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9: Fluids and Electrolytes
PRACTICE QUESTIONS
1. The registered nurse (RN) tells the licensed practical nurse (LPN) that the physician has prescribed a hypotonic IV solution for a client. Which IV solution would the LPN obtain for administration to the client? 1. 0.45% saline 2. 5% dextrose in water 3. 10% dextrose in water 4. 5% dextrose in 0.9% saline Answer: 1 Rationale: 5% dextrose in water is an isotonic solution. 10% dextrose in water and 5% dextrose in 0.9% saline are hypertonic solutions. 0.45% saline is hypotonic and is probably the only hypotonic solution used in clinical situations. Distilled water is another example of a hypotonic solution. Hypotonic solutions contain a lower concentration of salt or more water than an isotonic solution. Test-Taking Strategy: Use the process of elimination. Note the similarities in options 2, 3, and 4. All these solutions contain dextrose. Option 1 is different than the others. Review the tonicity of IV solutions if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 237. 2. Intravenous (IV) lactated Ringer’s solution is prescribed for a postoperative client. A nursing student is caring for the client, and the nursing instructor asks the student about the tonicity of the prescribed IV solution. The student responds by telling the instructor that the solution is: 1. Isotonic 2. Normotonic 3. Hypotonic 4. Hypertonic Answer: 1 Rationale: Lactated Ringer’s solution is an isotonic solution. Other isotonic solutions include 5% dextrose in water, 0.9% normal saline, and 5% dextrose in 0.225% normal saline. 0.45% normal saline is hypotonic. 10% dextrose in water, 5% dextrose in 0.9% normal saline, and 5% dextrose in 0.45% normal saline are hypertonic solutions. Test-Taking Strategy: Knowledge regarding the tonicity of the various IV solutions is needed to answer the question. Remember that lactated Ringer’s solution is an isotonic solution. Review this information if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity

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Integrated Process: Teaching/Learning Content Area: Fundamental Skills References: Linton, A. & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 238. Potter, P. & Perry, A. (2005) Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 1160. 3. A nurse is reading the physician’s progress notes in the client’s record and sees that the physician has documented “insensible fluid loss of approximately 800 mL daily.” The nurse understands that this type of fluid loss can occur through: 1. The GI tract 2. Urinary output 3. Wound drainage 4. The skin Answer: 4 Rationale: Sensible losses are those that the person is aware of, such as through wound drainage, GI tract losses, and urination. Insensible losses may occur without the person’s awareness. Insensible losses occur daily through the skin and the lungs. Test-Taking Strategy: Note that the issue of the question is insensible fluid loss. Use the process of elimination, noting the similarity in options 1, 2, and 3. These types of losses can be measured for accurate output. Fluid loss through the skin cannot be accurately measured, only approximated. If you had difficulty with this question, review the difference between sensible and insensible fluid loss. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 230. Linton, A., & Maebius, N. (2003), Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 154-159. 4. A nurse is reviewing the health records of assigned clients. The nurse plans care knowing that which client is likely at the lowest risk for the development of third-spacing? 1. The client with cirrhosis 2. The client with diabetes mellitus 3. The client with sepsis 4. The client with renal failure Answer: 2 Rationale: Fluid that shifts into the interstitial spaces and remains there is referred to as thirdspace fluid. Common sites for third-spacing include the abdomen, pleural cavity, peritoneal cavity, and pericardial sac. Third-space fluid is physiologically useless because it does not circulate to provide nutrients for the cells. Risk factors include clients with liver or kidney disease, major trauma, burns, sepsis, wound healing or major surgery, malignancy, malabsorption syndrome, malnutrition, and alcoholic or older clients. Test-Taking Strategy: Note the key words, least likely. These words indicate a false response

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question and that you need to select the client at least risk for third-spacing. Eliminate options 1 and 4 first because it is likely that fluid balance disturbances will occur with these conditions. From the remaining options, sepsis is the option that is most acute and therefore is most similar to options 1 and 4. Review the risk factors associated with third-spacing if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Fundamental Skills Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, pp. 213-219. 5. A nurse is reviewing the health records of assigned clients. The nurse plans care knowing that which client is at risk for fluid volume deficit? 1. A client with a colostomy 2. A client with cirrhosis 3. A client with congestive heart failure (CHF) 4. A client with decreased kidney function Answer: 1 Rationale: Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient IV fluid replacement, draining fistulas, or an ileostomy or colostomy. A client with cirrhosis, CHF, or decreased kidney function is at risk for fluid volume excess. Test-Taking Strategy: Read the question carefully, noting that it asks for the client at risk for a deficit. Read each option and think about the fluid imbalance that can occur in each client. The clients presented in options 2, 3, and 4 retain fluid. The only condition that can cause a fluid volume deficit is the condition noted in option 1. If you had difficulty with this question, review the causes of fluid volume deficit. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Fundamental Skills Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 158-159, 697. 6. A nurse is caring for a client who has been taking diuretics on a long-term basis. A fluid volume deficit is suspected. Which finding would be noted in the client with this condition? 1. Gurgling respirations 2. Increased blood pressure 3. Decreased hematocrit 4. Increased specific gravity of the urine Answer: 4 Rationale: Findings in a client with a fluid volume deficit include increased respirations and heart rate, decreased central venous pressure (CVP), weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, dark-colored and

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odorous urine, an increased hematocrit, and altered level of consciousness. The signs in options 1, 2, and 3 are seen in a client with fluid volume excess. Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 first. Gurgling respirations and increased blood pressure are noted in fluid volume excess. Remember that the specific gravity of urine is increased in a client with a fluid volume deficit. If you had difficulty with this question, review the findings noted in fluid volume deficit. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 2494. 7. A nurse is caring for a client with cirrhosis. The nurse notes that the client is dyspneic and crackles are heard on auscultation of the lungs. The nurse suspects fluid volume excess. What additional signs would the nurse expect to note in this client if a fluid volume excess is present? 1. Flat hand and neck veins 2. A weak and thready pulse 3. An increase in blood pressure 4. An increased urine output Answer: 3 Rationale: Findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, an elevated blood pressure and a bounding pulse, an elevated central venous pressure, weight gain, edema, neck and hand vein distention, altered level of consciousness, and a decreased hematocrit. Test-Taking Strategy: Use the process of elimination. Note the similarities in options 1, 2, and 4. Each of these signs relates to a decrease in fluid volume. Option 3 reflects an increase. If you had difficulty with this question review the signs noted in fluid volume excess. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 225. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 159, 730. 8. The nurse is reviewing the health records of assigned clients. The nurse plans care knowing that which client is at risk for a potassium deficit? 1. The client on nasogastric (NG) suction 2. The client with renal disease 3. The client with Addison’s disease 4. The client with metabolic acidosis Answer: 1 Rationale: Potassium-rich gastrointestinal (GI) fluids are lost through GI suction, placing the

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client at risk for hypokalemia. The client with renal disease, Addison’s disease, and metabolic acidosis are at risk for hyperkalemia. Test-Taking Strategy: Read the question carefully, noting that it asks for the client at risk for hypokalemia. Read each option and think about the electrolyte loss that can occur in each. Option 1 clearly identifies a loss of body fluid. If you had difficulty with this question, review the causes of hypokalemia. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Fundamental Skills Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 162. 9. A nurse is instructing a client on how to decrease the intake of magnesium in the diet. The nurse tells the client that which food item contains the least amount of magnesium? 1. Processed drinking water 2. Peanut butter 3. Spinach 4. Broccoli Answer: 1 Rationale: Drinking water that has not been processed through a water softener is high in magnesium. Peanut butter, spinach, and broccoli are magnesium-containing foods and should be avoided by the client on a magnesium-restricted diet. Test-Taking Strategy: Use the process of elimination and note the key words, least amount. These words indicate a false response question and that you need to select the item lowest in magnesium. Eliminate options 3 and 4 first because they are similar. Recalling that unprocessed water is high in magnesium will direct you to option 1 from the remaining options. Review the foods that are high in magnesium if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Fundamental Skills Reference: Peckenpaugh, N. (2003). Nutrition essentials and diet therapy (9th ed.). Philadelphia: W.B. Saunders, pp. 97, 115. 10. A nurse instructs a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse tells the client that which food provides the least amount of potassium? 1. Spinach 2. Carrots 3. Apricots 4. Apple Answer: 4 Rationale: An apple provides approximately 3 mEq of potassium per serving. Spinach and carrots (½ cup cooked) and four apricots provide approximately 7 mEq of potassium per serving.

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Test-Taking Strategy: Use the process of elimination and note the key words, least amount. These words indicate a false response question and that you need to select the item lowest in potassium. Recalling the potassium content of the foods identified will direct you to option 4. Review the foods high in potassium if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Fundamental Skills Reference: Peckenpaugh, N. (2003). Nutrition essentials and diet therapy (9th ed.). Philadelphia: W.B. Saunders, p. 98. 11. A nurse reviews a client’s electrolyte results and notes a potassium level of 5.5 mEq/L. The nurse understands that a potassium value at this level would be noted in which condition? 1. The client who sustained a traumatic burn 2. The client with Cushing’s syndrome 3. The client with colitis 4. The client who has been overusing laxatives Answer: 1 Rationale: A serum potassium level that exceeds 5.1 mEq/L is indicative of hyperkalemia. Clients who experience cellular shifting of potassium, as in the early stages of massive cell destruction, such as in trauma, burns, sepsis, or with metabolic or respiratory acidosis, are at risk for hyperkalemia. The client with Cushing’s syndrome or colitis and the client who has been overusing laxatives are at risk for hypokalemia. Test-Taking Strategy: Use the process of elimination and eliminate options 3 and 4 first because they are similar and reflect a gastrointestinal loss. From the remaining options, recalling that cell destruction causes potassium shifts will assist in directing you to the correct option. Remember that Cushing’s syndrome presents a risk for hypokalemia and that Addison’s disease presents a risk for hyperkalemia. Review the causes of hyperkalemia if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills References: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 889. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 1034. 12. A nurse reviews a client’s electrolyte results and notes that the potassium level is 5.4 mEq/L. Which of the following would the nurse note on the cardiac monitor as a result of the laboratory value? 1. Narrow, peaked T waves 2. Prominent U wave 3. ST elevation 4. Peaked P wave

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Answer: 1 Rationale: A serum potassium level of 5.4 mEq/L is indicative of hyperkalemia. Cardiac changes include a wide, flat P wave, prolonged PR interval, widened QRS complex, narrow, peaked T waves, and depressed ST segment. Test-Taking Strategy: From the information in the question, you need to determine that this condition is a hyperkalemic one. From this point, it is necessary to know the cardiac changes that are expected when hyperkalemia exists. Review these cardiac changes if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 698. 13. A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to the client. Before administering the medication, the nurse reviews the action of the medication and understands that it: 1. Releases bicarbonate in exchange for primarily sodium ions 2. Releases sodium ions in exchange for primarily bicarbonate ions 3. Releases sodium ions in exchange for primarily potassium ions 4. Releases potassium ions in exchange for primarily sodium ions Answer: 3 Rationale: Sodium polystyrene sulfonate (Kayexalate) is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration. Test-Taking Strategy: Use the process of elimination. Looking at the name of the medication (Kayexalate) closely will assist in recalling the action of the medication. If you had difficulty with this question, review the action of this medication. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, pp. 980-981. 14. A nurse reviews electrolyte values and notes a sodium level of 130 mEq/L. The nurse understands that which client is at risk for the development of a sodium value at this level? 1. The client with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 2. The client with an inadequate daily water intake 3. The client with watery diarrhea 4. The client with diabetes insipidus Answer: 1 Rationale: Hyponatremia is a serum sodium level below 135 mEq/L. Hyponatremia can result

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secondary to SIADH. The client with an inadequate daily water intake, watery diarrhea, or diabetes insipidus is at risk for hypernatremia. Test-Taking Strategy: Knowledge regarding the normal sodium level and the causes of hyponatremia are required to answer the question. Remember that hyponatremia can result secondary to SIADH. Review these causes if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 814. 15. A nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in this client if hyponatremia is present? 1. Dry mucous membranes 2. Postural blood pressure changes 3. Intense thirst 4. Slow bounding pulse Answer: 2 Rationale: Postural blood pressure changes occur in the client with hyponatremia. Dry mucous membranes and intense thirst are seen in clients with hypernatremia. A slow, bounding pulse is not indicative of hyponatremia. In hyponatremia, a rapid thready pulse is noted. Test-Taking Strategy: Use the process of elimination and note the information provided in the question. Eliminate options 1 and 3 first because they are similar (a client with dry mucous membranes is likely to have intense thirst). From the remaining options, it is necessary to recall the signs of hyponatremia. If you have difficulty with this question, review the signs associated with hyponatremia. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 160-161. 16. A nurse is caring for a client with a diagnosis of hyperthyroidism. Laboratory studies are performed and the serum calcium level is 12.0 mg/dL. Based on this laboratory value, the nurse takes which action? 1. Documents the value in the client’s record 2. Places the laboratory result form in the client’s record 3. Informs the registered nurse of the laboratory value 4. Reassures the client that the laboratory result is normal Answer: 3 Rationale: The normal serum calcium level ranges from 8.6 to 10.0 mg/dL. The client is experiencing hypercalcemia and the nurse would inform the registered nurse of the laboratory

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value. Because the client is experiencing hypercalcemia, options 1, 2, and 4 are incorrect. Test-Taking Strategy: Focus on the laboratory value in the question to determine that the client is experiencing hypercalcemia. Also, note that options 1, 2, and 4 are similar and indicate that no action would be taken to report the value. Review the normal calcium level if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Malarkey, L., & McMorrow, M. (2005). Nursing guide to laboratory and diagnostic tests. Philadelphia: W.B. Saunders, p. 164. 17. A nurse reviews a client’s serum sodium level and notes that the level is 150 mEq/L. The physician prescribes dietary instructions for the client based on the sodium level. Which of the following food items will the nurse instruct the client to avoid? 1. Spinach 2. Squash 3. Processed oat cereals 4. Molasses Answer: 3 Rationale: The normal serum sodium level is 135 to 145 mEq/L. A serum sodium level of 150 mEq/L is indicative of hypernatremia. Based on this finding, the nurse would instruct the client to avoid foods high in sodium. Spinach and molasses are good food sources of calcium. Squash is high in phosphorus. Test-Taking Strategy: Note the key word, avoid. This word indicates a false response question and that you need to select the food item high in sodium. Recall the normal serum sodium level. After determining that the client has hypernatremia, determining the food to avoid is the issue. Eliminate options 1 and 2 first because these are basically very healthy foods. From the remaining options, note the word “processed” in option 3. Processed foods tend to be higher in sodium content, so this is the food to avoid. Review foods high in sodium content if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Fundamental Skills Reference: Peckenpaugh, N. (2003). Nutrition essentials and diet therapy (9th ed.). Philadelphia: W.B. Saunders, p. 156. 18. A nurse reviews the client’s serum calcium level and notes that the level is 4.0 mEq/L. The nurse understands that which condition would cause this serum calcium level? 1. Prolonged bed rest 2. Excessive administration of vitamin D 3. Renal disease 4. Multiple myeloma Answer: 1

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Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. A client with a serum calcium level of 4.0 mEq/L is experiencing hypocalcemia. Excessive ingestion of vitamin D, renal disease, and multiple myeloma are causative factors associated with hypercalcemia. Although immobilization can initially cause hypercalcemia, the long-term effect of prolonged bed rest is hypocalcemia. Test-Taking Strategy: Knowledge regarding the normal serum calcium level will assist in determining that the client is experiencing hypocalcemia. This should help in eliminating option 2. Recalling the causative factors associated with hypocalcemia is necessary to select the correct option from those remaining. Remember that the long-term effect of prolonged bed rest is hypocalcemia. If you had difficulty with the question, review the causative factors associated with hypocalcemia. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 280. 19. A nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which of the following signs would be an indication of this diagnosis? 1. Generalized muscle weakness 2. Twitching 3. Hyperactive bowel sounds 4. Positive Trousseau’s sign Answer: 1 Rationale: Generalized muscle weakness is seen in hypercalcemia. Options 2, 3, and 4 identify signs of hypocalcemia. Test-Taking Strategy: Use the process of elimination, noting that options 2, 3, and 4 are similar because they all reflect a hyperactivity of body systems. The option that is different is option 1. Review the signs of hypercalcemia if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Phipps, W., Monahan, F., Sands, J., Marek, J., & Neighbors, M. (2003). Medicalsurgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, p. 257. 20. A nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse tells the client that which food item contains the least amount of calcium? 1. Butter 2. Milk 3. Spinach 4. Broccoli Answer: 1 Rationale: Butter comes from milk fat and does not contain significant amounts of calcium.

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Milk, spinach, and turnip greens are calcium-containing foods and should be avoided by the client on a calcium-restricted diet. Test-Taking Strategy: Note the key words, least amount. These words indicate a false response question and that you need to select the item lowest in calcium. Option 2 can be easily eliminated first. Eliminate options 3 and 4 next because they are similar. Review the foods high and low in calcium if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Fundamental Skills Reference: Peckenpaugh, N. (2003). Nutrition essentials and diet therapy (9th ed.). Philadelphia: W.B. Saunders, p. 97. 21. A nurse is caring for a client with hyperparathyroidism and notes that the client’s serum calcium level is 13 mg/dL. Which medication would the nurse prepare to administer as prescribed to the client? 1. Calcium gluconate 2. Calcium chloride 3. Calcitonin (Calcimar) 4. Large doses of vitamin D Answer: 3 Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used in the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration. Test-Taking Strategy: Recalling the normal serum calcium level will assist in determining that the client is experiencing hypercalcemia. With this knowledge, you can easily eliminate options 1 and 2, because you would not administer medication that adds calcium to the body. Remembering that excessive vitamin D is a causative factor of hypercalcemia will assist in eliminating option 4. If you had difficulty with this question, review the treatment for hypercalcemia. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 153. 22. A nurse is instructing a client on how to decrease the intake of potassium in the diet. The nurse tells the client that which food contains the least amount of potassium? 1. Potatoes 2. Apricots 3. Avocado 4. Lettuce

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Answer: 4 Rationale: Lettuce contains less than 100 mg of potassium. Potatoes, apricots, and avocado are potassium-containing foods and should be avoided by the client on a potassium-restricted diet. Test-Taking Strategy: Note the key words, least amount. These words indicate a false response question and that you need to select the item that is lowest in potassium. Recalling the foods high in potassium will direct you to option 4. If you had difficulty with the question, review these foods. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Fundamental Skills Reference: Nix, S. (2005). Williams’ basic nutrition and diet therapy (11th ed.). St. Louis: Mosby, pp. 137-138. 23. The nurse is caring for a client with renal failure. The laboratory results reveal a magnesium level of 3.6 mg/dL. Which of the following signs would the nurse expect to note in the client based on this magnesium level? 1. Twitching 2. Hyperactive reflexes 3. Irritability 4. Loss of deep tendon reflexes Answer: 4 Rationale: The normal magnesium level is 1.6 to 2.6 mg/dL. A client with a magnesium level of 3.6 mg/dL is experiencing hypermagnesemia. Options 1, 2, and 3 would be noted in a client with hypomagnesemia. Test-Taking Strategy: Knowledge regarding the normal magnesium level and the associated signs related to an imbalance are helpful in answering the question. Use the process of elimination, noting that options 1, 2, and 3 are similar because they reflect neurological excitability. If you had difficulty with this question, review the signs noted for magnesium imbalance. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Linton, A., & Maebius, N. (2003), Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 163. 24. The nurse reviews the client’s serum phosphorus level and notes that the level is 2.0 mg/dL. The nurse understands that which condition caused this serum phosphorus level? 1. Alcoholism 2. Hypoparathyroidism 3. Chemotherapy 4. Vitamin D intoxication Answer: 1 Rationale: The normal serum phosphorus level is 2.7 to 4.5 mg/dL. The client in this question is

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experiencing hypophosphatemia. Causative factors relate to decreased nutritional intake and malnutrition. A poor nutritional state is associated with alcoholism. Hypoparathyroidism, chemotherapy, and vitamin D intoxication are causative factors of hyperphosphatemia. Test-Taking Strategy: Knowledge regarding the normal phosphorus level is required to determine the condition that this client is experiencing. From this point, it is necessary to know the causes of hypophosphatemia. Remember that causative factors relate to decreased nutritional intake and malnutrition. If you had difficulty with this question, review the causative factors associated with hypophosphatemia. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 242. Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, pp. 672-673. 25. A nurse is instructing a client on how to decrease the intake of phosphorus in the diet. The nurse tells the client that which food item contains the least amount of phosphorus? 1. Oranges 2. Fish 3. Whole-grain bread 4. Almonds Answer: 1 Rationale: An orange contains the least amount of phosphorus. Foods high in phosphorus include fish, pork, beef, chicken, organ meats, nuts, whole-grain breads, and cereals. Test-Taking Strategy: Note the key words, least amount. These words indicate a false response question and that you need to select the food that contains the least amount of phosphorus. Recalling the foods that are high and low in phosphorus will direct you to option 1. Review these foods if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Fundamental Skills Reference: Nix, S. (2005). Williams’ basic nutrition and diet therapy (11th ed.). St. Louis: Mosby, pp. 133-134. <AQ>26. A nurse is caring for a client with a nasogastric (NG) tube. NG tube irrigations are prescribed to be performed once every shift. Which solution is the most appropriate to use for the NG irrigation? CLIENT’S CHART Laboratory Test Results Potassium level of 4.5 mEq/L Sodium level of 132 mEq/L 1. Tap water

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2. Distilled water 3. Sterile water 4. Normal saline Answer: 4 Rationale: A potassium level of 4.5 mEq/L is within normal range. A sodium level of 132 mEq/L is low, indicating hyponatremia. In clients with hyponatremia, normal (isotonic) saline should be used rather than sterile water for GI irrigations. Test-Taking Strategy: Use the process of elimination. Note that sterile water, distilled water, and tap water are similar. The only option that is different is option 4. If you had difficulty with this question, review the care for the client experiencing hyponatremia. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 160-161.

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