Chapter 42: Agents Affecting the Volume and Ion Content of Body Fluids

Chapter 42: Agents Affecting the Volume and Ion Content of Body Fluids

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient who is a chronic alcoholic is admitted to the hospital. Admission laboratory work reveals a magnesium level of 1.2 mEq/L. The prescriber orders intravenous magnesium sulfate in a 10% solution at a rate of 10 mL/min. What will the nurse do?

a.	Administer the IV dose as ordered and have calcium gluconate on hand.
b.	Administer the IV dose and make preparations for mechanical ventilation.
c.	Hold the IV dose until the infusion rate has been clarified with the provider.
d.	Request an order for renal function tests before administering the IV dose.

 

 

ANS:  C

This patient has hypomagnesemia and should be given magnesium sulfate intravenously. The percent of magnesium in solution is correct; however, magnesium should not be infused faster than 1.5 mL/min, so the nurse is correct to question the rate of infusion. Calcium gluconate should be available when magnesium is given, but the nurse needs to clarify the rate of infusion first. Mechanical ventilation is necessary with excessive magnesium. Renal function tests are not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 462

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

2. A patient who was injured at home is brought to the emergency department. The nurse caring for this patient notes a respiratory rate of 32 breaths per minute and a heart rate of 90 beats per minute. The injuries are minor, but the patient is inconsolable and hysterical. The nurse expects that initial management will include:

a.	administering a gas mixture of 5% carbon dioxide (CO2).
b.	providing 100% oxygen via nasal cannula.
c.	giving sodium bicarbonate IV.
d.	providing sedatives to calm the patient.

 

 

ANS:  A

The patient is at risk for respiratory alkalosis as a result of hyperventilation, and giving the patient a gas mixture containing CO₂ will help correct the alkalosis. Administering oxygen would worsen the problem. Sodium bicarbonate is given to correct metabolic acidosis. Sedatives may be necessary if initial measures fail.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 460

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. A child who ingested a handful of aspirin tablets from a medicine cabinet at home is brought to the emergency department. The nurse caring for the child notes a respiratory rate of 48 breaths per minute. The nurse understands that this child’s respiratory rate is the result of the body’s attempt to compensate for:

a.	metabolic acidosis.
b.	metabolic alkalosis.
c.	respiratory acidosis.
d.	respiratory alkalosis.

 

 

ANS:  A

Metabolic acidosis can result from the ingestion of aspirin. The body responds by hyperventilating to reduce CO₂, which represents volatile carbonic acid, and raise pH. This child has a rapid respiratory rate in response to metabolic acidosis. In patients with metabolic alkalosis, the body responds with hypoventilation in an effort to increase the CO₂ level. Patients with respiratory acidosis usually have retention of CO₂ secondary to hypoventilation, and compensation is the result of retention of bicarbonate by the kidneys, which is a slow process. Respiratory alkalosis is caused by hyperventilation; treatment involves having the patient rebreathe CO₂ or administering sedatives.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 460-461

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. A patient with congestive heart failure is admitted to the hospital. During the admission assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes that the admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately. What will the nurse do initially?

a.	Give the digoxin and maintain close cardiac monitoring.
b.	Hold the digoxin and report the laboratory values to the provider.
c.	Hold the thiazide diuretic and give the digoxin.
d.	Request an order for an electrocardiogram (ECG).

 

 

ANS:  B

Potassium depletion is common with thiazide diuretics, and hypokalemia is especially dangerous for patients receiving digoxin, because the drug can precipitate a fatal dysrhythmia and digoxin toxicity. The provider should be notified of the serum potassium level so that it can be corrected before the digoxin is administered. Giving the digoxin could produce a fatal adverse effect, so this is not an appropriate course of action. Holding the thiazide diuretic will not correct the potassium deficiency. An ECG is not the initial priority.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 461

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential