Deck 6: Nursing Care of Patients With Fluid, Electrolytes, and Acid-Base Imbalances

Question 1

While assessing an older adult patient with fluid excess, the nurse notes the following: T = 98.6°F, P = 92, R = 18, BP = 166/88 mm Hg, bilateral crackles, oxygen saturation = 95%. Which action should the nurse take first?

A)Provide oxygen at 2 L per nasal cannula.
B)Place the patient in a high Fowler position.
C)Provide a urinal and encourage the patient to void.
D)Lay the patient flat in bed to listen to bowel sounds.

Answer 1

Place the patient in a high Fowler position.

Question 2

The nurse is caring for a patient with fluid volume excess. Which medication can the nurse expect to administer?

A)Pamidronate disodium (Aredia)
B)Potassium chloride
C)Furosemide (Lasix)
D)Calcium gluconate

Answer 2

Furosemide (Lasix)

Question 3

The nurse is reviewing laboratory results for a group of patients. Which value should be of most concern to the nurse?

A)Sodium level 140 mEq/L
B)Magnesium level 1.0 mEq/L
C)Potassium level 3.5 mEq/L
D)Calcium level 10 mg/dL

Answer 3

Magnesium level 1.0 mEq/L

Question 4

A patient develops an irregular heart rate, abdominal cramping, and diarrhea after a thyroidectomy. Which emergency medication should the nurse anticipate being prescribed for this patient?

A)Furosemide (Lasix)
B)Calcium gluconate
C)Potassium chloride
D)Diazepam (Valium)

Question 5

The nurse is caring for a patient with arterial blood gas results of: pH 7.18, PCO₂ 42, HCO₃ 15, and Pa O₂ 84%. The patient has a blood glucose level of 84

A)Respiratory acidosis
B)Metabolic acidosis
C)Respiratory alkalosis
D)Metabolic alkalosis
E) How should the nurse interpret these results?

Question 6

A patient with hypertension is placed on a low-sodium diet. The nurse recognizes that further teaching is necessary if the patient chooses which menu?

A)Pork chop, steamed brown rice, and fruit cocktail
B)Broiled salmon, mashed sweet potato, broccoli, and pumpkin pie
C)Tomato soup, grilled cheese sandwich, salad, and chocolate chip cookie
D)Grilled chicken, boiled potatoes, frozen green beans, and gelatin dessert

Question 7

The nurse reviews the following results for an arterial blood gas (ABG). How does the nurse interpret these results? pH 7.46, PCO₂ 34, HCO₃ 26, PaO₂ 88%

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

Question 8

The nurse is caring for a patient with dehydration. The patient asks the nurse about the cause. Which does the nurse identify as the most likely cause?

A)Constipation
B)Nausea
C)Kidney failure
D)Profuse diaphoresis

Question 9

The nurse is preparing to administer furosemide (Lasix) to a patient with a potassium level of 2.8 mEq/L. Which action should the nurse take?

A)Administer the medication as ordered.
B)Notify the HCP before administering the dose.
C)Hold the medication and document the potassium level.
D)Give the patient half of the ordered dose.

Question 10

An older adult with gastroenteritis is disoriented and weak and has the following laboratory test results: Hematocrit (Hct) 56% (normal 40%-51%)
Blood urea nitrogen (BUN) 32 mg/dL (normal 6-20 mg/dL)
Which nursing diagnosis should the nurse select for this patient?

A)Risk for injury
B)Excess fluid volume
C)Deficient fluid volume
D)Impaired skin integrity

Question 11

The nurse is told to administer IV fluid the same osmolarity as blood. Which fluid can the nurse expect to administer?

A)0.9% normal saline
B)0.45% saline (1/2 NS)
C)10% dextrose in water (D10W)
D)5% dextrose in 0.9% saline (D5NS)

Question 12

An older adult patient has an IV infusion of 0.45% normal saline infusing at 150 mL/hr. Which assessment finding should cause the nurse to be most concerned?

A)Tenderness at the IV site
B)Capillary refill is <3 seconds
C)Urine specific gravity is 1.018
D)Newly noted crackles in the lungs

Question 13

The nurse is using Chvostek sign to assess for hypocalcemia. Which statement correctly describes this test?

A)Inflate a blood pressure cuff around the upper arm for 4 minutes.
B)Apply pressure over the ulnar and radial arteries.
C)Tap the face just below and in front of the ear.
D)Forcefully dorsiflex the ankle when the knee is in an extended position.

Question 14

An older patient is admitted for treatment of fluid volume excess. For which serious respiratory complication of fluid volume excess should the nurse assess this patient?

A)Pulmonary edema
B)Pulmonary infarction
C)Pulmonary fibrosis
D)Pulmonary embolism

Question 15

The nurse is caring for a patient who is being treating for fluid volume excess. Which assessment finding indicates that treatment has been effective?

A)Respiratory rate 24/min
B)Output 1,500 mL in 24 hours
C)Blood pressure 132/80 mm Hg
D)Weight loss of 5 lb in 24 hours

Question 16

The nurse is caring for a group of patients. Which patient most warrants a phone call to the health care provider (HCP)?

A)A patient with end-stage renal failure and 1+ pitting edema
B)A patient who is crying and wants a visitor
C)A patient with abdominal cramping and hyperactive deep tendon reflexes
D)A patient who just received furosemide (Lasix) for hypervolemia

Question 17

The nurse is concerned that an older patient is at risk for dehydration. What reduced function did the nurse assess in this patient?

A)Filtration
B)Kidney function
C)Sensation of thirst
D)Cardiac contractility

Question 18

Which serum pH can the nurse expect to see in a patient with chronic obstructive pulmonary disease (COPD)?

A)7.30
B)7.40
C)7.50
D)7.60

Question 19

A patient with uncontrolled diabetes mellitus develops metabolic acidosis. Which assessment finding indicates that the patient's compensatory mechanisms are working?

A)Vomiting
B)Excessive thirst
C)Watery diarrhea
D)Deep rapid breathing

Question 20

The nurse is caring for a group of patients. Which patient is at highest risk for hyponatremia?

A)A patient with a nasogastric tube connected to suction
B)A patient with chronic constipation
C)A patient who experienced a saltwater near-drowning
D)A patient with diabetes insipidus

Question 21

A patient with dehydration is prescribed 1 L of 0.9% normal saline intravenously to run over 8 hours. At what rate should the nurse set the infusion pump? Enter the numeral only.

Question 22

The nurse is preparing to administer furosemide (Lasix) 40 mg intravenously to a patient with heart failure. Available is furosemide (Lasix) 20 mg/mL vials. How many mL will the nurse administer? Enter the numeral only.

Question 23

The nurse is planning care for a patient with a fluid volume excess and a serum sodium level of 125 mg/dL. Which interventions should the nurse include in this patient's plan of care? (Select all that apply.)

A)Weigh daily.
B)Monitor strict intake and output.
C)Administer diuretics as prescribed.
D)Implement fluid restriction as prescribed.
E)Administer IV saline as prescribed.

Question 24

The nurse is caring for a patient with hypokalemia. Which clinical manifestations can the nurse expect to find upon assessment? (Select all that apply.)

A)Muscle cramping
B)Weak and thready pulse
C)Nausea
D)Diarrhea
E)Hyperactive deep tendon reflexes (DTRs)

Question 25

The nurse is caring for a group of patients. Which patient is at highest risk for hypovolemia?

A)A patient with congestive heart failure
B)A patient with end-stage kidney failure
C)A patient who received 6 liters of IV fluid
D)A patient who lost 2 liters of blood during surgery

Question 26

The nurse is teaching a patient about taking oral potassium supplements. Which topics should the nurse cover in the teaching? (Select all that apply.)

A)Take potassium supplements on an empty stomach.
B)Keep appointments for laboratory tests to check potassium level.
C)It is okay to supplement the potassium supplement for a cheaper version.
D)Do not crush extended-release potassium tablets.
E)Nausea, vomiting, and diarrhea are normal side effects of this medication.

Question 27

During an assessment, the nurse learns that an older patient has been taking twice the prescribed amount of calcium supplements. Which physical assessment findings should the nurse identify as being consistent with this patient's intake of calcium? (Select all that apply.)

A)Muscle weakness
B)Faint bowel sounds
C)Increased heart rate
D)Elevated blood pressure
E)Dry mucous membranes

Question 28

A patient having a severe anxiety attack has an arterial blood gas result showing respiratory alkalosis. Which nursing action should the nurse take first?

A)Administer nasal oxygen at 6 L/min.
B)Give the patient a glass of orange juice.
C)Place the patient in high Fowler position.
D)Have the patient rebreathe air from a paper bag.

Question 29

The nurse is caring for a group of patients. Which patient is at highest risk for developing metabolic alkalosis?

A)A patient with COPD
B)A patient with diabetes
C)A patient with severe anxiety
D)A patient with prolonged vomiting

Question 30

The nurse is teaching a patient with a calcium level of 7.8 mg/dL about food choices. Which food choice made by the patient indicates an understanding of the teaching?

A)1.5 ounces of cheddar cheese
B)1 large apple
C)1 small steak
D)1-ounce potato chips

Question 31

The nurse is caring for a group of patients. Prioritize from 1 to 4, with one being the highest priority, the order in which the nurse should assess the patients. __

A) A 47-year-old patient who reports two loose stools and feels nauseated __
B) A 52-year-old patient with fluid volume excess and 2+ pedal edema __
C) A 60-year-old patient with a potassium level of 2.6 mEq/L and heart palpitations __
D) A 71-year-old patient with a calcium level of 10 mg/dL and negative Trousseau sign