16 Fluid and Electrolyte Replacement Study Questions ‘Match the electrolyte in Column I with its normal value in Column I. Column I Column I 1. Magnesium a 95-108 mEgiL. b. 135-145 mEq/L — 2 Calcium © 17-2.6mEgiL. 3. Sodium’ é 152.5 mEgiL. ©, 3.55.3 mEgiL. 4. Potassium f asssmeat 5. Chloride 6. Phosphorus Mateh the terms in Column TI with the descriptions in Column I. Column I Column 2. Similar to plsta concentetion Osmolality 8. Based on milismoles per kilogram of water Osmolriy 9. Fluids contain fewer particles and more water Hypo-osmolar Hyperosmolar 10. Fluids have a higher solute/particle concentration Match the electrolyte in Column II with the related drug in Column I (answers may be used more than once). Column I Column I 11. Normal saline a. Potassium b. Sodium 12. Potassium chloride Calcium 13. Epsom salt Magnesium 14. Caleium chloride 15. Slow-K. 82 ong © 2015, 281,200 206 2005, 200,197,198NCLEX Review Questions 16. F i The nurse has taught the patient how to take his ‘oral potassium supplement. Which statement by the patient indicates that he requires more education on. taking this medication? “I can take this with a few sips of water.” “It may upset my stomach” . “I should drink at least six ounces of water or Juice when I take it.” <4. “I must not chew up the tablet.” ‘The patient has been diagnosed with hypokalemia ‘and will be admitted to the hospital for IV potas- sium replacement. What is the nurse’s best action ‘when preparing to give this medication? 4, Prepare the syringe with the ordered amount of ‘medication to give IV push. ’. Push the potassium into the IV bag and keep it stil before administration. «. Push the potassium chloride into the IV bag and shake vigorously. 4. Obtain an IV pump and pump tubing since this drip must be controlled, ‘A patient has been receiving IV potassium therapy ‘and the nurse notices thatthe site has become ery= ‘thematous and edematous. What is the nurse's best action? ‘2. Flush the IV site with normal saline and ine ‘crease the rate. ». Flush the IV site with heparin. cc. Stop the IV and check for blood return. 4. Discontinue the IV and restart in another site. ‘A patient has been receiving IV potassium supplements. The nurse notices thatthe patient's heart rate is now 116 beats‘minute. What other symptom(s) might the nurse expect to see ifthe patient is becoming hyperkalemic? (Select all that appl) ‘8 Abdominal distention b. Nausea «. Numbness in extremities 4. Polyurea ©. Confusion Chapter 16 * Fluid and Electrolyte Replacement. 83 20, The patient presents to the hospital and is found B19 hypetalemi. What wl the mrs antici 1) administering? a, 10 mEq/L magnesium mixed in 1000 mL of nor ‘mal saline », 0.9% normal saline bolus of 500 mL . Afluid challenge of 250 mL of high molecular- ‘weight dextran 4, Sodium bicarbonate 21, The patient has been started on a potassium supple- ZZ) ment, What should be included in the teaching plan for this patient? (Select al shat appl) ‘List the signs and symptoms of both hypokale- ‘mia and hyperkalemia, b, Regular testing of serum potassium levels is required, c. The patient should increase his intake of potassium-rich foods 4, The medication must be taken on a full stomach ‘or with a glass of water, . The patient should sit up for 30 minutes after taking the medication, 22, What is the normal range for serum osmolality? a 175-195 mOsm/kg », 280-300 mOsm/kg . 330-350 mOsm/kg 4d, 475-495 mOsm/kg 23, What isthe term used to deseribe the body fluid ‘when the serum osmolality is 285 mOsm/kg? Hypo-osmolar b, Hyperosmolar . Iso-osmolar 4, Neo-osmolar 24, Appatient with severe head trauma is receiving 3% saline, Ithas an osmolality of 900 mOsm/kg, This is considered to be what type of solution? a. Hypotonie », Hypertonic «. Isotonie 4, Neotonie 25, How is the majority of potassium excreted? Feces », Kidneys ©. Liver 4. Lungs84 27. 28, 29, 30, 31 32, Chapter 16 « Fluid and Electrolyte Replacement ‘The patient has pancreatitis, The nurse knows he is at risk for which electrolyte abnormality? Hypocaleemia . Hypernatremia , Hypomagnesemia d. Hyperkalemia ‘The nurse is teaching the patient about caleium absorption and includes the health teaching that vitamin D is needed for caleium absorption. Where in the body is calcium absorbed? a, Colon b. Gltract ©, Kidneys d. Liver Caleium is distributed intercellularly and intracel- lulaly in what proportions? b d A patient is prescribed 2 L of IV fluids; 1000 ml. DW followed by 1000 ml. of D,/4 NS. What are these fluids classified as? a, Colloids b. Crystalloids ©, Lipids d, Parenteral nutrition ‘The patient is in the hospital overnight after having. surgery and the nurse has received an order to start an IV of ,% NS. What type of fuid is D,% NS? a, Hypotonie b. Hypertonic «, Isotonie 4d. Nommotonie A patient is receiving high molecular-weight dex- tran after an explosion, What is the purpose of this fluid? a, Temporarily restore circulating volume b, Serve as a line to infuse blood into Piggyback fluid for antibioties dd, Whole blood substitute Which body fluid has a similar composition to lac- tated Ringer's IV solution? a, Plasma b, Skin , Tears d. White blood cells 33, 34, 36, 31, 38, ‘The patient is taking Slow-K, She i also taking hy- rochlorothiavide (HCTZ) 50 mg daily to contro! her hypertension, The patient's serum potassium level is 2.8 mEq/L. What clinical manifestations \ould the nurse expect to see in this patient? a, Bradycardia b. Headache fc, Musele weakness. 4. Nausea Magnesium deficiencies are frequently associated with which other electrolyte imbalance? a, Hypocaleemia b. Hyperkalemia , Hyponatremia . Hyperphosphatemia “The patient has a serum potassium level of 3.2 mEqil-and has been prescribed K-Dur. She asks the nutse why she has to take the supplement, What is the nurse's best response? a, “A low potassium level can be dangerous, and 3.2 mEqll. is considered too low.” b. “You will only be on the medication fora few days, so don't worry.” fou obviously aren't taking enough in your diet, o you have to take this.” 4. “Have you been constipated lately? Constipation will eause a low potassium level.” ‘The patient has the following lab results: Na’ 150 mEqiL, K’ 4.2 mEq/L, Cl 100 mEq, iCa 2.2 mEq/L, Mg 1.8 mg/dL., PO, 1.9. What electrolyte abnormality is present? a, Hypocaleemia b. Hyperkalemia , Hypematremia 4. Hypomagnesemia ‘The patent has a serum potassium level of 6.1 imFq/L. What clinical manifestation() should the murse expect to assess inthis patent? (Select all ‘hat apply) a Abdominal cramps b. Muscle weakness ¢, Oliguria 4. Paresthesas of face e Tachycardia and later bradycardia ‘Which drug() ilare used to treat hyperkalemia? (Select all that apply) a. Digoxin and furosemide Glucagon and magnesium Glucose and insulin Kayexalate and sorbitol b. 4 , Sodium bicarbonate and calcium gluconate39, The patient has had diarthea for several days and, hhas a serum calcium level of 3,6 mEq/L. What clinical manifestations will the nurse expect to see inthis patient? (Select all shat apply) Hyperactive deep tendon reflexes Irritability Numbness of the fingers Pathologie fractures Tetany ve Chapter 16 * Fluid and Electrolyte Replacement 85 Case Study [Read the scenario and answer the following questions on a separate sheet of paper. DM., 28 years old, has been stabbed multiple times in the chest and abdomen, His vital signs on arrival are blood pressure 84/62 mm Hg, heart rate 118 beats/mine ute, respiratory rate 30 breaths/minute, pulse oximetry (94%, and temperature 35.2° C 1. What isthe priority assessment for this patient? 2. What type of fluids would the nurse anticipate to be ordered? 3. Explain the advantage of using whole blood versus packed red blood cells,