NR 324 Final Exam with verified Questions and Answers
Guaranteed Pass A Graded
Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances
1. What are possible causes of hypervolemia?
● Excessive isotonic or hypotonic IV fluids
● Heart failure
● Renal failure
● Primary polydipsia
● SIADH ( syndrome of inappropriate antidiuretic hormone secretion)
● Cushing Syndrome
● Long-term use of corticosteroids
2. What are the clinical manifestations of hypervolemia?
o Elevated BP
o Bounding pulse
o Peripheral edema
o Dyspnea, crackles, pulmonary edema
o Jugular vein distention
o Headache, confusion, lethargy
3. What are remarks that a patient might say if they are experiencing fluid volume overload?
A patient experiencing fluid volume overload might complain of:
● Shortness of breath, especially when lying down (orthopnea)
● Feeling like they can’t catch their breath
● Swelling, especially in the lower extremities
● Headache
, 4. What are the vital signs changes you’ll see with hypervolemia?
o Elevated BP
o Bounding pulse
5. What are specific nursing assessments to assess for hypervolemia?
o Lung sounds- crackles will be heard if in fluid overload
o Skin assessment- especially in the lower extremities for edema
o I&O
o Daily weights
o Vital signs
o Neurologic assessment- ECF excess may result in cerebral edema
6. What is the treatment for these patients?
Stop IV fluid infusions, fluid and sodium restrictions, diuretics
o What are the different types of diuretics?
Loop diuretics (furosemide)
Thiazide diuretics
Potassium sparing diuretics (Spironolactone)
o How would you educate your patient with each type?
All:
● Frequent laboratory tests may be indicated at the beginning of and during therapy with diuretics. These tests
may include measurement of electrolytes, uric acid, and blood gases.
● Encourage patients to change positions slowly and to rise slowly after sitting or lying to prevent dizziness and
possible fainting (syncope).
● Forcing of fluids may be needed (if not contraindicated) to prevent dehydration and minimize constipation.
Increased consumption of fiber may also help with constipation.
Loop Diuretics:
● Educate the patient about the signs and symptoms of hypokalemia, such as anorexia, nausea, lethargy, muscle
weakness, mental confusion, and hypotension. In addition, emphasize the importance of being cautious with hot
climates, excessive sweating, fever, and the use of saunas or hot tubs. Heat raises core body temperature and
causes further loss of potassium, sodium, and water through sweat, which may increase the risk for more
problems with hypotension and fluid-electrolyte imbalances. Fluid volume and electrolyte loss may also occur
with vomiting and diarrhea.
● Educate patients with diabetes who are also taking thiazide and/or loop diuretics about the need for close
monitoring of blood glucose levels.
● Patients taking diuretics need to maintain proper nutritional intake and fluid volume and eat potassium-rich
foods, except when contraindicated or when potassium-sparing diuretics are used. Foods high in potassium
include bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat
bread, and legumes.
● Potassium supplementation may be recommended by a prescriber, depending on the symptoms the patient
presents and the serum levels. Normal serum potassium levels are 3.5 to 5 mEq/L.
7. What are possible causes of hypovolemia?
o Increased insensible water loss (high fever, heatstroke)
o Diabetes insipidus
, o Osmotic diuresis
o Hemorrhage
o GI losses: vomiting, NG suction, diarrhea, fistula drainage
o Overuse of diuretics
o Inadequate fluid intake
o Third-space fluid shifts: burns, intestinal obstruction
8. What are the clinical manifestations of hypovolemia?
· Restlessness, lethargy, drowsiness, confusion
· Thirst, dry mucous membranes
· Decreased skin turgor and decreased capillary refill
· Postural hypotension, increased pulse, decreased central venous pressure (BP)
· Decreased urine output, concentrated urine
· Increased respiratory rate
· Weakness, dizziness
· Weight loss
· Seizures, coma
9. What are remarks that a patient might say if they are experiencing dehydration?
· I am thirsty
· I am dizzy
· I am cold and clammy
· My heart is pounding
· I feel weak
· I am tired
10. What are the vital signs changes you’ll see with hypervolemia?
· HR: Increased heart rate
· BP: decreased blood pressure
· Pulses: weak thready pulses
· Temp: decreased body temperature
· O2: decreased O2 sats
· RR: increased respiratory rate
11. What are specific nursing assessments to assess for hypovolemia?
· I&Os
· daily weights
· mucous membranes for dryness
· skin turgor (tenting)
Guaranteed Pass A Graded
Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances
1. What are possible causes of hypervolemia?
● Excessive isotonic or hypotonic IV fluids
● Heart failure
● Renal failure
● Primary polydipsia
● SIADH ( syndrome of inappropriate antidiuretic hormone secretion)
● Cushing Syndrome
● Long-term use of corticosteroids
2. What are the clinical manifestations of hypervolemia?
o Elevated BP
o Bounding pulse
o Peripheral edema
o Dyspnea, crackles, pulmonary edema
o Jugular vein distention
o Headache, confusion, lethargy
3. What are remarks that a patient might say if they are experiencing fluid volume overload?
A patient experiencing fluid volume overload might complain of:
● Shortness of breath, especially when lying down (orthopnea)
● Feeling like they can’t catch their breath
● Swelling, especially in the lower extremities
● Headache
, 4. What are the vital signs changes you’ll see with hypervolemia?
o Elevated BP
o Bounding pulse
5. What are specific nursing assessments to assess for hypervolemia?
o Lung sounds- crackles will be heard if in fluid overload
o Skin assessment- especially in the lower extremities for edema
o I&O
o Daily weights
o Vital signs
o Neurologic assessment- ECF excess may result in cerebral edema
6. What is the treatment for these patients?
Stop IV fluid infusions, fluid and sodium restrictions, diuretics
o What are the different types of diuretics?
Loop diuretics (furosemide)
Thiazide diuretics
Potassium sparing diuretics (Spironolactone)
o How would you educate your patient with each type?
All:
● Frequent laboratory tests may be indicated at the beginning of and during therapy with diuretics. These tests
may include measurement of electrolytes, uric acid, and blood gases.
● Encourage patients to change positions slowly and to rise slowly after sitting or lying to prevent dizziness and
possible fainting (syncope).
● Forcing of fluids may be needed (if not contraindicated) to prevent dehydration and minimize constipation.
Increased consumption of fiber may also help with constipation.
Loop Diuretics:
● Educate the patient about the signs and symptoms of hypokalemia, such as anorexia, nausea, lethargy, muscle
weakness, mental confusion, and hypotension. In addition, emphasize the importance of being cautious with hot
climates, excessive sweating, fever, and the use of saunas or hot tubs. Heat raises core body temperature and
causes further loss of potassium, sodium, and water through sweat, which may increase the risk for more
problems with hypotension and fluid-electrolyte imbalances. Fluid volume and electrolyte loss may also occur
with vomiting and diarrhea.
● Educate patients with diabetes who are also taking thiazide and/or loop diuretics about the need for close
monitoring of blood glucose levels.
● Patients taking diuretics need to maintain proper nutritional intake and fluid volume and eat potassium-rich
foods, except when contraindicated or when potassium-sparing diuretics are used. Foods high in potassium
include bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat
bread, and legumes.
● Potassium supplementation may be recommended by a prescriber, depending on the symptoms the patient
presents and the serum levels. Normal serum potassium levels are 3.5 to 5 mEq/L.
7. What are possible causes of hypovolemia?
o Increased insensible water loss (high fever, heatstroke)
o Diabetes insipidus
, o Osmotic diuresis
o Hemorrhage
o GI losses: vomiting, NG suction, diarrhea, fistula drainage
o Overuse of diuretics
o Inadequate fluid intake
o Third-space fluid shifts: burns, intestinal obstruction
8. What are the clinical manifestations of hypovolemia?
· Restlessness, lethargy, drowsiness, confusion
· Thirst, dry mucous membranes
· Decreased skin turgor and decreased capillary refill
· Postural hypotension, increased pulse, decreased central venous pressure (BP)
· Decreased urine output, concentrated urine
· Increased respiratory rate
· Weakness, dizziness
· Weight loss
· Seizures, coma
9. What are remarks that a patient might say if they are experiencing dehydration?
· I am thirsty
· I am dizzy
· I am cold and clammy
· My heart is pounding
· I feel weak
· I am tired
10. What are the vital signs changes you’ll see with hypervolemia?
· HR: Increased heart rate
· BP: decreased blood pressure
· Pulses: weak thready pulses
· Temp: decreased body temperature
· O2: decreased O2 sats
· RR: increased respiratory rate
11. What are specific nursing assessments to assess for hypovolemia?
· I&Os
· daily weights
· mucous membranes for dryness
· skin turgor (tenting)
