hesi practice - F & E, Acid-base balance

Which intravenous fluid is a hypertonic solution? 1 Ringer solution 2 5% dextrose in water 3 Lactated Ringer solution 4 5% dextrose in normal saline

5% dextrose in normal saline An isotonic solution has the same osmolarity as body fluids. A hypertonic solution has a higher osmolarity than body fluids; it pulls fluid from cells, causing them to shrink and the extracellular space to expand. The hypertonic solution (5% dextrose in normal saline) provides 586 mOsm/kg. Ringer and Lactated Ringer [273 mOsmol/kg] are isotonic, whereas 5% dextrose in water [252 mOsmol/kg]) is slightly hypotonic.

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco2 of 45 mm Hg, HCO3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support which diagnosis? 1 Hypocapnia 2 Hyperkalemia 3 Metabolic alkalosis 4 Respiratory acidosis

Metabolic alkalosis Elevated plasma pH and elevated bicarbonate levels support metabolic alkalosis. The arterial carbon dioxide level of 45 mm Hg is within the expected value of 35 mm Hg to 45 mm Hg; no hypocapnia is present. The client's serum potassium level is within the expected level of 3.5 mEq/L to 5 mEq/L (3.5-5 mmol/L). With respiratory acidosis the pH will be less than 7.35 and the Pco2 will be elevated.

A client who experienced extensive burns is receiving intravenous fluids to replace fluid loss. The nurse would monitor for which initial symptom of fluid overload? 1 Crackles in the lungs 2 Decreased heart rate 3 Decreased blood pressure 4 Cyanosis of nailbeds

Crackles in the lungs Crackles, or rales, in the lungs are an early sign of pulmonary congestion and edema caused by fluid overload. Clients with fluid overload will usually demonstrate an increased heart rate and increased blood pressure. A decreased heart rate and decreased blood pressure and cyanosis in a client with fluid overload would be very late and fatal signs.

A client is to receive a transfusion of packed red blood cells (PRBCs). Which solution would the nurse use to prime the blood intravenous (IV) tubing? 1 Lactated Ringer solution 2 5% dextrose and water 3 0.9% normal saline 4 0.45% normal saline

0.9% normal saline Blood and blood products for transfusion should be infused/diluted only with 0.9% normal saline solution. Solutions other than normal saline are incompatible and may cause RBC destruction by hemolysis. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question.

A client with a history of severe diarrhea for the past 3 days is admitted for dehydration. The nurse anticipates administering which intravenous (IV) solution? 1 3% sodium chloride 2 0.9% sodium chloride 3 5% dextrose and 0.9% sodium chloride 4 5% dextrose and lactated Ringer solution

0.9% sodium chloride An IV solution of 0.9% sodium chloride is the most appropriate initial IV fluid for this client because it is an isotonic solution that will act as a volume expander to quickly replace volume losses and promote physiological stabilization. Three percent sodium chloride is a high-concentration (hypertonic) electrolyte solution; it would only be used in a client with hyponatremia and must be closely monitored during infusion. Five percent dextrose and 0.9% sodium chloride and 5% dextrose and lactated Ringer solution may be appropriate fluids to infuse after 0.9% sodium chloride. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.

During an 8-hour shift a client drinks two 6-oz (180-mL) cups of tea and vomits 125 mL of fluid. Intravenous fluids absorbed equaled the urinary output. What is the client's fluid balance during this 8-hour period? Record your answer using a whole number. ___ mL

235 mL is the correct calculation. The client's intake was 360 mL (12 oz × 30 mL = 360 mL), and the loss was 125 mL of fluid; 360 mL - 125 mL = 235 mL. Test-Taking Tip: When taking the NCLEX exam, an on-screen calculator will be available for you to determine your response, which you will then type into the provided space.

Which clinical manifestations indicate to the nurse that the client has an inadequate fluid volume? Select all that apply. One, some, or all responses may be correct. 1 Decreased urine 2 Hypotension 3 Dyspnea 4 Dry mucous membranes 5 Lung crackles 6 Poor skin turgor 00:00:06 Question Answer Confidence Buttons

Correct 1 Decreased urine Correct 2 Hypotension Correct 4 Dry mucous membranes Correct 6 Poor skin turgor Decreased urinary output, hypotension, dry mucous membranes, and poor skin turgor are all symptomatic of dehydration. Dyspnea and crackles in the lungs may be caused by fluid overload.

An infant with persistent diarrhea is subject to significant fluid and electrolyte alterations. Which physiologic imbalances would the nurse most likely encounter? Select all that apply. One, some, or all responses may be correct. 1 Hypovolemia 2 Hyperkalemia 3 Hypercalcemia 4 Metabolic acidosis 5 Decreased hematocrit

Hypovolemia Metabolic acidosis Fluid loss causes hypovolemia. Loss of bicarbonate and sodium in the stools causes metabolic acidosis. Potassium will be lost with diarrhea. Sodium may be increased, decreased, or unchanged. Hypercalcemia does not occur. The hematocrit is increased because of fluid loss (hemoconcentration). Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Although there is no penalty for guessing, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point.

After a fire, a client in the emergency department is diagnosed with smoke inhalation and has arterial blood gases that demonstrate an oxygen saturation (SaO2) of 91%, partial pressure of oxygen (PaO2) of 75 mm Hg, a partial pressure of carbon dioxide (PaCO2) of 45 mm Hg, and a pH of 7.35. Which intervention would the nurse anticipate implementing? 1 Oral and tracheal suctioning 2 Intubation and mechanical ventilation 3 Oxygen administration by nasal cannula 4 Discharge teaching and follow up instructions

Oxygen administration by nasal cannula The SaO2 and PaO2 indicate mild hypoxemia and need for oxygen administration, which would be done using a nasal cannula because that is the most comfortable means for oxygen administration. Oral and tracheal suctioning are not needed based on the client's data and would further traumatize the upper airway. Mild hypoxemia does not require intubation and mechanical ventilation. Because the client does have hypoxemia, continued observation is needed and discharge teaching is not indicated.

Which change in the arterial blood gases would the nurse expect in a client with hyperventilation due to anxiety? 1 Respiratory acidosis 2 Respiratory alkalosis 3 Respiratory compensation 4 Respiratory decompensation

Respiratory alkalosis Hyperventilation causes excess amounts of carbon dioxide (CO2) to be eliminated, causing respiratory alkalosis. Respiratory acidosis is caused by excess CO2 retained in the lungs from conditions such as hypoventilation or chronic obstructive pulmonary disease (COPD). Respiratory compensation and decompensation are terms not associated with this situation.