Fluid and Electrolytes

The 61-year-old patient with liver cirrhosis reports extreme fatigue on a daily basis. The nurse pursues which intervention?

The lab calls the nurse and reports an adult patient’s serum calcium of 5.9 mg/dL and serum potassium of 6.2 mEq/dL. Which action by the nurse is appropriate?

The nurse is caring for the patient with intestinal obstruction who is receiving total parenteral nutrition (TPN). The nurse reviews which lab results to ensure the patient is tolerating the infusion? Select all that apply. 

The pediatric patient is hospitalized for fever, nausea, vomiting, and diarrhea. Capillary refill is >2 seconds. The nurse anticipates an order for which intravenous infusion?

Which patient is triaged first in the emergency department? 

The nurse is helping the nursing student to relate patient findings to pathophysiological concepts. Which findings, if selected by the nursing student as characteristics that prompt the kidneys to release renin, indicates a need for further teaching?

Which statement effectively summarizes the effect of the renin-angiotensin-aldosterone system?

Which comorbidities increase the risk for refeeding syndrome in the chronically ill patient who is started on total parenteral nutrition (TPN)? Select all that apply.

Prior to initiating routine hemodialysis for the patient with end stage renal disease (ESRD), which assessments does the nurse perform? Select all that apply.

The patient presents to the emergency department with abdominal pain, dehydration, a blood glucose level of 425 mg/dL. Blood testing reveals metabolic acidosis, hypokalemia, and ketones. The patient is alert and conversant, but in moderate distress. The nurse anticipates administering which medication?

The nurse is caring for the patient who was admitted to the hospital in septic shock due to Escherichia coli bacteremia. Which patient assessment is most appropriate to report to the inpatient pharmacist on the patient’s medical team?

The patient has been prescribed enalapril and spironolactone for the treatment of hypertension. The nurse is providing medication education to the patient regarding diet. Which food, if selected by the patient, indicates a need for further teaching?

The nurse receives report from the operating room regarding a postoperative craniotomy patient and recognizes the patient is at risk for which complications? Select all that apply.

The nurse is caring for a patient on the night shift in respiratory distress due to influenza. Over the last few hours, the patient has become increasingly confused, perfusion has decreased, and urine output has fallen to zero. The nurse contacts the resident physician to come assess the patient and requests an order for transfer to the intensive care unit. The physician orders the nurse to administer 1L 0.9% NaCl via IV infusion. One hour after the infusion is complete, the patient has made no improvement. What is the nurse’s next action?

The patient’s arterial blood gas and serum electrolyte results are as follows: pH 7.28, PCO2 = 32, PaO2 = 59, HCO3- = 16, SaO2 = 88%, Sodium = 149, Potassium 3.9, Chloride 112. Calculate this patient’s anion gap. Enter your answer using a whole number.

The patient with congestive heart failure in the cardiac intensive care unit (CICU) is ordered to receive IV furosemide once per day. The lab just called and reported the patient’s serum potassium is 2.9 mEq/L. The next dose of furosemide is due now. Which is the appropriate nursing action?

The drowning victim is admitted to the intensive care unit (ICU) after being without oxygen for 10 minutes. When he was found, he did not have a pulse and was resuscitated at the site. Once return of spontaneous circulation (ROSC) occurred, he was transported to the hospital. He was found to be profoundly hypotensive and was fluid resuscitated in the ambulance. In the ICU, his Glasgow coma score is found to be 7. He is intubated and has a central line and a peripheral arterial catheter in place. Which constellation of symptoms concern the nurse the most?

The patient who takes milk of magnesia every day is at risk for which electrolyte imbalance?

The patient returns from Mexico with severe diarrhea lasting 4 days. The nurse anticipates the serum electrolyte levels to reflect which imbalances? Select all that apply.

The patient has received an infusion of packed red blood cells for the treatment of anemia. The nurse anticipates which lab result following the transfusion?

The nurse is concerned the patient is experiencing hypocalcemia following the removal of the thyroid. In which location does the nurse assess for the Chvostek’s sign?

The nurse is reviewing a patient’s medications during discharge. Which further education can the nurse provide regarding spironolactone when the patient asks, “I thought that I took a furosemide pill for my water?”

The nurse questions the order for an infusion of 0.45% NaCl in the patient with which condition?

Which patient characteristic prompts the nurse to hold the infusion of Lactated Ringer’s and contact the provider?

The patient has a phosphorus level of 5.2 mg/dL. Which additional lab value does the nurse anticipate in the patient related to the phosphorus level?

The patient who is NPO has an order to receive enemas until the intestines are devoid of stool. After 3 enemas, the patient is still passing a moderate amount of loose stool. Which action by the nurse is appropriate?

The patient has not yet voided in the 3 hours following a total knee replacement surgery. Which action by the nurse is appropriate?

The patient with diabetes insipidus has been prescribed vasopressin. The nurse instructs the student nurse about which characteristic of the medication?

An adult weighing 70 kg just arrived to the emergency department (ED) with burns on the front of both legs and the genital region. Using the Parkland formula, how much fluid is to be administered to the patient over the next 8 hours?

The patient's serum calcium quickly changed to 14 mg/dL (3.5 mmol/L). The nurse anticipates observing which symptoms? Select all that apply.

The nurse plans which intervention for the patient with toxic epidermal necrolysis?

The nurse is administering intravenous fluids to the patient with toxic epidermal necrolysis. Which parameters are most helpful to assess when determining the appropriate fluid rate for the patient?

The patient developed toxic epidermal necrolysis after receiving phenytoin for seizures. The nurse prioritizes nursing interventions to address which life-threatening comorbidities? Select all that apply.

The patient with kidney failure is scheduled to undergo the placement of a peritoneal dialysis catheter. Which instruction does the nurse give the patient?

The nurse is providing discharge teaching to the patient who will be discharged with a peritoneal dialysis catheter. Which statement indicates a need for further teaching?

The nurse is assessing the arteriovenous fistula in the patient’s right arm; it is without thrill or bruit. Which action does the nurse take next?

The patient found unresponsive in the park is determined to be in ventricular fibrillation. After cardiopulmonary resuscitation and defibrillation, the patient experienced return of spontaneous circulation. Initial survey upon arrival to the emergency department (ED) reveals a cachectic appearance and an edematous mass on the right forearm; upon palpation, the nurse palpates a thrill. The nurse is aware life-saving measures will have which aim?

The nurse expects the patient with severe hypomagnesemia to also show signs of which deficiency? Select all that apply.

Which statement is true regarding the administration of intravenous potassium?

Which is an example of hypertonic intravenous (IV) fluid?

A ten-year-old patient presents to the emergency department (ED) complaining of abdominal pain. He states, “I poop every day. It sometimes hurts to go and the poop is small, hard pieces. Which response does the nurse anticipate when the child is asked, “How much water do you drink in a day?”

The patient receiving bosentan therapy for pulmonary arterial hypertension presents to the emergency department (ED) complaining of dyspnea. Which nursing assessment is most important for this patient?

The patient presents to the emergency department (ED) and states, “I don’t know what happened! I was walking and ran into a door with my right shoulder. I closed my right eye and my vision was normal, but when I closed my left eye, I couldn’t see anything at all!” The patient’s assessment is otherwise normal. The nurse reports this to the provider immediately for assessment. Which question is most important for the nurse to ask the patient while waiting for the provider to write orders for treatment?

Which is the normal range for serum potassium levels in the blood?

Which represents the normal range for serum chloride levels in the blood?

Which represents the normal range for serum calcium levels in the blood?

The nurse is creating a bladder retraining program for the 74-year-old female patient who is incontinent of urine. Which aspect of the training program is most important?

Which evening meal choice is appropriate for this patient? Look at the patient’s chart to make a selection.

Which meal selection is appropriate for this patient? Review the patient’s chart to make a selection.

The nurse has received an order to initiate nasogastric tube feedings for the patient with long-standing anorexia. After the tube feeding is initiated, the nurse is vigilant for which electrocardiogram changes which may indicate the patient is experiencing life-threatening complications of tube feeding? Select all that apply.