ATI RN
Fluid and Electrolytes ATI
1. A patient admitted with a gastrointestinal bleed and anemia is receiving a blood transfusion. Based on the patient's hypotensive blood pressure, the nurse anticipates an order for IV fluids from the physician. Which of the following IV solutions may be administered with blood products?
- A. D5 and 0.45% Normal Saline
- B. Lactated Ringer's
- C. 5% dextrose in water
- D. 0.9% NaCl
Correct answer: D
Rationale: The correct answer is D: 0.9% NaCl. The only IV solution that can be administered with blood products is normal saline (0.9% NaCl). This solution is compatible with most blood products and is commonly used during transfusions to maintain hemodynamic stability. Choices A, B, and C are incorrect. Choice A, D5 and 0.45% Normal Saline, contains dextrose and is not recommended to be given simultaneously with blood products. Choice B, Lactated Ringer's, contains calcium, which can cause coagulation and should not be mixed with blood. Choice C, 5% dextrose in water, is hypotonic and not suitable to be administered with blood products.
2. 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.
3. A nurse is taking care of a 65-year-old female patient in a medical-surgical unit who is in renal failure; during the assessment, the patient complains of tingling in her lips and fingers. When the nurse takes her blood pressure, she has a spasm in her wrist and hand. The nurse suspects:
- A. Hypophosphatemia
- B. Hypocalcemia
- C. Hypermagnesemia
- D. Hyperkalemia
Correct answer: B
Rationale: The patient's symptoms of tingling in the lips and fingers along with the wrist and hand spasm are indicative of tetany, a characteristic manifestation of hypocalcemia. Hypocalcemia and hypomagnesemia can present with sensations of tingling in the extremities and around the mouth. The spasm in the wrist and hand when taking blood pressure could be due to slight ischemia of the ulnar nerve, further supporting the suspicion of hypocalcemia in this patient. Hypophosphatemia, hypermagnesemia, and hyperkalemia do not typically present with these specific symptoms and manifestations.
4. The nurse is caring for a patient who is diaphoretic from a fever. The amount of sodium excreted in the urine will:
- A. Decrease
- B. Increase
- C. Remain unchanged
- D. Fluctuate
Correct answer: A
Rationale: Increased sweating (diaphoresis) causes the loss of sodium and other electrolytes from the body. As a result, the body tries to conserve sodium, leading to a decrease in the amount of sodium excreted in the urine. Choice B is incorrect because increased sweating results in sodium loss, not retention. Choice C is incorrect because with increased sweating, there is a need to conserve sodium, leading to a decrease in its excretion. Choice D is incorrect as there is a clear physiological response to sweating that results in a more consistent decrease in sodium excretion.
5. When preparing a site for the insertion of an IV catheter, how should excess hair at the site be treated?
- A. Leaving the hair intact
- B. Shaving the area
- C. Clipping the hair in the area
- D. Removing the hair with a depilatory
Correct answer: C
Rationale: The correct answer is to clip the hair in the area. Excess hair at the site of IV catheter insertion should be removed because it can be a potential source of infection. Clipping the hair is preferred over shaving because shaving can cause skin abrasions, increasing the risk of infection. Using depilatories is not recommended as they can irritate the skin, which is undesirable when preparing a clean site for an invasive procedure. Therefore, clipping the hair in the area is the most appropriate and safe method to prepare the site for IV catheter insertion.
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