Acid Base Imbalances, Fluids & Electrolytes

Question 1

Oral interventions for elderly, dehydrated man.
Which are within scope of practice of LPN being supervised by RN

1. Remind client to not use commercial mouthwash
2. Encourage mouth rinsing with warm saleine
3. Assess skin turgor by pinching the skin on dorsal side of hand
4. Observe lips, tongue, and mucous membranes.
5. Provide mouth care every 2 hrs while awake
6. Seek dietary counsel to increase fluids in meal trays.

Answer 1

1. Remind client to not use commercial mouthwash - Contains alcohol NoNo
2. Encourage mouth rinsing with warm saleine
3. Observe lips, tongue, and mucous membranes.
4. Provide mouth care every 2 hrs while awake

Incorrect
3. Assess skin turgor by pinching the skin on dorsal side of hand - Access skin tugor in Elderly on sternum or forehead. Hand will always tent

6. Seek dietary counsel to increase fluids in meal trays.

Question 2

HCP provider has written these orders, for client diagnosed with PE. Morning assessment revealed Bounding Pulses, 2lb weight gain, pitting ankle edema, moist bilateral crackles. Which order takes priority.

1. Weight client every morning
2. Maintain accurate I&O
3. Restrict fluid to 1500mL/day
4. Admin furosemide 40 mg IV push

Answer 2

4. Admin furosemide 40 mg IV push

Assessment has already been done. Now it’s time to do

Question 3

Which order would be questioned for a client with Hypercalcemia

1. 0.9 NS 50mL/hr IV
2. Furosemide 20 mg orally morning
3. Apply cardiac telemetry monitor
4. Hydroclorothiazide (HCTZ) 25 mg Oral morning

Answer 3

Hydroclorothiazide (HCTZ) 25 mg Oral morning

Thiazide diuretics don’t get rid of calcium. This will make the situation worse, by removing fluid and increasing concentration of calcium

Question 4

Electrolyte problem with SIADH

Answer 4

Hyponatremia

Question 5

Client on ventilator with resp acidosis. Which interventions will help

1. Increase rate from 6 - 10 resp/min
2. Decrease rate from 10- 6 resp /min
3. Increase oxygen con from 30% - 40
4. Decrease oxygen con from 40% - 30

Answer 5

1. Increase rate from 6 - 10 resp/min

Increased resp will exhale more and remove CO².

Oxygen con will not affect the CO² Level

Question 6

Patient takes hydroclorothiazide 10mg. What should be included in the teaching plan?

1. Take in AM
2. Take in AM & before bed
3. Eat foods with extra salt
4. Inform HCP if you notice weight gain or swelling
5. Except urine output to increase
6. HCP may also prescribe a K supplement.

Answer 6

1. Take in AM
2. Inform HCP if you notice weight gain or swelling
3. Except urine output to increase
4. HCP may also prescribe a K supplement.

Thiazide diuretics cause K loss.

Question 7

Dehydration & Hypovolemic shock. Which intervention is Contradicted

1. BP Q15MIN
2. Place two 18 Guage IV lines
3. Oxygen 3L nasal canula
4. IV 5% Dextrose in water (D⁵W) @ 250mL/hr

Answer 7

4. IV 5% Dextrose in water (D⁵W) @ 250mL/hr

D⁵W is Hypotonic in the body. Hence, the fluid will flow into the cells (greater concentration of solutes).This is the opposite of what we want.

Hypovolemia wants fluid to stay Intervascular. Isotonic is needed to increase intravascular volume

Question 8

Describe acid based disorder

1. Chronic emphysema
2. Daily antacids use
3. Anxiety disorder
4. Salicylate intox

Answer 8

1. Chronic emphysema: Resp Acid
2. Daily antacids use: Meta Alk
3. Anxiety disorder: Resp Alk
4. Salicylate intox: Meta Acid

Question 9

Frequent tonic clonic seizures and apnea. Alert for which Acid- Base disorder

Answer 9

Metabolic Acidosis

Hypoxemia from apena, cells contine to break down glucose without Oxygen (Anaerobic Metabolism) Incomplete glucose breakdown forms Lactic acid as byproduct- Hence Metabolic Acidosis