F&E sample questions

Question 1

Why do older adults generally have less total body water than younger adults?

a. As functional cells die during the aging process, less water is needed.
b. The muscle mass of older adults is smaller than the muscle mass of younger adults.
c. Older adults have a smaller extracellular fluid to intracellular fluid ratio than younger adults.
d. The plasma volume of older adults is decreased to reduce the risk for excess fluid volume and heart failure.

Answer 1

ANS: B

Muscle cells are a large portion of the body and contain more water than many other types of cells. As a person ages, the size of muscle cells tends to decrease and the volume of total body water decreases in proportion to this loss of muscle cell mass.

Question 2

Which clinical manifestation supports the concept that filtration is directly related to hydrostatic pressure?

a. Capillary refill is faster in fingers than in toes.
b. Central venous pressure is lowest in the right atrium.
c. Pitting edema is usually detected first in dependent areas.
d. Systolic blood pressure is higher than diastolic blood pressure.

Answer 2

ANS: C

Capillary hydrostatic pressure is greater in dependent areas because of the influence of gravity, which promotes the process of filtration and leads to the formation of interstitial edema.

Question 3

What effect would an infusion of 200 mL of albumin have on a healthy client’s plasma osmotic and hydrostatic pressures?

a. Increased osmotic pressure, increased hydrostatic pressure
b. Increased osmotic pressure, decreased hydrostatic pressure
c. Decreased osmotic pressure, increased hydrostatic pressure
d. Decreased osmotic pressure, increased hydrostatic pressure

Answer 3

ANS: A

The addition of albumin to the plasma would add a colloidal substance that does not move into the interstitial space. Thus, the osmotic pressure would immediately increase. Not only does the additional 200 mL add to the plasma hydrostatic pressure, but the increased osmotic pressure would draw water from the interstitial space, increasing the plasma volume and ultimately leading to increased hydrostatic pressure in the plasma volume.

Question 4

Why does pulmonary edema form in a client who has left-sided heart failure?

a. Increased blood volume in pulmonary vessels, increased blood osmotic pressure
b. Increased blood volume in pulmonary vessels, decreased blood osmotic pressure
c. Increased blood volume in pulmonary vessels, increased blood hydrostatic pressure
d. Increased blood volume in pulmonary vessels, decreased blood hydrostatic pressure

Answer 4

ANS: C

Left-sided heart failure reduces the movement of blood from the left ventricle into the aorta. As a result, there is damming of blood in the left ventricle, which eventually backs up into the left atrium and then into the pulmonary vessels. This increased volume in the pulmonary vessels increases the hydrostatic pressure, forcing fluid to leave the pulmonary vessels by filtration and moving into the pulmonary interstitial tissues.

Question 5

What is the expected action when capillary pores increase in size?

a. Increased filtration, increased plasma volume
b. Increased filtration, decreased plasma volume
c. Decreased filtration, increased plasma volume
d. Decreased filtration, decreased plasma volume

Answer 5

ANS: B

Filtration is the movement of fluids through pores in response to hydrostatic pressure differences. As capillary pores enlarge, more fluid (including solute) filters from the plasma volume into the interstitial space. If such conditions persist, the plasma volume can be seriously depleted while the interstitial volume increases.

Question 6

Which condition is most likely to cause formation of edema?

a. Increased plasma osmotic pressure, increased plasma hydrostatic pressure
b. Increased plasma osmotic pressure, decreased plasma hydrostatic pressure
c. Decreased plasma osmotic pressure, increased plasma hydrostatic pressure
d. Decreased plasma osmotic pressure, decreased plasma hydrostatic pressure

Answer 6

ANS: C

Both decreased plasma osmotic pressure and increased plasma hydrostatic pressure are forces that tend to move fluid out from the plasma volume and into the interstitial space. Increasing the interstitial fluid volume leads to the formation of visible edema that forms pits when pressure is applied.

Question 7

Which assessment technique would be the best for the nurse to use to determine the adequacy of circulation in a client whose blood osmolarity is 250 mOsm/L?

a. Checking urine output
b. Measuring abdominal girth
c. Monitoring fluid intake
d. Comparing the radial pulse with the apical pulse

Answer 7

ANS: A

The blood osmolarity is low. The client could be dehydrated (hypo-osmolar dehydration) or overhydrated, with dilution of blood solute. The most sensitive, noninvasive indicator of circulation adequacy is urine output.

Question 8

Which community-dwelling healthy person has the greatest risk for dehydration when exposed to a hot, dry environment for several hours?

a. 50-year-old man
b. 50-year-old woman
c. 80-year-old man
d. 80-year-old woman

Answer 8

ANS: D

Much of the total body water is located inside muscle cells. Women of any age have less muscle and more fat than a man of the same age, resulting in less total body water and a greater risk for dehydration when exposed to water-losing environmental conditions. As people age, muscle mass is lost. Thus, the person at greatest risk for dehydration is an older woman.

Question 9

How is the process of active transport beneficial to human living systems?

a. Active transport moves substances against a concentration gradient, allowing fluid compartment volume ionic differences to be maintained.
b. Active transport allows the fluid lost at the capillary–interstitial compartment interface to be returned by lymph flow to the systemic circulation.
c. When diffusion is limited by membrane impermeability, active transport maintains homeostasis of osmolarity across all body fluid compartments.
d. When osmosis cannot occur during periods of anoxia, active transport facilitates movement of glucose across cell membranes so that energy production is not disrupted.

Answer 9

ANS: A

Excitable membrane function (nerves and muscle of all types) is dependent on major differences between extracellular ion concentrations (especially sodium and potassium) and intracellular ion concentrations. Active transport allows extracellular potassium to be moved back into the cells against a concentration gradient and excess sodium inside the cells to be moved back into the extracellular fluid against a concentration gradient. If the systems for active transport were not functioning, no ionic differences would be maintained, leading to cellular swelling, loss of resting membrane potential, and death.

Question 10

Which client is at greatest risk for dehydration?

a. The younger adult client with immobility
b. The older adult client receiving hypotonic IV fluid
c. The younger adult client receiving hypertonic IV fluid
d. The older adult client with cognitive impairment

Answer 10

ANS: D

Older adults, because of having less total body water than younger adults, are at greater risk for development of dehydration. Anyone who is cognitively impaired, and either cannot obtain fluids independently or cannot make his or her need for fluids known, is at high risk for dehydration.

Question 11

What are the fluid compartment consequences of isotonic dehydration?

a. ECF compartment volume contracts, ICF volume contracts
b. ECF compartment volume contracts, ICF volume remains the same
c. ECF compartment volume expands, ICF volume contracts
d. ECF compartment volume expands, ICF volume remains the same

Answer 11

ANS: B

Isotonic dehydration involves loss of isotonic fluids from the extracellular fluid (ECF) space, including both the plasma and interstitial spaces. Thus, there is a loss of water and electrolytes in equal proportions. Because isotonic fluid is lost, ECF osmolarity remains normal while volume is reduced. This type of dehydration does not cause a shift of fluids between spaces, so the intracellular fluid (ICF) volume remains normal.

Question 12

What are the fluid compartment consequences of hypertonic dehydration?

a. ECF compartment volume contracts, ICF volume contracts
b. ECF compartment volume contracts, ICF volume remains the same
c. ECF compartment volume expands, ICF volume contracts
d. ECF compartment volume expands, ICF volume remains the same

Answer 12

ANS: C

Hypertonic dehydration involves loss of water in greater proportion than the loss of electrolytes from the extracellular fluid (ECF) space, including both the plasma and interstitial spaces. This water loss increases the osmolarity of the remaining plasma, making it hypertonic or hyperosmolar compared with normal ECF. The hyperosmolar plasma has an increased osmotic pressure that causes water to move from the ICF into the plasma and interstitial fluid spaces. The fluid shift leads to cellular dehydration and shrinkage. The fluid shift also causes the plasma volume to increase to normal or greater than normal levels.

Question 13

The client has been diagnosed with hypotonic dehydration. Which assessment finding should the nurse expect?

a. Flattened hand veins when the hand is positioned above the heart
b. Increased urine output, decreased urine specific gravity
c. Nonpitting dependent edema
d. Poor handgrip strength

Answer 13

ANS: D

In hypotonic dehydration, electrolyte loss exceeds fluid loss. The remaining fluid is dilute, with hyponatremia and hypokalemia causing skeletal muscle weakness.

Question 14

Which choice of mouth care product or technique is best for the nurse to use every 2 hours when providing mouth care for the client with dehydration who has a dry, sticky mouth?

a. A commercial, alcohol-based mouthwash
b. A dilute solution of 50% hydrogen peroxide and 50% normal saline
c. Lemon and glycerol swabs
d. Warm tap water

Answer 14

ANS: D

Peroxide, glycerol, and alcohol all increase mouth dryness and their use should be limited for the client with a dry mouth. Tap water rinses can be used as often as the client wishes (for a conscious client).

Question 15

Which blood electrolyte level is most important to monitor in the client who has hypertonic dehydration?

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

Answer 15

ANS: B

Although all electrolyte levels can be elevated when a client has hypertonic dehydration, the one that is most life-threatening is potassium. Elevated potassium levels (whether an actual elevation or a relative elevation) can lead to bradydysrhythmias and cardiac arrest.

Question 16

Which intravenous solution should the nurse be prepared to administer to a client who has isotonic dehydration?

a. Dextrose 5% in water
b. Dextrose 10% in water
c. 0.45% sodium chloride
d. 0.9% sodium chloride

Answer 16

ANS: D

Generally, the selection of fluid to treat dehydration is based on the type of dehydration present. Isotonic dehydration is treated with administration of isotonic fluids (and the only “true” isotonic fluid on this list is 0.9% saline), hypertonic dehydration is treated with hypotonic fluids, and hypotonic dehydration is treated with hypertonic fluids.

Question 17

Why is dextrose 5% in water considered to be a hypotonic solution rather than an isotonic solution, even though its osmolarity is 272 mOsm/L?

a. An isotonic solution must have an osmolarity greater than 300 mOsm/L.
b. Glucose is not an electrolyte and does not completely dissociate in water.
c. Glucose is immediately metabolized upon administration, leaving pure water in circulation.
d. Intravenous glucose immediately draws water from the interstitial and intracellular spaces, resulting in hemodilution.

Answer 17

ANS: C

Dextrose 5% in water is isotonic in its container but, upon reaching the blood, glucose is taken up by cells for metabolism (in the nondiabetic client) as rapidly as it is infused, with the remainder of the infused fluid being water.

Question 18

Which intravenous fluid solution should the nurse be prepared to administer as rehydration therapy for the client with hypertonic dehydration?

a. 0.9% saline
b. Dextrose 5% in water
c. Dextrose 5% in saline
d. Dextrose 5% in Ringer’s lactate

Answer 18

ANS: B

Hypertonic dehydration occurs when fluid loss exceeds electrolyte loss, so that the client’s remaining extracellular fluid is hypertonic. Hypertonic dehydration is best treated with hypotonic fluids. Although dextrose 5% in water is isotonic in its container, upon infusion the dextrose is metabolized and the remaining water is hypotonic.

Question 19

Which assessment data obtained by the home care nurse suggests that a 74-year-old client may be dehydrated?

a. The client has dry skin on the upper and lower extremities.
b. The client states that he gets up three or more times during the night to urinate.
c. The client states that he feels lightheaded when he gets out of bed or stands up.
d. The nurse observes tenting of skin on the back of the hand when testing skin turgor.

Answer 19

ANS: C

Orthostatic or postural hypotension can be caused by or worsened by dehydration.

Question 20

What are the fluid compartment consequences of hypertonic overhydration?

a. ECF compartment volume contracts, ICF volume contracts
b. ECF compartment volume contracts, ICF volume remains the same
c. ECF compartment volume expands, ICF volume contracts
d. ECF compartment volume expands, ICF volume remains the same

Answer 20

ANS: C

Hypertonic overhydration is caused by an excessive sodium intake. The hyperosmolarity of the plasma and interstitial compartments draws fluid from the intracellular fluid (ICF) compartment. Thus the ECF volume expands and the ICF volume contracts.

Question 21

With which client should the nurse be most alert for the development of overhydration?

a. 65-year-old client who has diabetes mellitus and chronic hypertension
b. 45-year-old client who self-medicates with sodium-containing antacids for indigestion
c. 75-year-old client receiving blood replacement therapy with 3 units of packed red blood cells
d. 80-year-old client 1 day postoperative from abdominal surgery who has an NG tube to continuous suction

Answer 21

ANS: C

Blood replacement therapy involves intravenous fluid administration, which inherently increases the risk for overhydration. The fact that the fluid consists of packed red blood cells greatly increases the risk because this fluid increases the colloidal oncotic pressure of the blood, causing fluid to move from the interstitial and intracellular spaces into the plasma volume. An older adult may not have sufficient cardiac or renal reserve to manage this extra fluid.

Question 22

Which alteration in psychosocial functioning should alert the nurse to the possibility of hypokalemia?

a. Anxiety
b. Insomnia
c. Confusion
d. Combative behavior

Answer 22

ANS: C

Hypokalemia decreases cerebral function and is manifested by lethargy, confusion, inability to perform problem-solving tasks, disorientation, and coma.

Question 23

Which question is most important for the nurse to ask the client who has been diagnosed with hypokalemia to identify a possible cause for the imbalance?

a. “Do you use sugar substitutes?”
b. “Do you use diuretics or laxatives?”
c. “Have you or any member of your family been diagnosed with kidney disease?”
d. “Have you noticed any changes in your pattern of bowel elimination during the last month?”

Answer 23

ANS: B

Misuse or overuse of diuretics, especially high-ceiling (loop) and thiazide diuretics, and laxatives are common causes of hypokalemia among older adults or clients with eating disorders.

Question 24

Which clinical manifestation or condition indicates that treatment for hypokalemia is effective?

a. The client reports having a bowel movement daily.
b. The client has gained 2 pounds during the past week.
c. The client’s ECG shows an inverted T wave.
d. The client’s fasting blood glucose level is 106 mg/dL.

Answer 24

ANS: A

Hypokalemia depresses all excitable tissues, including gastrointestinal smooth muscle. Clients who have hypokalemia have reduced or absent bowel sounds and are constipated.

Question 25

What is the priority nursing diagnosis for a client who has moderate hypokalemia?

a. Imbalanced Nutrition, Less than Body Requirements related to biologic factors
b. Risk for Deficient Fluid Volume related to diarrhea
c. Risk for Injury related to falls
d. Fatigue related to anorexia

Answer 25

ANS: C

Hypokalemia decreases the excitability of all excitable tissues and causes skeletal muscle weakness, increasing the risk for falls. In addition, hypokalemia leads to orthostatic hypotension, also increasing the client’s risk for falls and injury.

Question 26

The client at risk for continuing hypokalemia is going home. What dietary meal selection for breakfast made by the client indicates an adequate understanding of how to increase dietary potassium intake?

a. Toasted English muffin with butter and blueberry jam, and tea with sugar
b. Two scrambled eggs, a slice of white toast, and a half-cup of strawberries
c. Sausage patty, one slice of whole wheat toast, half-cup of raisins, and a glass of milk
d. Bowl of oatmeal with brown sugar (2 tablespoons), half-cup of sliced peaches, and coffee

Answer 26

ANS: C

Meat, dairy products, and dried fruit have high concentrations of potassium. Eggs, breads, cereals, sugar, and some fruit (berries, peaches) are low in potassium.

Question 27

Which serum potassium value reflects mild hyperkalemia in a 40-year-old man?

a. 2.8 mEq/L
b. 4.8 mEq/L
c. 5.8 mEq/L
d. 6.8 mEq/L

Answer 27

ANS: C
The normal range for serum potassium in adults is 3.5 to 5.0 mEq/L. Both 5.8 and 6.8 mEq/L are higher than normal. A potassium level of 6.8 mEq/L is more serious and does not represent mild hyperkalemia.

Question 28

Which condition or clinical manifestation indicates that the client’s treatment for hyperkalemia is effective?

a. Pulse rate is 76 and regular.
b. Respiratory rate is 22.
c. Chvostek’s sign is negative.
d. Hematocrit is 42%.

Answer 28

ANS: A
Hyperkalemia affects cardiac conduction by inducing tall T waves, widened QRS complexes, absent P waves, prolonged PR intervals, bradycardia, and heart block. A heart rate that is regular and within the client’s normal range for rate indicates resolution of the hyperkalemia.

Question 29

The client with hyperkalemia is receiving 100 mL of dextrose 20% in water with 20 units of regular insulin. The client is slightly confused, has weaker handgrasps, and is pale and sweaty. What is the nurse’s best first action?

a. Notify the emergency team.
b. Apply oxygen by mask or nasal cannula.
c. Switch the IV solution to dextrose 5% in water.
d. Prepare to administer potassium chloride by IV push.

Answer 29

ANS: C

Intravenous fluids containing insulin place the client at risk for hypoglycemia as well as hypokalemia. The client’s clinical manifestations indicate both hypoglycemia and hypokalemia. The hypoglycemia can be life-threatening. Stopping the current IV solution but maintaining IV access is critical. Although potassium may be given as a small infusion (100 to 150 mL) of IV fluid, it is not given by IV push.

Question 30

Which serum sodium value indicates mild hyponatremia?

a. 148 mEq/L (mmol/L)
b. 138 mEq/L (mmol/L)
c. 128 mEq/L (mmol/L)
d. 118 mEq/L (mmol/L)

Answer 30

ANS: C

The normal range for serum sodium levels among healthy adults between the ages of 18 and 60 years is 136 to 145 mEq/L (mmol/L). Although both C and D indicate low levels of sodium, 118 mEq/L represents a severe hyponatremia.

Question 31

Which assessment finding should alert the nurse to a worsening of the client’s hyponatremia?

a. The client is anxious and combative.
b. Diastolic blood pressure has increased by 8 mm Hg.
c. Bowel sounds are hyperactive in all abdominal quadrants.
d. Deep tendon reflexes of the ankles and knees have changed from 1+ to 2+.

Answer 31

ANS: C

Clinical manifestations of hyponatremia are most evident in excitable tissues and include lethargy, decreased blood pressure, increased gastric motility, and diminished deep tendon reflexes.

Question 32

Which client is at greatest risk for developing hyponatremia?

a. 35-year-old client who is NPO and receiving D5W as the mainstay of intravenous therapy
b. 45-year-old client who is taking a sulfonamide antibiotic for a urinary tract infection
c. 55-year-old client who is taking ibuprofen for a sprained ankle
d. 65-year-old client who is taking digoxin

Answer 32

ANS: A

D5W contains no sodium or any other electrolyte. With the client not taking any food or fluids by mouth, normal sodium excretion can lead to hyponatremia.

Question 33

What is the priority nursing intervention for a client with moderate to severe hypernatremia?

a. Restricting fluid intake
b. Initiating seizure precautions
c. Weighing the client daily at the same time of day
d. Assessing pulse oximetry and respiratory status every hour

Answer 33

ANS: B

Moderate to severe hypernatremia can stimulate seizures.

Question 34

Which client is at greatest risk for development of an actual hypocalcemia?

a. The 26-year-old client with hyperparathyroidism
b. The 40-year-old client taking tetracycline for an infection
c. The 70-year-old client who has alcoholism and malnutrition
d. The 35-year-old athlete taking NSAIDs for joint and muscle pain

Answer 34

ANS: C

Calcium is absorbed from the gastrointestinal tract under the influence of vitamin D. When a client is malnourished, not only is the dietary intake of calcium usually low, the client is also vitamin deficient.

Question 35

When taking the blood pressure of a very ill client, the nurse observes that the client’s hand undergoes flexion contractions. What is the nurse’s best first action?

a. Place the client in the high-Fowler’s position and increase the IV flow rate.
b. Deflate the blood pressure cuff and give the client oxygen.
c. Document the finding as the only action.
d. Notify the emergency team.

Answer 35

ANS: B

Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions occurring during blood pressure measurement are indicative of hypocalcemia and are referred to as a positive Trousseau’s sign.

Question 36

What is the priority nursing diagnosis for a client with long-standing hypocalcemia?

a. Ineffective Breathing Pattern related to muscle weakness
b. Risk for Infection related to immunosuppression
c. Risk for Injury related to bone demineralization
d. Fatigue related to malnutrition and anemia

Answer 36

ANS: C

Chronic or long-standing hypocalcemia causes such severe bone calcium loss that the bones lose density and become brittle and easily broken. Clients who have long-standing hypocalcemia need to be handled gently.

Question 37

Which nursing intervention would be most effective in preventing injury in a hospitalized client with hypocalcemia of long duration?

a. Teaching the client to wear shoes when ambulating
b. Applying antiembolic stockings on the client’s legs
c. Placing an egg-crate mattress on the client’s bed
d. Using a lift sheet when moving the client in bed

Answer 37

ANS: D

Prolonged hypocalcemia results in loss of bone calcium, making the bones brittle and fragile. Using a lift sheet when moving the client rather than grasping or pulling the client helps prevent fractures.

Question 38

The client is admitted through the emergency department with multiple fractures from a motor vehicle accident. Which of the client’s previous or concurrent health problems is most likely to increase his or her risk for hypophosphatemia?

a. Has chronic alcoholic pancreatitis
b. Has smoked cigarettes for 50 years
c. Has had prostate cancer for one year
d. Had cardiac valve replacement surgery 8 years ago

Answer 38

ANS: A

Many people with chronic alcoholism are malnourished. Malnutrition is a major contributing factor to the development of hypophosphatemia.

Question 39

The client with chronic hypomagnesemia is discharged to home and prescribed to take an oral magnesium supplement. Which side effect is the most important to include when teaching the client?

a. Diarrhea
b. Impotence
c. Increased insomnia
d. Potential leg cramps at night

Answer 39

ANS: A

Oral magnesium preparations increase gastric motility and induce some degree of diarrhea in most clients. The diarrhea can be severe enough to increase magnesium loss and dehydrate the client.

Question 40

What is the best explanation for why changes in blood pH reflect the adequacy of acid-base homeostatic mechanisms?

a. Body fluid pH is a measure of the blood hydrogen ion concentration, and the acid-base homeostatic mechanisms control this concentration.
b. Body fluid pH is a measure of the blood bicarbonate concentration, and the acid-base homeostatic mechanisms control this concentration.
c. When homeostatic mechanisms are functioning properly, the blood electrolyte concentrations are normal, as measured by pH.
d. When body fluid pH is normal, acid-base homeostatic mechanisms are not needed.

Answer 40

ANS: A
The concentration of hydrogen ions is measured as pH units, which correspond to the negative logarithm of the number of milliequivalents of hydrogen ions per liter of fluid. Thus, pH and hydrogen ion concentration are inversely related. Hydrogen ions are produced continually and, if acid-base compensatory mechanisms were not functional, the blood pH would be abnormal. A normal pH indicates that acid-base homeostatic mechanisms are functioning well enough to maintain the proper balance between hydrogen ion (acid) production and hydrogen ion elimination.

Question 41

Why does a change in blood pH usually result in an abnormality of one or more blood electrolyte levels?

a. Because an increase in blood pH level stimulates the thirst reflex, the person then ingests hypotonic fluids to excess, resulting in a dilution of all other serum electrolytes.
b. A change in the pH is a change in the hydrogen ion concentration, which causes a corresponding change in the ability of the intestinal mucosa to absorb ingested electrolytes.
c. Because hydrogen ions carry a positive charge, a change in the pH requires a corresponding change in the amount of other positive and negative charges to maintain electroneutrality of the blood.
d. Because hydrogen ions and potassium ions exist in the blood in a balanced, reciprocal relationship, an increase or decrease in the blood pH requires a corresponding decrease or increase in potassium ions.

Answer 41

ANS: C

The blood pH is a measure of the concentration of the blood hydrogen ion concentration. Hydrogen ions are cations expressing a positive charge. In order for body fluids to remain electrically neutral, an increase in hydrogen ion concentration requires fewer other positive ions and more negative ions for balance. The reverse is true for decreased hydrogen ion concentration.

Question 42

What is the most correct description of normal arterial blood pH with regard to acid-base balance?

a. Arterial blood has a neutral pH.
b. Arterial blood is slightly acidic.
c. Arterial blood is slightly alkaline.
d. Arterial blood maintains electroneutrality.

Answer 42

ANS: C

A truly neutral pH is 7.0. The normal range of arterial blood pH (7.35 to 7.45) reflects a slight alkalinity.

Question 43

Which statement most accurately describes the relationship between the hydrogen ion concentration and carbon dioxide concentration in extracellular fluids?

a. Because carbon dioxide is a gas and hydrogen ions are electrolytes, these two substances have no relationship in extracellular fluids.
b. The concentrations of hydrogen ions and carbon dioxide are directly related, with an increase or decrease in one always resulting in a corresponding increase or decrease in the other.
c. Carbon dioxide buffers hydrogen ions; thus, these two concentrations are inversely related to each other. The higher the carbon dioxide concentration, the fewer hydrogen ions are present in that fluid.
d. Hydrogen ions and carbon dioxide ions exist in a balanced relationship as a result of their charges. The positively charged hydrogen ions are attracted to the negatively charged carbon dioxide ions, forming an electrically neutral substance.

Answer 43

ANS: B

Through the action of the carbonic anhydrase equation, the concentration of hydrogen ions is directly related to the concentration of carbon dioxide in the blood.

Question 44

Which statement regarding acid-base homeostasis is true?

a. In the renal tubules, when hydrogen ions are excreted, bicarbonate ions are reabsorbed.
b. The central chemoreceptors are very sensitive to changes in arterial oxygen concentration.
c. At the level of the alveolar capillary membrane, oxygen and carbon dioxide are exchanged evenly.
d. The first line of defense against major changes in blood pH is the renal control of hydrogen ion reabsorption and excretion.

Answer 44

ANS: A

Renal handling of bicarbonate and hydrogen ions functions to maintain acid-base balance. Thus, the kidney moves these substances in opposite directions based on existing conditions. When acidosis is present, the kidney excretes hydrogen ions and reabsorbs bicarbonate ions to return the pH to normal. When alkalosis is present, the kidney excretes bicarbonate ions and reabsorbs hydrogen ions to return the pH to normal.

Question 45

The client has severe respiratory impairment. Which alterations in acid-base balance could be expected as a compensatory response?

a. Decreased arterial blood pH
b. Increased arterial blood bicarbonate
c. Increased arterial blood oxygen
d. Decreased arterial blood carbon dioxide

Answer 45

ANS: B
Because kidneys regulate pH by controlling bicarbonate concentration and the lungs regulate pH by controlling carbon dioxide loss, a loss of one function can be at least partially compensated by the other function. When pulmonary function is decreased, so that adequate amounts of carbon dioxide are not excreted, the pH rises, stimulating the kidneys to reabsorb more bicarbonate to balance the increased acid production.

Question 46

The client has an arterial blood gas pH of 7.42. How should the nurse interpret this client’s acid-base status?

a. The client has no blood hydrogen ions.
b. The client has a normal blood hydrogen ion concentration.
c. The client has a deficit in the blood hydrogen ion concentration.
d. The client has an excess in the blood hydrogen ion concentration.

Answer 46

ANS: B
The pH is the negative log of the hydrogen ion concentration. The normal pH of arterial blood ranges between 7.35 and 7.45. A pH of 7.42 indicates that the client’s blood hydrogen ion concentration is within the normal range.

Question 47

What acid-base problem could result if a client being mechanically ventilated is ventilated at too high a rate of breaths per minute?

a. Acid deficit alkalosis
b. Base excess alkalosis
c. Acid excess acidosis
d. Base deficit acidosis

Answer 47

ANS: A

A ventilator set at either too high a ventilation rate and/or too high a tidal volume will cause the client to lose too much carbon dioxide, leading to an acid deficit respiratory alkalosis.

Question 48

Which acid-base problem is most likely to develop in a person prescribed to take furosemide (Lasix, Furoside) for hypertension?

a. Acid excess respiratory acidosis
b. Acid deficit respiratory alkalosis
c. Acid excess metabolic acidosis
d. Acid deficit metabolic alkalosis

Answer 48

ANS: D

Many diuretics, especially loop diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through the renal system. This situation is an acid deficit of metabolic origin.

Question 49

Which client is at greatest risk for acidosis?

a. The 78-year-old client on diuretic therapy with furosemide (Lasix, Furoside)
b. The 62-year-old client with moderate hypertension
c. The 75-year-old client with peptic ulcer disease
d. The 45-year-old client with pneumonia

Answer 49

ANS: D
Any respiratory problem can lead to oxygen insufficiency and carbon dioxide retention. The lack of oxygen also increases carbon dioxide production. The excessive levels of carbon dioxide result in greatly increased hydrogen ion production and acidosis through the carbonic acid pathway.

Question 50

Which acid-base imbalance should the nurse be prepared for in a client who has acute pancreatitis?

a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis

Answer 50

ANS: A

The pancreas is a major site of bicarbonate production. Pancreatitis can cause a relative metabolic acidosis through the underproduction of bicarbonate ions.

Question 51

Which laboratory data and clinical manifestations should cause the nurse to suspect a client may be experiencing acidosis?

a. A serum sodium level of 130 mEq/L and peripheral edema
b. A serum sodium level of 144 mEq/L and tachycardia
c. A serum potassium level of 6.5 mEq/L and flaccid paralysis
d. A serum potassium level of 4.5 mEq/L and hyperactive deep tendon reflexes.

Answer 51

ANS: C
When acidosis is present, the hydrogen ion concentration of the extracellular fluid (ECF) is increased above normal. Physiologic action to reduce the ECF hydrogen ion concentration is to move the hydrogen ions into the cells in exchange for potassium ions to maintain electroneutrality of the intracellular fluid. As a result, acidosis is accompanied by hyperkalemia, which diminishes nerve and skeletal muscle excitability, causing flaccid paralysis.

Question 52

Which client is at greatest risk for the development of metabolic acidosis?

a. 56-year-old man with chronic asthma
b. 36-year-old man hiking in the Canadian Rockies
c. 36-year-old woman on a carbohydrate-free diet
d. 56-year-old woman self-medicating with sodium bicarbonate for gastroesophageal reflux

Answer 52

ANS: C
One cause of acidosis is a strict, low-calorie diet or one that is low in carbohydrate content. Such a diet increases the rate of fat catabolism and results in the formation of excessive ketoacids.

Question 53

Which client is most at risk for the development of acute respiratory acidosis?

a. 58-year-old man with allergic rhinitis and sinusitis
b. 28-year old woman with type 1 diabetes who has a urinary tract infection
c. 68-year-old woman who has long-standing emphysema and is now undergoing continuous nasogastric suctioning
d. 38-year-old, 6’ 7” man being mechanically ventilated with a tidal volume of 500 mL at 15 breaths/minute

Answer 53

ANS: D

The ventilator settings for the man undergoing mechanical ventilation are based on the tidal volume and ventilation needs of an “average”-sized person. This man would have a tidal volume between 800 and 900 mL and is being seriously underventilated at the given settings.

Question 54

The client has sustained multiple injuries and hemorrhage from a motor vehicle crash and has received six units of packed red blood cells in the past 6 hours. To what acid-base imbalance should the nurse be alert for as a possible complication of this therapy?

a. Metabolic alkalosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Respiratory acidosis

Answer 54

ANS: A
Citrate is a substance used as a preservative in blood products. It is not only a base, but also a precursor for bicarbonate (bicarbonate can be formed from citrate). Rapid administration of blood products can cause metabolic alkalosis by infusing large amounts of citrate intravenously. Although this problem is more likely to occur with the administration of whole blood or blood plasma, multiple transfusions with packed red cells can also result in excessive amounts of citrate being received by the client.

Question 55

What is the priority nursing diagnosis or collaborative problem for a client with severe metabolic alkalosis?

a. Excess Fluid Volume related to reduced kidney function
b. Potential for Oversedation related to inadequate cerebral oxygenation
c. Risk for Impaired Skin Integrity related to accompanying peripheral edema
d. Risk for Injury related to increased neuronal sensitivity from accompanying hypocalcemia

Answer 55

ANS: D

Metabolic alkalosis is manifested by a high pH, which causes serum calcium to bind and reduces the concentration of free calcium. This relative hypocalcemia increases the risk for increased neuromuscular activity, including tetany and seizures.

Question 56

Which set of arterial blood gas values represents fully compensated respiratory acidosis?

a. pH 7.28, HCO3– 12 mEq/L, PCO2 45 mm Hg, PO2 96 mm Hg
b. pH 7.32, HCO3– 17 mEq/L, PCO2 25 mm Hg, PO2 98 mm Hg
c. pH 7.35, HCO3– 36 mEq/L, PCO2 65 mm Hg, PO2 78 mm Hg
d. pH 7.48, HCO3– 12 mEq/L, PCO2 35 mm Hg, PO2 85 mm Hg

Answer 56

ANS: C
The pH is normal, indicating acid-base balance (fully compensated). A respiratory problem with carbon dioxide retention and inadequate gas exchange is apparent from the high PCO2 and the low PO2. The bicarbonate level is greatly elevated, indicating renal synthesis and reabsorption of HCO3–, a powerful acid-base compensatory mechanism. Thus, the amount of bicarbonate (base) in the blood adequately compensates for the increased carbon dioxide level, so that the pH is normal (although no other arterial blood gas value is normal).

Question 57

How does prolonged fever contribute to acid-base imbalances?

a. Fever alone does not cause acid-base imbalances; rather, the conditions causing the fever are responsible for various types of imbalances.
b. Prolonged fever induces dehydration and hyperkalemia, resulting in a compensatory movement of hydrogen ions and metabolic alkalosis.
c. Fever increases the rate of metabolism, causing a metabolic acidosis by increasing the rate of carbon dioxide production.
d. Fever dries the pulmonary mucous membranes, impairing gas exchange and causing a respiratory alkalosis.

Answer 57

ANS: C

Increased body temperature is associated with hypermetabolism and increases the rate at which carbon dioxide is produced.

Question 58

How does a relative alkalosis differ from an actual alkalosis?

a. In an actual alkalosis, the amount of base components is increased and, in a relative alkalosis, the amount of acid components is decreased.
b. A relative alkalosis results from underelimination of base components and an actual alkalosis results from an overproduction of base components.
c. Relative alkalosis occurs with dehydration in which there is no real change in the amount or strength of base components.
d. There is no difference between an actual and a relative alkalosis.

Answer 58

ANS: A

An actual alkalosis occurs with an actual increase in the amount and/or strength of base components (a base excess alkalosis). A relative alkalosis occurs when there has been no change in the amount and/or strength of base components but there has been a loss of acid components (an acid-deficit alkalosis).

Question 59

Which acid-base imbalance should the nurse be most alert for when providing care to a client who has several broken ribs?

a. Respiratory alkalosis from anxiety
b. Respiratory acidosis from inadequate ventilation
c. Metabolic acidosis as a result of calcium loss from broken bones
d. Metabolic alkalosis as a result of ingesting base-containing analgesics

Answer 59

ANS: B

Pain from broken ribs often causes the client to breathe more shallow to avoid moving the ribs and increasing pain. If respiration is shallow enough, ventilation is inadequate, leading to poor gas exchange and respiratory acidosis.

Question 60

The client has metabolic alkalosis as a result of excessive ingestion of a base-containing antacid and drinking more than 2 L of milk daily as a home remedy for “heartburn.” Which electrolyte imbalance should the nurse expect to accompany this condition?

a. Hyponatremia
b. Hypernatremia
c. Hypokalemia
d. Hyperkalemia

Answer 60

ANS: C
Both potassium and hydrogen ions carry or express an overall positive charge (are cations). Body fluids maintain electroneutrality by keeping the number of positive ions matched with an equal number of negative ions (anions). A compensation of alkalosis is the movement of hydrogen ions inside cells into the blood and other extracellular fluids. To prevent the blood from expressing too many positive charges, another positive ion must leave the blood and enter the cells. Potassium is the positive ion that is usually exchanged for a hydrogen ion. Thus, a relative hypokalemia usually accompanies alkalosis as extracellular potassium ions move into cells in exchange for intracellular hydrogen ions entering the extracellular fluid.

Question 61

Which is the best intervention for the nurse to teach the client who is going home and continues to be at risk for the development of metabolic alkalosis?

a. “Avoid excess use of antacids.”
b. “Increase your intake of milk to at least three glasses daily.”
c. “Avoid aspirin and aspirin-containing over-the-counter medications.”
d. “Restrict your use of sodium by not adding salt to your food during meals.”

Answer 61

ANS: A

Many antacids contain either bicarbonate or calcium carbonate, both of which (when taken in excess) can increase the bicarbonate content of the blood and other extracellular fluids, increasing the risk for alkalosis even more.

Question 62

A nurse preparing to assess pediatric clients on a step-down unit should know that, compared with an adult, an infant has which amount of fluid per total body weight?

a. less fluid per total body weight
b. more fluid than body weight
c. double the fluid per total body weight
d. the same amount of fluid per total body weight

Answer 62

b. more fluid than body weight

Question 63

A nurse administers captopril (Capoten) to a client with FVE. Which option is decreased by this medication?

a. renal blood flow
b. fluid overload
c. arterial dilation
d. renin production

Answer 63

b. fluid overload

Question 64

An elderly client presents to a clinic c/o fatigue, SOB, and restlessness. A nurse assesses the client, suspecting FVE. Which manifestations identified during the assessment should the nurse associate with FVE? Select all that apply.

a. polyuria
b. weak pulse
c. weight gain
d. crackles in lungs
e. increased respirations

Answer 64

c. weight gain
d. crackles in lungs
e. increased respirations

Question 65

When assessing the fluid status of a client, how should a nurse expect normal fluid intake to compare with output?

a. less than urine output
b. more than sensible and insensible output
c. the same amount as the sensible and insensible output
d. equal to the urine output

Answer 65

c. the same amount as the sensible and insensible output

Question 66

A client is admitted with FVD caused by severe blood loss. What should a nurse identify as the most likely rationale for oliguria in this client?

a. an increase in serum osmolarity causes conservation of fluid
b. a decrease in ADH level causes conservation of fluid
c. activation of atrial natriuretic factor causes conservation of fluid
d. the renin-angiotensin-aldosterone mechanism causes conservation of fluid

Answer 66

d. the renin-angiotensin-aldosterone mechanism causes conservation of fluid

Question 67

A nurses assesses a client who reports vomiting and diarrhea. Which information is most important for the nurse to obtain?

a. when the client ate or drank last
b. what medication the client is taking
c. who has been caring for the client at home
d. how long the client has had these symptoms

Answer 67

d. how long the client has had these symptoms

Question 68

The nurse determines that which of the following clients is at highest risk for developing a FVD?

a. a 76-year-old client who has a NG tube set to low suctioning following surgery for colon cancer
b. a thin 55-year-old who smokes and takes glucocorticoids for chronic lung disease
c. a 1-year-old child being treated in the clinic for runny nose and ear infection
d. a 30-year-old client joggin in 50-degree weather

Answer 68

a. a 76-year-old client who has a NG tube set to low suctioning following surgery for colon cancer

Question 69

A 45 y.o. female client is receiving loop diuretics for Tx of edema. The nurse determines the client is experiencing an excessive response to the Tx when the client demonstrates which of the following?

a. BUN 28mg/dL, hematocrit 45%, and an 8lb weaight loss in 24 hours
b. BUN 21mg/dL, HCT 29%, and an 8lb weight gain in 24 hours
c. BUN 16mg/dL, HCT 31%, and an 8lb weight loss in 24 hours
d. BUN 25mg/dL, HCT 33%, and an 8lb weight gain in 24 hours

Answer 69

a. BUN 28mg/dL, hematocrit 45%, and an 8lb weaight loss in 24 hours

Question 70

A client hospitalized for GI bleeding has orders for NGT placement with irrigations until the returns are clear. Which of the following solutions should the nurse plan on using?

a. 3% Sodium Chloride
b. 5% Dextrose in water
c. 0.9% Sodium Chloride
d. Sterile water

Answer 70

c. 0.9% Sodium Chloride

Question 71

A 70 year-old hospitalized with a past medical history of HTN and MI is postoperative following stomach surgery. VS have been stable and an IV of D51/2NS is infusing at 10mL/hr. The client now c/o trouble breathing, has a moist cough, and the pulse oximetry reading has fallen to 92%. What action should the nurse take first?

a. Measure BP and HR
b. Assess legs and arms for pitting edema
c. Telephone and notify the physician
d. Slow the IV rate to 10-20mL/hr

Answer 71

d. Slow the IV rate to 10-20mL/hr

Question 72

When caring for an adult client receiving an IV infusion of 3% NaCl, the nurse places priority on monitoring which of the following to detect complications of therapy?

a. Neuro status, lung sounds and serum sodium levels
b. HR, BP and daily weights
c. Serum glucose levels and urine specific gravity
d. Pulse ox and peripheral edema in legs

Answer 72

a. Neuro status, lung sounds and serum sodium levels

Question 73

Which of the following clients would the nurse identify at being most at risk to develop a sodium imbalance?

a. an adult client taking corticosteroid therapy
b. an elderly client that drinks 8 glasses of water each day
c. a diabetic client who is under glycemic control
d. a teenage who is drinking gatorade during exercise workouts

Answer 73

a. an adult client taking corticosteroid therapy

Question 74

Which of the following interventions does the nurse complete when caring for a client admitted with a sodium level of 152 mEq/L?

a. Provide blankets for warmth
b. observe client for nausea and malaise
c. observe and prepare for possible seizures
d. restrict fluids to 1200 mL/day

Answer 74

c. observe and prepare for possible seizures

Question 75

The nurse should place highest priority on which of the following interventions for a client with renal failure who has a K+ level of 6.8 mEq/L?

a. obtain an ECG
b. evaluate LOC
c. measure urinary output
d. draw arterial blood gases

Answer 75

a. obtain an ECG

Question 76

When caring for a client who has a K+ level of 2.8 mEq/L the nurse should assess for which of the following?

a. perforated bowel
b. paralytic ileus
c. renal failure
d. diabetes mellitus

Answer 76

b. paralytic ileus

Question 77

The nurse determines the IV administration of calcium gluconate to a client with hyperkalemia has been effective when which finding is seen on assessment?

a. Urine output increases
b. BM are loose
c. cardiac dysrhythmia is corrected
d. bowel sounds become less active

Answer 77

c. cardiac dysrhythmia is corrected

Question 78

Which of the following ABGs would the nurse expect to see when a client has apnea?

a. pH 7.42, CO2 48, HCO3 25
b. pH 7.29, CO2 62, HCO3 23
c. pH 7.36, CO2 42, HCO3 26
d. pH 7.49, CO2 30, HCO3 35

Answer 78

b. pH 7.29, CO2 62, HCO3 23

Question 79

The nurse concludes that which of the following statements by a student nurse reflects correct understanding about the bodies attempt to restore homeostasis during period of acidosis?

a. the kidneys start to work within seconds after an imbalance occurs and are very effective in restoring the body to a correct acid-base balance
b. the kidneys may not start to function immediately but are very effective as a buffer system to restore the acid-base balance
c. The kidneys are not as effective as the lungs in restoring the acid-base balance because the bicarb is not a good buffer
d. the kidneys are very slow to respond to any acid-base imbalance but are very effective in ridding the body of carbonic acid

Answer 79

b. the kidneys may not start to function immediately but are very effective as a buffer system to restore the acid-base balance

Question 80

Which of the following lab values would the nurse expect to see in an anxious client?

a. 7.45
b. 7.38
c. 7.50
d. 7.20

Answer 80

c. 7.50

Question 81

Which of the following lab values would the nurse expect to see when a client is admitted with diarrhea that has lasted for 4 days?

a. pH 7.50, CO2 60, HCO3 28
b. pH 7.30, CO2 40, HCO3 18
c. pH 7.40, CO2 36, HCO3 28
d. pH 7.50, CO2 38, HCO3 32

Answer 81

b. pH 7.30, CO2 40, HCO3 18

Question 82

The nurse anticipates which of the following responses in a client who develops metabolic acidosis?

a. heart rate will increase
b. urinary output will increase
c. respiratory rate will increase
d. temperature will increase

Answer 82

c. respiratory rate will increase