Deck 40: Fluid, electrolyte, and Acid-base Balances

Question 1

The nurse is caring for a patient who has diabetes and is in renal failure.Which laboratory findings would the nurse expect?

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

Answer 1

pH of 7.3,PaCO₂ of 36 mm Hg,HCO₃^- level of 19 mEq/L (19 mmol/L).

Question 2

The nurse would expect a patient with increased levels of serum calcium to also have which abnormal values?

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

Answer 2

Decreased phosphate levels.

Question 3

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.

Answer 3

A 24-year-old adult admitted for chronic alcohol abuse.

Question 4

A patient receiving chemotherapy has gained 2 kg (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?"

Question 5

The nurse would expect a patient with respiratory acidosis to have an excessive amount of which of the following?

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

Question 6

What is the most abundant cation in the blood?

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

Question 7

The nurse understands that administering a hypertonic solution to a patient will shift water from which space to which space?

A)Intracellular to extracellular.
B)Extracellular to intracellular.
C)Intravascular to intracellular.
D)Intravascular to interstitial.

Question 8

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

Question 9

What is the process of passively moving water from an area of lower particle concentration to an area of higher particle concentration?

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

Question 10

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 11

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 12

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

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

Question 13

Approximately two thirds of the body's total water volume exists in which fluid?

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

Question 14

The nurse is assessing a patient and finds crackles in the lung bases and neck vein distension.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.

Question 15

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

A)Sodium level of 145 mmol/L (145 mEq/L).
B)Calcium level of 4.5 mmol/L (17.5 mg/dL).
C)Potassium level of 3.5 mmol/L (3.5 mEq/L).
D)Chloride level of 100 mmol/L (100 mEq/L).

Question 16

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

A)Partial pressure of arterial oxygen (PaO₂).
B)Anion gap.
C)PaCO₂.
D)HCO₃^-.

Question 17

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 18

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

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

Question 19

Which organ system is responsible for compensation of respiratory acidosis?

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

Question 20

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

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

Question 21

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

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

Question 22

A nurse is caring for a patient with diabetes who has 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 a nasogastric suction tube set to low continuous suction,which yielded an output of 300 mL.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 IV fluids to 100 mL/hr.
C)Discontinue the nasogastric suctioning.
D)Administer a diuretic to prevent fluid volume excess.

Question 23

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 24

The nurse knows that IV fluid therapy has been effective for a patient with hypernatremia when what happens?

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 25

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 distension.The nurse recognizes that the patient is experiencing which transfusion complication?

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

Question 26

A patient informs the nurse that he has the type of diabetes that does not have to do with "blood sugar." 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 glucose levels.
D)Include a serving of dairy in each meal to elevate calcium levels.

Question 27

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 28

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 solution.
D)Dextrose 5% in 0.9% sodium chloride.

Question 29

The physician asks the nurse to monitor the fluid volume statuses of a patient with heart failure 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 30

A patient was admitted for hypovolemia and has IV 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 which of the following?

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

Question 31

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

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 32

A patient had an acute intravascular hemolytic reaction during 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 to-keep-open (TKO)rate with new tubing.
C)Discontinue the IV catheter.
D)Return the blood to the blood bank.

Question 33

A nurse is caring for a patient who is in hypertensive crisis.When the nurse is flushing the patient's peripheral IV line,the patient complains of pain.Upon assessment,the nurse notices a red streak near the IV site 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 34

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

A)Check the colour 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 35

A nurse begins infusing a 250-mL bag of IV fluid at 1845 hours 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 36

The nurse selects appropriate tubing for a blood transfusion by ensuring that the tubing has which of the following?

A)Two-way valves to allow the patient's blood to mix and warm the incoming transfused blood.
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 37

A patient has the following laboratory values: sodium level,145 mmol/L (145 mEq/L);potassium level,4.5 mmol/L (4.5 mEq/L);calcium level,1.05 mmol/L (4.5 mg/dL).What would the nurse expect to find in the assessment?

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

Question 38

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 39

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

A)A continuous infusion.
B)A peripheral catheter with a heparin lock.
C)A peripherally inserted central catheter (PICC)line.
D)An implanted port catheter.

Question 40

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 41

When selecting a site to insert an IV catheter on an adult,the nurse should follow which procedure? (Select all that apply. )

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 using the extremity.
E)Select a vein that is rigid.
F)Avoid areas of flexion.

Question 42

How does the nurse discontinue peripheral IV access? (Select all that apply. )

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.

Question 43

Which of the following assessments would indicate infiltration of a patient's IV line? (Select all that apply. )

A)Edema of the extremity near the insertion site.
B)Skin discoloured 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.