Deck 18: Fluid,Electrolyte,and Acid-Base Balances

Question 1

The body's fluid and electrolyte balance is maintained partially by hormonal regulation.The nurse conveys an understanding of this mechanism in which statement?

A) "The pituitary gland secretes aldosterone."
B) "The kidney secretes antidiuretic hormone."
C) "The adrenal cortex secretes antidiuretic hormone."
D) "The pituitary gland secretes antidiuretic hormone."

Answer 1

"The pituitary gland secretes antidiuretic hormone."

Question 2

A patient has been admitted to the postsurgical nursing unit after surgery.The health care provider has ordered the patient to have an IV of 0.9% sodium chloride.The nurse who is caring for the patient recognizes this as what type of solution?

A) Hypotonic
B) Isotonic
C) Hypertonic
D) Hypnotic

Answer 2

Isotonic

Question 3

A patient's arterial blood gas levels indicate a pH of 7.51,PaCO? of 40 mm Hg,PaO? of 85 mm Hg,and HCO? of 32 mEq/L.The patient has been vomiting.The nurse knows the patient has which imbalance?

A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis

Answer 3

Metabolic alkalosis

Question 4

A college freshman has bulimia.She vomits after eating and has recently noticed tingling of her fingers and toes and muscle cramps.Her roommate is a nursing student and is concerned about which imbalance?

A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis

Question 5

A 15-year-old patient suffered a head injury as the result of a bicycle accident.The nurse is concerned about potential fluid complications caused by the injury.What should the nurse monitor most closely?

A) Aldosterone release
B) Urine output
C) Renin release
D) Body temperature

Question 6

A 76-year-old patient is hospitalized with pneumonia and has become increasingly confused throughout the shift.The nurse becomes concerned about the patient's condition and contacts the health care provider,who orders arterial blood gas analysis.The blood gas report shows a pH of 7.33,PaCO? of 47,PaO? of 78,and bicarbonate of 26.This indicates which imbalance?

A) Respiratory alkalosis
B) Respiratory acidosis
C) Metabolic alkalosis
D) Metabolic acidosis

Question 7

The patient is in a coma after a motor vehicle accident.In addition to IV medications,the patient is receiving an isotonic IV fluid.The primary purpose for this fluid infusion is to:

A) cause cells to shrink and reduce swelling.
B) move fluid from intravascular space into cells.
C) pull fluid from cells into the intravascular space.
D) expand the body's intravascular fluid volume.

Question 8

A patient presents to the emergency department complaining of increased urine output.The patient has been drinking alcohol and is still visibly impaired.He is aware of his condition and apologizes,stating that he has never gotten drunk before and if he survives he never will again,but he knows that if he drinks too much he will lose potassium and die.The nurse realizes that the patient is dealing with:

A) antidiuretic hormone (ADH) suppression.
B) ADH stimulation.
C) insensible water loss.
D) angiotensin II release.

Question 9

The patient is on a ventilator.The health care provider has indicated concern about the patient's acid-base status.The nurse anticipates that the health care provider will determine the acid-base levels via:

A) PaO2 measurement.
B) SaO2 levels.
C) chloride levels.
D) arterial blood gas analysis.

Question 10

Which measurement can the nurse delegate to nursing assistive personnel?

A) Oral fluid intake
B) Intravenous fluid intake
C) Tube drainage output
D) Nasogastric tube intake

Question 11

A 7-year-old patient was admitted to the hospital with a high fever.The nurse caring for the child knows that the child has increased insensible water loss resulting from the fever and should receive additional water to prevent hypernatremia.Insensible water loss occurs through which organ?

A) Kidneys
B) GI tract
C) Skin
D) Stomach

Question 12

The patient is taking furosemide (Lasix)and has been complaining of muscle weakness.The nurse should be most concerned about which imbalance?

A) Hyponatremia
B) Hypokalemia
C) Hypochloremia
D) Hyperchloremia

Question 13

A patient has recently been diagnosed with heart failure and has been put on a low sodium diet in the hospital.In addition,the patient has a fluid restriction.The nurse should suggest that half the total oral fluid allotment occur between which two times?

A) 7 AM; 7 PM
B) 3 AM; 3 PM
C) 7 AM; 3 PM
D) 3 PM; 7 AM

Question 14

The nurse works on the cardiac unit of a hospital.The health care provider has ordered 20 mEq of KCl per L to be added to the fluids that the patient is receiving.The patient currently has a bag of D?W IV fluid infusing.Which action is most appropriate?

A) Administer 20 mEq KCl diluted in 5 mL of fluid by IV push in 5 minutes.
B) Estimate the amount of fluid in the IV bag and add KCl to equal 20 mEq/L.
C) Give the KCl undiluted by IV push in 5 minutes for the most rapid action.
D) Check the patient's potassium level before hanging the new IV solution.

Question 15

A 27-year-old patient has seen a health care provider at the local clinic because he has had diarrhea for the past week.The health care provider instructed the patient to drink plenty of fluids,and the nurse clarifies these instructions by advising him to avoid which item as long as he has diarrhea?

A) Ice chips
B) Pedialyte
C) Coffee
D) Tap water

Question 16

A patient has heart failure.The patient's medications include an angiotensin-converting enzyme (ACE)inhibitor,a beta blocker,and a diuretic.To keep the patient safe,the nurse should:

A) weigh the patient daily using different scales for comparison.
B) monitor daily weight, comparing with the previous day's weight.
C) teach that daily weights are done in hospitals, but not at home.
D) weigh the patient at different times of the day to determine trends.

Question 17

A nurse is caring for a patient who is suffering from kidney failure and is receiving peritoneal dialysis.The nurse explains that peritoneal dialysis works by instilling a solution into the abdomen that contains dextrose that will pull extra fluid into the abdominal cavity.What is the name of this process?

A) Diffusion
B) Osmosis
C) Filtration
D) Active transport

Question 18

Which patient has the greatest risk for ECV deficit?

A) A 4-month-old infant with fever and vomiting
B) A 17-year-old adolescent with acute appendicitis
C) A 28-year-old woman with Crohn's disease
D) A 63-year-old man with peptic ulcer disease

Question 19

The patient is unable to eat and there are no bowel sounds,indicating that his bowels are not functioning.The best approach to providing nourishment would be:

A) intravenous crystalloids.
B) blood product administration.
C) parenteral nutrition (PN).
D) colloid administration.

Question 20

Two nursing students were having pizza one evening as they were studying.One student remarked that whenever she ate pizza,she was incredibly thirsty.The second student explained that this thirst was caused by:

A) colloid osmotic pressure.
B) osmoreceptors.
C) oncotic pressure.
D) hydrostatic pressure.

Question 21

Yesterday morning the patient weighed 169.4 lb (77 kg).This morning the patient weighs 171.6 lb (78 kg).The nurse determines that the patient has gained _____ liter(s)of fluid.

Question 22

A nurse is mentoring a new nurse who is learning to start IVs.The nurse tells the new nurse that in case the patient needs subsequent venipuncture sites,the best place to initially start an IV is the:

A) antecubital vein of the patient's nondominant arm.
B) most appropriate distal vein on the nondominant arm.
C) most appropriate proximal vein available on either arm.
D) antecubital vein of the patient's dominant arm.

Question 23

When a nurse is selecting a vein for IV placement,what is the most appropriate action?

A) Select a vein that appears to be well dilated.
B) Elevate the extremity to visualize the vein.
C) Tap and rub the vein vigorously with friction.
D) Stroke from proximal to distal above the site.

Question 24

A nurse is caring for a patient after a bowel resection.The nurse plans assessment based on the knowledge that body fluids maintain balance through homeostasis,which includes what processes? (Select all that apply.)

A) Fluid intake
B) Fluid distribution
C) Fluid output
D) Fluid catabolism

Question 25

A patient has a peripheral IV.The nurse should assess the IV site for what primary signs and symptoms of infiltration? (Select all that apply.)

A) Redness
B) Swelling
C) Pallor
D) Warmth
E) Red streaks

Question 26

During a clinical rotation at an orthopedic unit,a nursing student is caring for a 67-year-old patient who has undergone a knee replacement.The patient is complaining of pain at the IV site.The nursing student assesses the site and finds that the site is cool and pale.The student stops the IV and reports the situation to the nurse.What does the nursing student suspect?

A) Phlebitis
B) Infiltration
C) Thrombophlebitis
D) Local inflammation

Question 27

A 15-year-old adolescent has been recently diagnosed with cancer.The patient will be receiving IV chemotherapy for several weeks.Which vascular access device should be used for short-term administration of his IV fluid?

A) Implanted port
B) Peripherally placed IV catheter
C) Central line
D) Peripherally inserted central catheter

Question 28

The nurse is working for a medical unit in a hospital.The nurse is responsible for obtaining intake and output measurements for patients.What items should be considered intake? (Select all that apply.)

A) Gelatin eaten as a snack or for lunch or dinner
B) Water used to flush tubing between jejunostomy feedings
C) Amount of fluid contained in the gastric suction container
D) Volume of the blood components that were given IV
E) Volume of the postsurgical wound drainage

Question 29

A patient complains of chills,dizziness,and feeling hot during a blood transfusion.What are the nurse's most appropriate actions? (Select all that apply.)

A) Check the patient's vital signs.
B) Stop the blood transfusion.
C) Slow the rate of infusion.
D) Notify the physician and blood bank.

Question 30

The nurse suspects that the patient is experiencing a blood transfusion reaction.The nurse stops the infusion but is concerned about losing the IV line if blood clots in the catheter.The nurse should:

A) replace the entire transfusion line with a new set primed with normal saline.
B) turn off the blood and turn on the normal saline infusion to flush the tubing.
C) discontinue the IV and start a new IV of lactated Ringer's in the other extremity.
D) maintain the patency of the current IV line by hanging a new IV bag of D5W.

Question 31

The nurse is caring for an 84-year-old patient who gets hemodialysis 3 days a week.He is taking corticosteroids and has multiple bruises on his extremities.The patient needs an IV started.When starting the IV,the nurse should:

A) attempt to start the IV in the dorsum of the patient's hand.
B) avoid areas of skin that are red and warm to the touch.
C) use the arm on the side of the patient's dialysis fistula.
D) start the IV in the patient's foot after patient teaching.

Question 32

A patient is diagnosed with renal insufficiency.The results of an ABG analysis indicate metabolic acidosis.In metabolic acidosis,the nurse would expect the pH to decrease to less than _____ and the bicarbonate level to decrease to less than _____.