Med Surge Ch. 10 - Fluid Electrolytes NCLEX Questions

• / 4

Med Surge Ch. 10 - Fluid & Electrolytes NCLEX Questions

• A patient is admitted to the emergency department with hypovolemia. Which IV

solution should the nurse anticipate administering?

1.3% sodium chloride 2.10% dextrose in water 3.0.45% sodium chloride 4.lactated Ringer's solution: 4. Ringer's solution is an isotonic, balanced elec- trolyte solution that can expand plasma volume and help restore electrolyte balance.3% NaCl - hypertonic 0.45% NaCl - maintenance soln 10% dextrose - hypertonic

• Which manifestation should the nurse expect to assess in a patient with fluid volume

deficit?

1.Headache and muscle cramps 2.Dyspnea and respiratory crackles 3.Increased pulse rate and blood pressure 4.Orthostatic hypotension and flat neck veins: 4. In fluid volume deficit, there is less volume in the vascular system, which decreases venous return and cardiac output, leading to manifestations of dizziness, orthostatic hypotension, and flat neck veins.

• The nurse is planning care for a patient with acute hypernatremia. What should the

nurse include in this patient's plan of care? (Select all that apply) 1.Maintain IV access This study source was downloaded by 100000897618943 from CourseHero.com on 03-21-2025 01:47:45 GMT -05:00 https://www.coursehero.com/file/247082280/386ca303-52e8-44d3-a33c-1fa94061fd7fdocx/

• / 4

2.Limit length of visits 3.Restrict fluids to 1500 mL per day 4.Conduct frequent neurologic checks

5.Orient to time, place, and person every 2 hours.: 1, 4, 5

Frequent neurologic checks are necessary as hypernatremia draws water out of brain cells, causing them to shrink. As the brain shrinks, tension is placed on cerebral vessels, which may cause them to tear and bleed. Hypernatremia affects mental status and brain function including orientation to time, place, and person. Fluid replacement is the primary treatment for hypernatremia.

• A patient's serum potassium level is 2.2 mEq/L. Which nursing action is the highest

priority for this patient?

1.Start oxygen at 2 L/min 2.Initiate cardiac monitoring 3.Initiate seizure precautions 4.Keep the patient on bed rest: 2. Hypokalemia affects nerve impulse transmis- sion, including the transission of cardiac impulses. May develop ECG changes 5.The nurse instructs a patient on calcium supplement therapy. Which state- ment indicates that the patient understands how to take calcium supplemen- tation?

1.I will take the calcium with meals 2.I will take the calcium with a full glass of water 3.I will take these supplements as need for tremulousness 4.I will take these supplements all at one time in the morning.: 2. Calcium should be taken with full glass of water.Calcium supplements should actually be taken 1-1.5 hours after meals and at bedtime. This study source was downloaded by 100000897618943 from CourseHero.com on 03-21-2025 01:47:45 GMT -05:00 https://www.coursehero.com/file/247082280/386ca303-52e8-44d3-a33c-1fa94061fd7fdocx/

• / 4
• A patient is demonstrating confusing, hallucinations, and a positive Chvostek's sign.

Which medications should the nurse prepare to provide to this patient?

1.calcium chloride 2.magnesium sulfate 3.insulin and glucose 4.sodium bicarbonate: 2. A positive Chvostek's sign indicates increased neu- romuscular excitability, commonly associated with both hypomagnesemia and hypocalcemia.Hypomagnesemia also causes confusion, hallucinations, and pos- sible psychoses.

• A patient's arterial blood gas results are pH 7.21 PaO2 98 mmHg, PaCO2 32 mmHg,

and HCO3 17 mEq/L. Which acid-base imbalance do these results indicate to the nurse?

1.metabolic acidosis 2.metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis: 1. pH <7.35 indicates acidosis. The bicarbonate level is less than 22 Meq/L which indicates a deficit of bicarbonate because of acidosis. The PaCo2 of 32 is less than 35 mmHg. This indicates respiratory compensation for excess acid.

• A patient diagnosed with a suspected heroin overdose has a respiratory rate of 5 to 6

per minute. Which additional data should the nurse expect to collect on this patient?(Select all that apply)

• pH 7.29

2.PaCO2 54 mmHg 3.HCO3 32 mEq/L 4.alert and oriented This study source was downloaded by 100000897618943 from CourseHero.com on 03-21-2025 01:47:45 GMT -05:00 https://www.coursehero.com/file/247082280/386ca303-52e8-44d3-a33c-1fa94061fd7fdocx/

• / 4

5.skin warm and flushed: 1,2,5

The slow respiratory rate leads to inadequate alveolar ventilation. As a result, carbon dioxide is not effectively eliminated from the blood, causing it to accumulate. This increases carbonic acid levels, leading to respiratory acidosis, as indicated by the low pH and high PaCO2. The bicarbonate level is initially unchanged in acute respiratory acidosis because the compensatory response of the kidneys occurs over hours to days. Excess carbon dioxide causes vasodilation, leading to warm, flushed skin, particularly in acute respiratory acidosis. The increased carbon dioxide level will affect neurologic function and the patient will not be alert and oriented.

• The nurse is caring for a patient undergoing gastric decompression. For which

potential acid-base balance should the nurse plan interventions?

1.metabolic acidosis 2.metabolic alkalosis 3.respiratory acidosis 4.respiratory alkalosis: 2. Gastric suctioning removes highly acidic gastric secre- tions, increasing the risk of metabolic alkalosis.Respiratory alkalosis is caused be hyperventilation.

• A patient being mechanically ventilated after a severe chest wall injury and flail chest

complains of chest tightness, anxiety, and air hunger. The patient fears that a heart attack is pending. What should the nurse do first?

1.Notify the physician 2.Obtain arterial blood gases 3.Administer prescribed analgesic 4.Contact respiratory therapy to evaluate ventilator settings: 2. These are clas- sic manifestations of respiratory alkalosis, a potential complication of mechanical ventilation This study source was downloaded by 100000897618943 from CourseHero.com on 03-21-2025 01:47:45 GMT -05:00 https://www.coursehero.com/file/247082280/386ca303-52e8-44d3-a33c-1fa94061fd7fdocx/