Fluid And Electrolyte Imbalance Care - NCLEX Pn

1. What is a key assessment finding suggesting fluid volume excess?

   Crackles on lung auscultation. It signals pulmonary edema from excess fluid shifting into lung alveoli, impairing gas exchange.

2. Which imbalance is a seizure risk requiring precautions: hyponatremia or hypernatremia?

   Hyponatremia. Low sodium causes cerebral edema, lowering seizure threshold and necessitating protective measures.

3. What is the best initial nursing assessment finding suggesting fluid volume deficit?

   Orthostatic hypotension. It indicates reduced blood volume causing blood pressure drop upon standing due to inadequate compensatory mechanisms.

4. Which IV fluid is isotonic and commonly used for hypovolemia: $0.9\%$ NS or $0.45\%$ NS?

   $0.9\%$ normal saline. Its osmolality matches plasma, expanding intravascular volume without causing cellular fluid shifts.

5. What is the expected adult urine output per hour that indicates adequate renal perfusion?

   At least $30\ \text{mL/hr}$. This minimum output reflects sufficient glomerular filtration rate maintained by adequate blood flow to the kidneys.

6. What serum sodium range is considered normal for an adult?

   $135$–$145\ \text{mEq/L}$. This range maintains osmotic balance and nerve function without causing hypo- or hypernatremia symptoms.

7. What serum magnesium range is considered normal for an adult?

   $1.5$–$2.5\ \text{mEq/L}$. This range facilitates neuromuscular transmission and cardiovascular stability.

8. Which IV fluid is hypertonic: $3\%$ saline or $0.9\%$ saline?

   $3\%$ saline. Its high osmolality pulls fluid from cells into vasculature, treating severe hyponatremia.

9. What bedside sign is classically associated with hypocalcemia when BP cuff is inflated?

   Trousseau sign. Inflation induces ischemia, triggering carpopedal spasm due to hypocalcemia-induced neuromuscular irritability.

10. What is the most specific daily measure to trend fluid status in hospitalized patients?

    Daily weight at the same time. Consistent timing minimizes variables like food intake, providing accurate fluid retention or loss trends.

11. What serum calcium (total) range is considered normal for an adult?

    $8.5$–$10.5\ \text{mg/dL}$. This concentration ensures proper bone health, muscle contraction, and blood clotting mechanisms.

12. What serum potassium range is considered normal for an adult?

    $3.5$–$5.0\ \text{mEq/L}$. This level supports cardiac rhythm stability and muscle contraction without risking arrhythmias.

13. Which IV fluid is hypotonic: $0.45\%$ NS or lactated Ringer's?

    $0.45\%$ normal saline. Its lower osmolality than plasma draws fluid into cells, useful for hypernatremia correction.

14. What assessment finding is most associated with hypercalcemia?

    Constipation. Elevated calcium depresses gastrointestinal smooth muscle activity, reducing peristalsis.

15. What ECG change is most associated with hyperkalemia?

    Tall, peaked T waves. Elevated potassium disrupts cardiac repolarization, leading to this characteristic waveform alteration.

16. Which electrolyte imbalance causes neuromuscular irritability and tetany: hypocalcemia or hypercalcemia?

    Hypocalcemia. Low calcium increases neuronal excitability, leading to muscle spasms and potential tetany.

17. What serum phosphate range is considered normal for an adult?

    $2.5$–$4.5\ \text{mg/dL}$. This level balances calcium regulation and supports cellular energy production.

18. What does a $1\ \text{kg}$ weight change most closely equal in fluid gain or loss?

    About $1\ \text{L}$ of fluid. Body weight changes primarily reflect fluid shifts, as $1\ \text{kg}$ approximates $1\ \text{L}$ of water.

19. What serum osmolality range is considered normal for an adult?

    $275$–$295\ \text{mOsm/kg}$. This value indicates balanced fluid status, preventing cellular dehydration or swelling.

20. What ECG change is most associated with hypokalemia?

    Prominent U waves. Low potassium prolongs repolarization, manifesting as this waveform after the T wave.

21. What is the priority nursing action for suspected fluid volume excess with acute dyspnea?

    Position in high Fowler's and apply oxygen. This positioning reduces venous return and oxygenation relieves hypoxemia from pulmonary congestion.

22. What serum chloride range is considered normal for an adult?

    $96$–$106\ \text{mEq/L}$. This concentration aids in acid-base balance and nerve impulse transmission.

23. What is the priority nursing action for a patient with hypernatremia and dehydration?

    Encourage free water and administer hypotonic fluids as ordered. These interventions dilute serum sodium by increasing free water intake and extracellular fluid volume.

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