you are called to your patients room by a family member who voices concern about the patients status on assessment you find the patient tachypnic leth
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Nursing Elites

ATI RN

ATI Fluid Electrolyte and Acid-Base Regulation

1. You are called to your patients room by a family member who voices concern about the patients status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patients signs and symptoms?

Correct answer: C

Rationale:

2. A nurse is assessing a client who has an electrolyte imbalance related to renal failure. For which potential complications of this electrolyte imbalance should the nurse assess? (Select all that do mot apply.)

Correct answer: B

Rationale:

3. Your patient has alcoholism, and you may suspect during your assessment that his serum magnesium is low. What will the nurse potentially expect to assess related to hypomagnesemia?

Correct answer: A

Rationale: The correct answer is A: Tremor. Signs and symptoms of hypomagnesemia primarily affect the neuromuscular system and can include tremors, confusion, tetany, laryngeal stridor, and ataxia. Pruritus (choice B) refers to itching and is not typically associated with hypomagnesemia. Edema (choice C) is swelling caused by fluid retention and is not a common manifestation of hypomagnesemia. Decreased blood pressure (choice D) is not a typical sign of hypomagnesemia; instead, low magnesium levels are more likely to cause hypertension.

4. The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance does a positive Chvostek's sign indicate?

Correct answer: C

Rationale: Chvostek's sign is characterized by a brief contraction of the upper lip, nose, or side of the face and is indicative of hypocalcemia, making choice C the correct answer. Hypomagnesemia (choice B) is associated with Trousseau's sign, not Chvostek's sign. Hypermagnesemia (choice A) is not related to Chvostek's sign. Hyperkalemia (choice D) is not typically associated with Chvostek's sign; instead, it may present with muscle weakness and cardiac arrhythmias.

5. Where is the largest volume of water in the body located?

Correct answer: B

Rationale: The correct answer is B. The largest volume of water in the body is found inside the cells, known as intracellular fluid. This fluid makes up the majority of the body's total water content. Choices A, C, and D are incorrect because while plasma, interstitial fluid, and lymph are important components of the body's fluid compartments, they do not contain the largest volume of water in the body.

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