The client has been vomiting and has weak, flabby muscles. The client's pulse is irregular. The nurse would correctly suspect what type of imbalance?
The client is receiving potassium supplements. What is the most important nursing implication when administering this drug?
a. It cannot be given as an IV bolus
b. It must be diluted
c. It must be chilled before administration
d. It must be given only at bedtime
The client is due to receive Kayexalate for complaints of nausea, vomiting, abdominal cramps, short QT interval, weakness, and oliguria. The nurse is aware that this drug is used to treat which imbalance?
b. Severe Hypercalcemia
d. Severe Hyperkalemia
The nurse reviews the client's list of medications and results of laboratory tests. Which drug type may cause an elevated serum sodium level?
b. Oral contraceptives
c. Cortisone preparations
The client's magnesium level is 2.7 mEq/L. Specific health teaching by the nurse for this client should include which suggestion?
a. Eat fruits, fish, and peanut butter
b. Avoid selected laxatives and antacids
c. Avoid magnesium, which is irritating to the stomach
d. Measure weight daily
The client is receiving fluid replacement. The nurse's health teaching with this client includes which suggestions? (Select all that apply)
a. Measure weight daily
b. Know that thirst means a mild fluid deficit
c. Monitor fluid intake
d. Avoid the use of calcium supplements
The client gained 10 pounds in 2 days. It is determined that the weight gain is caused by fluid retention. The nurse correctly estimates that the weight gain may be equivalent to how many liters of fluid?
The health teaching for a client with hypophosphatemia includes eating which foods?
a. Meat, milk, whole grain cereals, nuts
b. Dairy products, vitamin D supplements
c. Dairy products, protein-rich foods
d. Dairy products, nuts, vitamin C supplements
The nurse reviews the client's medications as part of the initial interview for admission to the cardiac clinic. Which comment by the client indicates a need for health teaching? (Select all that apply)
a. "Tetracycline does not affect my medications."
b. "I can take as much calcium as I want."
c. "Calcium increases the effects of my digoxin."
d. "Magnesium and potassium deficits can cause digoxin toxicity."
Which findings indicate that a patient may have hypervolemia? (select all that apply)
a. Increased, bounding pulse
b. Jugular venous distention
c. Diminished peripheral pulses
d. Presence of crackles
e. Excessive thirst
f. Elevated blood pressure
g. Orthostatic hypotension
h. Skin pale and cool to touch
The difference in concentration of particles that is greater on one side of a permeable membrane than on the other side is known as what?
a. Hydrostatic pressure
b. Concentration gradient
c. Passive transport
d. Active transport
A patient's blood osmolality is 302 mOsm/L. What manifestation does the nurse expect to see in the patient?
a. Increased urine output
c. Peripheral edema
A patient is at risk for hypervolemia. For self-management at home, what does the nurse teach the patient to do? (select all that apply)
a. call the physician if swelling occurs
b. monitor skin turgor and record daily
c. limit the amount of free water intake
d. weigh self each day on the same scale
e. avoid high sodium foods
An older adult patient at risk for fluid and electrolyte problems is vigilantly monitored by the nurse for the first indication of a fluid balance problem. What is this indication?
b. Mental status changes
c. Poor skin turgor
d. Dry mucous membranes
Which intake-output record represents the norm for the average adult?
a. 500 mL of fluid per day, ingesting an additional 200 mL of fluid from food
b. 1500 mL of fluid per day, ingesting an additional 800 mL of fluid from food
c. 3000 mL of fluid per day, ingesting an additional 500 mL of fluid from food
d. 5000 mL of fluid per day, ingesting an additional 100 mL of fluid from food
What are the consequences for a patient who does not meet the obligatory urine output? (select all that apply)
a. Lethal electrolyte imbalances
c. Urine becomes diluted
d. Toxic buildup of nitrogen
What is the minimum amount of urine per day needed to excrete toxic waste products?
a. 200 to 300 mL
b. 400 to 600 mL
c. 500 to 1000 mL
d. 1000 to 1500 mL
A patient who loses a lot of fluid and so- dium is likely experiencing an increase in _______________ secretion.
Patients with which conditions are at great risk for deficient fluid volume? (Select all that apply.)
a. Fever of 103° F
b. Extensive burns
c. Thyroid crisis
d. Water intoxication
e. Continuous fistula drainage
f. Diabetes insipidus
The nurse is working in a long-term care facil- ity where there are numerous patients who are immobile and at risk for dehydration. Which task is best to delegate to the unlicensed assis- tive personnel (UAP)?
a. Offer patients a choice of fluids every 1 to 2 hours.
b. Check patients at the beginning of the shift to see who is thirsty.
c. Give patients extra fluids around medica- tion times.
d. Evaluate oral intake and urinary output.
The nurse is assisting a community group to plan a family sports day. In order to prevent dehydration, what beverage does the nurse suggest be supplied?
a. Iced tea
b. Light beer
c. Diet soda
d. Bottled water
The nurse is assessing the weight of a patient with chronic renal failure. The patient shows a 2 kg weight gain since the last clinic appoint- ment. This is equivalent to _____ liters of fluid.
"Which factors affect the amount and distribu- tion of body fluids? (Select all that apply.)
e. Body fat
The nurse is caring for a patient with hypovo- lemia secondary to severe diarrhea and vomit- ing. In evaluating the respiratory system for this patient, what does the nurse expect to assess?
a. No changes, because the respiratory sys- tem is not involved
b. Hypoventilation, because the respiratory system is trying to compensate for low pH
c. Increased respiratory rate, because the body perceives hypovolemia as hypoxia
d. Normal respiratory rate, but a decreased oxygen saturation
"he nurse is assessing skin turgor in a 65-year- old patient. What is the correct technique to use with this patient?
a. Pinch the skin over the sternum and observe for tenting and resumption of skin to
its normal position after release.
b. Observe the skin for a dry, scaly appearance and compare it to a previous assessment.
c. Pinch the skin over the back of the hand
and observe for tenting; count the number
of seconds for the skin to recover position.
d. Observe the mucous membranes and
tongue for cracks, fissures, or a pasty coating."
The emergency department (ED) nurse is car- ing for a patient who was brought in for sig- nificant alcohol intoxication and minor trauma to the wrist. What will serial hematocrits for this patient likely show?
b. Normal and stable hematocrits
c. Progressively lower hematocrits
d. Decreasing osmolality
The nurse is caring for a child at risk for dehy- dration secondary to diarrhea, vomiting, and fever. The child is alert, quiet, and clinging to the parent. What is the best nursing interven- tion to rehydrate this patient?
a. Give an oral rehydration solution such as Oralyte or Rehydralyte.
b. Have the parent give small sips of pre- ferred diluted fluids every 5 to 10 minutes.
c. Obtain an order for IV access and an iso- tonic solution such as normal saline.
d. Encourage the child to take as much water as possible and offer popsicles.
"Which statements about the function of the lymphatic system are true? (Select all that apply.)
a. Lymph fluid contains more protein than
b. Lymph flow is slower than blood flow.
c. Lymph flow is enhanced by a pump system.
d. Lymphatic vessels carry lymph fluid toward the heart.
e. Lymph fluid is filtered by lymph nodes.
f. The lymphatic system takes lymph to the
kidneys for excretion.
The nurse is caring for several older adult pa- tients who are at risk for dehydration. Which task can be delegated to the UAP?
a. Withhold fluids if patients are incontinent
of bowels or bladder.
b. Assess for and report any difficulties that
patients are having in swallowing.
c. Stay with patients while they drink and
note the exact amount ingested.
d. Divide the total amount of fluids needed
over a 24-hour period and post a note.
The nurse assessing a patient notes a bound- ing pulse quality, neck vein distention when supine, presence of crackles in the lungs, and increasing peripheral edema. These findings reflect a condition of fluid ____________.
A patient is at risk for fluid volume excess and dependent edema. Which task does the nurse delegate to the UAP?
a. Massage the legs and heels to stimulate cir-
b. Evaluate the effectiveness of a pressure reducing mattress.
c. Assess the coccyx, elbows, and hips daily
for signs of redness.
d. Assist the patient to change position every
The nurse is reviewing orders for several pa- tients who have risk for fluid volume excess. For which patient condition does the nurse question an order for diuretics?
a. Pulmonary edema
b. Congestive heart failure
c. End-stage renal disease
The UAP reports to the nurse that a patient being evaluated for kidney problems has produced a large amount of pale yellow urine. What does the nurse do next?
a. Instruct the UAP to measure the amount carefully and then discard the urine.
b. Instruct the UAP to save the urine in a large bottle for a 24-hour urine specimen.
c. Assess the patient for signs of fluid imbal-
ance and check the specific gravity of the
d. Compare the amount of urine output to
the fluid intake for the previous 8 hours.
On admission, a patient with pulmonary ede- ma weighed 151 lbs; now the patient's weight is 149 lbs. Assuming the patient was weighed both times with the same clothing, same scale, and same time of day, how many milliliters of fluid does the nurse estimate the patient has lost?
The nurse is giving discharge instructions to the patient with advanced congestive heart failure who is at continued risk for fluid volume excess. For which physical change does the nurse instruct the patient to call the health care provider?
a. Greater than 3 lbs gained in a week or greater than 1 to 2 lbs gained in a 24-hour period
b. Greater than 5 lbs gained in a week or greater than 1 to 2 lbs gained in a 24-hour period
c. Greater than 15 lbs gained in a month or greater than 5 lbs gained in a week
d. Greater than 20 lbs gained in a month or greater than 5 lbs gained in a week
The nurse is caring for several patients at risk for falls because of fluid and electrolyte imbalances. Which task related to patient safety and fall prevention does the nurse delegate to the UAP?
a. Assess for orthostatic hypotension.
b. Orient the patient to the environment.
c. Help the incontinent patient to toilet every
1 to 2 hours.
d. Encourage family members or significant
other to stay with the patient.
"The nurse is assessing a patient's urine specific gravity. The value is 1.035. How does the nurse interpret this result?
c. Normal value for an adult
d. Renal disease"
"What are the functions of potassium in the body? (Select all that apply.)
a. Regulates hydration status
b. Regulates protein synthesis
c. Stimulates the secretion of antidiuretic hormone (ADH)
d. Regulates glucose use and storage
e. Helps maintain normal cardiac rhythm"
"Which statements are true about the electrolyte chloride and its role in the cellular environment of the body? (Select all that apply.)
a. It is a major cation in extracellular fluid
b. It maintains plasma acid-base balance.
c. It provides electroneutrality in relation to
d. Chloride imbalances occur with alterations
in body water volume.
e. Chloride concentration varies inversely
with changes in bicarbonate concentration."
"What impacts does sodium have on body function? (Select all that apply.)
a. Maintains electroneutrality
b. Maintains electrical membrane excitability
c. Aids in carbohydrate and lipid metabolism
d. Regulates water balance
e. Regulates plasma osmolality"
"What impacts does phosphorus have in the body? (Select all that apply.)
a. Activates B-complex vitamins
b. Adds strength/density to bones and teeth
c. Aids in blood-clotting cascade
d. Assists in the formation of adenosine tri- phosphate (ATP)
e. Stabilizes excitable membranes"
"The electrolyte magnesium is responsible for which functions? (Select all that apply.)
a. Formation of hydrochloric acid
b. Stabilization of excitable membranes
c. Contraction of cardiac muscle
d. Regulation of intracellular osmolarity
e. Formation of adenosine triphosphate
"A patient is talking to the nurse about sodium intake. Which statement by the patient indicates an understanding of high-sodium food sources?
a. "I have bacon and eggs every morning for breakfast."
b. "We never eat seafood because of the salt water."
c. "I love Chinese food, but I gave it up because of the soy sauce."
d. "Pickled herring is a fish and my doctor told me to eat a lot of fish.""
"Which statement best explains how antidiuret- ic hormone (ADH) affects urine output?
a. It increases permeability to water in the
tubules causing a decrease in urine output.
b. It increases urine output as a result of water being absorbed by the tubules.
c. Urine output is reduced as the posterior
pituitary decreases ADH production.
d. Increased urine output results from increased osmolarity and fluid in the extra cellular space."
"A patient with hyponatremia would have which gastrointestinal findings upon assessment? (Select all that apply.)
a. Hyperactive bowel sounds on auscultation,
mostly in the left lower quadrant
b. Hard, dark brown stools
c. Hypoactive bowel sounds on auscultation
d. Bowel movements that are frequent and
e. Abdominal cramping"
"The nurse is caring for a patient with severe hyponatremia. What safety measures does the nurse put in place for this patient? (Select all that apply.)
a. Encourage the patient to use a cane when ambulating.
b. Turn on a bed alarm when the patient is in bed.
c. Obtain an order for zolpidem (Ambien) to ensure the patient sleeps at night.
d. Place the patient on a low bed.
e. Ensure three side rails are up when the patient is in bed."
"Which patients are at risk for developing hypo- natremia? (Select all that apply.)
a. Postoperative patient who has been NPO
for 24 hours with no IV fluid infusing
b. Patient with decreased fluid intake for several days
c. Patient with excessive intake of 5% dextrose solution
d. Diabetic patient with blood glucose of 250
e. Patient with overactive adrenal glands
f. Tennis player in 100° F weather who has
been drinking water"
"The nurse is evaluating the lab results of a pa- tient with hyperaldosteronism. What abnormal electrolyte finding does the nurse expect to see?
"The nurse assistant informs the nurse that a patient with hypernatremia who was initially confused and disoriented on admission to the hospital is now trying to pull out the IV access and Foley catheter. Which actions, in order of priority, does the nurse take? (Select in priority order.)"
a. "Place bilateral soft wrist re- straints."
b. "Inform the physician of the pa- tient's change in behavior and obtain an order for restraints."
c. "Assess the patient."
d. "Offer the patient oral fluids."
"Patients with which conditions are at risk for developing hypernatremia? (Select all that apply.)
a. Chronic constipation
b. Heart failure
c. Severe diarrhea
d. Severe vomiting
e. Profound diaphoresis"
"The physician has ordered therapy for a patient with low sodium and signs of hypervolemia. Which diuretic is best for this patient?
a. Conivaptan (Vaprisol)
b. Furosemide (Lasix)
c. Hydrochlorothiazide (HydroDIURIL)
d. Bumetanide (Bumex)"
"The nurse is assessing a patient with a mild in- crease in sodium level. What early manifesta- tion does the nurse observe in this patient?
a. Muscle twitching and irregular muscle
b. Inability of muscles and nerves to respond
to a stimulus
c. Muscle weakness occurring bilaterally with
no specific pattern
d. Reduced or absent deep tendon reflexes"
"The nurse is caring for a patient with hyper- natremia caused by fluid and sodium losses. What type of IV solution is best for treating this patient?
a. Hypotonic 0.225% sodium chloride
b. Small-volume infusions of hypertonic (2%
to 3%) saline
c. Isotonic sodium chloride (NaCl)
d. Isotonic Ringer's lactate"
"Which serum value does the nurse expect to see in a patient with hyponatremia?
a. Sodium less than 136 mEq/L
b. Chloride less than 95 mEq/L
c. Sodium less than 145 mEq/L
d. Chloride less than 103 mEq/L"
"A patient having watery diarrhea with abdominal cramping has the electrolyte imbalance of ____________________."
"The nurse is caring for a psychiatric patient who is continuously drinking water. The nurse monitors for which complication related to potential hyponatremia? a. Proteinuria/prerenal failure
b. Change in mental status/increased intracranial pressure
c. Pitting edema/circulatory failure
d. Possible stool for occult blood/gastrointestinal bleeding"
"What interventions are appropriate for a patient with mild hypernatremia caused by ex- cessive fluid loss? (Select all that apply.)
a. Hypotonic intravenous infusion
b. 0.45% sodium chloride intravenous infusion
c. D5W intravenous infusion
d. Administration of bumetanide (Bumex)
e. Gradual reduction of serum sodium to establish to normal level"
"The nurse is caring for several patients at risk for fluid and electrolyte imbalances. Which patient problem or condition can result in a relative hypernatremia?
a. Use of a salt substitute
c. Drinking too much water
d. NPO status for a prolonged period"
"The nurse is caring for an older adult patient whose serum sodium level is 150 mEq/L. The nurse assesses the patient for which common manifestations associated with this sodium level? (Select all that apply.)
a. Intact recall of recent events
c. Rigidity of extremities
e. Muscle weakness"
"Which conditions cause a patient to be at risk for hypernatremia? (Select all that apply.)
a. Renal failure
c. Use of corticosteroids
d. Watery diarrhea
e. Cushing's syndrome"
"An older adult patient with decreased sensitiv- ity to thirst is most at risk for developing the imbalance of _______________________."
"Which precaution or intervention does the nurse teach a patient at continued risk for hypernatremia?
a. Avoid salt substitutes
b. Avoid aspirin and aspirin containing products
c. Read labels on canned or packaged foods to determine sodium content
d. Increase daily intake of caffeine containing foods and beverages"
"The nurse identifies the priority problem of "potential for injury" for a patient with hyponatremia. What is the etiology of this priority patient problem?
a. Altered mental capabilities
b. Fragility of bones
d. Altered senses"
"A patient with renal failure that results in hypernatremia will require which interventions? (Select all that apply.)
a. Administration of furosemide (Lasix)
c. IV infusion of 0.9% sodium chloride
d. IV infusion of 0.45% sodium chloride
e. Administration of bumetanide (Bumex)"
"The nurse is teaching a patient to recognize foods that are high in sodium. Which food items does the nurse use as examples? (Select all that apply.)
a. Egg roll with soy sauce
b. White rice
c. Salad with oil and vinegar dressing
d. Bacon and eggs
e. Cottage cheese and tomato
g. Soup with saltine crackers
h. Steamed vegetables"
"A hospitalized patient who is known to be homeless has been diagnosed with severe malnutrition, end stage renal disease, and anemia. He is transfused with 3 units of packed red blood cells. Which potential electrolyte imbalance does the nurse anticipate to occur in this patient?
"A newly admitted patient with congestive heart failure has a potassium level of 5.7 mEq/L. How does the nurse identify contributing factors for the electrolyte imbalance? (Select all that apply.)
a. Assess the patient for hypokalemia.
b. Obtain a list of the patient's home medications.
c. Assess the patient for hyperkalemia.
d. Ask about the patient's method of taking
medications at home.
e. Evaluate the patient's appetite."
"A young adult patient is in the early stages of being treated for severe burns. Which electrolyte imbalance does the nurse expect to assess in this patient?
"A patient with hypokalemia is likely to have which conditions? (Select all that apply.)
b. Metabolic alkalosis
c. Chronic obstructive pulmonary disease
e. Short bowel syndrome"
"The nurse is taking care of a trauma patient who was in a motor vehicle accident. The patient has a history of hypertension which is managed with spironolactone (Aldactone). This patient is at risk for developing which electrolyte imbalance?
"A patient with lung cancer is admitted to the hospital for respiratory distress. Which imbalances does the nurse expect this patient to have? (Select all that apply.)
a. Metabolic alkalosis
e. Respiratory acidosis"
"The nurse is caring for a patient who has recently emigrated from Mexico to the U.S. The patient had been diagnosed with type 1 diabetes and placed on insulin one month before. Which nursing interventions are best for this patient? (Select all that apply.)
a. Have a social worker evaluate the patient's financial needs for purchasing insulin and food.
b. Consult a registered dietitian for meal planning.
c. Ask the physician to address the education needs of the patient and family.
d. Ask the patient how he manages his diabetes at home and work.
e. Provide information based on what the patient requests."
"Which serum laboratory value does the nurse expect to see in the patient with hypokalemia?
a. Calcium less than 8.0 mg/dL
b. Potassium less than 5.0 mEq/L
c. Calcium less than 11.0 mg/dL
d. Potassium less than 3.5 mEq/L"
"The patient's potassium level is 2.5 mEq/L. Which clinical findings does the nurse expect to see when assessing this patient? (Select all that apply.)
a. General skeletal muscle weakness
b. Moist crackles and tachypnea
d. Increased specific gravity and decreased
e. Weak hand grasps"
"The nurse administering potassium to a patient carefully monitors the infusion because of the risk for which condition?
a. Pulmonary edema
b. Cardiac dysrhythmia
c. Postural hypotension
d. Renal failure"
"Which changes on a patient's electrocardiogram (ECG) reflect hyperkalemia?
a. Tall peaked T waves
b. Narrow QRS complex
c. Tall P waves
d. Normal P-R interval"
"The nurse is teaching the patient about hypokalemia. Which statement by the patient indicates a correct understanding of the treatment of hypokalemia?
a. "My wife does all the cooking. She shops for food high in calcium."
b. "When I take the liquid potassium in the evening, I'll eat a snack beforehand."
c. "I will avoid bananas, orange juice, and salt substitutes."
d. "I hate being stuck with needles all the time to monitor how much sugar I can eat.""
"The nurse is caring for a patient who takes potassium and digoxin. For what reason does the nurse monitor both laboratory results?
a. Digoxin increases potassium loss through
b. Digoxin toxicity can result if hypokalemia
c. Digoxin may cause potassium levels to rise
to toxic levels.
d. Hypokalemia causes the cardiac muscle to
be less sensitive to digoxin."
"Which serum laboratory value does the nurse expect to see in a patient with hyperkalemia?
a. Calcium greater than 8.0 mg/dL
b. Potassium greater than 3.5 mEq/L
c. Calcium greater than 11.0 mg/dL
d. Potassium greater than 5.0 mEq/L"
" A patient has an elevated potassium level. Which assessment findings are associated with hyperkalemia? (Select all that apply.)
a. Wheezing on exhalation
b. Numbness in hands, feet, and around the mouth
c. Frequent, explosive diarrhea stools
d. Irregular heart rate and hypotension
e. Circumoral cyanosis"
"The nurse is teaching a patient with hypokalemia about foods high in potassium. Which food items does the nurse recommend to this patient? (Select all that apply.)
"A patient's serum potassium value is below 2.8 mEq/L. The patient is also on digoxin. The nurse quickly assesses the patient for which cardiac problem before notifying the physician?
a. Cardiac murmur
b. Cardiac dysrhythmia
c. Congestive heart failure
d. Cardiac tamponade"
"Which potassium levels are within normal limits? (Select all that apply.)
a. 2.0 mmol/L
b. 3.5 mmol/L
c. 4.5 mmol/L
d. 5.0 mmol/L e.
"A patient has hyperkalemia resulting from dehydration. Which additional laboratory findings does the nurse anticipate for this patient?
a. Increased hematocrit and hemoglobin lev-
b. Decreased serum electrolyte levels
c. Increased urine potassium levels
d. Decreased serum creatinine"
"A 65-year-old patient has a potassium laboratory value of 5.0 mEq/L. How does the nurse interpret this value?
a. High for the patient's age
b. Low for the patient's age
c. Normal for the patient's age
d. Dependent upon the medical diagnosis"
"A patient's potassium level is low. What change in the cardiovascular system does the nurse expect to see related to hypokalemia?
a. Tall, peaked T waves
b. Weak, thready pulse
c. Malignant hypertension
d. Distended neck vein"
"Plasma is part of which components? (Select all that apply.)
a. The intracellular compartment
b. The extracellular compartment
c. All fluid within the cells
d. Interstitial fluid
e. Intravascular fluid"
"Which fluid has the highest corresponding electrolyte content?
a. Intracellular fluid is highest in potassium.
b. Extracellular fluid is highest in sodium.
c. Extracellular fluid is highest in sodium and
d. Intracellular fluid is highest in magnesium
"Which component has a high content of potassium and phosphorus?
a. Extracellular fluid
b. Intracellular fluid
c. Extracellular fluid and the intravascular space
d. Intracellular fluid and lymph fluid"
"A patient with low potassium must have an IV potassium infusion. The pharmacy sends a 250 mL IV bag of dextrose in water with 40 mEq of potassium. The label is marked "to infuse over 1 hour." What does the nurse do?
a. Obtain a pump and administer the solution.
b. Double check the physician's order and
call the pharmacy.
c. Hold the infusion because there is an error
d. Recalculate the rate so that it is safe for the
"An older adult patient needs an oral potassium solution, but is refusing it because it has a strong and unpleasant taste. What is the best strategy the nurse uses to administer the drug?
a. Tell the patient that failure to take the drug
could result in serious heart problems.
b. Ask the patient's preference of juice and
mix the drug with a small amount.
c. Mix the solution into food on the patient's meal tray and encourage the patient to eat
d. Offer the drug to the patient several times
and then document the patient's refusal."
"A patient has a low potassium level and the physician has ordered an IV infusion. Before starting an IV potassium infusion, what does the nurse assess?
a. Adequate urine output
b. Oxygen saturation level
c. Baseline mental status
d. Apical pulse"
"Which foods will the nurse instruct a patient with kidney disease and hyperkalemia to avoid? (Select all that apply.)
a. Canned apricots
b. Dried beans
"Which assessment findings are related to hypercalcemia? (Select all that apply.)
c. Leg cramping
d. Hyperactive bowel sounds
e. Ineffective respiratory movements
f. Shortened QT interval
g. Impaired blood flow
h. Profound muscle weakness"
"Which nursing interventions apply to patients with hypercalcemia? (Select all that apply.)
a. Administer IV normal saline (0.9% sodium chloride).
b. Assess the patient for a positive Homans'
c. Measure the abdominal girth.
d. Massage calves to encourage blood return
to the heart.
e. Monitor for ECG changes.
f. Provide adequate intake of vitamin D.
g. During treatment, monitor for tetany."
"The nurse is reviewing the laboratory calcium level results for a patient. Which value indicates mild hypocalcemia?
a. 5.0 mg/dL
b. 8.0 mg/dL
c. 10.0 mg/dL
d. 12.0 mg/dL"
"A patient with a recent history of anterior neck injury reports muscle twitching and spasms with tingling in the lips, nose, and ears. The nurse suspects these symptoms may be caused by which condition?
"Which conditions cause a patient to be at risk for hypocalcemia? (Select all that apply.)
a. Crohn's disease
b. Acute pancreatitis
c. Removal or destruction of parathyroid glands
e. Use of digitalis"
"The nurse is assessing the patient with a risk for hypocalcemia. What is the correct technique to test for Chvostek's sign?
a. Patient flexes arms against the chest and
examiner attempts to pull the arms away
from the chest.
b. Place a blood pressure cuff around the upper arm and inflate the cuff to greater than
the patient's systolic pressure.
c. Tap the face just below and in front of the
ear to trigger facial twitching of one side of
the mouth, nose, and cheek.
d. Lightly tap the patellar and Achilles ten-
dons with a reflex hammer and measure the movement."
"The nurse is caring for several patients with electrolyte imbalances. Which interventions are included in the plan of care for a patient with hypocalcemia?
a. Implementing an oral fluid restriction of 1500 mL/day
b. Implementing a renal diet
c. Providing moderate environmental stimulation with music
d. Placing the patient on seizure precautions"
"Which clinical condition can result from hypocalcemia?
a. Stimulated cardiac muscle contraction
b. Increased intestinal and gastric motility
c. Decreased peripheral nerve excitability
d. Increased bone density"
"Which patient is at greatest risk of developing hypocalcemia?
a. 30-year-old Asian woman with breast cancer
b. 45-year-old Caucasian man with hypertension and diuretic therapy
c. 60-year-old African-American woman
with a recent ileostomy
d. 70-year-old Caucasian man on long-term
"Which is a preventive measure for patients at risk for developing hypocalcemia?
a. Increase daily dietary calcium intake to
b. Increase intake of phosphorus.
c. Apply sunblock and wear protective clothing whenever outdoors.
d. Administer calcium containing IV fluids
to patients receiving multiple blood transfusions."
"The patient who has undergone which surgical procedure is most at risk for hypocalcemia?
"Which medication order does the nurse clarify before administering the drug to a patient with hypocalcemia? a. Magnesium sulfate 1 g IM every 6 hours
for four doses
b. Aluminum hydroxide (AlternaGEL) 15
mL orally three times a day and at bedtime
c. Calcium carbonate 1000 mg orally after
meals and at bedtime
d. Calcium gluconate 5 mEq IV PRN for
"Which are typical nursing assessment findings for a patient with hypocalcemia? (Select all that apply.)
a. Positive Chvostek's sign
d. Prolonged ST interval
e. Elevated T wave"
"Which intervention does the nurse implement for a patient with hypocalcemia?
a. Encourage activity by the patient as tolerated, including weightlifting.
b. Encourage socialization and active participation in stimulating activities.
c. Include a tracheostomy tray at the bedside
for emergency use.
d. Provide adequate intake of vitamin D and
calcium rich foods."
"A patient has chronic renal failure (CRF). Which electrolyte imbalance often associated with hypocalcemia and CRF does the nurse monitor for?
"A patient with hypocalcemia is in need of supplemental diet therapy. Which foods does the nurse recommend to provide both calcium and vitamin D? (Select all that apply.)
"A patient shows a positive Trousseau's or Chvostek's sign. The nurse prepares to give the patient which urgent treatment?
a. IV calcium
b. Calcitonin (Calcimar)
c. IV potassium chloride
d. Large doses of oral calcium"
"Which is a preventive nursing intervention for a patient at risk for developing hypercalcemia? (Select all that apply.)
a. Administer D5W.
b. Administer furosemide (Lasix).
c. Ensure adequate hydration.
d. Administer plicamycin (Mithracin).
e. Discourage weight-bearing activity such as
"The nurse caring for a patient with hypercalcemia anticipates orders for which medications? (Select all that apply.)
a. Magnesium sulfate
b. Calcitonin (Calcimar)
c. Furosemide (Lasix)
d. Plicamycin (Mithracin)
e. Calcium gluconate
f. Aluminum hydroxide"
"The nurse instructs the UAP to use precautions with moving and using a lifting sheet for which patient with an electrolyte imbalance?
a. Young diabetic woman with hyperkalemia
b. Psychiatric patient with hyponatremia
c. Older woman with hypocalcemia
d. Child with severe diarrhea and hypomagnesemia"
"A patient's laboratory results show a decrease in serum phosphorus level. The nurse expects to see a reciprocal increased change in which serum level?
"______________________ is the accompanying and potentially life-threatening electrolyte imbalance that the nurse monitors for in a patient with hyperphosphatemia."
"Which nursing interventions does the nurse include for a patient with hypophosphatemia?
a. Aggressive treatment with parenteral
b. Administration of oral vitamin D and
c. Concurrent administration of calcium
d. Elimination of beef, pork, and legumes
from the diet"
"Which manifestations reflect severe hypophosphatemia? (Select all that apply.)
a. Profound muscle weakness
b. Decreased peristalsis
c. Elevated T wave
e. Cardiac muscle damage"
"Which factors can cause hyperphosphatemia?
(Select all that apply.)
a. Tumor lysis syndrome
b. Decreased intake of phosphorus
d. Decreased renal excretion
"A patient recently admitted to the hospi- tal with malnutrition from alcohol abuse is likely to have the electrolyte imbalance __________________________."
"What are common causes of hypophosphatemia? (Select all that apply.)
a. Increased intake of phosphorus
d. Uncontrolled diabetes
e. Use of magnesium based antacids"
"A patient with which condition would need priority nursing assessment?
a. Renal insufficiency
b. Potassium level of 3.4 mEq/L
c. Sodium level of 133 mEq/L
"The physician orders magnesium sulfate (MgSO4) for a patient with severe hypomagnesemia. What is the preferred route of administration for this drug?
"The nurse is assessing a patient with severe hypermagnesemia. Which assessment findings are associated with this electrolyte imbalance?
a. Bradycardia and hypotension
b. Tachycardia and weak palpable pulse
c. Hypertension and irritability
d. Irregular pulse and deep respirations"
"A patient in the hospital has a severely elevated magnesium level. What interventions, in order of priority, are performed by the nurse to treat the patient? (Select in order of priority.)"
a. Discontinue oral magnesium.
b. Administer furosemide (Lasix).
c. Discontinue parenteral magne- sium.
d. Administer calcium to treat bra- dycardia."
"A patient has a magnesium level of 0.8 mg/dL. Which treatment does the nurse expect to be ordered for this patient?
a. Intramuscular magnesium sulfate
b. Increased intake of fruits and vegetables
c. Oral preparations of magnesium sulfate
d. IV magnesium sulfate and discontinuation
of diuretic therapy"
"The nurse monitors the effectiveness of magnesium sulfate by assessing which factor every hour?
a. Deep tendon reflexes
b. Vital signs
c. Serum laboratory values
d. Urine output"
"Which patient condition places a patient at risk for hypocalcemia, hyperkalemia, and hypernatremia?
b. Diabetes mellitus
c. Chronic renal failure
d. Adrenal insufficiency"
"A patient with congestive heart failure is receiving a loop diuretic. The nurse monitors for which electrolyte imbalances? (Select all that apply.)
"What is the normal range of serum osmolality?
a. 175-195 mOsm/kg
b. 280-295 mOsm/kg
c. 375-395 mOsm/kg
d. 475-495 mOsm/kg"
"How is serum osmolality calculated?
a. doubling the serum sodium level
b. halving the serum sodium level
c. doubling the serum calcium level
d. halving the serum calcium level"
"What is the term used to describe the body fluid when the serum osmolality is 285 mOsm/kg?
"An IV solution with an osmolality of 540 mOsm is considered to be what type of solution?
"How is the majority of potassium excreted?
a. through the liver
b. through the kidneys
c. through the lungs
d. in the feces"
"When administering potassium orally, the nurse knows that it must be taken with at least how many ounces of water or juice?
"The nurse is teaching a client about calcium absorption and includes in the health teaching that vitamin D is needed for calcium absorption. Where in the body is calcium absorbed?
a. GI tract
"Calcium is distributed intercellularly and intracellularly in what proportions?
a. 25%; 75%
b. 75%; 25%
c. 50%; 50%
d. 90%; 10%"
"Thiazide diuretics such as hydrochlorothia- zide (HydroDIURIL) have what effect on the serum calcium level?
c. no change
d. marked decrease"
"A client is receiving 2 L of IV fluids: 1000 mL (1 L) of D5W and 1000 mL of D5/0.45% NaCl (D5/1⁄2 NS). What are the client's solutions classified as?
d. blood products"
"One liter (1000 mL) of 5% dextrose in 1⁄2 nor- mal saline solution (D5/0.45% NaCl) is what type of IV fluid?
"A client has received a continuous D5W infusion for the past several days. When this type of infusion is given for an extended period of time, what type of solution does it become?"
"What is the client's serum osmolality ac- cording to the following current laboratory values: serum sodium 140 mEq/L; BUN 15 mg/dl; blood glucose 110 mg/dl?"
a. 280 mOsm
b. 285 mOsm
c. 291 mOsm
d. 296 mOsm"
"How is a serum osmolality of approximately 290 mOsm classified?
"Which body component has a similar compo- sition to lactated Ringer's IV solution?
a. white blood cells
c. body tissue
"A 43-year-old client is taking Slow-K. She is taking hydrochlorothiazide 50 mg daily to control her hypertension. The client's serum potassium level is 3.2 mEq/L. What clinical manifestations would the nurse expect to assess in this client?"
b. increased serum glucose
"The nurse is giving a client Slow-K. What is the best way this should be given?
a. when the client's stomach is empty
b. at bedtime
c. with 8 ounces of water
d. 2 hours before meals"
"A client who is taking Slow-K complains of nausea, vomiting, and abdominal distention. These clinical manifestations are associated with which electrolyte imbalance?
"A client with a serum potassium level of 3.2 mEq/L asks why she has to take potassium. What reasons should the nurse give her for taking this medication? (Select all that apply.)
a. "Your diuretic causes not only water and sodium to be excreted but also potassium."
b. "Your serum potassium level is low, and Slow-K helps to prevent a potas- sium deficit."
c. "Your health care provider should discontinue the potassium supplement after a week."
d. "The potassium supplement should maintain a normal potassium level in your body while you are taking the diuretic (potassium-wasting).""
"Which serum potassium levels indicate hy- perkalemia?
a. 5.9 mEq/L
b. 4.6 mEq/L
c. 3.8 mEq/L
d. 2.9 mEq/L"
A 65-year-old client's serum potassium level is 6.1 mEq/L. What clinical manifestations should the nurse expect to assess in this cli- ent? (Select all that apply.)
a. abdominal cramps
b. muscle weakness
c. tachycardia and later bradycardia
"Which drugs are used to treat hyperkalemia? (Select all that apply.)
b. IV sodium bicarbonate, calcium gluconate
c. insulin and glucose
d. kayexalate and sorbitol"
"A 68-year-old client has a calcium deficit. Her serum calcium level is 3.6 mEq/L.What clini- cal manifestations should the nurse expect to assess in this client? (Select all that apply.)
c. numbness of the fingers
d. pathologic fractures"
"The health care provider orders calcium chloride in 5% dextrose and 0.45% sodium chloride (D5/1⁄2 NS) for a client with a cal- cium deficit. What effect may saline solution have on calcium chloride?
a. It may increase the effects of calcium; calcium should always be mixed with a saline solution.
b. It has little or no effect on the calcium additive.
c. Calcium additives should always be added to IV solutions containing so- dium chloride.
d. Sodium encourages calcium loss; cal- cium should not be mixed with a saline solution."
"What is the best response by the nurse to an IV order of calcium chloride in 5% dextrose and 0.45% sodium chloride (D5/1⁄2 NS)?
a. Explain to the client that she should not accept this IV fluid.
b. Suggest to the health care provider to change the IV order to 5% dextrose in water (D5W) and explain why.
c. Do nothing, because this solution would not have any effect on the cal- cium chloride additive.
d. Report the health care provider to the chiefs of both nursing and medicine."