ADULT HEALTH - FLUIDS Flashcards
The nurse is caring for a client with a phosphorus level of 5.3 mg/dL. The nurse identifies which of the following as possible causes of this condition? Select all that apply.
A. Tumor lysis syndrome
B. Hypoparathyroidism
C. Hypercalcemia
D. Renal failure
E. Anorexia
Explanation
Choices A, B, and D are correct.
A is correct. This client has a phosphorus level of 5.3, which is greater than the normal 3.0-4.5 mg/dL. Tumor lysis syndrome can cause increased phosphorus levels, because when a tumor lyses the cellular contents (including phosphorus) are spilled out into the blood causing an increase in their serum levels.
B is correct. Hypoparathyroidism is a cause of hyperphosphatemia. The client who experiences hypoparathyroidism has too little parathyroid hormone (PTH). PTH regulates the serum calcium concentration through its effects on the bones, kidneys, and intestines. When there is too little PTH, there are decreased calcium levels or hypocalcemia. Because calcium and phosphorus have an inverse relationship, when there are low levels of calcium there are high levels of phosphorus. Thus, hypoparathyroidism causes hyperphosphatemia.
C is incorrect. Hypercalcemia is a cause of hypophosphatemia. This client has a phosphorus level of 5.3, which is greater than the normal 3.0-4.5 mg/dL, not less than. Phosphorus and calcium have an inverse relationship, when there are high levels of calcium there are low levels of phosphorus. Thus, hypercalcemia would cause hypophosphatemia.
D is correct. Renal failure is a cause of hyperphosphatemia. Due to reduced kidney function, phosphorus is not able to be excreted as readily as it normally would, and increased levels of phosphorus build up in the blood causing hyperphosphatemia.
E is incorrect. Anorexia is a cause of hypophosphatemia due to poor dietary intake.
NCSBN Client Need: Reduction of Risk Potential
Topic: Lab Values
Subtopic: Potential for Alterations in Body Systems
Subject: Fundamentals of care
Lesson: Fluids & Electrolytes
Which risk factor relating to fluid and electrolyte imbalances is accurately paired with its specific fluid or electrolyte disorder? Select all that apply.
A. Hypermagnesemia: Alcoholism
B. Hypomagnesemia: Cushing’s syndrome
C. Hyperkalemia: Renal failure
D. Hypokalemia: Hypomagnesemia
E. Hypernatremia: Dehydration
F. Hyponatremia: Diarrhea
G. Hypercalcemia: Hypoparathyroidism
H. Hypocalcemia: Hypomagnesemia
Explanation
Choices C, D, E, F, and H are correct.
The risk factors/causes of fluid and electrolyte imbalances that are paired accurately are:
Hyperkalemia: Renal failure (Choice C) is correct. Hyperkalemia is a common finding seen in renal failure and may be life-threatening. Adequate kidney function is necessary to excrete potassium. End-stage renal disease (ESRD) is often characterized by hyperkalemia, fluid overload, metabolic acidosis, and pulmonary congestion. Dialysis is indicated in ESRD to eliminate excess fluid, excess acid, and excess potassium.
Hypokalemia: Hypomagnesemia (Choice D) and Hypocalcemia: Hypomagnesemia (Choice H) are correct. Hypomagnesemia is often associated with hypokalemia and hypocalcemia. Untreated hypomagnesemia may lead to treatment-refractory hypokalemia. The mechanism for hypomagnesemia-induced hypokalemia involves increased urinary potassium wasting via collecting duct cells due to a reduction in intracellular magnesium.
Hypomagnesemia can also cause hypocalcemia. Magnesium is necessary for the production and release of parathyroid hormone. Magnesium deficiency results in decreased production of parathyroid hormone and consequently, secondary hypocalcemia.
It is important to always look for and correct hypomagnesemia when treating hypokalemia, and hypocalcemia.
Hypernatremia: Dehydration (Choice E) is correct. Dehydration results in loss of free water more than the sodium and often, causes hypovolemic hypernatremia. Hypernatremia increases serum osmolality. Increased osmolality triggers Anti-Diuretic Hormone (ADH) release. ADH helps the body to conserve water and concentrates the urine.
Hyponatremia: Chronic Diarrhea (Choice F) is correct. Hypovolemic hyponatremia can occur with chronic diarrhea or persistent nausea/ vomiting. Chronic diarrhea results in loss of sodium and water. Ensuing decreased intravascular fluid volume triggers ADH release. ADH causes kidneys to retain free water further aggravating hyponatremia.
Choice A is incorrect. Alcoholism leads to hypomagnesemia, not hypermagnesemia. Hypermagnesemia is an uncommon electrolyte imbalance. Risk factors/ causes of hypermagnesemia include renal failure, adrenal insufficiency (Addison’s disease), hypothyroidism, drugs like Lithium, and increased intake of magnesium salts/ magnesium-containing laxatives.
Choice B is incorrect. A risk factor that is associated with hypomagnesemia is alcoholism, not Cushing’s syndrome. Other risk factors of hypomagnesemia include refeeding syndrome, diuretic use, and proton pump inhibitor (PPI) use.
Choice G is incorrect. Hypoparathyroidism causes hypocalcemia, not hypercalcemia. Decreased parathyroid hormone (PTH) results in decreased calcium and increased phosphorous.
Some risk factors/ causes associated with hypercalcemia include hyperparathyroidism, thiazide diuretics, malignancy (myeloma, metastatic cancer), milk-alkali syndrome, vitamin d toxicity, and sarcoidosis.
Reference:
Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice (10th Edition)
Your client is a patient with low potassium levels and accelerated hypertension. The physician has listed the cause as “hyperaldosteronism.” Which of the following endocrine disorders cause an increased amount of aldosterone? Select all that apply.
A. Cushing’s disease
B. Addison’s disease
C. Conn’s syndrome
D. Pheochromocytoma
Explanation
Choices A and C are correct.
Cushing’s disease (Choice A) is caused by an increased secretion of adrenocorticotropic hormone (ACTH) from the pituitary gland. Increased ACTH causes increased stimulation and hyperplasia of the adrenal cortex. This leads to increased levels of both glucocorticoids(cortisol) and mineralocorticoids(aldosterone). The physician may order ACTH and Cortisol levels to establish the diagnosis of Cushing’s disease. Clinical symptoms include abdominal obesity, moon facies, neck hump, abdominal striae, increased blood glucose, secondary diabetes, hypertension, and Hypokalemia. Other manifestations include Osteoporosis and increased risk of fractures. Clients are prone to increased risk of infections because excess steroids (cortisol) cause immunosuppression.
Cushing’s disease accounts for 65 to 70 percent of all Cushing’s syndrome. Please do not confuse Cushing’s disease with Cushing’s syndrome (Cushing’s syndrome can be ACTH-dependent or ACTH-independent. It includes Cushing’s disease as well as other causes of increased cortisol and non-pituitary causes of increased ACTH. In non-pituitary, ACTH-independent Cushing’s syndrome cases, aldosterone levels may be low instead of high). Another entity called iatrogenic Cushing’s syndrome refers to a condition resulting from prolonged and excessive use of exogenous steroids. This is quite common due to the widespread use of steroids in many autoimmune diseases like Lupus, Rheumatoid arthritis, etc. Iatrogenic Cushing’s is associated with decreased ACTH due to negative feedback on the pituitary gland.
Conn’s disease (choice C), or primary hyper-aldosteronism, is a disease where increased secretion of aldosterone occurs due to hyperplasia or aldosterone-secreting tumors involving the cortex. Please see the adrenal anatomy below to understand the zones of hormone production. Hyperplasia of the entire adrenal cortex would produce both glucocorticoids(cortisol) and mineralocorticoids(aldosterone) whereas, hyperplasia/ tumor of zona glomerulosa alone would cause an increase in aldosterone without affecting cortisol levels. 24-hour urinary aldosterone levels help make the diagnosis of Conn’s syndrome.
The above two conditions (Cushing’s disease and Conns’ syndrome) lead to secondary hypertension because the aldosterone hormone increases sodium and water retention in the body. While retaining sodium, aldosterone causes loss of potassium via the kidneys. Hyperaldosteronism is, therefore, associated with Hypokalemia. Hypertension and Hypokalemia may help the physician suspect hyperaldosteronism.
Choice B is incorrect. Addison’s disease is autoimmune destruction of the adrenal cortex. The resulting adrenal insufficiency would cause low levels of cortisol and aldosterone. There is a reflex increase in ACTH due to feedback from the Adrenal gland. Clinical manifestations of Addison’s disease include fatigue, diarrhea, hyperpigmentation, and hypotension (opposite of hyperaldosteronism). Hypoaldosteronism can be associated with hyperkalemia (elevated potassium levels), hyponatremia (low sodium levels), and mild metabolic acidosis.
Choice D is incorrect. Pheochromocytoma is a tumor of Adrenal Medulla. Since medulla produces catecholamines, cancer involving this area is associated with high levels of Adrenaline and Nor-adrenaline. Adrenal medulla does not produce aldosterone. Therefore, secondary refractory hypertension in Pheochromocytoma is mediated by Catecholamine excess, not by aldosterone excess.
NCSBN Client Need:
Topic: Physiological Integrity; Subtopic: Physiological adaptation
Reference: DeWit, S. C., Stromberg, H., & Dallred, C. (2016). Medical-surgical nursing: Concepts & practice. Elsevier Health Sciences.
The nurse is assisting in the placement of an indwelling Foley catheter in a male patient. The nurse knows to inflate the balloon on the catheter at which step in the procedure?
A. Upon meeting resistance
B. As soon as urine is observed in the tubing
C. After advancing to the point of bifurcation
D. After fully advancing the length of the catheter
Explanation
Answer: C
A is incorrect. It is not appropriate to inflate the balloon on the catheter upon meeting resistance. In a male client, this could cause serious trauma to the urethra. The nurse must ensure that the catheter is fully inside the bladder before the balloon is inflated.
B is incorrect. It is not appropriate to inflate the balloon on the catheter as soon as urine is observed in the tubing. The catheter will not be fully in the bladder as soon as urine is observed, and inflating the balloon at this point would cause trauma.
C is correct. The nurse should inflate the balloon on the catheter once she reaches the point of bifurcation. This is achieved by slowly advancing the catheter, observing the tubing for urine to appear, and then continuing to advance to the point of bifurcation after urine is observed. This will ensure the balloon is in the bladder before the nurse inflates it.
D is incorrect. It is not appropriate to fully advance the length of the catheter in every client. The length of the urethra and distance to the bladder will vary, and therefore the catheter will be advanced different lengths depending on the client. Fully advancing the catheter could result in an excessive length of the catheter sitting in the bladder, which can cause pain and irritation to the client.
NCSBN Client Need:
Topic: Reduction of Risk Potential
Subtopic: Potential for Complications of Diagnostic Tests/Treatments/Procedures
Subject: Fundamentals
Lesson: Elimination
The nurse is reviewing clients laboratory findings and notes that one client has a serum calcium level of 7.2 mg/dL. The nurse knows which of the following clients are most likely to have this lab result? Select all that apply.
A. The patient with breast cancer and bone metastases
B. The patient with obesity
C. The patient with Vitamin D toxicity
D. The patient with hypoparathyroidism
E. Patient with chronic renal failure
Explanation
Answer: D and E
A is incorrect. The client with malignancy and bone metastases are more likely to have hypercalcemia, not hypocalcemia. This is due to bone destruction from osteoclasts and the leak of calcium into blood. In addition, malignancies often cause “paraneoplastic hypercalcemia” by secreting substances called “PTH-related peptides” that have actions similar to Parathormone ( PTH).
B is incorrect. Obesity is not a risk factor for hypocalcemia. Malnutrition and malabsorption, such as in celiac and crohn’s disease patients, can cause hypocalcemia due to decreased absorption, but obesity would not cause this.
C is incorrect. The patient with Vitamin D toxicity would put a client at risk for hypercalcemia, or a serum calcium level greater than 10.2 mg/dL. This is due to the relationship between Vitamin D and calcium; Vitamin D enhances the absorption of calcium. Therefore, Vitamin D toxicity would lead to increased absorption of calcium and a hypercalcemic state.
D is correct. The client with hypoparathyroidism is most likely to suffer from hypocalcemia. The normal calcium level is 8.4-10.2 mg/dL, so with this client’s level of 7.2 they have too little calcium in the blood. The client who experiences hypoparathyroidism has too little parathyroid hormone (PTH). PTH regulates the serum calcium concentration through its effects on the bones, kidneys, and intestines. When there is too little PTH, there are decreased calcium levels, or hypocalcemia.
E is correct. Hypocalcemia is a common problem in chronic renal failure and end-stage renal disease (ESRD). There are two reasons for hypocalcemia in kidney disease: increased phosphorus and decreased renal production of activated Vitamin D (1,25 Dihydroxy vitamin D). Phosphorus accumulates in renal failure. Hyperphosphatemia results in binding to calcium and precipitates as calcium phosphate in tissues and bones, causing hypocalcemia. The kidney is responsible for activating Vitamin D and restoring calcium balance. In the setting of renal diseases, one loses the capacity to activate vitamin D and calcium level drops. For these reasons, physicians often order phosphate binders to reduce phosphorus and calcitriol (activated vitamin D, 1,25 Dihydroxy vitamin D) in chronic renal failure/ ESRD.
NCSBN Client Need:
Topic: Reduction of Risk Potential
Subtopic: Diagnostic Tests
Subject: Fundamentals of care
When reviewing your client’s labs in the morning, you note that his magnesium level is 3.4 mEq/L. On exam, his reflexes are decreased. Which of the following actions is appropriate? Select all that apply.
A. Administer calcium gluconate.
B. Repeat another level stat and continue monitoring
C. Notify the healthcare provider.
D. Administer Sevelamer hydrochloride.
Explanation
Choices A and C are correct. This magnesium level is critically high and must be addressed immediately. Calcium gluconate is administered as a treatment for hypermagnesemia and is appropriate to deliver as ordered. The healthcare provider should be notified right away. Decreased reflexes, headaches, confusion, and hypotension, may be seen with moderate hypermagnesemia.
B is incorrect. It is not appropriate to repeat another level and simply continue to monitor this patient. The patient is exhibiting symptoms, and magnesium level is critically high and must be addressed immediately.
D is incorrect. Sevelamer hydrochloride is not an appropriate medication in this situation. Sevelamer hydrochloride is a phosphate binder administered for hypocalcemia.
NCSBN Client Need:
Topic: Physiological Integrity; Subtopic: Pharmacological therapies
Reference: DeWit, S. C., Stromberg, H., & Dallred, C. (2016). Medical-surgical nursing: Concepts & practice. Elsevier Health Sciences.
The nurse is caring for a female client who is incontinent of urine. The MD orders an indwelling Foley catheter to be placed. Place the following actions in the correct order for the nurse to appropriately insert the Foley catheter:
Perform hand hygiene, identify the patient, explain the procedure to the patient, and prepare the insertion kit using sterile gloves.
Spread the labia and hold them open.
Cleanse the meatus from front to back on the right side, then left side, and down the center.
Insert the catheter and inflate the balloon.
Secure the catheter to the patient, and initial the securement device with the date and time.
Explanation
Answer: B, C, A, D, E
First: the nurse should perform hand hygiene, identify the client using 2 patient identifiers, explain the procedure to the client, and prepare the insertion tray using sterile gloves. Second: The nurse uses her nondominant hand (now dirty) to spread the labia and hold them open. Third: the nurse uses her dominant hand (sterile) to cleanse the meatus from front to back on the right side, then left side, then down the center. Fourth: the nurse will insert the catheter, wait for a urine return, and inflate the balloon. Last: the nurse will secure the catheter to the leg and place their initials, date, and time on the securement device.
NCSBN Client Need:
Topic: Reduction of Risk Potential
Subtopic: Potential for Complications of Diagnostic tests/Treatments/Procedures
Subject: Adult Health
Lesson: Genitourinary
The nurse is attending a newly admitted patient with a diagnosis of Hyponatremia.Which of the following should the nurse expect to assess in this patient?
A. Orthostatic hypotension.
B. Blood serum sodium level 148 mEq/L
C. Muscle twitching.
D. Increased thirst.
Explanation
Choice A is correct. The nurse should assess the client for the presence of orthostatic hypotension. Orthostatic hypotension is often seen in association with hyponatremia. The presence of orthostatic hypotension usually indicates hypovolemic status. The nurse must assess the volume status while evaluating a client with hyponatremia because it helps to differentiate between hypovolemic, euvolemic, and hypervolemic hyponatremia. Separating these will help in planning nursing and treatment interventions.
Orthostatic or postural hypotension refers to a significant decrease in systolic blood pressure of greater than 20 mmHg or a reduction of at least ten mmHg in diastolic pressure upon 3 to 5 minutes of standing. Often, it indicates hypovolemia.
Hyponatremia refers to sodium level lower than 135 mEq/L. Hyponatremia may be secondary to several causes; however, it is possible to get clues regarding the cause of hyponatremia by determining the type of Hyponatremia. Sodium and water go together. Sodium tends to draw and keep water with it—the decrease in sodium relative to free water results in hyponatremia.
Hyponatremia is classified into three types:
By knowing the type of hyponatremia, appropriate treatment intervention can be planned.
Hypovolemic Hyponatremia: Correcthypovolemia with Isotonic (0.9%) Normal saline. In severe cases of symptomatic hypovolemic hyponatremia, 3% (hypertonic) saline is used. Euvolemic Hyponatremia: Ask the client to restrict free water. Physicians may order medications such as demeclocycline or Tolvaptan. Hypervolemic hyponatremia: Ask the client to restrict free water intake. Diuretics may be administered to clear retained fluid.
Choice B is incorrect. Normal sodium is 135-145 mEq/L. A sodium level of 148 mEq/L would be a result found in hypernatremia (high sodium), not hyponatremia.
Choice C is incorrect. Muscle twitching would be found more commonly in hypernatremia, not Hyponatremia. Muscle twitches are likely due to excess sodium leading to irregular contraction of muscles. Hypernatremia often involves dehydration, and acute hypernatremia may be associated with confusion, muscle twitches, and seizures.
Hyponatremia is typically asymptomatic unless it is acute or severe (<120 mEq/L). A sharp fall in serum sodium may cause a free water shift from the intravascular to the interstitial space, resulting in cerebral edema. In such cases, patients may present with symptoms of increased intracranial pressure such as nausea, vomiting, headache, agitation, lethargy, seizures, coma, or death.
Choice D is incorrect. Increased thirst occurs in hypernatremia due to the body’s attempt to increase fluid intake and balance sodium levels. This is not a common finding in hyponatremia.
Reference: (DiGiulio & Keogh, 2014, p. 407)
The nurse is assigned to care for a client with hypophosphatemia. Which complications of this electrolyte imbalance should the nurse assess for in the client? Select All That Apply.
A. Rhabdomyolysis
B. Seizures
C. Osteopenia
D. Fractures
E. Arrhythmias
Explanation
Choices A, B, C, D and E are correct.
A is correct. Rhabdomyolysis is a serious complication of hypophosphatemia. When a client is suffering from severe hypophosphatemia, the available phosphorus is used to generate ATP. Consequently, the muscle cells are unable to maintain membrane integrity, and rhabdomyolysis can form.
B is correct. Seizures are a serious complication of hypophosphatemia. This only occurs with very severe, or acute, hypophosphatemia where there is neurologic instability. Other findings can include numbness and reflexive weakness.
C is correct. Osteopenia is a serious complication of hypophosphatemia. This is because hypophosphatemia leads to incomplete bone mineralization and, therefore, over time, can cause osteopenia if it goes untreated.
D is correct. Fractures are a serious complication of hypophosphatemia. This is because hypophosphatemia leads to incomplete bone mineralization, which can cause fractures to clients’ bones under normal stress.
E is correct. Arrhythmias are a serious complication hypophosphatemia. This is because hypophosphatemia can lead to muscle damage in the heart.
NCSBN Client Need: Reduction of Risk Potential
Topic: Potential for Alterations in Body Systems
Subject: Fundamentals of care
Lesson: Fluids & Electrolytes
The nurse is reviewing the results of her patient’s basic metabolic panel and notes a potassium level of 5.7 mEq/L. She knows that which of the following conditions could cause this result? Select all that apply.
A. Cushing’s disease
B. Continuous NG tube suction
C. Severe dehydration
D. Hyperinsulinism
Explanation
Answer: C
The normal level for potassium is 3.5 to 5. This patient has a potassium level of 5.7, indicating hyperkalemia.
A is incorrect. Cushing’s disease is likely to cause hypokalemia, not hyperkalemia. In this disease the adrenal glands produce too much aldosterone. Aldosterone causes the body to excrete potassium, putting patients with Cushing’s disease at risk for excessive potassium losses leading to hypokalemia.
B is incorrect. The patient with an NG tube to continuous suction is likely to experience hypokalemia, not hyperkalemia. NG tube suction removes all of the gastric contents, which are rich in potassium. With those excessive potassium losses, the patient becomes hypokalemic.
C is correct. Severe dehydration is a potential cause of hyperkalemia. When a patient is severely dehydrated (from vomiting, diarrhea, profuse sweating, etc.), potassium is lost and large amounts of fluid are lost. While this patient is experiencing a fluid volume deficit, the concentration of potassium in their blood is elevated, which is why they are hyperkalemic.
D is incorrect. Hyperinsulinism is likely to experience hypokalemia, not hyperkalemia. Insulin is a hormone secreted by the pancreas that facilitates the movement of insulin into cells. With it comes potassium, and therefore when there is too much insulin as there is in hyperinsulinism, too much potassium is moved into the cells and the serum potassium level drops causing hypokalemia.
NCSBN Client Need:
Topic: Physiological Integrity
Subtopic: Physiological adaptation
Reference: Cooper, K., & Gosnell, K. (2019). Study Guide for Foundations and Adult Health Nursing-E-Book. Elsevier Health Sciences.
Subject: Fundamentals of care
Lesson: Fluids & Electrolytes
The nurse is assigned the care of a client with a sodium level of 122 mEq/L. Which assessment findings does the nurse anticipate based on this lab result? Select all that apply.
A. Confusion
B. Abdominal cramps
C. Increased urine output
D. Hypoactive bowel sounds
E. Nausea and vomiting
Explanation
Answer: A, B, and E
A is correct. A sodium level of less than 135 mEq/L is indicative of hyponatremia - too little sodium in the blood. When sodium falls below 125 mEq/L, it is considered “severe” hyponatremia. Confusion is a common neurological symptom of acute or severe hyponatremia. Sodium plays a very important role in the brain, and low levels of this electrolyte can be devastating producing symptoms ranging from confusion, lethargy, and stupor, to seizures and cerebral edema
B is correct. Abdominal cramps is another symptom of hyponatremia. Because water follows sodium, when there are decreased levels of sodium in the blood there is decreased fluid. This creased a fluid volume deficit, decreased urine output, muscle spasms, and abdominal cramping.
C is incorrect. Increased urine output is not a sign of hyponatremia. Decreased urine output rather would be a symptom the nurse might observe if there are decreased levels of sodium in the blood. This is due to the relationship of sodium with water. With decreased levels of sodium, less water is pulled into the extracellular space and the intravascular volume is decreased causing decreased renal blood flow and therefore decreased urine output.
D is incorrect. Hypoactive bowel sounds are not a sign of hyponatremia. Hyperactive bowel sounds rather would be a symptom the nurse might observe if there are decreased levels of sodium in the blood. Sodium plays an important role in muscle cells as well, and when levels are too low there is cramping, spasms, and hyperactive bowel sounds.
E is correct. Nausea and vomiting are common signs of low sodium levels in the blood or hyponatremia.
NCSBN Client Need: Physiological Adaptation
Topic: Fluid and Electrolyte Imbalances
Subject: Fundamentals of care
Lesson: Fluids & Electrolytes
The nurse is assigned to care for a client with a chloride level of 90 mEq/L. The nurse identifies which of the following as reasons for this electrolyte imbalance? Select all that apply.
A. Fluid volume excess
B. Metabolic acidosis
C. Vomiting
D. Constipation
E. Congestive heart failure
Explanation
Answer: A and C
A is correct. The normal level for chloride is 96-108 mEq/L. Since this client has a level of 90 mEq/L, which is below the normal range, they are experiencing hypochloremia. Fluid volume excess is a cause of hypochloremia. This is due to a dilutional effect. There is not actually less chloride in the blood, but because there is increased fluid volume, there is a dilutional effect causing a relative hypochloremia.
B is incorrect. Metabolic acidosis is not a cause of hypochloremia. Metabolic alkalosis instead can cause hypochloremia.
C is correct. Vomiting is a common cause of hypochloremia. The stomach acid is hydrochloric acid, or HCl. This acid contains large amounts of chloride, and when the client vomits and loses stomach acid, they lose chloride causing hypochloremia. This loss of HCl also causes metabolic alkalosis.
D is incorrect. Constipation does not cause hypochloremia. Diarrhea can cause hypochloremia due to excessive loss of gastrointestinal contents that contain chloride.
NCSBN Client Need: Reduction of Risk Potential
Topic: Laboratory Values
Subject: Fundamentals of care
Lesson: Fluids & Electrolytes
The nurse is caring for a client with a serum magnesium level of 3.2 mg/dL. What does the nurse surmise could be the underlying cause of this electrolyte abnormality? Select all that apply.
A. Renal failure
B. Alcoholism
C. Anorexia
D. Diarrhea
E. Hypothyroidism
Explanation
Answer: A
A is correct. The normal magnesium level is 1.6-2.6 mg/dL. This patient has a level of 3.2, and is experiencing hypermagnesemia. Renal failure can cause hypermagnesemia due to the fact that the process that keeps the levels of magnesium in the body at normal levels does not work properly in people with kidney dysfunction.
B is incorrect. Alcoholism is a risk factor for hypomagnesemia, and this patient has hypermagnesemia. Hypomagnesemia is the most common electrolyte abnormality observed in alcoholic patients. There is a loss of magnesium from tissues and increased urinary loss, and chronic alcohol abuse depletes the total body supply of magnesium.
C is incorrect. Anorexia is a risk factor for hypomagnesemia, and this patient has hypermagnesemia. This is due to malnutrition and a lack of dietary intake of magnesium.
D is incorrect. Diarrhea is a risk factor for hypomagnesemia, and this patient has hypermagnesemia. Magnesium is absorbed in the GI tract, and with diarrhea there is decreased absorption of magnesium leading to hypomagnesemia.
E is correct. Hypothyroidism is a risk factor for hypermagnesemia.
NCSBN Client Need: Reduction of Risk Potential
Topic: Potential for Alterations in Body Systems
The nurse is caring for a client with a magnesium level of 1.1 mg/dL. Which signs and symptoms does the nurse closely monitor for? Select all that apply.
A. Diarrhea
B. Psychosis
C. Tetany
D. Decreased deep tendon reflexes
E. Cardiac arrhythmias
Explanation
Answer: B, C, and E
A is incorrect. While diarrhea can be an initial cause of hypomagnesemia, it is not an assessment finding indicative of magnesium levels already low. Once the client has low magnesium levels, they have decreased GI motility leading to constipation, not diarrhea.
B is correct. Psychosis is an assessment finding consistent with hypomagnesemia. This client’s magnesium level is below normal, 1.6-2.6 mg/dL, therefore the nurse will need to monitor for potential signs and symptoms of hypomagnesemia. From a neurological perspective this can range from confusion to psychosis.
C is correct. Tetany is another assessment finding consistent with hypomagnesemia for which the nurse should monitor. Other neuromuscular assessment findings consistent with hypomagnesemia, include numbness, tingling, seizures, and increased deep tendon reflexes.
D is incorrect. Decreased deep tendon reflexes is not an assessment finding consistent with hypomagnesemia, rather increased deep tendon reflexes would be. Remember, Magnesium calms the body, so when there are low levels of it the patient will be excitable - seizures, increased reflexes, and psychosis can occur.
E is correct. Cardiac arrhythmias can occur with hypomagnesemia due to alterations in the conductivity of heart muscle.
NCSBN Client Need: Reduction of Risk Potential
Topic: Potential for Alterations in Body Systems
Subject: Fundamentals of care
Lesson: Fluids & Electrolytes
The nurse is caring for a client who latest lab results show a serum calcium level of 13.2 mg/dL. Which medication does the nurse expect to administer based on this lab result? Select all that apply.
A. Phosphorus
B. Calcitonin
C. Vitamin D
D. IV calcium gluconate
E. IV Bisphosphonates
Explanation
Answer: A, B and E
A is correct. The normal serum calcium level is 8.4-10.2 mg/dL. This client has a high serum calcium level, or hypercalcemia. Phosphorus is a medication the nurse would expect to administer to treat hypercalcemia. Phosphorus and calcium have an inverse relationship, so by increasing the serum level of phosphorus the nurse can decrease the serum level of calcium. Oral phosphate is the preferred method of administering phosphorus. If given IV, Calcium Phosphate forms and precipitates in the tissues. This “precipitation phenomenon†reduces serum calcium levels very quickly.
B is correct. Calcitonin is a medication the nurse would expect to administer to treat hypercalcemia. Calcitonin is a thyroid hormone that decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.
C is incorrect. Vitamin D should be avoided in hypercalcemia. Vitamin D enhances the absorption of calcium and can therefore increase the level of serum calcium, which we do not want to do when the client’s level already high.
D is incorrect. IV calcium gluconate is given to patients that are hypocalcemic, not hypercalcemic. It can treat the tetany that occurs when a client is severely hypocalcemic. It can also be given to protect the cardiac muscle if a client has severe hyperkalemia or hypermagnesemia.
E is correct. Bisphosphinates are intravenous osteoporosis drugs which can quickly lower calcium levels, and are often used to treat hypercalcemia due to cancer.
NCSBN Client Need: Pharmacological and Parenteral therapies
Topic: Expected Actions/Outcomes
Subject: Medication administration
Lesson: Fluids & Electrolytes
