Deck 12: Fluid Volume and Electrolytes

Question 1

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

A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
D) Hypokalemia

Answer 1

Hypokalemia

Question 2

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:

A) a low-potassium diet.
B) intravenous sodium bicarbonate.
C) Sodium polystyrene sulfonate (Kayexalate).
D) salt substitutes.

Answer 2

a low-potassium diet.

Question 3

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?

A) 126 mEq/L
B) 140 mEq/L
C) 145 mEq/L
D) 158 mEq/L

Answer 3

126 mEq/L

Question 4

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?

A) To increase interstitial and intracellular hydration
B) To maintain plasma volume over time
C) To pull water from the interstitial space into the extracellular fluid
D) To replace water and electrolytes

Question 5

The provider has ordered sodium polystyrene sulfonate (Kayexalate) to be administered to a patient. The nurse caring for this patient would expect which serum electrolyte values prior to administration of this therapy?

A) Sodium 125 mEq/L and potassium 2.5 mEq/L
B) Sodium 150 mEq/L and potassium 3.6 mEq/L
C) Sodium 135 mEq/L and potassium 6.9 mEq/L
D) Sodium 148 mEq/L and potassium 5.5 mEq/L

Question 6

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?

A) Contact the provider to ask about increasing the IV rate to 90 mL/h.
B) Discuss with the provider the need to increase the IV rate to 150 mL/h.
C) Encourage the patient to drink more water so the IV can be discontinued.
D) Instruct the patient to drink 250 mL of water every 8 hours.

Question 7

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?

A) Contact the provider to request an order for serum electrolytes.
B) Encourage the patient to consume less fluids.
C) Report symptoms of hyperchloremia to the provider.
D) Request an order to increase the patient's potassium dose.

Question 8

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?

A) Decrease the IV fluid rate and notify the provider.
B) Increase the IV fluid rate and notify the provider.
C) Request an order for a colloidal IV solution.
D) Request an order for a hypertonic IV solution.

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?

A) Evaluate the patient's urine output.
B) Contact the provider to order arterial blood gases.
C) Request an order for an initial potassium bolus.
D) Suggest a diet low in sodium and potassium.

Question 10

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

A) Take a calcium and vitamin D combination supplement.
B) Take calcium along with phosphorus to improve absorption.
C) Take calcium with antacids to reduce stomach upset.
D) Use aspirin instead of acetaminophen when taking calcium.

Question 11

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

A) equaled urine output.
B) exceeded urine output by 1 L.
C) exceeded urine output by 2.5 L.
D) exceeded urine output by 3 L.

Question 12

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?

A) As a single-dose 200 mEq oral tablet
B) As an intravenous bolus over 15 to 20 minutes
C) In an intravenous solution at a maximum rate of 10 mEq/h
D) In an intravenous solution at a rate of 45 mEq/h

Question 13

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?

A) Contact the patient's provider to discuss increasing the potassium chloride to 40 mEq/L.
B) Continue the intravenous fluids as ordered and reassess the patient frequently.
C) Notify the provider and discuss increasing the rate of fluids to 200 mL/h.
D) Stop the intravenous fluids and notify the provider of the assessment findings.

Question 14

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

A) Iso-osmolar
B) Hypo-osmolar
C) Hyper-osmolar
D) Isotonic

Question 15

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?

A) Digitalis
B) Hydrochlorothiazide
C) Hydrocortisone
D) Vitamin D

Question 16

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?

A) Diuretic therapy
B) Intravenous hypertonic 5% saline
C) Intravenous normal saline 0.9%
D) Oral sodium supplements

Question 17

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?

A) Decreased urine output
B) Improved blood oxygenation
C) Increased interstitial fluid
D) Stabilization of heart rate and blood pressure

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?

A) Calcium and magnesium
B) Sodium and calcium
C) Potassium and chloride
D) Potassium and magnesium

Question 19

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?

A) Fluid volume deficit (FVD)
B) Fluid volume excess (FVE)
C) Mild extracellular fluid (ECF) deficit
D) Renal failure

Question 20

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?

A) Administer the digoxin and monitor the patient's electrocardiogram closely.
B) Hold the digoxin dose and notify the provider of the patient's lab values.
C) Request an order for an intravenous bolus of potassium.
D) Request an order for oral potassium supplements.

Question 21

A patient with cirrhosis is noted to have low serum albumin levels. The patient is to receive 200 mL of albumin in 30 minutes. The drop factor for the IV set is 15 gtt/mL. The nurse correctly adjusts the IV rate to what rate? _______________ gtt/min

Question 22

A patient is admitted with orthopnea, cough, pulmonary crackles, and peripheral edema. The patient's urine specific gravity is 1.002. The nurse will expect this patient's provider to order which treatment?

A) Diuretics
B) Colloidal IV fluids
C) Hypertonic IV fluids
D) Hypotonic IV fluids