ATI RN
Fluid and Electrolytes ATI
1. A patient who is hospitalized with a possible electrolyte imbalance is disoriented and weak, has an irregular pulse, and takes hydrochlorothiazide. He most likely suffers from:
- A. Hypernatremia
- B. Hyponatremia
- C. Hyperkalemia
- D. Hypokalemia
Correct answer: D
Rationale: The patient is displaying symptoms of hypokalemia, including weakness, disorientation, irregular pulse, which can lead to cardiac disturbances. Hydrochlorothiazide is a potassium-wasting diuretic that can cause hypokalemia if not accompanied by potassium replacement therapy. Hypernatremia (choice A) is characterized by high sodium levels, not potassium. Hyponatremia (choice B) is low sodium levels. Hyperkalemia (choice C) is high potassium levels, which is not consistent with the symptoms described in the question.
2. The renin and angiotensin systems help to maintain the balance of sodium and water in the body. What other functions do these systems serve?
- A. Regulating hemoglobin levels
- B. Maintaining a healthy blood volume
- C. Releasing platelets when tissues are injured
- D. Lowering blood volumes
Correct answer: B
Rationale: The correct answer is B: Maintaining a healthy blood volume. The renin and angiotensin systems not only help to regulate sodium and water balance in the body but also play a crucial role in maintaining an adequate blood volume. This is essential for normal blood pressure regulation and overall cardiovascular health. Choices A, C, and D are incorrect because hemoglobin levels are primarily regulated by the bone marrow and erythropoietin, platelets are released in response to blood vessel injury by a different mechanism, and the systems do not focus on lowering blood volumes but rather on maintaining them.
3. A female patient is discharged from the hospital after having an episode of heart failure. She's prescribed daily oral doses of digoxin (Lanoxin) and furosemide (Lasix). Two days later, she tells her community health nurse that she feels weak and her heart 'flutters' frequently. What action should the nurse take?
- A. Tell the patient to rest more frequently.
- B. Advise the patient to discontinue digoxin and contact the physician.
- C. Contact the physician, report the symptoms, and request a blood sample to determine the patient's potassium level.
- D. Instruct the patient to avoid caffeine-containing foods.
Correct answer: C
Rationale: The correct action for the nurse to take is to contact the physician, report the patient's symptoms, and request a blood sample to determine the patient's potassium level. Furosemide, a potassium-wasting diuretic, can lead to hypokalemia, causing weakness and palpitations. Therefore, checking the potassium level is crucial in this situation. Simply telling the patient to rest more frequently won't address the underlying issue of potassium depletion. While digoxin can cause adverse effects, in this case, the symptoms are more likely related to furosemide-induced potassium loss. Instructing the patient to avoid caffeine-containing foods may be beneficial in general, but it wouldn't directly address the potassium depletion that needs urgent attention.
4. What would be the best initial nursing action prior to inserting an IV?
- A. Instruct the patient to wash their hands.
- B. Prepare the IV insertion site with povidone iodine.
- C. Verify the order for IV therapy.
- D. Identify a suitable vein.
Correct answer: C
Rationale: The best initial nursing action prior to inserting an IV is to verify the order for IV therapy. This step ensures that the IV insertion is appropriate and necessary based on the physician's orders. Instructing the patient to wash their hands (Choice A) is important for infection control but not the immediate priority before IV insertion. While preparing the IV insertion site with povidone iodine (Choice B) and identifying a suitable vein (Choice D) are crucial steps in the process, confirming the order for IV therapy (Choice C) takes precedence to ensure the correct intervention is being performed.
5. A 65-year-old male patient was admitted to a medical-surgical unit 72 hours ago with pyloric stenosis; a nasogastric tube was inserted upon admission and has been on low intermittent suction since then. The nurse taking care of the patient notices that his potassium is very low and becomes concerned that the patient may be at risk for:
- A. Hypercalcemia
- B. Metabolic acidosis
- C. Metabolic alkalosis
- D. Respiratory acidosis
Correct answer: C
Rationale: The correct answer is C, metabolic alkalosis. The patient with pyloric stenosis has been on low intermittent suction, leading to the loss of hydrogen and chloride ions. This condition causes metabolic alkalosis due to the removal of these ions. Options A (Hypercalcemia) and D (Respiratory acidosis) are incorrect as they are not directly related to the scenario described. Option B (Metabolic acidosis) is also incorrect; in this case, the patient is at risk of metabolic alkalosis due to the loss of hydrogen and chloride ions through gastric suction.
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