal failure should not increase dietary potassium.

Question 14

Hyperaldosteronism causes

Accepted Answer

Hyperaldosteronism causes excessive renal retention of sodium and water and excessive potassium excretion, which lead to ECV excess and hypokalemia.Hyperaldosteronism does not cause ECV deficit, hyperkalemia, hyponatremia, or excessive water reabsorption without affecting sodium concentration.

Question 15

What form of oral rehydration, bottled water or salty broth, is best suited for a patient who is demonstrating signs of clinical dehydration?

Accepted Answer

This man has indicators of clinical dehydration and he needs salt to hold the water in his extracellular compartment.Replacing fluids and electrolytes is more important than meeting his nutritional needs now.

Question 16

When a parent asks how they will know if their 2-month-old baby, who is throwing up and has frequent diarrhea, is dehydrated, the nurse's best response is

Accepted Answer

Checking whether the head feels sunken and the mouth is dry between check and gums are useful assessments of ECV deficit in an infant, which is an important part of clinical dehydration.It is true that clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, but it does not address the question Mr.Worry is asking.Although the diaper information provides a useful assessment, neck veins are not a reliable assessment in an infant.Drowsiness and fatigue are not reliable assessments for dehydration.

Question 17

Total body water in older adults is

Accepted Answer

Older adults have decreased total body water due to increased adipose tissue and decreased muscle mass.Older adults have increased adipose tissue.Hormonal fluctuations and diuresis with sodium excretion are not characteristic of older adults.

Question 18

Clinical manifestations of moderate to severe hypokalemia include

Accepted Answer

Hypokalemia causes muscle weakness (or paralysis)and cardiac dysrhythmias.Hypokalemia does not cause muscle spasms and rapid respirations or confusion and irritability.Vomiting and diarrhea can cause hypokalemia, but they are not signs and symptoms of it.

Question 19

How is a patient hospitalized with a malignant tumor that secretes parathyroid hormone-related peptide monitored for the resulting electrolyte imbalance?

Accepted Answer

Parathyroid hormone increases the plasma calcium concentration, and constipation and lethargy are manifestations of hypercalcemia.Parathyroid hormone increases the plasma calcium concentration, but these are signs of increased neuromuscular excitability, which occurs with hypocalcemia.Parathyroid hormone affects plasma concentration of calcium, not potassium.

Question 20

A patient diagnosed with chronic compensated heart failure reports that, "My feet swell if I eat salt but I don't understand why" The nurse's best response is

Accepted Answer

Salt holds water in the ECV, thus increasing capillary hydrostatic pressure.Gravity leads to feet swelling, but it does not explain what the patient is asking.Salt does not cause vasodilation, nor does it bind to blood proteins and change osmotic pressure.

Quiz 24: Fluid and Electrolyte Homeostasis and Imbalances