Med-Surg: Fluid & Electrolyte 1. A nurse is caring for a client who had CKD. The nurse should monitor the client for which of the following manifestations of fluid overload? A. Flat Neck Veins B. Weak Pulse C. Increased Hematocrit D. Increased Blood Pressure Answer: D. The nurse should monitor the blood pressure of a client who has CKD. The client who is experiencing fluid overload due to CKD will manifest an increase in blood pressure. 2. A nurse is caring for a client who has CKD. Which of the following actions should the nurse take to manage fluid overload? A. Weight the client periodically throughout the day. B. Measures the client’s output every 8 hours C. Obtain the client’s blood pressure at least every 4 hours D. Limit client’s oral fluid intake to meal times Answer: C. The nurse should obtain the client’s blood pressure at least every 4 hr. An increase in the blood pressure can indicate fluid overload and hypertension which can lead to further kidney damage. The nurse should monitor the blood pressure of a client who has CKD. The client who is experiencing fluid overload due to CKD will manifest an increase in blood pressure. 3. A nurse is reinforcing discharge teaching with a client who has undergone a transurethral resection of the prostate (TURP). Which of the following statements should the nurse include in the teaching? A. increase fluid intake if you’re in becomes blood tinged B. take naproxen for discomfort. C. sexual activity is permitted after two weeks. D. urinary dribble and will resolve within 5 days. Answer : A. Rational. The nurse should reinforce that strenuous activity, straining to the bowel movement and coughing may cause the urine to become blood tinged. If this should occur the client should stop the activity, rest, and increase fluid intake. If urine becomes increasingly blood tinged or does not clear , or if the client has difficulty voiding, then he or she should be instructed to notify the provider. 2 A nurse is reviewing the medical records of a group of clients. The nurse should identify that hemodialysis is appropriate for which of the following clients ? A. A client who has minimal urine output following a drug overdose. B. A client who has acute kidney disease and is responding to diuretics. C. A client who took excessive laxatives and has a potassium level of 2.8mEq/L. D. A client who has been vomiting and has metabolic alkalosis. E. A client with a potassium level of 5.8 mEq/L F. A client who has been diarrhea and has metabolic acidosis Answer. A Rational: the nurse should recognize that hemodialysis therapy is appropriate for clients who have end stage kidney disease, drug overdose, hyperkalemia, fluid overdose or metabolic acidosis. 3. A nurse is observing a client who has acute alcohol intoxication. The nurse should identify that the client is at risk for which of the following acid-base imbalances? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis Answer: C. Common causes of metabolic acidosis include alcohol or ethanol intoxication, diabetic ketoacidosis, hypoxia, kidney failure, diarrhea, and pancreatitis. 4. A nurse is reviewing the laboratory results of a client who has metabolic alkalosis. Which of the following laboratory values should the nurse expect? A. pH 7.31, HCO3- 22 mEq/L, PaCO2 50 mmHg B. pH 7.48, HCO3- 23 mEq/L, PaCO2 25 mmHg C. pH 7.32, HCO3- 18 mEq/L, PaCO2 40 mmHg D. pH 7.49, HCO3- 32 mEq/L, PaCO2 40 mmHg Answer: D. These laboratory values reflect metabolic alkalosis. The pH and the bicarbonate are greater than the expected reference range, and the PaCO2 is within the expected reference range. 5. A nurse is caring for a client who is extremely anxious and is hyperventilating. The client's ABG results are pH 7.50, PaCO2 27 mmHg, and HCO3- 25 mEq/L. The nurse should identify that the client has which of the following acid-base imbalances? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis Answer: C. Because of rapid breathing, the client is exhaling excessive amounts of carbon dioxide. This loss of carbon dioxide decreases the hydrogen ion level of the blood, which causes the pH to increase and results in respiratory alkalosis. Which one is not common causes of metabolic acidosis? Liver Failure 6. A nurse is providing dietary teaching to a client who has kidney disease. Which of the following food choices should the nurse include in the teaching as containing the lowest amount of magnesium? A. Yogurt B. Corn Flakes C. Hard boiled egg D. Leafy Greens Answer: C. Hard Boiled Egg Rationale: Hard Boiled eggs contain as little as 5 mg of Magnesium, while yogurt contains 19 mg, leafy greens contain 24 mg and corn flakes contain 11 mg of Magnesium.