Deck 29: Fluids, Electrolytes, and Acid-Base Balance

Question 1

A nursing instructor teaches that which of the following body processes is an example of diffusion?

A) The movement of oxygen into the blood
B) The movement of water into the bloodstream after the injection of radiopaque dye
C) The movement of blood into a tube during a blood draw
D) The movement of fluid out of the bloodstream due to the force of the heart's contractions

Answer 1

The movement of oxygen into the blood

Question 2

When reviewing laboratory values of multiple patients with fluid and electrolyte imbalance, a nurse recognizes that which of the following values represents a therapeutic response to treatment?

A) Sodium = 132 mEq
B) Sodium = 136 mEq
C) Sodium = 147 mEq
D) Sodium = 149 mEq

Answer 2

Sodium = 136 mEq

Question 3

A nursing instructor teaches that the movement of fluid from extracellular to intracellular compartments is most dependent on which of the following?

A) Age
B) Water intake
C) Potassium balance
D) Percentage of body fat

Answer 3

Water intake

Question 4

During change of shift report, a nurse is informed that a patient has new orders for sodium polystyrene (Kayexalate). After providing the treatment later in the shift, which of the following statements would most likely document the patient's care?

A) "Telemetry shows normal sinus rhythm; Kayexalate provided; patient had two stools this shift."
B) "Kayexalate provided, monitoring patient's level of consciousness q2h."
C) "Kayexalate given per order for hypokalemia; patient resting comfortably."
D) "IV D51/2NS with 20 mEq potassium chloride (KCl) infusing without difficulty; Kayexalate provided; adequate urine output noted."

Question 5

A nurse is providing care for a patient recently admitted with hypercalcemia related to breast cancer. The nurse would be most concerned if the patient reported taking which of the following medications?

A) Lasix (furosemide)
B) Digitalis (digoxin)
C) Multivitamins
D) Tylenol (acetaminophen)

Question 6

A nurse is providing care for a patient admitted with nausea, vomiting, and diarrhea who has orders to remain NPO. Family members ask, "Why can't she have anything to drink?" Which of the following responses by the nurse is best?

A) "I think the doctor must have forgotten to order a diet. I'll call and get one ordered."
B) "She can have as many ice chips as she wants, but it might make her sick if she drinks anything."
C) "I don't know. Did the doctor mention any tests to be done that would need her stomach to be empty?"
D) "It is best to let her bowels rest, but you can use these mouth swabs to help her feel more comfortable."

Question 7

Which of the following individuals will be at the lowest risk for an electrolyte imbalance?

A) A 42-year-old with an estimated blood loss of 1/2 pint because of traumatic injury
B) A 28-year-old with third-degree burns to an estimated 30% of his body
C) A 31-year-old who has had vomiting and diarrhea for the past 3 days
D) A 55-year-old suffering from heat stroke after running a marathon

Question 8

While caring for a patient taking furosemide (Lasix), a nurse recognizes that teaching is successful if the patient chooses which of the following foods?

A) Green beans
B) Grapes
C) Oranges
D) Zucchini

Question 9

A nurse working in the sports medicine complex is counseling a female college athlete about dietary concerns. Which of the following recommendations should be included in the teaching?

A) "It is important for you to drink about a liter of fluid each day."
B) "You should be drinking four to five glasses of water every day."
C) "A woman your age needs to drink nearly 3 liters of fluid a day."
D) "Now that you've finished growing, you don't need as much fluid as you did before."

Question 10

While reviewing laboratory results, a nurse notes that one of the patients has a low blood urea nitrogen (BUN) level. Which of the following is the most likely cause of that result?

A) Dehydration
B) Fluid volume excess
C) Hypernatremia
D) Hypokalemia

Question 11

A patient with hypercalcemia is at increased risk for which of the following additional electrolyte imbalances?

A) Hypomagnesemia
B) Hypophosphatemia
C) Hypokalemia
D) Hyponatremia

Question 12

While caring for a newly admitted patient with fluid and electrolyte imbalances, a nurse would be most concerned by which of the following?

A) Urinary output of 300 mL in 8 hours
B) Blood pressure of 128/60 mm Hg
C) Lung fields with crackles noted bilaterally
D) Nausea

Question 13

Which of the following individuals should follow the American Heart Association recommendation to limit salt intake to 1500 mg/d?

A) A 41-year-old with hypertension
B) A 37-year-old with appendicitis
C) A 27-year-old with an ovarian cyst
D) An 18-year-old with pneumonia

Question 14

Which of the following statements indicates to a nurse that a patient taking an osmotic diuretic needs further teaching?

A) "I'll need to have blood work drawn periodically."
B) "A couple of the foods I should eat are yogurt and potatoes."
C) "Taking this medicine will make my body hold on to salt and water."
D) "Yellow fruits are high in potassium, so I should eat more of them."

Question 15

While caring for a patient with dehydration, a nurse is most likely to include which of the following in the patient's plan of care?

A) Chronic pain
B) Alteration in body temperature
C) Ineffective airway clearance
D) Readiness for enhanced coping

Question 16

While preparing for a rotation in the intensive care unit, a student nurse is told in report that a patient is "third spacing." Which of the following symptoms does the student expect to see?

A) Elevated body temperature
B) Large amounts of dilute urine
C) High blood pressure
D) Swelling in the extremities

Question 17

After receiving a report from the emergency department of a new admission with hyponatremia, a nurse anticipates that which of the following intravenous (IV) fluids may be included in the treatment plan?

A) Dextrose 5% in water (D5W)
B) Normal saline (NS)
C) 0.45% normal saline
D) Sodium bicarbonate

Question 18

A nurse caring for a patient taking the diuretic furosemide (Lasix) would be most concerned by which of the following findings?

A) Muscle spasms
B) Hypercalcemia
C) Low urine specific gravity
D) Constricted pupils

Question 19

A nurse is caring for multiple patients on a medical floor. Which of the following patients should the nurse see first?

A) A 94-year-old with a history of congestive heart failure receiving IV D51/2NS with 20 mEq potassium chloride (KCl) at 120 mL/hr
B) A 52-year-old admitted with sickle cell anemia who has a patient-controlled analgesia (PCA)
C) A 27-year-old with Crohn disease with IV 1/2NS at 100 mL/hr
D) A 39-year-old recovering from gastric bypass surgery with a saline lock

Question 20

For a patient with alkalosis, a nurse would expect which of the following assessments?

A) Slow respiratory rate
B) Urine that is more acidic
C) Urine that has a low level of NaHCO₃
D) Rapid respiratory rate

Question 21

While reviewing routine laboratory results for a 14-year-old, a nurse notes the patient's calcium level is lower than normal. Which of the following is most likely the contributing cause for this deficiency?

A) Diet low in potassium
B) Inadequate vitamin D levels
C) Alcohol abuse
D) Metabolic acidosis

Question 22

To ensure survival, an individual's blood pH must stay within the very narrow range of 7.35 to 7.45. A nurse identifies this range as being

A) Slightly acidic.
B) Neutral.
C) Slightly alkaline.
D) Highly acidic.

Question 23

Which of the following diagnostic tests indicates that a patient has a fluid volume deficit?

A) Elevated urine specific gravity
B) Decreased hemoglobin level
C) High hematocrit level
D) Elevated blood urea nitrogen (BUN)
E) Elevated red blood cell count

Question 24

A nurse identifies that the ratio of carbonic acid to sodium bicarbonate that must be met to maintain an acid-base balance is

A) 1 part H₂CO₃ to 20 parts NaHCO₃.
B) 1 part H₂CO₃ to 10 parts NaCl.
C) 1 part NaHCO₃ to 15 parts H₂CO₃.
D) 1 part NaOH to 10 parts NaHCO₃.

Question 25

An instructor explains that there are three basic systems that work together in the body to regulate and maintain acid-base balance. A student shows a need for additional instruction when identifying one of these systems as the

A) Renal system.
B) Digestive system.
C) Bicarbonate buffer system.
D) Respiratory system.

Question 26

A nurse is providing care for an individual admitted with an acute asthma attack. Arterial blood gas (ABG) results indicate pH = 7.33; CO₂ = 49; HCO₃ = 26; and oxygen saturation is 87%. After initiating treatment with intravenous (IV) fluids, bronchodilators, and oxygen therapy at 4 L via nasal cannula (NC), the patient's repeat ABG results are pH = 7.35; CO₂ = 47; HCO₃ = 26; and oxygen saturation is 89%. Which of the following actions should the nurse take next?

A) Prepare to send the patient to intensive care unit (ICU).
B) Document the findings in the chart.
C) Inform the family that the patient's condition is worsening.
D) Assess the characteristics of the patient's respirations, heart rate and rhythm, skin color, and function of oxygen delivery equipment.

Question 27

A nursing instructor teaches that which of the following are found in higher concentrations outside of cells?

A) Sodium
B) Protein
C) Potassium
D) Chloride
E) Bicarbonate

Question 28

It is recommended that individuals within certain populations restrict their sodium intake to 1500 mg/d. A nurse identifies that these groups include all of the following except

A) African Americans.
B) Individuals with hypertension.
C) Individuals younger than 15 years.
D) Individuals who are 40 years or older.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 29

A nurse is receiving a new admission from the emergency room with a diagnosis of nausea/vomiting/diarrhea and dehydration. Which of the following orders would the nurse question?

A) Repeat electrolyte panel in a.m.
B) Lomotil (Diphenoxylate and Atropine) 2 tablets PO qid for 24 hours
C) Intravenous (IV) normal saline at 30 mL/hr
D) Regular diet
E) Bedrest with bathroom privileges

Question 30

An instructor teaches that the chemical sodium bicarbonate is one of the two chemicals used in the bicarbonate buffer system. A student identifies the chemical symbol of sodium bicarbonate as

A) NaCl.
B) NaHCO₃.
C) H₂CO₃.
D) NaOH.

Question 31

A nurse is providing care for a patient whose arterial blood gas results are pH = 7.48; CO₂ = 44; NaHCO₃ = 29. The nurse recognizes that the patient's results indicate

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

Question 32

Which of the following individuals is at increased risk for hypokalemia?

A) A 52-year-old with malnutrition
B) A 61-year-old who has had a cerebral vascular accident
C) A 65-year-old with coronary heart disease
D) A 52-year-old who is in renal failure
E) A 74-year-old with a nasogastric (NG) tube hooked to suction

Question 33

An alcoholic patient is experiencing withdrawal and has been given an intravenous (IV) infusion of glucose. The nurse identifies that this treatment may cause a decline in the electrolyte

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

Question 34

A nurse overhears a student discussing the treatment of fluid volume deficit. The nurse intervenes when the student says:

A) "Fluid volume deficit requires the rapid infusion of intravenous (IV) fluids."
B) "The patient's urinary output will initially be absent or less than the intake, but should gradually increase as the patient becomes more hydrated."
C) "If the source of loss is from the gastrointestinal (GI) tract, antiemetic medications may be ordered for nausea or vomiting."
D) "Once the patient is able to tolerate oral fluids, a clear liquid diet advanced as tolerated is generally ordered."

Question 35

A nurse is caring for a patient who was admitted with severe hyponatremia. Which of the following symptoms would indicate the patient has increased intracranial pressure?

A) Presence of Chvostek sign
B) Presence of Trousseau sign
C) Patient is anxious and restless
D) Blood pressure (BP) = 184/80
E) Pulse (P) = 52

Question 36

A patient is diagnosed with mild hypochloremia. The nurse identifies that the patient's chloride level may return to normal by increasing his or her intake of

A) Dried fruits.
B) Salty snacks.
C) Whole grains.
D) Baked goods.

Question 37

A nurse teaches a patient that natural sources of dietary magnesium include which of the following?

A) Soybeans
B) Spinach
C) Barley
D) Fish
E) Tomatoes

Question 38

An instructor explains that the scale used to determine acid-base balance is known as the pH scale. A student identifies that "pH" stands for

A) Phosphoric hardness.
B) Parts per hectare.
C) Parts hydrogen.
D) Potassium hydrate.

Question 39

A nurse is providing care for a patient admitted with fluid volume overload. Which of the following would the nurse include in the patient's plan of care?

A) Provide diuretic therapy as ordered.
B) Assess daily weights.
C) Provide low-sodium diet.
D) Document intake/outtake every shift.
E) Encourage oral fluid of at least 2000 mL/d.

Question 40

An instructor explains the role of the respiratory system in maintaining proper acid-base balance in the blood. A student demonstrates understanding by saying:

A) "When body fluids become too acidic, the lungs remove excess hydrogen from the blood."
B) "When the blood is too alkaline, the lungs excrete more sodium bicarbonate into the atmosphere."
C) "The lungs work much slower than the kidneys, changing the pH balance over a period of days rather than hours."
D) "The lungs remove excess carbon dioxide to decrease the acidity of the blood."