EXAM 4

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Endurance athletes who exercise for long periods of time and consume only water may experience a sodium deficit in their extracellular fluid. What is this electrolyte imbalance known as?

• hyponatremia

• hyperkalemia

• hypernatremia

• hypokalemia

Answer explanation

Hyponatremia refers to a sodium deficit in the extracellular fluid caused by a loss of sodium or a gain of water. Hypernatremia is too much sodium. Hypokalemia refers to a potassium deficit. Hyperkalemia is too much potassium.

The primary care provider writes prescriptions for a client who is admitted with a serum potassium level of 6.9 mEq/L. What does the nurse implement first?

• Ensure that a potassium-restricted diet is ordered.

• Administer sodium polystyrene sulfonate (Kayexalate) orally.

• Teach the client about foods that are high in potassium.

• Place the client on a cardiac monitor.

Answer explanation

If a patient's potassium level is too low or too high, ALWAYS put them on a heart monitor to monitor their dysrhythmias!

A client is receiving an intravenous infusion of 1000 mL of normal saline with 40 mEq of potassium chloride. The care unit nurse is monitoring the client for signs of hyperkalemia. Which finding initially will be noted in the client if hyperkalemia is present?

• confusion

• muscle weakness

• mental status changes

• depressed deep tendon reflexes

Answer explanation

S/S hyperkalemia: too much potassium so confusion, muscle weakness/twitching, bradycardia, dysrhythmias

A patient is given: 3 oz apple juice, 1 oz of bread, 2 oz of gelatin and 4 oz of fruity pebbles. What is the patient's fluid intake in mL?

• 300 mL

• 90 mL

• 150 mL

• 100 mL

Answer explanation

oral intake includes liquid items like gelatin, popsicles, ice cream, ice chips, iv fluids, tube feedings, irrigations, large volume enemas. In this question, apple juice and gelatin are the liquid items. 5 oz = 150 mL because remember that 30 mL = 1 oz!

Hypotonic solutions shift from where?

• intracellular to extracellular

• extraceullar to intracellular

• it is equal inside and outside

Answer explanation

hypotonic shifts from extracellular to intracellular because the cells SWELL UP! :O water moves into the cells

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for?

• metabolic acidosis

• metabolic alkalosis

• respiratory acidosis

• respiratory alkalosis

Answer explanation

metabolic alkalosis = too much bicarb. This includes ingesting antacids, taking diuretics, and losing GI secretions by vomiting or tube suctioning

A patient who has renal failure has what acid-base imbalance?

Answer explanation

metabolic acidosis = losing bicarb = renal failure, aspirin overdose, diarrhea, sepsis

The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present?

• weight loss and dry skin

• flat neck and hand veins and decreased urinary output

• increased blood pressure and respirations

• weakness and decreased central venous pressure

Answer explanation

crackles = fluid volume overload. S/S hypervolemia: hypertension, tachycardia, moist crackles, weight gain, hyponatremia, distended neck and peripheral veins

A client with hypermagnesemia is seen in the emergency department (ED). Which of these interventions is most appropriate?

• monitor for hyperactive reflexes

• prepare for endotracheal intubation

• do patient teachings on avoiding magnesium rich foods

• place the client on a cardiac monitor

Answer explanation

Hypermagnesemia causes changes in cardiac rhythm and may result in cardiac arrest, therefore instituting cardiac monitoring is most appropriate.