Fluid, Electrolyte, and Renal Nursing Practice #2

A 45-year-old male presents with fatigue, nausea, and oliguria after receiving high doses of aminoglycoside antibiotics. Labs show BUN 60 mg/dL and creatinine 4.5 mg/dL. The nurse recognizes these as findings of:

• Prerenal failure

• Acute tubular necrosis

• Chronic renal failure

• Nephrotic syndrome

A patient admitted with diabetic ketoacidosis (DKA) is on IV insulin and fluids. The nurse notes muscle cramps and shallow respirations. Serum potassium is 2.8 mEq/L. What is the most appropriate intervention?

• Administer IV potassium chloride as prescribed

• Encourage oral potassium intake only

• Stop the insulin infusion

• Administer calcium gluconate

A client with ESRD is prescribed sevelamer hydrochloride. The nurse explains that the purpose of this medication is to:

• Increase urine output

• Bind dietary phosphate to prevent absorption

• Replace lost calcium

• Stimulate red blood cell production

A 32-year-old patient with chronic vomiting has ABG results: pH 7.55, PaCO₂ 46 mmHg, HCO₃⁻ 32 mEq/L. Which interpretation is correct?

• Metabolic alkalosis

• Respiratory alkalosis

• Respiratory acidosis

• Metabolic acidosis

After receiving a blood transfusion, a patient develops tingling sensations and facial twitching. The nurse suspects:

• Hyperkalemia from hemolysis

• Hypocalcemia due to citrate in blood products

• Hyponatremia from volume overload

• Hypomagnesemia from diuretics

A 58-year-old male with a history of heart failure presents with dyspnea, crackles, and +3 pitting edema. Which laboratory value should the nurse anticipate?

• Hematocrit 52%

• Sodium 132 mEq/L

• B-type natriuretic peptide (BNP) elevated

• Potassium 2.8 mEq/L

A patient on peritoneal dialysis complains of abdominal distention and slowed dialysate drainage. Which action should the nurse take first?

• Reposition the client to side-lying

• Add heparin to the solution

• Increase the dwell time

• Notify the provider immediately

A nurse caring for a patient with dehydration notes a serum sodium of 154 mEq/L and specific gravity 1.040. The priority action is to:

• Restrict fluids

• Administer hypotonic IV fluids slowly

• Administer furosemide

• Encourage salty snacks

A client with advanced kidney disease is experiencing severe pruritus. Which nursing intervention would provide the greatest relief?

• Apply talcum powder

• Administer prescribed phosphate binders with meals

• Encourage frequent hot showers

• Use alcohol-based lotions

A nurse prepares to administer IV calcium gluconate to a patient with hyperkalemia. Which concurrent finding justifies this intervention?

• ECG shows peaked T waves

• Serum sodium 140 mEq/L

• Serum phosphate 2.5 mg/dL

• Urine output 50 mL/hr