1.

Which of the following potassium levels would be of greatest concern to the nurse when seen in a client who is taking furosemide (Lasix)? A. 5.4 mEq/L B. 4.3 mEq/L C. 3.4 mEq/L D. 3.1 mEq/L 2. Which of the following statements should be the nurse include when teaching a client about oral potassium supplementation? A. When you take your potassium pill, if you cant swallow it, you can crush it up and put it in orange juice. B. Potassium should be only be taken in the morning on an empty stomach. C. Take your potassium tablet after you have eaten breakfast. D. You can continue to use salt substitute while you are taking your potassium supplement. 3. The nurse anticipates which of the following clients would be most at risk to develop hyperkalemia? The client: A. B. C. D. 4. The nurse should place highest priority on which of the following nursing interventions for a client with renal failure who has a potassium level of 6.8 mEq/L? A. Obtain an electrocardiogram (ECG) B. Evaluate level of consciousness. C. With intestinal and nasogastric suctioning D. Who has had diarrhea for the last four days. 5. The nurse anticipates using which of the following as the most effective route to administer sodium polystyrene sulfonate (Kayexalate) ordered for a client who has a serum potassium level of 6.0 mEq/L? A. Intravenous B. Rectal C. Oral D. Subcutaneous

6. When caring for a client who has a potassium level of 2.8 mEq/L, the nurse should assess for which of the following? A. Perforated bowel. B. Paralytic Ileus. C. Renal Failure D. Diabetes Mellitus 7. The nurse determines the intravenous (IV) administration of calcium gluconate to a client with hyperkalemia has been effective when which finding is seen on assessment? A. Urine output increases. B. Bowel movements are loose. C. Cardiac dysrhythmia is corrected. D. Bowel sounds become less hyperactive. 8. Which of the following statements by a client indicates a need for further instruction regarding treatment for hypokalemia? A.I will eat more bananas and cantaloupes for breakfast. B.I will eat more bran flakes to increase my potassium level. C.I will take my potassium in the morning after breakfast so it doesnt upset my stomach. D.I will tell my doctor if I start having any of the symptoms on the list you gave me. 9. Which of the following is the best response by the nurse to the 22 year old daughter of a 46 year-old client who was admitted with hypokalemia and is complaining of being dizzy upon standing? A.Your mother has just stayed in bed too long and when she stands up she will get dizzy. B.The level of your mothers potassium is making her dizzy. C.Your mother is probably dizzy because her heart is not pumping as effectively, making her blood pressure low. D.Your mother is dizzy because her nervous system isnt functioning correctly; once her potassium level goes up she will improve.

10.. A client with a potassium level of 5.5 mEq/L is to receive sodium polystyrene sulfonate
(Kayexalate) orally. After administering the drug, the priority nursing action is to monitor A.urine output. B.blood pressure. C.bowel movements. D.ECG for tall, peaked T waves.

13. A client is receiving intravenous potassium supplementation in addition to maintenance fluids. The urine output has been 120 ml every 8 hours for the past 16 hours and the next dose is due. Before administering the next potassium dose, which of the following is the priority nursing action? A.Encourage the client to increase fluid intake B.Administer the dose as ordered C.Draw a potassium level and administer the dose if the level is low or normal D.Notify the physician of the urine output and hold the dose

ANSWER C. Urine output is an indication of renal function. Normal urine output is at least 30 ml/hour. Clients with
impaired renal function are at risk for hyperkalemia. Initiating a lab draw requires a physician order.

20. A client who had a recent surgery has been vomiting and becomes dizzy while standing up to go to
the bathroom. After assisting the client back to bed, the nurse notes that the blood pressure is 55/30 and the pulse is 140. The nurse hangs which of the following IV fluids to correct this condition? A.D5.45 NS at 50 ml/hr B.0.9 NS at an open rate C.D5W at 125 ml/hr D.0.45 NS at open rate

ANSWER B. client who recently had surgery, is vomiting, becomes dizzy when standing up, has a blood pressure of
55/30, and has a pulse of 140 is hypovolemic and requires plasma volume expansion. Isotonic fluids such as 0.9 NS will expand volume. Hypotonic fluids such as 0.45 NS will leave the intravascular space. D5W will metabolize into free water and leave the intravascular space. D5.45 NS is a good maintenance fluid but a rate of 50 ml per hour is not sufficient to expand the vascular volume quickly.

30. The nurse is admitting a client with a potassium level of 6.0 mEq/L. The nurse reports this finding
as a result of A.acute renal failure. B.malabsorption syndrome. C.nasogastric drainage. D.laxative abuse

ANSWER A. A serum potassium level of 6.0 mEq/L is indicative of acute renal failure. Malabsorption syndrome,
nasogastric drainage, and laxative abuse may result in a low serum potassium level, because output may be greater than input. Diarrhea results in malabsorption syndrome and can come from laxative abuse. Fluids and electrolytes may be lost in the nasogastric drainage. Normal serum potassium is 3.5 to 5.5 mEq/L.

32. The nurse assesses a client to be experiencing muscle cramps, numbness, and tingling of the
extremities, and twitching of the facial muscle and eyelid when the facial nerve is tapped. THe nurse reports this assessment as consistent with which of the following?

A.Hypokalemia B.Hypernatremia C.Hypermagnesemia D.Hypocalcemia

ANSWER D. Normal serum calcium is 9 to 11 mg/dl. A client who has hypocalcemia would experience muscle
cramps, numbness, and twitching of the facial muscles and eyelid when the facial nerve is tapped. Hypocalcemia may result from renal failure, hypothyroidism, acute pancreatitis, liver disease, malabsorption syndrome, and vitamin D deficiency. Normal serum potassium level is 3.5 to 5.5 mEq/L. Normal serum sodium is 135 to 145 mEq/L. Normal serum magnesium is 1.5 to 2.5 mEq/L.

33. Which of the following should the nurse include when preparing to teach a class on the regulation
and functions of electrolytes? A.Sodium is essential to maintain intracellular fluid water balance B.Magnesium is essential to the function of muscle, red blood cells, and nervous system C.Less calcium is excreted with aging D. Chloride is lost in hydrochloride acid ANSWER D.
Sodium is essential to maintain extracellular fluid water balance. Phosphate is the major anion in intracellular fluid water balance that is essential in the function of muscle, red blood cells, and nervous system. A person tends to excrete more calcium with age. Chloride is lost through hydrochloride acid.

34. The nurse assists a client with a serum potassium of 3.2 mEq/L to make which of the following
menu selections? Select all that apply. A.Baked cod B.Ham and cheese omelet C.Fried eggs D.Baked potato E.Spinach

ANSWERS A D E. Normal serum potassium is 3.5 to 5.5 mEq/L. A client who has a potassium of 3.2 mEq/L would
benefit from a diet high in potassium. Baked cod, baked potato, and spinach are all food selections high in potassium. A ham and cheese omelet is high in sodium. Fried eggs are high in cholesterol. A whole grain muffin is high in grains.

36. The nurse is evaluating the serum laboratory results on the following four clients. Which of the
following laboratory results is a priority for the nurse to report first? A.A client with osteoporosis and a calcium level of 10.6 mg/dl B.A client with renal failure and a magnesium level of 2.5 mEq/L C.A client with bulimia and a potassium level of 3.6 mEq/L D.A client with dehydration and a sodium level of 149 mEq/L

ANSWER D Although a client with acute osteoporosis may have a high serum calcium, a level of 10.6 mg/dl is
normal. Normal serum calcium is 9 to 11 mg/dl. Normal serum magnesium is 1.5 to 2.5 mEq/L. A client who has renal failure is prone to hypermagnesemia, but a level of 2.5 mEq/L is at the upper limit of normal. A client who has bulimia generally vomits enough to result in a low potassium level, but a potassium level of 3.6 mEq/L is low normal. Normal serum potassium is 3.5 to 5.5 mEq/L. Normal serum sodium is 135 to 145 mEq/L. The sodium level generally goes up with dehydration. A sodium level of 149 mEq/L is elevated.

49. The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test

should the nurse monitor? A.Serum B.Serum C.Serum D.Serum calcium. phosphorus. potassium. sodium.

A. (incorrect) Serum calcium is decreased in conditions such as osteoporosis or post-thyroid surgery, but not in vomiting and diarrhea. B. (incorrect) Serum phosphorus levels are altered in acute and chronic renal failure or diabetic ketoacidosis, among other conditions, but not with acute fluid losses from the gastrointestinal tract. C. (correct) Clients lose potassium from the GI tract or through the use of diuretic medications. Potassium imbalances can lead to cardiac arrhythmias. D. (incorrect) The body is not at risk from losing sodium from these sources as it is with potassium.

55. A nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client was at risk for developing the potassium deficit because the client: A.Has renal failure. B.Requires nasogastric suction. C.Has a history of Addison's disease. D.Is taking a potassium-sparing diuretic.

ANSWER B, Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with renal failure or Addison's disease and the client taking a potassiumsparing diuretic are at risk for hyperkalemia.
57. A nursing student needs to administer potassium chloride intravenously as prescribed to a client
with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium? A.Obtaining a controlled IV infusion pump B.Monitoring urine output during administration C.Diluting in appropriate amount of normal saline D.Preparing the medication for bolus administration

ANSWER D. Potassium chloride administered intravenously must always be diluted in IV fluid and infused via a
pump or controller. The usual concentration of IV potassium chloride is 20 to 40 mEq/L. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. Dilution in normal saline is recommended, but dextrose solution is avoided because this type of solution increases intracellular potassium shifting. The IV bag containing the potassium chloride is always gently agitated before hanging. The IV site is monitored closely because potassium chloride is irritating to the veins and the risk of phlebitis exists. The nurse monitors urinary output during administration and contacts the physician if the urinary output is less than 30 mL/hr.

58. A nurse instructs a client at risk for hypokalemia about the foods high in potassium that should be
included in the daily diet. The nurse determines that the client understands the food sources of potassium if the client states that the food item lowest in potassium is: A.Apples B.Carrots

C.Spinach D.Avocado

AN SWER A. A medium apple provides about 159 mg of potassium. A large carrot provides 341 mg, spinach (3 1/2
oz) provides 470 mg, and a medium avocado provides 1097 mg of potassium.

66. A nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which of the following
clinical manifestations would the nurse expect to note in the client? A.Twitching B.Negative Trousseau's sign C.Hypoactive bowel sounds D.Hypoactive deep tendon reflexes

ANSWER A Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes,
and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and ansiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.

67. A nurse caring for a client with hypocalcemia would expect to note which of the following changes
on the electrocardiogram? A.Widened T wave B.Prominent U wave C.Prolonged QT interval D.Shortened ST segment

ANSWER C. Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or QT
interval. A shortened ST segment and a widened T wave occur with hypercalcemia. Prominent U waves occur with hypokalemia.