Nokea
As a nurse, you are administering intravenous fluids to a client. Which of the following types of IV fluids would be classified as isotonic? Select all that apply.
- A. Normal saline
- B. 1/2 Normal saline
- C. Lactated ringers
- D. D10W
- E. 3% NaCl
Correct Answer: A,C
Rationale: Normal saline and lactated ringers are isotonic, matching plasma osmolality, unlike hypotonic (1/2 NS) or hypertonic (D10W, 3% NaCl) fluids.
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The nurse is reviewing the client's laboratory data. Which current prescription should the nurse clarify with the primary healthcare provider (PHCP)?
- A. Dextrose 5% in water (D5W)
- B. dexamethasone
- C. digoxin
- D. ergocalciferol
Correct Answer: A
Rationale: D5W is hypotonic and may worsen hyponatremia, requiring clarification in a client with low sodium levels.
The following scenario applies to the next 1 items
The nurse is reviewing the medical record of a 55-year-old male client.
Item 1 of 1
History and Physical
0818: Client reports severe shortness of breath and swelling in his lower extremities. He reports a 3-day history of fatigue and decreased urine output. During the assessment, the client was alert and fully oriented. He has 2+ pitting pedal edema in the lower extremities. 2+ peripheral pulses in the upper extremities. Bibasilar crackles upon auscultation. Skin is warm, dry, and normal for ethnicity. Normoactive bowel sounds in all quadrants. Vital signs: T 98° F (36.7°C), P 89, RR 18, BP 164/95, pulse oximetry reading 96% on room air.
Laboratory Results
• Capillary blood glucose 121 mg/dL (6.72 mmol/L) [70-110 mg/dL (4-6 mmol/L)]
• Serum creatinine 2.5 mg/dL (221 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Serum BUN 36 mg/dL (12.9 mmol/L) ([10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum potassium: 5.2 mEq/L [3.5–5 mEq/L (3.5–5 mmol/L)]
• Urinalysis: Mild proteinuria, no hematuria
Intake and Output
24 hour fluid intake: 1560 mL
24 hour fluid output: 250 mL
Medical History
• hypertension
• hyperlipidemia
• coronary artery disease
• glaucoma
• diabetes mellitus (type two)
Current Medications
• carvedilol 6.25 mg p.o. daily
• multivitamin 1 tablet p.o. daily
• lisinopril 10 mg p.o. daily
• simvastatin 10 mg p.o. daily
• ergocalciferol 10000 units p.o. daily
• ethyl eicosapentaenoic acid 2 grams p.o. daily
The nurse is reviewing the client's assessment data to prepare the client's care plan. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress.
- A. Prepare the client for peritoneal dialysis, Request a prescription for sodium chloride (normal saline) 500 mL bolus, Obtain an order to discontinue the lisinopril, Obtain a prescription for a continuous infusion of regular insulin, Request a prescription for a diuretic.
- B. Nephrotic syndrome, Hyperglycemia hyperosmolar syndrome, Acute kidney injury, Chronic kidney disease.
- C. Peripheral pulses, Capillary blood glucose, Serum potassium, Temperature, Lung sounds.
Correct Answer: B: Acute kidney injury, A: Request a prescription for a diuretic, C: Obtain an order to discontinue the lisinopril, D: Serum potassium, E: Lung sounds.
Rationale: Elevated creatinine, BUN, and oliguria suggest AKI. Diuretics address fluid overload, discontinuing lisinopril prevents further renal stress, and monitoring potassium and lung sounds assesses progress.
The nurse is caring for a client who prescribed a 40 mEq potassium chloride capsule for hypokalemia. The client reports difficulty swallowing capsules. Which action should the nurse take when administering this medication?
- A. Sprinkle the contents of the capsule onto a spoonful of soft food.
- B. Have the client chew the capsule prior to swallowing.
- C. Sprinkle the contents of the capsule into a cup of warm water.
- D. Put the capsule under the client's tongue and have it dissolve.
Correct Answer: A
Rationale: Potassium chloride capsules can be opened and the contents sprinkled onto a small amount of soft food, such as applesauce, to aid swallowing. Chewing the capsule (B) could cause irritation or release the medication too quickly. Dissolving in warm water (C) is not recommended as it may affect the medication's stability. Sublingual administration (D) is not appropriate for potassium chloride.
A client with chronic kidney disease (CKD) is receiving hemodialysis treatment. Which of the following nursing interventions should be implemented for this client? Select all that apply.
- A. Monitor the client's blood pressure before, during, and after hemodialysis.
- B. Administer erythropoietin (EPO) as prescribed to stimulate red blood cell production.
- C. Restrict protein intake to minimize uremic symptoms.
- D. Assess the client's access site for signs of infection or thrombosis.
- E. Administer phosphate binders as prescribed to control serum phosphate levels.
- F. Encourage the client to consume a high-potassium diet to prevent electrolyte imbalances.
Correct Answer: A,B,D,E
Rationale: Monitoring BP, administering EPO, assessing the access site, and giving phosphate binders are standard CKD hemodialysis interventions. High-potassium diets are avoided.
The nurse is administering IV magnesium to a client with a magnesium level of 1.5 mEq/L (0.62 mmol/L) [1.5-2.5 mEq/L, 0.6-1.2 mmol/L]. You check on them halfway through the infusion, and they report that their face feels flushed. What is the priority nursing intervention?
- A. Slow down the infusion rate.
- B. Notify the primary healthcare provider (PHCP).
- C. Reassess the client when the infusion finishes.
- D. Stop the infusion.
Correct Answer: A
Rationale: Flushing is a common side effect of IV magnesium infusion and can often be managed by slowing the infusion rate to reduce symptoms. Stopping the infusion (D) or notifying the PHCP (B) is not necessary unless symptoms worsen. Reassessing later (C) delays intervention.