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

Question 1

A homeless client is brought into the emergency department with indications of extremely poor nutrition.Arterial blood gas levels are assessed,and the nurse anticipates that this client will demonstrate which of the following results?
1) pH 7.3,PaCO₂ 38 mm Hg,HCO₃ 19 mEq/L
2) pH 7.5,PaCO₂ 34 mm Hg,HCO₃ 20 mEq/L
3) pH 7.35,PaCO₂ 35 mm Hg,HCO₃ 24 mEq/L
4) pH 7.52,PaCO₂ 48 mm Hg,HCO₃ 28 mEq/L

Answer 1

1
Metabolic acidosis may be found in cases of starvation.The client's pH is below the normal of 7.35 (at 7.3),the PaCO₂ is in the normal range of 35 to 45 mm Hg (at 38 mm Hg),and the HCO₃ is below the normal of 22 mEq/L (at 19 mEq/L).These findings demonstrate metabolic acidosis.Values of pH 7.5,PaCO₂ 34 mm Hg,HCO₃ 20 mEq/L are consistent with respiratory alkalosis,compensated,which would not be typical of malnutrition.Values of pH 7.52,PaCO₂ 48 mm Hg,HCO₃ 28 mEq/L are consistent with metabolic alkalosis,compensated,which would not be an expected finding with extremely poor nutrition.

Question 2

The nurse will be starting a new intravenous infusion and needs to select the site for the insertion.In selection of a site,the nurse should:
1) Start with the most proximal site
2) Look for hard,cordlike veins
3) Use the dominant arm
4) Avoid sites on the extremity away from a dialysis graft

Answer 2

4
The nurse should avoid veins in an extremity with compromised circulation,such as a dialysis graft.The nurse should use the most distal site in the nondominant arm,if possible,and should avoid hardened cordlike veins.

Question 3

A client has intravenous therapy for the administration of antibiotics and is stating that the "IV site hurts and is swollen." Which of the following information assessed on the client indicates the presence of phlebitis,as opposed to infiltration?
1) Intensity of the pain
2) Warmth of integument surrounding the IV site
3) Amount of subcutaneous edema
4) Skin discoloration of a bruised nature

Answer 3

2
Signs of phlebitis may include increased temperature over the vein,erythema,pain,and edema.With phlebitis,the area is warm to the touch;with infiltration,the area is cool to the touch.The intensity of pain is not a differentiating factor between phlebitis and infiltration.Pain may occur with both.The amount of subcutaneous edema is not a differentiating factor between phlebitis and infiltration.Edema may occur with both.Skin discoloration of a bruised nature is not the best way to differentiate phlebitis from infiltration.With phlebitis,the area is typically reddened.With infiltration,the area is typically pale.

Question 4

When an excess of body fluid exists in the intravascular compartment,all of the following signs can be expected except:
1) Rales
2) A bounding pulse
3) Engorged peripheral veins
4) An elevated hematocrit level

Question 5

A client is admitted to the hospital with a diagnosis of adrenal insufficiency.In preparing to complete the admission history,the nurse anticipates that the client will have experienced:
1) Decreased muscle tone
2) Hypertension
3) Diarrhea
4) Fever

Question 6

An IV solution of 125 mL is to be infused over a 1-hour period.A microdrip infusion set will be used.The nurse calculates the infusion rate as:
1) 32 gtt/min
2) 60 gtt/min
3) 125 gtt/min
4) 250 gtt/min

Question 7

When a client's serum sodium level is 120 mEq/L,the priority nursing assessment is to monitor the status of which body system?
1) Neurological
2) Gastrointestinal
3) Pulmonary
4) Hepatic

Question 8

A client complains of a headache,nausea,and vomiting during a blood transfusion.Which one of the following actions should the nurse take immediately?
1) Check the vital signs.
2) Stop the blood transfusion.
3) Slow down the rate of blood flow.
4) Notify the health care provider and blood bank personnel.

Question 9

An 8-year-old is admitted to the pediatric unit with pneumonia.On assessment the nurse notes that the child is warm and flushed,is lethargic,has difficulty breathing,and has moist rales.The nurse determines that the child is suffering from:
1) Metabolic acidosis
2) Respiratory acidosis
3) Respiratory alkalosis
4) Metabolic alkalosis

Question 10

The health care provider orders 1000 mL of D₅LR with 20 mEq KCl to run for 8 hours.Using an infusion set with a drop factor of 15 gtt/mL,the nurse calculates the flow rate to be:
1) 12 gtt/min
2) 22 gtt/min
3) 32 gtt/min
4) 42 gtt/min

Question 11

In reviewing the results of the client's blood work,the nurse recognizes that the unexpected value that should be reported to the health care provider is:
1) Calcium 3.9 mEq/L
2) Sodium 140 mEq/L
3) Potassium 3.5 mEq/L
4) Magnesium 2.1 mEq/L

Question 12

The single best indicator of fluid status is the nurse's assessment of the client's:
1) Skin turgor
2) Intake and output
3) Serum electrolyte levels
4) Daily weight

Question 13

A rapid infusion of citrated blood has been given to the client.The nurse observes for:
1) Diaphoresis
2) Anxiety
3) Chvostek's sign
4) Nausea and vomiting

Question 14

The client has been experiencing right flank and lower back pain.Which of the following laboratory values would be most desirable for the nurse to obtain based on the client's assessment?
1) Serum potassium
2) Serum sodium
3) Serum magnesium
4) Serum calcium

Question 15

A client is currently taking Lasix and digoxin.As a result of the medication regimen,the nurse is alert to the presence of:
1) Cardiac dysrhythmias
2) Severe diarrhea
3) Hyperactive reflexes
4) Peripheral cyanosis

Question 16

For a child who has ingested the remaining contents of an aspirin bottle,the nurse suspects signs and symptoms consistent with:
1) Metabolic acidosis
2) Metabolic alkalosis
3) Respiratory acidosis
4) Respiratory alkalosis

Question 17

The nurse is aware that the compensating mechanism that is most likely to occur in the presence of respiratory acidosis is:
1) Hyperventilation to decrease the CO₂ levels
2) Hypoventilation to increase the CO₂ levels
3) Retention of HCO₃ by the kidneys to increase the pH level
4) Excretion of HCO₃ by the kidneys to decrease the pH level

Question 18

Of all of the following clients,the nurse recognizes that the individual who is most at risk for a fluid volume deficit is:
1) A 6-month-old learning to drink from a cup
2) A 12-year-old who is moderately active in 80° F weather
3) A 42-year-old with severe diarrhea
4) A 90-year-old with frequent headaches

Question 19

For a client with a nursing diagnosis of excess fluid volume,the nurse is alert to which one of the following signs and symptoms?
1) Weak,thready pulse
2) Hypertension
3) Dry mucous membranes
4) Flushed skin

Question 20

Arterial blood gas levels are obtained for the client.If the client's results are pH 7.48,CO₂ 42 mm Hg,and HCO₃ 32 mEq/L,the client is exhibiting which one of the following acid-base imbalances?
1) Metabolic acidosis
2) Respiratory acidosis
3) Respiratory alkalosis
4) Metabolic alkalosis

Question 21

Which of the following clinical assessment findings is most likely seen in a client experiencing hyperkalemia as a result of adrenal insufficiency?
1) Dry,sticky tongue
2) Increased anxiety
3) Nausea and vomiting
4) Decreased bowel sounds

Question 22

Which of the following clients is most at risk for fluid volume deficit?
1) 25-year-old male near-drowning victim
2) 56-year-old woman with salicylate poisoning
3) 45-year-old woman with second-degree burns over 20% of her body
4) 13-year-old boy with an oral temperature of 103.4° F

Question 23

Which of the following clinical assessment findings is most likely seen in a client experiencing partial-thickness burns over 35% of the body as a result of hyponatremia?
1) Dry,sticky tongue
2) Increased anxiety
3) Nausea and vomiting
4) Decreased bowel sounds

Question 24

The nurse anticipates that the client with a fluid volume excess will manifest a(n):
1) Increased urine specific gravity
2) Decreased body weight
3) Increased blood pressure
4) Decreased pulse strength

Question 25

Which of the following clients is at greatest risk for insensible water loss?
1) A 37-year-old with a superficial burn to the left hand
2) A 15-year-old experiencing an asthmatic attack
3) A 50-year-old with type 2 diabetes
4) A 73-year-old with a history of pneumonia

Question 26

Which of the following clinical assessment findings is most likely seen in a client experiencing hypokalemia as a result of the misuse of potassium-wasting diuretics?
1) Dry,sticky tongue
2) Increased anxiety
3) Nausea and vomiting
4) Decreased bowel sounds

Question 27

Which of the following foods will have the greatest impact on the neurochemical activity of the person consuming it?
1) A pickle
2) A banana
3) A milkshake
4) A spinach salad

Question 28

A client has severe anemia and will be receiving blood transfusions.The nurse prepares and begins the infusion.Ten minutes after the infusion has begun,the client develops tachycardia,chills,and low back pain.After stopping the transfusion,the nurse should:
1) Administer an antipyretic
2) Begin an infusion of epinephrine
3) Run normal saline through the blood tubing
4) Obtain and send a urine specimen to the laboratory

Question 29

Which of the following foods will have the greatest impact on the water balance of the person consuming it?
1) A pickle
2) A banana
3) A milkshake
4) A spinach salad

Question 30

The nurse recognizes which of the following clients is at the greatest risk for dehydration?
1) A 35-year-old client diagnosed with Crohn's disease
2) A 15-year-old client who is following a low-carbohydrate diet
3) A 2-year-old client diagnosed with an allergy to milk proteins
4) A 79-year-old client who has been diagnosed with advanced Alzheimer's disease

Question 31

A client who takes furosemide presents at the emergency department with weakness and fatigue and complains of nausea and vomiting for 3 days.Upon assessment,the nurse finds that the client has decreased bowel sounds and ECG abnormalities including a flattened T wave and flattened ST segment.The nurse knows that these are signs of:
1) Hypokalemia
2) Hyperkalemia
3) Hyponatremia
4) Hypocalcemia

Question 32

Which of the following foods will have the greatest impact on the heart's conductivity of the person consuming it?
1) A pickle
2) A banana
3) A milkshake
4) A spinach salad

Question 33

A client is prescribed 0.45% sodium chloride,which is a hypotonic solution.The nurse recognizes the primary goal of such intravenous therapy is to:
1) Expand the volume of fluid in the vascular system
2) Pull fluid from the cells
3) Keep protein levels normal
4) Move fluid into the cells

Question 34

A mother brings her 2-year-old daughter to the clinic with a 2-day history of a fever of unknown origin.The mother explains to the nurse that the air conditioning in her apartment is not working and it has been very hot;her daughter has been vomiting for 2 days and has had a fever,and the child is lethargic.The child's rectal temperature is 101.1° F.The nurse knows the child is probably dehydrated and should do which of the following first?
1) Give the child some juice to drink.
2) Prepare to start an IV.
3) Get an order for an antipyretic.
4) Sponge the child to bring down the fever.

Question 35

Which of the following foods will have the greatest impact on the blood-clotting mechanism of the person consuming it?
1) A pickle
2) A banana
3) A milkshake
4) A spinach salad

Question 36

A client is prescribed 0.9% sodium chloride (normal saline),which is an isotonic solution.The nurse recognizes the primary goal of such intravenous therapy is to:
1) Expand the volume of fluid in the vascular system
2) Pull fluid from the cells
3) Keep protein levels normal
4) Move fluid into the cells

Question 37

A client is prescribed 3% sodium chloride,which is a hypertonic solution.The nurse recognizes the primary goal of such intravenous therapy is to:
1) Expand the volume of fluid in the vascular system
2) Pull fluid from the cells
3) Keep protein levels normal
4) Move fluid into the cells

Question 38

Which of the following clinical assessment findings is most likely seen in a client experiencing hypernatremia as a result of diabetes insipidus?
1) Dry,sticky tongue
2) Increased anxiety
3) Nausea and vomiting
4) Decreased bowel sounds

Question 39

The nurse is caring for a 73-year-old female client who is 3 days postoperative for a bowel obstruction.The nurse knows that the stress response of surgery causes fluid-balance changes in the second to fifth postoperative day,when aldosterone,glucocorticoids,and antidiuretic hormone (ADH)are increasingly secreted,causing sodium and chloride retention and potassium excretion.Because of this,it is important for the nurse to closely monitor:
1) Urine output
2) Intake of sodium
3) Activity level
4) Oxygen level

Question 40

The nurse recognizes that the client,based on the imbalance that is present,will require fluid replacement with isotonic solution.One of the isotonic solutions that may be ordered by the health care provider is:
1) 0.45% saline
2) Lactated Ringer's
3) 5% dextrose in normal saline
4) 5% dextrose in lactated Ringer's

Question 41

Blood replacement or transfusion is the IV administration of whole blood or a component such as plasma,packed red blood cells (RBCs),or platelets.The minimum gauge IV cannula necessary for administering a blood transfusion is:
1) 24 gauge
2) 22 gauge
3) 20 gauge
4) 18 gauge

Question 42

The nurse is assessing the client with an IV line.The nurse notes that the IV insertion site is red,edematous,and painful.The nurse's first action should be to:
1) Immediately discontinue the IV line and remove the cannula
2) Put cool compresses on the IV site to decrease the edema
3) Notify the health care provider of the situation
4) Put warm compresses on the IV site to decrease the pain

Question 43

A client with transient atrial fibrillation has been taking 83 mg of aspirin daily for the past 3 years.When preparing the client for discharge from the hospital,the nurse discontinues his IV line.In order to prevent a hematoma,the nurse needs to hold pressure on the IV site for:
1) 1 to 2 minutes
2) 2 to 3 minutes
3) 3 to 5 minutes
4) 5 to 10 minutes

Question 44

A client has been hospitalized following a myocardial infarction.The client has an IV line running with multiple drips.The nurse assesses the client's medical record to determine the last time the IV tubing was changed,because the nurse knows that the Centers for Disease Control and Prevention (CDC)recommends that IV tubing be changed:
1) Every shift
2) Daily
3) Every 48 hours
4) Every 72 hours

Question 45

The nurse is discontinuing a client's IV line in preparation for the client's discharge home.Upon withdrawing the cannula from the peripheral site,the nurse notes that the tip of the cannula is missing.The first thing that the nurse should do is:
1) Notify the health care provider immediately
2) Apply pressure to the IV site
3) Apply a tourniquet high on the extremity
4) Ask another nurse to double-check the cannula

Question 46

The nurse is preparing to replace a bag of IV fluids for a client receiving fluid therapy.When assessing the client,the nurse notes that the IV solution is not dripping.Which of the following should the nurse do to assess the patency of the site?
1) Lower IV container below level of IV site for presence of blood return.
2) Use a large-volume syringe to apply negative pressure to achieve a blood return.
3) Carefully adjust the roller clamp to see an increase in flow rate.
4) Massage the client's arm proximal to where the catheter is inserted.

Question 47

A 66-year-old female client is admitted to the hospital with diabetic ketoacidosis.The client has a running IV line through which she receives her medications and fluid maintenance.Which of the following would not be counted on the daily intake and output (I&O)?
1) IV fluids
2) Cream of mushroom soup
3) Gelatin
4) Mashed potatoes