ATI Fluid and Electrolytes Questions

ATI Fluid and Electrolytes Questions ScienceMedicineNursing lacicolee Save ATI Fluid, Electrolyte, and Acid-Bas...30 terms whitney_flansburg Preview ATI- Gas Exchange and Oxygenatio...25 terms Monroe2009a Preview

ATI: Fluid, Electrolyte, and Acid/Bas...

30 terms Casandralvarez Preview Fluid a 33 terms Ale A nurse is admitting a client who reports nausea, vomiting, and weakness. The client has dry oral mucous membranes and blood pressure 102/64 mm Hg. Which of the following findings should the nurse identify as manifestations of fluid volume deficit? (Select all that apply.)

• Decreased skin turgor
• Concentrated urine
• Bradycardia
• Low-grade fever
• Tachypnea

A; Decreased skin turgor is a manifestation present with fluid volume deficit. Skin turgor is decreased due to the lack of fluid within the body and results in dryness of the skin.B; Concentrated urine is a manifestation present with fluid volume deficit. Urine is concentrated due to lack of fluid in the vascular system, causing a decreased profusion of the kidneys resulting in an increased urine specific gravity.D; Low-grade fever is a manifestation present with fluid volume deficit. Low-grade fever is one of the body's ways to maintain homeostasis to compensate for lack of fluid within the body.E; Tachypnea is a manifestation present with fluid volume deficit. Increased respirations are the body's way to obtain oxygen due to the lack of fluid volume within the body.

A nurse is admitting an older adult client who reports a weight gain of 2.3 kg (5 lb) in 48 hr. Which of the following manifestations of fluid volume excess should the nurse expect? (Select all that apply.)

• Dyspnea
• Edema
• Bradycardia
• Hypertension
• Weakness

A; Dyspnea is a manifestation present with fluid volume excess. Dyspnea is due to an excess of fluids within the body and lungs, and the client is struggling to breathe to obtain oxygen.B; Weight gain can be a result of edema.D; Blood pressure rises as the heart must work harder due to the excess fluid.E; Weakness is due to the excess fluid that is retained, which depletes energy and increases the workload for the body.A nurse is assessing a client who is dehydrated. Which of the following findings should the nurse expect?

• Moist skin
• Distended neck veins
• Increased urinary output
• Tachycardia

D; Tachycardia is an attempt to maintain blood pressure, a manifestation of fluid volume deficit.A nurse is caring for a client in a long-term facility who has become weak, confused, and experienced dizziness when standing. The client's temperature is 38.3 degrees C (100.9 degrees F), pulse 92/min, respirations 20/min, and blood pressure 108/60 mm Hg. Which of the following actions should the nurse take?

• Initiate fluid restrictions to limit intake
• Check for peripheral edema
• Encourage the client to ambulate to promote oxygenation
• Monitor for orthostatic hypotension

D; Monitor for orthostatic hypotension because they have manifestations of dehydration due to decreased circulatory volume.A nurse is caring for a client who has a blood sodium level 133 mEg/L and blood potassium level 3.4 mEq/L. The nurse should recognize that which of the following treatments can result in these laboratory findings?

• Three tap water enemas
• 0.9% NaCl solution IV at 50 ml/hr
• 5% dextrose with 0.45% NaCl solution with 20 mEq of K+ IV at 80 mL/hr
• Antibiotic therapy

A; Three tap water enemas can result in a decrease in blood sodium and potassium. Tap water is hypotonic, and gastrointestinal losses are isotonic. This creates an imbalance and solute dilution.

A nurse is caring for a client who has a blood potassium 5.4 mEq/L. The nurse should assess for which of the following manifestations?

• ECG changes
• Constipation
• Polyuria
• Paresthesia

A; Assess for ECG changes. Potassium levels can affect the heart and result in arrhythmias.A nurse is caring for a client who has a NGT attached to low intermittent suctioning. The nurse should monitor for which of the following electrolyte imbalances?

• Hypercalcemia
• Hyponatremia
• Hyperphosphatemia
• Hyperkalemia

B; Monitor the client for hyponatremia. Nasogastric losses are isotonic and contain sodium.A nurse is assessing a client who has hyperkalemia. The nurse should identify which of the following conditions as being associated with this electrolyte imbalance?

• Diabetic Ketoacidosis
• heart failure
• Cushing's syndrome
• Thyroidectomy

A; Hyperkalemia is a lab finding associated with DKA.A nurse is assessing a client for Chvostek's sign. Which of the following techniques should the nurse use to perform this test?

• Apply a blood pressure cuff to the client's arm
• Place the stethoscope bell over the client's carotid artery
• Tap lightly on the client's cheek
• Ask the client to lower their chin to their chest

C; Tap the client's cheek over the facial nerve just below and anterior to the ear to elicit Chvostek's sign. A positive response is indicated when the client exhibits facial twitching on this side of the face.

A nurse is caring for a client admitted with confusion and lethargy. The client was found at home unresponsive with an empty bottle of aspirin lying next to the bed. Vital signs reveal blood pressure 104/72 mm Hg, heart rate 116/min with regular rhythm, and respiratory rate 42/min and deep. Which of the following arterial blood gas findings should the nurse expect?

• pH 7.68

PaO2 96 mm Hg PaCO2 38 mm Hg HCO3 28 mEq/L

• pH 7.48

PaO2 100 mm Hg PaCO2 28 mm Hg HCO3 23 mEq/L

• pH 6.98

PaO2 100 mm Hg PaCO2 30 mm Hg HCO3 18 mEq/L

• pH 7.58

PaO2 96 mm Hg PaCO2 38 mm Hg HCO3 29 mEq/L C; An aspirin toxicity would result in ABG findings of metabolic acidosis.A nurse is caring for a client who was in a motor-vehicle accident. The client reports chest pain and difficulty breathing. A chest x-ray reveals the client has a pneumothorax. Which of the following ABG findings should the nurse expect?

• pH 7.06

PaO2 86 mm Hg PaCO2 52 mm Hg HCO3 24 mEq/L

• pH 7.42

PaO2 100 mm Hg PaCO2 38 mm Hg HCO3 23 mEq/L

• pH 6.98

PaO2 100 mm Hg PaCO2 30 mm Hg HCO3 18 mEq/L

• pH 7.58

PaO2 96 mm Hg PaCO2 38 mm Hg HCO3 29 mEq/L A; A pneumothorax can cause alveolar hypoventilation and increased carbon dioxide levels, resulting in a state of respiratory acidosis.