Question 1

A client has been admitted with hypokalemia but all treatments have failed to raise the potassium level suitably. The nurse would assess the client further and report findings of

Accepted Answer

A)   chronic insomnia.
B)   estrogen use.
C)   laxative abuse.
D)   recent leg fracture. C

Question 2

When giving IV potassium, the nurse takes the precaution of

Accepted Answer

A)   agitating the bag to prevent bolus administration.
B)   ensuring potassium dilution with glucose solution.
C)   leaving the IV cannula inserted as long as possible.
D)   using a large cannula for infusion. A

Question 3

A client has a low serum calcium level. During a bath the nurse cleans the client's face with a cloth, and the lips, nose, and side of the face contract. The nurse documents the presence of

Accepted Answer

A)   Bell's palsy.
B)   Chvostek's sign.
C)   tic douloureux.
D)   Trousseau's sign. B

Question 4

A client who is scheduled for surgery the following day has preoperative electrolyte levels drawn. The nurse would notify the surgeon's office to report

Accepted Answer

A)   a calcium level of 9.6 mg/dl.
B)   a chloride level of 101 mEq/L.
C)   a potassium level of 3.5 mEq/L.
D)   a sodium level of 132 mEq/L.

Question 5

A client has end-stage renal disease and is going to start dialysis this week. The nurse is aware the client is at most risk for which electrolyte imbalance?

Accepted Answer

A)   Hypocalcemia
B)   Hypophosphatemia
C)   Hyperkalemia
D)   Hypermagnesemia

Question 6

A client is being discharged from the hospital and will be taking oral potassium chloride. The nurse should teach the client to take this medication

Accepted Answer

A)   at bedtime.
B)   between meals.
C)   on an empty stomach.
D)   with a glass of juice.

Question 7

The nurse preparing IV calcium chloride for a client with hypocalcemia should administer the drug in

Accepted Answer

A)   0.9% normal saline using a 22-gauge IV catheter.
B)   3% normal saline using an 18-gauge IV catheter.
C)   5% dextrose in water using a 23-gauge IV catheter.
D)   Ringer's solution using a 20-gauge IV catheter.

Question 8

An elderly client is transported to the emergency department from a local nursing home with a serum calcium level of 3.9 mEq/L. The client's family is upset and says "This is the second time this has happened since she got admitted to that home!" The best answer by the nurse is

Accepted Answer

A)   "I can call a social worker to see if she can go to another home if you like."
B)   "It might be related to not getting enough sun; I'll call the home and ask about it."
C)   "Yes, people in nursing homes often start having illnesses after they are admitted."
D)   "You will just have to have them increase her calcium supplements."

Question 9

A client has been admitted in a hypercalcemic crisis and the family is distraught. One family member grabs the nurse's hand and states "I just don't know what I'll do if he/she dies!" The best response by the nurse is

Accepted Answer

A)   "Don't worry. We see this and treat it all the time in clients just like this."
B)   "I know that you are upset, but I have to take care of the client first."
C)   "What has your loved one been eating and drinking during the last week?"
D)   "Yes, this is serious but I can come back and answer some questions for you."

Question 10

Physical assessment of a client with cardiac dysrhythmia reveals hypoactive bowel sounds, muscle weakness, dizziness, postural hypotension, shallow respirations, increased fatigue, and decreased tendon reflexes. The laboratory result consistent with these findings is

Accepted Answer

A)   serum calcium level of 4.3 mEq/L.
B)   serum magnesium level of 1.3 mEq/L.
C)   serum phosphorus level of 1.1 mEq/L.
D)   serum potassium level of 3.0 mEq/L.

Question 11

Self-care teaching for a client with hypercalcemia should include

Accepted Answer

A)   administering antidiarrheal medications.
B)   decreasing sodium and calcium intake.
C)   encouraging foods that increase urine acidity.
D)   restricting fluid intake to less than 1 liter a day.

Question 12

The factor in the client's history that the nurse assesses as a risk for the development of hypermagnesemia is

Accepted Answer

A)   Addison's disease.
B)   gastrointestinal disease.
C)   vomiting.
D)   water intoxication.

Question 13

The nurse caring for a client taking thiazide diuretics should be sure to observe for

Accepted Answer

A)   decreased urine output.
B)   increased peristalsis.
C)   neurologic depression.
D)   neuromuscular irritability.

Question 14

A client is hypokalemic and the physician leaves an order for the nurse to infuse a bolus of 30 mEq of potassium in 100 ml of NS over 30 minutes. The most appropriate action by the nurse is to

Accepted Answer

A)   administer the potassium as ordered.
B)   clarify the order with the physician.
C)   order an infusion pump to give the potassium.
D)   request the pharmacy send 250 ml of saline instead.

Question 15

A nurse notes that a client has a "stat" order for sodium polystyrene sulfonate (Kayexalate). The nurse quickly checks serum laboratory results, anticipating

Accepted Answer

A)   hyperkalemia.
B)   hyperphosphatemia.
C)   hypokalemia.
D)   hypophosphatemia.

Question 16

The nurse reviewing a client's serum electrolytes notes a phosphorus level of 1.0 mEq/L. The nurse will assess the client for a history of

Accepted Answer

A)   chronic respiratory acidosis.
B)   malnutrition.
C)   morbid obesity.
D)   recent thyroidectomy.

Question 17

A client has hypercalcemia and is admitted for a work-up. During the diagnostic period, which nursing intervention(s) would be most important to add to the care plan? (Select all that apply.)

Accepted Answer

A)   Encourage weight-bearing activities.
B)   Institute safety precautions.
C)   Instruct client to report nightmares.
D)   Place client on fluid restriction.
E)   Turn and position client carefully.

Question 18

The nurse is instructing a client to eat foods that are high in potassium, such as (Select all that apply)

Accepted Answer

A)   bananas.
B)   broccoli.
C)   cantaloupe.
D)   corn.
E)   cranberry juice.F)  lima beans.

Question 19

A client has a magnesium deficit in addition to congestive heart failure (CHF). The most appropriate nursing diagnosis is

Accepted Answer

A)   Altered Comfort.
B)   High Risk for Injury.
C)   Impaired Skin Integrity.
D)   Risk for Decreased Cardiac Output.

Question 20

A client is being discharged after successful treatment for hyperphosphatemia. The nurse would know that diet teaching has been effective when the client says, "I can't eat large amounts of

Accepted Answer

A)   bananas."
B)   dairy products."
C)   fatty foods."
D)   green leafy vegetables."

Exam 12: Clients with Electrolyte Imbalances