MedSurg - 13 Fluids and Electrolytes

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?

Prepare to assist with ventilation.

Which of the following is considered an isotonic solution? a) 0.9% normal saline b) 0.45% normal saline c) Dextran in NS d) 3% NaCl

a) 0.9% normal saline

The nurse is caring for a patient in the intensive care unit (ICU) following a saltwater near-drowning event. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen dry tongue, flushed skin, and peripheral edema. The nurse anticipated that the patient's serum sodium value would be which of the following? a) 155 mEq/L b) 125 mEq/L c) 135 mEq/L d) 145 mEq/L

a) 155 mEq/L

The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance? a) A 52-year-old with diarrhea b) A 65-year-old with a myocardial infarction c) A 72-year-old with a total knee repair d) A 7-year-old with a fracture tibia

a) A 52-year-old with diarrhea

The nurse is caring for a patient with a metabolic acidosis (pH 7.25). Which of the following values is useful to the nurse in determining whether the cause of the acidosis is due to acid gain or to bicarbonate loss? a) Anion gap b) Bicarbonate level c) Serum sodium level d) PaCO2

a) Anion gap

The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. a) Document presenting signs and symptoms. b) Compare ABG findings with previous results. c) Suction the client's airway. d) Maintain intake and output records. e) Administer IV bicarbonate.

a) Document presenting signs and symptoms. b) Compare ABG findings with previous results. d) Maintain intake and output records.

Which nerve is implicated in the Chvostek's sign? a) Facial b) Hypoglossal c) Spinal accessory d) Optic

a) Facial

Oral intake is controlled by the thirst center, located in which of the following cerebral areas? a) Hypothalamus b) Brainstem c) Thalamus d) Cerebellum

a) Hypothalamus

The nurse is caring for a patient diagnosed with hyperchloremia. Signs and symptoms of hyperchloremia include which of the following? Select all that apply. a) Lethargy b) Tachypnea c) Weakness d) Dehydration e) Hypotension

a) Lethargy b) Tachypnea c) Weakness

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? a) Metabolic alkalosis b) Respiratory alkalosis c) Respiratory acidosis d) Metabolic acidosis

a) Metabolic alkalosis

Which of the following is a correct route of administration for potassium? a) Oral b) IV (intravenous) push c) Subcutaneous d) Intramuscular

a) Oral

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? a) Potassium: 5.8 mEq/L b) Sodium: 138 mEq/L c) Calcium: 10 mg/dL d) Magnesium:2 mEq/L

a) Potassium: 5.8 mEq/L

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? a) Pulse b) Respirations c) Temperature d) Blood pressure

a) Pulse

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? a) Tachycardia b) Bradycardia c) Vasodilation d) Increased urine output

a) Tachycardia

The nurse is providing afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in hypervolemia status? a) Weight b) Vital signs c) Intake and output d) Edema

a) Weight

A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her: a) electrocardiogram (ECG) results. b) neuromuscular function. c) respiratory rate. d) bowel sounds.

a) electrocardiogram (ECG) results.

Early signs of hypervolemia include a) increased breathing effort and weight gain b) a decrease in blood pressure. c) thirst. d) moist breath sounds.

a) increased breathing effort and weight gain

To evaluate a client for hypoxia, the physician is most likely to order which laboratory test? a) Red blood cell count b) Arterial blood gas (ABG) analysis c) Sputum culture d) Total hemoglobin

b) Arterial blood gas (ABG) analysis

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? a) Hypovolemia b) Dehydration c) Hypervolemia d) Fluid volume excess

b) Dehydration

A patient is being treated in the ICU 24 hours after having a radical neck dissection completed. The patient's serum calcium level is 7.6 mg/dL. Which of the following physical examination findings is consistent with this electrolyte imbalance? a) Muscle weakness b) Presence of Trousseau's sign c) Slurred speech d) Negative Chvostek's sign

b) Presence of Trousseau's sign

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? a) Vasodilation b) Tachycardia c) Bradycardia d) Increased urine output

b) Tachycardia

A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: a) hypercalcemia. b) hypokalemia. c) hyperkalemia. d) hypernatremia.

b) hypokalemia Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. Administering glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? a) HCO 21 mEq/L b) pH 7.48 c) PaCO 36 d) O saturation 95%

b) pH 7.48

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? a) O saturation 95% b) pH 7.48 c) PaCO 36 d) HCO 21 mEq/L

b) pH 7.48

Below which serum sodium level may convulsions or coma can occur? a) 145 mEq/L b) 142 mEq/L c) 135 mEq/L d) 140 mEq/L

c) 135 mEq/L

A client with emphysema is at a greater risk for developing which of the following acid-base imbalances? a) Respiratory alkalosis b) Metabolic alkalosis c) Chronic respiratory acidosis d) Metabolic acidosis

c) Chronic respiratory acidosis

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? a) Rapid respiration b) Low heart rate c) Elevated blood pressure d) Subnormal temperature

c) Elevated blood pressure

You are caring for a client who has been admitted with a possible clotting disorder. The client is complaining of excessive bleeding and bruising without cause. You know that you should take extra care to check for signs of bruising or bleeding in what condition? a) Hypomagnesemia b) Hypokalemia c) Hypocalcemia d) Dehydration

c) Hypocalcemia

Which of the following may occur with respiratory acidosis? a) Decreased blood pressure b) Decreased pulse c) Increased intracranial pressure (ICP) d) Mental alertness

c) Increased intracranial pressure (ICP)

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? a) Provides long-term pH regulation b) Decreases arterial pH c) Increases arterial pH d) No effect

c) Increases arterial pH

A patient with cancer is being treated on the oncology unit for bilateral breast cancer. The patient is undergoing chemotherapy. The nurse notes the patient's serum calcium level is 12.3 mg/ dL. Given this laboratory finding, the nurse should suspect which of the following statements? a) The patient may be developing hyperaldosteronism. b) The patient's diet is lacking in calcium-rich food products. c) The patient's malignancy is causing the electrolyte imbalance. d) The patient has a history of alcohol abuse.

c) The patient's malignancy is causing the electrolyte imbalance.

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? a) Absence of glucose b) Specific gravity of 1.02 c) Absence of protein d) Urine pH of 3.0

d) Urine pH of 3.0

A patient is ordered to receive hypotonic IV solution to provide free water replacement. Which of the following solutions will the nurse anticipate administering? a) 0.45% NaCl b) Lactated Ringer's solution c) 0.9% NaCl d) 5% NaCl

a) 0.45% NaCl Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to replace cellular fluid because it is hypotonic compared with plasma. Another is to provide free water to excrete body wastes. At times, hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar conditions. Lactated Ringer's solution and normal saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic.

The nurse is instructing a patient with recurrent hyperkalemia about following a potassium-restricted diet. Which of the following patient statements indicates the need for additional instruction? a) "I need to check if my cola beverage has potassium in it." b) "I will not salt my food, instead I'll use salt substitute." c) "I'll drink cranberry juice with my breakfast instead of coffee." d) "Bananas have a lot of potassium in them, I'll stop buying them."

b) "I will not salt my food, instead I'll use salt substitute."

A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond? a) Renin-angiotensin-aldosterone system b) Bicarbonate-carbonic acid buffer system c) Sodium-potassium pump d) ADH-ANP buffer system

b) Bicarbonate-carbonic acid buffer system

Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism? a) Jaundice b) Chest pain c) Hypertension d) Slow pulse

b) Chest pain

The nurse is caring for a patient with a serum sodium level of 113 mEq/L. The nurse should monitor the patient for the development of which of the following? a) Hallucinations b) Confusion c) Nausea d) Headache

b) Confusion

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? a) Flaccidity and thirst b) Confusion and seizures c) Sunken eyeballs and spasticity d) Tetany and increased blood urea nitrogen (BUN) levels

b) Confusion and seizures

The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume? Select all that apply. a) Absence of ketones in urine b) Electrolyte imbalance c) Low protein level in the urine d) A low urine specific gravity e) An elevated hematocrit level

b) Electrolyte imbalance e) An elevated hematocrit level

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration? a) Low urine specific gravity b) Elevated hematocrit level c) Low white blood count d) Abnormal potassium level

b) Elevated hematocrit level

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. Na + 130 mEq/L K + 4.6 mEq/L Cl - 94 mEq/L Mg ++ 2.8 mg/dL Ca ++ 13 mg/dL Which of the following alterations is consistent with the client's findings? a) Hypermagnesemia b) Hypercalcemia c) Hyperkalemia d) Hyponatremia

b) Hypercalcemia

The nurse is conducting a lecture on the difference between hypovolemia and dehydration. When completing a verbal comparison, which point needs clarified? a) Similar causes are present in both conditions. b) In dehydration, only extracellular is depleted. c) Hypovolemia contains only low blood volume. d) Both conditions result in abnormal laboratory studies.

b) In dehydration, only extracellular is depleted.

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? a) Offer the client fluids frequently. b) Instruct the client to breathe into a paper bag. c) Administer an ordered decongestant. d) Administer ordered supplemental oxygen.

b) Instruct the client to breathe into a paper bag.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? a) Nausea or vomiting b) Light-headedness or paresthesia c) Hallucinations or tinnitus d) Abdominal pain or diarrhea

b) Light-headedness or paresthesia

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? a) Respiratory acidosis b) Metabolic alkalosis c) Metabolic acidosis d) Respiratory alkalosis

b) Metabolic alkalosis

A priority nursing intervention for a client with hypervolemia involves which of the following? a) Establishing I.V. access with a large-bore catheter. b) Monitoring respiratory status for signs and symptoms of pulmonary complications. c) Encouraging the client to consume sodium-free fluids. d) Drawing a blood sample for typing and crossmatching.

b) Monitoring respiratory status for signs and symptoms of pulmonary complications.

A 77-year-old retired male client visits your general practice office twice monthly to maintain control of his congestive heart failure. He measures his weight daily and phones it to your office for his medical record. In a 24-hour period, how much fluid is this client retaining if his weight increases by 2 lb? a) 1250 ml b) 500 ml c) 1 L d) 1500 ml

c) 1 L

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which? a) Lung function b) Summer allergies c) Insensible fluid loss d) Cardiovascular compromise

c) Insensible fluid loss

A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action? a) Tetanic contractions b) Polyuria c) Jugular vein distention d) Weight loss

c) Jugular vein distention

The nurse is assigned a client with calcium level of 4.0 mg/dL. Which system assessment would the nurse ask detailed questions? a) Gastrointestinal system b) Endocrine system c) Neurological system d) Musculoskeletal system

c) Neurological system

A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client? a) Yes, this will correct the sodium deficit. b) Yes, along with the hypotonic IV. c) No, sodium intake should be restricted. d) No, start with the sodium chloride IV.

c) No, sodium intake should be restricted.

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? a) Respiratory acidosis b) Metabolic alkalosis c) Respiratory alkalosis d) Metabolic acidosis

c) Respiratory alkalosis

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? a) Serum bicarbonate of 21 mEq/L b) pH 7.26 c) Serum bicarbonate of 28 mEq/L d) pH 7.30

c) Serum bicarbonate of 28 mEq/L

A client with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis? a) Hyperglycemia b) Stroke c) Shock d) Seizures

c) Shock

Patients diagnosed with hypervolemia should avoid sweet or dry food because a) it can lead to weight gain. b) it obstructs water elimination. c) it increases the patient's desire to consume fluid. d) it can cause dehydration.

c) it increases the patient's desire to consume fluid.

A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: a) metabolic acidosis. b) metabolic alkalosis. c) respiratory alkalosis. d) respiratory acidosis.

c) respiratory alkalosis.

A 42-year-old client has chronic hypo natremia, which requires weekly blood labs to keep him from lapsing into convulsions or a coma. What is the level of serum sodium below which convulsions or coma can occur? a) 142 mEq/L b) 147 mEq/L c) 140 mEq/L d) 135 mEq/L

d) 135 mEq/L

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? a) Neutral b) Alkaline c) Basic d) Acidic

d) Acidic

Which of the following are the insensible mechanisms of fluid loss? a) Bowel elimination b) Nausea c) Urination d) Breathing

d) Breathing

A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following? a) Respiratory acidosis b) Metabolic alkalosis c) Altered blood urea nitrogen (BUN) value d) Extracellular fluid volume deficit

d) Extracellular fluid volume deficit

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? a) Myasthenia gravis b) Type 1 diabetes mellitus c) Opioid overdose d) Extreme anxiety

d) Extreme anxiety

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance? a) Hypercalcemia b) Hyperkalemia c) Hypokalemia d) Hypocalcemia

d) Hypocalcemia

The nurse is assigned to care for a patient with a serum phosphorus level of 5.0 mg/dL. The nurse anticipates that the patient will also experience which of the following electrolyte imbalances? a) Hypermagnesemia b) Hyponatremia c) Hyperchloremia d) Hypocalcemia

d) Hypocalcemia

A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. Laboratory values are as follows: Na + 147 mEq/L K + 3.0 mEq/L Cl - 112 mEq/L Mg ++ 2.3 mg/dL Ca ++ 1.5 mg/dL Which of the following is consistent with the client's findings? a) Hyperchloremia b) Hypernatremia c) Hypophosphatemia d) Hypokalemia

d) Hypokalemia

During his annual physical exam, your 72-year-old male client complains of muscle cramps in his calves and that he feels "tired a lot." He is taking ethacrynic acid (Edecrin) for his hypotension. Your client will be evaluated for which of the following electrolyte imbalance based on his symptoms? a) Hypocalcemia b) Hyperkalemia c) Hypercalcemia d) Hypokalemia

d) Hypokalemia

When caring for a patient who has risk factors for fluid and electrolyte imbalances, which of the following assessment findings is the highest priority for the nurse to follow up? a) Weight loss of 4 lb b) Blood pressure 96/53 mm Hg c) Mild confusion d) Irregular heart rate

d) Irregular heart rate

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? a) Respiratory alkalosis b) Respiratory acidosis c) Metabolic alkalosis d) Metabolic acidosis

d) Metabolic acidosis

Which of the following would be appropriate nursing interventions for a client with hypokalemia? Select all that apply. a) Administer the ordered potassium 40 mg IV push. b) Administer the ordered Kayexalate enema. c) Administer the ordered Furosemide (lasix) 60 mg po. d) Offer a diet with fruit juices and citrus fruits. e) Monitor intake and output every shift.

d) Offer a diet with fruit juices and citrus fruits. e) Monitor intake and output every shift.

The calcium level of the blood is regulated by which mechanism? a) Adrenal gland b) Thyroid hormone (TH) c) Androgens d) Parathyroid hormone (PTH)

d) Parathyroid hormone (PTH)

Which of the following electrolytes is a major cation in body fluid? a) Phosphate b) Chloride c) Bicarbonate d) Potassium

d) Potassium

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? a) Monitor the client's heart rhythm. b) Obtain a urine specimen for drug screening. c) Prepare for gastric lavage. d) Prepare to assist with ventilation.

d) Prepare to assist with ventilation.

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Respiratory alkalosis

d) Respiratory alkalosis

Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality? a) Calcium b) Magnesium c) Potassium d) Sodium

d) Sodium

A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis? a) The client has never traveled outside of the country. b) The client sees his physician for a check-up yearly. c) The client works in a health care insurance office. d) The client had a liver transplant 2 years ago.

d) The client had a liver transplant 2 years ago.

A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should: a) administer antibiotics as ordered. b) insert a nasogastric tube (NG) as ordered. c) administer acetaminophen (Tylenol) as ordered. d) instruct the client to breathe into a paper bag.

d) instruct the client to breathe into a paper bag.

Which set of arterial blood gas (ABG) results requires further investigation? a) pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L b) pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L c) pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L d) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

d) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

A client is experiencing edema in the tissue. The nurse is correct in anticipating which tonicity of intravenous fluid? a) Hypotonic solution b) Hypertonic solution c) No intravenous solution d) Isotonic fluid

c) No intravenous solution

Which of the following is the most common cause of symptomatic hypomagnesemia? a) Sedentary lifestyle b) Alcoholism c) Burns d) IV drug use

b) Alcoholism

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? a) Calcium: 10 mg/dL b) Magnesium:2 mEq/L c) Potassium: 5.8 mEq/L d) Sodium: 138 mEq/L

c) Potassium: 5.8 mEq/L