Ch . 13 - Electrolytes, Acid & Bases Prep U

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: A. muscle weakness. B. tremors. C. diaphoresis. D. constipation.

A

A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? A. Lactated Ringer solution B. 0.45% NaCl C. 0.9% NaCl D. 5% NaCl

B

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, start with the sodium chloride IV. D. No, sodium intake should be restricted.

D

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? A. Headache or blurry vision B. Abdominal pain or diarrhea C. Hallucinations or tinnitus D. Light-headedness or paresthesia

D

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. sodium 137 mEq/L (137 mmol/L) potassium 4.6 mEq/L (4.6 mmol/L) chloride 94 mEq/L (94 mmol/L) calcium 12.9 mg/dL (3.2 mmol/L) What laboratory value is of highest concern to the nurse? A. sodium 137 mEq/L (137 mmol/L) B. potassium 4.6 mEq/L (4.6 mmol/L) C. chloride 94 mEq/L (94 mmol/L) D. calcium 12.9 mg/dL (3.2 mmol/L)

D

A client has chronic hyponatremia, which requires weekly laboratory monitoring to prevent the client lapsing into convulsions or a coma. What is the level of serum sodium at which a client can experience these side effects? A. 114 mEq/L B. 130 mEq/L C. 135 mEq/L D. 148 mEq/L

A

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. Administer an ordered decongestant. B. Instruct the client to breathe into a paper bag. C. Offer the client fluids frequently. D. Administer ordered supplemental oxygen.

B

Which is the most common cause of symptomatic hypomagnesemia? A. Intravenous drug use B. Alcoholism C. Sedentary lifestyle D. Burns

B

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 sees his physician for a check-up yearly. B. The client has never traveled outside of the country. C. The client had a liver transplant 2 years ago. D. The client works in a health care insurance office.

C

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? A. Neutral B. Alkaline C. Acidic D. Basic

C

Fluid and electrolyte balance is maintained through the process of translocation. What specific process allows water to pass through a membrane from a dilute to a more concentrated area? A. osmosis B. filtration C. evaporation D. active transport

A

The nurse is caring for a 72-year-old client who has been admitted to the unit for a fluid volume imbalance. The nurse knows which of the following is the most common fluid imbalance in older adults? A. Hypovolemia B. Dehydration C. Hypervolemia D. Fluid volume excess

B

A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching? A. tingling sensation in the fingers B. polyuria C. flank pain D. hypertension

A

At which serum sodium concentration might convulsions or coma occur? A. 130 mEq/L (130 mmol/L) B. 145 mEq/L (145 mmol/L) C. 140 mEq/L (140 mmol/L) D. 142 mEq/L (142 mmol/L)

A

The nurse is caring for a patient with a diagnosis of hyponatremia. What nursing intervention is appropriate to include in the plan of care for this patient? (Select all that apply.) A. Assessing for symptoms of nausea and malaise B. Encouraging the intake of low-sodium liquids C. Monitoring neurologic status D. Restricting tap water intake E. Encouraging the use of salt substitute instead of salt

A,C,D

The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

C

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. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

D

The nurse has been assigned to care for various clients. Which client is at the highest risk for a fluid and electrolyte imbalance? A. An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide. B. A 45-year-old client who had a laparoscopic appendectomy 24 hours ago and is being advanced to a regular diet. C. A 79-year-old client admitted with a diagnosis of pneumonia. D. A 66-year-old client who had an open cholecystectomy with a T-tube placed that is draining 125 mL of bile per shift.

A

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? A. Serum sodium level of 124 mEq/L B. Serum creatinine level of 0.4 mg/dl C. Hematocrit of 52% D. Serum blood urea nitrogen (BUN) level of 8.6 mg/dl

A

A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition? A. dehydration B. hypervolemia C. hypercalcemia D. hyperkalemia

A

A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance? A. metabolic alkalosis B. metabolic acidosis C. respiratory acidosis D. respiratory alkalosis

A

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. Prepare to assist with ventilation. B. Monitor the client's heart rhythm. C. Prepare for gastric lavage. D. Obtain a urine specimen for drug screening.

A

A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed? A. furosemide B. hydrochlorothiazide C. metolazone D. spironolactone

A

Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism? A. Chest pain B. Hypertension C. Slow pulse D. Jaundice

A

The calcium concentration in the blood is regulated by which mechanism? A. Parathyroid hormone (PTH) B. Thyroid hormone (TH) C. Adrenal gland D. Androgens

A

The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? A. pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L B. pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L C. pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L D. pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L

A

The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching? A. "I can use laxatives and enemas but only once a week." B. "A good breakfast for me will include milk and a couple of bananas." C. "I will be sure to buy frozen vegetables when I grocery shop." D. "I will take a potassium supplement daily as prescribed."

A

The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client's serum sodium value would be A. 155 mEq/L (155 mmol/L) B. 145 mEq/L (145 mmol/L) C. 135 mEq/L (135 mmol/L) D. 125 mEq/L (125 mmol/L)

A

The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? A. Confusion B. Headache C. Nausea D. Hallucinations

A

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis

A

The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? A. 0.45% sodium chloride B. 0.9% sodium chloride C. 5% glucose in water D. 5% glucose in normal saline solution

A

The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? A. 1 L B. 500 ml C. 1500 ml D. 1250 ml

A

When caring for a client who has risk factors for fluid and electrolyte imbalances, which assessment finding is the highest priority for the nurse to follow up? A. Irregular heart rate B. Weight loss of 4 lb C. Mild confusion D. Blood pressure 96/53 mm Hg

A

Which condition might occur with respiratory acidosis? A. Increased intracranial pressure B. Decreased blood pressure C. Decreased pulse D. Mental alertness

A

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

A

Which nerve is implicated in the Chvostek's sign? A. Facial B. Hypoglossal C. Optic D. Spinal accessory

A

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? A. Serum bicarbonate of 28 mEq/L B. PaCO2 less than 35 mm Hg C. Serum bicarbonate of 21 mEq/L D. pH 7.26

A

Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality? A. Sodium B. Potassium C. Calcium D. Magnesium

A

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. Respiratory alkalosis B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis

B

A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse? A. renin-angiotensin-aldosterone system B. bicarbonate-carbonic acid buffer system C. sodium-potassium pump D. ADH-ANP buffer system

B

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

B

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? A. 5% dextrose and normal saline solution B. Lactated Ringer's solution C. Half-normal saline solution D. 10% dextrose in water

B

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 alkalosis B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis

B

Which set of arterial blood gas (ABG) results requires further investigation? A. 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 B. pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L C. pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L D. pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L

B

A nurse caring for a patient who is receiving an IV solution via a central vein suspects the complication of an air embolism. Which of the following are signs and symptoms consistent with that diagnosis? Select all that apply. A. Crackles on auscultation B. Cyanosis C. Hypertension D. Shoulder pain E. Dyspnea F. Tachycardia

B,D,E,F

A client reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the client's laboratory work has returned? A. Potassium B. Phosphorus C. Calcium D. Iron

C

A client weighing 160.2 pounds (72.7 kg), who has been diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the client loses 1,000 mL of fluid in 24 hours. What weight would be consistent with this amount of fluid loss? A. 156.0 lbs (70.8 kg) B. 157.0 lbs (71.2 kg) C. 158.0 lbs (71.7 kg) D. 159.0 lbs (72.1 kg)

C

A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C

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. Drawing a blood sample for typing and crossmatching. C. Monitoring respiratory status for signs and symptoms of pulmonary complications. D. Encouraging the client to consume sodium-free fluids.

C

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. Extreme anxiety D. Opioid overdose

C

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 7-year-old with a fracture tibia B. A 65-year-old with a myocardial infarction C. A 52-year-old with diarrhea D. A 72-year-old with a total knee repair

C

Which electrolyte is a major cation in body fluid? A. Chloride B. Bicarbonate C. Potassium D. Phosphate

C

Which is a correct route of administration for potassium? A. Subcutaneous B. Intramuscular C. Oral D. IV (intravenous) push

C

Which is an insensible mechanism of fluid loss? A. Urination B. Bowel elimination C. Breathing D. Nausea

C

With which condition should the nurse expect that a decrease in serum osmolality will occur? A. Influenza B. Hyperglycemia C. Kidney failure D. Uremia

C

A client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment? A. neuromuscular function B. bowel sounds C. respiratory rate D. electrocardiogram (ECG) results

D

A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows: pH 7.30 PaO2 97 PaCO2 37 HCO3 18 The nurse would expect which of the following sets of assessment findings? A. Headache, blood pressure 90/54, dry skin B. Blood pressure 188/120, nausea, vomiting C. Confusion, respiratory rate 8 breaths/min, dry skin D. Clammy skin, blood pressure 86/46, headache

D

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. Hyperkalemia B. Hypocalcemia C. Hypokalemia D. Hypercalcemia

D

The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? A. Cool and pale skin B. Crackles in the lung fields C. Distended jugular veins D. Dark, concentrated urine

D

The nurse is correct to state that a client's body needs to have adequate nutrition to maintain energy. Which type of transport of dissolved substances requires adenosine triphosphate (ATP)? A. Osmosis B. Passive diffusion C. Facilitated diffusion D. Active transport

D

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

D