Fluid and

Electrolytes
practice

Practice Time!!!!
A patient with heart failure is ordered furosemide (Lasix) 20
mEq orally twice daily.
What assessment data should the nurse have readily
available prior to administering the medication?

A patient is ordered K+ IVPB

replacement 20Meq in 250 mL
of saline (20Meq in 250 mL).
What is the safe rate(amount of K+) at which this
replacement can run? How long will it take to run
this replacement?
What are some nursing responsibilities while the
K+ is infusing? After the infusion is completed?
Prior to starting the infusion? What must the
nurse take into consideration and why?

Your patient is about to be

discharged to home on Lasix
What are some areas of teaching you need to consider?
What type of dietary measures does this patient need to take
while on Lasix?
What foods will you encourage the patient to consume?

The nurse is preparing to

administer Spironolactone
(Aldactone) to a patient with
heart failure
The nurse obtains the morning labs and they reveal a K+ level
of 5.8 mEq/l, Na+ 138 mEq/l, and a BP of 118/72.
What should the nurse do? Defend your answer with a
rationale.

A patient is admitted to the cardiac

floor with fluid excess due to an
excacerbation of congestive heart
failure (CHF)
What systems will you focus on assessing?
What assessment findings may you discover after
completing your assessment?
What will you anticipate will be ordered i.e. diet,
meds for this patient? List as many as possible.

A patient is ordered both Lasix and

Digoxin for treatment of CHF
Morning labs are obtained:
Na+ 135 mEq/L
Mg++ 1.8 mEq/L
Digoxin level 1.8 ng/dL
K+ 2.8 mEq/L
Is it safe to administer both medications? Explain your
answer with a rationale.
In addition to labs, what other data is needed to
administer the meds safely?

You enter a patients room and

find him hooked up to NGT
suction. He has no IV infusing
and is NPO.
What electrolyte imbalance(s) is he at risk for?
What assessment data would be present based
on your answer above?
What labs may support your findings?
What would you suggest to the physican?

A patient with kidney disease has

urine output of 160 mL in 8 hours
Is the amount of urine in the 8 hour shift acceptable. Defend
your answer
What is some of the collaborative care that might be ordered
for this patient?
What type of dietary restrictions may this patient have?
Defend your response(s)
What labs may be altered due to Kidney Disease?

Identify the potential imbalances with

the following therapies:
Linsinopril
Aldactone
Lasix
NGT suction
IV Fluids
Prednisone (corticosteroids)
Which of the above may cause an acid/base
imbalance?? Any drug interactions?

A patient with a history of ETOH is

admitted for alcohol withdrawl.
The doctor has ordered magnesium (mg++)
sulfate 2gm in 250 mL to run over 2 hours for a
mg++ of 1.3 mEq/L. The tubing is a 10gtt/mL.
How many drops per minute should this
replacement run??
Why is the mg++ level low?
Identify the causes of low mg++ levels
What are some nursing considerations when
administering mg++?

You admitted a patient to your unit

with a Calcium level of 7.0 mg/dL
What assessment finding(s) may be present with the
above value? Also include other labs if possible.
What type of dietary needs does this patient
require? Give some sample foods to teach the
patient to include in his/her diet.
What hazards may the patient encounter with this
level without intervention?
What may have led to this level?

You admit an 88 year old male patient for

dehydration and confusion
Why is the patient confused?
Would age put this patient at risk for the above? Any
meds possibly??
What type of IVF may be ordered?
What lab will you check after labs are obtained to
make sure it is the correct IVF tonicity? The IVF
odered is .9NS at 150mL/hr
What ongoing assessment will be necessary while the
IVF is infusing? Concerns???

A patient is ordered aldactone as part

of his heart failure management
Identify the area of teaching this patient will need as it relates
to his heart failure
Diet, S/S of a CHF flare up

What additional teaching will this patient need specific to

taking of aldactone? He is also on Enapril. Include dietary
needs specific to these drugs ordered. Give sample foods.

Identify the Acid/Base & Electrolyte

Imbalances that may occur with the
following:
Vomiting
Diarrhea

NGT suction

Loop diuretic use

Bone cancer

K+ sparing use

Head injury

Burn patients
CHF patients
Renal failure patients

Elderly patients
Lisinopril (ace inhibitor)

Infection

Prednisone

Ileostomy

Uncontrolled diabetes

Questions?
Dont forget
Hesi case studies
Iggy work book practice activities
NCLEX book practice questions (read rationales!)
Make a chart of the causes, S/S, treatment of each imbalance in
module
Read the chapter in IGGY. Also read Berman & Snyder