Fluid and Electrolytes ATI Review Answer Key Question 1: (see full question) An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? You selected: Hypokalemia Correct Explanat ion: Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a defict in total potassium stores. Potassium -losing diuretics, such as loop diuretics, can induce hypokalemia. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook o f Medical -Surgical Nursing , 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 255. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 255 Question 2: (see full question) The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? Correct response: Potassium: 5.8 mEq/L Explanation: Normal potassium level is 3.5 to 5.5 mEq/L. Elevated potassium levels can lead to muscle weakness, paresthesias, and cardiac dysrhythmias. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing , 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 254. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 254 Question 3: (see full question) A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/ dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO 2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? You selected: Potassium Correct Explanat ion: The nurse should identify potassium: 2.2 mEq/L as critical because a normal potassium level is 3.8 to 5.5 mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dl) and the chloride level is a bit low (normal is 100 to 110 mEq/L). Although these levels should be reported, neither is life-threatening. The BUN (normal is 8 to 26 mg/dl) and creatinine (normal is 0.8 to 1.4 mg/dl) are within normal range. (less) Latest Updated Solutions 3 3 Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing , 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chap ter 13: Fluid and Electrolytes: Balance and Disturbance, p. 255. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 255 Question 4: (see full question) Which nerve is implicated in the Chvostek’s sign? You selected: Facial Correct Explanation: Chvostek’s sign consists of twitching of muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing , 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 259. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 259 Question 5: (see full question) A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (Pa CO 2), 40 mm Hg; and bicarbonate (HCO –), 15 mEq/L. These ABG values suggest which disorder? You selected: Metabolic acidosis Corr ect Explanation: This client's pH value is below normal, indicating acidosis. The HCO – value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO 2 value is normal, i ndicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis. ( less) Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing , 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 268. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 268 Question 6: (see full question) The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? You selected: Dark, concentrated urine Correct Explanation: Dehydration indicates a fluid volume deficit. Dark, concentrated urine indica tes a lack of fluid volume. Adding more fluid would dilute the urine. The other options indicate fluid excess. ( less) Latest Updated Solutions Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing , 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 246. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 246 Question 7: (see full question) To compensate for decreased fluid volume (hypovolemia) , the nurse can anticipate which response by the body? You selected: Tachycardia Correct Explanation: Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid hear t rate, vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid, weak pulse and orthostatic hypotension. ( less) Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing , 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 245 -246. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245 Question 8: (see full question) Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism? You selected: Chest pain Correct Explanation: Manifestations of air embolism include dyspnea and cyanosis; hypotension; weak, rapid pulse; loss of consciousness; and chest, shoulder, and low back pain. Jaundice is not associated with air embolism. ( less) Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing , 13th ed. Philadelphia: Lippinco tt Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 280. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 280 Question 9: (see full question) The nurse is analyzing the arterial blood gas (AGB ) results of a patient diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? Correct response: pH: 7.20, PaCO 2: 65 mm Hg, HCO 3–: 26 mEq/L Explanation: 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 HCO 3– occurs. It may be either acute or chronic. Latest Updated Solutions The ABG of pH: 7.32, PaCO 2: 40 mm Hg, HCO 3–: 18 mEq/L indicates metabolic acidosis. The ABGs of pH: 7.50, PaCO 2: 30 mm Hg, and HCO 3–: 24 mEq/L indicate respiratory alkalosis. The ABGs of pH 7.42, PaCO 2: 45 mm Hg, and HCO 3–: 22 mEq/L indicate a normal result/no imbalance. (less) Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medic al-Surgical Nursing , 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 269. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269 Question 10: (see full questio n) Below which serum sodium level may convulsions or coma can occur? You selected: 135 mEq/L Correct Explanation: Normal serum concentration level ranges from 135 to 145 mEq/L. When the level dips below 135 mEq/L, there is hyponatremia. Manifestations of hyponatremia include mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the deficit is severe. Values of 140, 142, and 145 mEq/L are within the normal range. (less) Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturban ce, p. 253. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 253 Question 11: (see full question) Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon d ioxide (PaCO 2) of 26 mm Hg, oxygen (O 2) saturation of 96%, bicarbonate (HCO 3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? You selected: Instruct the client to breathe into a paper bag. Correct Explanation: The ABG results reveal respiratory alkalosis. The best intervention to raise the Pa CO 2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered Pa CO 2 level. (less) Reference: Hinkle, J .L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical -Surgical Nursing , 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13: Fluid and Electrolytes: Balance and Disturbance, p. 271. Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 271 Latest Updated Solutions
