Chapter 13: Fluid and Electrolytes: Balance and Disturbance

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A client is brought in by ambulance in a nauseous and confused state and demonstrating carpopedal spasm. Initial arterial blood gases show increased pH and HCO3 and normal PaCO2 levels. Breathing is slow and shallow. As the nurse caring for this client, you know that potassium salt should be a part of the treatment for this client when?

You Selected:

  •  When base bicarbonate accumulates

Correct response:

  •  When hypokalemia is present
  Explanation:

The findings suggest metabolic alkalosis. Treatment involves eliminating the cause. Loss of hydrogen and chloride ions may be one of the causes, and this loss can be a result of hypokalemia. Potassium salt should be administered if there is evidence of hypokalemia. It is not always part of the treatment for metabolic alkalosis. If there is volume depletion, the nurse should always administer sodium chloride solutions. Accumulation of base bicarbonate is what leads to metabolic alkalosis and is not a defining condition for treatment with potassium.

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Question 2    See full question15sReport this Question

The calcium concentration in the blood is regulated by which mechanism?

You Selected:

  •  Parathyroid hormone (PTH)

Correct response:

  •  Parathyroid hormone (PTH)
  Explanation:

The serum calcium concentration is controlled by PTH and calcitonin. The thyroid hormone, adrenal gland, or androgens do not regulate the calcium concentration in the blood.

Reference:

  • Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 273. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 273
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Question 3    See full question30sReport this Question

Hypomagnesemia is a common yet often overlooked imbalance in acutely and critically ill patients. Which of the following patients is most likely at the highest risk of experiencing low serum magnesium levels?

You Selected:

  •  A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use

Correct response:

  •  A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use
  Explanation:

Alcoholism is currently the most common cause of symptomatic hypomagnesemia in the United States. Hypomagnesemia is particularly troublesome during treatment of alcohol withdrawal. Therefore, the serum magnesium level should be routinely measured in patients undergoing withdrawal from alcohol. TPN, heart disease, and lymphoma are not identified as central risk factors for the development of hypomagnesemia.

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Question 4    See full question22sReport this Question

A patient in the ICU starts complaining of being “short of breath.” An arterial blood gas (ABG) is drawn. The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?

You Selected:

  •  Respiratory alkalosis

Correct response:

  •  Respiratory acidosis
  Explanation:

The pH < 7.35 indicates acidosis. The PACO2 > 45 means this is respiratory acidosis, not metabolid acidosis. The HCO3 of 24 is normal, indicating that the respiratory acidosis is uncompensated.

Reference:

  • Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 4: Fluid and Electrolyte and Acid, p. 87. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 87
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Question 5    See full question3sReport this Question

A nurse is providing client teaching about the body’s plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse?

You Selected:

  •  bicarbonate–carbonic acid buffer system

Correct response:

  •  bicarbonate–carbonic acid buffer system
  Explanation:

The major chemical regulator of plasma pH is the bicarbonate–carbonic acid buffer system. The renin–angiotensin–aldosterone system regulates blood pressure. The sodium–potassium pump regulate homeostasis. The ADH-ANP buffer system regulates water balance in the body.

Reference:

  • Hinkle, J. L., Cheever, K. H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 284. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 284
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Question 6    See full question20sReport this Question

Which set of arterial blood gas (ABG) results requires further investigation?

You Selected:

  •  pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3– 18 mEq/L

Correct response:

  •  pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3– 18 mEq/L
  Explanation:

The ABG results pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3– 18 mEq/L indicate respiratory alkalosis. The pH level is increased, and the HCO3– and PaCO2 levels are decreased. Normal values are pH 7.35 to 7.45; PaCO2 35 to 45 mm Hg; HCO3– 22 to 26 mEq/L.

Reference:

  • Hinkle, J. L., Cheever, K. H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 287. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 287
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Question 7    See full question19sReport this Question

The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for?

You Selected:

  •  Metabolic acidosis

Correct response:

  •  Metabolic acidosis
  Explanation:

Metabolic acidosis is a common clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3 occurs. Respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg.

Reference:

  • Hinkle, J. L., Cheever, K. H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 284. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 284
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Question 8    See full question4sReport this Question

The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer?

You Selected:

  •  0.45% sodium chloride

Correct response:

  •  0.45% sodium chloride
  Explanation:

Half-strength saline (0.45% sodium chloride) solution is frequently used as an IV hypotonic solution.

Reference:

  • Hinkle, J. L., Cheever, K. H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 282. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 282
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Question 9    See full question19sReport this Question

A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed?

You Selected:

  •  furosemide

Correct response:

  •  furosemide
  Explanation:

Furosemide is the only loop diuretic choice. Hydrochlorothiazide and metolazone are thiazide diuretics that block sodium reabsorption. Spironolactone is a potassium-sparing diuretic that prevents sodium absorption.

Reference:

  • Hinkle, J. L., Cheever, K. H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 263. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 263
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Question 10    See full question27sReport this Question

A nurse is reviewing a report of a client’s routine urinalysis. Which value requires further investigation?

You Selected:

  •  Urine pH of 3.0

Correct response:

  •  Urine pH of 3.0
  Explanation:

Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.010 to 1.025, making this client’s value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.

Reference:

  • Hinkle, J. L., Cheever, K. H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 256. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 256

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Question 1    See full question17sReport this Question

The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely?

You Selected:

  •  Magnesium

Correct response:

  •  Magnesium
  Explanation:

Chronic alcohol abuse is a major cause of symptomatic hypomagnesemia in the United States. The serum magnesium concentration should be measured at least every 2 or 3 days in clients undergoing alcohol withdrawal. The serum magnesium concentration may be normal at admission but may decrease as a result of metabolic changes, such as the intracellular shift of magnesium associated with intravenous glucose administration.

Reference:

  • Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 277. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 277
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Question 2    See full question21sReport this Question

A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client’s serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance?

You Selected:

  •  Presence of Trousseau sign

Correct response:

  •  Presence of Trousseau sign
  Explanation:

After radical neck resection, a client is prone to developing hypocalcemia. Hypocalcemia is defined as a serum value <8.6 mg/dL (<2.15 mmol/L). Signs and symptoms of hypocalcemia include Chvostek sign, which consists of muscle twitching enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe, just below the zygomatic arch, is tapped; and a positive Trousseau sign can be elicited by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and metacarpophalangeal joints, and extended interphalangeal joints with fingers together) will occur as ischemia of the ulnar nerve develops. Slurred speech and muscle weakness are signs of hypercalcemia.

Reference:

  • Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, Figure 13-7, Table 13-8, p. 273–274.
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Question 3    See full question21sReport this Question

A client reports muscle cramps in the calves and feeling “tired a lot.” The client is taking ethacrynic acid (Edecrin) for hypertension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance?

You Selected:

  •  hypokalemia

Correct response:

  •  hypokalemia
  Explanation:

Hypokalemia causes fatigue, weakness, anorexia, nausea, vomiting, cardiac dysrhythmias, leg cramps, muscle weakness, and paresthesias. Many diuretics, such as ethacrynic acid (Edecrin), also waste potassium. Symptoms of hyperkalemia include diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias. Signs of hypocalcemia include tingling in the extremities and the area around the mouth and muscle and abdominal cramps. Hypercalcemia causes deep bone pain, constipation, anorexia, nausea, vomiting, polyuria, thirst, pathologic fractures, and mental changes.

Reference:

  • Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 268. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 268
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Question 4    See full question17sReport this Question

A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:

You Selected:

  •  280 mOsm/kg.

Correct response:

  •  280 mOsm/kg.
  Explanation:

Serum osmolality can be estimated by doubling the serum sodium or using the formula: Na × 2 = glucose/18 + BUN/3. Therefore, the nurse could estimate a serum osmolality of 280 mOsm/kg by doubling the serum sodium value of 140 mEq/L.

Reference:

  • Hinkle, J. L., Cheever, K. H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 255. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 255
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Question 5    See full question28sReport this Question

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant?

You Selected:

  •  Provide oral care every 2–3 hours.

Correct response:

  •  Provide oral care every 2–3 hours.
  Explanation:

Providing oral care for the client every 2–3 hours is within the scope of practice of a nursing assistant. The other actions should be completed by the registered nurse.

Reference:

  • Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 13: Fluids and Electrolytes: Balance and Disturbance, p. 268. Chapter 13: Fluid and Electrolytes: Balance and Disturbance – Page 268
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