Chapter 16: Fluid, Electrolyte, and Acid-Base Imbalances Lewis:
Medical-Surgical Nursing, 10th Edition
A patient who has a small cell carcinoma of the
... [Show More] lung develops syndrome of
inappropriate antidiuretic hormone (SIADH). The nurse should notify the health care
provider about which assessment finding?
a. Serum hematocrit of 42%
b. Serum sodium level of 120 mg/dL
c. Reported weight gain of 2.2 lb (1 kg)
d. Urinary output of 280 mL during past 8 hours - ANS: B
Hyponatremia is the most important finding to report. SIADH causes water retention
and a decrease in serum sodium level. Hyponatremia can cause confusion and other
central nervous system effects. A critically low value likely needs to be treated. At
least 30 mL/hr of urine output indicates adequate kidney function. The hematocrit
level is normal. Weight gain is expected with SIADH because of water retention.
A patient who is taking a potassium-wasting diuretic for treatment of hypertension
complains of generalized weakness. Which action is appropriate for the nurse to
take?
a. Assess for facial muscle spasms.
b. Ask the patient about loose stools.
c. Recommend the patient avoid drinking orange juice with meals.
d. Suggest that the health care provider order a basic metabolic panel. - ANS: D
Generalized weakness is a manifestation of hypokalemia. After the health care
provider orders the metabolic panel, the nurse should check the potassium level.
Facial muscle spasms might occur with hypocalcemia. Orange juice is high in
potassium and would be advisable to drink if the patient is hypokalemic. Loose stools
are associated with hyperkalemia.
Spironolactone (Aldactone), an aldosterone antagonist, is prescribed for a patient.
Which statement by the patient indicates that the teaching about this medication has
been effective?
a. "I will try to drink at least 8 glasses of water every day."
b. "I will use a salt substitute to decrease my sodium intake."
c. "I will increase my intake of potassium-containing foods."
d. "I will drink apple juice instead of orange juice for breakfast." - ANS: D
Because spironolactone is a potassium-sparing diuretic, patients should be taught to
choose low-potassium foods (e.g., apple juice) rather than foods that have higher
levels of potassium (e.g., citrus fruits). Because the patient is using spironolactone
as a diuretic, the nurse would not encourage the patient to increase fluid intake.
Teach patients to avoid salt substitutes, which are high in potassium.
A patient with new-onset confusion and hyponatremia is being admitted. When
making room assignments, the charge nurse should take which action?
a. Assign the patient to a semi-private room.
b. Assign the patient to a room near the nurse's station.
c. Place the patient in a room nearest to the water fountain.
d. Place the patient on telemetry to monitor for peaked T waves.. - ANS: B
The patient should be placed near the nurse's station if confused for the staff to
closely monitor the patient. To help improve serum sodium levels, water intake is
restricted. Therefore a confused patient should not be placed near a water fountain.
Peaked T waves are a sign of hyperkalemia, not hyponatremia. A confused patient
could be distracting and disruptive for another patient in a semiprivate room.
A postoperative patient who had surgery for a perforated gastric ulcer has been
receiving nasogastric suction for 3 days. The patient now has a serum sodium level
of 127 mEq/L (127 mmol/L). Which prescribed therapy should the nurse question?
a. Infuse 5% dextrose in water at 125 mL/hr.
b. Administer 3% saline at 50 mL/hr for a total of 200 mL.
c. Administer IV morphine sulfate 4 mg every 2 hours PRN.
d. Give IV metoclopramide (Reglan) 10 mg every 6 hours PRN for nausea. - ANS: A
Because the patient's gastric suction has been depleting electrolytes, the IV solution
should include electrolyte replacement. Solutions such as lactated Ringer's solution
would usually be ordered for this patient. The other orders are appropriate for a
postoperative patient with gastric suction.
A patient who was involved in a motor vehicle crash has had a tracheostomy placed
to allow for continued mechanical ventilation. How should the nurse interpret the
following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg,
and HCO3 25 mEq/L? CONTINUES... [Show Less]