Fluids, electrolytes, acid/base balances

Question 1

The client is admitted complaining of nausea and vomiting for the past three days. The doctor has ordered D5 1/2NS with potassium added. Which action by the nurse is most appropriate?
A. obtain an IV controller
B. Check the client’s vital signs hourly
C. Check the sodium level
D. Obtain an 18 gauge cathlon to begin the infusion.

Answer 1

A. If potassium is added to IV fluids, a controller is required because a too-rapid infusion of potassium can lead to cardiac arrhythmias.

Question 2

The client is admitted to the unit with third degree burns to his chest and neck. The nurse should be vigiliant to assess which of the following? 
A. Circulation
B. Airway 
C. Urinary output 
D. Pain

Answer 2

B. Because the client has burns to the chest, it is likely that he has airway difficulty. The nurse should also assess the client for smoke inhalation.

Question 3

The client with hypoparathyroidism has a lack of parathyroid hormone. This client will most likely have a serum calcium level of which of the following? 
A. 3.5 mg/dl
B. 10.9 mg/dl 
C. 14.7 mg/dl
D. 18.5 mg/dl

Answer 3

A. The normal calcium level is 8.5-10.5 mg/dl. B,C,D all indicate a higher than normal calcium level. Only A. indicates a lower level that is associated with hypoparathyroidism.

Question 4

The client is admitted with a pH of 7.30, PaCO2 of 48mm Hg, and a HCO3 of 30. The nurse assesses these findings as which of the following? 
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

Answer 4

C. When assessing arterial blood gases, the nurse should look at the pH. In this case the pH is low. After assessing the pH, the nurse should look at the PaCO2. In this case the PaCO2 is elevated. Finally look at the HCO3. In this case, the HCO3 is elevated.

Question 5

The client is admitted following a motor vehicle accident. Extensive internal bleeding is suspected. The serum pH is 7.0, and the PaCO2 is 32 mm Hg, and the HCO3 is 20 mEq/dl. The nurse should assess the laboratory finding as which of the following? 
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

Answer 5

A. The client with internal bleeding will most likely have metabolic acidosis. The laboratory findings reflect this suspicion. The pH is down, the PaCO2 is down, and the HCO3 is down.

Question 6

Which of the following equipment should be obtained to safely administer magnesium sulfate?
A. an internal fetal heart monitor
B. an IV rate controller
C. a blood administration set
D a wall suction device

Answer 6

B. An IV rate controller must be obtained in order to safely administer magnesium sulfate. If magnesium sulfate is administered too quickly, toxicity can result, leading to respiratory arrest.

Question 7

Which medication can potentiate a fluid volume deficit? 
A. Insulin 
B. Inderal (propanolol)
C. Lasix (furosemide)
D. Valium (diazepam)

Answer 7

C. Lasix is a non-potassium-sparing diuretic. This drug can potentiate fluid volume deficit.

Question 8

The client is admitted to the unit with anorexia nervosa. The nurse is aware that this client might show signs of which of the following? 
A. Metabolic alkalosis
B. Metabolic acidosis 
C. Respiratory alkalosis
D. Respiratory acidosis

Answer 8

B. The client with anorexia nervosa is in a state of negative nitrogen balance. She is likely experiencing metabolic acidosis.

Question 9

The client is admitted with a blood glucose level of 545 mg/dl. Which action by the nurse indicates that the nurse is aware of the client’s needs?
A. the nurse prepares an IV of D10W
B. the nurse prepares to administer insulin IV
C. the nurse obtains NPH insulin for administration
D. the nurse inserts a Foley catheter

Answer 9

B. The client with a blood glucose level of 545 mg/dl is in metabolic acidosis. An IV with insulin will be ordered.

Question 10

The function of the lungs in the acid/base balance is to perform which of the following:
A. control HCO3 levels 
B. retain or blow off CO2
C. regulate potassium levels 
D. maintain sodium levels

Answer 10

B. The lungs assist in the control of acid/base balance by regulating the amount of CO2 that is retained or exhaled.

Question 11

The client is admitted with isotonic dehydration. The nurse would anticipate an order for which IV fluid? 
A. 5% dextrose and water
B. 3% sodium chloride 
C. 0.9% sodium chloride
D. 0.45% sodium chloride

Answer 11

C. To treat isotonic dehydration, the doctor will order fluids containing normal saline.

Question 12

The client with COPD is admitted with a serum carbon-dioxide content level of 42 mEq/L, oxygen saturation of 86%, and a blood glucose level of 190mg/dl. The nurse is aware that the client’s condition might require which of the following?
A. an injection of NPH insulin
B. oxygen application with a venturi mask
C. renal dialysis using an arterio-venous shunt
D. a prescription for a bronchodilator

Answer 12

D. The normal serum carbon-dioxide level is 24-30. This is different from the normal arterial blood gas level of 35-45 mEq/L. A serum carbon dioxide level of 42 mEq/L is elevated. The client with COPD might require a prescription for a bronchodilator to assist with exhalation of carbon dioxide.

Question 13

The nurse caring for a client admitted with a potassium level of 3.9 mEq/L, a blood glucose level of 98 mg/dL, a serum calcium levle of 10.0 mg/dL, and a blood urea nitrogen level of 30 mg/dL. Which of these values should be reported to the physician immediately? 
A. The potassium level of 3.9
B. the serum calcium level of 10.
C. the blood glucose level of 98
D. the blood urea nitrogen level of 30

Answer 13

D. the normal BUN range is 7-22 mg/dl

Question 14

The ICU nurse is assessing several clients assigned to his care. Which client should receive priority of care?
A. a 65 year old client with emphysema with an oxygen saturation level of 82%
B. a 45 year old motor vehicle accident client with chest tubes and a CO2 level of 48mE/L
C. an 80 year old diabetic with a blood glucose level of 430 mg/dl
D. a 50 year old client with cirrhosis of the liver and blood urea nitrogen level of 35 mg/dl

Answer 14

C. The client with a blood glucose of 430 mg/dl is at risk for diabetic coma.

Question 15

The client admitted with hypokalemia has an order for potassium to be administered orally. Prior to administering the potassium the nurse should:
A. check the client’s creatinine level
B. ask the doctor to order an ECG
C. insert a nasogastric tube
D. acquire milk to give the oral potassium

Answer 15

A. Prior to adminstering potassium, the nurse should check renal function. This can be done by checking the client’s creatinine level. The normal creatinine level is 0.60-1.60 mg/dL. If the client’s creatinine level is elevated, the nurse should contact the physician prior to administering the potassium.

Question 16

The nurse is preparing to administer potassium to the client with hypokalemia. The best liquid for the nurse to dilute the potassium in is: 
A. cranberry juice
B. prune juice
C. tomato juice 
D. chocolate milk

Answer 16

C. Potassium should be administered in a juice containing ascorbic acid. The liquid with the most ascorbic acid is the tomato juice. Other acceptable juices are orange, pineapple, and grape juice.

Question 17

The client is admitted with a sodium level of 100 mEq/L. After checking the other laboratory values, the nurse should:
A. chart the finding
B. contact the doctor
C. teach the client about low-sodium meal options
D. check the client’s deep tendon reflexes for hyperflexia

Answer 17

B. The normal sodium level is 135-145 mEq/L.

Question 18

The nurse is checking the client for a positive Trousseau's sign. Which finding indicates a positive Trousseau's sign? 
A. Facial grimacing 
B. Carpopedal spasms
C. Nuchal rigidty 
D. Abdominal tenderness

Answer 18

B. A positive Trousseau’s sign would be indicated by jerking of the wrist when the blood pressure cuff is inflated. This indicates hypocalcemia.

Question 19

The client with hypercholesterolemia asked about vitamins that can help to lower his cholesterol. Which vitamin has been shown to be helpful in lowering the client's cholesterol level? 
A. Cyanocbalamine 
B. Ascorbic acid 
C. Niacin 
D. Riboflavin

Answer 19

C. To facilitate lowering of the cholesterol level, the doctor might order that the client to supplement his diet with niacin or B3.

Question 20

The client with hypoparathroidism is admitted with a calcium level of 7.6 mg/dL. The nurse should anticipate an order for which medication? 
A. Furosemide (Lasix) 
B. Levothyroxin (Synthyroid)
C. PTH (Forteo)
D. Propanolol (inderal)

Answer 20

C. The client with hypoparathyroidism will require supplementation with parathyroid hormone.

Question 21

The client is admitted with a magnesium level of 10.0 mEq/L. Which sign indicates that the client has a toxic level of magnesium? 
A. hot flashes
B. respirations of 10 per minute 
C. tendon reflexes of 2+
D. urinary output of 40 ml/hr

Answer 21

B. The signs of toxicity to magnesium include oliguria, absence of deep tendon reflexes, and decreased respiration (fewer than 12 per minute).

Question 22

Which staff member would be least appropriate to assign to the client receiving magnesium intravenously? 
A. the nursing assistant 
B. the licensed practical nurse 
C. the graduate registered nurse 
D. the surgical resident

Answer 22

A. Magnesium can cause renal failure and apnea. The nursing assistant should not be assigned to care for this client. The licensed practical nurse can evaulate urinary output and report to the registered nurse alterations in renal function.

Question 23

Which of the following should be kept available when intravenous magnesium is ordered? 
A. Protamine sulfate 
B. Calcium gluconate 
C. AquaMEPHYTON 
D. Aminocaproic acid

Answer 23

B. Calcium gluconate is the antidote for magnesium sulfate.

Question 24

The client is admitted with a pH of 7.38, an HCO3 level of 34 mEq/L, and a CO2 level of 48 mEq/L. The nurse is aware that these laboratory values reveal: 
A. Metabolic acidosis 
B. Metabolic alkalosis 
C. Respiratory alkalosis 
D. Respiratory acidosis

Answer 24

B. The pH is elevated, as are the HCO3 and CO2 levels. This indicates metabolic alkalosis.

Question 25

The client is admitted with chronic obstructive pulmonary disease. The client's laboratory values reveal a CO2 level of 49 mEq/L. The HCO3 level is 26 mEq/L, and the pH is 7.32. The nurse is aware that these laboratory values reveal: 
A. Metabolic acidosis 
B. Metabolic alkalosis 
C. Respiratory alkalosis 
D. Respiratory acidosis

Answer 25

D. The pH is below normal. The HCO3 and CO2 are elevated. This indicates respiratory acidosis.

Question 26

While the client is taking Digoxin (digitalis), the nurse should check the client's lab values. Which lab value should be reported to the doctor? 
A. Sodium Level 138 mEq/L
B. Chloride level of 98 mEq/L 
C. Potassium level of 3.0 mEq/L 
D. Magnesium level of 1.8 mEq/L

Answer 26

C. A potassium level of 3.0 is low.

Question 27

The client with renal disease has an order for a low potassium diet. Which food is highest in potassium?
A. Marshmellows 
B. Raisins 
C. Cake 
D. Mashed potatoes

Answer 27

B. Dried fruits contain large amount of potassium.

Question 28

The client with hypertension and renal disease is admitted to the clinic with a blood pressure of 190/100. The physician decides to order a beta blocker and a potassium sparing diuretic. The nurse should anticipate an order for which diuretic? 
A. Furosemide (Lasix)
B. Hydrochlorothiazide (HCTZ)
C. Spironolactone (Aldactone)
D. Torsemide (Demadex)

Answer 28

C. Spironolactone is the only answer that is a potassium sparing diuretic.

Question 29

The client is admitted with Cushing's disease. The nurse is aware that a client with an adrenal disorder such as Cushing's disease will most likely exhibit signs of: 
A. Hypercalcemia 
B. Hyperkalemia 
C. Hypernatremia 
D. Hypermagnesemia

Answer 29

C. Clients with Cushing’s disease often retain sodium.

Question 30

The client is admitted to the unit with diabetes insipidus. Which laboratory result supports this diagnosis?
A. specific gravity of 1.000
B. Sodium of 140 mEq/L
C. Glucose of 110 mg/dL
D. Potassium of 3.8 mEq/dL

Answer 30

A. Diabetes insipidus is a lack of antidiuretic hormone. This results in a large volume of urinary output with an extremely low specific gravity. The normal specific gravity is 1.010-1.030

Question 31

Which action by the nurse is most appropriate for the patient receiving an infusion of packed red blood cells?
A. flush the IV line with normal saline before the blood is added to the infusion
B. flush the IV line with dextrose before the blood is added to the infusion
C. check the patient’s vital signs once the infusion is completed
D. anticipate that flushed skin and fever are expected reactions to a blood transfusion.

Answer 31

A. flush the line with normal saline before the blood is added to the infusion

Question 32

When preparing an IV solution that contains potassium, the nurse knows that a contraindication to the potassium infusion would be
A. diarrhea
B. serum sodium level of 145 mEq/L
C. serum potassium level of 5.6 mEq/L
D. dehydration

Answer 32

C. serum potassium level of 5.6 mEq/L

Question 33

When assessing a patient who is about to receive an albumin infusion, the nurse knows that a contraindication for albumin would be
A. acute liver failure 
B. heart failure 
C. severe burns 
D. fluid-volume deficit

Answer 33

B. heart failure

Question 34

The nurse is preparing an infusion for a patient who has a deficiency in clotting factors. Which type of infusion is most appropriate? 
A. Albumin 5%
B. Packed RBCs
C. Whole blood 
D. Fresh frozen plasma

Answer 34

D. fresh frozen plasma

Question 35

While monitoring a patient who is receiving an infusion of a crystalloid solution, the nurse will monitor for which potential problem? 
A. bradycardia 
B. hypotension 
C. decreased skin turgor
D. fluid overload

Answer 35

D. fluid overload

Question 36

The nurse is administering an IV solution that contains potassium chloride to a patient in the critical care unit who has a severely decreased serum potassium level. Which action(s) by
the nurse are appropriate?
A. administer the potassium by slow IV bolus
B. administer the potassium at a rate no faster than 20 mEq/hr
C. monitor the patient’s cardiac rhythm with a heart monitor
D. use an infusion pump for the administration of IV potassium chloride
E. administer the potassium IV push

Answer 36

B,C,D

Administer the potassiu at a rate no faster than 20 mEq/hr. Monitor the patient’s cardiac rhyth with a heart monitor. Use an infusion pump for the administration of IV potassium chloride

Question 37

The order reads: “Infuse 1000mL of normal saline over the next 8 hours.” The IV tubing has a drop factor of 15 gtt/mL. Calculate the mL/hour rate, and calculate the drops/minute setting for the IV tubing with this gravity infusion.

Answer 37

125 ml/hr 31 gtt/min

Question 38

A patient who is comatose is admitted to the hospital with an unknown history. Respirations are deep and rapid. Arterial blood gas levels on admission are pH, 7.20; PaCO2, 21 mm Hg; PaO2, 92 mm Hg; and HCO3, 8. You interpret these laboratory values to indicate: 
A. metabolic acidosis 
B. metabolic alkalosis 
C. respiratory acidosis 
D. respiratory alkalosis

Answer 38

A. metabolic acidosis

Question 39

A patient with a cardiac history is taking the diuretic furosemide (Lasix) and is seen in the emergency department for muscle weakness. Which laboratory value do you asses first? 
A. serum albumin 
B. serum sodium 
C. hematocrit 
D. serum potassium

Answer 39

D. serum potassium

Question 40

Which of these patients do you expect will need teaching regarding dietary sodium restriction?
A. an 88 year old with a fractured femur scheduled for surgery
B. a 65 year old recently diagnosed with heart failure
C. a 50 year old recently diagnosed with asthma and diabetes
D. a 20 year old with vomiting and diarrhea from gastroenteritis

Answer 40

B. a 65 year old recently diagnosed with heart failure.

Question 41

You teach patients to replace sweat, vomiting, or diarrhea fluid losses with which type of fluid?
A. tap water or bottled water 
B. fluid that has sodium in it 
C. fluid that has K+ and HCO3 in it 
D Coffee or tea, whichever they prefer

Answer 41

B. fluid that has sodium in it

Question 42

You assess four patients. Which patient is at greatest risk for the development of hypocalcemia?
A. 56 year old with acute kidney renal failure
B. 40 year old with appendicitis
C. 28 year old who has acute pancreatitis
D. 65 year old with hypertension and asthma

Answer 42

C. 28 year old who has acute pancreatitis

Question 43

Which of the following activities can you delegate to nursing assistive personnel?
A. measuring oral intake and urine output
B. preparing intravenous tubing for routine change
C. reporting an IV container that is low in fluid
D. changing an IV fluid container

Answer 43

A. C. measuring oral intake and urine output and reporting an IV container that is low in fluid are both within the parameters of NAP training

Question 44

Place the following steps for intravenous catheter insertion in the correct order:
A. perform hand hygiene
B. open and prepare infusion set
C. select appropriate vein and insert catheter
D. use two identifiers to ensure correct patient
E. assess for risk factors such as age or platelet count
F. carefully check the HCP’s order for the IV therapy

Answer 44

F. E. D. A. B. C.

Question 45

Assessment findings consistent with intravenous fluid infiltration include: 
A. edema and pain 
B. streak formation 
C. pain and erythema 
D. pallor and coolness 
E. numbness and pain

Answer 45

A. edema and pain

D. pallor and coolness

Question 46

Which of the following defining characteristics to consistent with fluid volume deficit?
A. a 1lb weight loss, pale yellow urine
B. engorged neck veins when upright, bradycardia
C. dry mucous membranes, thready pulse, tachycardia
D. bounding radial pulse, flat neck veins when supine

Answer 46

C. dry mucous membranes, thready pulse, tachycardia

Question 47

Which of the following assessments do you perform routinely when an older adult patient is receiving intravenous 0.9% NaCl?
A. auscultate dependent portions of the lungs
B. check color of urine
C. assess muscle strength
D. check skin turgor over sternum or shin

Answer 47

A. auscultate dependent portions of the lungs

Question 48

While receiving a blood transfusion, your patient develops chills, tachycardia, and flushing. What is your priority action? 
A. notify a HCP
B. insert an indwelling catheter 
C. alert the blood bank
D. stop the transfusion

Answer 48

D. stop the transfusion

Question 49

The HCP's order is 1000ml 0.9% NaCl with 20 mEq K+ intravenously over 8 hours. Which assessment finding causes you to clarify the ordewr ith the HCP before hanging this fluid? 
A. flat neck veins 
B. tachycardia 
C. hypotension 
D. oliguria

Answer 49

D. oliguria

Question 50

Your patient who has diabetic ketoacidosis is breathing rapidly and deeply. IV fluids and other treatments have just been started. What should you do about this patient’s breathing?
A. notify her HCP that she is hyperventilating
B. provide frequent oral care to keep her mucous membranes moist
C. ask her to breathe slower and help her to calm down and relax
D. asses her for pain and requent an order for a sedative

Answer 50

B. provide frequent oral care to keep her mucous membranes moist

Question 51

Your patient had 200mL of ice chips and 900mL intravenous fluid during your shift. Which total intake should you record?
A. 700 mL
B. 900 mL 
C. 1000 mL
D. 1100 mL

Answer 51

C. 1000 mL

Question 52

The HCP's order is 1000mL 0.9% NaCl IV over 6 hours. Which rate do you program into the infusion pump?
A. 125 ml/hr
B. 167 ml/hr
C. 200 ml/hr 
D. 1000 ml/hr

Answer 52

B. 167 ml/hr

Question 53

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition is a cause for these findings?
A. overhydration 
B. anemia 
C. dehydration 
D. renal failure

Answer 53

C. Dehydration results in concentrated serum, causing laboratory values to increase because the blood has normal constituents but not enough volume to dilute the values to within normal range or possibly lower.

Question 54

The client who has undergone an exploratory lapratomy and subsequent removal of a large intestinal tumor has nasogastric tube in place and an IV running at 150ml/hr via an IV pump. Which data should be reported to the HCP?
A. the pump keeps sounding an alarm indicating the high pressure has been reached
B. intake is 1800mL, NGT output is 550mL, and Foley output is 950mL
C. on auscultation, crackles, and rhonchi in all lung fields are noted
D. client has negative pedal edema and an increasing level of consciousness

Answer 54

C. Crackles and rhonchi in all lung fields indicate the body is not able to process the amount of fluid being infused. This should be brought to the HCP’s attention.

Question 55

The client diagnosed with diabetes insipidus weighed 180 pounds when the daily weight was taken yesterday. This morning’s weight is 175.6 pounds. One liter of fluid weighs approximately 2.2 pounds. How much fluid has the client lost?

Answer 55

2000mL has been lost

Question 56

The nurse writes the client problem of “fluid volume excess”. Which intervention should be included in the plan of care?
A. Change the IV fluid from 0.9% NS to D5W
B. Restrict the sodium in the client’s diet
C. monitor blood glucose levels
D. prepare the client for hemodialysis

Answer 56

B. Fluid volume excess refers to an isotonic expansion of the extracellular fluid by an abnormal expansion of water and sodium. Therefore, sodium is restricted to allow the body to excrete the extra volume.

Question 57

The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented?
A. encourage fluids orally
B. administer 10% saline solution IVPB
C. administer antidiuretic hormone intranasally
D. place on seizure precautions

Answer 57

D. Clients with sodium levels less than 120 mEq/L are at risk for seizures as a complication. The lower the sodium level, the greater the risk of a seizure.

Question 58

The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first?
A. the client in normal sinus rhythm with a peaked T wave
B. the client diagnosed with atrial fibrillation with a rate of 100
C. the client diagnosed with a myocardial infarction who has occasional PVCs.
D. the client with a first degree atrioventricular block and a rate of 92

Answer 58

A. A client with a peaked T wave could be experiencing hyperkalemia. Changes in potassium levels can initiate cardiac dysrhythmias and instability.

Question 59

The client who is post-thyroidectomy complains of numbness and tingling around the mouth and tips of the fingers. Which intervention should the nurse implement first?
A. notify the HCP immediately
B. tap the cheek about two cm anterior to the earlobe
C. check the serum calcium and magnesium levels
D. prepare to administer calcium gluconate IVP

Answer 59

B. These are signs and symptoms of hypocalcemia, and the nurse can confirm this by tapping the cheek to elicit the Chvostek’s sign. If the muscles of the cheek begin to twitch, then the HCP should be notified immediately because hypocalcemia is a medical emergency.

Question 60

The nurse is caring for a client diagnosed with diabetic ketoacidosis. Which statement best explains the scientific rationale for the client’s Kussmaul’s respirations?
A. the kidneys produce excess urine and the lungs try to compensate
B. the respirations increase the amount of carbon dioxide in the bloodstream
C. the lungs speed up to release carbon dioxide and increase the pH
D. the shallow and slow respirations will increase the HCO3 in the serum

Answer 60

C. The lungs attempt to increase the blood pH level by blowing off the carbon dioxide (carbonic acid).

Question 61

The client is NPO and is receiving total parenteral nutrition via a subclavian line. Which precautions should the nurse implement?
A. place the solution on an IV pump at the prescribed rate
B. monitor blood glucose every 6 hours
C. weight the client weekly, first thing in the morning
D. change the IV tubing every three days
E. monitor intake and output every shift.

Answer 61

A. TPN is a hypertonic solution with enough calories, proteins, lipids, electrolytes, and trace elements to sustain life. It is administered via a pump to prevent too-rapid infusion.
B. TPN contains 50% dextrose solution; therefore, the client is monitored to ensure the pancreas is adapting to the high glucose levels.
E. Intake and output are monitored to observe for fluid balance.

Question 62

The client has received IV solutions for three days through a 20 gauge IV catheter placed in the left cephalic vein. On morning rounds, the nurse notes the IV site is tender to palpation and a red streak has formed. Which intervention should the nurse implement first? 
A. start a new IV in the right hand 
B. discontinue the intravenous line 
C. complete an incident record 
D. place a warm washrag over the site

Answer 62

B. The client has signs of phlebitis and the IV must be removed to prevent further complications.

Question 63

The nurse and an unlicensed assistive personnel are caring for a group of clients. Which nursing intervention should the nurse perform?
A. measure the client’s output from the indwelling cathete
B. record the client’s intake and output on the I & O sheet
C. instruct the client on appropriate fluid restrictions
D. provide water for a client diagnosed with diabetes insipidus

Answer 63

C. The nurse cannot delegate teaching.

Question 64

The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor? 
A. serum calcium 
B. serum phosphorus 
C. serum potassium 
D. serum sodium

Answer 64

C. Clients lose potassium from the GI tract or through the use of diuretic medications. Potassium imbalances can lead to cardiac arrythmias

Question 65

During the postoperative care of a 76 year old patient, the nurse monitors the patient’s intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because
A. older adults have an impaired thirst mechanism and need reminding to drink fluids
B. water accounts for a great percentage of body weight in the older adult than in younger adults
C. older adults are more likely than younger adults to lose extracellular fluid during surgical procedures
D. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults

Answer 65

D. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults

Question 66

During administration of a hypertonic IV solution, the mechanism involved in the equalizing the fluid concentration between ECF and the cells is
A. osmosis 
B. diffusion 
C. active transport 
D. facilitated diffusion

Answer 66

A. osmosis

Question 67

An older woman was admitted to the medical unit with dehydration. Clinical indications of this problem are: 
A. weight loss 
B. dry oral mucosa 
C. full bounding pulse 
D. engorged neck veins 
E. decreased central venous pressure

Answer 67

A. B. E.

weight loss, dry oral mucosa, decreased central venous pressure

Question 68

The nursing care for a patient with hyponatremia includes
A. fluid restriction
B. administration of hypotonic IV fluids
C. administraiton of a cation-exchange resin
D. increased water intake for patients on nasogastric suction.

Answer 68

A. fluid restriction

Question 69

The nurse should be alert for which manifestations in a patient receiving a loop diuretic?
A. restlessness and agitation
B. paresthesias and irritability
C. weak, irregular pulse and poor muscle tone
D. increased blood pressure and muscle spasms

Answer 69

C. weak, irregular pulse and poor muscle tone

Question 70

Which patient would be at greatest risk for the potential development of hypermagnesemia?
A. 83 year old man with lung cancer and hypertension
B. 65 year old woman with hypertension taking B-adrenergic blockers
C. 42 year old woman with systemic lupus erythematosus and renal failure
D. 50 year old man with benign prostatic hyperplasia and a urinary tract infection

Answer 70

C. 42 year old woman with systemic lupus erythematosus and renal failure

Question 71

It is especially important for the nurse to assess for which clinical manifestation(s) in a patient who has just undergone a total thyroidectomy?
A. confusion 
B. weight gain 
C. depressed reflexes 
D. circumoral numbness
E. postive Chvostek's sign

Answer 71

A.D.E.

confusion, circumoral numbness, positive Chvostek’s sign

Question 72

The nurse anticipates that treatment of the patient with hyperphosphatemia secondary to renal failure will include 
A. fluid restriction 
B. calcium supplements 
C. loop diuretic therapy 
D. magnesium supplements

Answer 72

B. calcium supplements

Question 73

The lungs act as an acid buffer by
A. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load
B. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load
C. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load
D. decreasing respiratory rate and depth when CO2 levels in the blood are low, increassing acid load

Answer 73

A. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load

Question 74

A patient has the following arterial blood gas results: pH 7.52; PaCO2 30 mm Hg; HCO3 24 mEq/L. The nurse determines that these results indicate
A. metabolic acidosis 
B. metabolic alkalosis 
C. respiratory acidosis 
D. respiratory alkalosis

Answer 74

D. respiratory alkalosis

Question 75

The typical fluid replacement for the patient with a fluid volume deficit is 
A. dextran 
B. 0.45% saline 
C. lactated Ringer's 
D. 5% dextrose in 0.45% saline

Answer 75

C. lactated Ringer’s

Question 76

The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to
A. apply warm moist compresses to the insertion site
B. attempt to force 10mL of normal saline into the device
C. place the patient on the left side with head down position
D. instruct the patient to change positions, raise arm, and cough

Answer 76

D. instruct the patient to change positions, raise arm, and cough

Question 77

The primary components of the extracellular fluid are 
A. lymph and cerebrospinal fluid 
B. plasma and serous fluids 
C. interstitial fluid and plasma 
D. all of these

Answer 77

C. interstitial fluid and plasma

Question 78

The principal anions in the ICF are
A. phosphate and proteins
B. phosphate and bicarbonate
C. sodium and chloride 
D. sodium and potassium

Answer 78

A. phosphate and proteins

Question 79

Osmoreceptors in the hypothalamus monitor the osmotic concentration of the ECF and secrete \_\_\_\_\_\_\_\_ in response to higher osmotic concentrations. 
A. BNP 
B. ANP
C. aldosterone 
D. ADH

Answer 79

D. ADH

Question 80

Calcium homeostasis primarily reflects
A. a balance between absorption in the gut and excretion by the kidneys
B. careful regulation of blood calcium levels by the kidneys
C. an interplay between parathormone and aldosterone
D. an interplay among reserves in the bones, the rate of absorption, and the rate of excretion
E. hormonal control of calcium reserves in the bones

Answer 80

D. an interplay among reserves in the bones, the rate of absorption, and the rate of excretion

Question 81

The most important factor affecting the pH of body tissues is the concentration of 
A. lactic acid 
B. ketone bodies 
C. organic acids 
D. carbon dioxide 
E. hydrochloric acid

Answer 81

D. carbon dioxide

Question 82

Changes in the pH of body fluids are compensated for by all of the following except
A. an increase in urine output
B. the carbonic acid-bicarbonate buffer system
C. the phosphate buffer system
D. changes in the rate and depth of breathing
E. protein buffers

Answer 82

A. an increase in urine output

Question 83

Respiratory acidosis develops when the blood pH is
A. increased due to a decreased blood CO2 level
B. decreased due to an increased blood CO2 level
C. increased due to an increased blood CO2 level
D. decreased due to a decreased blood CO2 level

Answer 83

B. decreased due to an increased blood CO2 level

Question 84

Metabolic alkalosis occurs when
A. bicarbonate ion concentrations become elevated
B. a severe biocarbonate loss occurs
C. the kidneys fail to excrete hydrogen ions
D. ketone bodies are generated in abnormally large quantities

Answer 84

A. bicarbonate ion concentrations become elevated

Question 85

Identify four hormones that mediate major physiological adjustments affecting fluid and electrolyte balance. What are the primary effects of each hormone?

Answer 85

antidiuretic hormone-stimulates water conservation by the kidneys and stimulates the thirst center
aldosterone-determines the rate of sodium reabsorption and potassium secretion along the DCT and collecting system of the kidney and the natriuretic peptides
ANP and BNP-reduce thirst, promote the loss of Na and water by the kidneys, and block the release of ADH and aldosterone

Question 86

Drinking a solution hypotonic to the ECF causes the ECF to
A. increase in volume and become hypertonic to the ICF
B. decrease in volume and become hypertonic to the ICF
C. decrease in volume and become hypotonic to the ICF
D. increase in volume and become hypotonic to the ICF

Answer 86

D. increase in volume and become hypotonic to the ICF

Question 87

The osmotic concentration of the ECF decreases if an individual gains water without a corresponding 
A. gain of electrolytes 
B. loss of water 
C. fluid shift from the ECF to the ICF 
D. A,B, and C

Answer 87

A. gain of electrolytes

Question 88

When the pH of body fluids begins to decrease, free amino acids and proteins will
A. release a hydrogen from the carboxyl group
B. release a hydrogen from the amino group
C. release a hydrogen at the carboxyl group
D. bind a hydrogen at the amino group

Answer 88

D. bind a hydrogen at the amino group

Question 89

In a protein buffer system, if the pH increases,
A. the protein acquires a hydrogen ion from carbonic acid
B. hydrogen ions are buffered by hemoglobin molecules
C. a hydrogen ion is released and a carboxylate ion is formed
D. a chloride shift occurs

Answer 89

C. a hydrogen ion is released and a carboxylate ion is formed

Question 90

What are fluid shifts? What is their function, and what factors can cause them?

Answer 90

Fluid shifts are rapid water movements between the ECF and the ICF that occur in response to increases or decreases in the osmotic concentration of the ECF. Such water movements dampen extreme shifts in electrolyte balance.

Question 91

Why should a person with a fever drink plenty of fluids?

Answer 91

A person with a fever should increase fluid intake because for each degree Celsius the body temperature increases above normal, daily water loss increases by 200mL

Question 92

Define and give an example of 
A. a volatile acid 
B. a fixed acid
C. an organic acid 
Which represents the greatest threat to acid-base balance? Why?

Answer 92

A volatile acid can leave solution and enter the atmosphere, such as carbonic acid.
A fixed acid does not leave solution, such as sulfuric acid.
An organic acid is produced during metabolsim such as ketone or lactic acid.
Volatile acids are the greatest threat because of the large amounts generated by normal cellular processes.

Question 93

How do respiratory and renal mechanisms support the buffer systems?

Answer 93

Respiratory and renal mechanisms support buffer systems by secreting or absorbing hydrogen ions, by controlling the excretion of acids and bases, and by generating additional buffers.

Question 94

Differentiate between respiratory compensation and renal compensation.

Answer 94

Respiratory compensation is a change in the respiratory rate that helps stabilize the pH of the ECF. Increasing or decreasing the rate of respiration alters pH by decreasing or increasing the CO2. When the CO2 decreases, the pH, the pH increases; when the CO2 increases, the pH decreases. Renal compensation is a change in the rates of hydrogen and bicarbonate ion secretion or reabsorption in response to changes in plasma pH. Tubular hydrogen ion secretion results in the diffusion of bicarbonate ions into the ECF.

Question 95

Distinguish between respiratory and metabolic disorders that disturbe acid-base balance.

Answer 95

Respiratory disorders result from abnormal CO2 levels in the ECF. An imbalance exists between the rate of CO2 removal by the lungs and its generation in other tissues. Metabolic disorders are caused by the generation of organic or fixed acids or by conditions affecting the concentration of bicarbonate ions in the ECF.

Question 96

What is the difference between metabolic acidosis and respiratory acidosis? What can cause these conditions?

Answer 96

Respiratory acidosis, which results from an abnormally high level of carbon dioxide, is usually caused by hypoventilation. Metabolic acidosis, which occurs when bicarbonate ion levels decrease, can result from overproduction of fixed or organic acids, impaired ability to secrete H+ ions by the kidney, or severe bicarbonate loss.

Question 97

The most recent advice from medical and nutritional experts is to monitor one’s intake of salt so that it does not exceed the amount needed to maintain a constant ECF volume. What effect does excessive salt intake have on blood pressure?

Answer 97

Excessive salt intake causes an increase in total blood volume and blood pressure due to an obligatory increase in water absorption across the intestinal lining and recall of fluid from the ICF

Question 98

Exercise physiologists recommend that adequate amounts of fluid be ingested before, during, and after exercise. Why is fluid replacement during extensive sweating is important?

Answer 98

Since sweat is usually hypotonic, the loss of a large volume of sweat causes hypertonicity in body fluids. The loss of fluid volume is primarily from the interstitial space, which leads to a decrease in plasma volume and increase in the hematocrit. Severe dehydration can cause the blood viscosity to increase substantially, resulting in an increased workload on the heart, ultimately increasing the probability of heart failure.

Question 99

Dan has been lost in the desert for two days with very little water. As a result of this exposure, you would expect to observe which of the following? 
A. increased ADH levels 
B. decreased blood osmolarity 
C. normal urine production 
D. increased blood volume 
E. cells enlarged with fluid

Answer 99

A. increased ADH levels

Question 100

Yuka is dehydrated, so her physician prescribes intravenous fluids. The attending nurse becomes destracted and erroneously gives Yuka a hypertonic glucose solution instead of normal saline. What effect will this mistake have on Yuka’s plasma ADH levels and urine volume?

Answer 100

The hypertonic solution will cause fluid to move from the ICF to the ECF, further aggravating Yuka’s dehydration. The slight increase in pressure and osmolarity of the blood should lead to an increase in ADH, even though ADH levels are probably quite high already. Despite the high ADH levels, urine volume would probably increase, because the kidneys could not reabsorb much of the glucose. The remaining glucose would increase the osmolarity of the tubular filtrate, decreasing water reabsorption and increasing urine volume.

Question 101

Name the following condition:

pH 7.5, CO2 32, Na 138, HCO3 22, Cl 106, Anion gap 10

Answer 101

Compensated respiratory alkalosis

Question 102

Name the following condition:

pH 7.2, CO2 45, Na 140, HCO3 20, Cl 102, Anion gap 18

Answer 102

Acute metabolic acidosis due to generation or retention of organic or fixed acids

Question 103

Name the following condition:

pH 7.0, CO2 60, Na 140, HCO3 28, Cl 101, Anion gap 12

Answer 103

Acute respiratory acidosis

Question 104

Name the following condition:

pH 7.7, CO2 50, Na 136, HCO3 34, Cl 91, Anion gap 11

Answer 104

Metabolic alkalosis