Question: What is the nurse's primary concern regarding fluid & electrolytes when caring for an elderly pt who is intermittently confused?
1. risk of dehydration
2. risk of kidney damage
3. risk of stroke
4. risk of bleeding

Answer: Answer: 1

Rationale 1: As an adult ages, the thirst mechanism declines. Adding this in a pt with an altered level of consciousness, there is an increased risk of dehydration & high serum osmolality.
Rationale 2: The risks for kidney damage are not specifically related to aging or fluid & electrolyte issues.
Rationale 3: The risk of stroke is not specifically related to aging or fluid & electrolyte issues.
Rationale 4: The risk of bleeding is not specifically related to aging or fluid & electrolyte issues.

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Question: The nurse is planning care for a pt with severe burns. Which of the following is this pt at risk for developing?
1. intracellular fluid deficit
2. intracellular fluid overload
3. extracellular fluid deficit
4. interstitial fluid deficit

Answer: Answer: 1

Rationale 1: Because this pt was severely burned, the fluid within the cells is diminished, leading to an intracellular fluid deficit.
Rationale 2: The intracellular fluid is all fluids that exist within the cell cytoplasm & nucleus. Because this pt was severely burned, the fluid within the cells is diminished, leading to an intracellular fluid deficit.
Rationale 3: The extracellular fluid is all fluids that exist outside the cell, including the interstitial fluid between the cells. Because this pt was severely burned, the fluid within the cells is diminished, leading to an intracellular fluid deficit.
Rationale 4: The extracellular fluid is all fluids that exist outside the cell, including the interstitial fluid between the cells. Because this pt was severely burned, the fluid within the cells is diminished, leading to an intracellular fluid deficit.

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Question: A pt, experiencing multisystem fluid volume deficit, has the symptoms of tachycardia, pale, cool skin, & decreased urine output. The nurse realizes these findings are most likely a direct result of which of the following?
1. the body's natural compensatory mechanisms
2. pharmacological effects of a diuretic
3. effects of rapidly infused intravenous fluids
4. cardiac failure

Answer: Answer: 1

Rationale 1: The internal vasoconstrictive compensatory reactions within the body are responsible for the symptoms exhibited. The body naturally attempts to conserve fluid internally specifically for the brain & heart.
Rationale 2: A diuretic would cause further fluid loss, & is contraindicated.
Rationale 3: Rapidly infused intravenous fluids would not cause a decrease in urine output.
Rationale 4: The manifestations reported are not indicative of cardiac failure in this pt.

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Question: A pregnant pt is admitted with excessive thirst, increased urination, & has a medical diagnosis of diabetes insipidus. The nurse chooses which of the following nursing diagnoses as most appropriate?
1. Risk for Imbalanced Fluid Volume
2. Excess Fluid Volume
3. Imbalanced Nutrition
4. Ineffective Tissue Perfusion

Answer: Answer: 1

Rationale 1: The pt with excessive thirst, increased urination & a medical diagnosis of diabetes insipidus is at risk for Imbalanced Fluid Volume due to the pt &'s excess volume loss that can increase the serum levels of sodium.
Rationale 2: Excess Fluid Volume is not an issue for pts with diabetes insipidus, especially during the early stages of treatment.
Rationale 3: Imbalanced Nutrition does not apply.
Rationale 4: Ineffective Tissue Perfusion does not apply

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Question: A pt recovering from surgery has an indwelling urinary catheter. The nurse would contact the pt's primary healthcare provider with which of the following 24-hour urine output volumes?
1. 600 mL
2. 750 mL
3. 1000 mL
4. 1200 mL

Answer: Answer: 1
Rationale 1: A urine output of less than 30 mL per hour must be reported to the primary healthcare provider. This indicates inadequate renal perfusion, placing the pt at increased risk for acute renal failure & inadequate tissue perfusion. A minimum of 720 mL over a 24-hour period is desired (30 mL multiplied by 24 hours equals 720 mL per 24 hours).

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Question: A pt is receiving intravenous fluids postoperatively following cardiac surgery. Nursing assessments should focus on which postoperative complication?
1. fluid volume excess
2. fluid volume deficit
3. seizure activity
4. liver failure

Answer: Answer: 1
Rationale 1: Antidiuretic hormone & aldosterone levels are commonly increased following the stress response before, during, & immediately after surgery. This increase leads to sodium & water retention. Adding more fluids intravenously can cause a fluid volume excess & stress upon the heart & circulatory system.
Rationale 2: Adding more fluids intravenously can cause a fluid volume excess, not fluid volume deficit, & stress upon the heart & circulatory system.
Rationale 3: Seizure activity would more commonly be associated with electrolyte imbalances.
Rationale 4: Liver failure is not anticipated related to postoperative intravenous fluid administration.

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Question: A pt is diagnosed with severe hyponatremia. The nurse realizes this pt will mostly likely need which of the following precautions implemented?
1. seizure
2. infection
3. neutropenic
4. high-risk fall

Answer: Answer: 1
Rationale 1: Severe hyponatremia can lead to seizures. Seizure precautions such as a quiet environment, raised side rails, & having an oral airway at the bedside would be included.
Rationale 2: Infection precautions not specifically indicated for a pt with hyponatremia.
Rationale 3: Neutropenic precautions not specifically indicated for a pt with hyponatremia.
Rationale 4: High-risk fall precautions not specifically indicated for a pt with hyponatremia.

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Question: A pt is diagnosed with hypokalemia. After reviewing the pt's current medications, which of the following might have contributed to the pt's health problem?
1. corticosteroid
2. thiazide diuretic
3. narcotic
4. muscle relaxer

Answer: Answer: 1
Rationale 1: Excess potassium loss through the kidneys is often caused by such meds as corticosteroids, potassium-wasting diuretics, amphotericin B, & large doses of some antibiotics.
Rationale 2: Excessive sodium is lost with the use of thiazide diuretics.
Rationale 3: Narcotics do not typically affect electrolyte balance.
Rationale 4: Muscle relaxants do not typically affect electrolyte balance.

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Question: A pt prescribed spironolactone is demonstrating ECG changes & complaining of muscle weakness. The nurse realizes this pt is exhibiting signs of which of the following?
1. hyperkalemia
2. hypokalemia
3. hypercalcemia
4. hypocalcemia

Answer: Answer: 1
Rationale 1: Hyperkalemia is serum potassium level greater than 5.0 mEq/L. Decreased potassium excretion is seen in potassium-sparing diuretics such as spironolactone. Common manifestations of hyperkalemia are muscle weakness & ECG changes.
Rationale 2: Hypokalemia is seen in non-potassium diuretics such as furosemide.
Rationale 3: Hypercalcemia has been associated with thiazide diuretics.
Rationale 4: Hypocalcemia is seen in pts who have received many units of citrated blood & is not associated with diuretic use.

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Question: The nurse is planning care for a pt with fluid volume overload & hyponatremia. Which of the following should be included in this pt's plan of care?
1. Restrict fluids.
2. Administer intravenous fluids.
3. Provide Kayexalate.
4. Administer intravenous normal saline with furosemide.

Answer: Answer: 1
Rationale 1: The nursing care for a pt with hyponatremia is dependent on the cause. Restriction of fluids to 1,000 mL/day is usually implemented to assist sodium increase & to prevent the sodium level from dropping further due to dilution.
Rationale 2: The administration of intravenous fluids would be indicated in fluid volume deficit & hypernatremia.
Rationale 3: Kayexalate is used in pts with hyperkalemia.
Rationale 4: The administration of normal saline with furosemide is used to increase calcium secretion.

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Question: When caring for a pt diagnosed with hypocalcemia, which of the following should the nurse additionally assess in the pt?
1. other electrolyte disturbances
2. hypertension
3. visual disturbances
4. drug toxicity

Answer: Answer: 1
Rationale 1: The pt diagnosed with hypocalcemia may also have high phosphorus or decreased magnesium levels.
Rationale 2: The pt with hypocalcemia may exhibit hypotension, & not hypertension.
Rationale 3: Visual disturbances do not occur with hypocalcemia.
Rationale 4: Hypercalcemia is more commonly caused by drug toxicities.

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Question: A pt with a history of stomach ulcers is diagnosed with hypophosphatemia. Which of the following interventions should the nurse include in this pt's plan of care?
1. Request a dietitian consult for selecting foods high in phosphorous.
2. Provide aluminum hydroxide antacids as prescribed.
3. Instruct pt to avoid poultry, peanuts, & seeds.
4. Instruct to avoid the intake of sodium phosphate.

Answer: Answer: 1
Rationale 1: Treatment of hypophosphatemia includes treating the underlying cause & promoting a high phosphate diet, especially milk, if it is tolerated. Other foods high in phosphate are dried beans & peas, eggs, fish, organ meats, Brazil nuts & peanuts, poultry, seeds & whole grains.
Rationale 2: Phosphate-binding antacids, such as aluminum hydroxide, should be avoided.
Rationale 3: Poultry, peanuts, & seeds are part of a high phosphate diet.
Rationale 4: Mild hypophosphatemia may be corrected by oral supplements, such as sodium phosphate.

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Question: When analyzing an arterial blood gas report of a pt with COPD & respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms?
1. The kidneys retain bicarbonate.
2. The kidneys excrete bicarbonate.
3. The lungs will retain carbon dioxide.
4. The lungs will excrete carbon dioxide.

Answer: Answer: 1
Rationale 1: The kidneys will compensate for a respiratory disorder by retaining bicarbonate.
Rationale 2: Excreting bicarbonate causes acidosis to develop.
Rationale 3: Retaining carbon dioxide causes respiratory acidosis.
Rationale 4: Excreting carbon dioxide causes respiratory alkalosis

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Question: The nurse is caring for a pt diagnosed with renal failure. Which of the following does the nurse recognize as compensation for the acid-base disturbance found in pts with renal failure?
1. The pt breathes rapidly to eliminate carbon dioxide.
2. The pt will retain bicarbonate in excess of normal.
3. The pH will decrease from the present value.
4. The pt's oxygen saturation level will improve.

Answer: Answer: 1
Rationale 1: In metabolic acidosis compensation is accomplished through increased ventilation or "blowing off" C02. This raises the pH by eliminating the volatile respiratory acid & compensates for the acidosis.
Rationale 2: Because compensation must be performed by the system other than the affected system, the pt cannot retain bicarbonate; the manifestation of metabolic acidosis of renal failure is a lower than normal bicarbonate value.
Rationale 3: Metabolic acidosis of renal failure causes a low pH; this is the manifestation of the disease process, not the compensation.
Rationale 4: Oxygenation disturbance is not part of the acid-base status of the pt with renal failure.

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Question: When caring for a group of pts, the nurse realizes that which of the following health problems increases the risk for metabolic alkalosis?
1. bulimia
2. dialysis
3. venous stasis ulcer
4. COPD

Answer: Answer: 1
Rationale 1: Metabolic alkalosis is cause by vomiting, diuretic therapy or nasogastric suction, among others. A pt with bulimia may engage in vomiting or indiscriminate use of diuretics.
Rationale 2: A pt receiving dialysis has kidney failure, which causes metabolic acidosis.
Rationale 3: A venous stasis ulcer does not result in an acid-base disorder.
Rationale 4: The pt diagnosed with COPD typically has hypercapnea & respiratory acidosis.

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Question: The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial intervention to correct this problem?
1. Encourage the pt to breathe in & out slowly into a paper bag.
2. Immediately administer oxygen via a mask & monitor oxygen saturation.
3. Prepare to start an intravenous fluid bolus using isotonic fluids.
4. Anticipate the administration of intravenous sodium bicarbonate.

Answer: Answer: 1
Rationale 1: This pt is exhibiting signs of hyperventilation that is confirmed with the blood gas results of respiratory alkalosis. Breathing into a paper bag will help the pt to retain carbon dioxide & lower oxygen levels to normal, correcting the cause of the problem.
Rationale 2: The oxygen levels are high, so oxygen is not indicated, & would exacerbate the problem if given. Intravenous fluids would not be the initial intervention.
Rationale 3: Not enough information is given to determine the need for intravenous fluids.
Rationale 4: Bicarbonate would be contraindicated as the pH is already high.

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Question: A pt is prescribed 20 mEq of potassium chloride. The nurse realizes that the reason the pt is receiving this replacement is
1. to sustain respiratory function.
2. to help regulate acid-base balance.
3. to keep a vein open.
4. to encourage urine output.

Answer: Answer: 2
Rationale 1: Potassium does not sustain respiratory function.
Rationale 2: Electrolytes have many functions. They assist in regulating water balance, help regulate & maintain acid-base balance, contribute to enzyme reactions, & are essential for neuromuscular activity.
Rationale 3: Intravenous fluids are used to keep venous access not potassium.
Rationale 4: Urinary output is impacted by fluid intake not potassium.

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Question: An elderly pt does not complain of thirst. What should the nurse do to assess that this pt is not dehydrated?
1. Ask the physician for an order to begin intravenous fluid replacement.
2. Ask the physician to order a chest x-ray.
3. Assess the urine for osmolality.
4. Ask the physician for an order for a brain scan.

Answer: Answer: 3
Rationale 1: It is inappropriate to seek an IV at this stage.
Rationale 2: There is no indication the pt is experiencing pulmonary complications thus a cheat x-ray is not indicated.
Rationale 3: The thirst mechanism declines with aging, which makes older adults more vulnerable to dehydration & hyperosmolality. The nurse should check the pt's urine for osmolality as a 1st step in determining hydration status before other detailed & invasive testing is done.
Rationale 4: There is no data to support the need for a brain scan.

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Question: An elderly pt who is being medicated for pain had an episode of incontinence. The nurse realizes that this pt is at risk for developing
1. dehydration.
2. over-hydration.
3. fecal incontinence.
4. a stroke.

Answer: Correct Answer: 1
Rationale 1: Functional changes of aging also affect fluid balance. Older adults who have self-care deficits, or who are confused, depressed, tube-fed, on bed rest, or taking medications (such as sedatives, tranquilizers, diuretics, & laxatives), are at greatest risk for fluid volume imbalance.
Rationale 2: There is inadequate evidence to support the risk of over-hydration.
Rationale 3: There is inadequate evidence to support the risk of fecal incontinence.
Rationale 4: There is inadequate evidence to support the risk of a stroke.

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Question: The nurse assesses a pt's weight loss as being 22 lbs. How many liters of fluid did this pt lose?

Answer: Correct Answer: 10
Rationale: Each liter of body fluid weighs 1 kg or 2.2 lbs. This pt has lost 10 liters of fluid.

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Question: A postoperative pt with a fluid volume deficit is prescribed progressive ambulation yet is weak from an inadequate fluid status. What can the nurse do to help this pt?
1. Assist the pt to maintain a standing position for several minutes.
2. This pt should be on bed rest.
3. Assist the pt to move into different positions in stages.
4. Contact physical therapy to provide a walker.

Answer: Answer: 3
Rationale 1: The pt should avoid prolonged standing.
Rationale 2: Bed rest can promote skin breakdown.
Rationale 3: The pt needs to be taught how to avoid orthostatic hypotension which would include assisting & teaching the pt how to move from one position to another in stages.
Rationale 4: A physician referral is needed for physical therapy intervention & is not indicated in this situation.

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Question: A postoperative pt is diagnosed with fluid volume overload. Which of the following should the nurse assess in this pt?
1. poor skin turgor
2. decreased urine output
3. distended neck veins
4. concentrated hemoglobin & hematocrit levels

Answer: Answer: 3
Rationale 1: Poor skin turgor is associated with fluid volume deficit.
Rationale 2: Decreased urine output is associated with fluid volume deficit.
Rationale 3: Circulatory overload causes manifestations such as a full, bounding pulse; distended neck & peripheral veins; increased central venous pressure; cough; dyspnea; orthopnea; rales in the lungs; pulmonary edema; polyuria; ascites; peripheral edema, or if severe, anasarca, in which dilution of plasma by excess fluid causes a decreased hematocrit & blood urea nitrogen (BUN); & possible cerebral edema.
Rationale 4: Increased hemoglobin & hematocrit values are associated with fluid volume deficit.

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Question: An elderly pt is at home after being diagnosed with fluid volume overload. Which of the following should the home care nurse instruct this pt to do?
1. Wear support hose.
2. Keep legs in a dependent position.
3. Avoid wearing shoes while in the home.
4. Try to sleep without extra pillows.

Answer: Answer: 1
Rationale 1: The home care nurse should instruct this pt about ways to decrease dependent edema, which include wearing support hose, elevating feet when in a sitting position, & resting in a recliner or bed with extra pillows.
Rationale 2: The pt should elevate the legs.
Rationale 3: As long as the shoes are well fitting, there is not reason to avoid wearing them.
Rationale 4: It is appropriate for the pt to use extra pillows to keep the head up while sleeping.

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Question: A pt with fluid retention related to renal problems is admitted to the hospital. The nurse realizes that this pt could possibly have which of the following electrolyte imbalances?
1. hypokalemia
2. hypernatremia
3. carbon dioxide
4. magnesium

Answer: Answer: 2
Rationale 1: The kidneys are the principal organs involved in the elimination of potassium. Renal failure is often associated with elevations potassium levels.
Rationale 2: The kidney is the primary regulator of sodium in the body. Fluid retention is associated with hypernatremia.
Rationale 3: Carbon dioxide abnormalities are not normally seen in this type of pt.
Rationale 4: Magnesium abnormalities are not normally seen in this type of pt.

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Question: An elderly pt comes into the clinic with the complaint of watery diarrhea for several days with abdominal & muscle cramping. The nurse realizes that this pt is demonstrating which of the following?
1. hypernatremia
2. hyponatremia
3. fluid volume excess
4. hyperkalemia

Answer: Answer: 2
Rationale 1: Hypernatremia is associated with fluid retention & overload. FVE is associated with hypernatremia.
Rationale 2: This elderly pt has watery diarrhea, which contributes to the loss of sodium. The abdominal & muscle cramps are manifestations of a low serum sodium level.
Rationale 3: This pt is more likely to develop clinical manifestations associated with fluid volume deficit.
Rationale 4: Hyperkalemia is associated with cardiac dysrhythmias.

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Question: A pt is admitted with hypernatremia caused by being str&ed on a boat in the Atlantic Ocean for five days without a fresh water source. Which of the following is this pt at risk for developing?
1. pulmonary edema
2. atrial dysrhythmias
3. cerebral bleeding
4. stress fractures

Answer: Answer: 3
Rationale 1: Pulmonary edema is not associated with dehydration.
Rationale 2: Atrial dysrhythmias are not a factor for this pt.
Rationale 3: The brain experiences the most serious effects of cellular dehydration. As brain cells contract, the brain shrinks, which puts mechanical traction on cerebral vessels. These vessels may tear, bleed, & lead to cerebral vascular bleeding.
Rationale 4: There have been no activities to support the development or occurrence of stress fractures.

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Question: The nurse is admitting a pt who was diagnosed with acute renal failure. Which of the following electrolytes will be most affected with this disorder?
1. calcium
2. magnesium
3. phosphorous
4. potassium

Answer: Answer: 4
Rationale 1: This pt will be less likely to develop a calcium imbalance.
Rationale 2: This pt will be less likely to develop a magnesium imbalance.
Rationale 3: This pt will be less likely to develop a phosphorous imbalance.
Rationale 4: Because the kidneys are the principal organs involved in the elimination of potassium, renal failure

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Question: A pt who is taking digoxin (Lanoxin) is admitted with possible hypokalemia. Which of the following does the nurse realize might occur with this pt?
1. Digoxin toxicity may occur.
2. A higher dose of digoxin (Lanoxin) may be needed.
3. A diuretic may be needed.
4. Fluid volume deficit may occur.

Answer: Answer: 1
Rationale 1: Hypokalemia increases the risk of digitalis toxicity in pts who receive this drug for heart failure.
Rationale 2: More digoxin is not needed.
Rationale 3: A diuretic may cause further fluid loss.
Rationale 4: There is inadequate information to assess for concerns related to fluid volume deficits.

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Question: A pt is prescribed 40 mEq potassium as a replacement. The nurse realizes that this replacement should be administered
1. directly into the venous access line.
2. mixed in the prescribed intravenous fluid.
3. via a rectal suppository.
4. via intramuscular injection.

Answer: Answer: 2
Rationale 1: Never administer undiluted potassium directly into a vein.
Rationale 2: The intravenous route is the recommended route for diluted potassium.
Rationale 3: The nurse should administer diluted potassium into the pt's intravenous line.
Rationale 4: The nurse should administer diluted potassium into the pt's intravenous line.

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Question: An elderly pt with a history of sodium retention arrives to the clinic with the complaints of "heart skipping beats" & leg tremors. Which of the following should the nurse ask this pt regarding these symptoms?

1. "Have you stopped taking your digoxin medication?"
2. "When was the last time you had a bowel movement?"
3. "Were you doing any unusual physical activity?"
4. "Are you using a salt substitute?"

Answer: Answer: 4
Rationale 1: Although this pt may be prescribed digoxin this is not the primary focus of this question.
Rationale 2: The pt's bowel habits are not of concern at this time.
Rationale 3: The cardiac & musculoskeletal discomforts being reported are not consistent with physical exertion.
Rationale 4: The pt has a history of sodium retention & might think that a salt substitute can be used. Advise pts who are taking a potassium supplement or potassium-sparing diuretic to avoid salt substitutes, which usually contain potassium.

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Question: A 35-year-old female pt comes into the clinic postoperative parathyroidectomy. Which of the following should the nurse instruct this pt?
1. Drink one glass of red wine per day.
2. Avoid the sun.
3. Milk & milk-based products will ensure an adequate calcium intake.
4. Red meat is the protein source of choice.

Answer: Answer: 3
Rationale 1: This pt should avoid alcohol.
Rationale 2: This pt can benefit from sun exposure.
Rationale 3: This pt is at risk for developing hypocalcemia. This risk can be avoided if instructed to ingest milk & milk-based products.
Rationale 4: Protein monitoring is not indicated.

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Question: A pt is admitted for treatment of hypercalcemia. The nurse realizes that this pt's intravenous fluids will most likely be which of the following?
1. dextrose 5% & water
2. dextrose 5% & ? normal saline
3. dextrose 5% & ? normal saline
4. normal saline

Answer: Answer: 4
Rationale 1: If isotonic saline is not used, the pt is at risk for hyponatremia in addition to the hypercalcemia.
Rationale 2: This solution is hypotonic. Isotonic saline is used because sodium excretion is accompanied by calcium excretion through the kidneys.
Rationale 3: This solution is hypotonic. Isotonic saline is used because sodium excretion is accompanied by calcium excretion through the kidneys.
Rationale 4: Isotonic saline is used because sodium excretion is accompanied by calcium excretion through the kidneys.

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Question: A 28-year-old male pt is admitted with diabetic ketoacidosis. The nurse realizes that this pt will have a need for which of the following electrolytes?
1. sodium
2. potassium
3. calcium
4. magnesium

Answer: Answer: 4
Rationale 4: One risk factor for hypomagnesaemia is an endocrine disorder, including diabetic ketoacidosis.

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Question: An elderly pt with peripheral neuropathy has been taking magnesium supplements. The nurse realizes that which of the following symptoms can indicate hypomagnesaemia?
1. hypotension, warmth, & sweating
2. nausea & vomiting
3. hyperreflexia
4. excessive urination

Answer: Answer: 1
Rationale 1: Elevations in magnesium levels are accompanied by hypotension, warmth, & sweating.
Rationale 2: Lower levels of magnesium are associated with nausea & vomiting.
Rationale 3: Lower levels of magnesium are associated & hyperreflexia.
Rationale 4: Urinary changes are not noted.

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Question: A pt is admitted with burns over 50% of his body. The nurse realizes that this pt is at risk for which of the following electrolyte imbalances?
1. hypercalcemia
2. hypophosphatemia
3. hypernatremia
4. hypermagnesemia

Answer: Correct Answer: 2

Rationale 1: Pts who experience burns are not at an increased risk for developing increased blood calcium levels.
Rationale 2: Causes of hypophosphatemia include stress responses & extensive burns.
Rationale 3: Pts who experience burns are not at an increased risk for developing increased blood sodium levels.
Rationale 4: Pts who experience burns are not at an increased risk for developing increased blood magnesium levels.

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Question: A pt is diagnosed with hyperphosphatemia. The nurse realizes that this pt might also have an imbalance of which of the following electrolytes?
1. calcium
2. sodium
3. potassium
4. chloride

Answer: Answer: 1
Rationale 1: Excessive serum phosphate levels cause few specific symptoms. The effects of high serum phosphate levels on nerves & muscles are more likely the result of hypocalcemia that develops secondary to an elevated serum phosphorus level. The phosphate in the serum combines with ionized calcium, & the ionized serum calcium level falls.

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Question: The nurse is reviewing a pt's blood pH level. Which of the systems in the body regulate blood pH? Select all that apply.
1. renal
2. cardiac
3. buffers
4. respiratory

Answer: Answer: 1,3
Rationale 1: Three systems work together in the body to maintain the pH despite continuous acid production: buffers, the respiratory system, & the renal system.
Rationale 2: The cardiac system is responsible for circulating blood to the body. It does not help maintain the body's pH.
Rationale 3: Three systems work together in the body to maintain the pH despite continuous acid production: buffers, the respiratory system, & the renal system.
Rationale 4: Three systems work together in the body to maintain the pH despite continuous acid production: buffers, the respiratory system, & the renal system.

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Question: The nurse observes a pt's respirations & notes that the rate is 30 per minute & the respirations are very deep. The metabolic disorder this pt might be demonstrating is which of the following?
1. hypernatremia
2. increasing carbon dioxide in the blood
3. hypertension
4. pain

Answer: Answer: 2
Rationale 1: Hypernatremia is associated with profuse sweating & diarrhea.
Rationale 2: Acute increases in either carbon dioxide or hydrogen ions in the blood stimulate the respiratory center in the brain. As a result, both the rate & depth of respiration increase. The increased rate & depth of lung ventilation eliminates carbon dioxide from the body, & carbonic acid levels fall, which brings the pH to a more normal range.
Rationale 3: The respiratory rate in a pt exhibiting hypertension is not altered.
Rationale 4: Pain may be manifested in rapid, shallow respirations.

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Question: The blood gases of a pt with an acid-base disorder show a blood pH outside of normal limits. The nurse realizes that this pt is
1. fully compensated.
2. demonstrating anaerobic metabolism.
3. partially compensated.
4. in need of intravenous fluids

Answer: Answer: 3

Rationale 1: If the pH is restored to within normal limits, the disorder is said to be fully compensated.
Rationale 2: Anaerobic metabolism results when the body's cells become hypoxic.
Rationale 3: If the pH is restored to within normal limits, the disorder is said to be fully compensated. When these changes are reflected in arterial blood gas (ABG) values but the pH remains outside normal limits, the disorder is said to be partially compensated.
Rationale 4: Although the pt may be in need of intravenous fluids, this is not the most correct or definitive answer.

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Question: A pt's blood gases show a pH greater of 7.53 & bicarbonate level of 36 mEq/L. The nurse realizes that the acid-base disorder this pt is demonstrating is which of the following?
1. respiratory acidosis
2. metabolic acidosis
3. respiratory alkalosis
4. metabolic alkalosis

Answer: Answer: 4
Rationale 1& 2: Respiratory acidosis & metabolic acidosis are both consistent with pH less than 7.35.
Rationale 3: Respiratory alkalosis is associated with a pH greater than 7.45 & a PaCO2 of less than 35 mmHG. It is caused by respiratory related conditions.
Rationale 4: Arterial blood gases (ABGs) show a pH greater than 7.45 & bicarbonate level greater than 26 mEq/L when the pt is in metabolic alkalosis.

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Question: An elderly postoperative pt is demonstrating lethargy, confusion, & a resp rate of 8 per minute. The nurse sees that the last dose of pain medication administered via a pt controlled anesthesia (PCA) pump was within 30 minutes. Which of the following acid-base disorders might this pt be experiencing?
1. respiratory acidosis
2. metabolic acidosis
3. respiratory alkalosis
4. metabolic alkalosis

Answer: Answer: 1
Rationale 1: Acute respiratory acidosis occurs due to a sudden failure of ventilation. Overdoses of narcotic or sedative medications can lead to this condition.
Rationale 2: The pt condition being described is respiratory not metabolic in nature.
Rationale 3: Acute respiratory acidosis occurs due to a sudden failure of ventilation. Overdoses of narcotic or sedative medications can lead to this condition.
Rationale 4: Acute respiratory acidosis occurs due to a sudden failure of ventilation. Overdoses of narcotic or sedative medications can lead to this condition. The pt condition being described is respiratory not metabolic in nature.

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Question: The pt has been placed on a 1200 mL daily fluid restriction. The pt's IV is infusing at a keep open rate of 10 mL/hr. The pt has no additional IV medications. How much fluid should the pt be allowed from 0700 until 1500 daily?

Answer: Answer: 540
Rationale: Fluid allowed is calculated by figuring the total daily IV intake (in this case 10 mL/hr × 24 hours = 240 mL/day), subtracting that total from the daily allowance (in this case 1200mL - 240 mL = 960mL). The amount calculated is then distributed as 50% for the traditional day shift, 25%-35% for the traditional evening shift, & the remainder for the traditional night shift. In this case, 50% of 960 is 540 mL.

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Question: The pt is receiving intravenous potassium (KCL). Which nursing actions are required? Select all that apply.
1. Administer the dose IV push over 3 minutes.
2. Monitor the injection site for redness.
3. Add the ordered dose to the IV hanging.
4. Use an infusion controller for the IV.
5. Monitor fluid intake & output.

Answer: Answer: 2,4,5

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Question: Which pts are at risk for the development of hypercalcemia? Select all that apply.
1. the pt with a malignancy
2. the pt taking lithium
3. the pt who uses sunscreen to excess
4. the pt with hyperparathyroidism
5. the pt who overuses antacids

Answer: Correct Answer: 1,2,4,5
Rationale 1: Pts with malignancy are at risk for development of hypercalcemia due to destruction of bone or the production of hormone-like substances by the malignancy.
Rationale 2: Lithium & overuse of antacids can result in hypercalcemia. Hypercalcemia can result from hyperparathyroidism which causes release of calcium from the bones, increased calcium absorption in the intestines & retention of calcium by the kidneys.
Rationale 3: The pt who uses sunscreen to excess is more likely to have a vitamin D deficiency which would result in hypocalcemia.
Rationale 4: Hypercalcemia can result from hyperparathyroidism which causes release of calcium from the bones, increased calcium absorption in the intestines & retention of calcium by the kidneys.
Rationale 5: Lithium & overuse of antacids can result in hypercalcemia.

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Question: The pt who has a serum magnesium level of 1.4 mg/dL is being treated with dietary modification. Which foods should the nurse suggest for this pt? Select all that apply.
1. bananas
2. seafood
3. white rice
4. lean red meat
5. chocolate

Answer: Answer: 1,2,5
Rationale: Serum magnesium level of 1.4 mg/dL suggests mild hypomagnesaemia, so this pt should be counseled to eat foods high in magnesium. Foods high in magnesium include green leafy vegetables, seafood, milk, bananas, citrus fruits, & chocolate. White rice & lean red meat are not included.

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Question: The pt has a serum phosphate level of 4.7 mg/dL. Which interdisciplinary treatments would the nurse expect for this pt? Select all that apply.
1. IV normal saline
2. calcium containing antacids
3. IV potassium phosphate
4. encouraging milk intake
5. increasing vitamin D intake

Answer: Answer: 1,2
Rationale: Serum phosphate level of 4.7 mg/dL indicates hyperphosphatemia. IV normal saline promotes renal excretion of phosphate.

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Question: The pt, newly diagnosed with diabetes mellitus, is admitted to the emergency department with nausea, vomiting, & abdominal pain. ABG results reveal a pH of 7.2 & a bicarbonate level of 20 mEq/L. Which other assessment findings would the nurse anticipate in this pt? Select all that apply.
1. tachycardia
2. weakness
3. dysrhythmias
4. Kussmaul's respirations
5. cold, clammy skin

Answer: Answer: 2,3,4
Rationale: Further assessment findings of this condition are weakness, bradycardia, dysrhythmias, general malaise, decreased level of consciousness, warm flushed skin, & Kussmaul's respirations.

Rationale: These ABG results, coupled with the pt's recent diagnosis of diabetes mellitus & history of vomiting would lead the nurse to suspect metabolic acidosis. Further assessment findings of this condition are weakness, bradycardia, dysrhythmias, general malaise, decreased level of consciousness, warm flushed skin, & Kussmaul's respirations.

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Question: daily body fluid excretion

Answer: skin by diffusion 400ml Total 2450
skin by perspiration 100ml
lungs 300ml
feces 150ml
kidneys 1500ml

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Question: water intake

Answer: 2500ml daily required to cover loss

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Question: Isotonic dehydration(hypovolemia)
most common

Answer: water and electrolytes loss in equal proportions
caused by inadequate intake of fluids and solutes
shift in fluid, and excessive losses
Treatment Isotonic Replacement :
0.9% sodium chloride, 5%dextrose in water, and 5% dextrose in 0.225%saline, Ringer's Lactate

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Question: Hypovolemic signs and symptoms Cardiovascular

Answer: Cardiovascular
Thready, increased pulse
decreased blood pressure and orthostatic hypotension
flat neck and hand veins in dependent position
diminished peripheral pulses

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Question: Hypovolemic signs and symptoms Respiratory Neuromuscular

Answer: Respiratory
Increase rate and depth
Neuromuscular
decreased central nervous system activity(lethargy to coma) and fever

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Question: hypovolemia Renal

Answer: Decreased urinary output
Increase urine specific gravity

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Question: Hypovolemia Integumentary

Answer: Dry skin
poor turgor, tenting present
Dry mouth mucosal membranes

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Question: Hypovolemia Gastrointestinal

Answer: decreased motility and diminished bowel sounds
constipation
thrist
decreased body weight

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Question: Lab finding

Answer: Increased serum osmolality
Increased hematocrit
increased BUN
increased serum sodium level

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Question: Hypertonic dehydration

Answer: Water loss exceeds electrolyte loss
caused by excessive perspiration, hyperventilation, ketoacidosis, prolonged fever, diarrhea, early stage renal failure, and diabetes insipidus. cells shrink
Replacement of water using hypotonic solutions
0.45% sodium chloride, 0.225% sodium chloride, and 0.33% sodium chloride

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Question: Hypertonic dehydration signs and symptoms

Answer: Hyperactive deep tendon reflexes
Pitting edema

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Question: Hypotonic dehydration

Answer: electrolyte loss exceeds water loss and causes
cells to swell
caused by chronic illness, excessive fluid replacement
renal failure, chronic malnutrition
Treatment Replacement of electrolytes: 3% sodium chloride, 5%sodium chloride, 10% dextrose in water, 5% dextrose in 0.9% sodium chloride, 5% dextrose in 0.45% sodium chloride and 5% dextrose in Ringer's Lactate

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Question: dehydration Interventions

Answer: monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestional status
prevent further fluid loss and increase fluid compartment volumes to normal ranges
provide oral rehydration and IV rehydration is severe monitor intake and output
administer medications as prescribed
antidiarrheal, antimicrobial, antiemetic and treat symptoms
Administer O2 as prescribed
monitor electrolyte labs and treat

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Question: Fluid overload Isotonic hypervolemia

Answer: causes circulatory overload and interstitial edema when severe or when client has poor cardiac function cogestive heart failure, and pulmonary edema
caused by
Inadequately controlled IV therapy
renal failure
long-term corticosteroid therapy

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Question: Isotonic signs and symptoms

Answer: enlarged liver and ascites

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Question: fluid overload signs and symptoms cardiovascular

Answer: bounding, increased pulse rate
elevated blood pressure
distended neck and hand veins
elevated central venous pressure

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Question: Fluid overload Respiratory

Answer: increased shallow respiration
dyspnea
moist crackles on auscultation

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Question: Fluid overload Neromuscular

Answer: altered level of consciousness
headache
visual disturbances
skeletal muscle weakness
paresthesias

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Question: Fluid overload integumentary

Answer: pitting edema in dependant areas
skin pale and cool to touch

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Question: Fluid overload gastrointestinal tract

Answer: increased motility

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Question: Fluid overload Lab

Answer: Decreased serum osmolality
decreased hematocrit
decreased BUN level
decreased serum sodium level
decreased urine specific gravity

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Question: Fluid overload intervention

Answer: monitor cardiovascular, respiratory, neuromuscular, renal, integumentary and gastrointestinal status.
Prevent further fluid overload and restore normal fluid balance
administer diurectics; osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances
Restrict fluid and sodium intake
monitor intake and output
monitor electrolyte values

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Question: fluid overload hypertonic

Answer: caused by excessive sodium, Raip infusion of hypertonic solution, excessive sodium bicarbonate therapy

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Question: Fluid overload hypotonic

Answer: water intoxication caused by early renal failure, syndrome of inappropriate antidiuretic hormone secretion
Inadequately controlled IV therapy
Replacement of isotonic fluid loss with hypotonic fluids
irrigation of wounds and body cavities with hypotonic fluids

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Question: Fluid overload hypotonic signs and symptoms

Answer: Polyuria, diarrhea, nonpitting edema, dysrhythmias, projectile vomiting

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Question: Sodium NA

Answer: Normal 135 to 145
Common food source
bacon, butter, canned food, cheese( american, cottage)
frankfurters, ketchup, lunch meat, milk, mustard, processed food, snack food, table salt, white and whole wheat bread

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Question: Hyponatremia

Answer: below 135
caused by increased sodium excretion
excessive diaphoresis
diurectics, vomiting, diarrhea, wound drainage( especially gastrointestinal), renal disease, decreased secretion of aldosterone, inadequate sodium intake, NPO, low salt diet, excessive ingestion of hypotonic fluids or irragation with hypotonic fluids
renal failure, freshwater drowning, syndrome of inappropriate antidiuretic hormone secretion
hyperglycemia, and congestive heart failure

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Question: Hyponatremia signs and symptoms

Answer: change as vascular volume change
Normovolemic: Rapid pulse rate, normal blood pressure
Hypovolemic: Thready, weak, rapid pulse rate, hypotension, flat neck and hand veins, normal or low central venous pressure
Hypervolemic: Rapid bounding pulse, blood pressure normal to elevated. normal to elevated central venous pressure

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Question: Hyponatremia signs and symptoms
Respiratory

Answer: shallow, ineffective respiratory movements as a late manifestation related to skeletal muscle weakness

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Question: Hyponatremia neurmuscular

Answer: generalized muscle weakness that is worse in the extremities
Diminished deep tendon reflexes

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Question: Hyponatremia Cereberal function

Answer: headache, personality changes, confusion, seizures, coma

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Question: Hyponatremia gastrointestinal

Answer: increased motility and hyperactive bowel sounds
nausea
abdominal cramping and diarrhea

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Question: Hyponatremia Renal

Answer: decreased urinary specific gravity
increased urinary output

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Question: Hyponatremia Interventions

Answer: Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and gastrointestinal status
hyponatremia/hypovolemia: IV sodium chloride infusion
hyponatremia/hypervolemia: osmotic diuretics
if caused by inappropriate or excessive secretion of antidiuretic hormone, Use lithium or Demeclocycline
Instruct to take in more sodium
Monitor lithium levels for toxicity

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Question: Hypernatremia

Answer: levels above 145
caused by
corticosteroids
cushing syndrome, renal failure, hyperaldosteronism
Excessive oral sodium, excessive IV infusion, Decreased water intake, increased water loss,increased metabolism, fever, hyperventilation, infection, excessive diaphoresis, watery dirrahea, diabetes insipids

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Question: Hypernatremia signs and symptoms
Cardiovascular

Answer: heart rate and blood pressure responde to vascular volume status

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Question: Hypernatremia Respiratory

Answer: Pulmonary edema if hypervolemia present

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Question: hypernatremia neuromuscular

Answer: Early: spontaneous muscle twitches; irregular muscle contractions
Late: skeletal muscle weakness, deep tendon reflex diminished or absent

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Question: Hypernatremia central nervous system

Answer: altered cerebral function is most common manifestations
Normovolemia and hypovolemia agitation, confusion, seizures
hypovolemia lethargy, stupor, coma

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Question: hypernatremia renal

Answer: increased urinary specific gravity
decreased urinary ouput

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Question: hypernatremia integumentary

Answer: dry skin
Presence of absence of edema, depending on fluid volume changes

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Question: hypernatremia Interventions

Answer: monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and integumentary status.
Adminsiter IV if caused by fluid loss
if caused by inadequate renal excreation of sodium, administer diurectics that promote sodium loss
restrict sodium intake as prescribed

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Question: hypokalemaia normal Potassium values 3.5 to 5.1 mEq/L

Answer: total body loss of potassium
caused by: excessive use of medications such as diuretics or corticosteroids
Increased secretion of aldosterone, such as in cushing's syndrome
vomiting diarrhea
wound drainage, particularly gastronintestional
prolonged nasogastric suction
excessive diaphrosis
renal disease impairing reabsorption of potassium
inadequate intake NPO
extracellular fluid to intracellular fluid
alkalosis
hyperinsulinism
silution of serum potassium due to water intoxication
IV therapy with poor potassium solution

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Question: hypokalemia cardiovascular

Answer: assessment
thready, weak, irregular pulse
peripheral pulses weak
orthostatic hypotension
ST depression, shallow flat or inverted T wave, and prominent u wave

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Question: hypokalemia respiratory

Answer: shallow, ineffective respirations that result from profound weakness of the skeletal nuscles of respiration
Diminished breath sounds

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Question: hypokalemis neuromuscular

Answer: anxiety, lethargy, confussion, coma
skeletal muscle weakness, eventual flaccid paralysis
loss of tactile discrimination
deep tendon hyporeflex

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Question: hypokalemia gastrointestinal

Answer: decreased motility, hypoactive to absent bowel sounds
nausea, vomiting, constipation, abdominal distention
paralytic ileus

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Question: hypokalemia renal

Answer: decreased urinary specific gravity
increased urinary output

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Question: hypokalemia interventions

Answer: monitor cardiovascular, respiratory, neuromuscular, gastrointestinal, and renal status, and place on a cardiac monitor
monitor electrolytes values
administer potassium supplements not on empty stomach
may need to be discontinued if client complains of abdominal pain, distention, nausea, vomiting, diarrhea, or gastrointestional bleeding.
Liquid potassium chloride has un unpleasant taste and should be taken with juice or another liquid

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Question: hypokalemia interventions

Answer: potassium never given as IV push or intramuscular or subcutaneous route.
1mEq/ per 10mL of solution is recommended
after adding to IV bag, invert bag to distributed evenly throughout IV solution/hr. never to exceed 20 mEq/hr.
label IV bag properly
maxium infusion rate is 5 to 10 mEq
client receiving more than 10 mEq/hr should be placed on cardiac monitor and monitored during the entire infusion and controlled by an infusion pump

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Question: hypokalemia interventions

Answer: phlebitis and infiltration precaution: inspection of IV site and stopped immediately if occurs
renal function before administering potassium and monitor intake and output during administration
safety measures for muscle weakness
prescribed potassium sparing diuretic may need to replace potassium losing diuretic
Instruct client about foods high in potassium content
avocado,bananas,cantalope,carrots,fish,mushrooms,
oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, tomatoes

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Question: Hyperkalemia

Answer: caused by excessive potassium intake
overingestion of foods, medications, salt substitutes
rapid infusion of potassium containing solutions
decreased potassium excretion
potassium sparing diuretics
renal failure
adrenal insuffiency, (addison's disease)
intracellular fluid in to extracellular fluid
Tissue damage
acidosis
hyperuricemia
hypercatabolism

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Question: hyperkalemia cardiovascular

Answer: slow, weak, irregular heart rate
decreased blood pressure
Tall peaked T waves, flat P waves, widened QRS complex and prolonged PR intervals

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Question: hyperkalemia respiratory

Answer: profound weakness of the skeletal muscles leading to respiratory failure

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Question: hyperkalemia neuromuscular

Answer: Early: muscle twitches, cramps, paresthesias (tingling and burning followed by numbness in the hands and feet and around the mouth)
Late: Profound weakness, ascending flaccid paralysis in the arms and legs (trunk, head, and respiratory muscles become affected when the serum potassium level reaches a lethal level)

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Question: hyperkalemia Gastrointestinal

Answer: increased motility, hyperactive bowel sounds
Diarrhea

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Question: hyperkalemia Interventions

Answer: monitor cardiovascular, respiratory, neuromuscular, renal, and gastrointestional status; place on cardiac monitor
Discontinue IV and hold oral potassium supplements
potassium restricted diet
administer potassium excreting diurects if renal function is not impaired

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Question: hyperkalemia Interventions

Answer: if renal function impaired then administer Kayexalate a cation exchange resin that promotes gastrointestional sodium absorption and potassium excretion
dialysis if potassium level is critically high
IV administration of hypertonic glucose with regular insulin to move excess potassium into the cells
monitor renal function

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Question: hyperkalemia Interventions

Answer: Blood transfusion should be fresh blood, if possible, stored blood may elevate potassium level, breakdown of old blood causes potassium release
avoid potassium foods
avoid use of salt substitutes

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Question: hypocalcemia normal values 8.6 to 10mg/dL

Answer: causes: inhibition of calcium absorption from the gastrointestinal tract
inadequate oral intake, lactose intolerance
malabsorption syndromes such as celiac sprue or Crohn's disease
inadequate intake of vitamin D
end stage renal disease
increased calcium excretion
renal failure
diarrhea, steatorrhea, wound drainage, gastrointestional

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Question: hypocalcemia

Answer: decrease in ionized fraction of calcium
hyperproteinemia,alkalosis, calcium binders chelators
acute pancreatitis, hyperphospatemia, immobility
Removal or destruction of parathyroid glands

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Question: hypocalcemia cardiac

Answer: decreased heart rate
hypotension, diminished peripheral pulses
Prolonged ST interval, prolonged QT interval

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Question: hypocalcemia respiratory

Answer: not directly affected but, respiratory failure and arrest may result from decreased respiratory movement because of muscle tetany or seizures

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Question: hypocalcemia neuromuscular

Answer: irritable skeletal muscles Twitches, cramps, tetany, seizures
painful muscles spasms in the calf or foot during periods of inactivity
paresthesias followed by numbness that may affect the lips, nose, and ears in addition to the limbs
Positive Trousseau's and Chvostek's signs
hyperactive deep tendon relexes
anxiety, irritability

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Question: hypocalcemia gastrointestional

Answer: increased gastric motility; hyperactive bowel sounds
abdominal cramping, diarrhea

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Question: hypocalcemia Interventions

Answer: monitor cardiovascular, respiratory, neuromuscular, and gastrointestional status; place the client on a cardiac monitor
administer calcium supplements orally or calcium intravenously
Warm injection to body temperature before administration and administer slowly; monitor for ECG changes, observe for infiltration, and monitor for hypercalcemia
administer medications that increase absorption of calcium

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Question: hypocalcemia Interventions

Answer: aluminum hydroxide reduces serum phosphorus levels, causing the countereffect of increasing calcium levels.
Vitamin D aids in the absorption of calcium from the intestinal tract
Provide quiet environment to reduce environmental stimuli
initiate seizure precautions
move the client carefully, and monitor for signs of a fracture
Keep 10% calcium gluconate available for treatment of acute calcium deficit
instruct client to consume foods high in calcium
Cheese, collard greens, milk and soy milk, Rhubarb, sardines, spinach, tofu, yogurt

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Question: hypercalcemia

Answer: increased calcium absorption
excessive oral intake
excessive oral intake of vitamin D
decreased calcium excretion
renal failure
use of thiazide diuretics
Increased bone resorption of calcium
hyperparathyroidism
hyperthyroidism, Malignancy (bone destruction from metastatic tumors)
immobility, use of glucocorticoids
Hemoconcentration
Dehydration, use of lithium, adrenal insufficiency

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Question: hypercalcemia cardiovascular

Answer: increased heart rate in early phase, bradycardia that can lead to cardiac arrest in the late phase
increased blood pressure
bounding, full peripheral pulses
ECG Shortened ST segment, widened T wave

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Question: hypercalcemia respiratory

Answer: ineffective respriatory movement as a result of profound skeletal muscle weakness

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Question: hypercalcemia neuromuscular

Answer: profound muscle weakness
diminished or absent deep tendon reflexes
disorientation, lethargy, coma

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Question: hypercalcemia renal

Answer: increased urinary output leading to dehyfreation
formation of renal calculi

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Question: hypercalcemia gastrointestional

Answer: decreased motility and hypoactive bowel sounds
anorexia, nausea, abdominal distention constipation

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Question: hypercalcemia intervention

Answer: monitor cardiovascular, respiratory, neuromuscular, renal, and gastrointestional status; place on cardiac monitor
Discontinue IV infusions of solutions containing calcium and oral medications containing calcium and vitamin D
discontinue thiazide diuretics and replace with diurectics that enhance the excretion of calcium
administer medications as prescribed that inhibit calcium resorption from the bone, such a phosphorus, calcitonin (Calcimar), bisphosphonates, and prostaglandin synthesis inhibitors (aspirin, nonsteroidal antiinglammatory drugs)

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Question: hypercalcemia

Answer: prepare the client with severe hypercalcemia for dialysis if medications fail to reduce the serum calcium level
Move carefully and monitor for signs of fracture
monitor for flank or abdominal pain, and strain the urine to check for the presence of urinary stones.
Instruct the client to avoid foods high in calcium
cheese
collard greens, milk and soy milk, rhubarb, sardines, spinach, tofu, yogurt

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Question: hypomagnesemia normal values 1.6 to 2.6mg/dL

Answer: casuses increased magnesium intake
antacids and laxatives, Excessive IV infusion
Decreased renal excretion as a result of renal insufficiency

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Question: hypomagnesemia cardiovascular

Answer: Bradycardia, dysrhythmias
Hypotension Prolonged PR interval, widened QRS complexes

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Question: hypomagnesemia respiratory

Answer: insufficiency with skeletal muscles of respiration are involved.

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Question: hypomagnesemia neuromuscular

Answer: diminished or absent deep tendon reflexes
skeletal muscle weakness

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Question: hypomagnesemia central nervous system

Answer: Drowsiness and lethargy that progresses to coma

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Question: hypomagnesemia Interventions

Answer: IV administration of calcium chloride or calcium gluconate to reverse the effects of magnesium on cardiac muscle.
restrict dietary intake of magnesium
avoid use of laxatives and antacids.

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Question: hypophosphatemia normal values 2.7 to 4.5mg/dL

Answer: decrease in phosphorus and increase in serum calcium
causes: malnutrition and starvation
increased excretion by hyperparathyroidism, malignancey and use of aluminum hydroxide-based or magnesium based antacids
Intracellular shifts
hyperglycemia, respiratory alkalosis

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Question: hypophosphatemia cardiovascular

Answer: decreased contractility and cardiac output
slowed peripheral pulses

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Question: hypophosphatemia respiratory

Answer: shallow respirations

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Question: hypophosphatemia neuromuscular

Answer: weakness, decreased deep tendon reflexes, Decreased bone density that can result in contractures and alterations in bone shape, Rhabdomyolysis

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Question: hypophosphatemia central nervous system

Answer: irritability, confusion, seizures

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Question: hypophosphatemia hematological

Answer: decreased platelet aggregation and increased bleeding
immunosuppression

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Question: hypophosphatemia interventions

Answer: monitor cardiovascular, respiratory, neuromuscular, central nervous system, and hematological status.
discontinue meds that contribute to hypophosphatemia
administer oral phosphorus with vitamin D
Intravenously administer phosphorus when levels fall below 1mg/dL and critical clinical manifestations

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Question: hypophosphatemia interventions

Answer: adminster IV phosphorus slowly because of risks associated with hyperphosphatemia
assess renal system before administering
move client carefully, and monitor for signs of fracture
instruct client to increase intake of phosphorus containg foods while decreasing the intake of calcium containg foods.

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Question: hypophosphatemia interventions

Answer: Increase:
Fish, organ meats, nuts, pork, beef, chicken, whole grain breads and cereals.
decrease: cheese, collard greens, milk and soy milk,rhubarb, sardines,spinach, tofu, yogurt.

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Question: Hyperohosphatemia

Answer: body tolerates well
increase in phosphorus accompanied by a decreased
serum calcium level. Problems occur in hypocalcemia

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Question: Hyperohosphatemia

Answer: causes: decreased renal excretion resulting from renal insufficiency
Tumor lysis syndrome
Increased intake dietary intake and or overuse of phosphate containing laxatives or enemas
hypoparathyroidism

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Question: Hyperphosphatemia cardiac

Answer: hypocalcemia assessmentdecreased heart rate
hypotension, diminished peripheral pulses
Prolonged ST interval, prolonged QT interval

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Question: hyperphosphatemia respiratory

Answer: not directly affected but, respiratory failure and arrest may result from decreased respiratory movement because of muscle tetany or seizures

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Question: hyperphosphatemia neuromuscular

Answer: irritable skeletal muscles Twitches, cramps, tetany, seizures
painful muscles spasms in the calf or foot during periods of inactivity
paresthesias followed by numbness that may affect the lips, nose, and ears in addition to the limbs
Positive Trousseau's and Chvostek's signs
hyperactive deep tendon relexes
anxiety, irritability

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Question: hyperphosphatemia gastrointestional

Answer: increased gastric motility; hyperactive bowel sounds
abdominal cramping, diarrhea

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Question: hyperphosphatemia Interventions

Answer: management of hypocalcemia
administer phosphate binding medications that increase fecal excretion of phosphorus by binding phosphorus from food in the gastrointestional tract.
avoid phosphate containing medications, laxatives and enemas

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Question: hyperphosphatemia Interventions

Answer: decrease intake of food high in phosphorus
Fish, organ meats, nuts, pork, beef, chicken, whole grain breads and cereals
instruct client in medication administration: taking phosphate binding medications, emphasizing that they should be taken with meals or immediately after meals.

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