ATI RN
Fluid and Electrolytes ATI
1. The healthcare provider is evaluating a patient's laboratory results. Based on the laboratory findings, what results will cause the release of an antidiuretic hormone (ADH)?
- A. Increased serum sodium
- B. Decreased serum sodium
- C. Decrease in serum osmolality
- D. Decrease in thirst
Correct answer: A
Rationale: The correct answer is A: Increased serum sodium. When serum sodium levels increase, it triggers the release of ADH by the posterior pituitary gland. ADH helps in retaining water, reducing urine output, and maintaining fluid balance. Choices B, C, and D are incorrect because decreased serum sodium, decrease in serum osmolality, and decrease in thirst do not stimulate the release of ADH.
2. A nurse admitting a patient with a history of emphysema reviews her past lab reports and notes that the patient's PaCO2 has been 56 to 64 mmHg. The nurse will be cautious administering oxygen because:
- A. The patient's calcium will rise dramatically due to pituitary stimulation.
- B. The oxygen will increase the patient's intracranial pressure and create confusion.
- C. The oxygen may cause the patient to hyperventilate and become acidotic.
- D. Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.
Correct answer: D
Rationale: When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla, and the use of oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia. Choice A is incorrect because administering oxygen does not lead to a dramatic rise in calcium due to pituitary stimulation. Choice B is incorrect because administering oxygen does not directly increase intracranial pressure or create confusion. Choice C is incorrect because administering oxygen to a patient with emphysema and high PaCO2 levels is more likely to cause respiratory depression than hyperventilation and acidosis.
3. A patient who is in renal failure partially loses the ability to regulate changes in pH because the kidneys:
- A. Regulate and reabsorb carbonic acid to change and maintain pH
- B. Buffer acids through electrolyte changes
- C. Regenerate and reabsorb bicarbonate to maintain a stable pH
- D. Combine carbonic acid and bicarbonate to maintain a stable pH
Correct answer: C
Rationale: The correct answer is C. In renal failure, the kidneys lose the ability to regulate pH by controlling bicarbonate levels in the extracellular fluid (ECF). The kidneys can regenerate and reabsorb bicarbonate ions to maintain a stable pH. Choices A, B, and D are incorrect because the kidneys do not primarily regulate or reabsorb carbonic acid, buffer acids through electrolyte changes, or combine carbonic acid and bicarbonate to maintain pH. The key function of the kidneys in maintaining pH balance lies in the control of bicarbonate levels.
4. What electrolyte value should be monitored when a patient is receiving a loop diuretic?
- A. Calcium levels
- B. Phosphorus levels
- C. Potassium levels
- D. Magnesium levels
Correct answer: C
Rationale: When a patient is receiving a loop diuretic like furosemide (Lasix), potassium levels should be monitored closely. Loop diuretics act on the ascending loop of Henle to inhibit the reabsorption of sodium and water, leading to potassium loss. Monitoring potassium levels is crucial to prevent hypokalemia, which can result in serious complications such as cardiac arrhythmias. Calcium levels (Choice A), phosphorus levels (Choice B), and magnesium levels (Choice D) are not typically affected directly by loop diuretics and do not require routine monitoring in this context.
5. The nurse is caring for a postthyroidectomy patient at risk for hypocalcemia. What action should the nurse take when assessing for hypocalcemia?
- A. Monitor laboratory values daily for an elevated thyroid-stimulating hormone.
- B. Observe for swelling of the neck, tracheal deviation, and severe pain.
- C. Evaluate the quality of the patient's voice postoperatively, noting any drastic changes.
- D. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
Correct answer: D
Rationale: Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications the nurse should also be observing for; however, tetany and neurologic alterations are primary indications of hypocalcemia. Monitoring for an elevated thyroid-stimulating hormone (choice A) is not relevant in assessing for hypocalcemia. Observing for swelling of the neck, tracheal deviation, and severe pain (choice B) are more related to airway compromise. Evaluating the quality of the patient's voice postoperatively (choice C) is important but not a primary sign of hypocalcemia.
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