Fluid And Electrolyte Imbalances - NCLEX Rn

1. What symptom pattern is most consistent with hypercalcemia?

   Lethargy, constipation, polyuria (decreased excitability). High calcium depresses neuromuscular activity and promotes renal calcium excretion.

2. What is the expected adult serum potassium reference range in mEq/L?

   K$^+$ $3.5$–$5.0$ mEq/L. This level supports cardiac and muscle function, preventing arrhythmias from hypo- or hyperkalemia.

3. What is the priority clinical manifestation of acute hyponatremia to monitor for?

   Neurologic changes (confusion, seizures). Rapid sodium drop causes cerebral edema, leading to these symptoms requiring urgent intervention.

4. What is the expected adult serum phosphate reference range in mg/dL?

   PO$_4^{3-}$ $2.5$–$4.5$ mg/dL. This level balances with calcium for bone metabolism, with elevations causing hypocalcemia in renal issues.

5. What is the maximum recommended peripheral IV infusion rate for potassium chloride?

   $10$ mEq/hr (peripheral line). This rate minimizes vein irritation and cardiac risks during potassium repletion.

6. Which ECG change is most associated with hyperkalemia?

   Tall peaked T waves. Excess potassium alters cardiac repolarization, risking ventricular arrhythmias.

7. What is the expected adult urine specific gravity reference range?

   $1.005$–$1.030$. This measures urine concentration, indicating hydration status or renal concentrating ability.

8. What is the classic clinical sign of hypocalcemia at the bedside?

   Trousseau sign (carpal spasm with BP cuff). Low calcium increases neuromuscular irritability, eliciting spasm with arterial occlusion.

9. What is the key neuromuscular finding expected in hypomagnesemia?

   Hyperreflexia and tetany (neuromuscular irritability). Low magnesium heightens nerve and muscle excitability, mimicking hypocalcemia effects.

10. What is the priority treatment approach for severe hypercalcemia?

    IV isotonic fluids plus loop diuretic (after hydration). Hydration dilutes calcium, and loop diuretics enhance excretion after volume restoration.

11. What is the expected adult serum sodium reference range in mEq/L?

    Na$^+$ $135$–$145$ mEq/L. This range maintains osmotic balance and nerve function in adults, with deviations indicating hypo- or hypernatremia.

12. What is the minimum urine output required before administering IV potassium?

    At least $30$ mL/hr. Adequate output confirms renal function to excrete excess potassium and avoid hyperkalemia.

13. What is the priority clinical manifestation of hypernatremia to assess for?

    Thirst and neurologic irritability (restlessness). Cellular dehydration from high sodium causes thirst and CNS excitation as compensatory responses.

14. What is the priority nursing action for severe symptomatic hyponatremia?

    Administer hypertonic saline (e.g., $3\%$ NaCl). It corrects severe sodium deficit rapidly to prevent cerebral edema and seizures.

15. What is the immediate IV medication to stabilize the myocardium in severe hyperkalemia?

    IV calcium gluconate. It antagonizes potassium's cardiac effects, protecting against arrhythmias without lowering levels.

16. Which ECG change is most associated with hypokalemia?

    Flattened T waves and U waves. Low potassium prolongs repolarization, potentially causing arrhythmias like ventricular tachycardia.

17. Which IV fluid is isotonic: $0.9\%$ NS, $0.45\%$ NS, or D$5$W?

    $0.9\%$ normal saline is isotonic. Its osmolality matches plasma, preventing cell shrinkage or swelling during infusion.

18. Which IV fluid is hypertonic: $0.9\%$ NS, D$5$W, or D$5$NS?

    D$5$NS is hypertonic. Combining dextrose and saline increases osmolality above plasma, drawing fluid from cells.

19. What is the expected adult serum osmolality reference range in mOsm/kg?

    $275$–$295$ mOsm/kg. This reflects body fluid tonicity, guiding assessment of dehydration or overhydration states.

20. Which IV fluid is hypotonic: $0.9\%$ NS, $0.45\%$ NS, or D$5$W?

    $0.45\%$ normal saline is hypotonic. Its lower osmolality than plasma promotes water movement into cells for rehydration.

21. Which medication shifts potassium into cells for acute hyperkalemia management?

    Regular insulin with dextrose. Insulin drives potassium intracellularly via sodium-potassium pump, with dextrose preventing hypoglycemia.

22. What is the expected adult serum magnesium reference range in mEq/L?

    Mg$^{2+}$ $1.3$–$2.1$ mEq/L. This range facilitates enzyme activity and neuromuscular transmission, avoiding seizures in hypomagnesemia.

23. Which electrolyte abnormality is most likely when phosphate is elevated in renal failure?

    Hypocalcemia. Renal failure impairs phosphate excretion, leading to binding with calcium and reduced levels.

24. What is the priority intervention for symptomatic hypocalcemia (tetany or seizures)?

    Administer IV calcium gluconate. It rapidly restores calcium levels to alleviate life-threatening neuromuscular symptoms.

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