Deck 41: Fluid, electrolyte, and Acid-Base Balance

Question 1

The nurse is assessing a patient and finds crackles in the lung bases and neck vein distention.The nurse gives the patient a diuretic.What electrolyte imbalance is the nurse most concerned about?

A) Potassium imbalance
B) Sodium imbalance
C) Calcium imbalance
D) Phosphate imbalance

Answer 1

Potassium imbalance

Question 2

A chemotherapy patient has gained 5 pounds in 2 days.Which assessment question by the nurse is most appropriate?

A) "Are you having difficulty sleeping at night?"
B) "How many calories a day do you consume?"
C) "Do you have dry mouth or feel thirsty?"
D) "How many times a day do you urinate?"

Answer 2

"How many times a day do you urinate?"

Question 3

The nurse knows that the most abundant cation in the blood is

A) Sodium.
B) Potassium.
C) Chloride.
D) Magnesium.

Answer 3

Sodium.

Question 4

The nurse knows that an imbalance of which ion causes acid-base impairment?

A) Hydrogen
B) Calcium
C) Magnesium
D) Sodium

Question 5

Which patient is most at risk for sensible water loss?

A) A 7-year-old child with asthma
B) A 24-year-old adult with constipation
C) A 56-year-old patient with gastroenteritis
D) An 80-year-old patient with pneumonia

Question 6

The nurse knows that edema in a patient who has venous congestion from right heart failure is facilitated by an imbalance with regard to _____ pressure.

A) Hydrostatic
B) Osmotic
C) Oncotic
D) Concentration

Question 7

In which patient would the nurse expect to see a positive Chvostek sign?

A) A 7-year-old child admitted for severe burns
B) A 24-year-old adult admitted for chronic alcohol abuse
C) A 50-year-old patient admitted for an acute exacerbation of hyperparathyroidism
D) A 75-year-old patient admitted for a broken hip related to osteoporosis

Question 8

A 2-year-old child was brought into the emergency department after ingesting several morphine tablets from a bottle in his mother's purse.The nurse knows that the child is at greatest risk for which acid-base imbalance?

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

Question 9

Which organ system is responsible for compensation of respiratory acidosis?

A) Respiratory
B) Renal
C) Gastrointestinal
D) Endocrine

Question 10

The nurse is caring for a diabetic patient in renal failure.Which laboratory findings would the nurse expect?

A) pH 7.3, PaCO₂ 36 mm Hg, HCO₃^- 19 mEq/L
B) pH 7.5, PaCO₂ 35 mm Hg, HCO₃^- 35 mEq/L
C) pH 7.3, PaCO₂ 47 mm Hg, HCO₃^- 23 mEq/L
D) pH 7.35, PaCO₂ 40 mm Hg, HCO₃^- 25 mEq/L

Question 11

The nurse would not expect full compensation to occur for which acid-base imbalance?

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

Question 12

The nurse understands that administering a hypertonic solution to a patient will shift water from the _____ to the _____ space.

A) Intracellular; extracellular
B) Extracellular; intracellular
C) Intravascular; intracellular
D) Intravascular; interstitial

Question 13

Which laboratory value should the nurse examine when evaluating uncompensated respiratory alkalosis?

A) PaO₂
B) Anion gap
C) PaCO₂
D) HCO₃^-

Question 14

Approximately two thirds of the body's total water volume exists in the _____ fluid.

A) Intracellular
B) Interstitial
C) Intravascular
D) Transcellular

Question 15

A nurse is caring for a patient whose ECG presents with changes characteristic of hypokalemia.Which assessment finding would the nurse expect?

A) Thready peripheral pulses
B) Abdominal distention
C) Dry mucous membranes
D) Flushed skin

Question 16

The process of passively moving water from an area of lower particle concentration to an area of higher particle concentration is known as

A) Hydrolysis.
B) Osmosis.
C) Filtration.
D) Active transport.

Question 17

A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low intermittent suction for the past 3 days.The patient's respiratory rate has decreased to 12 breaths per minute.The nurse would expect the patient to have which of the following arterial blood gas values?

A) pH 7.78, PaCO₂ 40 mm Hg, HCO₃^- 30 mEq/L
B) pH 7.52, PaCO₂ 48 mm Hg, HCO₃^- 28 mEq/L
C) pH 7.35, PaCO₂ 35 mm Hg, HCO₃^- 26 mEq/L
D) pH 7.25, PaCO₂ 47 mm Hg, HCO₃^- 29 mEq/L

Question 18

The nurse would expect a patient with respiratory acidosis to have an excessive amount of

A) Carbon dioxide.
B) Bicarbonate.
C) Oxygen.
D) Phosphate.

Question 19

The nurse receives the patient's most recent blood work results.Which laboratory value is of greatest concern?

A) Sodium of 145 mEq/L
B) Calcium of 17.5 mg/dL
C) Potassium of 3.5 mEq/L
D) Chloride of 100 mEq/L

Question 20

The nurse would expect a patient with increased levels of serum calcium to also have _____ levels.

A) Increased potassium
B) Decreased phosphate
C) Decreased sodium
D) Increased magnesium

Question 21

A nurse is caring for a diabetic patient with a bowel obstruction and has orders to ensure that the volume of intake matches the output.In the past 4 hours,the patient received dextrose 5% with 0.9% sodium chloride through a 22-gauge catheter infusing at 150 mL/hr and has eaten 200 mL of ice chips.The patient also has an NG suction tube set to low continuous suction that had 300 mL output.The patient has voided 400 mL of urine.After reporting these values to the physician,what orders does the nurse anticipate?

A) Add a potassium supplement to replace loss from output.
B) Decrease the rate of intravenous fluids to 100 mL/hr.
C) Discontinue the nasogastric suctioning.
D) Administer a diuretic to prevent fluid volume excess.

Question 22

A patient presents to the emergency department with the complaint of vomiting and diarrhea for the past 48 hours.The nurse anticipates which fluid therapy initially?

A) 0.9% sodium chloride
B) Dextrose 10% in water
C) Dextrose 5% in water
D) 0.45% sodium chloride

Question 23

The nurse selects appropriate tubing for a blood transfusion by ensuring that the tubing has

A) Two-way valves to allow the patient's blood to mix and warm the blood transfusing.
B) An injection port to mix additional electrolytes into the blood.
C) An air vent to let bubbles in the blood escape.
D) A filter to ensure that clots do not enter the patient.

Question 24

A nurse has just received a bag of packed red blood cells.The nurse knows that the blood must not remain at room temperature for longer than

A) 30 minutes.
B) 1 hour.
C) 2 hours.
D) 4 hours.

Question 25

The physician asks the nurse to monitor the fluid volume status of a congestive heart failure patient and a patient at risk for clinical dehydration.What is the most effective nursing intervention for monitoring both of these patients?

A) Weigh the patients every morning before breakfast.
B) Ask the patients to record their intake and output.
C) Measure the patients' blood pressure every 4 hours.
D) Assess the patients for edema in extremities.

Question 26

A patient is to receive 1500 mL of 0.9% sodium chloride intravenously at a rate of 125 mL/hr.The nurse is using microdrip gravity drip tubing.What is the minute flow rate (drops per minute)?

A) 12 gtt/min
B) 24 gtt/min
C) 125 gtt/min
D) 150 gtt/min

Question 27

A nurse is caring for a patient who is in hypertensive crisis.When the nurse is flushing the patient's peripheral IV,the patient complains of pain.Upon assessment,the nurse notices a red streak that is warm to the touch.What is the nurse's initial action?

A) Notify the physician.
B) Administer pain medication.
C) Discontinue the IV.
D) Start a new IV line.

Question 28

A nurse begins infusing a 250-mL bag of IV fluid at 1845 on Monday and programs the pump to infuse at 20 mL/hr.At what time should the infusion be completed?

A) 0645 Tuesday
B) 0675 Tuesday
C) 0715 Tuesday
D) 0735 Tuesday

Question 29

Which assessment finding should cause a nurse to question administering a sodium-containing isotonic intravenous fluid?

A) Blood pressure 102/58
B) Dry mucous membranes
C) Poor skin turgor
D) Pitting edema

Question 30

A patient had an acute intravascular hemolytic reaction to a blood transfusion.After discontinuing the blood transfusion,what is the nurse's next action?

A) Run normal saline through the existing tubing.
B) Start normal saline at TKO rate using new tubing.
C) Discontinue the IV catheter.
D) Return the blood to the blood bank.

Question 31

The nurse is caring for a patient with sepsis.The plan of care for the patient is to administer antibiotics 3 times a day for 4 weeks.What device will be used to administer these antibiotics?

A) A continuous infusion
B) A heparin locked peripheral catheter
C) A PICC line
D) An implanted port catheter

Question 32

A patient was admitted for hypovolemia and has intravenous fluid running at 250 mL/hr.The patient complains of burning at the IV insertion site.Upon assessment,the nurse does not find redness,swelling,heat,or coolness.The nurse suspects that the

A) IV has infiltrated.
B) IV has caused phlebitis.
C) Fluid is infusing too quickly.
D) Patient is allergic to the fluid.

Question 33

A patient with a lower respiratory infection has pH of 7.25,PaCO₂ of 55 mm Hg,and HCO₃^- of 20 mEq/L.The physician has been notified.Which is the priority nursing intervention for this patient?

A) Check the color of the patient's urine output.
B) Place the patient in Trendelenburg position.
C) Encourage the patient to increase respirations.
D) Place the patient in high Fowler's position.

Question 34

The nurse knows that intravenous fluid therapy has been effective for a patient with hypernatremia when

A) Serum sodium concentration returns to normal.
B) Systolic and diastolic blood pressure decrease.
C) Large amounts of emesis and diarrhea decrease.
D) Urine output increases to 150 mL/hr.

Question 35

Which fluid order should the nurse question for a patient with a traumatic brain injury?

A) 0.45% sodium chloride
B) 0.9% sodium chloride
C) Lactated Ringer's
D) Dextrose 5% in 0.9% sodium chloride

Question 36

The nurse would select the dorsal venous plexus of the foot as an IV site for which patient?

A) A 2-year-old child
B) A 22-year-old adult
C) A 50-year-old patient
D) An 80-year-old patient

Question 37

A nurse is caring for a cancer patient who presents with anorexia,blood pressure 100/60,elevated white blood cell count,and oral candidiasis.The nurse knows that the purpose of starting total parenteral nutrition (TPN)is to

A) Replace fluid, electrolytes, and nutrients in the patient.
B) Stimulate the patient's appetite to eat.
C) Provide medication to raise the patient's blood pressure.
D) Deliver antibiotics to fight off infection.

Question 38

A nurse is preparing to administer a blood transfusion.Which assessment finding would the nurse report immediately?

A) Blood pressure 120/60
B) Temperature 101.3° F
C) Poor skin turgor and pallor
D) Heart rate of 100 beats per minute

Question 39

A nurse is assessing a patient who is receiving a blood transfusion and finds that the patient is anxiously fidgeting in bed.The patient is afebrile and dyspneic.The nurse auscultates crackles in both lung bases and sees jugular vein distention.The nurse recognizes that the patient is experiencing which transfusion complication?

A) Anaphylactic shock
B) Septicemia
C) Fluid volume overload
D) Hemolytic reaction

Question 40

The nurse is caring for a patient with hyperkalemia.Which body system would be most important for the nurse plan to monitor closely?

A) Gastrointestinal
B) Neurological
C) Cardiac
D) Respiratory

Question 41

When selecting a site to insert an intravenous catheter on an adult,the nurse should

A) Start proximally and move distally on the arm.
B) Choose a vein with minimal curvature.
C) Choose the patient's dominant arm.
D) Check for contraindications to the extremity.
E) Select a vein that is rigid.
F) Avoid areas of flexion.

Question 42

A patient informs the nurse that he has the type of diabetes that does not require insulin.The nurse advises the patient to make which dietary change?

A) Drink plenty of fluids throughout the day to stay hydrated.
B) Avoid food high in acid to avoid metabolic acidosis.
C) Reduce the quantity of carbohydrates ingested to lower blood sugar.
D) Include a serving of dairy in each meal to elevate calcium levels.

Question 43

Which assessment finding would the nurse expect for a patient with the following laboratory values: sodium 145 mEq/L,potassium 4.5 mEq/L,calcium 4.5 mg/dL?

A) Lightheadedness when standing up
B) Weak quadriceps muscles
C) Tingling of the extremities and tetany
D) Decreased deep tendon reflexes

Question 44

Which of the following assessments would indicate that a patient's IV has infiltrated?

A) Edema of the extremity near the insertion site
B) Skin discolored or bruised in appearance
C) Pain and warmth at the insertion site
D) Skin cool to the touch
E) Reddish streak proximal to the insertion site
F) Numbness or loss of sensation
G) Palpable venous cord

Question 45

When discontinuing a peripheral IV access,the nurse should

A) Use scissors to remove the IV site dressing and tape.
B) Keep the catheter parallel to the skin while removing it.
C) Apply firm pressure with sterile gauze during removal.
D) Stop the infusion before removing the IV catheter.
E) Wear sterile gloves and a mask.
F) Apply pressure to the site for 2 to 3 minutes after removal.