Electrolytes

Question 1

What the role of sodium (Na) and its expected range?

Answer 1

Maintains B/P, blood volume, and pH balance.

135 - 145 mEq/L

*TIP: think heart happy

Question 2

Sign and symptoms of hypernatremia:

*TIP: “big and bloated”

Answer 2

Skin is dry and flushed
Pitting edema
Low grade fever
Polydipsia (excessive thirst)

Question 3

LATE signs and symptoms of hypernatremia:

Answer 3

Swollen and dry tongue
Nausea/vomiting
Increased muscle tone

Question 4

Signs and symptoms of hyponatremia?

*TIP: “depressed and deflated”

Answer 4

Seizures
Coma
Tachycardia
Weak/thready pulse
Respiratory arrest

*NOTE: Hyponatremia can occur due to too much OR too little fluid.

Question 5

Treatment of hypernatremia due to fluid loss includes:

Answer 5

Administer IV infusions (NS first then D5W slowly)

Restrict fluid and sodium intake as prescribed

Question 6

Treatment of hypernatremia due to inadequate renal secretion of sodium includes:

Answer 6

Administer IV fluids (NS, hypertonic sol.)
Loop diuretics (encourage sodium loss)
Restrict fluid and sodium intake as prescribed

Question 7

Treatment of hyponatremia due to hypovolemia (decreased blood volume) includes:

Answer 7

Give IV sodium chloride infusions (isotonic)

Instruct client to increase oral sodium intake

Question 8

Treatment of hyponatremia due to hypervolemia (increased blood volume) includes:

Answer 8

Osmotic diuretics

Instruct client to increase oral sodium intake

Question 9

What is the role of potassium (K) and its expected range?

Answer 9

Maintains heart and muscle contractions, vital role in metabolism, nerve impulse transmission, and acid-base balance.

3. 5 - 5 mEq/L
   * TIP: think muscles

Question 10

Cardiac signs and symptoms of hyperkalemia:

*TIP: “tight and contracted”

Answer 10

Wide QRS, peaked T wave, and ST elevation

Severe: ventricular fibrillation, cardiac standstill, hypotension, and bradycardia.

Question 11

GI signs and symptoms of hyperkalemia:

*TIP: “tight and contracted”

Answer 11

Diarrhea

Hyperactive BS

Question 12

Neuromuscular signs and symptoms of hyperkalemia:

*TIP: “tight and contracted”

Answer 12

Paresthesias
Paralysis in extremities
Increased DTR
Muscle weakness

Question 13

Cardiac signs and symptoms of hypokalemia:

*TIP: “low and slow”

Answer 13

Flat T wave
ST depression
Prominent U wave

Question 14

GI signs and symptoms of hypokalemia:

*TIP: “low and slow”

Answer 14

Decreased motility 
Hypoactive BS
Constipation
Abdominal distension
Paralytic ileus (EMERGENT - may lead to sm bowel obstruction)

Question 15

Neuromuscular signs and symptoms of hypokalemia:

*TIP: “low and slow”

Answer 15

Decreased DTR
Muscle cramping
Flaccid paralysis

Question 16

Treatment of hyperkalemia includes:

Answer 16

Discontinue IV and PO potassium
Initiate a potassium-restricted diet
Potassium-excreting diuretics
IV calcium and IV hypertonic glucose
Avoid salt substitutes (high in K)
If level is critically high = prepare client for dialysis

Question 17

Treatment of hypokalemia includes:

Answer 17

Oral K supplements
Liquid KCl
Potassium-sparing diuretics

Question 18

True or false:

Potassium is always diluted and administered with an infusion device.

Answer 18

TRUE

Potassium is NEVER administered by IV push, IM, or subcut routes; potassium imbalances can cause life-threatening cardiac dysrhythmias!

Question 19

What is the role of calcium (Ca) and its expected range?

Answer 19

Maintains strength in 3 Bs:
Bones (and teeth)
Blood (clotting factor)
Beats (heart)

9 - 10.5 mEq/L

Question 20

Signs and symptoms of hypercalcemia:

*TIP: “moans, groans, and stones”

Answer 20

Constipation
Bone pain
Kidney stones
Decreased DTR
Severe muscle weakness

Question 21

Signs and symptoms of hypocalcemia:

*TIP: “signs”

Answer 21

Trousseau's sign (BP cuff + chef's kiss)
Chvostek's sign (Facial nerve tap = twitch/smile)
Diarrhea
Numbness in fingers, face, and limbs
Stridor and spasms
Convulsions

Question 22

Clients with hypocalcemia are at risk for:

Answer 22

Bleeding

Cardiac dysrhythmias

Question 23

Treatment of hypercalcemia includes:

Answer 23

D/C IV or PO calcium
D/C thiazide diuretics
Administer NSAIDs
Administer phosphorus, calcitonin, and bisphosphonates
Avoid foods high in calcium

Question 24

Treatment of hypocalcemia includes:

Answer 24

Administer calcium PO or IV (For IV, warm before administering and administer slowly)
Administer aluminum hydroxide and vitamin D
Initiate seizure precautions
Consume foods high in calcium
10% calcium for acute calcium deficit

Question 25

A client with a calcium imbalance is at risk for:

Answer 25

Pathological fracture

*Move patient slowly and carefully.

Question 26

What is the role of magnesium (Mg) and its expected range?

Answer 26

Think of a sheriff - Mg maintains law and order in the muscles (mainly cardiac muscles and the uterus)

1.3 - 2.1 mEq/L

• Fun facts:
  1. Most Mg is found in the bones
  2. Ca is its BFF

Question 27

Sign and symptoms of hypermagnesemia:

*TIP: “calm and quiet” and LOW everything

Answer 27

Low energy
Low HR/BP/RR
Decreased DTR
Hypoactive BS

Question 28

Signs and symptoms of hypomagnesemia:

*TIP: “No sheriff = buck wild!” and HIGH everything

Answer 28

High HR/BP/RR
Increased DTR (hyperreflexia)
Hyperactive BS
Shallow respirations
Twitches/tetany/seizures
Irritability/confusion
Positive Trousseau's
Positive Chvostek's

Question 29

Treatment of hypermagnesemia includes:

Answer 29

Diuretics
IV administration of CaCl or calcium gluconate
Restrict dietary intake of Mg containing foods
Avoid the use of laxatives and antacids containing Mg

Question 30

Treatment of hypomagnesemia includes:

Answer 30

Magnesium sulfate IV or PO
Seizure precautions
Instruct client to increase Mg containing foods