PCC II: Fluid & Electrolyte Imbalance; NCLEX Practice Questions

PCC II: Fluid & Electrolyte Imbalance; NCLEX Practice

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PCC II: Fluid, Electrolytes, Acid-Bas...

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PCC II:

94 terms elys In a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because vomiting results in...

• Fluid movement from the cells into the interstitial

space and the blood vessels

• Excretion of large amounts of interstitial fluid with

depletion of extracellular fluids

• An overload of extracellular fluid with a significant

increase in intracellular fluid volume

• Fluid movement from the vascular system into the

cells, causing cellular swelling and rupture

• Fluid movement from the cells into the interstitial space and the blood vessels

HypOvolemia Lab Values; Increased, Decreased, or Normal?Na Hct Serum Osmolality Urine Specific Gravity

Na: Both

Hct: Increased

Serum Osmolality: Increased

Urine Specific Gravity: Increased

HypERvolemia Lab Values; Increased, Decreased, or Normal?Na Hct Serum Osmolality Urine Specific Gravity

Na: Decreased

Hct: Decreased

Serum Osmolality: Decreased

Urine Specific Gravity: Decreased

Taking care of a patient with history of urosepsis, CKD.Admitted 7 days ago for pneumonia, independent in the room, now has 3+ pitting edema in the legs.Which Diagnosis?

• Hypovolemia
• Hypervolemia
• Dehydration

Two S/S:

• Wt. gain
• High serum Na

C. HR 80

• Serum osmolality 274
• ↓ capillary hydrostatic pressure

Treatment:

• Place foley
• Diuretic
• IV 0.9% NaCl
• Paracentesis
• Compression stockings

Diagnosis:

• Hypervolemia

S/S:

• Wt. gain
• Serum osmolality 274

Treatment:

• Diuretic
• Compression stockings

Which fluid order should the nurse question for a patient with a traumatic brain injury?

• 0.45% sodium chloride
• 0.9% sodium chloride
• Lactated Ringer's

D. D10W

• 0.45% sodium chloride

A patient presents to the emergency department with vomiting and diarrhea for the past 2 days. The nurse anticipates which fluid therapy initially?

• 0.9% sodium chloride
• Dextrose 10% in water
• Dextrose 5% in water
• 0.45% sodium chloride
• 0.9% sodium chloride

Isotonic Which lab value is consistent with fluid overload?

• Plasma osmolality of 270 mOsm/kg
• BUN 12 mg/dl
• Hematocrit of 46%
• Plasma sodium of 135 mEq/l
• Plasma osmolality of 270 mOsm/kg

Osmolality is low due to less particles.Sodium is almost abnormal.

Match the Patient with the PRIORITY Solution

Patients:

• End stage liver disease (ESLD), ascites, BP 80/60
• Accident victim hemorrhaging
• High serum Sodium level
• 87 yo dehydrated
• Acute Burn victim
• 3 month old, dehydrated
• Head injury with brain swelling
• Pre-op patient admitted for surgery
• Acute AKI
• CHF, crackles in lungs
• CKD, 3+ pitting edema

Solution:

1. D5W

• Albumin
• 0.9% NaCl
• Packed red blood cells
• Lactated Ringers
• Platelets

7. TPN

• 3% NaCl
• 0.45% NaCl
• Saline lock
• End stage liver disease (ESLD), ascites, BP 80/60

→ 2. Albumin

• Accident victim hemorrhaging

→ 4. Packed red blood cells (with saline and LR)

• High serum Sodium level

→ 1. D5W

• 87 yo dehydrated

→ 3. 0.9% NaCl

• Acute Burn victim

→ 5. Lactated Ringers (or normal saline)

• 3 month old, dehydrated

→ 3. 0.9% NaCl

• Head injury with brain swelling

→ 8. 3% NaCl

• Pre-op patient admitted for surgery

→ 5. Lactated Ringers

• Acute AKI

→ 10. Saline lock

• CHF, crackles in lungs

→ 10. Saline lock (with NO fluids)

• CKD, 3+ pitting edema

→ 2. Albumin The nurse is administering 3.0 % saline solution IV to a patient with severe hyponatremia. It is most important for the nurse to observe for what?

• Decreased heart rate and blood pressure
• Prolonged QT interval and facial flushing
• Shortness of breath and increased respiratory
• Increased urine output and decreased urine specific

gravity

• Shortness of breath and increased respiratory

D/t fluid overload A patient with breast cancer and mets is admitted with a calcium level of 16. Which foods should the patient avoid?

• Soybeans
• White rice
• Canned salmon
• Hominy grits
• Bananas
• Figs
• Soybeans
• Canned salmon
• Figs

The nurse is assessing a patient with AKI. What is expected during the diuretic phase?

• Low serum osmolality
• Low output
• Low BUN
• High output
• High output

Which patient are at greatest risk for pre-renal AKI?

• A patient with kidney stones.
• A patient with breast cancer.
• A patient who is hemorrhaging.
• A patient with a BP of 70/50.
• A patient with low potassium.
• A patient who is hemorrhaging.
• A patient with a BP of 70/50.

Nurses need to teach patients at risk for developing chronic renal kidney disease (CKD). Individual considered to beat increased risk include (Select all that apply.)

• 20 yo with urinary tract infections as a child
• 60 yo Native American
• 40 yo with a history of pancreatitis
• 30 yo with a history of hypertension
• 50 yo with type 2 diabetes
• 60 yo Native American
• 30 yo with a history of hypertension
• 50 yo with type 2 diabetes

During peritoneal dialysis, the patient notices the return of fluid to be cloudy. What does this indicate, possible?

• Anemia
• Pyelonephritis
• Bowel perforation
• Peritonitis
• Peritonitis

A client with hyperparathyroidism has a serum calcium level of 12.1 mg/dL. Which symptom should the nurse anticipate?

• Tetany and muscle cramps
• Positive Trousseau's sign
• Decreased deep tendon reflexes and lethargy
• Prolonged QT interval
• Decreased deep tendon reflexes and lethargy

A patient undergoes peritoneal dialysis exchanges several times each day. What should the nurse plan to increase in the patient's diet?

• Fat
• Protein
• Calories
• Carbohydrates
• Protein