Lewis: Acid-Base and Fluid and Electrolytes Flashcards
The nurse is caring for a patient with a massive burn injury and possible hypovolemia. Which assessment data will be of most concern to the nurse?
Blood pressure is 90/40 mm Hg.
A patient who has a small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the health care provider about which assessment finding?
Serum sodium level of 120 mg/dL
A patient is admitted for hypovolemia associated with multiple draining wounds. Which assessment would be the most accurate way for the nurse to evaluate fluid balance?
Daily weight
Daily weight is the most easily obtained and accurate means of assessing volume status.
The home health nurse cares for an alert and oriented older adult patient with a history of dehydration. Which instructions should the nurse give to this patient related to fluid intake?
Increase fluids if your mouth feels dry.
A patient who is taking a potassium-wasting diuretic for treatment of hypertension complains of generalized weakness. It is most appropriate for the nurse to take which action?
Ask the health care provider to order a basic metabolic panel.
Spironolactone (Aldactone), an aldosterone antagonist, is prescribed for a patient. Which statement by the
patient indicates that the teaching about this medication has been effective?
I will drink apple juice instead of orange juice for breakfast
Because spironolactone is a potassium-sparing diuretic, patients should be taught to choose low-potassium foods (e.g., apple juice) rather than foods that have higher levels of potassium (e.g., citrus fruits).
A newly admitted patient is diagnosed with hyponatremia. When making room assignments, the charge nurse should take which action?
Assign the patient to a room near the nurses station.
IV potassium chloride (KCl) 60 mEq is prescribed for treatment of a patient with severe hypokalemia.
Which action should the nurse take?
Infuse the KCl at a rate of 10 mEq/hour.
A postoperative patient who had surgery for a perforated gastric ulcer has been receiving nasogastric suction
for 3 days. The patient now has a serum sodium level of 127 mEq/L (127 mmol/L). Which prescribed therapy
should the nurse question?
Infuse 5% dextrose in water at 125 mL/hr.
A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued
mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2
85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L?
Respiratory alkalosis
The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations.
Which action should the nurse take?
Administer the prescribed normal saline bolus and insulin.
The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the need for correction of the
acidosis with a saline bolus to prevent hypovolemia followed by insulin administration to allow glucose to reenter the cells
An older adult patient who is malnourished presents to the emergency department with a serum protein
level of 5.2 g/dL. The nurse would expect which clinical manifestation?
Edema
The normal range for total protein is 6.4 to 8.3 g/dL. Low serum protein levels cause a decrease in plasma oncotic pressure and allow fluid to remain in interstitial tissues
A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the patient is receiving this infusion?
Lung sounds
Hypertonic solutions cause water retention, so the patient should be monitored for symptoms of fluid excess. Crackles in the lungs may indicate the onset of pulmonary edema and are a serious manifestation of fluid
excess
The long-term care nurse is evaluating the effectiveness of protein supplements for an older resident who
has a low serum total protein level. Which assessment finding indicates that the patients condition has
improved?
Decreased peripheral edema
Edema is caused by low oncotic pressure in individuals with low serum protein levels. The decrease in edema
indicates an improvement in the patients protein status
- A patient who is lethargic and exhibits deep, rapid respirations has the following arterial
blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the
nurse interpret
these results?
Metabolic acidosis
A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum
potassium level of 3.0 mEq/L. The nurse should alert the health care provider immediately that the patient is
on which medication?
Oral digoxin (Lanoxin) 0.25 mg daily
Hypokalemia increases the risk for digoxin toxicity, which can cause serious dysrhythmias
The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the
nurse include on the care plan?
Encourage fluid intake up to 4000 mL every day.
To decrease the risk for renal calculi, the patient should have a fluid intake of 3000 to 4000 mL daily.
When caring for a patient with renal failure on a low phosphate diet, the nurse will inform unlicensed
assistive personnel (UAP) to remove which food from the patients food tray?
Milk carton
Foods high in phosphate include milk and other dairy products, so these are restricted on low-phosphate diets.
A nurse in the outpatient clinic is caring for a patient who has a magnesium level of 1.3 mg/dL. Which
assessment would be most important for the nurse to make?
Daily alcohol intake
Hypomagnesemia is associated with alcoholism
A patient has a parenteral nutrition infusion of 25% dextrose. A student nurse asks the nurse why a
peripherally inserted central catheter was inserted. Which response by the nurse is most appropriate?
The 25% dextrose is hypertonic and will be more rapidly diluted when given through a central line.
The nurse is caring for a patient who has a central venous access device (CVAD). Which action by the nurse is appropriate?
Use the push-pause method to flush the CVAD after giving medications
An older patient receiving iso-osmolar continuous tube feedings develops restlessness, agitation, and
weakness. Which laboratory result should the nurse report to the health care provider immediately?
Na+ 154 mEq/L (154 mmol/L)
The elevated serum sodium level is consistent with the patients neurologic symptoms and indicates a need for
immediate action to prevent further serious complications such as seizures
The nurse assesses a patient who has been hospitalized for 2 days. The patient has been receiving normal saline IV at 100 mL/hr, has a nasogastric tube to low suction, and is NPO. Which assessment finding would be apriority for the nurse to report to the health care provider?
Gradually decreasing level of consciousness (LOC)
A nurse is assessing a newly admitted patient with chronic heart failure who forgot to take prescribed
medications and seems confused. The patient complains of just blowing up and has peripheral edema and shortness of breath. Which assessment should the nurse complete first?
Mental status
