Deck 38: Fluids,Electrolytes, Acidbase Balance

Question 1

Which process requires energy to maintain the unique composition of extracellular and intracellular compartments?

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

Answer 1

Active transport

Question 2

A patient's arterial blood gas results are as follows: pH = 7.30; PCO₂ = 40; HCO₃ = 19 mEq/L; PO₂ = 80.An appropriate nursing diagnosis for the patient is which of the following?

A) Impaired Gas Exchange
B) Metabolic Acidosis
C) Risk for Impaired Gas Exchange
D) Risk for Acid-Base Imbalance

Answer 2

Impaired Gas Exchange

Question 3

Which electrolyte is the primary regulator of fluid volume?

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

Answer 3

Sodium

Question 4

A patient is receiving an IV infusion of lactated Ringer's solution and 40 mEq of KCl at 100 mL/hr.When assessing the IV site,the nurse notes swelling,erythema,and warmth.There is a palpable cord along the vein,and the infusion is sluggish.The patient is complaining of pain at the site.The nurse would recognize these findings to be consistent with which of the following?

A) Infiltration
B) Extravasation
C) Hematoma
D) Phlebitis

Question 5

A patient receiving a unit of whole blood begins to complain of "feeling funny" and having chills.The nurse assesses that the patient has dyspnea,hypotension,and tachycardia.Which blood transfusion reaction should the nurse suspect?

A) Febrile
B) Circulatory overload
C) Hemolytic
D) Allergic

Question 6

A patient's vital signs prior to a blood transfusion were: T = 97.6°F (36.4°C); P = 72 beats/min; R = 22 breaths/min; and BP = 132/76 mm Hg.Twenty minutes after the transfusion was begun,the patient began complaining of feeling "itchy and hot." The nurse discovered a rash on the patient's trunk.Vital signs were T = 100.8°F (38.2°C); P = 82 beats/min; R = 24 breaths/min; BP = 146/88 mm Hg.Based on these findings,what is the priority intervention?

A) Administer an antihistamine (antiallergenic) medication.
B) Flush the blood tubing with D5W immediately.
C) Prepare for emergency resuscitation.
D) Stop the blood transfusion immediately.

Question 7

What is the recommended position for a patient who is experiencing an air embolus because of failure to prime the IV tubing?

A) High-Fowler's
B) Supine
C) Trendelenburg, on the left side
D) Prone, on the right side

Question 8

The nurse has started to infuse the first of two units of packed red blood cells (prbc)on her patient.What is the nurse's next best action?

A) Delegate to the NAP to take vital signs every 15 minutes for 1 hour.
B) Infuse the blood at a rate of 100 mL/hr so it will infuse in 4 hours.
C) Infuse an IV solution of lactated Ringer's with the blood.
D) Remain with the patient for the first 15 minutes of the infusion.

Question 9

The nurse is caring for a patient with a medical diagnosis of hypernatremia.The following prescriptions are written in the client's electronic health record.Which one should the nurse question?

A) Administer an IV of D₅W at 125 mL/hr.
B) Strict I&O monitoring.
C) Restrict oral intake to 900 mL every 24 hr.
D) Monitor serum electrolytes every 4 hr.

Question 10

After morning care,the nurse lowered the height of the IV container infusing via gravity flow,at the patient's request.What is the nurse's next best action?

A) Calculate the new infusion rate.
B) Readjust the infusion rate, as needed.
C) Change the IV site and move it to the other arm.
D) Instruct the client to call when the IV bag is empty.

Question 11

A patient is admitted to the emergency department (ED)in respiratory distress.The results of his first arterial blood gases were pH = 7.30; PCO₂ = 40; HCO₃ = 19 mEq/L; PO₂ = 80.The nurse evaluates the patient's treatment plan by examining repeat arterial blood gases (ABGs).The results are pH = 7.38; PCO₂ = 32; HCO₃ = 19 mEq/L.The nurse concludes which of the following?

A) Respiratory acidosis; the treatment plan is ineffective.
B) Metabolic alkalosis; the treatment plan is effective.
C) Partial compensation; the treatment plan is ineffective.
D) Complete compensation; the treatment plan is effective.

Question 12

Which of the following is the principal site for regulation of fluid and electrolyte balance?

A) Cardiac system
B) Vascular system
C) Pulmonary system
D) Renal system

Question 13

The nurse assesses that her patient's intravenous solution has infiltrated into the tissues.What action should she take first?

A) Aspirate, then inject 0.5 mL normal saline.
B) Restart the IV line in a different vein.
C) Stop the infusion immediately.
D) Notify the primary care provider.

Question 14

Which of the following is the most appropriate goal for a patient with the nursing diagnosis of Deficient Fluid Volume?

A) Electrolyte balance restored, as evidenced by improved levels of alertness and cognitive orientation.
B) Electrolyte balance restored, as evidenced by sodium returning to normal range.
C) Patient demonstrates effective coughing and deep-breathing techniques.
D) Fluid balance restored, as evidenced by moist mucous membranes and urinating every 4 hours.

Question 15

A client is admitted to the emergency department (ED)in respiratory distress.The results of his arterial blood gases are the following: pH = 7.30; PCO₂ = 40; HCO₃ = 19 mEq/L; PO₂ = 80.The nurse interprets the findings as which of the following?

A) Respiratory acidosis with normal oxygen levels
B) Respiratory alkalosis with hypoxia
C) Metabolic acidosis with normal oxygen levels
D) Metabolic alkalosis with hypoxia

Question 16

A patient has been vomiting for 2 days and has not been able to eat or drink anything during this time.She has not urinated for 12 hours.Physical examination reveals the following: T = 99.6°F (37.6°C)orally; P = 110 beats/min,weak and thready; BP = 80/52 mm Hg.Her skin and mucous membranes are dry,and there is decreased skin turgor.The patient states that she feels very weak.The following are her laboratory results:
Sodium 138mEg/L
Potassium 3.7 mEq/L
Calcium 9.2mg/dL
Magnesium 1.8 mg/dL,
Chloride 99mEq/L
BUN 29 mg/dL
Which of the following is an appropriate nursing diagnosis for this patient?

A) Impaired Gas Exchange related to ineffective breathing
B) Excess Fluid Volume related to limited fluid output
C) Deficient Fluid Volume related to abnormal fluid loss
D) Electrolyte Imbalance related to decreased oral intake

Question 17

Which laboratory result on a client's health record should alert the nurse to a potential problem?

A) Na+ = 137 mEq/L
B) K+ = 5.2 mEq/L
C) Ca2+ = 9.2 mg/dL
D) Mg2+ = 1.8 mg/dL

Question 18

The nurse records a patient's hourly urine output from an indwelling catheter as follows: 0700: 36 mL 0800: 45 mL 0900: 85 mL 1000: 62 mL 1100: 50 mL 1200: 48 mL 1300: 94 mL 1400: 78 mL 1500: 60 mL The nurse can conclude that the patient's urine output should be described as which of the following?

A) Low
B) Within normal limits
C) High
D) Inconclusive

Question 19

When a patient has metabolic acidosis,which body system influences the acid-base imbalance to produce the compensatory changes in the arterial blood gases?

A) Respiratory system
B) Renal system
C) Vascular system
D) Neurological system

Question 20

An 82-year-old woman was brought to the emergency department by her granddaughter.She is a widow and lives alone,although her granddaughter checks on her daily.She has been vomiting for 2 days and has not been able to eat or drink anything during this time.She has not urinated for 12 hours.Physical examination reveals the following: T = 99.6°F (37.6°C)orally; P = 110 beats/min,weak and thready; BP = 80/52 mm Hg.Her skin and mucous membranes are dry,and there is decreased skin turgor.The patient states that she feels very weak.The following are her laboratory results:
Sodium 138mEq/L
Potassium 3.7 mEQ/L
Calcium 9.2mg/dL
Magnesium 1.8 mg/dL,
Chloride 99mEq/L
BUN 29 mg/dL
The nurse recognizes that the patient is displaying symptoms associated with which of the following?

A) Hypovolemia
B) Hypervolemia
C) Hypernatremia
D) Hyponatremia

Question 21

The nurse is caring for a patient with no spontaneous respiratory effort who requires mechanical ventilation.The first blood gas after initiating the ventilator shows a pH of 7.52 and a PCO₂ of 20.What intervention is required to correct this pH imbalance?

A) Increase fluid infusion.
B) Increase oxygen percentage.
C) Reduce number of breaths/min.
D) Increase number of breaths/min.

Question 22

The nurse is caring for a patient with heart failure.The patient has chronic fluid volume excess secondary to ineffective pumping action of the heart.When teaching this patient about fluid and electrolyte balance,which diet is most important for the nurse to explain?

A) High calcium
B) Low sodium
C) Low potassium
D) High magnesium

Question 23

A new father begins to hyperventilate as his baby is about to be born; he becomes light headed.The nurse instructs him to breathe into the paper bag until his breathing slows down.When he feels better he asks the nurse why using the paper bag helped him.What is the nurse's best response? "Breathing into the paper bag allowed you to

A) Rebreathe carbon dioxide to correct respiratory alkalosis"
B) Reduce carbon dioxide to correct respiratory acidosis"
C) Rebreathe carbon dioxide to correct metabolic alkalosis"
D) Reduce carbon dioxide to correct metabolic acidosis"

Question 24

At a first aid station on a marathon route,a patient after the race complains of headache,muscle cramps,weakness,nausea,and confusion.Which statement made by the patient might explain these symptoms?

A) "I was really thirsty after the race. I drank several large bottles of water."
B) "I perspired quite a bit during the race so I drank sports drinks when I finished."
C) "I take steroids regularly and did not stop taking them for the race."
D) "I am diabetic and checked my blood sugar after the race. It was normal."

Question 25

A patient had gastric surgery 10 days ago and continues to require gastric suction because of a paralytic ileus.The patient reports tingling in the fingers,has hypertonic reflexes,and has a respiratory rate of 8 breaths per minute that are deep in nature.The nurse recognizes that these symptoms are consistent with which diagnosis?

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

Question 26

A patient with pitting edema in the feet and ankles has excess volume in which fluid compartment?

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

Question 27

A patient has a continuous IV infusion at 60 mL/hr.The right hand IV has infiltrated and the nurse has started a new IV on the left forearm.Which of the following interventions should the nurse also perform?

A) Elevate the patient's left forearm.
B) Schedule daily dressing changes to the new IV site.
C) Change the administration set.
D) Place the patient in Fowler's position.

Question 28

In order to evaluate a patient's acid-base balance,the primary provider has prescribed diagnostic tests to measure pH,PCO₂,and HCO₃ - .The nurse realizes that the patient will:

A) Have a venous blood sample drawn
B) Have an arterial blood sample taken
C) Need to provide a fresh voided urine sample
D) Need to provide a 24-hour urine sample

Question 29

In a healthy adult,which of the following regulate body fluids? Select all that apply.

A) Hormone levels
B) Fluid intake
C) Oxygen saturation
D) Kidney function

Question 30

By which method is water absorbed by the small intestine and the colon?

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

Question 31

The nurse examines the electrocardiogram (ECG)tracing of a client and notes tall T waves.What electrolyte imbalance should the nurse suspect?

A) Hypokalemia
B) Hypophosphotemia
C) Hyperkalemia
D) Hypercalcemia

Question 32

A 60-year-old woman complains of muscle weakness,constipation,nausea,and frequent urination,and is displaying bizarre behavior.The woman takes prescribed thiazide diuretics.What statement made by the patient might be an additional cause of her symptoms?

A) "I have been working hard to drink plenty of water to prevent dehydration."
B) "I should probably tell you I take steroids regularly because of my asthma."
C) "I take calcium supplements to prevent osteoporosis and eat lots of dairy foods."
D) "I recently quit drinking alcohol. I quit cold turkey and did it all by myself."

Question 33

Which of the following older adult patients needs to increase his daily fluid intake? One who typically drinks (assume three meals per day):

A) 200 mL at each meal, plus 1,000 mL throughout the day
B) 250 mL at each meal, plus 600 mL throughout the day
C) 300 mL at each meal, plus 1,000 mL throughout the day
D) 400 mL at each meal, plus 500 mL throughout the day

Question 34

The nurse is caring for a patient with a low hematocrit.Which condition would accurately explain this finding?

A) Elevated blood cell count
B) Excess transcellular fluid
C) Extracellular fluid deficit
D) Intravascular fluid excess

Question 35

The physician has ordered a complete blood count for a 6-year-old child.When the nurse enters the room,she finds the child sobbing uncontrollably.His mother tells him to "shut up and act your age." How should the nurse proceed?

A) Request that the mother leave the room immediately.
B) Request the help of a coworker to hold the child down.
C) Inform the child that "this won't hurt a bit."
D) Calmly approach the child and tell him what is going to happen.

Question 36

The nurse is to administer an intravenous solution to a patient with diffuse edema.This will pull fluid from the interstitial space to the intravascular space.Which prescription would the nurse question for this patient? A prescription for:

A) 5% Dextrose in water (D₅W)
B) 10% Dextrose in water (D₁₀W)
C) 5% Dextrose in normal saline (D₅ 0.9% NaCl)
D) 5% Dextrose lactated Ringer's (D₅LR)

Question 37

The nurse gathers the following data: BP = 150/94 mm Hg; neck veins distended; P = 104 beats/min; pulse bounding; respiratory rate = 20 breaths/min; T = 37°C (98.6°F).What disorder should the nurse suspect?

A) Hypovolemia
B) Hypercalcemia
C) Hyperkalemia
D) Hypervolemia

Question 38

When performing a central venous catheter dressing change,which of the following steps is correct?

A) Wear sterile gloves while removing and discarding the soiled dressing.
B) Apply pressure on the catheter-hub junction when removing the soiled dressing.
C) Place a sterile transparent dressing over the site and the catheter-hub junction.
D) Have the patient wear a mask or turn his head away from the site.

Question 39

The nurse is caring for a patient with gastroenteritis who has been vomiting for 48 hours.A family member of the patient asks the nurse,"Why is he breathing that way?" What is the nurse's most accurate response after explaining the meaning of pH? "He is breathing

A) Fast and deep to help reduce carbon dioxide to increase his pH"
B) Slow and shallow to try to retain carbon dioxide to decrease his pH"
C) Fast and deep to help reduce carbon dioxide to decrease his pH"
D) Slow and shallow to try to retain carbon dioxide to increase his pH"

Question 40

A healthcare provider prescribes 250 mL of 0.9% sodium chloride to be infused over 2 hours.A microdrip infusion set is being used.What is the drip rate (drops/min)that the nurse should monitor?

A) 60
B) 75
C) 125
D) 250

Question 41

A patient has been diagnosed with hypovolemia.Which prescriptions for hydration should the nurse question? Select all that apply.

A) 0.9% (normal) saline at 100 mL/hr
B) Lactated Ringer's solution at 100 mL/hr
C) D₅₀W at 100 mL/hr
D) D₅W solution at 100 mL/hr

Question 42

A nurse is caring for a patient with a peripheral IV line located in the right forearm.The patient informs the nurse that the IV site is burning.Upon assessment the nurse determines that the IV solution has infiltrated.What site(s)is/are appropriate to consider when restarting the IV line? Select all that apply.

A) Left hand
B) Right wrist
C) Right antecubital area
D) Right saphenous vein

Question 43

The nurse is caring for a patient who is normally healthy but is experiencing dehydration secondary to acute diarrhea and vomiting.What assessment findings would indicate a return to fluid homeostasis? Select all that apply.

A) Urine output of 35 mL/hour
B) Elevated antidiuretic hormone levels
C) Reduced renin production
D) Reduced aldosterone release
E) Formed stools

Question 44

The nurse is caring for a patient with metabolic acidosis secondary to renal failure caused by poor glucose regulation.The patient reports a headache,weakness,and nausea.The nurse assesses an elevated blood sugar,Kussmaul breathing,and peripheral vasodilation.What collaborative interventions will the nurse anticipate to restore pH balance? Select all that apply.

A) Insulin to lower blood sugar
B) Tylenol for headache
C) Mechanical ventilation to correct breathing
D) Dialysis to remove toxins
E) Bicarbonate administration

Question 45

A patient has been admitted to the nursing unit with a diagnosis of chronic renal failure.She will be dialyzed for the first time tomorrow morning.Which of the following are appropriate nursing interventions for the patient? Select all that apply.

A) Encourage oral fluid intake as desired.
B) Place the patient on strict I&O.
C) Weigh the patient before and after dialysis.
D) Maintain a total fluid restriction of 1,000 mL as prescribed.

Question 46

A patient's blood group is B.The nurse knows the patient can receive blood only from donors with what group of blood? Select all that apply.

A) A
B) B
C) O
D) AB

Question 47

Identify the mechanisms involved in acid-base balance.Select all that apply.

A) Respiratory mechanisms
B) Active transport mechanisms
C) Renal mechanisms
D) Buffer systems

Question 48

When assisting with bedside central venous catheter (CVC)placement,which nursing intervention is appropriate? Select all that apply.

A) Don sterile gloves and mask (and possibly gown).
B) Scrub the insertion site with antibacterial soap for 1 min.
C) Verify that informed consent has been obtained.
D) Place the patient in low-Fowler's position.

Question 49

Identify the appropriate interventions for a patient with hypovolemia.Select all that apply.

A) Teach deep-breathing techniques.
B) Monitor I&O daily.
C) Encourage fluid intake.
D) Monitor electrolyte balance.