Fluids and electrolytes

Question 1

A patient is experiencing a fluid imbalance caused by excessive blood loss. Which fluid should the nurse expect to be prescribed for this patient?

A. Colloid
B. Crystalloid
C. Electrolytes
D. Oral fluids

Answer 1

A. Colloid - Fluids are replaced in an attempt to put back what is lost, so blood loss is replaced with blood transfusions, albumins, or other large-molecule protein solutions (colloids). Fluids lost secondary to excessive diuresis, perspiration, inadequate intake, or insensible water losses are replaced by using crystalloids.

Question 2

The nurse is teaching a patient about maintenance of fluid and electrolyte balance. Which patient statement indicates an understanding of the modifiable risk factor with the most direct effect on calcium balance?

A. “I need to manage my stress level to help keep a good calcium level.”
B. “I should maintain adequate fluid intake for better calcium balance.”
C. “I need to take my diuretic medication as directed to maintain the appropriate calcium level.”
D. “I should exercise to help me to maintain an appropriate calcium balance.”

Answer 2

D. “I should exercise to help me to maintain an appropriate calcium balance.” - Regular weight-bearing exercise helps maintain calcium balance. Stress, fluid intake, and diuretics can all affect fluid and electrolyte balance in a general way, but they do not specifically target calcium.

Question 3

A nurse is unable to secure an intravenous access site due to severe dehydration.
Which prescription should the nurse expect to replace this patient’s fluid deficit?

A. “Administer fluids via hypodermoclysis.”
B. “Administer sodium supplements.”
C. “Administer oral fluid replacement.”
D. “Administer diuretics.”

Answer 3

A. “Administer fluids via hypodermoclysis.” - When IV access is problematic, fluids can be administered subcutaneously, using a method called hypodermoclysis. Diuretics are used to treat fluid volume excess, not dehydration. Oral fluid replacement is ordered for mild dehydration, not severe dehydration. Fluid replacement, not sodium supplements, would be anticipated. Fluids are replaced gradually, particularly in older adults, to prevent too-rapid rehydration of the cells. In general, fluid deficits are replaced at a rate of approximately 30–50% of the deficit per 24 hours.

Question 4

A patient has a severe fluid deficit caused by hypovolemia. Which fluid should the nurse expect to be prescribed for this patient?

A. Colloid
B. Oral water
C. Ice chips
D. Crystalloid

Answer 4

D. Crystalloid - Fluids are replaced in an attempt to put back what is lost, so blood loss is replaced with blood transfusions, albumins, or other large-molecule protein solutions (colloids). Fluids lost secondary to excessive diuresis, perspiration, inadequate intake, or insensible water losses are replaced by using crystalloids.

Question 5

The nurse is caring for a patient who exhibits manifestations of fluid volume overload. Which body mechanism should the nurse anticipate will be activated to assist in the regulation of body fluids?

A. Secretion of thyroxine from the thyroid gland
B. Suppression of norepinephrine from the adrenal gland
C. Suppression of antidiuretic hormone from the posterior pituitary gland
D. Secretion of growth hormone from the anterior pituitary gland

Answer 5

C. Suppression of antidiuretic hormone from the posterior pituitary gland - Antidiuretic hormone (ADH) regulates water excretion from the kidneys. With fluid volume overload, decreased blood osmolality leads to suppression of ADH, causing distal tubules to become less permeable to water. This leads to decreased reabsorption of water into blood and an increase in urine output as serum osmolality returns to normal.

Question 6

A nurse is assessing a patient with fluid volume overload. Which mechanism should the nurse understand assists in the regulation of body fluids?

A. Release of cortisol from the adrenal gland
B. Renin-angiotensin-aldosterone pathway
C. Suppression of epinephrine from the adrenal gland
D. Erythropoietin release from the kidney

Answer 6

B. Renin-angiotensin-aldosterone pathway - The renin-angiotensin-aldosterone pathway is one of the mechanisms used to maintain fluid balance in the body. Cortisol and epinephrine are stress hormones that are not related to the maintenance of body fluids. Erythropoiesis is the process to stimulate red blood cell production. This process would be stimulated to increase oxygenation but not to maintain the balance of body fluids.

Question 7

The nurse is providing discharge instructions to a patient with fluid volume excess who is prescribed furosemide. Which patient statement should the nurse identify as indicative of a need for additional instruction?

A. “I will weigh myself weekly and notify my healthcare provider if I gain more than 1 pound.”
B. “I will eat a banana every day.”
C. “I will wear shoes that fit well and will not walk barefoot.”
D. “It is important to change positions frequently.”

Answer 7

A. “I will weigh myself weekly and notify my healthcare provider if I gain more than 1 pound.” - Daily, not weekly, weight is important after discharge to monitor for fluid volume excess. Eating foods rich in potassium, wearing shoes that fit well and not walking barefoot, and changing positions frequently are all responses that indicate understanding of the discharge instructions provided by the nurse.

Question 8

The nurse is teaching a patient about oral fluid volume replacement.
Which fluid should the patient be advised to avoid?

A. Water
B. Milk
C. Juice
D. Coffee

Answer 8

D. Coffee - Coffee contains caffeine, which exerts a diuretic effect. Water, milk, and juice are acceptable forms of oral fluid replacement and will not exert a diuretic effect.

Question 9

The nurse is performing an assessment on a patient who has had nothing by mouth since the previous evening.
Which manifestation related to the patient’s fluid restriction should be of concern to the nurse?

A. Edema
B. Increased blood pressure
C. Dry mucous membranes
D. Bounding pulse

Answer 9

C. Dry mucous membranes - Oral fluid restriction can cause dehydration. The nurse should monitor for manifestations of dehydration such as dry mucous membranes, increased hematocrit, and tenting skin. Edema, increased blood pressure, and bounding pulse are manifestations of fluid volume excess, not deficit.

Question 10

The nurse prepares to assess patients arriving at the clinic for routine prenatal care. Which factor should the nurse identify that contributes to fluid and electrolyte imbalances in pregnant patients?

A. Decreased thirst mechanism
B. Increased vascular volume
C. Hyperemesis gravidarum
D. Decreased kidney function

Answer 10

C. Hyperemesis gravidarum - Hyperemesis gravidarum can cause fluid and electrolyte imbalances. It is a disorder that involves an extreme amount of vomiting during pregnancy. Increased intravascular volume is expected during pregnancy. Decreased kidney function and decreased thirst mechanism are not causes of fluid imbalance in pregnant women.

Question 11

A patient with fluid volume excess has hypokalemia. Which collaborative therapy should the nurse expect to implement for this patient?

A. Oral fluid solution
B. Heparin
C. Isotonic electrolyte solution
D. Diuretic

Answer 11

D. Diuretic - Diuretics are used to remove excess fluid. A specific diuretic that does not remove potassium will be prescribed. Oral fluids, isotonic electrolyte solutions, and heparin are not appropriate for this patient’s health problem.

Question 12

The nurse is teaching older adult patients how to prevent fluid volume deficit. Which information should the nurse include?

A. “Avoid extreme temperatures.”
B. “Decrease fluid intake.”
C. “Increase sodium in the diet.”
D. “Take diuretics daily.”

Answer 12

A. “Avoid extreme temperatures.” - Exposure to extreme temperatures such as heat can cause the patient to sweat and experience insensible fluid loss. Decreasing the amount of fluid intake and taking diuretics will cause fluid loss. Increasing sodium in the diet will cause fluid volume excess.

Question 13

A patient is prescribed daily weights. Which information should the nurse recall as the purpose of daily weights to evaluate fluid balance?

A. Though blood pressure is always a better indicator of fluid imbalance, daily weight is a good adjunct measure.
B. A gain or loss of 5–8% of body weight can represent fluid imbalance.
C. Daily weights are only required for patients taking cardiac medications.
D. Daily weights will not reflect fluid imbalance unless greater than 20% of body weight is affected.

Answer 13

B. A gain or loss of 5–8% of body weight can represent fluid imbalance. - A change in weight of 5–8% (gain or loss) can represent fluid imbalance. A change in body weight greater than 20% would be problematic and more serious than fluid imbalance. Blood pressure can represent alterations in fluid imbalance, but it is not always the best indicator of changes in fluid status. Daily weights are required in many patients, regardless of the medications taken.

Question 14

A patient’s urine specific gravity is elevated at 1.045. Which explanation should the nurse identify as the reason for this value?

A. The concentration of the solute in the urine is increased and could indicate fluid volume excess.
B. The concentration of the solute in the urine is decreased and could indicate fluid volume excess.
C. The concentration of solute in the urine is elevated and could indicate fluid volume deficit.
D. The concentration of the solute in the urine is decreased and could indicate fluid volume deficit.

Answer 14

D. The concentration of the solute in the urine is decreased and could indicate fluid volume deficit. - Specific gravity is an indicator of urine concentration that can be performed quickly and easily by nursing personnel. Normal specific gravity ranges from 1.005 to 1.030 (usually 1.015–1.024). When the concentration of solutes in the urine is high, the specific gravity rises; in very dilute urine with few solutes, it is abnormally low.

Question 15

The nurse recalls that sodium and potassium are major electrolyte components in the intracellular and extracellular fluid. Which function should the nurse identify that these electrolytes share?

A. Transmitting electrical impulses and muscle contraction
B. Forming bones and teeth
C. Regulating acid–base balance
D. Maintaining blood volume

Answer 15

A. Transmitting electrical impulses and muscle contraction - Sodium and potassium are involved in the transmission of electrical impulses and muscle contraction. Calcium and phosphate are involved in the formation of bones and teeth. Potassium, along with chloride and bicarbonate, is involved in regulating acid–base balances, but sodium is not. Sodium, along with chloride, maintains blood volume, but potassium does not.

Question 16

A patient is experiencing signs of a decrease in extravascular volume.
Which should the nurse expect the patient to experience in response to this drop in volume?

A. Increasing kidney function
B. Decreasing secretion of insulin
C. Stimulation of the thirst center
D. Stimulation of thyroid function

Answer 16

C. Stimulation of the thirst center - In order to temporarily respond to decreased extracellular volume, the hypothalamus will be stimulated to initiate thirst. Increasing kidney function would cause more fluid volume loss. Decreased secretion of insulin and stimulation of thyroid function would not decrease extracellular fluid volume.

Question 17

The nurse is documenting a patient’s fluid output. Which fluid should the nurse include in this calculation?

A. Liquid feces
B. Parenteral fluids
C. Irrigants
D. Tube feeding

Answer 17

A. Liquid feces - Liquid feces is considered output. Parenteral fluids, irrigants, and tube feedings are considered input.

Question 18

A patient with severe heat exhaustion asks what type of fluid is in the intravenous infusion. Which response should the nurse provide?

A. “I’m giving you a solution that has proteins in it. It will help replace the fluid you lost.”
B. “I’m giving you a solution that is a lot like the fluid outside your cells. It will replace the fluid you lost.”
C. “I’m giving you a solution that is a lot like your blood. It will replace the fluid you lost.”
D. “I’m giving you a solution with a drug that will keep you from losing water.”

Answer 18

B. “I’m giving you a solution that is a lot like the fluid outside your cells. It will replace the fluid you lost.” - Crystalloid solutions are given intravenously to patients like this who have lost fluids from excessive sweating, inadequate intake, or insensible water loss. Crystalloid solutions mimic the body’s extracellular fluid and replace lost fluids. Colloid solutions resemble blood more closely, because they contain proteins and other large molecules, and are given in cases of excessive blood loss. Crystalloid solutions do not contain a drug that causes a person to retain water.

Question 19

The nurse is reviewing laboratory values for a patient with hyperthyroidism. Which component of the urinalysis should the nurse use to help determine the patient’s fluid status?

A. Nitrites
B. Glucose
C. Urine specific gravity
D. Ketones

Answer 19

C. Urine specific gravity - Specific gravity is an indicator of urine concentration that can be performed quickly and easily by nursing personnel. Normal specific gravity ranges from 1.005 to 1.030 (usually 1.015–1.024). When the concentration of solutes in the urine is high, the specific gravity rises. In very dilute urine with few solutes, it is abnormally low. Ketones are found in the urine when the body is breaking down fats to have an alternate form of energy. Nitrites found in the urine are usually related to an infection. Glucose found in the urine can indicate elevated blood sugar.

Question 20

The nurse is teaching a patient taking a loop diuretic about prevention of fluid volume excess. Which should the nurse include in this teaching session?

A. “You should perform daily weights.”
B. “You will need to increase the dose of the medication.”
C. “You can eat a banana each day.”
D. “You should decrease fluid intake.”

Answer 20

A. “You should perform daily weights.” - Daily weights are the best indicator of fluid imbalance. The patient should not increase the amount of diuretic medication because that can cause fluid volume deficit. Bananas provide a source of potassium for the patient and bear no impact on fluid balance. Decreasing fluid intake could promote a fluid volume deficit and would be incorrect advice.

Question 21

The nurse is reviewing the medication record of a patient admitted with dehydration. Which medication type should cause the nurse concern?

A. Nonsteroidal anti-inflammatory drug
B. Antibiotic
C. Antipsychotic
D. Selective serotonin reuptake inhibitor

Answer 21

C. Antipsychotic - Patients with dehydration are likely to develop electrolyte imbalances as the body attempts to compensate for the lost fluid. Individuals taking antipsychotic agents are often at risk for alterations in fluid intake due to the effect on thirst mechanisms. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics are not associated with fluid or electrolyte imbalances and do not affect fluid balance.

Question 22

A patient had the following during the previous shift: emesis 75 mL, urine output 725 mL, water 240 mL, IV fluids 650 mL, and IV medication 100 mL. Which intake and output values should the nurse document for this patient?

A. Intake 950 mL, output 840 mL
B. Intake 940 mL, output 850 mL
C. Intake 890 mL, output 900 mL
D. Intake 990 mL, output 800 mL

Answer 22

D. Intake 990 mL, output 800 mL - Output consists of urine and emesis and this totals 800 mL for this patient. IV fluids, IV medication, and water are counted as intake and this totals 990 mL for this patient. Accurate intake and output is important to determine if the amount of intake is proportional to the amount of output, because this is objective and can be measured. This must be considered when looking at insensible fluid losses, as well.

Question 23

The nurse is assessing a patient with a fluid volume deficit. Which finding should the nurse expect in this patient?

A. BP 92/56 mmHg, P 134 beats/min, R 22 breaths/min
B. BP 124/63 mmHg, P 56 beats/min, R 16 breaths/min
C. BP 90/54 mmHg, P 68 beats/min, R 18 breaths/min
D. BP 155/100 mmHg, P 144 beats/min, R 24 breaths/min

Answer 23

A. BP 92/56 mmHg, P 134 beats/min, R 22 breaths/min - When a patient experiences a deficiency in fluid volume, the body’s vital signs will try to compensate for the decreased volume to maintain perfusion. Typical changes that are seen with fluid volume deficit include decreased blood pressure, increased heart rate, and increased respiration, along with decreased urine output. Vital signs of BP 92/56 mmHg, P 134 beats/min, and R 22 breaths/min would be consistent with these typical changes.

Question 24

The nurse prepares an educational program for colleagues about intracellular and extracellular fluid compartments. Which solutes or electrolytes that are predominantly found within the intracellular and extracellular fluids, should the nurse explain help with transmitting nerve impulses and contracting muscles?

A. Chloride and phosphate
B. Sodium and potassium
C. Calcium and bicarbonate
D. Albumin and magnesium

Answer 24

B. Sodium and potassium - Sodium and potassium are found in both intracellular and extracellular fluid and are involved in transmitting nerve impulses and contracting muscles. Albumin is a protein found in cellular fluid but plays no role in transmitting nerve impulses or contracting muscles. Magnesium is involved with relaxing muscle contractions. Calcium and phosphate are involved in teeth and bone formation. Phosphate is involved with nerve function but does not transmit nerve impulses. Chloride and bicarbonate are involved with acid–base balance.

Question 25

A patient has a low serum sodium level. Which intervention should the nurse expect to be prescribed for this patient?

A. Oral furosemide
B. IV vasopressin
C. 0.9% saline IV infusion
D. Heparin injection

Answer 25

C. 0.9% saline IV infusion - Normal saline, or 0.9% saline, solution contains the sodium chloride necessary to treat the hyponatremia. Heparin is an anticoagulant and has a potential side effect of hyponatremia. Furosemide blocks sodium and water reabsorption, possibly causing further hyponatremia. Vasopressin is a vasoconstrictor that can cause fluid retention, which could exacerbate hyponatremia as dilutional hyponatremia.

Question 26

The nurse discusses how active transport differs from other transport processes with colleagues. Which statement should the nurse include?

A. “Unlike osmosis, active transport moves water from a solution with a lower concentration of solutes to a more concentrated solution.”
B. “Unlike osmosis, active transport moves water from a solution with a higher concentration of solutes to a less concentrated solution.”
C. “Unlike diffusion, active transport moves solutes from a solution with a lower concentration of solutes to a more concentrated solution.”
D. “Unlike diffusion, active transport moves solutes from a solution with a higher concentration of solutes to a less concentrated solution.”

Answer 26

C. “Unlike diffusion, active transport moves solutes from a solution with a lower concentration of solutes to a more concentrated solution.” - Unlike diffusion, active transport moves solutes against their concentration gradients from a solution with a lower concentration to a more concentrated solution. Active transport does not move water, only solutes. Osmosis is the movement of water from a solution with a lower concentration of solutes to a more concentrated solution.

Question 27

A parent asks how a 4-month-old infant with frequent vomiting can become dehydrated. Which response by the nurse is the best response to this query?

A. “Infants have a smaller body water percentage than adults, so if they lose a lot of fluid through vomiting, it is easy for them to get dehydrated.”
B. “Infants need to take in a lot of fluid, so if they lose a lot of fluid through vomiting, it is easy for them to get dehydrated.”
C. “Infants have a low body surface area, so they lose fluid more easily than adults and it is easy for them to get dehydrated.”
D. “Infants have a smaller percentage of their body water outside their cells than adults, so it is easy for them to get dehydrated.”

Answer 27

B. “Infants need to take in a lot of fluid, so if they lose a lot of fluid through vomiting, it is easy for them to get dehydrated.” - Infants have a proportionally higher body water percentage, higher fluid requirements, higher body surface area, and lower intracellular fluid volume than adults, all of which make them more prone to dehydration. If the infant is unable to adequately take in enough fluids due to vomiting, dehydration can happen rapidly.

Question 28

The nurse is teaching parents about fluid replacement in an infant who has been vomiting. Which statement made by the parents should indicate to the nurse that further teaching is required?

A. “Oral fluid replacement is the preferred method of fluid replacement.”
B. “When fluid loss is minimal, water may be sufficient to use for replacement.”
C. “With fluid loss due to diarrhea or vomiting, a rehydrating solution with electrolytes may be needed.”
D. “I will withhold oral fluids until the vomiting stops.”

Answer 28

D. “I will withhold oral fluids until the vomiting stops.” - Oral fluid replacement is preferred when treating fluid volume deficit. Water may be acceptable, a rehydrating solution may be necessary, and oral fluid replacement is preferred.

Question 29

The community health nurse is performing health screenings at a homeless shelter. When assessing for fluid and electrolyte imbalances, which statement or question is the most important for the nurse to ask?

A. “Describe what you eat and drink on a typical day.”
B. “Are you currently being treated for joint problems?”
C. “Have you recently had a cold?”
D. “Describe your anxiety level on a typical day.”

Answer 29

A. “Describe what you eat and drink on a typical day.” - It is important for the nurse to consider socioeconomic factors affecting food and fluid intake when assessing a patient’s risk for fluid and electrolyte imbalances, especially with a vulnerable population such as the homeless. Asking a patient to describe a typical day’s food and fluid intake will help the nurse determine if a patient’s oral intake is adequate. Joint problems and minor respiratory infections are not primary risk factors for fluid and electrolyte imbalances. It would be more important for the nurse to ask about kidney or thyroid disease, diabetes, or hypertension and acute conditions that cause fluid loss, such as gastroenteritis. Asking about anxiety is too general when assessing a patient’s fluid and electrolyte status, because some anxiety is to be expected in a homeless patient.

Question 30

The nurse is preparing a plan of care for a client diagnosed with an extracellular fluid imbalance. Which interventions should the nurse anticipate implementing in the plan of​ care?
Select all that apply.
             
A. Take daily weight.
B. Assess the​ client’s ability to complete​ self-care
C. Monitor intake and output.
D. Give the client unlimited amount of oral intake.
E. Monitor serum electrolytes.

Answer 30

A, C, D - When caring for a client with​ hyponatremia, the nurse must focus on imbalanced fluid volume and potential for ineffective cerebral perfusion. Interventions for these clients should include monitoring intake and​ output, taking daily​ weights, monitoring serum​ electrolytes, and assessing neurologic status and mental status changes. Clients with hyponatremia are often on a fluid restriction and are unable to have an unlimited amount of oral intake.

Question 31

The nurse is completing discharge teaching with a client diagnosed with congestive heart​ failure. The instructions should include which findings for the client to notify the health care provider about regarding fluid volume​ excess?
Select all that apply.

A. Urine output of 320 mL in 8 hours
B. Dizziness when standing
C. Cough with increased sputum production
D. ​Five-pound weight gain in a week
E. Dry mouth

Answer 31

C, D - Weight gain of more than 5 pounds in a week and a cough with increased sputum production are indications of excess fluid​ volume, and the health care provider must be notified of these findings.Dizziness when standing and a dry mouth are not signs of fluid volume excess and do not need to be reported to the health care provider.A urine output of 320 mL in 8 hours is not a finding that needs to be reported to the health care provider.

Question 32

The nurse is preparing a teaching plan on the physiology of fluids and electrolytes to discuss with a group of nurses during orientation. Which teaching points should the nurse​ include?
Select all that apply.

A. Most extracellular fluid is interstitial
B. Fluids and electrolytes play a major role in maintaining homeostasis
C. Osmosis is the movement of solutes from a higher concentration to a lower concentration
D. Protein is a substance in the body that is a solvent
E. Glucose and electrolytes are located in intracellular fluid

Answer 32

A, B, E - Intracellular fluid is found within the cell and is two thirds of the​ body’s fluids. Intracellular fluid​ (ICF) contains​ oxygen, electrolytes, and glucose. Several fluid and electrolyte mechanisms function to keep the body in balance. The proper maintenance of fluids and electrolytes helps the body with muscle​ action, blood​ chemistry, and other processes. Interstitial fluid accounts for​ 75% of the extracellular fluid​ (ECF). This is the fluid that surrounds the cells. Solutes are substances that dissolve in liquids.​ Glucose, oxygen, carbon​ dioxide, amino​ acid, urea, and proteins are all solutes. Solvents are components of a solution that can dissolve a solute. Water is a solvent. When solutions with different concentrations need to merge to equalize their​ concentration, diffusion is a means to move the solutes across a semipermeable membrane from a higher concentration to a lower concentration.

Question 33

The nurse is answering a question from a participant during orientation training about the fluids found in the two major body fluid compartments. Which information regarding extracellular fluid​ (ECF) should be​ included?
Select all that apply.

A. The ECF carries nutrients and oxygen to body cells
B. The ECF compartment fluid only contains intravascular fluid
C. ECF is found inside the cells
D. Interstitial fluid accounts for the majority of the ECF
E. ​Pericardial, pleural, and synovial fluids are transcellular fluids and part of ECF

Answer 33

A, D, E - Extracellular fluid is found outside the cells and comprises one third of the total body fluid. The two compartments of the ECF are intravascular and interstitial. Intravascular fluid is also known as plasma and accounts for​ 20% of the ECF. Interstitial fluid accounts for​ 75% of the ECF and is the fluid that surrounds the cells.
The ECF carries oxygen and nutrients to the body​ cells, and carries waste products away from the body cells. The remaining​ 5% of the ECF is known as the transcellular fluid.​ Cerebrospinal, pericardial,​ pancreatic, pleural,​ intraocular, biliary,​ peritoneal, and synovial fluids are all examples of transcellular fluid.