Deck 3: Fluid, Electrolytes, Acid-Base Balance, and Intravenous Therapy

Question 1

The patient who has had diarrhea for the last 3 days has blood gases of pH of 7.1,HCO₃^- of 20 mEq/L,and PCO₂ of 36 mm Hg.These laboratory values are consistent with which acid-base imbalance?

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

Answer 1

Metabolic acidosis

Question 2

The nurse assesses the patient's IV insertion site and observes that the vein is hard,the skin is red and tender,and a blood return in the IV line.After removing the IV catheter,which action should the nurse take next?

A) Obtain an arm board to properly secure the IV.
B) Elevate the arm above the level of the heart.
C) Clean the site with alcohol and apply cool compresses.
D) Apply a warm moist pack.

Answer 2

Apply a warm moist pack.

Question 3

The patient with long-term obstructive pulmonary disease has a pH of 7,HCO₃- of 18 mEq/L,and a PaCO₂ of 40 mm Hg.These laboratory values are consistent with which acid-base imbalance?

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

Answer 3

Metabolic acidosis

Question 4

The nurse is caring for a patient with metabolic acidosis.Which assessment finding reveals that the compensatory mechanism to correct this imbalance is in effect?

A) Increased urinary output
B) Reduced abdominal distention
C) Kussmaul respirations
D) Decreased blood pressure

Question 5

The nurse is assessing a patient with renal failure and notes fatigue,muscle cramps,confusion,and headache.Which laboratory abnormality corresponds with these findings?

A) Potassium of 3.3 mEq/L
B) Sodium of 129 mEq/L
C) Calcium of 8.2 mg/dL
D) Chloride of 105 mEq/L

Question 6

The nurse is caring for a young patient with asthma.Which activity should the nurse encourage in order to help prevent respiratory acidosis?

A) Engage in deep-breathing exercises every 2 hours.
B) Drink 8 ounces of fluid every 4 hours.
C) Ambulate for 15 minutes twice a day.
D) Sleep with the head of the bed elevated 45 degrees.

Question 7

The patient taking furosemide (Lasix)to correct excess edema shows a weight loss of 5.5 pounds in 24 hours.The nurse calculates that this weight loss is equivalent to how many liters (L)of fluid?

A) 1 L
B) 1.5 L
C) 2.0 L
D) 2.5 L

Question 8

Which statement demonstrates that the patient accurately understands the nurse's teaching related to a low-sodium diet?

A) "I can have all the dried fruits I want."
B) "I'm looking forward to a tall glass of tomato juice."
C) "I'm going to eat my favorite avocado and orange salad."
D) "I'm going to eat a cheeseburger with extra ketchup."

Question 9

Because there are no IV pumps available for the immediate infusion of an IV medication,the nurse must calculate the flow rate for 500 mL to run for 4 hours,using a set that delivers 15 gtt/mL.Which flow rate is correct?

A) 30 gtt/min
B) 35 gtt/min
C) 40 gtt/min
D) 45 gtt/min

Question 10

After selecting an appropriate fluid,which action should the nurse take to correctly flush a PRN lock?

A) Flush forcefully to clear the lumen.
B) Use slow, gentle pressure to clear the lumen.
C) Flush hard enough to clear resistance.
D) Aspirate for blood return prior to flushing.

Question 11

The nurse uses a picture to show how ions equalize their concentration by which passive transport process?

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

Question 12

While the nurse is washing the face of a patient in renal failure,the patient demonstrates a spasm of the lips and face.Which laboratory value corresponds with the nurse's assessment findings?

A) Potassium of 3.4 mEq/L
B) Calcium of 7.9 mg/dL
C) Sodium of 140 mEq/L
D) Phosphorus of 2.8 mg/dL

Question 13

The nurse uses a diagram to demonstrate how in dehydration the water is drawn into the plasma from the cells by which process?

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

Question 14

The nurse assessing a patient with vomiting and diarrhea observes that the urine is scant and concentrated.Which controlling factor is responsible for compensatory reabsorption of water?

A) Osmoreceptors in the hypothalamus
B) Antidiuretic hormone in the posterior pituitary
C) Baroreceptors in the carotid sinus
D) Insulin from the pancreas

Question 15

The nurse is caring for a patient who has been on total parenteral nutrition (TPN)for 48 hours.Which action demonstrates effective nursing care?

A) Checking the patient's blood glucose level according to facility protocol.
B) Increasing the infusion rate if the prescribed intake falls behind.
C) Informing the patient that TPN can only be administered via a central line for 1 week.
D) Monitoring the peripheral IV site of TPN infusion for signs of infiltration at least every 8 hours.

Question 16

The nurse is caring for a patient with a potassium level of 2.9 mEq/L.The nurse should carefully monitor the patient for which potential problem?

A) Excessive urinary output
B) Abdominal distention
C) Increased reflexes
D) Hyperactive bowel sounds

Question 17

The count of the solution in the IV container at the beginning of the shift is 800 mL.A new 1000-mL bag was hung during the shift and has 650-mL left at the end of the shift.What amount should the nurse record as the IV fluid intake for the shift?

A) 1000 mL
B) 1050 mL
C) 1100 mL
D) 1150 mL

Question 18

The nurse is caring for an 80-year-old patient.Which finding is the best early indicator of dehydration in this patient?

A) Reduced skin turgor
B) Constipation
C) Increased temperature
D) Thirst

Question 19

Which term describes the active transport process that moves sodium and potassium into or out of cells?

A) Filtration
B) Sodium pump
C) Diffusion
D) Osmosis

Question 20

Which finding is most important for the nurse to confirm prior to hanging an intravenous (IV)bag containing potassium?

A) Verify a blood pressure of at least 60 mm Hg diastolic.
B) Check for urine output of at least 30 mL/hr.
C) Ensure filter placement on the IV line.
D) Verify a pulse of at least 50 beats/min.

Question 21

The nurse explains to the 85-year-old patient with a temperature that,with each degree of fever,the body loses _____% of water.

Question 22

The nurse is caring for a newly admitted patient with uncontrolled nausea and vomiting.The patient has a history of alcoholism and diabetes.After receiving these orders from the health care provider,which order(s)should the nurse question?

A) Administer 10 mg prochlorperazine maleate (Compazine), IM every 4 to 6 hours for nausea and vomiting.
B) Administer diphenoxylate atropine (Lomotil), two tabs, by mouth after first occurrence of nausea and vomiting.
C) Administer furosemide (Lasix) 40 mg by slow IV push.
D) Monitor the patient's intake and output every 4 hours.
E) Obtain patient's weight every morning and record.

Question 23

The nurse explains that the chain of events that results in hypocalcemia for the patient in early renal failure occurs in which order? (Match the events to the proper sequence.)

Step 5

A)Loss of calcium ions
B)Vitamin D not activated
C)Bone loss
D)Retention of phosphates
E)Loss of absorption of calcium from the gastrointestinal tract

Question 24

The nurse is assessing the hydration status of the patient.Which action(s)demonstrates knowledge of proper assessment?

A) Monitoring the patient's daily weight.
B) Assessing the patient's skin turgor on the back of the hand.
C) Checking the patient's blood glucose level four times a day.
D) Assessing for skin tenting on the patient's forehead.
E) Asking the patient if he is experiencing thirst.

Question 25

The nurse explains that the chain of events that results in hypocalcemia for the patient in early renal failure occurs in which order? (Match the events to the proper sequence.)

Step 3

A)Loss of calcium ions
B)Vitamin D not activated
C)Bone loss
D)Retention of phosphates
E)Loss of absorption of calcium from the gastrointestinal tract

Question 26

The nurse explains that the chain of events that results in hypocalcemia for the patient in early renal failure occurs in which order? (Match the events to the proper sequence.)

Step 1

A)Loss of calcium ions
B)Vitamin D not activated
C)Bone loss
D)Retention of phosphates
E)Loss of absorption of calcium from the gastrointestinal tract

Question 27

The nurse is caring for a patient that has a potassium level of 5.0.The nurse should carefully monitor the patient for which signs and symptoms?

A) Muscle weakness
B) Cardiac dysrhythmias
C) Decreased reflexes
D) Urinary retention
E) Hypotension

Question 28

The nurse explains that the chain of events that results in hypocalcemia for the patient in early renal failure occurs in which order? (Match the events to the proper sequence.)

Step 2

A)Loss of calcium ions
B)Vitamin D not activated
C)Bone loss
D)Retention of phosphates
E)Loss of absorption of calcium from the gastrointestinal tract

Question 29

The primary care provider writes an order for the patient to receive an IV of a solution that has the same osmotic pressure as intracellular fluid.The nurse would correctly question which IV order(s)?

A) 5% dextrose in water
B) 0.45% sodium chloride
C) 5% dextrose in 0.9% sodium chloride
D) Lactated Ringer solution
E) 0.9% sodium chloride

Question 30

The nurse demonstrates knowledge of IV solutions by identifying that the IV solution which provides free water,as well as 340 calories/L,is ______________.

Question 31

The nurse explains that the chain of events that results in hypocalcemia for the patient in early renal failure occurs in which order? (Match the events to the proper sequence.)

Step 4

A)Loss of calcium ions
B)Vitamin D not activated
C)Bone loss
D)Retention of phosphates
E)Loss of absorption of calcium from the gastrointestinal tract

Question 32

The nurse reminds the patient that the three body mechanisms that attempt to compensate to correct acid-base imbalances are the __________ system,the __________ system,and the __________.