Ch. 8 Fluids & Electrolytes

Question 1

A nurse is performing an admission assessment on a client who has hypovolemia due to vomiting and diarrhea. The nurse should expect which of the following findings? (Select all that apply.)

A. Distended neck veins
B. Hyperthermia
C. Tachycardia
D. Syncope
E. Decreased skin turgor

Answer 1

C. CORRECT: Tachycardia is an expected finding of hypovolemia.
D. CORRECT: Syncope is an expected finding of hypovolemia.
E. CORRECT: Decreased skin turgor is an expected finding of hypovolemia

Question 2

A nurse on a medical‑surgical unit is caring for a group of clients. The nurse should identify that which of the following clients is at risk for hypovolemia?

A. A client who has nasogastric suctioning
B. A client who has chronic constipation
C. A client who has syndrome of inappropriate antidiuretic hormone
D. A client who took an toxic dose of sodium bicarbonate antacids

Answer 2

A. CORRECT: Identify that a client who has nasogastric suctioning is at risk for hypovolemia due to excessive gastrointestinal losses

Question 3

A nurse is reviewing the laboratory test results for a client who has an elevated temperature. The nurse should identify which of the following findings is a manifestation of dehydration? (Select all that apply.)

A. Hct 55%
B. Blood osmolarity 260 mOsm/kg
C. Blood sodium 150 mEq/L
D. Urine specific gravity 1.035
E. Blood creatinine 0.6 mg/dL

Answer 3

A. CORRECT: This Hct is greater than the expected reference range of 42‑52% for males and 37‑47% for females and is an
indication of dehydration due to hemoconcentration.
C. CORRECT: This blood sodium level is greater than the expected reference range of 136‑145 mEq/L and is an indication of dehydration due to hemoconcentration.
D. CORRECT: This urine specific gravity is greater than the expected reference range of 1.005‑1.030. An increased urine specific gravity is an indication of dehydration

Question 4

A nurse on a medical‑surgical unit is caring for a group of clients. For which of the following clients should the nurse expect a prescription for fluid restriction?

A. A client who has a new diagnosis of adrenal insufficiency
B. A client who has heart failure
C. A client who is receiving treatment for diabetic ketoacidosis
D. A client who has abdominal ascites

Answer 4

B. CORRECT: Anticipate a client who has heart failure to require fluid and sodium restriction to reduce the workload on the heart

Question 5

A nurse is planning care for a client who has dehydration. Which of the following actions should the nurse include?

A. Administer antihypertensive on schedule.
B. Check the client’s weight each morning.
C. Notify the provider of a urine output greater than 30 mL/hr.
D. Encourage independent ambulation four times a day.

Answer 5

B. CORRECT: Include obtaining the client’s weight each day in the plan of care. To ensure accuracy the client’s weight should be obtained at the same time each day using the same scale. By determining the client’s weight gain or loss each day the nurse can evaluate the client’s response to treatment.

Question 6

A nurse is planning care for a client who has hypernatremia. Which of the following actions should the nurse include in the plan of care?

A. Infuse hypotonic IV fluids.
B. Implement a fluid restriction.
C. Increase sodium intake.
D. Administer sodium polystyrene sulfonate

Answer 6

A. CORRECT: Hypotonic IV fluids are indicated for the treatment of hypernatremia related to fluid loss to expand the ECF volume and rehydrate the cells.

Question 7

A nurse is reviewing the medical record of a client who has hypocalcemia. The nurse should identify which of the following findings as a risk factor for the development of this electrolyte imbalance?

A. Crohn’s disease
B. Postoperative following appendectomy
C. History of bone cancer
D. Hyperthyroidism

Answer 7

A. CORRECT: Crohn’s disease is a risk factor for hypocalcemia. This malabsorption disorder places the client at risk for hypocalcemia due to inadequate calcium absorption.

Question 8

A nurse receives a laboratory report for a client indicating a potassium level of 5.2 mEq/L. When notifying the provider, the nurse should expect which of the following actions?

A. Starting an IV infusion of 0.9% sodium chloride
B. Consulting with dietitian to increase intake of potassium
C. Initiating continuous cardiac monitoring
D. Preparing the client for gastric lavage

Answer 8

C. CORRECT: A potassium level of 5.2 mEq/L indicates hyperkalemia. Anticipate the initiation of continuous cardiac monitoring due to the client’s risk for dysrhythmias (ventricular fibrillation).

Question 9

A nurse is collecting data from a client who has hypercalcemia as a result of long‑term use of glucocorticoids. Which of the following findings should the nurse expect? (Select all that apply.)

A. Hyperreflexia
B. Confusion
C. Positive Chvostek’s sign
D. Bone pain
E. Nausea and vomiting

Answer 9

B. CORRECT: Expect the client who has hypercalcemia to have confusion and a possible decreased level of consciousness.
D. CORRECT: Expect the client who has hypercalcemia to have bone pain.
E. CORRECT: Expect the client who has hypercalcemia to have nausea and vomiting along with anorexia.

Question 10

A nurse is providing education for a client who has severe hypomagnesemia and is prescribed oral magnesium sulfate. Which of the following information should the nurse include in the teaching?

A. “Avoid green, leafy vegetables while taking this medication.”
B. “You should receive a prescription for a thiazide diuretic to take with the magnesium.”
C. “You should eliminate whole grains from your diet until your magnesium level increases.”
D. “Report diarrhea while taking this medication.”

Answer 10

D. CORRECT: Instruct the client to report diarrhea while taking oral magnesium replacement. This is a potential adverse effect of taking oral magnesium, which could worsen the client’s hypomagnesemia.

Question 11

Fluid loss in response to hypervolemia is promoted by:

a. stimulating secretion of ADH, thereby promoting urinary sodium and water elimination.
b. inhibiting the secretion of aldosterone, thereby promoting urinary sodium and water elimination.
c. lowering mean arterial pressure.
d. administering osmotically active fluids.

Answer 11

b. inhibiting the secretion of aldosterone, thereby promoting urinary sodium and water elimination.

Question 12

Which of the following ions is most closely related to water movement?

a. Potassium
b. Sodium
c. Chloride
d. Calcium

Answer 12

b. Sodium

Question 13

Which compartment contains the greatest amount of body water?

a. Transcellular
b. Plasma
c. Interstitial
d. Intracellular

Answer 13

d. Intracellular

Question 14

Which of the following transport mechanisms is associated with movement of water across a semipermeable membrane?

a. Diffusion
b. Osmosis
c. Facilitated diffusion
d. Active transport

Answer 14

b. Osmosis

Question 15

Which one of the following conditions will most likely result in edema?

a. Intravascular filtration pressure greater than interstitial filtration pressure
b. Intravascular reabsorption greater than interstitial reabsorption
c. Intravascular colloid osmotic pressure greater than interstitial colloid osmotic pressure
d. Increased lymphatic reabsorption

Answer 15

a. Intravascular filtration pressure greater than interstitial filtration pressure

Question 16

Ascites is the primary mechanism of body fluid imbalance in which of the following conditions?

a. Salt-losing tubulopathy
b. Cirrhosis
c. AIDS
d. Isonatremic dehydration

Answer 16

b. Cirrhosis

Question 17

Hypokalemia is a hallmark of which of the following conditions?

a. Salt-losing tubulopathy
b. Cirrhosis
c. AIDS
d. Isonatremic dehydration

Answer 17

a. Salt-losing tubulopathy

Question 18

Hypotonic fluid loss may result in:

a. hyponatremic dehydration.
b. isonatremic dehydration.
c. hypernatremic dehydration.
d. none of the above.

Answer 18

c. hypernatremic dehydration.

Question 19

A diabetic client with heart disease is brought into the ER with nausea, vomiting, and abdominal pain. The health care provider (HCP) confirms DKA. When correcting this client’s moderate fluid and electrolyte balance, which intravenous solution is best indicated?

A) 1/2 NS (0.45% NaCl)
B) D5W 2.5%
C) NaCl 3%
D) NS 0.9% NaCl

Answer 19

A) 1/2 NS (0.45% NaCl)

Hypotonic solutions are indicated in clients with DKA, except for dextrose since dextrose is sugar and can result in hyperglycemia. It would be important to avoid hypertonic solutions in clients with cardiac dysfunction due to the potential for circulatory overload. The most appropriate solution would be ½ NS 0.45% NaCl due to its low osmolarity.

This answer is correct because the client is a diabetic and has heart disease. It is a low hypotonic solution with low osmolarity. The client in DKA is burning ketones instead of glucose as a primary source of energy. This solution will safely replace intracellular fluid without the risk of hyperglycemia or circulatory overload.

Question 20

Which client would hypotonic fluids be contraindicated?

A) Diabete Insipidus
B) Diarrhea from stomach virus
C) Peritoneal dialysis
D) Second-degree burns

Answer 20

D) Second-degree burns

Hypotonic solution shifts fluid from intravascular spaces to intracellular and interstitial spaces to hydrate the cells and cause them to swell. Anything that causes dehydration or hypernatremia would require a hypotonic solution. A hypotonic solution has less salt and more water than other solutions.

This answer is correct because a burn victim is at risk for third-space fluid shifts. A hypotonic solution pushes fluid into the cells and interstitial cells as well. A more appropriate solution would be a solution that does not shift fluid, such as Lactated Ringer’s, which is an isotonic solution.

Question 21

A client recovering from an exploratory laparotomy and the removal of a large intestinal tumor has a nasogastric tube (NGT) in place and intravenous (IV) fluid infusion at 150 mL/hr via a pump. Which data should the nurse report to the health care provider?

A) The IV pump sounds an alarm that the high pressure has been reached
B) Intake is 1800 mL, NGT ouput is 550 mL, urine output is 950 mL
C) Crackles are present in all fields
D) WBC count is 9.0

Answer 21

C) Crackles are present in all fields

The nursing process includes assessment, diagnosis, planning, implementation, and evaluation. The nurse should report crackles present in all lung fields to the health care provider as this finding is abnormal and requires further evaluation.

This answer is correct because crackles in the lungs can indicate pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis, bronchiectasis, acute respiratory distress syndrome (ARDS), interstitial lung disease, post-thoracotomy, or metastasis ablation.

Question 22

A client has received intravenous (IV) infusions for three (3) days through a 20-gauge IV catheter placed in the left cephalic vein. On morning rounds, the nurse notes the catheter site is tender to palpation and a red streak has formed. Which action should the nurse implement first?

A) Complete an incident record
B) Start a new IV in the right hand
C) Discontinue the IV
D) Place a warm washcloth over the site

Answer 22

C) Discontinue the IV

Intravenous (IV) therapy is a medical technique that delivers a liquid directly into a client’s vein. An assessment of tenderness with palpation and a red streak at the infusion site are signs of infiltration so the nurse should discontinue the IV line immediately.

This answer is correct because pain at the insertion site and red streaking are indicative of phlebitis, a complication associated with IV therapy. The first action is to discontinue the IV line to decrease the likelihood of further complications.