Fluid & Electrolytes exam today, I have a few questions

Halcyonn · Feb 12, 2014

I'll preface my response by saying I'm still studying for my F/E exam.

One question was "A client is at risk for developing hypercalcemia, what patient teaching would you recommend to this client? "
Only two answers made sense were:
Have them drink more fluids.
Or restrict dairy and milk products from their diet.

I was thinking the dairy/calcium restriction option. Question says the patient is "at risk", so diet modification may help prevent the "at risk" from turning into the real deal. Increasing fluids is something I would think to do for someone who already has hypercalcemia, but not for an "at risk" person.

Another question was...
A patient who is taking Lasix should contact their physician if:
A. They gain 3 lbs in a week.
B. Lose 3 lbs in a week.
C. Hear ringing in their ear.

For this one I would go with A) weight gain. My rationale is that Lasix is a diuretic. If the person is gaining weight, that could indicate that the medicine is no longer effective, or the condition it was prescribed to treat has gotten worse.

Another question was: A patient who has fluid volume excess is starting to get confused, what should the nurse do?
A. Put them in trendelenberg postion with the feet and legs elevated and the chest and head lay flat. isn't this reverse trendelburg ?
B. Give them diuretics.

For this one, I honestly have no idea. But, I probably would have picked the bed positioning just because giving meds would require an order and that seems complicated, lol.

I'm interested to see what others think!

StudentOfHealing · Feb 12, 2014

For the last one ... it sounds as if their confusion is related to possible IICP... so I am really uneasy about placing them in Trendelenburg.

In Trendelenburg the head is lower than the feet.

I would definitely say Lasix.

.... I wish we could see the other answer choices though.

Jocelwyn · Feb 12, 2014

Good questions! Fluids and Electrolytes seem to be a doosey for everybody--glad it wasn't just me!

The first question is most likely testing (indirectly) your ability to determine what foods contain different electrolytes. Since dairy products are the number 1 classic for calcium content, and we know that hypercalcemia means you want to decrease your already-too-high blood calcium level, the best option would be to restrict dairy and milk products. Increasing fluids would be good to do, but I would say it's not the best answer to this question. Remember, most answers to nursing test questions are correct--it's a matter of figuring out which is *most* correct and the highest priority.

#2: I can tell you for certain that you will see a variation of this question on the NCLEX. "Ototoxicity" should come to mind about 0.001 seconds after you hear the word "Lasix", and a huge teaching point for patients is that they should call their doctor immediately if they experience ringing of the ears. You are absolutely correct that taking daily weights and reporting changes is also important while on Lasix, but the key here is the time period the question gave. The threshold at which you want to start worrying is losing or gaining more than 2 pounds in a *day*, so losing or gaining three pounds in a week would definitely not be as important as reporting possible ototoxicity.

#3: this one is a little tricky, but I know for sure that you do not want to put a patient with FVE in Trendelenburg (feet higher than head). A major concern with fluid volume excess is impaired breathing from extra fluid in the lungs (pulmonary edema), and having the feet higher than the chest will only serve to shunt more extra fluid towards the lungs.

I can see you being hesitant to pick the "give diuretic" option since that requires an order and it wasn't specified in the question that you had one, but in reality this is probably the correct answer (or at least, out of the two that you gave). You should ask your teacher if you should assume with these types of questions that you had/could get the order and should just pick the best answer accordingly. In reality, most units you'll be working on will have standing orders that would cover situations like this. It would also amaze me if any patient had a diagnosis of FVE and no PRN prescription for diuretics.

The best course of action would be to quickly perform a more thorough assessment (what's the I+O? B/P? HR? Do the labs indicate FVE? Are there any other possible causes of the confusion?), elevate the head of the patient's bed, and call the doctor to request diuretics.

Best of luck in your course! Remember: prioritize, choose the *most* correct option, don't read into the question, go with what you know, and never ever change your answers!

Hope that helps :)

Halcyonn · Feb 12, 2014

Yea, I totally read that question as 'day' instead of 'week'. Whoops!

nurseprnRN, BSN, RN · Feb 12, 2014

I have a question I had my Fluid and Electrolytes exam today and I am just wondering about a few things on my exam..
One question was "A client is at risk for developing hypercalcemia, what patient teaching would you recommend to this client? "
Only two answers made sense were:
Have them drink more fluids.
Or restrict dairy and milk products from their diet.
I know that hypercalcemia is related to a lot of calcium intake, but I also know it's related to other things as well...However I looked it up and calcium in a lot of other food items and not just calcium, so I chose drink more fluids....am I thinking wrong on this one? In my book it says to rehydrate the patient.
Another question was...
A patient who is taking Lasix should contact their physician if:
A. They gain 3 lbs in a week.
B. Lose 3 lbs in a week.
C. Hear ringing in their ear.
I chose the ringing in their ear, now I am not wording these questions the same as they were on the exam, nor the answers...But isn't ringing in the ear a serious side effect of Lasix? I know it can cause deafness if pushed too fast. I am not sure what to think about this one!
Another question was: A patient who has fluid volume excess is starting to get confused, what should the nurse do?
A. Put them in trendelenberg postion with the feet and legs elevated and the chest and head lay flat. isn't this reverse trendelburg ?
B. Give them diuretics.
I know 2 of the answers, weren't right at all, I chose give them diuretics?
Can someone give me pointers?

Hypercalcemia-- why do we care? What happens to the patient if s/he (not "they-- it's only one person we're talking about here) has high calcium levels? Where do high calcium levels come from most often, in what kind of patients, and why? (HINT: It isn't from food!!)

Is that good-bad-dangerous-benign? What's a nursing intervention you can do to decrease high levels, anticipating this condition in that patient population?

Lasix: We would get around to mentioning the 3# in a week, though 3# in a day would be much more concerning. Which is more serious and less reversible-- temporary weight gain or frying an eighth cranial nerve?

Fluid volume excess: YOU cannot choose to give diuretics. That is not a nursing intervention. It's part of the medical plan of care.

Let's think about why someone with fluid volume excess might be getting confused. There's a list as long as your arm in the NANDA-I 2012-2014 (which you should have even if it's not in the bookstore list for your class) for defining characteristics for the nursing diagnosis of "Excess fluid volume." Many of these could cause confusion.

All that said, though, I think that whoever wrote that question isn't up on current nursing diagnosis (wrong terminology) and didn't think clearly about the difference between a nursing intervention and a medical one. The better answer from a physiological standpoint would probably be the diuretic, and the question should have reflected that. Something like, "The nurse should anticipate which of the following interventions in a medical plan of care?"

"Trendelenburg" is feet up, head down. "Reverse Trendelenburg" is head up, feet down (not just raising the head of the bed). Trendelenburg would be a lousy idea for a many people with fluid volume excess because it would make their difficulties with breathing that much worse.