Fluid and Electrolytes

Free preview · Original latest version

Sample questions from Fluid and Electrolytes

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 72-year-old client admitted to a medical unit has had vomiting and diarrhea for 2 days. The client is dizzy when standing, has a heart rate of 116/min, blood pressure of 88/54 mm Hg, dry mucous membranes, and urine output of 15 mL/hr. Which action should the nurse take first?

   • A.Begin the prescribed isotonic IV fluid bolus
   • B.Restrict oral and IV fluids until the diarrhea stops
   • C.Administer the prescribed potassium supplement
   • D.Obtain a daily weight before intervening

   Rationale: The client has signs of hypovolemia with impaired perfusion, so prompt isotonic fluid replacement is the priority. Fluid restriction could worsen the volume deficit, and potassium replacement does not correct the immediate perfusion problem. A daily weight is useful for ongoing monitoring but must not delay resuscitation.

2. 2.A 64-year-old client with heart failure is admitted with worsening dyspnea. The client has crackles, jugular venous distention, a 2-kg weight gain in 2 days, and an oxygen saturation of 89% on room air. Which action should the nurse take first?

   • A.Place the client upright and apply prescribed oxygen
   • B.Encourage the client to drink a glass of water
   • C.Administer a prescribed potassium supplement
   • D.Obtain a urine specimen before providing care

   Rationale: Upright positioning and oxygen address the immediate breathing and oxygenation problem associated with fluid overload. Encouraging fluids may worsen congestion, while potassium does not treat the acute respiratory compromise. Urine testing may be appropriate later but is not the first priority.

3. 3.A 58-year-old client receiving IV furosemide for pulmonary edema has a potassium level of 2.8 mEq/L and reports new muscle weakness. The cardiac monitor shows frequent premature ventricular contractions. Which action is the priority?

   • A.Notify the provider and anticipate potassium replacement
   • B.Continue the infusion and recheck potassium in 8 hours
   • C.Encourage a high-sodium snack
   • D.Ask the client to walk to assess muscle strength

   Rationale: Severe hypokalemia with ventricular ectopy can progress to a life-threatening dysrhythmia, so the provider must be notified and replacement anticipated promptly. Waiting several hours risks deterioration, and sodium intake does not correct potassium deficiency. Ambulation is unsafe with weakness and active ectopy.

4. 4.A 70-year-old client with chronic kidney disease has a potassium level of 6.6 mEq/L and peaked T waves on the ECG. The client is alert and denies chest pain. Which prescribed intervention should the nurse implement first?

   • A.Administer IV calcium gluconate
   • B.Give oral potassium chloride
   • C.Provide a high-potassium snack
   • D.Administer a loop diuretic and reassess tomorrow

   Answer and rationale are in the full material.

5. 5.A 45-year-old client with a serum sodium of 119 mEq/L is confused and has a generalized seizure in the emergency department. The airway is patent, and oxygen is being applied. Which action should the nurse take next?

   • A.Initiate seizure precautions and prepare to administer prescribed hypertonic saline
   • B.Encourage the client to drink water
   • C.Administer hypotonic IV fluid
   • D.Place the client in a quiet room and reassess in 1 hour

   Answer and rationale are in the full material.