Fluid and electrolytes nursing quiz. Below is a NCLEX exam practice quiz to test your knowledge on fluids and electrolytes. The NCLEX exam will test your knowledge on how to take care of patients with fluid and electrolyte problems. For example, what nursing interventions would you take when caring for a patient with a magnesium level of 1.2 or what signs and symptoms would you expect to see in a patient with congestive heart failure?
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Fluid and Electrolytes Nursing Quiz
1. On morning assessment of your patient in room 2502 who has severe burns. You notice that fluid is starting to accumulate in his abdominal tissue. You note that his weight has not changed and his intake and output is equal. What do you suspect?
A. Third spacing B. This is normal and expected after a burn and it is benign C. Document this finding as non-pitting abdominal edema.
D. Intravascular compartment syndrome
The answer is A. You would suspect third spacing. Third-spacing is the accumulation of trapped extracellular fluid in a body space as a result in this case of a burn. Third spacing can occur in body spaces such as the pericardial, pleural, peritoneal, and joint cavities, bowel, and abdomen after a trauma or burn. It is normal not to see a change in weight or abnormal intake or output values.
2. Which patient is at more risk for an electrolyte imbalance?
A. An 8 month old with a fever of 102.3 ‘F and diarrhea B. A 55 year old diabetic with nausea and vomiting C. A 5 year old with RSV
D. A healthy 87 year old with intermittent episodes of gout
The answer is A. The 8 month old with a fever of 102.3 ‘F and diarrhea is the correct answer. Infants (age 1 and under) and older adults are at a higher risk of fluid-related problems than any other age group. This is because infants have the highest amount of total body fluid (80% of the body is made up of fluid) and if any type of illness especially GI effects the body this increases the chances of an electrolyte imbalance.
3. A patient is admitted to the ER with the following findings: heart rate of 110 (thready upon palpation), 80/62 blood pressue, 25 ml/hr urinary output, and Sodium level of 160. What interventions do you expect the medical doctor to order for this patient?
A. Restrict fluid intake and monitor daily weights B. Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output C. Administer hypotonic IV fluid and administer sodium tablets.
D. No interventions are expected
The answer is B. The patient must be re-hydrated and the sodium levels should be decreased at the same time. So a hypertonic solution of 5% dextrose and 0.45% NA will help do this. The solution is hypertonic because of the 5% Dextrose which will rapidly metabolize to the cells. When the dextrose metabolizes to the cells it leaves behind 0.9% NA which acts as a isotonic solution. This allows the 0.45% NA to act as a hypotonic solution to repair the vascular compartment. After these fluids are infused the patient’s NA level should decrease, BP increase, HR return to normal etc. It is a complicated physiological process because the Dextrose has unique capabilities when it is metabolized….although the solution is labeled as hypertonic it becomes a hypotonic solution when the Dextrose is metabolized by the cells.
4. After obtaining an EKG on a patient you notice that ST depression is present along with an inverted T wave and prominent U wave. What lab value would be the cause of this finding?
A. Magnesium level of 2.2 B. Potassium level of 5.6 C. Potassium level of 2.2
D. Phosphorus level of 2.0
The answer is C. Hypokalemia (normal potassium levels are 3.5 to 5.1) will present with these type of EKG findings.
5. Which patient below would have a potassium level of 5.5?
A. A 76 year old who reports taking Lasix (Furosemide) four times a day B. A patient with Addison’s disease C. A 55 year old woman who have been vomiting for 3 days consistently
D. A patient with liver failure
The answer is B. A patient with Addison disease suffers from increased potassium levels due to adrenal insufficiency. Therefore, potassium levels higher than 5.1 may present in patients with Addison’s disease.
6. You are taking a patient’s blood pressure manually. As you pump up the cuff above the systolic pressure for a few minutes you notice that the patient develop a carpal spasm. Which of the following is true?
A. The patient is having a normal nervous response to an inflating blood pressure cuff that is inflated above the systolic pressure B. This is known as Trousseau’s Sign and is present in patients with HYPERcalcemia C. This is known as Chvostek’s Sign
D. This is known as Trousseau’s Sign and is present in patients with hypocalcemia
The answer is D. The correct answer is “this is known as Trousseau’s Sign and is present in patients with hypocalcemia”. Patient’s with hypokalemia may present with a positive Trousseau’s and Chvostek sign.
7. Which patient is at most risk for hypomagnesemia?
A. A 55 year old chronic alcoholic B. A 57 year old with hyperthyroidism C. A patient reporting overuse of antacids and laxatives
D. A 25 year old suffering from hypoglycemia
The answer is A. The correct answer is a 55 year old who is a chronic alcoholic. Patients who suffer from alcoholism have an increased secretion of magnesium and usually do not eat a proper diet, therefore, they are at risk for lower magnesium levels.
8. In report from a transferring facility you receive information that your patient’s Magnesium level is 1.2. When the patient arrives you are ordered by the doctor to administer Magnesium Sulfate via IV. Which of the following interventions takes priority?
A. Set-up bedside suction B. Set-up IV Atropine at bedside due to the bradycardia effects of Magnesium Sulfate C. Monitor the patient’s for reduced deep tendon reflexes and initiate seizure precautions
D. None of the above are correct
The answer is C. As the nurse administering Magnesium sulfate IV, you must monitor for reduced deep tendon reflexes because the patient could quickly develop hypermagnesemia. In addition, seizure precautions should be initiated due to the patient’s low magnesium level.
9. Which patient is at most risk for fluid volume deficient?
A. A patient who has been vomiting and having diarrhea for 2 days. B. A patient with continuous nasogastric suction. C. A patient with an abdominal wound vac at intermittent suction.
D. All of the above are correct.
The answer is D. All the patients above are at risk for losing too much fluid volume.
10. A patient is admitted with exacerbation of congestive heart failure. What would you expect to find during your admission assessment?
A. Flat neck and hand veins B. Furrowed dry tongue C. Increased blood pressure and crackles throughout the lungs
D. Bradycardia and pitting edema in lower extremities
The answer is C. The correct answer is increased blood pressure and crackles throughout the lungs. Patients with CHF are in fluid volume overload and the heart can not compensate for the extra fluid volume, therefore, the fluid starts to “backup”. You would find an increased blood pressure and crackles in the lungs. You would also see pitting edema in the lower extremities but NOT bradycardia.
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Got it, thanks!- Symptoms
- Causes
- Types
- Diagnosis
- Treatment
- Risk factors
- Prevention
Understanding electrolyte disorders
Electrolytes are elements and compounds that occur naturally in the body. They control important physiologic functions.
Examples of electrolytes include:
- calcium
- chloride
- magnesium
- phosphate
- potassium
- sodium
These substances are present in your blood, bodily fluids, and urine. They’re also ingested with food, drinks, and supplements.
An electrolyte disorder occurs when the levels of electrolytes in your body are either too high or too low. Electrolytes need to be maintained in an even balance for your body to function properly. Otherwise, vital body systems can be affected.
Severe electrolyte imbalances can cause serious problems such as coma, seizures, and cardiac arrest.
Mild forms of electrolyte disorders may not cause any symptoms. Such disorders can go undetected until they’re discovered during a routine blood test. Symptoms usually start to appear once a particular disorder becomes more severe.
Not all electrolyte imbalances cause the same symptoms, but many share similar symptoms.
Common symptoms of an electrolyte disorder include:
Call your doctor right away if you’re experiencing any of these symptoms and suspect you might have an electrolyte disorder. Electrolyte disturbances can become life-threatening if left untreated.
Electrolyte disorders are most often caused by a loss of bodily fluids through prolonged vomiting, diarrhea, or sweating. They may also develop due to fluid loss related to burns.
Certain medications can cause electrolyte disorders as well. In some cases, underlying diseases, such as acute or chronic kidney disease, are to blame.
The exact cause may vary depending on the specific type of electrolyte disorder.
Elevated levels of an electrolyte are indicated with the prefix “hyper-.” Depleted levels of an electrolyte are indicated with “hypo-.”
Conditions caused by electrolyte level imbalances include:
Calcium
Calcium is a vital mineral that your body uses to stabilize blood pressure and control skeletal muscle contraction. It’s also used to build strong bones and teeth.
Hypercalcemia occurs when you have too much calcium in the blood. This is usually caused by:
Hypocalcemia occurs due to a lack of adequate calcium in the bloodstream. Causes can include:
Chloride
Chloride is necessary for maintaining the proper balance of bodily fluids.
Hyperchloremia occurs when there’s too much chloride in the body. It can happen as a result of:
- severe dehydration
- kidney failure
- dialysis
Hypochloremia develops when there’s too little chloride in the body. It’s often caused by sodium or potassium problems.
Other causes can include:
Magnesium
Magnesium is a critical mineral that regulates many important functions, such as:
- muscle contraction
- heart rhythm
- nerve function
Hypermagnesemia means excess amounts of magnesium. This disorder primarily affects people with Addison’s disease and end-stage kidney disease.
Hypomagnesemia means having too little magnesium in the body. Common causes include:
Phosphate
The kidneys, bones, and intestines work to balance phosphate levels in the body. Phosphate is necessary for a wide variety of functions and interacts closely with calcium.
Hyperphosphatemia can occur due to:
- low calcium levels
- chronic kidney disease
- severe breathing difficulties
- underactive parathyroid glands
- severe muscle injury
- tumor lysis syndrome, a complication of cancer treatment
- excessive use of phosphate-containing laxatives
Low levels of phosphate, or hypophosphatemia, can be seen in:
Potassium
Potassium is particularly important for regulating heart function. It also helps maintain healthy nerves and muscles.
Hyperkalemia may develop due to high levels of potassium. This condition can be fatal if left undiagnosed and untreated. It’s typically triggered by:
Hypokalemia occurs when potassium levels are too low. This often happens as a result of:
- eating disorders
- severe vomiting or diarrhea
- dehydration
- certain medications, including laxatives, diuretics, and corticosteroids
Sodium
Sodium is necessary for the body to maintain fluid balance and is critical for normal body function. It also helps to regulate nerve function and muscle contraction.
Hypernatremia occurs when there’s too much sodium in the blood. Abnormally high levels of sodium may be caused by:
- inadequate water consumption
- severe dehydration
- excessive loss of bodily fluids as a result of prolonged vomiting, diarrhea, sweating, or respiratory illness
- certain medications, including corticosteroids
Hyponatremia develops when there’s too little sodium. Common causes of low sodium levels include:
A simple blood test can measure the levels of electrolytes in your body. A blood test that looks at your kidney function is important as well.
Your doctor may want to perform a physical exam or order extra tests to confirm a suspected electrolyte disorder. These additional tests will vary depending on the condition in question.
For example, hypernatremia (too much sodium) can cause loss of elasticity in the skin due to significant dehydration. Your doctor can perform a pinch test to determine whether dehydration is affecting you.
They may also test your reflexes, as both increased and depleted levels of some electrolytes can affect reflexes.
An electrocardiogram (ECG or EKG), an electrical tracing of your heart, may also be useful to check for any irregular heartbeats, rhythms, or ECG or EKG changes brought on by electrolyte problems.
Treatment varies depending on the type of electrolyte disorder and on the underlying condition that’s causing it.
In general, certain treatments are used to restore the proper balance of minerals in the body. These include:
Intravenous (IV) fluids
Intravenous (IV) fluids, typically sodium chloride, can help rehydrate the body. This treatment is commonly used in cases of dehydration resulting from vomiting or diarrhea. Electrolyte supplements can be added to IV fluids to correct deficiencies.
Certain IV medications
IV medications can help your body restore electrolyte balance quickly. They can also protect you from negative effects while you’re being treated by another method.
The medication you receive will depend on the electrolyte disorder you have. Medications that may be administered include calcium gluconate, magnesium chloride, and potassium chloride.
Oral medications and supplements
Oral medications and supplements are often used to correct chronic mineral abnormalities in your body. This is more common in if you’ve been diagnosed with ongoing kidney disease.
Depending on your electrolyte disorder, you may receive medications or supplements such as:
- calcium (gluconate, carbonate, citrate, or lactate
- magnesium oxide
- potassium chloride
- phosphate binders, which include sevelamer hydrochloride (Renagel), lanthanum (Fosrenol), and calcium-based treatments such as calcium carbonate
They can help replace depleted electrolytes on a short- or long-term basis, depending on the underlying cause of your disorder. Once the imbalance has been corrected, your doctor will treat the underlying cause.
Although some of the supplements can be purchased over the counter, most people with electrolyte disorders get a prescription for supplements from their doctor.
Hemodialysis
Hemodialysis is a type of dialysis that uses a machine to remove waste from your blood.
One way to get the blood to flow to this artificial kidney is for your doctor to surgically create a vascular access, or an entrance point, into your blood vessels.
This entrance point will allow a larger amount of blood to flow through your body during hemodialysis treatment. This means more blood can be filtered and purified.
Hemodialysis can be used when an electrolyte disorder is caused by sudden kidney damage and other treatments aren’t working. Your doctor may also decide on hemodialysis treatment if the electrolyte problem has become life-threatening.
Anyone can develop an electrolyte disorder. Certain people are at an increased risk because of their medical history. Conditions that increase your risk for an electrolyte disorder include:
Follow this advice to help prevent electrolyte disorders:
- stay hydrated if you’re experiencing prolonged vomiting, diarrhea, or sweating
- visit your doctor if you’re experiencing common symptoms of an electrolyte disorder
If the electrolyte disorder is caused by medications or underlying conditions, your doctor will adjust your medication and treat the cause. This will help prevent future electrolyte imbalances.
Last medically reviewed on April 29, 2019