ATI RN
Chapter 14 Nutrition and Fluid Balance Questions
Question 1 of 5
A patient with a serum magnesium level of 1.1 mg/dL is at risk for which complication?
Correct Answer: A
Rationale: Rationale: Low serum magnesium levels can lead to cardiac arrhythmias due to its role in regulating heart muscle function. Magnesium deficiency can disrupt electrical conduction in the heart, potentially causing arrhythmias. Hypokalemia (Choice B), hypercalcemia (Choice C), and hypertension (Choice D) are not directly associated with low magnesium levels. Potassium and calcium imbalances have different physiological implications, while hypertension is more commonly linked to sodium levels. Therefore, the correct answer is A: Cardiac arrhythmias.
Question 2 of 5
A patient with liver cirrhosis is receiving diuretic therapy. The nurse observes confusion, irritability, and muscle twitching. The serum sodium level is 118 mEq/L. What is the most likely diagnosis?
Correct Answer: C
Rationale: The correct answer is C: Hyponatremia. In liver cirrhosis, impaired liver function can lead to decreased production of plasma proteins, causing fluid to shift into the interstitial spaces and diluting the sodium concentration in the blood. This results in hyponatremia, which can present with confusion, irritability, and muscle twitching. A: Hypernatremia is incorrect as the patient's serum sodium level is low. B: Hypocalcemia is incorrect as the symptoms are more indicative of hyponatremia. D: Hyperkalemia is incorrect as the patient's symptoms are not consistent with high potassium levels.
Question 3 of 5
The patient taking furosemide (Lasix) to correct excess edema shows a weight loss of 5.5 pounds in 24 h. The nurse calculates that this weight loss is equivalent to how many liters (L) of fluid given that each kilogram of weight loss is equivalent to 1 L of fluid?
Correct Answer: D
Rationale: To calculate the amount of fluid loss in liters, we need to convert the weight loss from pounds to kilograms (1 kg = 2.2 lbs). 5.5 lbs ÷ 2.2 = 2.5 kg. Since each kilogram of weight loss is equivalent to 1 L of fluid, the patient lost 2.5 L of fluid in 24 hours. Therefore, the correct answer is D: 2.5 L. Choice A (1 L) is incorrect because the patient lost 2.5 kg, not just 1 kg. Choice B (1.5 L) is incorrect because the patient lost 2.5 kg, not 1.5 kg. Choice C (2.0 L) is incorrect because the patient lost 2.5 kg, not 2 kg.
Question 4 of 5
The nurse is caring for an 80-year-old patient. Which finding is the best early indicator of dehydration in this patient?
Correct Answer: B
Rationale: The correct answer is B: Constipation. Constipation is the best early indicator of dehydration in an 80-year-old patient because dehydration can lead to decreased gastrointestinal motility, resulting in constipation. Reduced skin turgor (A) is a late sign of dehydration. Increased temperature (C) can be a sign of other conditions, not specifically dehydration. Thirst (D) is a normal physiological response to dehydration but may not be the best early indicator in older adults who may have decreased thirst sensation.
Question 5 of 5
The nurse assesses the patient's IV insertion site and observes that the vein is hard, the skin is red and tender, and a blood return in the IV line. After removing the IV catheter, which action should the nurse take next?
Correct Answer: D
Rationale: The correct answer is D: Apply a warm moist pack. Rationale: 1. The symptoms described suggest phlebitis, which is inflammation of the vein. 2. Applying a warm moist pack helps to promote vasodilation and increase blood flow, aiding in the resolution of inflammation. 3. Warmth can also help to alleviate pain and discomfort associated with phlebitis. Summary: A: Obtaining an arm board is unnecessary for phlebitis and does not address the inflammation. B: Elevating the arm above the heart may help reduce swelling but does not directly address the inflammation. C: Cleaning the site and applying cool compresses are not recommended for phlebitis as cold may exacerbate the condition.