Exam 16: Fluid, electrolyte, and Acid-Base Imbalances

The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid,deep respirations. Which action should the nurse take?

The nurse is caring for a patient with a massive burn injury and possible hypovolemia. Which assessment data will be of most concern to the nurse?

Which action can the registered nurse (RN)who is caring for a critically ill patient with multiple IV lines and medications delegate to a licensed practical/vocational nurse (LPN/LVN)?

A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data will require the most rapid response by the nurse?

A patient has a magnesium level of 1.3 mg/dL. Which assessment would help the nurse identify a likely cause of this value?

A patient is admitted to the emergency department with severe fatigue and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse?

A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the patient is receiving this infusion?

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?

A patient comes to the clinic complaining of frequent,watery stools for the past 2 days. Which action should the nurse take first?

An older adult patient who is malnourished presents to the emergency department with a serum protein level of 5.2 g/dL. The nurse would expect which clinical manifestation?

The nurse is caring for a patient who has a central venous access device (CVAD). Which action by the nurse is appropriate?

A nurse is assessing a newly admitted patient with chronic heart failure who forgot to take prescribed medications and seems confused. The patient has peripheral edema and shortness of breath. Which assessment should the nurse complete first?

The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan?

A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.0 mEq/L. The nurse should alert the health care provider immediately that the patient is on which medication?

The long-term care nurse is evaluating the effectiveness of protein supplements for an older resident who has a low serum total protein level. Which assessment finding indicates that the patient's condition has improved?

A patient who is lethargic and exhibits deep,rapid respirations has the following arterial blood gas (ABG)results: pH 7.32,PaO₂ 88 mm Hg,PaCO₂ 37 mm Hg,and HCO₃ 16 mEq/L. How should the nurse interpret these results?

IV potassium chloride (KCl)60 mEq is prescribed for treatment of a patient with severe hypokalemia. Which action should the nurse take?

A patient with multiple draining wounds is admitted for hypovolemia. Which assessment would be the most accurate way for the nurse to evaluate fluid balance?

After receiving change-of-shift report,which patient should the nurse assess first?

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?