Chapter - 014 Electrolyte Imbalances

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Chapter 14: Clients with Electrolyte Imbalances
Black & Hawks: Medical-Surgical Nursing: Clinical Management for

Positive Outcomes, 7th Edition
MULTIPLE CHOICE
1. On admission to the hospital, a client has a serum sodium concentration of 125

mEq/L. The nurse describes the pathophysiologic effect of this at the cellular level as
a. sodium in the cells moves into the extracellular fluid (ECF), causing a decrease in
cellular size and decreasing cell excitability.
b. sodium in the ECF moves into the cells and causes cellular swelling and damage.
c. water in the ECF moves by osmosis into the cells and results in delayed membrane
depolarization.
d. water in the cell moves by osmosis into the ECF and the cells become
hyperexcitable.
ANS: c
When the extracellular sodium level decreases, the ECF becomes hyposmolar. Water
moves into the cell to the area of greater concentration to rebalance the water
concentration. This osmotic shift can lead to intracellular edema. These changes also
mean that less sodium is available to move across the excitable membrane, which usually
results in a delayed membrane depolarization.
DIF: Cognitive Level: Analysis REF: Text Reference: 226

TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
2. The aspect of an older adult’s history indicating a risk for developing hypernatremia is
that the client
a. has been on a diet high in potassium.
b. drinks three full glasses of water a day.
c. takes an over-the-counter antacid.
d. has had frequent urinary tract infections.
ANS: b
Major risk factors include inadequate water intake in conjunction with decreased thirst
(hypodipsia) and excessive water loss or insufficient fluid replacement associated with
febrile illness, vomiting, or diarrhea.

Elsevier items and derived items © 2005 by Elsevier Inc.

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3. A client has a serum sodium concentrtion of 160 mEq/L and exhibits generalized
weakness and confusion. The nurse should plan to initiate
a. fluid restrictions.
b. frequent assessment of breath sounds.
c. monitoring of urine specific gravity.
d. seizure precautions.
ANS: d
As hypernatremia progresses to sodium levels greater than 155 mEq/L, cells (especially
brain cells) shrink due to the increased ECF osmolality. Neurologic changes can occur,
including confusion, convulsions, coma, and irreversible brain damage. Safety and
seizure precautions should be instituted.
DIF: Cognitive Level: Application REF: Text Reference: 226

4. Physical assessment of a client with cardiac dysrhythmia reveals hypoactive bowel

sounds, muscle weakness, dizziness, postural hypotension, shallow respirations,
increased fatigue, and decreased tendon reflexes. The laboratory result consistent with
these findings is
a. serum potassium level of 3.0 mEq/L.
b. serum potassium level of 5.5 mEq/L.
c. serum sodium level of 120 mEq/L.
d. serum sodium level of 150 mEq/L.
ANS: a
Hypokalemia will cause slowed smooth and skeletal muscle contraction. Hypokalemia is
present when serum potassium level is less than 3.5 mEq/L.

TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
5. A client receiving diuretics is also taking oral potassium chloride to prevent

hypokalemia. The nurse should administer this medication
a. between meals.
b. on an empty stomach.
c. with a glass of juice.
d. at bedtime.
ANS: c

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Instruct the client to take liquid or tablet potassium supplements with a glass or more of
water or juice and with food. The client should consume oral potassium supplements with
food to prevent gastrointestinal irritation.

6. The nurse is instructing a client to eat foods that are high in potassium, such as
a. cranberry juice.
b. cantaloupe.
c. lima beans.
d. corn.
ANS: b
Cantaloupe is considered a high-potassium food, whereas cranberry juice, lima beans,
and corn are low in potassium.
DIF: Cognitive Level: Application REF: Text Reference: 233, Box 14-2;
7. For a client in renal failure with an abnormally elevated serum potassium level, the
nurse would make an assessment through
a. monitoring the client’s electrocardiogram (ECG) strips.
b. evaluating level of consciousness.
c. measuring urine output.
d. obtaining serial blood levels.
ANS: a
High potassium levels have the potential to induce life-threatening dysrhythmias. The
nurse would monitor and treat these according to protocol and report ECG changes.

8. The nurse would expect that no visible manifestations will be apparent with an
abnormal potassium level of
a. 6.2 mEq/L.
b. 6.6 mEq/L.
c. 3.3 mEq/L.
d. 2.8 mEq/L.

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ANS: c
Abnormalities may not be apparent with mild hypokalemia (3.3-3.4 mEq/L).

9. A client with acute pancreatitis has an abnormally low serum calcium level. During a
bath the nurse cleans the client’s face with a cloth, and the lips, nose, and side of the
face contract. When documenting this information, the nurse would state that the
client’s facial twitching indicates the presence of
a. Trousseau’s sign.
b. tic douloureux.
c. Chvostek’s sign.
d. Bell’s palsy.
ANS: c
Chvostek’s sign is spasm of the muscles innervated by the facial nerve. It is best elicited
by tapping the client’s face lightly below the temple. Spasm of the face, lip, or nose
would indicate a positive test for tetany.

10. For a client with cardiac disease receiving a digitalis preparation, discharge teaching
should include explaining the need to
a. avoid potassium-rich foods.
b. avoid over-the-counter calcium-based antacids.
c. increase intake of dairy products.
d. increase intake of fruits and vegetables.
ANS: b
The nurse should be sure to ask whether the client is taking a digitalis preparation with
calcium. This combination increases the risk for digitalis potentiation.

11. The nurse caring for a client taking thiazide diuretics should be sure to observe for
a. neurologic depression.
b. neuromuscular irritability.
c. increased peristalsis.
d. decreased urine output.

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ANS: a
Thiazide diuretics cause retention of calcium and can lead to hypercalcemia.
Neurological depression will be seen as lethargy and loss of sensorium and confusion.

12. Nursing care for a client with hypercalcemia should include

a. decreasing fluid intake.
b. administering antidiarrheal medications.
c. decreasing sodium intake.
d. encouraging intake of foods that increase urine acidity.
ANS: d
An acid-ash diet may be recommended to decrease the risk of urinary stone formation.
Foods in this diet include meat, cheese, eggs, whole grains, cranberry juice, and prune
juice.

13. A client has a magnesium deficit in addition to congestive heart failure (CHF). The
most appropriate nursing diagnsos is
a. high risk for injury.
b. impairment of skin integrity.
c. alteration in comfort (pain).
d. alteration in cardiac output: decreased.
ANS: d
Low magnesium levels have been linked with increased ventricular dysrhythmias and
decreased 1-year survival rates in CHF clients as well as with lethal dysrhythmia in
clients with myocardial infarction.

14. When a client receiving an intravenous (IV) infusion of magnesium sulfate begins to
complain of feelings of warmth, the nurse first should
a. encourage client to sit in a chair.
b. remove excess covers.

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c. reduce the infusion rate.

d. check for sudden hypotension.
ANS: c
Rapid infusion of magnesium sulfate can cause a hot or flushed feeling and phlebitis. The
nurse should avoid giving magnesium in saline solutions.

15. The factor in the client’s history that the nurse assesses as a risk for the development
of hypermagnesemia is
a. water intoxication.
b. Addison’s disease.
c. gastrointestinal disease.
d. vomiting.
ANS: b
Hypermagnesemia is also seen with severe dehydration from ketoacidosis in conditions
that decrease the synthesis of aldosterone, such as Addison’s disease or adrenalectomy,
and from overuse of IV magnesium sulfate for controlling premature labor or
pregnancy-induced hypertension.

16. The nurse should to ensure that the rate of an infusion of potassium chloride (KCl)
never exceeds the rate of
a. 2 mEq/hour.
b. 5 mEq/hour.
c. 20 mEq/hour.
d. 40 mEq/hour.
ANS: c
For severe potassium deficits, 10 to 20 mEq of KCl can be given every hour if diluted in
IV fluids; a cardiac monitor must be used to ensure safety.

17. A client who has multisystem organ failure has the following electrolyte levels: Na +

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of 129 mEq/L, Mg++ of 2.6 mEq/L, and K+ of 5.9 mg/dl. The nurse interprets that this
client has
a. hypernatremia, hypomagnesemia, and hyperkalemia.
b. hypernatremia, hypermagnesemia, and hypokalemia.
c. hyponatremia, hypermagnesemia, and hyperkalemia.
d. hyponatremia, hypomagnesemia, and hypokalemia.
ANS: c
Plasma ranges for electrolytes include 135 to 145 mEq/L for sodium, 1.5 to 2.5 mEq/L
for magnesium, and 3.5 to 5.0 mEq/L for potassium.

18. A client who is scheduled for surgery the following day has preoperative electrolyte
levels drawn. The nurse would notify the surgeon’s office to report
a. serum sodium of 132 mEq/L.
b. serum calcium of 4.8 mg/dl.
c. serum potassium of 3.5 mEq/L.
d. chloride of 101 mEq/L.
ANS: c
Plasma ranges for electrolytes are 135 to 145 mEq/L for sodium, 3.5 to 5.0 mEq/L for
potassium, 98 to 106 mEq/L for chloride, and 4.5 to 5.5 mEq/L (or 9-11 mg/dl) for
calcium. Marginal levels should be reported because anesthesia increases potassium loss.

19. A nurse notes that a client has a “stat” order for sodium polystyrene sulfonate
(Kayexalate). The nurse quickly checks serum laboratory results, anticipating
a. hyponatremia.
b. hypokalemia.
c. hypernatremia.
d. hyperkalemia.
ANS: d
As hyperkalemia persists or increases, a cation-exchange resin such as sodium
polystyrene sulfonate may be given orally or rectally as a retention enema.
DIF: Cognitive Level: Comprehension REF: Text Reference: 236

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20. The nurse reviewing a client’s serum electrolytes notes a phosphorus level of 1.0
mEq/L. The nurse will assess the client for a history of
a. long-term use of antacids.
b. morbid obesity.
c. recent thyroidectomy.
d. chronic respiratory acidosis.
ANS: a
The major causes of hypophosphatemia are long-term ingeston of antacids, malnutrition,
hyperparathryoidism, and respiratory alkalosis.

21. The nurse preparing IV calcium chloride for a client with hypocalcemia should
administer the drug in
a. 55% normal saline using 18-gauge cannula.
b. 5% dextrose in 25% normal saline using 22-gauge cannula.
c. 5% dextrose in water using 23-gauge cannula.
d. Ringer’s solution using 20-gauge cannula.
ANS: c
Calcium products should not be given in saline solutions because saline increases calcium
loss. The calcium solution should be given in a large vein with a small cannula to
encourage rapid dilution and to decrease the threat of phlebitis.

22. An older adult woman comes to the emergency department with a serum calcium
level of 3.9 mEq/L. From the client’s history, the nurse recognizes the probable
etiology of this finding as
a. presence of urinary infection.
b. cessation of estrogen supplementation 3 years ago.
c. client’s residency in a nursing home for the last 3 years.
d. inhalant medication taken for chronic obstructive pulmonary disease.
ANS: c

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Hypocalcemia can be caused by lack of exposure to sunlight, long periods of confinement

in nursing homes or prisons, and disorders that interfere with absorption of vitamin D.

23. When giving IV potassium, the nurse takes the precaution of

a. agitating the bag to prevent bolus administration.
b. leaving the IV cannula inserted as long as possible.
c. ensuring potassium dilution with glucose solution.
d. using a large cannula for infusion.
ANS: a
Potassium products should be agitated before administration to prevent unintended bolus
administration. The drug should be given with adequate dilution and through a small
cannula. The site should be changed every 72 hours, or sooner if tenderness develops.
Use of glucose in the IV administration may facilitate entry of potassium into the cell.

24. The nurse caring for a client with a potassium level of 5.6 mEq/L would remind the
client to avoid such foods as
a. cranberries.
b. broccoli.
c. sweet potatoes.
d. french fries.
ANS: b
Broccoli is high in potassium. Cranberries and potatoes are low in potassium.
DIF: Cognitive Level: Comprehension REF: Text Reference: 233, Table 14-2;

Chapter - 014 Electrolyte Imbalances

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1

Chapter 14: Clients with Electrolyte Imbalances

Black & Hawks: Medical-Surgical Nursing: Clinical Management for

Chapter 14: Clients with Electrolyte Imbalances

1. On admission to the hospital, a client has a serum sodium concentration of 125

DIF: Cognitive Level: Analysis REF: Text Reference: 226

DIF: Cognitive Level: Analysis REF: Text Reference: 225

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 226

4. Physical assessment of a client with cardiac dysrhythmia reveals hypoactive bowel

DIF: Cognitive Level: Application REF: Text Reference: 232

5. A client receiving diuretics is also taking oral potassium chloride to prevent

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 232

DIF: Cognitive Level: Analysis REF: Text Reference: 235

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 232

DIF: Cognitive Level: Application REF: Text Reference: 238

DIF: Cognitive Level: Application REF: Text Reference: 240

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 240

12. Nursing care for a client with hypercalcemia should include

DIF: Cognitive Level: Analysis REF: Text Reference: 241

DIF: Cognitive Level: Analysis REF: Text Reference: 243

Elsevier items and derived items © 2005 by Elsevier Inc.

c. reduce the infusion rate.

DIF: Cognitive Level: Analysis REF: Text Reference: 243

DIF: Cognitive Level: Analysis REF: Text Reference: 243

DIF: Cognitive Level: Application REF: Text Reference: 233

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 223

DIF: Cognitive Level: Analysis REF: Text Reference: 233

DIF: Cognitive Level: Comprehension REF: Text Reference: 236

Elsevier items and derived items © 2005 by Elsevier Inc.

TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

DIF: Cognitive Level: Analysis REF: Text Reference: 241

DIF: Cognitive Level: Analysis REF: Text Reference: 239

Elsevier items and derived items © 2005 by Elsevier Inc.

Hypocalcemia can be caused by lack of exposure to sunlight, long periods of confinement

DIF: Cognitive Level: Application REF: Text Reference: 237

23. When giving IV potassium, the nurse takes the precaution of

DIF: Cognitive Level: Analysis REF: Text Reference: 233

Elsevier items and derived items © 2005 by Elsevier Inc.

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