Fluid and Electrolyte

Question 1

What is the treatment for hypovolemia?

Answer 1

replace water and electrolytes with lactated ringers or 0.9% NaCl

Question 2

What is the treatment for hypervolemia?

Answer 2

diuretics and fluid restriction

Question 3

What is the range for sodium?

Answer 3

135-145

Question 4

What is the range for potassium?

Answer 4

3.5-5.0

Question 5

4 Nursing implications for admin of K+

Answer 5

1. Always dilute IV potassium
2. never give KCL via IV push or as bolus
3. should not exceed 10-20mEq/hr
4. IV potassium can be irritating to veins

Question 6

What occurs with the QRS complex during hyperkalemia?

Answer 6

widens

Question 7

What is a positive Trousseau’s sign?

Answer 7

1. place BP cuff around arm
2. keep inflated for 1-4min
   positive: hand and fingers go into spasm in flexion

Question 8

What is a positive Chvostek’s sign?

Answer 8

1. tap the face just below and in front of the ear
   positive: facial twitching of one side of the mouth, nose, and cheek

Question 9

What are the manifestations for hypocalcemia?

Answer 9

1. positive Trousseau’s sign
2. positive Chvostek’s sign
3. Laryngeal stridor
4. dysphagia
5. tingling around mouth/extremities

Question 10

In a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because vomiting results in…

Answer 10

fluid movement from the cells into the interstitial space and blood vessels

Question 11

The nurse is administering 3.0% NaCl to a patient with severe hyponatremia. It is most important for the nurse to observe for what?

Answer 11

Shortness of breath and increased RR

Question 12

A patient is admitted with renal failure and an arterial blood pH level of 7.29. Which lab result would the nurse expect?

Answer 12

serum potassium of 5.9mEq/L

Question 13

What lab value is the best indicator of kidney function?

Answer 13

creatine

Question 14

What is azotemia?

Answer 14

accumulation of nitrogenous waste products

Question 15

What 2 lab values elevate with loss of kidney function?

Answer 15

BUN and K+

Question 16

Nephrotoxic antibiotics

Answer 16

amphotericin, rifampin, sulfonamides, tetracycline, vancomycin, gentamicin

Question 17

Nephrotoxic chemotherapy agents

Answer 17

cisplatin, methotrexate

Question 18

Nephrotoxic NSAIDS

Answer 18

celecoxib, ibuprofen, meloxicam, acetaminophen

Question 19

What are phenols?

Answer 19

byproduct of antioxidants

Question 20

What is the most serious electrolyte disorder in kidney disease?

Answer 20

hyperkalemia

Question 21

Drug therapy for hyperkalemia?

Answer 21

IV glucose and insulin
Kayexalate

Question 22

3 Calcium channel blockers

Answer 22

Norvasc
Cardizem
Procardia

Question 23

4 ACE inhibitors

Answer 23

Lotensin
Captopril
Vasotec
Altec

Question 24

3 ARB agents

Answer 24

Avapro
Teveten
Benicar

Question 25

What 5 components are restricted in the AKI patient’s diet?

Answer 25

1. protein
2. fluid
3. sodium
4. potassium
5. phosphate

Question 26

Identify individuals at risk for CKD

Answer 26

1. hypertension
2. diabetes mellitus
3. repeated UTIs

Question 27

Cardiovascular findings for dehydration

Answer 27

• thready, increased PR
• decreased BP
• dysrhythmias

Question 28

Respiratory findings for dehydration

Answer 28

• increased RR
• dyspnea

Question 29

Neuromuscular findings for dehydration

Answer 29

• lethargy to coma
• fever
• muscle weakness

Question 30

What lab values increase due to dehydration?

Answer 30

serum osmolality
hct and hgb (false reads)
BUN
serum sodium
urine specific gravity

Question 31

What is the nutritional status for severe dehydration?

Answer 31

NPO status allows gut to rest

Question 32

What is the relationship between sodium and calcium?

Answer 32

high sodium levels slow the movement of calcium into the heart cells which causes decreased contractility

Question 33

What are the potential complications for the patient whose serum sodium drops too low?

Answer 33

confusion
irritability
headache
seizures
coma

Question 34

At what value should a nurse notify the provider of I & O?

Answer 34

if output is 200mL less than intake

Question 35

Why would the patient with renal failure be given Epoetin?

Answer 35

when someone’s kidneys don’t work, the kidneys produce less EPO and so the person becomes anemic

Question 36

What treatments can be used to lower K+ level?

Answer 36

1. cation exchange resin or diuretics
2. insulin
3. B2 agonists
4. Sodium bicarbonate
5. Lasix

Question 37

Clinical manifestations for patient with hyperkalemia

Answer 37

impair renal excretion, renal failure
leg cramps
weak
paralysis
abdominal cramping
diarrhea
cardiac dysrhythmias = widen QRS, depresses ST, elevates P

Question 38

Clinical manifestations for patient with hypokalemia

Answer 38

metabolic alkalosis
muscle weakness
weak respiratory muscles
decreased GI
hyperglycemia