1. A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which treatment should the nurse prepare to give? Intravenous administration of a KCl solution o Response Feedback: Rationale: KCl administration facilitates the renal retention of hydrogen ions, resulting in lowering of pH. It is not possible to administer free H+ ions, and sodium bicarbonate would exacerbate her condition. Mechanical ventilation is indicated in cases of respiratory acidosis. 2. A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? Selected Answer: a. Spironolactone [Aldactone] Response Feedback: Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.  3. A patient collapses after running a marathon on a hot day and is brought to the emergency department to be treated for dehydration. The nurse will expect to provide which therapy? Selected Answer: d. Intravenous hypotonic fluids administered in stages Response Feedback: Because this patient is experiencing fluid volume loss as the result of excessive sweating, this is most likely hypertonic dehydration, in which loss of water exceeds loss of electrolytes. This should be treated with a hypotonic solution or with fluids that contain no solutes at all. Initial treatment may consist of having the patient drink water. When intravenous therapy is provided, volume replenishment should occur in stages. Hypertonic fluids are used to treat hypotonic contraction, usually caused by excessive sodium loss through the kidneys as the result of diuretic therapy. Isotonic fluids are used to treat isotonic contraction, which is generally caused by vomiting and diarrhea. An oral electrolyte solution would only increase the hypertonicity; if oral rehydration is used in this case, the patient should drink plain water. 4. A nurse is caring for a child whose respirations are shallow and marked by a prolonged expiratory phase. The nurse auscultates wheezes and poor air movement bilaterally. The child’s respiratory rate is 26 breaths per minute, and the oxygen saturation is 89%. What does the nurse suspect? Selected Answer: b. Respiratory acidosis Response Feedback: Respiratory acidosis results from retention of CO2 secondary to hypoventilation caused either by depression of the medullary respiratory center in the central nervous system (CNS) or by a pathologic lung condition, such as asthma. This child has shallow respirations with evidence of airway obstruction and poor ventilation. Metabolic acidosis occurs in chronic renal failure, loss of bicarbonate with severe diarrhea, metabolic disorders, and ingestion of acids such as salicylates; hyperventilation is a compensatory mechanism. Metabolic alkalosis is usually caused by excessive loss of gastric acid or by ingestion of alkalinizing salts; hypoventilation is a compensatory mechanism. Respiratory alkalosis is produced by hyperventilation and can occur in any condition that increases the respiratory rate and depth. 5. The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. The nurse observes which clinical manifestations in this client? A. Muscular spasms and reports of tingling in hands/feet Response Feedback: Rationale: Paresthesias, muscle spasms, and cramping are common manifestations of low serum calcium. Polydipsia, polyuria, anorexia, and lethargy and stupor are associated with hypercalcemia. 6. The nurse evaluates the ECG of a client who has developed hypokalemia secondary to diuretic use. Which manifestation of hypokalemia does the nurse anticipate on the ECG? Selected Answer: B. A prominent U wave and a flattened T wave. Response Feedback: Rationale: ECG changes associated with hypokalemia include a prominent u wave and a flattening of the T wave. Atrial fibrillation, a low P wave, and the absence of a U wave are not associated with hypokalemia. 7. A patient arrives in the emergency department after becoming dehydrated. Based on the patient’s history, the provider determines that isotonic dehydration has occurred. Which solution will the nurse expect to infuse to treat this patient? Selected Answer: a. 0.9% sodium chloride in sterile water Response Feedback: Isotonic dehydration should be treated with an isotonic solution of 0.9% NaCl in sterile water. A 0.45% solution or 5% dextrose is used to treat hypertonic dehydration. A 3% NaCl solution is used to treat hypotonic dehydration. 8. 8. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? Selected Answer: d. Spironolactone [Aldactone] Spironolactone is a non–potassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.