Chapter 12: Clients with Electrolyte Imbalances Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 12: Clients with Electrolyte Imbalances

MULTIPLE CHOICE

1. Physical assessment of a client with cardiac dysrhythmia reveals hypoactive bowel sounds, muscle weakness, dizziness, postural hypotension, shallow respirations, increased fatigue, and decreased tendon reflexes. The laboratory result consistent with these findings is

a.

serum calcium level of 4.3 mEq/L.

b.

serum magnesium level of 1.3 mEq/L.

c.

serum phosphorus level of 1.1 mEq/L.

d.

serum potassium level of 3.0 mEq/L.

ANS: D

Hypokalemia will cause slowed smooth and skeletal muscle contraction. Hypokalemia is present when serum potassium level is less than 3.5 mEq/L. Hypocalcemia (option a) would cause manifestations such as a positive Chvosteks sign and positive Trousseaus sign due to neuronal excitability and irritability in the motor and sensory nerves. Hypomagnesemia (option b) can cause myocardial irritability, psychological manifestations, and decreased contractility in the GI tract leading to nausea, anorexia, and abdominal distention. Severe hypomagnesemia can also cause positive Chvosteks and Trousseaus signs. Option c, hypophosphatemia, leads to manifestations that result from impaired ATP production: decreased cardiac and respiratory function, weakness, fatigue, brittle bones, bone pain, confusion, and seizures.

DIF: Application/Applying REF: pp. 152-153 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

2. A client is being discharged from the hospital and will be taking oral potassium chloride. The nurse should teach the client to take this medication

a.

at bedtime.

b.

between meals.

c.

on an empty stomach.

d.

with a glass of juice.

ANS: D

Instruct the client to take liquid or tablet potassium supplements with a glass or more of water or juice or with food to prevent gastrointestinal irritation. Intolerable GI side effects may lead to the client not being compliant with the treatment regimen.

DIF: Application/Applying REF: pp. 153-154 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

3. For a client in renal failure with an abnormally elevated serum potassium level, the priority assessment by the nurse would be the clients

a.

electrocardiogram (ECG) strips.

b.

level of consciousness.

c.

serial BUN and creatinine levels.

d.

urine output.

ANS: A

High potassium levels have the potential to induce life-threatening dysrhythmias. The nurse would monitor and treat these according to protocol and report ECG changes. Unfortunately, with severely elevated potassium levels, the myocardium will be unresponsive to medications or defibrillation, so changes in the ECG need to be reported immediately. The other options are needed assessments as well, but do not carry the priority of the ECG readings. The renal changes are a precursor to hyperkalemia, not the result of it.

DIF: Application/Applying REF: pp. 157-158 OBJ: Assessment

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

4. A client has a low serum calcium level. During a bath the nurse cleans the clients face with a cloth, and the lips, nose, and side of the face contract. The nurse documents the presence of

a.

Bells palsy.

b.

Chvosteks sign.

c.

tic douloureux.

d.

Trousseaus sign.

ANS: B

Chvosteks sign is spasm of the muscles innervated by the facial nerve. It is best elicited by tapping the clients face lightly below the temple. Spasm of the face, lip, or nose would indicate a positive test for tetany. Trousseaus sign is carpal spasm when a blood pressure cuff is inflated on the arm for 5 minutes. Bells palsy and tic douloureux are both peripheral nervous system disorders.

DIF: Application/Applying REF: pp. 159, 160 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

5. A client has been admitted with hypokalemia but all treatments have failed to raise the potassium level suitably. The nurse would assess the client further and report findings of

a.

chronic insomnia.

b.

estrogen use.

c.

laxative abuse.

d.

recent leg fracture.

ANS: C

Hypomagnesemia can cause refractory hypokalemia and hypocalcemia. The hypomagnesemic state inhibits potassium reabsorption and must be corrected before successful treatment of the potassium imbalance. Laxative abuse is a known etiology of hypomagnesemia.

DIF: Analysis/Analyzing REF: p. 164 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

6. The nurse caring for a client taking thiazide diuretics should be sure to observe for

a.

decreased urine output.

b.

increased peristalsis.

c.

neurologic depression.

d.

neuromuscular irritability.

ANS: C

Thiazide diuretics are one of the most common causes of hypercalcemia. Neurologic depression will be seen as lethargy, decreased sensorium, and confusion.

DIF: Analysis/Analyzing REF: pp. 161, 162 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

7. Self-care teaching for a client with hypercalcemia should include

a.

administering antidiarrheal medications.

b.

decreasing sodium and calcium intake.

c.

encouraging foods that increase urine acidity.

d.

restricting fluid intake to less than 1 liter a day.

ANS: C

An acid-ash diet may be recommended to decrease the risk of urinary stone formation. Foods in this diet include meat, cheese, eggs, whole grains, cranberry juice, and prune juice. Antidiarrheals are not indicated as clients often have constipation. Sodium intake should be increased if not contraindicated to promote calcium loss through the kidney. Clients need a large fluid intake to prevent kidney stones.

DIF: Application/Applying REF: p. 162 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

8. A client has a magnesium deficit in addition to congestive heart failure (CHF). The most appropriate nursing diagnosis is

a.

Altered Comfort.

b.

High Risk for Injury.

c.

Impaired Skin Integrity.

d.

Risk for Decreased Cardiac Output.

ANS: D

Low magnesium levels have been linked with increased ventricular dysrhythmias and decreased 1-year survival rates in CHF clients as well as with lethal dysrhythmia in clients with myocardial infarction.

DIF: Application/Applying REF: p. 164 OBJ: Diagnosis

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

9. A client has been admitted in a hypercalcemic crisis and the family is distraught. One family member grabs the nurses hand and states I just dont know what Ill do if he/she dies! The best response by the nurse is

a.

Dont worry. We see this and treat it all the time in clients just like this.

b.

I know that you are upset, but I have to take care of the client first.

c.

What has your loved one been eating and drinking during the last week?

d.

Yes, this is serious but I can come back and answer some questions for you.

ANS: D

Hypercalcemic crisis carries a 30-50% death rate, so the best response by the nurse acknowledges the seriousness of the condition and validates the concern of the family, but allows the nurse to be present for the family and answer questions when the client has stabilized. It does not offer false hope (option a), dismiss the familys fears (option b), or change the subject (option c).

DIF: Application/Applying REF: p. 162 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Communication

10. The factor in the clients history that the nurse assesses as a risk for the development of hypermagnesemia is

a.

Addisons disease.

b.

gastrointestinal disease.

c.

vomiting.

d.

water intoxication.

ANS: A

Hypermagnesemia is also seen with severe dehydration from ketoacidosis; in conditions that decrease the synthesis of aldosterone, such as Addisons disease or adrenalectomy; and from overuse of IV magnesium sulfate for controlling premature labor or pregnancy-induced hypertension.

DIF: Analysis/Analyzing REF: p. 165 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

11. A client is hypokalemic and the physician leaves an order for the nurse to infuse a bolus of 30 mEq of potassium in 100 ml of NS over 30 minutes. The most appropriate action by the nurse is to

a.

administer the potassium as ordered.

b.

clarify the order with the physician.

c.

order an infusion pump to give the potassium.

d.

request the pharmacy send 250 ml of saline instead.

ANS: B

For severe potassium deficits, 10 to 20 mEq of KCl can be given every hour if diluted in IV fluids; a cardiac monitor must be used to ensure safety. IV potassium cannot be given by the IV push route.

DIF: Analysis/Analyzing REF: p. 154 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Client Safety

12. A client has end-stage renal disease and is going to start dialysis this week. The nurse is aware the client is at most risk for which electrolyte imbalance?

a.

Hypocalcemia

b.

Hypophosphatemia

c.

Hyperkalemia

d.

Hypermagnesemia

ANS: C

Hyperkalemia affects more than 50% of clients with acute or chronic renal failure.

DIF: Knowledge/Remembering REF: p. 156 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

13. A client who is scheduled for surgery the following day has preoperative electrolyte levels drawn. The nurse would notify the surgeons office to report

a.

a calcium level of 9.6 mg/dl.

b.

a chloride level of 101 mEq/L.

c.

a potassium level of 3.5 mEq/L.

d.

a sodium level of 132 mEq/L.

ANS: C

Plasma ranges for electrolytes are 135 to 145 mEq/L for sodium, 3.5 to 5.0 mEq/L for potassium, 98 to 106 mEq/L for chloride, and 4.5 to 5.5 mEq/L (or 9-11 mg/dl) for calcium. The nurse should report even borderline potassium levels because general anesthesia not only promotes potassium loss, but in combination with lower plasma potassium levels, synergistically increases the risk of cardiac dysrhythmias.

DIF: Analysis/Analyzing REF: p. 154 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

14. A nurse notes that a client has a stat order for sodium polystyrene sulfonate (Kayexalate). The nurse quickly checks serum laboratory results, anticipating

a.

hyperkalemia.

b.

hyperphosphatemia.

c.

hypokalemia.

d.

hypophosphatemia.

ANS: A

As hyperkalemia persists or increases, a cation-exchange resin such as sodium polystyrene sulfonate may be given orally or rectally as a retention enema.

DIF: Comprehension/Understanding REF: p. 157 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

15. The nurse reviewing a clients serum electrolytes notes a phosphorus level of 1.0 mEq/L. The nurse will assess the client for a history of

a.

chronic respiratory acidosis.

b.

malnutrition.

c.

morbid obesity.

d.

recent thyroidectomy.

ANS: B

The major causes of hypophosphatemia are loss/long-term lack of intake, increased growth or tissue repair, and recovery from malnutrition. Hyperparathyroidism and Cushings syndrome with its concurrent hypercalcemia, respiratory alkalosis, lead poisoning, and mild renal losses in metabolic alkalosis are also causes.

DIF: Application/Applying REF: p. 163 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

16. The nurse preparing IV calcium chloride for a client with hypocalcemia should administer the drug in

a.

0.9% normal saline using a 22-gauge IV catheter.

b.

3% normal saline using an 18-gauge IV catheter.

c.

5% dextrose in water using a 23-gauge IV catheter.

d.

Ringers solution using a 20-gauge IV catheter.

ANS: C

Calcium products should not be given in saline solutions because saline increases calcium loss. The calcium solution should be given in a large vein with a small cannula to encourage rapid dilution and to decrease the threat of phlebitis.

DIF: Application/Applying REF: p. 160 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Medication Administration

17. An elderly client is transported to the emergency department from a local nursing home with a serum calcium level of 3.9 mEq/L. The clients family is upset and says This is the second time this has happened since she got admitted to that home! The best answer by the nurse is

a.

I can call a social worker to see if she can go to another home if you like.

b.

It might be related to not getting enough sun; Ill call the home and ask about it.

c.

Yes, people in nursing homes often start having illnesses after they are admitted.

d.

You will just have to have them increase her calcium supplements.

ANS: B

Hypocalcemia can be caused by lack of exposure to sunlight, long periods of confinement in nursing homes or prisons, and disorders that interfere with absorption of vitamin D. It only takes a few minutes of sun exposure to change ingested vitamin D to its active form.

DIF: Analysis/Analyzing REF: p. 158 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Fluid and Electrolyte Imbalances

18. When giving IV potassium, the nurse takes the precaution of

a.

agitating the bag to prevent bolus administration.

b.

ensuring potassium dilution with glucose solution.

c.

leaving the IV cannula inserted as long as possible.

d.

using a large cannula for infusion.

ANS: A

Potassium products should be agitated before administration to prevent unintended bolus administration. The drug should be given with adequate dilution using normal saline and through a small cannula. The site should be changed every 72 hours, or sooner if tenderness develops.

DIF: Application/Applying REF: p. 155 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Medication Administration

19. A client is being discharged after successful treatment for hyperphosphatemia. The nurse would know that diet teaching has been effective when the client says, I cant eat large amounts of

a.

bananas.

b.

dairy products.

c.

fatty foods.

d.

green leafy vegetables.

ANS: B

Foods high in phosphate include milk, cheese, ice cream, large amounts of meat and fish, and carbonated beverages. Clients also need to avoid calcium or aluminum binding products that lead to excess phosphate excretion. Bananas contain potassium, fatty foods contain fats and cholesterol, and green leafy vegetables affect vitamin K.

DIF: Evaluation/Evaluating REF: p. 164 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

MULTIPLE RESPONSE

1. The nurse is instructing a client to eat foods that are high in potassium, such as (Select all that apply)

a.

bananas.

b.

broccoli.

c.

cantaloupe.

d.

corn.

e.

cranberry juice.

f.

lima beans.

ANS: A, B, C

Bananas, broccoli, and cantaloupe are considered high-potassium foods, whereas cranberry juice, lima beans, and corn are low in potassium.

DIF: Application/Applying REF: p. 154 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

2. A client has hypercalcemia and is admitted for a work-up. During the diagnostic period, which nursing intervention(s) would be most important to add to the care plan? (Select all that apply.)

a.

Encourage weight-bearing activities.

b.

Institute safety precautions.

c.

Instruct client to report nightmares.

d.

Place client on fluid restriction.

e.

Turn and position client carefully.

ANS: A, B, E

Once a hypercalcemic crisis has passed, nursing interventions focus on safety for the client and teaching. The client is at risk of fractures and so safety precautions are required. Fractures can occur with minimal force; even turning and repositioning the client can fracture a bone, so this must be done carefully. However, weight-bearing activities help limit calcium loss from the bone, so these activities should be encouraged as the client is able with appropriate precautions to prevent injury. Nightmares are unrelated to hypercalcemia, and to prevent renal stones from forming, clients should force fluids if not contraindicated.

DIF: Application/Applying REF: p. 163 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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