Osborn Chapter 18: Learning Outcomes Number and Title

Osborn chapter 18
Learning Outcomes Number and Title

Learning Outcome 1
Explain the normal composition of fluids and electrolytes in the
body.
Learning Outcome 2
Describe the normal osmolality of the blood and urine.
Learning Outcome 3
Define the normal ranges of electrolytes in the body.
Learning Outcome 4
Discuss various circumstances that place the client at risk for
fluid and electrolyte imbalances.
Learning Outcome 5
Evaluate fluid status of an adult according to normal fluid and
electrolyte values.
Learning Outcome 6
Identify nursing interventions to restore fluid and electrolyte
balance.
Learning Outcome 7
Explain discharge teaching implications to assist clients to
maintain fluid and electrolyte balance.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. The nurse is planning care for a patient with severe burns. Which of the following is
this patient at risk for developing?
1.
2.
3.
4.
Intracellular fluid deficit

Intracellular fluid overload
Extracellular fluid deficit
Interstitial fluid deficit
Correct Answer: Intracellular fluid deficit

Rationale: Because this patient was severely burned, the fluid within the cells is
diminished, leading to an intracellular fluid deficit. The intracellular fluid is all fluid that
exists within the cell cytoplasm and nucleus. The extracellular fluid is all fluid that exists
outside the cell, including the interstitial fluid between the cells.
Cognitive Level: Applying
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 1
2. The nurse is instructing a healthy 60-kilogram client on nutritional and hydration

needs. The nurse explains that the client will need how many 8-ounce glasses of water
per day to help meet the bodys daily fluid requirements?
1.
2.
3.
4.
811 glasses
1520 glasses
56 glasses
23 glasses
Correct Answer: 811 glasses

Rationale: The healthy 60-kg client will need between 60 and 90 ounces of water per day
to meet the bodys normal daily fluid requirements. This equals between 8 and 11 (8ounce) glasses of water per day. A client will have more fluid requirements with illness or
increased physical activity. Less than 8 glasses of water will not meet the bodys daily
fluid requirements.
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 1
3. A female client was admitted to an acute care unit with weakness and complaints of
dizziness. Dehydration is suspected as the cause. The nurse would expect which of the
following lab values?
1.
2.
3.
4.
Sodium of 150 mEq/L; potassium 5.1 mEq/L; hematocrit of 50%

Correct Answer: Sodium of 150 mEq/L; potassium 5.1 mEq/L; hematocrit of 50%
Rationale: For a dehydrated client, the nurse would expect the hematocrit, sodium, and
potassium to be high (sodium of 150 mEq/L; potassium 5.1 mEq/L; hematocrit of 50%).
For overhydration, the client would have low levels of sodium, potassium, and hematocrit
(sodium of 132 mEq/L; potassium 3.1 mEq/L; hematocrit of 35%). Lab results within
normal limits would not be expected with dehydration.
Cognitive Level: Analyzing
Nursing Process: Assessment
LO: 1
4. A female patients hematocrit is 38% with serum sodium of 140 mEq/L. The nurse
realizes this patient is demonstrating:
1.
2.
3.
4.
Normal hydration status.

Over hydration.
Dehydration.
Sodium imbalance.
Correct Answer: Normal hydration status.

Rationale: The normal hematocrit level for a female is between 37% and 47%. The
normal osmolality of the blood is 275 to 295 mOsm/kg of water. Serum osmolality can be
roughly calculated by doubling the serum sodium value. This patients serum sodium is
140 mEq/L, which means the serum osmolality is roughly 280 mOsm/kg, or within
normal limits. These findings indicate a normal hydration status. Values above 295
indicate a water deficit or dehydration. Values below 275 indicate a water excess or
overhydration.
LO: 2
5. A marathon runner is taken to the emergency department (ED) following a race in

which the runner became disoriented, complained of a significant headache, and was
dizzy. The client reports drinking several bottles of water immediately following the race.
A new ED nurse starts an IV of D5W on this client and the symptoms become worse.
Another nurse notices the IV fluids and discusses her concerns regarding the IV fluid
with the new nurse. What are the concerns?
1. D5W breaks down into free water when the glucose is metabolized and is
increasing the degree of the clients hyponatremia.
2. D5W is the IV fluid of choice and should be infusing at a faster rate.
3. D5W is only given to clients who are admitted to an acute care setting, not
those in the ED.
4. D5W increases the sodium for this client too rapidly.
Correct Answer: D5W breaks down into free water when the glucose is metabolized and
is increasing the clients hyponatremia.
Rationale: The marathon runner is at risk for alteration in sodiumeither hypernatremia
due to the excessive sweating from physical exertion of running 26.2 miles or
hyponatremia from losing excessive sodium. However, when the runner drank large
quantities of water following the race, the runners risk for developing hyponatremia
increased, especially if the runners electrolytes were already low. The D5W breaks down
into free water when the glucose is metabolized and makes the circulating sodium levels
even lower. D5W is not the IV fluid of choice when hyponatremia is suspected. D5W can
be utilized for many other clients, as appropriate, in various settings, not just a medical
surgical inpatient setting. D5W does not increase the sodium in a client.
Nursing Process: Evaluation
LO: 2
6. A pregnant client with hyperemesis gravidarum is admitted to the hospital. Which of

the following lab results would the nurse expect for this client?
1. Urine osmolality of 41 mOsm/kg; urine specific gravity of 1.038; serum
osmolality of 300 mOsm/kg
Correct Answer: Urine osmolality of 41 mOsm/kg; urine specific gravity of 1.038; serum
Rationale: The client with hyperemesis gravidarum is at risk for dehydration. The nurse
can expect that the client will have lab results that are abnormal and reflect greater water
concentration and lower solutes, such as urine osmolality of 41 mOsm/kg; urine specific
gravity of 1.038; serum osmolality of 300 mOsm/kg. When the urine osmolality is high
and the urine specific gravity is low, such as urine osmolality of 1210 mOsm/kg; urine
specific gravity of 1.00; serum osmolality of 283 mOsm/kg, the client is overhydrated.
The lab results are within normal limits in the other answer choices.
LO: 2
7. A pregnant client is admitted with excessive thirst, increased urination, and has a
medical diagnosis of diabetes insipidus. The nurse chooses which of the following
nursing diagnoses as most appropriate?
1.
2.
3.
4.
Risk for Imbalanced Fluid Volume

Excess Fluid Volume
Imbalanced Nutrition
Ineffective Tissue Perfusion
Correct Answer: Risk for Imbalanced Fluid Volume

Rationale: The client with excessive thirst, increased urination, and a medical diagnosis
of diabetes insipidus is at risk for imbalanced fluid volume due to the clients excess
volume loss that can increase the serum levels of sodium. Excess fluid volume is not an
issue for clients with diabetes insipidus, especially during the early stages of treatment.
Imbalanced nutrition and ineffective tissue perfusion do not apply.
LO: 3
8. The patient with renal disease is prescribed a diuretic. Which of the following
laboratory values does the nurse expect would reflect the outcome of diuretic therapy?
1.
2.
3.
4.
Serum magnesium level 1.0 mg/dL

Serum potassium level 4.5 mEq/L
Serum sodium level 142 mEq/L
Serum calcium level 9.0 mg/dL
Correct Answer: Serum magnesium level 1.0 mg/dL

Rationale: Normal serum magnesium levels are 1.4 to 2.1 mg/dL. Excessive magnesium
losses occur with diuretic therapy. The other laboratory values listed are within normal
ranges.
Cognitive Level: Evaluating
LO: 3
9. An elderly client is received into the postanesthesia recovery room (PACU) following a
6-hour abdominal surgery. The client received several liters of IV fluids during the
surgery. Which of the following lab results would the nurse most likely see with this
client?
1. Sodium128 mEq/L; potassium3.0 mEq/L; chloride96 mEq/L
Correct Answer: Sodium128 mEq/L; potassium3.0 mEq/L; chloride96 mEq/L
Rationale: This client has an excess fluid volume and the nurse would anticipate the
electrolytes to be low (sodium128 mEq/L; potassium3.0 mEq/L; chloride96
mEq/L). These values would be of greatest concern. If the electrolyte values are high
(sodium148 mEq/L; potassium5.1 mEq/L; chloride107 mEq/L), the nurse could
anticipate the client to be dehydrated. For the answer response with the sodium140
mEq/L; potassium4.0 mEq/L; chloride100 mEq/L, these reflect normal lab values.
The sodium level of 135 mEq/L is just barely below normal limits; however, the client
could still be at risk for excess fluid volume since all electrolytes are at the lower end of
normal range.
LO: 3
10. The postoperative client has a nasogastric tube in place for 5 days. On the fifth day,
the client begins to exhibit confusion and lethargy. The nurse anticipates which of the
following?
1. The confusion is related to the gastric suctioning removing electrolytes from
the stomach.
2. The confusion is a delayed effect from anesthesia.
3. The confusion is most likely age related.
4. The confusion is related to the gastric suctioning and has decreased the
clients fluid volume.
Correct Answer: The confusion is related to the gastric suctioning removing electrolytes
from the stomach.
Rationale: Gastric suctioning via nasogastric tube may impact a clients electrolyte
balance by removing electrolytes via extracted gastric fluids. Confusion can occur as a
result of hyponatremia. While confusion can occur as a result of anesthesia, it usually
does not take 5 days to occur. Elderly clients are more susceptible to electrolyte
imbalance, but electrolyte imbalance is not exclusive to the elderly client. Decreasing the
clients fluid volume is not the cause of electrolyte disturbance, but can also cause
acidbase problems.
LO: 4
11. An elderly patient tells the nurse that she does not drink many fluids because she is on
a water pill and does not want to harm what the water pill is supposed to do. Which
of the following is the nurses best response to this patient?
1. Taking a water pill does not mean you should not drink fluids. You can
become dehydrated.
2. Limiting fluids will ensure that you wont be overhydrated.
3. Just make sure you drink the things that you like, such as coffee and juice.
4. Its not necessary for you to drink water throughout the day.
Correct Answer: Taking a water pill does not mean you should not drink fluids. You can
become dehydrated.
Rationale: The most common cause of dehydration or pure water deficit is the excessive
loss of free water through urine as seen in people taking diuretics and not replacing fluids
through drinking. Elderly individuals have decreased perception of thirst due to aging and
may not replace fluids appropriately. The elderly are particularly vulnerable to
dehydration because many are taking prescription diuretics. The nurse should explain that
drinking fluids is important to avoid dehydration. The nurse should not support the
patients reasoning that by limiting fluids, the diuretic would work more effectively.
Everyone needs an intake of fluids every day.
LO: 4
12. A patient taking spironolactone is demonstrating ECG changes and complaining of

muscle weakness. The nurse realizes this patient is exhibiting signs of:
1.
2.
3.
4.
Hyperkalemia.
Hypokalemia.
Hypercalcemia.
Hyopcalcemia.
Correct Answer: Hyperkalemia.

Rationale: Hyperkalemia is serum potassium level greater than 5.0 mEq/L. Decreased
potassium excretion is seen in potassium-sparing diuretics such as spironolactone.
Common manifestations of hyperkalemia are muscle weakness and ECG changes.
Hypokalemia is seen in nonpotassium diuretics such as furosemide. Hypercalcemia has
been associated with thiazide diuretics. Hypocalcemia is seen in patients who have
received many units of citrated blood and is not associated with diuretic use.
LO: 4
13. A patient is admitted with fluid-volume deficit. Which of the following will the nurse
most likely assess in this patient?
1.
2.
3.
4.
Blood pressure 80/60 mm Hg

Blood pressure 150/86 mm Hg
Pitting edema lower extremities
Respiratory rate 26 per minute
Correct Answer: Blood pressure 80/60 mm Hg

Rationale: In fluid-volume deficit, the blood pressure will be lower than normal. A blood
pressure higher than normal is indicative of fluid-volume excess. Pitting edema of the
lower extremities and a respiratory rate of greater than 20 per minute are also indicative
of fluid-volume excess.
LO: 5
14. A nurse is providing discharge instructions for a client with a history of heart failure.
Until a scale is obtained, which of the following instructions would be most helpful if the
client does not have a scale at home to weigh on?
1. Wear the same belt in the same location around the waist and alert the
physician if the belt becomes tighter.
2. Wear a name band around the wrist to see if it gets tighter.
3. Wear a ball cap every day to determine whether there is an increase in head
circumference.
4. Discuss taking extra medication if the client feels there is weight gain.
Correct Answer: Wear the same belt in the same location around the waist and alert the
physician if the belt becomes tighter.
Rationale: If the client does not have access to a scale initially and is waiting to get one,
the nurse can advise the client to utilize a piece of clothing, such as a belt, used in the
same location, to help determine weight gain. Other methods might be to discuss
awareness of socks or rings getting tight. The wrist and head circumference are not good
locations to judge weight gain. Discussing taking extra medication based upon a clients
feeling like there is weight gain is not advised without consulting the health care
provider. The most reliable measurement of weight gain is utilizing scales.
Nursing Process: Evaluation
LO: 5
15. A patient is admitted with fluid-volume overload. The nurse realizes the laboratory
value that supports this finding is:
1.
2.
3.
4.
Serum sodium level 130 mEq/L.

Serum potassium level 4.6 mEq/L.
Serum calcium level 9.8 mg/dL.
Serum phosphorous level 4.0 mg/dL.
Correct Answer: Serum sodium level 130 mEq/L.

Rationale: A low sodium level, such as serum sodium level 130 mEq/L, or hyponatremia,
is seen in patients with extensive retention of water or fluid overload. The serum
potassium, calcium, and phosphorous levels are all within normal ranges.
LO: 5
16. The nurse is planning care for a patient with fluid-volume overload and
hyponatremia. Which of the following should be included in this patients plan of care?
1.
2.
3.
4.
Restrict fluids.
Administer intravenous fluids.
Provide Kayexalate.
Administer intravenous normal saline with furosemide.
Correct Answer: Restrict fluids.

Rationale: The nursing care for a patient with hyponatremia is dependent on the cause.
Restriction of fluids to 1,000 mL/day is usually implemented to assist sodium increase
and to prevent the sodium level from dropping further due to dilution. The administration
of intravenous fluids would be indicated in fluid-volume deficit and hypernatremia.
Kayexalate is used in patients with hyperkalemia. The administration of normal saline
with furosemide is used to increase calcium secretion.
LO: 6
17. If a client has hypocalcemia, the nurse should also evaluate the client for:
1.
2.
3.
4.
Other electrolyte disturbances.

Hypertension.
Visual disturbances.
Drug toxicity.
Correct Answer: Other electrolyte disturbances.

Rationale: The client who has hypocalcemia may also have high phosphorus or decreased
magnesium levels. The hypocalcemic client may exhibit hypotension, not usually
hypertension. Visual disturbances do not occur with hypocalcemia. Hypercalcemia is
more commonly caused by drug toxicities.
LO: 6
18. A patient with a history of stomach ulcers is diagnosed with hypophosphatemia.

Which of the following interventions should the nurse include in this patients plan of
care?
1.
2.
3.
4.
Request dietitian consult for selecting foods high in phosphorous.

Provide aluminum hydroxide antacids as prescribed.
Instruct patient to avoid poultry, peanuts, and seeds.
Instruct patient to avoid the intake of sodium phosphate.
Correct Answer: Request dietitian consult for selecting foods high in phosphorous.
Rationale: Treatment of hypophosphatemia includes treating the underlying cause and
promoting a high-phosphate diet, especially milk, if it is tolerated. Other foods high in
phosphate are dried beans and peas, eggs, fish, organ meats, Brazil nuts and peanuts,
poultry, seeds, and whole grains. Phosphate-binding antacids, such as aluminum
hydroxide, should be avoided. Mild hypophosphatemia may be corrected by oral
supplements, such as sodium phosphate.
LO: 6
19. A client who experienced hypokalcemia is being discharged. Which of the following
foods contain the best choices for increasing the clients potassium?
1.
2.
3.
4.
Potatoes, tomatoes, artichokes, lima beans

Tomatoes, fresh mushrooms, onions, bread
Bananas, grapes, apple, chocolate chip cookies
Asparagus, cauliflower, lettuce, chocolate cake
Correct Answer: Potatoes, tomatoes, artichokes, lima beans

Rationale: Potatoes, tomatoes, artichokes, and lima beans all contain high levels of
potassium. Each of the other combinations contains some level of potassium, but
potatoes, tomatoes, artichokes, and lima beans collectively contain the most potassium.
LO: 7
20. Discharge teaching for the client with electrolyte disturbances is aimed at:
1.
2.
3.
4.
Identifying the underlying problem and preventing a reoccurrence.

Teaching the client to manage the underlying problem.
Identifying the clients knowledge deficits and correcting misconceptions.
Review of the clients health problems.
Correct Answer: Identifying the underlying problem and preventing a reoccurrence.

Rationale: The plan for the clients discharge involves identifying the underlying cause
for an electrolyte disturbance and preventing a reoccurrence by assisting the client with
home management and prevention strategies. Teaching the client to manage the
underlying problem, identifying the clients knowledge deficits and correcting
misconceptions, and review of the clients health problems will all be part of the overall
discharge plan.
LO: 7
21. The nurse is planning the care of a patient diagnosed with hyperkalemia. Which of the
following should be included in this patients plan of care?
1. Providing oral Kayexalate as prescribed
2. Dietary consult to select foods low in calcium

3. Dietary consult to select foods high in sodium
4. Maintain fluid restriction
Correct Answer: Providing oral Kayexalate as prescribed
Rationale: Treatment for hyperkalemia includes reducing oral or IV intake of potassium
while treating the underlying cause of the hyperkalemia by administering potassiumreducing agents such as oral Kayexalate combined with sorbitol to rapidly remove
potassium from the gastrointestinal tract via diarrhea. The patient has not been diagnosed
with hypercalcemia or hyponatremia. There is no evidence to support the patient needing
to restrict fluids.
LO: 7

Osborn Chapter 18: Learning Outcomes Number and Title

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Osborn Chapter 18: Learning Outcomes Number and Title

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Osborn chapter 18

Learning Outcomes Number and Title

Intracellular fluid deficit

Correct Answer: Intracellular fluid deficit

2. The nurse is instructing a healthy 60-kilogram client on nutritional and hydration

Correct Answer: 811 glasses

Sodium of 150 mEq/L; potassium 5.1 mEq/L; hematocrit of 50%

Normal hydration status.

Correct Answer: Normal hydration status.

5. A marathon runner is taken to the emergency department (ED) following a race in

6. A pregnant client with hyperemesis gravidarum is admitted to the hospital. Which of

Risk for Imbalanced Fluid Volume

Correct Answer: Risk for Imbalanced Fluid Volume

Serum magnesium level 1.0 mg/dL

Correct Answer: Serum magnesium level 1.0 mg/dL

12. A patient taking spironolactone is demonstrating ECG changes and complaining of

Correct Answer: Hyperkalemia.

Blood pressure 80/60 mm Hg

Correct Answer: Blood pressure 80/60 mm Hg

Serum sodium level 130 mEq/L.

Correct Answer: Serum sodium level 130 mEq/L.

Correct Answer: Restrict fluids.

Other electrolyte disturbances.

Correct Answer: Other electrolyte disturbances.

18. A patient with a history of stomach ulcers is diagnosed with hypophosphatemia.

Request dietitian consult for selecting foods high in phosphorous.

Potatoes, tomatoes, artichokes, lima beans

Correct Answer: Potatoes, tomatoes, artichokes, lima beans

Identifying the underlying problem and preventing a reoccurrence.

Correct Answer: Identifying the underlying problem and preventing a reoccurrence.

2. Dietary consult to select foods low in calcium

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