Hoffman: Chapter 8: Fluid and Electrolyte Management

Question 1

A patient presents in the emergency department (ED) with fever, nausea, and vomiting over the past 2 days. The nurse monitors for which laboratory result in this patient?

1. Urine specific gravity of 1.040
2. Serum potassium of 4.8 mEq/L
3. Serum sodium of 135 mEq/L
4. Urine positive for glucose and ketones

Answer 1

Urine specific gravity of 1.040

The normal range for specific gravity is 1.005 to 1.030. High specific gravity values indicate concentrated urine and can be seen in patients with decreased renal perfusion or dehydration.

Question 2

Which assessment data collected by the nurse indicate that an older adult patient is at risk for dehydration?

Answer 2

Oral intake of 48 ounces per day

A poor intake of water could indicate a loss of the thirst response, which occurs as a normal age-related change. Because the patient only ingests 48 ounces of water each day, this could indicate a reduction in the normal thirst response

Question 3

The nurse plans care for a hospitalized patient. Which data necessitate the inclusion of interventions to address a fluid volume deficit?

Answer 3

Heart rate of 110 bpm

An increased heart rate is indicative of a fluid volume deficit.

Question 4

In reviewing laboratory results for a female patient suspected of having a fluid imbalance, the nurse correlates which laboratory value with a diagnosis of dehydration?

Answer 4

Hematocrit 49%

The hematocrit measures the volume of whole blood that is composed of red blood cells. Because the hematocrit is a measure of the volume of cells in relation to plasma, it is affected by changes in plasma volume. The hematocrit increases with severe dehydration. The normal hematocrit value for a female is 36% to 48%.

Question 5

The nurse is analyzing the intake and output record for a patient being treated for dehydration. The patient weighs 176 lbs and had a 24-hour intake of 2,000 mL and urine output of 1,200 mL. Based on this data, which conclusion by the nurse is the most appropriate?

Answer 5

Treatment is effective and should continue.

Urinary output is normally equivalent to the amount of fluids ingested; the usual range is 1,500 to 2,000 mL in 24 hours, or 40 to 80 mL in 1 hour (0.5 mL/kg per
hour). Patients whose intake substantially exceeds output are at risk for fluid volume excess; however, the patient is dehydrated. The extra fluid intake is being used to improve body fluid balance. The patient’s output is 40 mL/hour which is within the normal range.

Question 6

The nurse provides care to a patient who is prescribed 0.45% normal saline (NS) by intravenous (IV) infusion. Which data cause the nurse to question the healthcare provider regarding this IV fluid order?

Answer 6

Blood pressure 100/60 mm Hg

Hypotonic IV fluid, such as 0.45% normal saline (NS), shifts fluid out of the vessels and into the cells. Because of this fluid shift, hypotension may be worsened. Therefore, the patient’s blood pressure causes the nurse to question the healthcare provider about this prescription.

Question 7

The nurse is caring for a patient who is receiving intravenous fluids postoperatively after cardiac surgery. The nurse correlates the patient’s risk for fluid volume excess to which cause?

Answer 7

Increased levels of antidiuretic hormone

Antidiuretic hormone (ADH) and aldosterone levels are commonly increased as a result of the stress response before, during, and immediately after surgery. This increase leads to sodium and water retention.

Question 8

The nurse is planning care for the patient with acute renal failure and incorporates the nursing diagnosis of Excess Fluid Volume. Which assessment data support this nursing diagnosis?

Answer 8

Pitting edema in the lower extremities

The patient in acute renal failure will likely be edematous, as the kidneys are not producing urine.

Question 9

The nurse is providing care to an older adult patient who is receiving intravenous (IV) fluids at 150 mL/hour. It is important that the nurse assess for which clinical manifestations that could indicate fluid volume excess in this patient?

Answer 9

Elevated blood pressure

The blood pressure may increase if fluids are administered too quickly, and older adults may not be able to tolerate the increased fluid

Question 10

The nurse provides care to a patient whose serum potassium level is 3.2 mEq/L. Which healthcare provider order does the nurse question based on this data?

Answer 10

10 mEq KCl (potassium chloride) in 100 mL normal saline slow IVP (intravenous pyelogram)

Although this is an appropriate dose of KCl, it is never given by intravenous pyelogram (IVP). The nurse questions this order.

Question 11

In reviewing laboratory results for a patient presenting to the Emergency Department with changes in level of consciousness, the nurse correlates which value as placing the patient at greatest risk for seizures?

Answer 11

Serum sodium of 135 mEq/L

Neurological changes such as confusion, muscle twitching, lethargy, and seizures can indicate low sodium levels, especially in older adults.

Question 12

The nurse is providing care to a patient who seeks emergency treatment for headache and nausea. The patient works in a mill without air conditioning. The patient states, “I drink water several times each day, but I seem to sweat more than I am able to replace.” Which suggestions does the nurse provide to this patient?

Answer 12

Eat something salty when drinking water

Both salt and water are lost through sweating. When only water is replaced, the individual is at risk for salt depletion. Clinical manifestations include fatigue, weakness, headache, and gastrointestinal symptoms such as loss of appetite and nausea. The patient should be instructed to eat something salty when drinking water to help replace the loss of sodium.

Question 13

A nurse is reviewing the serum chemistry results on a patient who has a nasogastric tube to
low intermittent suction econdary to a gunshot to the abdomen 2 days ago. Which electrolyte value does the nurse correlate to the NG suctioning?

Answer 13

Serum chloride of 90 mEq/L

Serum chloride decreases in patients with severe vomiting, burns, chronic respiratory acidosis, nasogastric suctioning, metabolic alkalosis, and Addison’s disease (adrenal cortex insufficiency). The normal range for serum chloride is 97 to 107 mEq/L.

Question 14

The nurse is caring for a patient with congestive heart failure who is admitted to the medical-surgical unit with acute hypokalemia. Which prescribed medication may havecontributed to the patient’s current hypokalemic state?

Answer 14

Cortisol

Excess potassium loss through the kidneys is often caused by such medications as corticosteroids, potassium-wasting (loop) diuretics, amphotericin B, and large doses of some antibiotics. Cortisol is a type of corticosteroid and can cause hypokalemia.

Question 15

A patient is prescribed 20 mEq of potassium chloride because of excessive vomiting. The nurse includes which information in explaining the rationale for this medication?

Answer 15

It is needed to maintain skeletal, cardiac, and neuromuscular activity

Potassium is the major cation in intracellular fluids, with only a small amount found in plasma and interstitial fluid. Potassium is a vital electrolyte for skeletal, cardiac, and smooth muscle activity.

Question 16

In reviewing a patient’s laboratory results before administering digoxin, which laboratory
result places the patient at greatest risk for digoxin toxicity?

Answer 16

Serum potassium 3.0 mEq/L

17. Hypokalemia can potentiate the effects of digitalis by increasing blood levels of digoxin, leading to digoxin toxicity. Symptoms of digoxin toxicity include loss of appetite, nausea, vomiting, cardiac dysrhythmias, and visual isturbances

Question 17

The nurse is providing care to a patient who is prescribed furosemide for treatment of
congestive heart failure (CHF). The patient’s serum potassium level is 3.4 mEq/L. Which food should the nurse encourage the patient to eat based on this data?

Answer 17

Bananas

A potassium level of 3.4 is low, so the client should be encouraged to consume potassium-rich foods. Of the foods listed, the highest in potassium is banana.

Question 18

The nurse is caring for a patient admitted with hypertension and chronic renal failure who receives hemodialysis three times per week. The nurse is assessing the patient’s diet and notes the use of salt substitutes. When teaching the patient to avoid salt substitute, which rationale supports this teaching point?

Answer 18

They can potentiate hyperkalemia

Many salt substitutes use potassium chloride. Potassium intake is carefully regulated in patients with renal failure, and the use of salt substitutes will worsen hyperkalemia.

Question 19

The nurse is caring for a patient with a potassium level of 5.9 mEq/L. The healthcare provider prescribes both glucose and insulin for the patient. The patient’s spouse asks, “Why is insulin needed?” Which response by the nurse is the most appropriate?

Answer 19

“The insulin will cause his extra potassium to move into his cells, which will lower potassium in the blood.”

Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells.

Question 20

The nurse provides care for a patient who is experiencing hypomagnesemia. Which food
choice is best for this patient?

Answer 20

Three ounces of cooked halibut

Three ounces of cooked halibut contains 90 mg of magnesium. Of the foods provided, this choice is the most magnesium rich.

Question 21

The nurse monitors for which clinical manifestations in the patient admitted with hypermagnesemia?

Answer 21

Bradycardia

Cardiac symptoms in hypermagnesemia include hypotension caused by vasodilation and dysrhythmias such as bradycardia, atrial fibrillation, and intraventricular conduction delays exhibited by widening of the QRS complexes.

Question 22

The nurse is monitoring laboratory results on assigned patients. The patient with which laboratory has the highest risk of laryngospasm?

Answer 22

Serum calcium 7.5 mg/dL

Clinical manifestations of hypocalcemia include positive Trousseau’s and Chvostek’s signs, tetany, and laryngospasm

Question 23

The nurse is providing care to a patient whose serum calcium levels have increased since a
surgical procedure performed 3 days ago. Which intervention does the nurse implement to
decrease the risk for the development of hypercalcemia?

Answer 23

Encourage ambulation three times a day.

Hypercalcemia can occur from immobility. Encouraging early and frequent ambulation of patients at risk for hypercalcemia, as well as adequate hydration, assists in preventing elevated serum calcium.

Question 24

The nurse recognizes which intervention as the priority in the care of the patient with a
serum phosphorus level of 2.0 mg/dL?

Answer 24

Encourage consumption of milk and yogurt

A phosphorus level of 2.0 is low, and the patient needs additional dietary phosphorus. Providing phosphorus-rich foods such as milk and yogurt is a good way to provide that additional phosphorus.

Question 25

The nurse recognizes which clinical manifestations as age-related changes that may impact
fluid and electrolyte in the older adult? Select all that apply.

Answer 25

Decreased sense of smell
Decreased visual acuity
Changes in taste sensation

With aging, there is a decrease in taste, smell, and thirst, which
can impact fluid and electrolyte balance because it affects intake of fluids and food. With aging, there is a decline in olfactory function as a result of the decrease in olfactory fibers and receptors. Loss of these fibers and receptors results in a decrease in olfactory function and the ability to discriminate smells. Alterations in smell also affect taste, impacting oral intake, especially fluids, of older adults

Question 26

The nurse is preparing an educational session for members of a community health center that focuses on ways to maintain fluid balance during the summer months. Which interventions should the nurse recommend? Select all that apply.

Answer 26

Reduce the intake of coffee and tea.
Drink more fluids during hot weather.
Drink flat cola or ginger ale if vomiting

Actions to prevent fluid volume deficit during the summer months
include increasing fluid intake, drinking flat cola or ginger ale if vomiting, and reducing the intake of coffee and tea.

Question 27

The nurse is providing care to a patient who is exhibiting clinical manifestations of a fluid and electrolyte deficit. Which of the following orders does the nurse implement to address this disorder? Select all that apply.

Answer 27

Place the patient in high-Fowler’s position??
Initiate hypodermoclysis
Monitor patient’s I&O
Initiate intravenous therapy

Question 28

The nurse correlates which clinical manifestations to the patient at risk for hypovolemic shock? Select all that apply.

Answer 28

Heart rate of 146
Urine output of 0 to 10 mL/hour
Cool, clammy skin

The heart rate is increased. Complications of fluid volume deficit occur with losses of large amounts of fluid volume. Hypovolemic shock can develop as evidenced by hypotension, tachycardia, and signs of organ hypoperfusion such as cool, clammy skin, oliguria progressing to anuria (lack of urine output), decreased level of consciousness, and tachypnea

Question 29

A patient’s serum sodium level is 150 mg/dL. Based on this information, which interventions should the nurse plan for this patient? Select all that apply.

Answer 29

Instruct on a low-sodium diet.
Administer diuretics as prescribed.

For an elevated sodium level, the electrolyte will need to be
restricted, in the form of a low-sodium diet. Diuretics will remove excess fluid being held in the body because of the extra sodium.