Question 1

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

Accepted Answer

Loop diuretics such as furosemide cause increased excretion of potassium in the urine, leading to hypokalemia. Anorexia and fatigue are common symptoms of hypokalemia. Hypercalcemia and hyperkalemia are not typically associated with loop diuretic use, and although hypocalcemia can occur with loop diuretic use in rare cases, it is not the most likely electrolyte imbalance to occur.

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:

Accepted Answer

The patient's serum potassium level is elevated (normal range is 3.5-5.0 mEq/L), indicating hyperkalemia. A low-potassium diet can help manage this condition.

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?

Accepted Answer

The patient's symptoms and vital signs suggest hyponatremia, or low sodium levels. A sodium value of 126 mEq/L is consistent with this diagnosis. A normal sodium level is typically between 135-145 mEq/L, but in cases of hyponatremia, the levels can drop lower. Additionally, the patient's lethargy and muscle weakness are common symptoms of hyponatremia.

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?

Accepted Answer

Intravenous lactated Ringer's solution is a fluid used to replace water and electrolytes lost due to vomiting and diarrhea. It contains electrolytes such as sodium, potassium, and chloride, as well as lactate, which is metabolized in the liver to produce bicarbonate, helping to maintain acid-base balance. It does not pull water from the interstitial space or increase interstitial and intracellular hydration, but it does help to maintain plasma volume over time.

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?

Accepted Answer

Sodium polystyrene sulfonate (Kayexalate) is used to treat hyperkalemia (high serum potassium levels). Therefore, the nurse would expect the patient to have elevated potassium levels (option C has the highest potassium value at 6.9 mEq/L) and normal sodium levels (option C has a sodium value of 135 mEq/L which is within the normal range). Options A, B, and D do not have the expected elevated potassium levels.

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?

Accepted Answer

The patient has a low fluid intake (100 mL orally in 24 hours) and a low IV fluid rate (50 mL/h), which may not be sufficient for their needs. Increasing the IV rate to 90 mL/h could help ensure adequate hydration.

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?

Accepted Answer

The patient is exhibiting symptoms of hyperkalemia, which can be caused by excessive potassium intake. The nurse should contact the provider to request an order for serum electrolytes to determine the patient's potassium level and potentially adjust the dose as necessary. Encouraging the patient to consume less fluids could further exacerbate their symptoms, reporting hyperchloremia is not relevant to the situation, and increasing the potassium dose would worsen the hyperkalemia.

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?

Accepted Answer

The patient's vital signs and lung sounds indicate fluid overload, so the nurse should decrease the IV fluid rate to prevent further fluid accumulation and notify the provider for further evaluation and possible medication adjustments. Increasing the IV fluid rate or switching to a different type of IV solution would not be appropriate in this situation.

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

Prior to administering intravenous fluids, the nurse should evaluate the patient's urine output to ensure adequate renal function and avoid fluid overload. Contacting the provider for arterial blood gases would not be necessary for this fluid order. A potassium bolus may be necessary for severe hypokalemia, but the potassium level in this scenario is within normal range. Suggesting a low sodium and potassium diet may be important for long-term management, but is not necessary prior to administering this fluid.

Question 10

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

Accepted Answer

Taking a calcium and vitamin D combination supplement is recommended to prevent hypocalcemia. Vitamin D helps the body absorb calcium better, and taking the two together can improve calcium levels in the body. Taking calcium with phosphorus or antacids is not necessary for preventing hypocalcemia, and there is no evidence to suggest that using aspirin instead of acetaminophen improves calcium absorption or prevents hypocalcemia.

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

Accepted Answer

One liter of water weighs approximately 2.2 pounds. Therefore, a weight gain of 2.25 pounds suggests the patient's fluid intake exceeded urine output by about 1 liter.

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?

Accepted Answer

Serum potassium levels less than 3.0 mEq/L indicate severe hypokalemia. Replacement of potassium can be done intravenously or orally depending on the severity of hypokalemia. In this case, the patient needs a total of 200 mEq potassium replacement. The safest and most effective way to administer potassium intravenously is in an intravenous solution at a maximum rate of 10 mEq/h to prevent hyperkalemia and other complications. Option A is not safe because it delivers a high dose of potassium in a single oral tablet, which can increase the risk of hyperkalemia. Option B is not safe because an intravenous bolus can cause dangerous hyperkalemia and cardiac arrest. Option D is not safe because it delivers potassium too quickly and can cause hyperkalemia.

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?

Accepted Answer

The answer of A patient who is being treated for...

Question 14

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

Accepted Answer

A serum osmolality of 305 mOsm/kg indicates that the patient's body fluid osmolality is hyper-osmolar, meaning it is higher than the normal range of 275-295 mOsm/kg.

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?

Accepted Answer

Digitalis can increase the risk of cardiac dysrhythmias when given with calcium gluconate, so the nurse should notify the healthcare provider and monitor the patient closely during the infusion. Hydrochlorothiazide, hydrocortisone, and vitamin D do not interact with calcium gluconate in a way that would cause concern.

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?

Accepted Answer

The patient's serum sodium level is low, indicating hyponatremia, which can occur due to vomiting, sweating, or other fluid losses. Treatment typically involves correcting the underlying cause of the fluid loss and administering intravenous normal saline 0.9% to restore serum sodium levels. Diuretic therapy and oral sodium supplements may be appropriate in certain cases, but they are not the initial treatment for hyponatremia. Intravenous hypertonic 5% saline may be used in severe cases of hyponatremia, but it carries a higher risk of complications and is not the first-line treatment.

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?

Accepted Answer

6% dextran 75 is a type of colloid solution that is used to expand intravascular volume and improve cardiac output, thereby stabilizing heart rate and blood pressure in shock patients. It does not have any effect on urine output or blood oxygenation, and it does not increase interstitial fluid.

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

Before administering digoxin, the nurse should review the patient's electrolytes with careful attention to the potassium and magnesium levels. Hydrochlorothiazide, an antihypertensive medication, can cause hypokalemia (low potassium levels), which increases the risk of digoxin toxicity. Additionally, over-the-counter laxatives can cause electrolyte imbalances, particularly low magnesium levels, which can also increase the risk of digoxin toxicity. Monitoring the patient's potassium and magnesium levels, and correcting any imbalances before administering digoxin, can help prevent adverse drug reactions.

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?

Accepted Answer

The patient's symptoms suggest dehydration, which is characteristic of fluid volume deficit (FVD). The rapid respiratory rate and elevated heart rate are the body's compensatory mechanisms to try to maintain adequate tissue perfusion. The low blood pressure and dizziness upon position change also suggest low circulating volume. The cool, clammy skin may be due to vasoconstriction in an effort to redirect blood flow to vital organs. There is no indication of fluid volume excess or mild ECF deficit, and renal failure would present with different symptoms, such as changes in urine output or quality.

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?

Accepted Answer

A serum potassium level of 2.9 mEq/L is considered hypokalemia, which increases the risk of digoxin toxicity. Therefore, the nurse should hold the digoxin dose and notify the provider of the patient's lab values. The provider may order potassium replacement therapy to resolve the hypokalemia before administering digoxin. Administering digoxin with low potassium levels can cause life-threatening arrhythmias.

Quiz 12: Fluid Volume and Electrolytes