Fluids, Electrolytes, Acid Base Flashcards
A nurse is assessing a client who has a serum calcium level of 8.1 mg/dL. Which of the following findings is the priority for the nurse to assess?
-Deep tendon reflexes
-Cardiac rhythm
-Peripheral sensation
-Bowel sounds
Cardiac rhythm
When using the airway, breathing, circulation approach to client care, the nurse should first assess the client’s cardiac rhythm because this total serum calcium level is below the expected reference range. Hypocalcemia can cause ECG changes, bradycardia, or tachycardia.
A nurse is caring for a client who requires nasogastric suctioning. Which of the following sets of laboratory results indicates that the client has metabolic alkalosis?
-pH 7.51, PaO2 94 mmHg, PaCO2 36 mmHg, HCO3- 31 mEq/L
-pH 7.48, PaO2 89 mmHg, PaCO2 30 mmHg, HCO3- 26 mEq/L
-pH 7.31, PaO2 77 mmHg, PaCO2 52 mmHg, HCO3- 23 mEq/L
-pH 7.26, PaO2 84 mmHg, PaCO2 38 mmHg, HCO3- 20 mEq/L
pH 7.51, PaO2 94 mm Hg, PaCO2 36 mm Hg, HCO3- 31 mEq/L
An elevated pH and HCO3- with a PaCO2 either elevated or within the expected reference range indicates metabolic alkalosis.
A nurse is caring for a client who has dehydration and is receiving IV fluids. When assessing for complications, the nurse should recognize which of the following manifestations as a sign of fluid overload?
-Increased urine specific gravity
-Hypoactive bowel sounds
-Bounding peripheral pulses
-Decreased respiratory rate
Bounding peripheral pulses
The nurse should recognize that increased vascular volume results in full, bounding peripheral pulses.
A nurse is caring for a client who is experiencing respiratory distress as a result of pulmonary edema. Which of the following actions should the nurse take first?
-Assist with intubation
-Initiate high-flow oxygen therapy
-Administer a rapid-acting diuretic
-Provide cardiac monitoring
Initiate high-flow oxygen therapy.
When using the airway, breathing, circulation approach to client care, the nurse should first administer high-flow oxygen therapy by face mask at 5 to 6 L/min to keep the client’s oxygen saturation above 90%.
A nurse is admitting a client who takes 40 mg furosemide daily for heart failure and has experienced 3 days of vomiting. The nurse suspects hypokalemia. Which of the following medications should the nurse prepare to administer?
-Sodium polystyrene sulfonate 30 g/day
-0.9% sodium chloride with 10 mEq/L of potassium chloride at 100 mL/hr
-Bumetanide 8 mg/day
-100 mL of dextrose 10% in water with 10 units of insulin
0.9% sodium chloride with 10 mEq/L of potassium chloride at 100 mL/hr
This IV solution will provide adequate fluid and potassium replacement to offset the losses from vomiting. The typical amount of potassium chloride to administer IV is 5 to 10 mEq/hr and not to exceed 20 mEq/hr. The dilution should be 1 mEq to 10 mL of 0.9% sodium chloride.
A nurse is admitting a client who has status asthmaticus. The client’s ABG results are pH 7.32, PaO2 74 mmHg, PaCO2 56 mmHg, and HCO3- 26 mEq/L. The nurse should interpret these laboratory values as which of the following imbalances?
-Respiratory acidosis
-Respiratory alkalosis
-Metabolic acidosis
-Metabolic alkalosis
Respiratory acidosis
Status asthmaticus causes inadequate gas exchange, resulting in a low pH and PaO2, an elevated PaCO2, and an HCO3- within the expected reference range. These laboratory values indicate respiratory acidosis.
A nurse is assessing a client who has dehydration. Which of the following assessments is the priority?
-Skin turgor
-Urine output
-Weight
-Mental status
Mental status
The greatest risk to this client is injury from a fall due to a decline in the client’s mental status. Therefore, assessing the client’s mental status is the nurse’s priority.
A nurse is caring for a client who requires continuous cardiac monitoring. The nurse identifies a prolonged PR interval and a widened QRS complex. Which of the following laboratory values supports this finding?
-Sodium 152 mEq/L
-Chloride 102 mEq/L
-Magnesium 1.8 mEq/L
-Potassium 6.1 mEq/L
Potassium 6.1 mEq/L
Hyperkalemia, defined as a potassium level above 5.0 mEq/L, can cause a prolonged PR interval, a wide QRS complex, flat or absent P waves, and tall, peaked T waves.
While reviewing a client’s laboratory results, a nurse notes a serum calcium level of 8.0 mg/dL. Which of the following actions should the nurse take?
-Implement seizure precautions
-Administer phosphate
-Initiate diuretic therapy
-Prepare the client for hemodialysis
Implement seizure precautions.
The client is at risk for seizures due to low excitation threshold as a result of a decreased calcium level. The nurse should initiate seizure precautions to prevent injury.
A nurse is providing dietary teaching to a client who has kidney disease. Which of the following food choices should the nurse include in the teaching as containing the lowest amount of magnesium?
-1 large hard boiled egg
-1 cup bran cereal
- 1/2 cup almonds
- 1 cup cooked spinach
1 large hard-boiled egg
One large hard-boiled egg contains 5 mg of magnesium. Therefore, the nurse should recommend this food as containing the lowest amount of magnesium.
A nurse is assessing a client who has hypomagnesemia. Which of the following findings should the nurse expect?
-Hyperactive deep-tendon reflexes
-Increased bowel sounds
-Drowsiness
-Decreased blood pressure
Hyperactive deep-tendon reflexes
Hyperactive deep-tendon reflexes is an expected finding for a client who has hypomagnesemia. Other expected findings include muscle cramps, numbness, and tingling.
A nurse is reviewing the medical record of a client who has diabetes mellitus and is receiving regular insulin by continuous IV infusion to treat diabetic ketoacidosis. Which of the following findings should the nurse report to the provider?
-Urine output of 30 mL/hr
-Blood glucose of 80 mg/dL
-Serum potassium 3.0 mEq/L
-BUN 18 mg/dL
Serum potassium 3.0 mEq/L
This serum potassium level is below the expected reference range. Hypokalemia is a serious complication that can occur when a client who has diabetic ketoacidosis is receiving insulin to treat the condition. The nurse should report this finding to the provider.
A nurse is reviewing the ABG results for four clients. Which of the following findings should the nurse identify as metabolic acidosis?
- pH 7.51, PaO2 94 mm Hg, PaCO2 38 mm Hg, HCO3- 29 mEq/L
- pH 7.48, PaO2 89 mm Hg, PaCO2 30 mm Hg, HCO3- 24 mEq/L
- pH 7.36, PaO2 77 mm Hg, PaCO2 52 mm Hg, HCO3- 26 mEq/L
- pH 7.26, PaO2 84 mm Hg, PaCO2 38 mm Hg, HCO3- 20 mEq/L
pH 7.26, PaO2 84 mm Hg, PaCO2 38 mm Hg, HCO3- 20 mEq/L
A pH below 7.35 is an indication of acidosis. HCO3- below 22 mEq/L is an indication of metabolic acidosis.
A nurse is providing teaching for a client who has venous insufficiency of the lower extremities. Which of the following statements by the client indicates an understanding of the teaching?
-“If my stockings feel tight, I’ll just roll them down for a while.”
-“I’ll put on my elastic stockings at the first sign of swelling.”
-“When I sit down to watch television, I’ll be sure to put my feet up.”
-“It’s okay to cross my legs as long as it’s for less than an hour.”
“When I sit down to watch television, I’ll be sure to put my feet up.”
Venous insufficiency makes it difficult for blood flow to return to the heart. Elevating her feet will increase the return. The client should elevate her feet for at least 20 min several times per day.
A nurse is providing dietary teaching to a client who has heart failure and is receiving furosemide. Which of the following food should the nurse recommend as containing the greatest amount of potassium?
-1/2 cup chopped celery
-1 cup plain yogurt
-1 slice whole grain bread
-1/2 cup cooked tofu
1 cup plain yogurt
One cup of plain yogurt contains 380 g of potassium. Therefore, the nurse should recommend this food as containing the greatest amount of potassium.
