Fluid & Electrolyte Quiz

Which of the following solutions has an effective osmolarity greater than body fluids?

• Hypertonic

• Hypotonic

• Isotonic

• Osmotic

Answer explanation

Hypertonic IV solutions have a greater concentration of solutes (375 mEq/L and greater) than plasma and cause fluids to move out of the cells and into the ECF in order to normalize the concentration of particles between two compartments. This effect causes cells to shrink and may disrupt their function. They are also known as volume expanders as they draw water out of the intracellular space, increasing extracellular fluid volume; contain a higher concentration of sodium and chloride than normally contained in plasma.

Dextrose 10% in Water (D10W)

Dextrose 20% in Water (D20W)

Dextrose 50% in Water (D50W)

Nursing Considerations for Hypertonic Solutions. The following are the general nursing interventions and considerations when administering hypertonic IV solutions:

Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue monitoring during and after the infusion.

Watch for signs of hypervolemia. Since hypertonic solutions move fluid from the ICF to the ECF, they increase the extracellular fluid volume and increases the risk for hypervolemia. Look for signs of swelling in arms, legs, face, shortness of breath, high blood pressure, and discomfort in the body (e.g., headache, cramping). Monitor and observe the patient during administration. Hypertonic solutions should be administered only in high acuity areas with constant nursing surveillance for potential complications.

Verify order. Prescription for hypertonic solutions should state the specific hypertonic fluid to be infused, the total volume to be infused, the infusion rate and the length of time to continue the infusion. Assess health history. Patients with kidney or heart disease and those who are dehydrated should not receive hypertonic IV fluids. These solutions can affect renal filtration mechanisms and can easily cause hypervolemia to patients with renal or heart problems. Prevent fluid overload. Ensure that administration of hypertonic fluids does not precipitate fluid volume excess or overload.

Monitor blood glucose closely. Rapid infusion of hypertonic dextrose solutions can cause hyperglycemia. Use with caution for patients with diabetes mellitus.

Do not administer peripherally. Hypertonic solutions can cause irritation and damage to the blood vessel and should be administered through a central vascular access device inserted into a central vein.

Which of the following is most likely an isotonic solution?

• Normal Saline (0.9% NaCl) (NS)

• Dextrose 5% in 0.45% NaCl (D51/2)

• 1/2 Normal Saline (0.34% NaCl)

• Dextrose 10% in Water (D10W)

When infusing an intravenous (IV) solution in cases of isotonic contraction, it is a priority for the nurse to do what?

• Assess for crackles in the lungs

• Calculate the infusion rate on drops per minute and hang by gravity.

• Infuse the fluid quickly

• Infuse 0.45% sodium chloride.

Answer explanation

The IVF should be administered slowly to avoid pulmonary edema. These fluids remain within the extracellular compartment and are distributed between intravascular (blood vessels) and interstitial (tissue) spaces, increasing intravascular volume. They are used primarily to treat fluid volume deficit.

General nursing considerations: •

Document baseline vital signs, edema, lung sounds, and heart sounds, and continue monitoring during and after the infusion.

• Monitor for continued signs of hypovolemia, including urine output < 0.5 mL/kg/hour, poor skin turgor, tachycardia, weak pulse, and hypotension.

• Monitor for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular vein distension (JVD) and extra heart sounds such as S3.

A 15 year old patient with bulimia who abuses laxatives is admitted to the hospital after experiencing extreme leg weakness. Potassium chloride 40mEq by mouth twice a day has been prescribed. The nurse reviews the most recent laboratory tests before administering the drug. Results include Na+ 137 mEq/L, K+ 3.5mEq/L,

and Cl- 100 mEq/L. What should the nurse do?

• Page the prescriber STAT

• Administer the medication

• Hold the medication and contact the prescriber

• Administer the medication and contact the prescriber

Answer explanation

Laxative abuse can lead to hypokalemia; treatment is potassium.

Therapeutic range:

Na+ 135-145 mEq/L

K+ 3.5-5 mEq/L

Cl- 97mEq/L-107mEq/L

This patient's lab values are within therapeutic range but K+ is on the lower end and has the risk of decreasing d/t laxative abuse and diarrhea.

S&S:

Common symptoms include anorexia, nausea and vomiting, lethargy, muscle weakness, and leg cramps.

Nursing Assessments/Considerations:

Assess the patient's LOC

Hypokalemic patients may be confused; apathetic; anxious; irritable; or, in severe cases, even comatose.

Assess the rate and depth of respirations and the color of nailbeds and mucous membranes. Note cardiovascular changes, such as weak and thready peripheral pulses and heart rate variability.

Orthostatic VS

Gastrointestinal function is altered during hypokalemia, and the patient may have abdominal distention and hypoactive bowel sounds.

The nurse is administering furosemide and sustain-release potassium chloride to a patient with heart failure (HF). The nurse notes that the patient is chewing the potassium chloride. The patient states she can not swallow the large pill. What the nurse should do?

• Crush the pill and mix it with applesauce of pudding.

• Instruct the patient to drink at lease 8 ounces of water after chewing the potassium pill.

• Contact the prescriber.

• Page the prescriber STAT.

Answer explanation

Except for the sustain released tablets, solid formulations of KCL can produce high local concentrations of potassium, resulting in severe intestinal injury (ulcerative lesions, bleeding, & perforation).

Ask the prescriber for liquid formulation.

Which lab result would be a priority to report to the prescriber when a patient is receiving IV fluids containing potassium?

• BUN 28mg/dL

• Creatinine 4.2mg/dL

• Potassium 3.5mEq/dL

• Serum glucose 220mg/dL

Answer explanation

Serum levels of potassium are regulated primarily by the kidneys; normal creatinine ranges 0.5-1.2

Nursing Interventions/Actions:

I&O q shift

Daily weight

Monitor VS

Excess Fluid Volume

Assess for edema

Low Na+ diet

Educate about possible hemodialysis

Which action is of greatest priority when a patient is diagnosed with hyperkalemia?

• Administer sodium polystyrene sulfonate

• Initiate cardiac monitoring

• Question the patient about medical history

• Teach foods that should be avoided because of high potassium content.

Answer explanation

The most serious consequence of hyperkalemia is disruption of electrical activity of the heart.

Nursing Considerations:

Muscle weakness, twitching, cramps. Numbness and tingling. Nausea and vomiting.

Irregular heartbeat.

Shortness of breath.

Diarrhea

Monitor VS (decrease =d BP)

Because of the risk of neuromuscular blockade when administering magnesium, the nurse must know how to obtain which IV medication?

• Calcium gluconate

• Potassium gluconate

• Sodium chloride

• Sodium polystyrene sulfonate

A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments?

• Intracellular fluid (ICF)

• Extracellular fluid (ECF)

• Interstitial fluid

• Intravascular fluid

Answer explanation

TOTAL BODY WATER

Intracellular Fluid

(ICF) The intracellular fluid is all fluid contained inside the cells. ICF is located within the cell membrane and contains water, electrolytes and proteins. Potassium, magnesium, and phosphate are the three most common electrolytes in the ICF

Extracellular Fluid:

(ECF) Extracellular fluid is fluid that is outside of the cells.

The ECF includes the intravascular, the interstitial (includes lymph as well), and transcellular compartments. The extracellular fluid (ECF) contains about one-third of total body water.

-Intravascular Fluid: blood and lymphatic vessels

-Interstitial Fluid: surrounds the body's cells

-Transcellular fluid: fluid that fills up the spaces of chambers that are created or formed from the linings of epithelial cells.

While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have a(n):

• Higher total body water volume

• Decreased muscle mass

• Increase in thirst

• Increased tendency towards developing edema