Question 1

A patient is admitted after experiencing vomiting and diarrhea for several days.The provider orders intravenous lactated Ringer's solution.The nurse understands that this fluid is given for which purpose?

Accepted Answer

Lactated Ringer's solution is an isotonic solution and is used to replace water and electrolytes and is often used to replace gastrointestinal losses.Hypotonic fluids increase interstitial and intracellular hydration.Colloidal solutions are used to maintain plasma volume over time.Hypertonic solutions pull water from the interstitial space into the extracellular fluid.

Question 2

The nurse is caring for a patient who weighs 75 kg.The patient has intravenous (IV)fluids infusing at a rate of 50 mL/h and has consumed 100 mL of fluids orally in the past 24 hours.Which action will the nurse take?

Accepted Answer

The recommended daily fluid intake for adults is 30 to 40 mL/kg/day.This patient should have a minimum of 2250 mL/day and is currently receiving 1200 mL IV plus 100 mL orally for a total of 1300 mL.Increasing the IV rate to 90 mL/h would give the patient 2160 mL.If the patient continues to take oral fluids,the amount of 2250 mL can be met.A rate of 150 mL/h would give the patient 3600 mL/day,which exceeds the recommended amount.Since this patient is not taking fluids well and is not receiving adequate IV fluids,encouraging an increased fluid intake is not indicated.Even if the patient drank 250 mL of water every 8 hours,the amount would not be sufficient.

Question 3

A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/h.The nurse assuming care for the patient reviews the patient's serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L.The patient had a urine output of 250 mL during the last 12-hour shift.Which action will the nurse take?

Accepted Answer

The patient's potassium level is within normal limits,but the urine output is decreased,so the patient should not be receiving IV potassium.The nurse should stop the IV and report the findings to the provider.The patient does not need an increase in potassium.The patient needs more fluids but not with potassium.

Question 4

A patient asks the nurse about taking calcium supplements to avoid hypocalcemia.The nurse will suggest that the patient follow which instruction?

Accepted Answer

Vitamin D enhances the absorption of calcium in the body.Calcium and phosphorus have an inverse relationship-an increased level of one mineral decreases the level of the other.Antacids can contain magnesium,which can promote calcium loss.Aspirin can alter vitamin D levels and interfere with calcium absorption.

Question 5

A patient has a serum potassium level of 2.7 mEq/L.The patient's provider has determined that the patient will need 200 mEq of potassium to replace serum losses.How will the nurse caring for this patient expect to administer the potassium?

Accepted Answer

Potassium chloride should be given intravenously when hypokalemia is severe,so this patient should receive IV potassium chloride.Potassium should never be given as a bolus and should be administered slowly.The maximum infusion rate for adults with a serum potassium level greater than 2.5 mEq/L is 10 mEq/h or 200 mEq/24 hours.

Question 6

The nurse is preparing to administer digoxin to a patient who is newly admitted to the intensive care unit.The nurse reviews the patient's admission electrolytes and notes a serum potassium level of 2.9 mEq/L.Which action by the nurse is correct?

Accepted Answer

Hypokalemia can cause digoxin toxicity,so the nurse should hold the dose and notify the provider.Potassium should never be given as an IV bolus.Oral supplements are not used when hypokalemia is severe.

Question 7

A patient is being treated for shock after a motor vehicle accident.The provider orders 6% dextran 75 to be given intravenously.The nurse should expect which outcome as the result of this infusion?

Accepted Answer

6% Dextran 75 is a high-molecular-weight colloidal solution and is used to treat shock from hemorrhage,burns,or trauma.Colloids are plasma expanders,and the end result is an improvement in heart rate (decreased)and blood pressure (increased).Plasma expanders will result in an increase in urine output.Blood oxygenation is not affected,and colloids do not increase the amount of interstitial fluid.

Question 8

The nurse is caring for a patient who will receive 10% calcium gluconate to treat a serum potassium level of 5.9 mEq/L.The nurse performs a drug history prior to beginning the infusion.Which drug taken by the patient would cause concern?

Accepted Answer

Calcium gluconate is given to treat hyperkalemia in order to decrease irritability of the myocardium.When administered to a patient taking digitalis,it can cause digitalis toxicity.The other drugs may affect potassium levels but are not a cause for concern with calcium gluconate.

Question 9

The nurse is caring for a newly admitted patient who has severe gastroenteritis.The patient's electrolytes reveal a serum sodium level of 140 mEq/L and a serum potassium level of 3.5 mEq/L.The nurse receives an order for intravenous 5% dextrose and normal saline with 20 mEq/L potassium chloride to infuse at 125 mL/h.Which action is necessary prior to administering this fluid?

Accepted Answer

If the patient is receiving potassium and the urine output is <25 mL/h or <600 mL/d,potassium accumulation may occur.Patients with a low urine output should not receive IV potassium.Arterial blood gases are not necessary prior to IV potassium administration.Potassium should never be given as a bolus.Patients should be put on a potassium-enriched diet when foods are tolerated.

Question 10

The nurse is caring for a patient who is receiving isotonic intravenous (IV)fluids at an infusion rate of 125 mL/h.The nurse performs an assessment and notes a heart rate of 102 beats per minute,a blood pressure of 160/85 mm Hg,and crackles auscultated in both lungs.Which action will the nurse take?

Accepted Answer

The patient shows signs of fluid volume excess,so the nurse should slow the IV fluid rate and notify the provider.Increasing the rate would compound the problem.Colloidal and hypertonic fluids would pull more fluids into the intravascular space and compound the problem.

Question 11

The nurse is caring for a patient whose serum sodium level is 140 mEq/L and serum potassium level is 5.4 mEq/L.The nurse will contact the patient's provider to discuss an order for

Accepted Answer

Mild hyperkalemia may be treated with dietary restriction of potassium-rich foods.The patient's sodium level is normal,so sodium bicarbonate is not indicated.Kayexalate is used for severe hyperkalemia.Salt substitutes contain potassium and would only compound the hyperkalemia.

Question 12

A patient is taking a thiazide diuretic and reports anorexia and fatigue.The nurse suspects which electrolyte imbalance in this patient?

Accepted Answer

Thiazide diuretics cause the body to lose potassium.Patients who take thiazide diuretics should be monitored for hypokalemia.

Question 13

The nurse is administering intravenous fluids to a patient who is dehydrated.On the second day of care,the patient's weight is increased by 2.25 pounds.The nurse would expect that the patient's fluid intake has

Accepted Answer

A weight gain of 1 kg,or 2.2 to 2.5 lb,is equivalent to 1 L of fluid.

Question 14

The nurse is performing an assessment on a patient brought to the emergency department for treatment for dehydration.The nurse assesses a respiratory rate of 26 breaths/minute,a heart rate of 110 beats/minute,a blood pressure of 86/50 mm Hg,and a temperature of 39.5° C.The patient becomes dizzy when transferred from the wheelchair to a bed.The nurse notes cool,clammy skin.Which diagnosis does the nurse suspect?

Accepted Answer

Patients with FVD will exhibit elevated temperature,tachycardia,tachypnea,hypotension,orthostatic hypotension,and cool,clammy skin.Patients with FVE will have bounding pulses,elevated blood pressure,dyspnea,and crackles.Mild ECF deficit causes thirst.Renal failure generally leads to FVE.

Question 15

The nurse is caring for a patient who has had severe vomiting.The patient's serum sodium level is 130 mEq/L.The nurse will expect the patient's provider to order which treatment?

Accepted Answer

Patients with hyponatremia may be treated with oral sodium supplements if the patient is able or if the deficit is mild.This patient is vomiting and would not be able to take supplements easily.For a serum level between 125 and 135 mEq/L,normal saline may increase sodium content in vascular fluid.Hypertonic saline is used for severe hyponatremia with a serum sodium <120 mEq/L.Diuretics would further deplete sodium and fluid volume in a patient already likely to be dehydrated from severe vomiting.

Question 16

The nurse is caring for a patient who has a heart rate of 98 beats per minute and a blood pressure of 82/58 mm Hg.The patient is lethargic,is complaining of muscle weakness,and has had gastroenteritis for several days.Based on this patient's vital signs,which sodium value would the nurse expect?

Accepted Answer

Patients who are hyponatremic will have tachycardia and hypotension along with lethargy and muscle weakness.The normal range for serum sodium is 135 to 145 mEq/L; a serum sodium level of 126 mEq/L would be considered hyponatremic.

Question 17

The nurse is caring for a patient who is receiving oral potassium chloride supplements.The nurse notes that the patient has a heart rate of 120 beats per minute and has had a urine output of 200 mL in the past 12 hours.The patient reports abdominal cramping.Which action will the nurse take?

Accepted Answer

Oliguria,tachycardia,and abdominal cramping are signs of hyperkalemia,so the nurse should request an order for serum electrolytes.This patient should increase fluid intake.The patient is not exhibiting signs of hyperchloremia; the patient is showing signs of hyperkalemia,and an increased potassium dose is not indicated.

Question 18

The nurse is caring for a newly admitted patient who will receive digoxin to treat a cardiac dysrhythmia.The patient takes hydrochlorothiazide (HydroDIURIL)and reports regular use of over-the-counter laxatives.Before administering the first dose of digoxin,the nurse will review the patient's electrolytes with careful attention to the levels of which electrolytes?

Accepted Answer

Hypomagnesemia,like hypokalemia,enhances the action of digitalis and causes digitalis toxicity.Laxatives and diuretics can deplete both of these electrolytes.

Question 19

The provider has ordered Kayexalate and sorbitol to be administered to a patient.The nurse caring for this patient would expect which serum electrolyte values prior to administration of this therapy?

Accepted Answer

Severe hyperkalemia,with a potassium level of 6.9 mEq/L,requires aggressive treatment with Kayexalate and sorbitol to increase the body's excretion of potassium.The normal range for serum potassium is 3.5 to 5.5 mEq/L,so patients with the other potassium levels would not be treated aggressively or would need potassium supplementation.

Question 20

A patient's serum osmolality is 305 mOsm/kg.Which term describes this patient's body fluid osmolality?

Accepted Answer

Normal osmolality is 275 to 295 mOsm/kg.This patient is therefore hyper-osmolar.

Quiz 12: Fluid Volume and Electrolytes