Deck 18: Fluid, Electrolyte, and Acid-Base Balances

Question 1

The nurse is caring for a patient with a sodium level of 156 mEq/L due to diabetes insipidus.Which is the highest priority nursing diagnosis for this patient?

A) Activity intolerance related to fatigue from chronic illness
B) Imbalanced nutrition related to excessive carbohydrate intake
C) Excess fluid volume related to increased isotonic fluid retention
D) Risk for ineffective airway clearance related to secretions during seizure

Answer 1

Risk for ineffective airway clearance related to secretions during seizure

Question 2

Which patient has the greatest risk for extracellular fluid volume (ECV)deficit?

A) A female with Crohn's disease
B) A male with peptic ulcer disease
C) An infant with fever and vomiting
D) An adolescent with acute appendicitis

Answer 2

An infant with fever and vomiting

Question 3

The nurse is caring for a dyspneic patient with a long history of smoking.The blood gas report shows a pH of 7.33,PaCO₂ of 47,PaO₂ of 78,and HCO₃⁻ of 26.What is the patient's acid-base status?

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

Answer 3

Respiratory acidosis

Question 4

Which intake and output measurement can the nurse delegate to the nursing assistant?

A) Oral fluid intake
B) Nasogastric tube intake
C) Wound drainage output
D) Intravenous fluid intake

Question 5

What causes the patient to feel thirsty and drink more water?

A) Colloid osmotic pressure
B) Osmoreceptor stimulation
C) Increased oncotic pressure
D) Decreased hydrostatic pressure

Question 6

The nurse is teaching a patient with vomiting and diarrhea about appropriate dietary fluids.Which option chosen by the patient would indicate further teaching is needed?

A) Ice chips
B) Tap water
C) Black coffee
D) Chicken broth

Question 7

Which is the best method for measuring the patient's daily weight?

A) Weigh the patient daily using different scales for comparison.
B) Teach that daily weights are done in hospitals,but not at home.
C) Monitor daily weight,comparing with the previous day's weight.
D) Weigh the patient at different times of the day to determine trends.

Question 8

The nurse is caring for a patient with bulimia.The patient vomits after eating and is experiencing tingling of the fingers and toes and muscle cramps.What is the patient's expected acid-base status?

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

Question 9

The nurse is caring for a patient with a poorly controlled hypoparathyroid condition.Which is the highest priority nursing diagnosis for this patient?

A) Risk for injury/fracture related to bone fragility
B) Disturbed energy field related to chronic illness
C) Deficient knowledge related to importance of exercise
D) Disturbed body image related to hormonal changes

Question 10

The nurse is caring for a patient who is very malnourished and laboratory results show that the patient's albumin level is extremely low.Which finding would the nurse expect to observe during the patient's physical assessment?

A) The patient has generalized edema.
B) The patient is confused and irritable.
C) The patient has an irregular heartbeat.
D) The patient's eyes are red,irritated,and itchy.

Question 11

The patient reports muscle weakness after taking prescribed furosemide daily.Which laboratory finding will the nurse expect to see in the patient's chart?

A) Chloride 84 mEq/L
B) Sodium 124 mEq/L
C) Calcium 12.6 mg/dL
D) Potassium 2.8 mEq/L

Question 12

Which patient should receive an IV solution of D₅W?

A) A trauma patient with massive hemorrhage
B) A patient being resuscitated after cardiac arrest
C) A patient with CHF and acute pulmonary edema
D) A patient with a serum sodium level of 162 mEq/L

Question 13

The patient receives an infusion of albumin to pull water from the tissues into the bloodstream.Which process is demonstrated by this treatment?

A) Diffusion
B) Osmosis
C) Filtration
D) Clarification

Question 14

The nurse is caring for a patient who has been vomiting.The patient's sodium level is 124 mEq/L.Which laboratory result will the nurse also expect to see in the patient's chart?

A) Chloride 81 mEq/L
B) Calcium 11.1 mg/dL
C) Phosphate 5.1 mg/dL
D) Magnesium 2.3 mEq/L

Question 15

The nurse is caring for a patient with a serum potassium level of 7.1 mEq/L.Which is the highest priority nursing diagnosis for this patient?

A) Risk for spiritual distress related to chronic illness despair
B) Powerlessness related to illness-related physical limitations
C) Impaired social interaction related to limited physical activity
D) Risk for decreased cardiac output related to altered heart rhythm

Question 16

The nurse is to administer 40 mEq of IV KCl to the patient with severe hypokalemia.Why did the pharmacy send up four 100 mL IV bags with 10 mEq of KCl in each bag?

A) To prevent the patient from receiving too much IV fluid.
B) The four smaller bags are less expensive than one large one.
C) To prevent accidentally infusing the 40 mEq of KCl too quickly.
D) The doctor may change his mind and lower the prescribed KCl dose.

Question 17

The nurse is caring for a diabetic patient with a blood sugar of 879 mg/dL,and notes the patient has fruity breath,and Kussmaul respirations.Which acid-base imbalance should the nurse expect?

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

Question 18

Lactated Ringer's solution is administered to the patient during surgery.What is the purpose of this infusion?

A) Cause cells to shrink and reduce swelling.
B) Expand the body's intravascular fluid volume.
C) Move fluid from intravascular space into cells.
D) Pull fluid from cells into the intravascular space.

Question 19

The nurse works on the cardiac unit of a hospital.The health care provider has ordered 20 mEq of KCl per L to be added to the fluids that the patient is receiving.The patient currently has a bag of D₅W IV fluid infusing.Which is the priority action of the nurse?

A) Check the patient's potassium level before hanging the new IV solution.
B) Administer 20 mEq KCl diluted in 5 mL of fluid by IV push in 5 minutes.
C) Give the KCl undiluted by IV push in 5 minutes for the most rapid action.
D) Estimate the amount of fluid in the IV bag and add KCl to equal 20 mEq/L.

Question 20

The nurse is caring for a patient with metabolic acidosis due to severe hyperglycemia.Which assessment finding indicates to the nurse that the patient's body is attempting to compensate for the acidosis?

A) The patient's breathing is very deep and rapid.
B) The patient's temperature has been rising steadily.
C) The patient's skin is flushed and warm to the touch.
D) The patient is urinating large amounts of light colored urine.

Question 21

The nurse is caring for a patient whose pituitary secretes excessive amounts of antidiuretic hormone (ADH).Which findings will the nurse expect to see during assessment of the patient?

A) The patient's serum sodium level is 122 mEq/L.
B) The patient's serum chloride level is 116 mEq/L.
C) The patient is voiding large amounts of watery urine.
D) The patient's mucus membranes are dry and cracked.
E) The patient has gained 5 pounds and has swollen feet.

Question 22

Which complication is suspected when the patient's IV site is swollen,cool,and pale with no blood return?

A) Phlebitis
B) Infiltration
C) Thrombophlebitis
D) Local inflammation

Question 23

A patient reports chills,dizziness,and feeling hot during a blood transfusion.What are the appropriate actions of the nurse?

A) Slow the rate of infusion.
B) Stop the blood transfusion.
C) Check the patient's vital signs.
D) Notify the physician and blood bank.
E) Restart the patient's IV at a different site.

Question 24

Order: IV 500 mL 0.9% NS to infuse over 10 hours
IV tubing: 10 drops/mL
What will the infusion pump rate be set at-how many mL/hour? ____

Question 25

The patient is scheduled for hip replacement surgery and significant blood loss is expected.What is the best possible action of the patient to reduce the risk of transfusion complications?

A) Arrange for an autologous blood donation.
B) Take an iron supplement daily prior to the surgery.
C) Expect transfusions will come from a directed donor.
D) Request that donated blood be screened twice by the blood bank.

Question 26

Approximately 30 minutes into the transfusion of this blood product,the patient becomes short of breath with wheezing,low BP,and hives.Which medication must be administered to the patient immediately?

A) 500 mL 0.9 NS IV fluid bolus
B) Epinephrine 0.4 mg IM
C) Diphenhydramine 50 mg IV
D) Methylprednisolone 40 mg IV

Question 27

Which is the priority assessment to be documented prior to administering a blood product to a patient?

A) Strength of peripheral pulses
B) Vital signs and pulse oximetry
C) Presence/absence of bowel sounds
D) Height,weight,and body mass index (BMI)

Question 28

The nurse is caring for a patient who has just been found in respiratory arrest.Which laboratory values will the RN expect to find in the patient's chart?

A) pH 7.28
B) PaO₂ 65 mm Hg
C) PaCO₂ 58 mm Hg
D) HCO₃- 15 mEq/L

Question 29

Order: IV 1000 mL 0.9% NS to infuse over 5 hours
IV tubing: 10 drops/mL
No infusion pump is used.What is the flow rate in drops/minute? _____

Question 30

Order: Merrem 500 mg in 100 mL D₅W IVPB infuse over 30 minutes
IV tubing: 10 drops/mL
What will the infusion pump rate be set at-how many mL/hour? _____

Question 31

The patient is receiving an intravenous infusion of 40 mEq of potassium chloride in a 1000 mL solution of 0.9% saline.The patient states that the area around the IV site burns.What intervention does the nurse perform first?

A) Notify the physician.
B) Stop the IV infusion.
C) Document the finding.
D) Increase the IV drip rate.

Question 32

Which is the highest priority of the nurse immediately after withdrawing the needle from the IV catheter after venipuncture?

A) Engage the safety device to cover the needle.
B) Check for blood return in the flashback chamber.
C) Stabilize the catheter with the nondominant hand.
D) Align the catheter on the top of vein at a 15-degree angle.

Question 33

Which patients can receive a unit of A+ blood?

A) Type A+
B) Type A-
C) Type B+
D) Type B-
E) Type AB+

Question 34

Which is the appropriate action of the nurse when selecting a vein for IV placement?

A) Select a vein that appears to be well dilated.
B) Elevate the extremity to visualize the vein.
C) Tap and rub the vein vigorously with friction.
D) Stroke from proximal to distal above the site.

Question 35

Order: 500 mL D₅W to infuse at 50 mL/hour
IV tubing: 10 drops/mL
How many mL will infuse over the nurse's 12 hour shift? _____

Question 36

Which assessment findings prevent the nurse from starting an IV in the patient's right arm?

A) The patient is right-handed.
B) The IV pole will be on the left side of the bed.
C) The patient has a dialysis fistula in the right arm.
D) The patient has right-sided paralysis after a stroke.
E) The patient had a right mastectomy 6 years ago.

Question 37

Which assessment findings indicate that the patient has developed fluid overload as a result of transfusing two units of packed red blood cells?

A) Hypotension and thirst
B) Dyspnea and tachycardia
C) Shivering and high fever
D) Hypotension and urticaria

Question 38

Order: 500 mL D₅W to infuse at 100 mL/hour
IV tubing: 10 drops/mL
The IV bag was hung at 12:00 noon.
What time will the IV bag be completed? _____