Fluids and Electrolytes (Practice Questions)

Question 1

Dietary recommendations for a patient with a hypotonic fluid excess should include:
A.decreased sodium intake
B.increased sodium intake
C.increased fluid intake
D.intake of potassium-rich foods

Answer 1

B

Hypotonic fluid volume excess (FVE) involves an increase in water volume without an increase in sodium concentration. Increased sodium intake is part of the management of this condition.

Question 2

Which electrolyte would the nurse identify as the major electrolyte responsible for determining the concentration of the extracellular fluid?
A. Potassium
B. Phosphate
C. Chloride
D. Sodium

Answer 2

D

Sodium is the electrolyte whose level is the primary determinant of the extracellular fluid concentration. Sodium a cation (e.g., positively charged ion), is the major electrolyte in extracellular fluid. Chloride, an anion (e.g., negatively charged ion), is also present in extracellular fluid, but to a lesser extent. Potassium (a cation) and phosphate (an anion) are the major electrolytes in the intracellular fluid.

Question 3

Jon has a potassium level of 6.5 mEq/L, which medication would nurse Wilma anticipate?
A.Potassium supplements
B.Kayexalate
C.Calcium gluconate
D.Sodium tablets

Answer 3

B

The client’s potassium level is elevated; therefore, Kayexalate would be ordered to help reduce the potassium level. Kayexalate is a cation-exchange resin, which can be given orally, by nasogastric tube, or by retention enema. Potassium is drawn from the bowel and excreted through the feces. Because the client’s potassium level is already elevated, potassium supplements would not be given. Neither calcium gluconate nor sodium tablets would address the client’s elevated potassium level.

Question 4

Osmotic pressure is created through the process of:
A osmosis
B diffusion
C filtration
D capillary dynamics

Answer 4

B

In diffusion, the solute moves from an area of higher concentration to one of lower concentration, creating osmotic pressure. Osmotic pressure is related to the process of osmosis. Filtration is created by hydrostatic pressure. Capillary dynamics are related to fluid exchange at the intravascular and interstitial levels.

Question 5

Respiratory regulation of acids and bases involves:
A.hydrogen
B.hydroxide
C.oxygen
D. carbon dioxide

Answer 5

D

Respiratory regulation of acid-base balance involves the elimination or retention of carbon dioxide.

Question 6

For a patient with hypomagnesemia, which of the following medications may become toxic?
A.Lasix
B.Digoxin
C.calcium gluconate
D.CAPD

Answer 6

B.

n hypomagnesemia, a patient on digoxin is likely to develop digitalis toxicity. Neither A nor C has toxicity as a side effect. CAPD is not a medication.

Question 7

Which clinical manifestation would lead the nurse to suspect that a client is experiencing hypermagnesemia?
A Muscle pain and acute rhabdomyolysis
B Hot, flushed skin and diaphoresis
C Soft-tissue calcification and hyperreflexia
D Increased respiratory rate and depth

Answer 7

B

Hypermagnesemia is manifested by hot, flushed skin and diaphoresis. The client also may exhibit hypotension, lethargy, drowsiness, and absent deep tendon reflexes. Muscle pain and acute rhabdomyolysis are indicative of hypophosphatemia. Soft-tissue calcification and hyperreflexia are indicative of hyperphosphatemia. Increased respiratory rate and depth are associated with metabolic acidosis.

Question 8

Which of the following is the most important physical assessment parameter the nurse would consider when assessing fluid and electrolyte imbalance?
A skin turgor
B intake and output
C osmotic pressure
D cardiac rate and rhythm

Answer 8

D

Cardiac rate and rhythm are the most important physical assessment parameter to measure. Skin turgor, intake and output are physical assessment parameters a nurse would consider when assessing fluid and electrolyte imbalance, but choice d is the most important.

Question 9

Patient X is diagnosed with constipation. As a knowledgeable nurse, which nursing intervention is appropriate for maintaining normal bowel function?
A Assessing dietary intake
B Decreasing fluid intake
C Providing limited physical activity
D Turning, coughing, and deep breathing

Answer 9

A

Assessing dietary intake provides a foundation for the client’s usual practices and may help determine if the client is prone to constipation or diarrhea. Limited physical activity may contribute to constipation due to decreased peristalsis. Turning, coughing and deep breathing help promote gas exchange. Fluid intake should be increased to aid bowel elimination.

Question 10

Khaleesi is admitted in the hospital due to having lower than normal potassium level in her bloodstream. Her medical history reveals vomiting and diarrhea prior to hospitalization. Which foods should the nurse instruct the client to increase?
A.Whole grains and nuts
B.Milk products and green, leafy vegetables
C.Pork products and canned vegetables
D.Orange juice and bananas

Answer 10

D.

The client with hypokalemia needs to increase the intake of foods high in potassium. Orange juice and bananas are high in potassium, along with raisins, apricots, avocados, beans, and potatoes. Whole grains and nuts would be encouraged for the client with hypomagnesemia; milk products and green, leafy vegetables are good sources of calcium for the client with hypocalcemia. Pork products and canned vegetables are high in sodium and are encouraged for the client with hyponatremia.

Question 11

The nurse would analyze an arterial pH of 7.46 as indicating:
A.acidosis
B.alkalosis
C.homeostasis
D.neutrality

Answer 11

B

Alkalosis is indicated by a pH above 7.45

Question 12

Which of the following conditions is an equal decrease of extracellular fluid (ECF) solute and water volume?
A hypotonic FVD
B isotonic FVD
C hypertonic FVD
D isotonic FVE

Answer 12

D

Isotonic FVD involves an equal decrease in solute concentration and water volume.

Question 13

Which client situation requires the nurse to discuss the importance of avoiding foods high in potassium?
A 14-year-old Elena who is taking diuretics
B 16-year-old John Joseph with ileostomy
C 16-year-old Gabriel with metabolic acidosis
D 18-year-old Albert who has renal disease

Answer 13

D

Clients with renal disease are predisposed to hyperkalemia and should avoid foods high in potassium. Clients receiving diuretics, with ileostomies, or with metabolic acidosis may be hypokalemic and should be encouraged to eat foods high in potassium.

Question 14

When assessing a patient for signs of fluid overload, the nurse would expect to observe:
A bounding pulse
B flat neck veins
C poor skin turgor
D vesicular

Answer 14

A

Bounding pulse is a sign of fluid overload as more volume in the vessels causes a stronger sensation against the blood vessel walls. Flat neck veins and vesicular breath sounds are normal findings. Poor skin turgor is consistent with dehydration.

Question 15

Aldosterone secretion in response to fluid loss will result in which one of the following electrolyte imbalances?
A hypokalemia
B hyperkalemia
C hyponatremia
D hypernatremia

Answer 15

A

Aldosterone is secreted in response to fluid loss. Aldosterone causes sodium reabsorption and potassium elimination, further exacerbating hypokalemia.

Question 16

A client with very dry mouth, skin and mucous membranes is diagnosed of having dehydration. Which intervention should the nurse perform when caring for a client diagnosed with fluid volume deficit?
A Assessing urinary intake and output
B Obtaining the client’s weight weekly at different times of the day
C Monitoring arterial blood gas (ABG) results
D Maintaining I.V. therapy at the keep-vein-open rate

Answer 16

A

For the client with fluid volume deficit, assessing the client’s urine output (using a urometer if necessary) is essential to ensure an output of at least 30 ml/hour. The client should be weighed daily, not weekly, and at same time each day, usually in the morning. Monitoring ABGs is not necessary for this client. Rather, serum electrolyte levels would most likely be evaluated. The client also would have an I.V. rate at least 75 ml/hour, if not higher, to correct the fluid volume deficit.

Question 17

When monitoring the daily weight of a patient with fluid volume deficit (FVD), the nurse is aware that fluid loss may be considered when weight loss begins to exceed:
A 0.25 lb
B 0.50 lb
C 1 lb
D 1 kg

Answer 17

B

Weight loss of more than 0.50 lb. is considered to be fluid loss.

Question 18

Lisa, a client with altered urinary function, is under the care of nurse Tine. Which intervention is appropriate to include when developing a plan of care for Lisa who is experiencing urinary dribbling?
A Inserting an indwelling Foley catheter
B Having the client perform Kegel exercises
C Keeping the skin clean and dry
D Using pads or diapers on the client

Answer 18

B

Kegel exercises, which help strengthen the muscles in the perineal area, are used to maintain urinary continence. To perform these exercises, the client tightens pelvic floor muscles for 4 seconds 10 times at least 20 times each day, stopping and starting the urinary flow. Inserting an indwelling Foley catheter increases the risk for infection and should be avoided. The nurse should encourage the client to develop a toileting schedule based on normal urinary habits. However, suggesting bathroom use every 8 hours may be too long an interval to wait. Pads or diapers should be used only as a resort.

Question 19

Which of the following intravenous solutions would be appropriate for a patient with severe hyponatremia secondary to syndrome of inappropriate antidiuretic hormone (SIADH)?
A.hypotonic solution
B.hypertonic solution
C.isotonic solution
D.normotonic solution

Answer 19

B

When hyponatremia is severe, hypertonic solutions may be used but should be infused with caution due to the potential for development of CHF. In SIADH, isotonic and hypotonic solutions are not indicated, because urine output is minimal, so water is retained. this water retention dilutes serum sodium levels, making the patient hyponatremic and necessitating administration of hypertonic solutions to balance sodium and water. Normotonic solutions do not exist.

Question 20

Normal venous blood pH ranges from:
A 6.8 to 7.2
B 7.31 to 7.41
C 7.35 to 7.45
D 7.0 to 8.0

Answer 20

B

Normal venous blood pH ranges from 7.31 to 7.41. Normal arterial blood pH ranges from 7.35 to 7.45.

Question 21

The physician has ordered IV replacement of potassium for a patient with severe hypokalemia. The nurse would administer this:
A by rapid bolus
B diluted in 100 cc over 1 hour
C diluted in 10 cc over 10 minutes
D IV push

Answer 21

B

Potassium must be well diluted and given slowly because rapid administration will cause cardiac arrest.

Question 22

Insensible fluid losses include:
A urine
B.gastric drainage
C bleeding
D.perspiration

Answer 22

D

Perspiration and the fluid lost via the lungs are termed insensible losses; normally, insensible losses equal about 1000 cc/day.

Question 23

A patient with tented skin turgor, dry mucous membranes, and decreased urinary output is under nurse Mark’s care. Which nursing intervention should be included the care plan of Mark for his patient?

A Administering I.V. and oral fluids
B Clustering necessary activities throughout the day
C Assessing color, odor, and amount of sputum
D Monitoring serum albumin and total protein levels

Answer 23

A

Question 24

When assessing a patient for electrolyte balance, the nurse is aware that etiologies for hyponatremia include:
A water gain
B diuretic therapy
C diaphoresis
D all of the following

Answer 24

D

Question 25

Maya, who is admitted in a hospital, is scheduled to have her general checkup and physical assessment. Nurse Timothy observed a reddened area over her left hip. Which should the nurse do first?
A Massage the reddened are for a few minutes
B Notify the physician immediately
C Arrange for a pressure-relieving device
D Turn the client to the right side for 2 hour

Answer 25

D

Turning the client to the right side relieves the pressure and promotes adequate blood supply to the left hip. A reddened area is never massaged, because this may increase the damage to the already reddened, damaged area. The health care provider does not need to be notified immediately. However, the health care provider should be informed of this finding the next time he is on the unit. Arranging for a pressure-relieving device is appropriate, but this is done after the client has been turned.

Question 26

Mr. Salcedo has the following arterial blood gas (ABG) values: pH of 7.34, partial pressure of arterial oxygen of 80 mm Hg, partial pressure of arterial carbon dioxide of 49 mm Hg, and a bicarbonate level of 24 mEq/L. Based on these results, which intervention should the nurse implement?

A. Instructing the client to breathe slowly into a paper bag
B Administering low-flow oxygen
C. Encouraging the client to cough and deep breathe
D Nothing, because these ABG values are within normal limits.

Answer 26

C

The ABG results indicate respiratory acidosis requiring improved ventilation and increased oxygen to the lungs. Coughing and deep breathing can accomplish this. The nurse would administer high oxygen levels because the client does not have chronic obstructive pulmonary disease. Breathing into a paper bag is appropriate for a client hyperventilating and experiencing respiratory alkalosis. Some action is necessary, because the ABG results are not within normal limits.

Question 27

22-year-old lady is displaying facial grimaces during her treatment in the hospital due to burn trauma. Which nursing intervention should be included for reducing pain due to cellular injury?
A Administering anti-inflammatory agents as prescribed
B Elevating the injured area to decrease venous return to the heart
C Keeping the skin clean and dry
D Applying warm packs initially to reduce edema

Answer 27

A

Anti-inflammatory agents help reduce edema and relieve pressure on nerve endings, subsequently reducing pain. Elevating the injured area increases venous return to the heart. Maintaining clean, dry skin aids in preventing skin breakdown. Cool packs, not warm packs, should be used initially to cause vasoconstriction and reduce edema.

Question 28

Nurse John Joseph is totaling the intake and output for Elena Reyes, a client diagnosed with septicemia who is on a clear liquid diet. The client intakes 8 oz of apple juice, 850 ml of water, 2 cups of beef broth, and 900 ml of half-normal saline solution and outputs 1,500 ml of urine during the shift. How many milliliters should the nurse document as the client’s intake.
A 2,230
B 2,740
C 2,470
D 2,320

Answer 28

C

The fluid intake includes 8 oz (240 ml) of apple juice, 850 ml of water, 2 cups (480 ml) of beef broth, and 900 ml of I.V. fluid for a total of 2,470 ml intake for the shift.

Question 29

A client is diagnosed with metabolic acidosis, which would the nurse expect the health care provider to order?
A Potassium
B Sodium bicarbonate
C Serum sodium level
D Bronchodilator

Answer 29

B

Metabolic acidosis results from excessive absorption or retention of acid or excessive excretion of bicarbonate. A base is needed. Sodium bicarbonate is a base and is used to treat documented metabolic acidosis. Potassium, serum sodium determinations, and a bronchodilator would be inappropriate orders for this client.