Question 1 of 5
Which of the following statements about sodium imbalances are true? Select all that apply.
Hypernatremia may occur with fluid excess or fluid deficit.
Hypernatremia causes muscle inflexibility.
Hypernatremia may result in increased thirst.
Hyponatremia accompanied by fluid excess may result in cell swelling.
Hyponatremia only occurs with fluid excess.
Hypernatremia may occur with fluid excess or fluid deficit.
Hypernatremia may result in increased thirst.
Hyponatremia accompanied by fluid excess may result in cell swelling.
Question 2 of 5
A registered nurse is teaching a student nurse how to analyze the electrocardiogram of a hyperkalemic client. Assess the statements made by the student nurse and choose the clinical manifestation that can be observed on the electrocardiogram of a hyperkalemic client.
"It will show
a flattened T wave."
"It will show a prominent U wave."
"It will show a prolonged PR interval."
"It will show wide QRS complexes."
"It will show inverted P waves."
"It will show wide QRS complexes."
Question 3 of 5
Your client's lab results show that the client's serum calcium level is very elevated. What signs and symptoms would the client exhibit? Select all that apply.
Dizziness
Diarrhea
Muscle
spasms
Muscle weakness
Edema
Muscle weakness
Question 4 of 5
A nurse is providing nutritional advice to a client with hypomagnesemia. Which of the following is a risk factor for hypomagnesemia?
Athletic endurance events
Obesity
Alcoholism
Kidney failure
Alcoholism
Question 5 of 5
Which of the following are incorrectly mismatched? Select all that apply.
Acidosis - false hyperkalemia
Hypokalemia - prolonged PR intervals
Hypocalcemia - hypophosphatemia
Hypovolemic hypernatremia - edema
Hypervolemic hyponatremia - diluted sodium concentration
Hypokalemia - prolonged PR intervals
Hypocalcemia - hypophosphatemia
Hypovolemic hypernatremia - edema
Question 1 of 12
Louise recently had thyroid surgery due to a tumor. You are a nurse working at acute care clinic. She comes in to the office today complaining of tingling around her mouth and fingers and small muscle spasms. She is surprised when you ask if you can tap along her cheekbone. When you do this, you note a slight twitch in her facial muscles.
Louise wonders if any of this could be related to her surgery.
What tissues do you suspect may have been damaged during Louise's surgery?
Parathyroid
glands
Muscles of the jaw
Muscles of the eyes
Nerves affecting the lips
Diaphragm
Parathyroid glands
The parathyroid glands are small structures located near the posterior aspect of the thyroid gland. Surgery of the thyroid gland may inadvertently damage the parathyroid glands.
Question 2 of 12
Recall Louise complained about tingling around her mouth and in her fingers and muscle spasms. Based on Louise's symptoms, what electrolyte imbalance do you suspect?
Hypokalemia
Hyperkalemia
Hypocalcemia
Hyponatremia
Hypocalcemia
The signs and symptoms of hypocalcemia include neuromuscular excitability, which can be demonstrated as paresthesias around the mouth, hands, and feet; muscle spasms of the face, hands, and feet; laryngeal spasm; seizures; and death.
Question 3 of 12
What other electrolyte imbalance may you also suspect?
Hypernatremia
Hyperphosphatemia
Hyperkalemia
Hypernatremia
Hypokalemia
Hyperphosphatemia
is usually accompanied by hypocalcemia, and many of its symptoms are related to low calcium levels.
Question 4 of 12
What is the term for the twitch noted when you tapped along Louise's jaw?
Bell's palsy
Kernig sign
Trousseau's
sign
Chvostek's sign
Trigeminal neuralgia
Chvostek's sign
is elicited by tapping on the patient's face, in front of the ear and below the cheek bone. Facial twitching constitutes a positive sign.
Question 5 of 12
While working in the emergency room, you are called to help a patient named Frank who believes he is having a heart attack. He states that his heart rate "feels different." He states also that his fingers feel as if they are going numb.
The results of a preliminary ECG show wide QRS complexes; tall, peaked T waves; and bradycardia.
Blood analysis reveals metabolic acidosis, with elevated ketones. This is most likely due to Frank having type 1 diabetes. Frank is also being managed for diabetic nephropathy and shows decreased renal function.
What electrolyte abnormality due would account for Frank's ECG results?
Hypernatremia
Hyperkalemia
Hypokalemia
Hypercalcemia
Hypophosphatemia
Hyperkalemia
Early symptoms of hyperkalemia include numbness or tingling of the extremities, muscle cramping, diarrhea, apathy, and mental confusion. The ECG will show wide QRS complexes and tall, peaked T waves. As the potassium level rises, the ECG will show bradycardia, irregular pulse rate and, ultimately, cardiac arrest
Question 6 of 12
How may metabolic acidosis play a role in Frank's condition?
Acidosis causes sodium to shift into cells.
Acidosis causes calcium to shift out of cells.
Acidosis causes potassium to shift out of cells.
Acidosis inhibits calcium transporters.
Acidosis elevates serum sodium.
Acidosis causes potassium to shift out of cells.
Potassium will move from intracellular fluid (ICF) to extracellular fluid (ECF) based on changes in the hydrogen ion (H+) concentration in the bloodstream. During acidosis, extracellular H+ exchanges with intracellular K+. H+ ions enter the cells, while K+ leaves the cells and enters the plasma. The shift in K+ to the plasma appears as hyperkalemia.
Question 7 of 12
How may Frank's renal issues play a role in the electrolyte imbalance?
Increased sodium reabsorption by the kidneys
Decreased potassium excretion by the kidneys
Increased calcium reabsorption by the kidneys
Increased phosphate
excretion by the kidneys
Decreased sodium filtration by the kidneys
Decreased potassium excretion by the kidneys
In acidosis, hydrogen ions enter the cells, causing potassium ions to leave the cells and enter into the plasma. The elevation in plasma potassium concentration can be compounded by poorly functioning kidneys, as the kidneys normally filter excess potassium into the urine.
Question 8 of 12
Leslie, a 42-year-old woman, was admitted into the emergency room after completing 32 of 50 miles in an ultramarathon. The medical team brought her to ER after noticing her movements were uncoordinated and she was confused about her surroundings. They report that she had difficulty speaking. She complained of nausea but denied vomiting. She was clutching her calf muscle as it contracted in a spasm. ECG results were normal. Blood chemistry values showed a key electrolyte imbalance, and treatment began.
After stabilization, she told you that she had been doing "fine" during the race. It had been hotter than she expected, so she had made certain to hydrate and drank a "ton" of water. She did not feel like consuming food or other nutrients during the race.
What electrolyte imbalance do you suspect?
Hyponatremia
Hypercalcemia
Hypokalemia
Hypermagnesemia
Hypophosphatemia
Hyponatremia
One of the concerns with
an event such as an ultramarathon is keeping fluid and electrolyte levels within the normal range. In Leslie's situation, the fact she drank a "ton" of water without significant electrolyte replacement through food, beverages, or tablets, would lead you to be concerned about diluting plasma concentrations of electrolytes, particularly sodium. Her symptoms, such as confusion and muscle cramps, point to hyponatremia.
Question 9 of 12
Which action contributed to this imbalance? Select all that apply.
Increased sweating
Being above age 40
Running over 20 miles
Increased fluid intake
Lack of electrolyte intake
Increased sweating, Increased fluid intake, lack of electrolyte intake
Leslie is experiencing hyponatremia because she was over-hydrating without taking in enough food or nutrients during the race, including sodium, which she was sweating out due to the physical exertion
experienced during the ultramarathon. This resulted in the sodium in Leslie's system diluting to the point that she began to experience dilutional hyponatremia.
Question 10 of 12
John is a 41-year-old sales manager. A routine ECG on John shows a prolonged PR interval and smaller than normal T waves. When he stands up from bed, he complains of dizziness. His medical history indicates that orthostatic hypotension is a concern.
John has been in poor health for some time. He has heart failure and is currently taking digitalis and a diuretic to manage his condition. He admits his diet is poor. He consumes mainly processed, fast foods.
Lately, John states he has been experiencing muscle weakness and feels more tired than usual. He is frequently awakened at night with leg cramps. He also complains of difficulty breathing, especially at night. He states that he needs to prop himself up with two to three pillows.
What electrolyte imbalance do you suspect?
Hypernatremia
Hypocalcemia
Hyponatremia
Hypomagnesemia
Hypokalemia
Hypokalemia
The two keys pointing to hypokalemia in this case are the abnormalities observed with electrocardiography and the usage of diuretics.
Hypokalemia alters the resting membrane potential of cells, causing hyperpolarization. Flattened, smaller T waves appear on ECG's as repolarization is delayed.
Hypokalemia may develop with the use of diuretics. For some diuretics, the mechanism of action is a reduction in ion reabsorption, which also reduces water reabsorption, increasing urine output.
John's symptoms, such as leg cramps, provide further support that hypokalemia may be present.
Question 11 of 12
Which factors may contribute to this imbalance? Select all that apply.
Being male
Digitalis usage
Age
Diet, perhaps lacking in
nutrients
Diuretic usage
Diet, perhaps lacking in nutrients
Diuretic usage
Diuretic therapy is the most common cause of hypokalemia; it is present in 20% to 50% of patients on nonpotassium-sparing diuretics. Thiazide and loop diuretics increase the loss of potassium ions in the urine. Inadequate potassium intake can also be a frequent cause of hypokalemia. Patients who are NPO, alcoholic, who have undergone bariatric surgery, and who suffer eating disorders are at greatest risk, but it can also be due to a poor nutritional diet.
Question 12 of 12
Select the signs and symptoms that are associated with this electrolyte imbalance. Select all that apply.
Leg cramps
Dyspnea
Prolonged PR interval
Flattened T waves
Orthostatic hypotension
Leg cramps
Prolonged PR interval
Flattened T waves
The major signs and symptoms of hypokalemia include anorexia, nausea, vomiting, sluggish bowel, cardiac arrhythmias, postural hypotension, muscle fatigue, and weakness. Leg cramps are common and, in severe hypokalemia, respiratory muscles can be weakened. On ECG, there is a prolonged PR interval, flattened T wave, and prominent U wave.
Question 1 of 5
Reduced sodium concentration accompanied by fluid deficit is also known as:
hypervolemic
hypernatremia.
hypervolemic hyponatremia.
hypovolemic hypernatremia.
hypovolemic hyponatremia.
hypernatremia.
hypovolemic hyponatremia.
Question 2 of 5
What condition may result in "false hyperkalemia"?
hypernatremia
acidosis
hypermagnesemia
alkalosis
hypercalcemia
acidosis
Question 3 of 5
One sign associated with hypokalemia is __________________.
dark-colored urine
edema
prolonged PR interval on electrocardiogram.
weight gain
elevated blood pressure
prolonged PR interval on electrocardiogram.
Question 4 of 5
Hypercalcemia is often associated with _______________.
Hyperphosphatemia
Hyponatremia
Hypophosphatemia
Hypernatremia
Hypokalemia
Hypophosphatemia
Question 5 of 5
Fluid volume excess may cause which of the following signs? Select all that apply.
Thirst
Edema
Dark-colored urine
Crackles in the lungs
Weight loss
Edema
Crackles in the lung
Symptoms of Fluid volume deficit
Dark urine
depressed
fontanelles (infant)
dry mucous membranes
low urine output
orthostatic hypotension
poor skin turgor
thirst
weight loss
Symptoms of fluid volume excess
ascites
crackles in lung
dyspnes caused by pulmonary fluid accumulation
edema, ankle or sacral
weight gain (2lbs= 1l of fluid)
Normal ranges of Electrolytes
Sodium
Potassium
Calcium
Phosphorus
Magnesium
Sodium- 153-145 mEq/L
Potassium- 3.5-5 mEq/L
Calcium- 8.7-10mg/dL
Phosphorus- 2.5-4.5 mg/dL
Magnesium- 1.5-2.5mEq/L