Deck 16: Fluid and Electrolyte Replacement

Question 1

Which sign or symptom may be noted in a client with overhydration?

A) Bradycardia
B) Hypotension
C) Pulmonary congestion
D) Weight loss

Answer 1

Pulmonary congestion

Question 2

A client's serum potassium level is 5.4 mEq/L. What intervention may correct this type of potassium imbalance?

A) Restriction of foods containing potassium
B) Administration of sodium bicarbonate (NaHCO₃)
C) Administration of insulin and glucose
D) Administration of sodium polystyrene sulfonate (Kayexalate) and sorbitol

Answer 2

Restriction of foods containing potassium

Question 3

Which physician order would the nurse question when administering IV fluids with potassium chloride (KCl)?

A) Inject IV KCl directly into the IV tubing.
B) Check for infiltration because potassium is irritating to subcutaneous tissues.
C) Check for phlebitis because potassium is irritating to the veins.
D) Check for adequate urinary output (kidney dysfunction can cause potassium retention that may lead to hyperkalemia).

Answer 3

Inject IV KCl directly into the IV tubing.

Question 4

A client received 3 L of D₅W. With continuous use of 5% dextrose in water, the intravenous (IV) fluids become:

A) isotonic.
B) hypotonic.
C) hypertonic.
D) megatonic.

Question 5

In monitoring a client taking potassium supplements, the nurse observes for which signs and symptoms of hyperkalemia?

A) Oliguria, tachycardia, and later bradycardia
B) Soft, flabby muscles
C) Abdominal distention
D) Blurred vision and loss of hearing

Question 6

A client is ordered to receive potassium. The nurse should instruct the client to take KCl at what time of day?

A) Throughout the day with sips of water
B) Before breakfast
C) At bedtime with 1 ounce of fluid
D) At mealtime

Question 7

A client's serum potassium level is 6.9 mEq/L. The nurse anticipates that the healthcare provider will order:

A) atropine.
B) sodium bicarbonate (NaHCO₃).
C) insulin and glucose.
D) sodium polystyrene sulfonate (Kayexalate) and sorbitol.

Question 8

A client in severe shock is ordered to receive dextran as a volume expander. This type of fluid known as a:

A) lipid.
B) crystalloid.
C) colloid.
D) blood product.

Question 9

A client is admitted to the emergency department with tachycardia, hypotension, and a serum sodium level of 115 mEq/L. What does the client's serum sodium level indicate?

A) Normal serum sodium value
B) Hyponatremia
C) Hypernatremia
D) Hypocalcemia

Question 10

A client is receiving D₅ 1/2 NSS via a peripheral IV. The client is prescribed to receive calcium gluconate (Kalcinate). The nurse knows that calcium should not be mixed with saline solution. What is the appropriate response from the nurse?

A) Ask the healthcare provider about changing the IV solution to 5% dextrose in water (D₅W), because saline encourages calcium loss.
B) Do not give the medication because it is the wrong solution.
C) Report the healthcare provider immediately to the supervisor because it is the wrong solution.
D) Change the IV solution to D₅W and report it later to the healthcare provider.

Question 11

A client's serum chemistry measurements are serum sodium level 146 mEq/L, BUN 24 mg/dl, and glucose level 90 mg/dl. What is the client's serum osmolality?

A) 275 mOsm/kg
B) 285 mOsm/kg
C) 295 mOsm/kg
D) 305 mOsm/kg

Question 12

A client's serum chemistry values are serum sodium level 142 mEq/L, blood urea nitrogen (BUN) 15 mg/dl, and glucose level 90 mg/dl. What is the client's body fluid osmolality?

A) Iso-osmolar
B) Hypo-osmolar
C) Hyperosmolar
D) Hypotonic

Question 13

A client's serum osmolality is 270 mOsm/kg. What is the client's body fluid osmolality?

A) Iso-osmolar
B) Hypo-osmolar
C) Hyperosmolar
D) Normosmolar

Question 14

The nurse is aware that which groups of drugs contains magnesium and can cause hypermagnesemia if taken in excess?

A) Laxatives and steroids
B) Laxatives and antacids
C) Antacids and antibiotics
D) Antacids and steroids

Question 15

A nurse is teaching a client about ways to avoid hypocalcemia. Dietary recommendations indicate that vitamin _____ is necessary for calcium absorption.

A) A
B) B
C) D
D) E

Question 16

A client is ordered to receive lactated Ringer's solution. What type of intravenous (IV) solution is this?

A) Lipid
B) Crystalloid
C) Colloid
D) Blood product

Question 17

A client is instructed to use potassium supplements because a medication that has been prescribed may cause hypokalemia. The nurse is aware that which group of drugs may cause hypokalemia?

A) Potassium-sparing diuretics
B) Potassium-wasting diuretics
C) Beta-blockers
D) Narcotics

Question 18

A client with congestive heart failure is noted to have gained 17 pounds in the 2 weeks since the last appointment. The nurse is aware that this represents an approximate fluid retention volume of which amount?

A) 5 L
B) 8 L
C) 10 L
D) 15 L

Question 19

A nurse is calculating a client's daily fluid needs. The client weighs 85 kg. The approximate daily fluid requirement is _____ mL.

A) 1700
B) 2000
C) 2550
D) 3000

Question 20

A client's serum calcium level is 3.7 mEq/L. Concerning this level, the nurse knows that it is:

A) low.
B) normal.
C) high.
D) dangerously high.

Question 21

Which symptom would alert the nurse to the diagnosis of deficient fluid volume?

A) Weight gain
B) Tachycardia
C) Moist mucous membranes
D) Urine output greater than 600 mL/day

Question 22

The client is experiencing potassium excess and is being treated with 10% calcium gluconate. The client has been diagnosed with cardiac disease. The highest priority action on the part of the nurse is to check the client's:

A) medications since this drug can lead to digitalis toxicity.
B) pulse frequently since bradycardia is likely to result.
C) pedal pulses frequently and lower extremities for swelling.
D) mental status since alteration in consciousness may occur.

Question 23

A client who is taking calcium supplements is concerned about her ability to determine that the supplements are absorbable. The nurse should instruct the client to check the tablet's absorbability by performing which action?

A) Put 1 tablet into 1 ounce of white vinegar; the tablet should dissolve within 30 minutes.
B) Put 1 tablet into 1 ounce of hydrogen peroxide; the tablet should not dissolve.
C) Put 1 tablet into 1 ounce of alcohol; the tablet should dissolve within 1 hour.
D) Put 1 tablet into 1 ounce of water; the tablet should dissolve within 15 minutes.

Question 24

The client has been ordered Kayexalate as a treatment for potassium excess. The nurse is gathering equipment to administer the medication and recognizes that the drug will be given as a(n):

A) intramuscular injection.
B) intravenous medication.
C) rectal medication.
D) subcutaneous injection.

Question 25

Tetany symptoms result from severe calcium deficit. The nurse checks for symptoms of tetany. Which symptoms are associated with tetany? (Select all that apply.)

A) twitching of the mouth and numbness of the fingers
B) muscle weakness
C) carpopedal spasms
D) laryngeal spasm

Question 26

A client with cirrhosis is noted to have low serum albumin levels. The client 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?

Question 27

A postoperative client enters the postanesthesia care unit and blood studies are done. The client's serum potassium level is 2.9 mEq/L. What will the nurse do next?

A) Institute seizure precautions.
B) Monitor ECG readings.
C) Draw liver enzyme levels.
D) Elevate the head of the bed.