A licensed practical/vocational nurse (LPN/LVN) is preparing to add a new IV of 5% dextrose in water (D5W) with potassium (K) to an existing line. The LPN/LVN notices that only 25 mL of urine has been collected over the past hour. What is the most appropriate nursing intervention?

Avoid hanging the IV with K and inform the registered nurse (RN) of the urine output.

Run the IV rapidly for 30 minutes to stimulate urine production.

Call the physician who ordered the K+.

Hang the IV as ordered and chart the output.

Answer and Explanation

The Correct Answer is A

A. Avoid hanging the IV with K and inform the registered nurse (RN) of the urine output: The low urine output suggests potential renal impairment, which could lead to potassium retention. Administering potassium could cause dangerous hyperkalemia, so it’s important to hold the IV and consult the RN for further evaluation.

B. Run the IV rapidly for 30 minutes to stimulate urine production: Rapid infusion could worsen fluid overload or cause other complications, and it will not address the renal issue causing the low urine output. Potassium should be avoided to prevent complications.

C. Call the physician who ordered the K+: While notifying the physician is important, the immediate priority is to inform the RN, as the potassium infusion should be withheld until renal function is assessed and corrected, if necessary.

D. Hang the IV as ordered and chart the output: Hanging the IV with potassium is risky in this case, as the client may not be able to eliminate potassium due to decreased renal function. Monitoring urine output is crucial before proceeding with potassium administration.

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Correct Answer is D

Explanation

A. High: The relationship between calcium and phosphate is inverse, meaning when calcium levels rise, phosphate levels tend to decrease, and vice versa. Therefore, the phosphate level would not be expected to be high if the calcium level is within the normal range.

B. The same as the calcium level: While calcium and phosphate levels are related, they do not typically mirror each other directly. They have an inverse relationship, not a one-to-one correlation.

C. Low: Since calcium and phosphate have an inverse relationship, a normal calcium level generally indicates that phosphate levels are also normal, not necessarily low.

D. Normal: With a calcium level of 9.5 mg/dL, which is within the normal range, it is expected that the phosphate level would also be within the normal range, as long as there are no other underlying conditions affecting these levels.

A. chemical buffer system B. renal system C. respiratory system D. endocrine system

Correct Answer is B

Explanation

A. Chemical buffer system: This system provides an immediate but short-term response to changes in pH by neutralizing excess acids or bases. It works quickly but does not provide the long-term regulation of pH that is needed for maintaining acid-base balance over time.

B. Renal system: The renal system is the slowest regulatory system, taking hours to days to respond. It regulates pH by excreting hydrogen ions (H+) and reabsorbing bicarbonate (HCO3-) in the kidneys, helping to maintain long-term pH balance in the extracellular fluid (ECF). This makes it the most effective system for sustained pH regulation.

C. Respiratory system: The respiratory system responds more quickly than the renal system but not as rapidly as the chemical buffer system. It regulates pH by adjusting the level of carbon dioxide (CO2) in the blood through changes in the rate and depth of breathing.

D. Endocrine system: The endocrine system plays a role in fluid and electrolyte balance but is not directly involved in regulating acid-base balance. It influences pH indirectly through hormones that affect kidney function, but it is not the primary system for pH regulation.

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A licensed practical/vocational nurse (LPN/LVN) is preparing to add a new IV of 5% dextrose in water (D5W) with potassium (K) to an existing line. The LPN/LVN notices that only 25 mL of urine has been collected over the past hour. What is the most appropriate nursing intervention?

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Naxlex Comprehensive Predictor Exams

A client's calcium level is 9.5 mg/dL (Normal 9.0-10.5 mg/dL). A nurse would expect the client's phosphate level to be:

Correct Answer is D

Explanation

The regulatory system of acid-base balance takes the longest time to respond, and regulates pH of extracellular (ECF) by eliminating hydrogen ions or bicarbonate in body fluids.

Correct Answer is B

Explanation

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