carlo fluid and electrolyte

8/3/2019 Carlo Fluid and Electrolyte

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Fluids and Electrolytes

Carlo S. Payabyab, R.N.


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1. Nurse Raffa is reading a physician's progressnotes in the client's record and reads that thephysician has documented "insensible fluid lossof approximately 800 mL daily." Nurse Raffaunderstands that this type of fluid loss can occurthrough:

1. the skin

2. urinary output3. wound drainage4. the gastrointestinal tract


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1. skin - Sensible losses are those ofwhich the person is aware such as throughwound drainage, GIT losses and urination.

Insensible losses may occur without theperson's awareness. Options 2,3, and 4can all be measured accurately. fluid loss

through the skin cannot be measuredaccurately, only approximately.

RATIONALIZATION


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2. Nurse Melvin is assigned to care for agroup of clients' medical records. NurseMelvin determines that which of the client

is at risk for deficient fluid volume?

1. a client with congestive heart failure.

2. a client with decreased kidney function3. a client with colostomy4. a client receiving wound irrigations.


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3. a client with colostomy - Among thecauses of fluid volume deficit are vomiting,diarrhea, conditions that increase

respiration or increased urinary output,insufficient IV replacement, and presenceof ileostomy or colostomy. Choices 1,2

and 4 can all lead to fluid volume excess.

RATIONALIZATION


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3. Nurse Bon is caring for a client withcongestive heart failure. On assessment, nurseBon notes that the client is dyspneic and thatcrackles are audible upon auscultation. Nurse

Bon suspects excess fluid volume. Whatadditional signs would nurse Bon expect to notein this client if excess fluid volume is present?

1. Flat neck and hand veins

2. Weight loss3. An increase in blood pressure4. A decrease in Central venous pressure


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3. An increase in blood pressure - assessmentfindings associated with fluid volume excessinclude cough, dsypneam crackles, tachypnea,tachycardia, an elevated blood pressure and abounding pulse, elevated CVP, weight gain,edema, neck and hand distention, altered levelof consciousness and decreased hematocritlevel. Options 1,2 and 4 are all associated with

fluid volume deficit.

RATIONALIZATION


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4. Nurse Angel is preparing to care for a clientwith potassium deficit. He reviews the client'srecords and determines that the client was atrisk for developing potassium deficit because the

client:

1. Is taking a Aldactone2.Has history of Addisson's disesae3. Requires nasogastric suction

4. has renal failure


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3. Requires nasogastric suction-Potassium-rich gstrointestinal fluids arelost though GI suction, placing the client at

risk of Hypokalemia. the client with renalfailure or Addison's disease and the clienttaking aldactone are all at risk of

hyperkalemia and not of hypokalemia.

RATIONALIZATION


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5. Nurse Donnie reviews a client's laboratoryreport and notes that the potassium level is 3.2mEq/L. Which of the following would the nursenote on the electrocardiogram as a result of the

laboratory value?

1. prolonged St or Qt interval2. Widened T wave3. Presence of U waves

4. Shortened ST segment


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3. Presence of U waves - a serum potassiumlevel of less than 3.5 mEq/L indicateshypokalemia. Electrocardiographic changes forhypokalemia include inverted T waves, STsegment depression and prominet U wave.Presence of prolonged ST or QT intervalindicates hypocalcemia while presence ofwidened t wave and shortened st segment

indicate hypercalcemia.

RATIONALIZATION


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6. Nurse Joseph needs to administer potassium

chloride intravenously as prescribed to a client withhypokalemia. the nursing instructor determines thatthe student is unprepared for this procedure if thestudent states that which of the following is part of

the plan for the preparation and administration ofthe potassium?

1. Diluting in appropriate amount of Normal Saline

2. Monitoring urine output during administration3. Preparing the medication for bolus administration4. Obtaining a controlled IV infusion pump


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3. Preparing the medication for bolus administration- potassium chloride administered intravenously should

always be diluted in IV fluid and infused via a pump orcontroller. The usual concentration of IV potassiumchloride is 20 to 40 mEq/L. Potassium chloride given byIV push/bolus should never be done for it can result intosudden cardiac arrest. Dilution in normal saline isrecommended but never with dextrose for this type ofsolution increases intracellular potassium shifting. thenurse should always monitor urine output during

administration. Urine output less than 30ml/hr should benotified to the physician for this may indicate renalimpairment.

RATIONALIZATION


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7. Nurse Dennis reviews the electrolyte resultsof an assigned client and notes that thepotassium level is 5.4 mEq/L. which of thefollowing would the nurse expect to note on theelectrocardiogram as a result of the laboratoryvalue?

1. ST depression

2. Prominent U wave3. Inverted T wave4. Tall peaked T waves


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4. Tall peaked T waves - A serum potassiumlevel greater than 5.1 mEq/L indicateshyperkalemia. Electrocardiographic changes

include flat P waves, prolonged PR intervals,widened QRS complexes and tall peaked Twaves. Choices 1,2 and 3 all inidcateelectrocardiographic changes for a patient with

hypokalemia.

RATIONALIZATION


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8. Nurse Adrian is caring for a client with acutecongestive heart failure who is receiving highdoses of diuretic on assessment, he notes that

the client has flat neck veins, generalizedmuscle weakness, and diminished deep tendonreflexes. The nurse suspects hyponatremia.What additional signs would the nurse expect tonote in this client if hyponatremia were present?

1. Decreased Urinary output2. Increased specific gravity3. Hyperactive bowel sounds4. Dry skin


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3. Hyperactive bowel sounds - thepatient is suffering from dilutedhyponatremia. options 1,2 and4 are allsigns for hypernatremia.

RATIONALIZATION


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9. A nurse is reviewing client's laboratory reportand notes that the serum calcium is 4.0 mg/dL.The nurse understands that which conditionmost likely caused this serum calcium

1. Renal insufficiency2. Hyperparathyroidism3. Prolonged bed rest

4. excessive ingestion of vitamin D


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3. Prolonged bed rest - the normal serumcalcium level is 8.6 - 10.0 mg/dl. A client withserum calcium level of 4.0 mg/dl is experiencinghypocalcemia. Hyperparathyroisdism andexcessive ingestion of vitamin d can lead tohypercalcemia. Endstage Renal disease, notrenal insufficiency, can lead to hypocalcemia.Prolonged bed rest can lead to hypocalcemia.

although immobilization can initially lead tohypercalcemia, the long term effect of bed rest ishypocalcemia

RATIONALIZATION


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10. A nurse reviews a client's laboratory reportand notes that the client's serum phosporuslevel is 2.0 mg/dl. Which condition most likelycaused the serum phosporus level?

1. Renal insuiciency2. Alcoholism3. Tumor Lysis Syndrome

4. Hypoparathyroism


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2. Alcoholismthe normal phosphorus level is 2.7 to 4.5mg/dl. the patient is experiencing

hypophosphatemia. options 1,3,4 can alllead to hyperphospathemia whilealcoholism is greatly associated with

malnutrit

RATIONALIZATION


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Thank you for listening.

carlo fluid and electrolyte

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