Nclexrn Flashcards: Fluid And Electrolyte Imbalances

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Flashcard 1: What symptom pattern is most consistent with hypercalcemia?

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

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

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

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

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

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

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

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

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

Flashcard 6: Which ECG change is most associated with hyperkalemia?

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

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

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

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

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

Flashcard 9: What is the key neuromuscular finding expected in hypomagnesemia?

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

Flashcard 10: What is the priority treatment approach for severe hypercalcemia?

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

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

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

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

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

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

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

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

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

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

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

Flashcard 16: Which ECG change is most associated with hypokalemia?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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