Patho Test 4- Ch.39

During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?

0.9% sodium chloride

5% dextrose and water

3% sodium chloride

Lactated Ringer solution

A 34-year-old male client has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The client's family is questioning the care team as to why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide the family?

An inordinate amount of interstitial fluid is accumulating his abdomen.

The transcellular component of the intracellular fluid compartment contains far more fluid than normal.

Normally small transcellular fluid compartment, or third space, is becoming enlarged.

Gravity-dependent plasma is accumulating in his peritoneal cavity.

Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply.

An 81-year-old man with right-sided heart failure and hypothyroidism

A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus

A 34-year-old industrial worker who has suffered extensive burns in a job-related accident

A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia

A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa

Recognizing the prevalence and incidence of dehydration among older adults, a care aide at a long-term care facility is in the habit of encouraging residents to drink even though they may not feel thirsty at the time. Which of the following facts underlies the care aide's advice?

Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.

The metabolic needs for both fluid and sodium in older adults differ from those of younger individuals.

Regulation and maintenance of effective circulating volume by the kidneys is less effective in the elderly.

The renin–angiotensin–aldosterone system (RAAS) is less able to facilitate sodium clearance in older adults.

A patient arrives in the ED very hypovolemic related to excretion of “at least 3 gallon jugs of urine in the past 24 hours.” He describes the urine as being clear-like water. The physician suspects diabetes insipidus. The nurse should be prepared to administer which of the following medications?

Desmopressin acetate (DDAVP)

Benadryl, an anticholinergic

Calcium gluconate

Prednisone

A patient has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit, the nurse will be assessing the patient for syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessments would alert the clinic nurse that the patient may be developing this complication?

Complaints that his urine output is decreased, no edema noted in ankles, and increasing headache

Elevated blood glucose levels, dry mucous membranes, and severe projectile vomiting

Fever, diarrhea, and nausea

Muscle cramps, pins and needle sensation around the mouth/lips, and unexplained bruising

A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?

She is susceptible to isotonic fluid volume deficit.

She is prone to isotonic fluid volume excess.

She could develop third-spacing edema as a result of plasma protein losses.

She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses.

You are volunteering in the medical tent of a road race on a hot, humid day. A runner who has collapsed on the road is brought in with the following symptoms: sunken eyes, a body temperature of 100°F, and a complaint of dizziness while sitting to have his blood pressure taken (which subsides upon his lying down). These are signs of a fluid volume deficit. Which of the following treatments should be carried out first?

Offer water by mouth.

Begin cooling of his body by ice packs

Give him a transfusion of FFP.

Give him an electrolyte solution by mouth.

A client is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. What is the client's most likely diagnosis?

Hyponatremia

Fluid volume excess

Electrolyte imbalance: hypocalcemia

Hyperkalemia

A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Given this diagnosis, what clinical manifestations and lab results should the nurse anticipate the patient will exhibit?

High urine specific gravity, tachycardia, and a weak, thready pulse

Low blood pressure, dry mouth, and increased urine osmolality

Increased hematocrit and blood urea nitrogen and seizures

Muscle weakness, lethargy, and headaches.

An ECG technician is performing an ECG on a hospital patient who has developed hypokalemia secondary to diuretic use. Which of the following manifestations of the client's health problem will the technician anticipate on the ECG?

Irregular heart rate and a peaked T wave

A low T wave and an absent P wave

A prominent U wave and a flattened T wave

A narrow QRS complex and an absent U wave

A nurse in a medical unit has noted that a client’s potassium level is elevated at 6.1 mEq/L. The nurse has notified the physician, removed the banana from the client’s lunch tray, and is performing a focused assessment. When questioned by the client for the rationale for these actions, which of the following explanations is most appropriate?

�Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness.”

�Your potassium levels in the blood are higher than they should be, which brings a risk of changes in the brain function.”

�I'll need to monitor you today for signs of high potassium; tell me if you feel as if your heart is beating quickly or irregularly.”

�The amount of potassium in your blood is too high, but this can be resolved by changing the intravenous fluid you are receiving.”

A renal failure patient with severe hyperkalemia (K+ level 7.2 mEq/L) has just been admitted to the nursing unit. Given the severity of this situation, the nurse should be prepared to administer which intravenous infusion stat?

Lactated Ringer solution at 150 mL/hour to maintain blood glucose levels

Regular insulin infusion, rate dependent on lab values

Infusion of Solu-Medrol to decrease irritation to the intravascular system

Dilaudid via patient-controlled device (PCA) to control pain

Vitamin D is integral to the regulation of calcium and phosphate levels. Put the following steps in the action of vitamin D into the correct sequence. Use all the options. A) Vitamin D is present in the skin or intestine. B) Vitamin D is concentrated in the liver C) Absorption of calcium from the intestine increases D) Vitamin D is transported to the kidneys. E) Calcitriol is produced.

ABDEC

ABCDE

EDCBA

A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well. What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy?

Parathyroid hormone level

Bone scan

Plasma phosphate levels

Serum magnesium level

An 81-year-old female has a long-standing diagnosis of hypocalcemia secondary to kidney disease. She will be moving into an assisted living facility shortly. Which of the following clinical manifestations would the nursing staff at the facility likely observe in this patient?

Loss of appetite and complaints of nausea

Muscular spasms and complaints of tingling in the hands/feet

High fluid intake and copious amounts of dilute urine output

Lethargy and change in level of consciousness

A terminally ill cancer patient with metastasis to the bone has been admitted with elevated calcium levels (hypercalcemic crisis). The patient is very lethargic and exhibiting muscle flaccidity. The nurse should be prepared to administer (Select all that apply.)

Pamidronate, a bisphosphonate.

Intravenous drip of insulin.

Furosemide, a loop diuretic.

Gallium nitrate, a gallium salt of nitric acid.

Prednisone, a corticosteroid

A 56-year-old female hospital patient with a history of alcohol abuse is receiving intravenous (IV) phosphate replacement. Which of the following health problems will this IV therapy most likely resolve?

The client has an accumulation of fluid in her peritoneal cavity.

The client is acidotic and has impaired platelet function.

The client has an irregular heart rate and a thread pulse.

The client has abdominal spasms and hyperactive reflexes.

A patient who has had a prolonged period of nasogastric (NG) suctioning following colon surgery is experiencing electrolyte imbalances. The magnesium level is low (1.2 mg/dL). Knowing that magnesium deficiency occurs in conjunction with low calcium levels, the nurse should assess the patient for which of the following clinical manifestations of hypocalcaemia? Select all that apply.

Patho Test 4- Ch.39

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