Unit 1 Module 2: F&E, Acid-Base Balance

Question 1

A renal patient has high phosphorus levels. What lab finding is EXPECTED in this patient?

Answer 1

low calcium levels

Question 2

Which lab value is more concerning?

K 3.0 mEq/L
Na 130 mEq/L

Answer 2

K 3.0 mEq/L (small changes in K are more important!)

Normal ranges:
K 3.5-5
Na 135-145

Question 3

Which is more concerning?

Na 120
Na 150

Answer 3

Na 120

Normal range 135-145

Question 4

A patient is admitted to the hospital and is given a hypotonic solution (1/2 normal saline). Where will the fluid move?

Answer 4

from the bloodstream to the cell

Question 5

ABG:
pH 7.27
pCO2 49
HCO3- 25

Answer 5

respiratory acidosis with no compensation

pH 7.35-7.45
pCO2 35-45
Bicarb 22-26

Question 6

Which two lab values have an inverse relationship?

Answer 6

calcium and phosphorus

Question 7

t/f: A hypotonic solution will provide cellular rehydration when given.

Answer 7

true

Question 8

What does “partial compensation” mean when discussing ABG interpretation?

Answer 8

The pH does not return to normal.

Question 9

If a patient has a low albumin level noted on his laboratory work, the nurse suspects that the patient will have what physical assessment finding?

Answer 9

edema

Patients with low albumin don’t have the oncotic pulling power to hold fluid in the intravascular space. Remember albumin is a bully—if it is not there, then the water won’t still around. These patients often have edema as the fluid is in the interstitial space.

Question 10

ABG:
pH 7.26
pCO2 37
HCO3- 18

Answer 10

Metabolic acidosis without compensation

pH 7.35-7.45
pCO2 35-45
Bicarb 22-26

Question 11

A patient with end stage COPD is breathing very shallow at a rate of 8 breaths per minute. An ABG is drawn. What does the nurse expect to find as the result?

Answer 11

This patient would have very shallow respirations and would retain CO2, which would lead to respiratory acidosis (too much carbonic acid in the bloodstream.)

Question 12

A patient with type 1 diabetes mellitus presents to the emergency department in diabetic ketoacidosis. Which ABG result does the nurse expect to find?

Answer 12

metabolic acidosis

Question 13

What is the most common cause of hyponatremia?

Answer 13

overhydration

Question 14

A hospitalized patient has gained 4.4 lbs in a 24 hour period. Making the assumption that the weight gain is all fluid, how many liters does that equate to?

Answer 14

The patient gained 2 liters worth of fluid.

1 liter=1 kg=2.2 lbs

Question 15

Which symptom is an expected finding for a patient admitted in fluid volume overload because of missing two sessions of dialysis for renal failure?

Answer 15

This patient will have greater intravascular fluid volume and this will be seen through the distension of the jugular vein. Other symptoms may include hypertension, bounding pulses, weight gain, peripheral edema

Question 16

Which is the most likely to cause edema:

• hypertension
• low albumin
• hypoglycemia
• heart failure

Answer 16

low albumin (but heart failure will also cause edema)

Question 17

ABG:
pH 7.29
pCO2 32
HCO3- 19

Answer 17

metabolic acidosis with partial compensation

pH 7.35-7.45
pCO2 35-45
Bicarb 22-26

Question 18

If an isotonic solution is given into a patient’s IV. What should happen to the fluid?

Answer 18

It will remain in the intravascular space.

Isotonic solutions are equal in tonicity to the human body and will remain in the intravascular space where it was infused. Isotonic solutions like normal saline are used to raise blood pressure because it will stay in the intravascular space.

Question 19

A patient with diabetes has splurged on a bag of candy and the blood sugar has elevated. What symptom does the nurse expect?

Answer 19

Thirst

Glucose is a bully and it has a pulling power to it. It pulls fluid. When blood sugar is high, fluid is pulled from inside the cell. The increase in fluid in the bloodstream promotes urination. The individual is then dehydrated and becomes thirsty.

Question 20

If the Renin-Angiontensin-Aldosterone system is activated in the body, the end result will be:

Answer 20

increased blood pressure

RAAS and ADH both result in the retention of Na and water; which would in turn increase intravascular volume and blood pressure.

Aldosterone results in the retention of K and fluid retention

Question 21

A patient is having an anxiety attack and is breathing super fast (50 breaths per minute). If an ABG was drawn, the nurse would expect what abnormality?

Answer 21

respiratory alkalosis: The fast breathing is “blowing off carbon dioxide” also known as blowing off carbonic acid. That means that the person will have low levels of carbonic acid in the blood and therefore will have a respiratory alkalosis.

Question 22

Which solution has the highest number of solutes?

hypotonic, hypertonic, isotonic

Answer 22

hypertonic

Hypertonic solutions are more concentrated and have more solutes in them in comparison to normal human fluids. Examples include D5.45 NS, D5NS, D5LR.

Question 23

Which is most likely to cause edema:

• congestive heart failure
• diuretics
• sickle cell anemia
• IV fluids for dehydration

Answer 23

congestive heart failure

fluid volume overload

Question 24

An alteration in which electrolyte has the most profound effects on the body?

Answer 24

Potassium

Question 25

What system is the quickest to respond to acid-base imbalances?

Answer 25

The respiratory system can respond with minutes to hours.

Question 26

A patient is admitted with severe dehydration after becoming lost out in the woods for a week. The provider orders an isotonic solution (normal saline). The nurse understands what movement will happen to this fluid administered into the bloodstream.

Answer 26

The fluid will maintain in the bloodstream and will raise the blood pressure

Question 27

A patient presents to the ED with hyponatremia. What symptoms does the nurse expect to find?

Answer 27

Hyponatremia symptoms include: muscle cramps, weakness, fatigue, GI symptoms, headache, confusion, seizures and coma. Neuro symptoms like headache, confusion, seizures and coma are the most concerning.

Question 28

ABG:
pH 7.32
pCO2 27
HCO3- 18

Answer 28

metabolic acidosis with partial compensation

pH 7.35-7.45
pCO2 35-45
Bicarb 22-26

Question 29

ABG:
pH 7.52
pCO2 22
HCO3- 24

Answer 29

respiratory alkalosis with no compensation

pH 7.35-7.45
pCO2 35-45
Bicarb 22-26