Chapter 26 Alterations in Fluid and Electrolyte Balance

Question 1

1) The nurse is planning the care of a 50-year-old patient with the risk of developing fluid volume deficit. Which assessment finding would have the greatest contribution to this risk?
1. Loose bowel movement one per day
2. First-degree steam burn on hand and forearm
3. Temperature of 99.6°F
4. Diuretic therapy two doses per day

Answer 1

Answer: 4
Explanation: 1. Diarrhea does contribute to fluid volume deficit, but one loose bowel movement per day does not constitute diarrhea.
2. Burns also can cause a fluid volume deficit, but it is unlikely that a first-degree burn on the hand and forearm will produce a significant amount of fluid loss.
3. Fever does increase fluid loss, but this is a low-grade temperature so the effect would be minimal.
4. The patient receiving two doses of diuretic therapy per day is at risk for high volumes of urine output that could increase the risk of developing a fluid volume deficit.

Question 2

2) A patient in the intensive care unit has developed gastrointestinal hemorrhage. The nurse would prepare to fluid resuscitate this patient with which intravenous fluid?
1. 5% dextrose and 0.45% normal saline
2. 2.5% dextrose
3. 0.45% normal saline
4. 0.9% normal saline

Answer 2

Answer: 4
Explanation: 1. The solution 5% dextrose and 0.45% normal saline is a hypertonic solution and is not the best choice for expanding the patient’s blood volume.
2. The 2.5% dextrose is a hypotonic solution and would not help expand the patient’s blood volume.
3. The 0.45% normal saline is a hypotonic solution and would not help expand the patient’s blood volume.
4. The patient needs an isotonic solution to expand the blood volume. The appropriate intravenous solution is 0.9% normal saline.

Question 3

3) The nurse is assessing the effectiveness of fluid replacement therapy in a patient who has a fluid volume deficit. Which assessment findings would indicate the therapy is effective?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Blood pressure 90/48 mm Hg
2. Weight gain of 2 pounds since yesterday
3. Urine output increase to 40 mL per hour
4. Tenting of skin
5. Serum osmolality of 284 mOm/kg

Answer 3

Answer: 2, 3, 5
Explanation: 1. Low blood pressure indicates that the therapy has not been effective.
2. Increase in weight of 2 pounds in 1 day indicates a change in fluid balance.
3. Increase in urine output indicates improvement of fluid balance status.
4. Tenting of skin indicates poor skin turgor and fluid volume deficit.
5. Normal serum osmolality is 280-300 mOm/kg. Presence of normal serum osmolality indicates normal fluid volume status.

Question 4

4) A patient with fluid volume excess has a hemoglobin level of 9 mg/dL. How would the nurse explain the more likely cause of this laboratory value?
1. An undiagnosed bleeding disorder exists.
2. The patient has chronic anemia.
3. The patient has iron deficiency anemia.
4. Plasma dilution has occurred due to excess fluid.

Answer 4

Answer: 4
Explanation: 1. While this may be the case, it is not the most likely reason for this lab value.
2. While this may be the case, it is not the most likely reason for this lab value.
3. While this may be the case, it is not the most likely reason for this lab value.
4. Since this patient has fluid volume excess, the most likely etiology of a low hemoglobin level is plasma dilution from excess extracellular fluid volume

Question 5

5) A patient being treated for fluid volume excess has blood glucose elevation. The nurse would review the patient’s medication history for which medication?
1. Furosemide (Lasix)
2. Spironolactone (Aldactone)
3. Potassium chloride (K-Dur)
4. Hydrochlorothiazide (Esidrix)

Answer 5

Answer: 4
Explanation: 1. Furosemide does not cause hyperglycemia.
2. Spironolactone does not result in hyperglycemia.
3. Potassium supplements do not cause hyperglycemia.
4. Hydrochlorothiazide has hyperglycemia as a major side effect.

Question 6

6) A patient comes into the emergency department with complaints of feeling weak, confused, and having abdominal cramps after spending several hours in the hot sun attending a baseball game. The patient’s blood pressure is 96/58 mm Hg. The nurse would conduct additional assessment for which condition?
1. Hyponatremia
2. Hypercalcemia
3. Hypernatremia
4. Hypocalcemia

Answer 6

Answer: 1
Explanation: 1. Manifestations of hyponatremia include hypotension, confusion, headache, lethargy, seizures, decreased muscle tone, muscle twitching, tremors, vomiting, diarrhea, and cramping. The patient is complaining of feeling weak and confused with abdominal cramps, which are symptoms associated with hyponatremia. The blood pressure of 96/58 mm Hg is another indication of hyponatremia. Because of these findings and the patient history, the nurse should assess for additional symptoms of hyponatremia.
2. The symptoms and the patient history do not suggest hypercalcemia.
3. Manifestations of hypernatremia include hypertension, thirst, nausea, and vomiting. Hypernatremia would be unlikely in the patient with this history.
4. These symptoms and this history do not support a diagnosis of hypocalcemia.

Question 7

7) The nurse is preparing intravenous fluids for a patient whose serum sodium is 156 mmol/L. Which types of fluid would the nurse select?
1. 10% dextrose in water
2. Lactated Ringer’s
3. 0.45% normal saline
4. 5% dextrose and 0.45% normal saline

Answer 7

Answer: 3
Explanation: 1. Hypertonic solutions such as 10% dextrose in water are not used to treat hypernatremia.
2. Lactated Ringer’s is an isotonic solution and would not be effective when treating hypernatremia.
3. To effectively treat hypernatremia, the patient will need to be provided with hypotonic intravenous fluids. The fluid 0.45% normal saline is a hypotonic fluid.
4. Hypertonic fluids such as 5% dextrose and 0.45% normal saline would not be used to treat hypernatremia.

Question 8

8) A patient is receiving several units of packed red blood cells over several days to replace the blood lost during an active gastrointestinal bleed. The nurse would assess this patient for findings associated with which electrolyte imbalance?
1. Hyponatremia
2. Hypercalcemia
3. Hypokalemia
4. Hypomagnesaemia

Answer 8

Answer: 4
Explanation: 1. Blood is administered with normal saline so hypernatremia would be a more likely condition.
2. Blood administration is not a primary cause of hypercalcemia.
3. Blood transfusion is not a likely cause of hypokalemia.
4. Hypomagnesaemia can be induced by the administration of large amounts of stored blood because stored blood is preserved with citrate. Citrate is added to stored blood as a preservative.

Question 9

9) A patient has a serum calcium level of 7.9 mg/dL. Which nursing interventions would be appropriate for this patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Treat tachycardia.
2. Monitor for the development of hypertension.
3. Place on seizure precautions.
4. Strain all urine.
5. Reorient as indicated.

Answer 9

Answer: 3, 5
Explanation: 1. Bradycardia is the expected result of this calcium level.
2. Hypotension is the expected effect of this calcium level.
3. A serum calcium level of less than 8.5 mg/dL is indicative of hypocalcemia. Nursing interventions appropriate for the patient would include monitoring the patient for seizures.
4. Straining urine is associated with the possibility of kidney stones. This calcium level is not associated with kidney stone development.
5. This calcium level indicates hypocalcemia. Reduced cognitive ability is a common finding associated with hypocalcemia. The nurse should reorient this patient as needed.

Question 10

10) A patient has a serum calcium level of 11 mg/dL. The nurse would review this patient’s medical record for which conditions?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. History of taking thiazide diuretics
2. Diagnosis of hyperparathyroidism
3. Diagnosis of acute pancreatitis
4. Low serum magnesium level
5. Long-term bedrest

Answer 10

Answer: 1, 2, 5
Explanation: 1. Hypercalcemia may result from use of thiazide diuretics.
2. Primary hyperparathyroidism is associated with hypercalcemia.
3. The diagnosis acute pancreatitis is associated with hypocalcemia.
4. A low serum magnesium level often occurs with hypocalcemia.
5. Immobility can cause hypercalcemia.

Question 11

11) The nurse caring for a patient receiving digoxin plans to monitor which electrolyte because of increased risk of digitalis toxicity?
1. Potassium
2. Chloride
3. Calcium
4. Sodium

Answer 11

Answer: 1
Explanation: 1. In patients receiving digoxin therapy, low serum potassium levels can increase the risk for development of dysrhythmias.
2. Chloride levels do not increase risk for digitalis toxicity.
3. Calcium levels do not increase risk for digitalis toxicity.
4. Sodium levels do not increase risk for digitalis toxicity

Question 12

12) The nurse is concerned that a patient’s arterial blood carbon dioxide level is increasing because this can contribute to the development of which electrolyte imbalance?
1. Hyperkalemia
2. Hypokalemia
3. Hypercalcemia
4. Hypocalcemia

Answer 12

Answer: 1
Explanation: 1. A rise in arterial blood carbon dioxide is a diagnostic indicator of acidosis. Acidosis contributes to hyperkalemia because excess hydrogen ions shift into the cells, forcing potassium out into the serum. The nurse should be concerned about the patient developing hyperkalemia.
2. Acidosis does not contribute to the development of hypokalemia.
3. Acidosis does not contribute to the development of hypercalcemia.
4. Acidosis does not contribute to the development of hypocalcemia.

Question 13

13) A patient’s electrocardiogram reveals a prolonged P-R interval and ST segment depression. The nurse should review laboratory results for which electrolyte imbalance?
1. Hypokalemia
2. Hyperkalemia
3. Hypocalcemia
4. Hypernatremia

Answer 13

Answer: 2
Explanation: 1. Prolongation of the PR interval is not an ECG finding associated with hypokalemia.
2. Cardiovascular manifestations of hyperkalemia include prolonged P-R interval; flat or absent P wave; slurring of QRS; tall peaked T wave; and ST segment depression.
3. Hypocalcemia causes prolongation of the QT interval and a long ST segment.
4. Cardiovascular manifestations of hypernatremia include hypertension and tachycardia.

Question 14

14) A patient is demonstrating tremors and a positive Chvostek’s sign even though the serum calcium level is low normal. The nurse would review the medical record for which electrolyte imbalance?
1. Low phosphate
2. Low potassium
3. Low magnesium
4. Elevated sodium

Answer 14

Answer: 3
Explanation: 1. A positive Chvostek’s sign is associated with hyperphosphatemia.
2. Potassium levels are not associated with a positive Chvostek’s sign.
3. The symptoms associated with a low magnesium level are similar to those seen in a low calcium level. Therefore, the nurse should suspect that the patient is experiencing a low magnesium level since tremors and a positive Chvostek’s sign are also seen with a low calcium level.
4. Sodium level is not associated with a positive Chvostek’s sign.

Question 15

15) A patient diagnosed with chronic renal failure has a magnesium level of 6 mg/dL. Which history data would the nurse evaluate as contributing to this electrolyte imbalance?
1. The patient had an episode of nasal congestion last week and took decongestant.
2. The patient had a recent sprain injury treated with rest and compression wrapping.
3. The patient has been trying to reduce intake of caffeine-containing fluids.
4. The patient has been taking over-the-counter laxative for chronic constipation.

Answer 15

Answer: 4
Explanation: 1. Taking a decongestant would not contribute to hypermagnesemia.
2. A sprain injury treated with rest and compression would not cause hypermagnesemia.
3. Reduction of caffeine-containing beverages would not contribute to hypermagnesemia.
4. Many over-the-counter laxatives contain magnesium. Chronic overuse of these laxatives may result in hypermagnesemia.

Question 16

16) A patient who was admitted to the intensive care unit has a magnesium level of 8.4 mg/dL. The nurse would prepare for which interventions?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Maintenance of strict bedrest
2. Administration of insulin
3. Observation for fluid volume excess
4. Intravenous administration of magnesium
5. Initiation of dialysis

Answer 16

Answer: 3, 5
Explanation: 1. While ambulation may not be indicated for this patient due to changes in neuromuscular function, strict bedrest is not required. The patient may be able to sit on the side of the bed, use a bedside commode, or sit in a bedside chair.
2. Insulin is not used in the treatment of hypermagnesemia. It may be used in the treatment of hyperkalemia.
3. The nurse must plan to observe for findings associated with the common complication of fluid volume excess.
4. This magnesium level is elevated, so additional magnesium is not indicated.
5. Dialysis may be required to remove magnesium in severe cases.

Question 17

17) A patient with a history of heart failure is admitted with dehydration, malnutrition, and fatigue. The nurse learns that the patient has been taking multiple doses of a thiazide diuretic. The nurse would review laboratory reports for which electrolyte imbalance?
1. Hypernatremia
2. Hypophosphatemia
3. Hypocalcemia
4. Hypermagnesemia

Answer 17

Answer: 2
Explanation: 1. Hypernatremia is not associated with dehydration.
2. Hypophosphatemia is associated with malnourished states and is a relatively common imbalance in the high-acuity patient. Other conditions that can cause hypophosphatemia include those disorders that cause hypercalcemia, such as taking thiazide diuretics.
3. Thiazide diuretics can cause hypercalcemia.
4. Dehydration, malnutrition, and fatigue are not directly linked to hypermagnesemia.

Question 18

18) A hospitalized patient has a phosphorus level of 4.8 mg/dL. The nurse would review this patient’s history for the presence of which conditions?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Chronic kidney failure
2. Hyperthyroidism
3. Recent cardiac surgery
4. Alcoholism
5. Treatment for gram-negative sepsis

Answer 18

Answer: 1, 2
Explanation: 1. Hyperphosphatemia is predominantly associated with chronic kidney failure.
2. Hyperthyroidism can precipitate hypocalcemia, which leads to hyperphosphatemia.
3. Cardiac surgery is associated with hypophosphatemia.
4. Alcoholism is associated with hypophosphatemia.
5. Gram-negative sepsis is associated with hypophosphatemia.

Question 19

19) A patient admitted with hyperphosphatemia is to be treated with the administration of intravenous fluids. Which fluid would the nurse anticipate providing?
1. 0.9% normal saline
2. Lactated Ringer’s solute
3. 5% dextrose and 0.25% normal saline
4. 5% dextrose and water

Answer 19

Answer: 1
Explanation: 1. Treatment of hyperphosphatemia is directed at lowering serum levels. This is accomplished by either administering agents that bind phosphate in the gastrointestinal tract or administering an intravenous solution with saline, since saline promotes the renal excretion of phosphate. The intravenous solution of choice for this patient would be 0.9% normal saline.
2. Lactated Ringer’s solution does not provide the most benefit to this patient.
3. 5% dextrose and 0.25% normal saline is not the best fluid choice as it has insufficient amounts of an essential ingredient.
4. 5% dextrose and water is not the best fluid choice as it lacks an essential ingredient.

Question 20

20) Potassium phosphate IV has been prescribed for a patient who has hypophosphatemia. Which nursing interventions are indicated when administering this medication?
1. Dilute the dose in 100 mL of normal saline (NS) and administer over 20 minutes.
2. Monitor the patient for respiratory distress.
3. Monitor for the development of hypotension.
4. Ensure that pharmacy has mixed the medication with a local anesthetic.

Answer 20

Answer: 2
Explanation: 1. The dose should be diluted in 500 mL of 0.45 NS and given over 6 hours.
2. Replacement of phosphorus may cause respiratory changes. The patient should be monitored for respiratory distress.
3. Hypotension is not an expected effect of phosphorus replacement.
4. There is no indication that mixing this medication with a local anesthetic is required.