SAUNDERS NCLEX RN EXAM FLUIDELECTROLYTES ACIDBASE

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Saunders NCLEX RN exam Fluid/electrolytes Acid/Base

SAUNDERS NCLEX RN EXAM FLUID/ELECTROLYTES ACID/BASE

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The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client?

• Twitching
• Hypoactive bowel sounds
• Negative Trousseau's sign
• Hypoactive deep tendon reflexes
• Twitching

Rationale:

Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.

The nurse caring for a client with hypocalcemia would expect to note which change on the electrocardiogram (ECG)?

• Widened T wave
• Prominent U wave
• Prolonged QT interval
• Shortened ST segment
• Prolonged QT interval

Rationale:

Electrocardiographic changes that occur in a client with hypocalcemia include a 1 / 4

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Saunders NCLEX RN exam Fluid/electrolytes Acid/Base prolonged ST or QT interval. A shortened ST segment and a widened T wave occur with hypercalcemia. Prominent U waves occur with hypokalemia.The nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.7 mEq/L. Which finding would the nurse expect to note on the electrocardiogram as a result of the laboratory value?

• ST depression
• Inverted T wave
• Prominent U wave
• Tall peaked T waves
• Tall peaked T waves

Rationale:

Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves.The nurse caring for a group of clients reviews the electrolyte laboratory results and notes a sodium level of 130 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a sodium value at this level?

• The client who is taking diuretics
• The client with hyperaldosteronism
• The client with Cushing's syndrome
• The client who is taking corticosteroids
• The client who is taking diuretics

Rationale:

Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the client with hyperaldosteronism or Cushing's syndrome are at risk for hypernatremia.The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a 2 / 4

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Saunders NCLEX RN exam Fluid/electrolytes Acid/Base client with hyponatremia?

• Muscle twitches
• Decreased urinary output
• Hyperactive bowel sounds
• Increased specific gravity of the urine
• Hyperactive bowel sounds

Rationale:

Hyperactive bowel sounds indicate hyponatremia. The remaining options are signs of hypernatremia. In hyponatremia, muscle weakness, increased urinary output, and decreased specific gravity of the urine would be noted.The nurse reviews a client's laboratory report and notes that the client's serum phosphorus level is 2 mg/dL. Which condition most likely caused this serum phosphorus level?

• Alcoholism
• Renal insufficiency
• Hypoparathyroidism
• Tumor lysis syndrome
• Alcoholism

Rationale:

Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based or magnesium-based antacids. Malnutrition is associated with alcoholism. Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia.

The nurse is reading a health care provider's (HCP) progress notes in the client's record and reads that the HCP has documented "insensible fluid loss of approximately 800 mL daily." The nurse interprets that this type of fluid loss can occur through which route?

• The skin
• Urinary output 3 / 4

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Saunders NCLEX RN exam Fluid/electrolytes Acid/Base

• Wound drainage
• The gastrointestinal tract
• The skin

Rationale:

Insensible losses occur daily through the skin and the lungs. Sensible losses are those of which the person is aware, such as through urination, wound drainage, and gastrointestinal tract losses.The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit?

• A client with an ileostomy
• A client with heart failure
• A client on long-term corticosteroid therapy
• A client receiving frequent wound irrigations
• A client with an ileostomy

Rationale:

Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy. A client with heart failure or on long-term corticosteroid therapy, or a client receiving frequent wound irrigations, are most at risk for fluid volume excess.The nurse caring for a client who has been receiving intravenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition?

• Lung congestion
• Decreased hematocrit
• Increased blood pressure
• Decreased central venous pressure (CVP)
• Decreased central venous pressure (CVP)

Rationale:

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