Deck 13: Fluid and Electrolytes: Balance and Disturbance

Question 1

You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Your patients plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the patients health?

A) Nutritional status
B) Potassium balance
C) Calcium balance
D) Fluid volume status

Answer 1

Fluid volume status

Question 2

You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patients most recent laboratory reports, you note that the patients magnesium levels are high. You should prioritize assessment for which of the following health problems?

A) Diminished deep tendon reflexes
B) Tachycardia
C) Cool, clammy skin
D) Acute flank pain

Answer 2

Diminished deep tendon reflexes

Question 3

You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance?

A) Metabolic alkalosis
B) Hypermagnesemia
C) Hypercalcemia
D) Hypovolemia

Answer 3

Hypovolemia

Question 4

A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acidbase imbalance?

A) Respiratory acidosis
B) Respiratory alkalosis
C) Increased $\mathrm{PaCO}_{2}$
D) CNS disturbances

Question 5

You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: $\mathrm{pH} 7.26, \mathrm{PaCO}_{2} 28, \mathrm{HCO}_{3} 11 \mathrm{mEq} / \mathrm{L}$ . How would you interpret these results?

A) Respiratory acidosis with no compensation
B) Metabolic alkalosis with a compensatory alkalosis
C) Metabolic acidosis with no compensation
D) Metabolic acidosis with a compensatory respiratory alkalosis

Question 6

You are making initial shift assessments on your patients. While assessing one patients peripheral IV site, you note edema around the insertion site. How should you document this complication related to IV therapy?

A) Air emboli
B) Phlebitis
C) Infiltration
D) Fluid overload

Question 7

You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patients skin turgor?

A) Overhydration is common among healthy older adults.
B) Dehydration causes the skin to appear spongy.
C) Inelastic skin turgor is a normal part of aging.
D) Skin turgor cannot be assessed in patients over 70 .

Question 8

The physician has ordered a peripheral IV to be inserted before the patient goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter?

A) Choose a hairless site if available.
B) Consider potential effects on the patients mobility when selecting a site.
C) Have the patient briefly hold his arm over his head before insertion.
D) Leave the tourniquet on for at least 3 minutes.

Question 9

A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patients blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following?

A) Hydrostatic pressure
B) Osmosis and osmolality
C) Diffusion
D) Active transport

Question 10

You are the surgical nurse caring for a 65 -year-old female patient who is postoperative day 1 following a thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should you first suspect?

A) Hypophosphatemia
B) Hypocalcemia
C) Hypermagnesemia
D) Hyperkalemia

Question 11

A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, A patient in renal failure partially loses the ability to regulate changes in $\mathrm{pH}$ . What is the cause of this partial inability?

A) The kidneys regulate and reabsorb carbonic acid to change and maintain $\mathrm{pH}$ .
B) The kidneys buffer acids through electrolyte changes.
C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable $\mathrm{pH}$ .
D) The kidneys combine carbonic acid and bicarbonate to maintain a stable $\mathrm{pH}$ .

Question 12

You are caring for a 65 -year-old male patient admitted to your medical unit 72 hours ago with pyloric stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since. Upon review of the mornings blood work, you notice that the patients potassium is below reference range. You should recognize that the patient may be at risk for what imbalance?

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

Question 13

The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV antibiotics. How should the nurse always start the process of insertion?

A) Leave one hand ungloved to assess the site.
B) Cleanse the skin with normal saline.
C) Ask the patient about allergies to latex or iodine.
D) Remove excessive hair from the selected site.

Question 14

A patient who is being treated for pneumonia starts complaining of sudden shortness of breath. An arterial blood gas $(\mathrm{ABG})$ is drawn. The $\mathrm{ABG}$ has the following values: $\mathrm{pH} 7.21, \mathrm{PaCO}_{2} 64 \mathrm{~mm} \mathrm{Hg}$ , $\mathrm{HCO}_{3}=24 \mathrm{~mm} \mathrm{Hg}$ . What does the ABG reflect?

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

Question 15

One day after a patient is admitted to the medical unit, you note that the patient is oliguric. You notify the acute-care nurse practitioner who orders a fluid challenge of $200 \mathrm{~mL}$ of normal saline solution over 15 minutes. This intervention will achieve which of the following?

A) Help distinguish hyponatremia from hypernatremia
B) Help evaluate pituitary gland function
C) Help distinguish reduced renal blood flow from decreased renal function
D) Help provide an effective treatment for hypertension-induced oliguria

Question 16

The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom. What would be the nurses best response?

A) I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup.
B) Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids.
C) It is normal to be a little confused following surgery, and it is safe not to urinate at night.
D) If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress.

Question 17

A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and $40 \mathrm{~mL}$ of urine is present. What is the nurses most likely explanation for the low urine output?

A) The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.
B) The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin.
C) The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output.
D) The man is having a sympathetic reaction, which has stimulated the reninangiotensinaldosterone system that results in diminished urine output.

Question 18

A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How should these nurses be encouraged to deal with excess hair at the intended site?

A) Leave the hair intact.
B) Shave the area.
C) Clip the hair in the area.
D) Remove the hair with a depilatory.

Question 19

You are the nurse evaluating a newly admitted patients laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone $(\mathrm{ADH})$ ?

A) Increased serum sodium
B) Decreased serum potassium
C) Decreased hemoglobin
D) Increased platelets

Question 20

A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurses preceptor is going over the patients past lab reports with the new nurse. The nurse takes note that the patients $\mathrm{PaCO}_{2}$ has been between 56 and $64 \mathrm{~mm} \mathrm{Hg}$ for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurses best response?

A) The patients calcium will rise dramatically due to pituitary stimulation.
B) Oxygen will increase the patients intracranial pressure and create confusion.
C) Oxygen may cause the patient to hyperventilate and become acidotic.
D) Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.

Question 21

The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process?

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

Question 22

When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur?

A) Active transport of hydrogen ions across the capillary walls
B) Pressure of the blood in the renal capillaries
C) Action of the dissolved particles contained in a unit of blood
D) Hydrostatic pressure resulting from the pumping action of the heart

Question 23

The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect?

A) Decrease in the release of aldosterone
B) Increase of filtration in the Loop of Henle
C) Decrease in the reabsorption of sodium
D) Decrease in glomerular filtration

Question 24

You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle accident. You and your colleague note that the patients labs indicate minimally elevated serum creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older adults?

A) Substantially reduced renal function
B) Acute kidney injury
C) Decreased cardiac output
D) Alterations in ratio of body fluids to muscle mass

Question 25

You are the nurse caring for a patient who is to receive IV daunorubicin, a chemotherapeutic agent. You start the infusion and check the insertion site as per protocol. During your most recent check, you note that the IV has infiltrated so you stop the infusion. What is your main concern with this infiltration?

A) Extravasation of the medication
B) Discomfort to the patient
C) Blanching at the site
D) Hypersensitivity reaction to the medication

Question 26

The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at $125 \mathrm{~mL} / \mathrm{hr}$ . The patient reports pain at the incision site rated at a 3 on a 0 -to- 10 rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs) and you suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to exhibit?

A) Diarrhea
B) Dilute urine
C) Increased muscle tone
D) Joint pain

Question 27

You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. During your assessment, you note the patient complains of a new onset of weakness with abdominal pain. Further assessment suggests that the patient likely has a fluid volume deficit. You should recognize that this patient may be experiencing what electrolyte imbalance?

A) Hypernatremia
B) Hypomagnesemia
C) Hypophosphatemia
D) Hypercalcemia

Question 28

A medical nurse educator is reviewing a patients recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?

A) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.
B) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.
C) The kidneys react rapidly to compensate for imbalances in the body.
D) The kidneys regulate the bicarbonate level in the intracellular fluid.

Question 29

The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequate ventilation. What diagnosis could the patient have that could cause inadequate ventilation?

A) Endocarditis
B) Multiple myeloma
C) Guillain-Barr syndrome
D) Overdose of amphetamines

Question 30

The ICU nurse is caring for a patient who experienced trauma in a workplace accident. The patient is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: $\mathrm{pH}$ $7.28, \mathrm{PaCO}_{2} 50 \mathrm{~mm} \mathrm{Hg}, \mathrm{HCO}_{3} 23 \mathrm{mEq} / \mathrm{L}$ . The nurse should recognize the likelihood of what acidbase disorder?

A) Respiratory acidosis
B) Metabolic alkalosis
C) Respiratory alkalosis
D) Mixed acidbase disorder

Question 31

A patient has questioned the nurses administration of IV normal saline, asking whether sterile water would be a more appropriate choice than saltwater. Under what circumstances would the nurse administer electrolyte-free water intravenously?

A) Never, because it rapidly enters red blood cells, causing them to rupture.
B) When the patient is severely dehydrated resulting in neurologic signs and symptoms
C) When the patient is in excess of calcium and/or magnesium ions
D) When a patients fluid volume deficit is due to acute or chronic renal failure

Question 32

A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply.

A) Decreased kidney mass
B) Increased conservation of sodium
C) Increased total body water
D) Decreased renal blood flow
E) Decreased excretion of potassium

Question 33

You are called to your patients room by a family member who voices concern about the patients status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find $3+$ pitting edema. What electrolyte imbalance is the most plausible cause of this patients signs and symptoms?

A) Hypocalcemia
B) Hyponatremia
C) Hyperchloremia
D) Hypophosphatemia

Question 34

Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis?

A) Metastases
B) Excessive potassium intake
C) Water intoxication
D) Excessive administration of chloride

Question 35

The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the medication orders?

A) Cimetidine
B) Maalox
C) Potassium chloride elixir
D) Furosemide

Question 36

You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a vague historian. The patient appears malnourished and on day 3 of the patients admission total parenteral nutrition (TPN) has been started. Why would you know to start the infusion of TPN slowly?

A) Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.
C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
D) Patients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to accumulate

Question 37

You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? Select all that apply.

A) Milk
B) Beef
C) Poultry
D) Green vegetables
E) Liver

Question 38

You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis?

A) Hypertension
B) Kussmaul respirations
C) Increased DTRs
D) Shallow respirations

Question 39

A patients most recent laboratory results show a slight decrease in potassium. The physician has opted to forego drug therapy but has suggested increasing the patients dietary intake of potassium. Which of the following would be a good source of potassium?

A) Apples
B) Asparagus
C) Carrots
D) Bananas

Question 40

The nurse is assessing the patient for the presence of a Chvosteks sign. What electrolyte imbalance would a positive Chvosteks sign indicate?

A) Hypermagnesemia
B) Hyponatremia
C) Hypocalcemia
D) Hyperkalemia