Prep U Chapter 13: Fluid and Electrolytes: Balance and Disturbance

What is a normal urine output per hour?

30 ml

Which condition might occur with respiratory acidosis? a. Increased intracranial pressure b. Decreased blood pressure c. Decreased pulse d. Mental alertness

a. Increased intracranial pressure

The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely? a. Magnesium b. Calcium c. Phosphorus d. Potassium

a. Magnesium

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. "I can use laxatives and enemas but only once a week."

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

a. "I will not salt my food; instead I'll use salt substitute."

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. metabolic alkalosis

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: a. muscle weakness. b. tremors. c. diaphoresis. d. constipation.

a. muscle weakness.

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. a. pH b. PaCO2 c. HCO3 d. Glucose e. Na+ f. K+

a. pH b. PaCO2 c. HCO3

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? a. <136 mOsm/kg b. 275-300 mOsm/kg c. >408 mOsm/kg d. 350-544 mOsm/kg

b. 275-300 mOsm/kg

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

b. Elevated hematocrit level

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. 158.0 lbs (71.7 kg)

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. A 52-year-old with diarrhea

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. Hypovolemia contains only low blood volume. c. In dehydration, only extracellular is depleted. d. Both conditions result in abnormal laboratory studies.

c. In dehydration, only extracellular is depleted.

Oncotic pressure refers to the a. number of dissolved particles contained in a unit of fluid. b. excretion of substances such as glucose through increased urine output. c. amount of pressure needed to stop the flow of water by osmosis. d. osmotic pressure exerted by proteins.

d. osmotic pressure exerted by proteins.

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 acidosis. d. respiratory alkalosis.

d. respiratory alkalosis.

A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status? a. vital signs b. edema c. intake and output d. weight

d. weight

What is the preferred route of administration for potassium?

oral

Which electrolyte is a major anion in body fluid?

chloride

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

b. Elevated blood pressure

The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance? a. Hypocalcemia b. Hyperchloremia c. Hypermagnesemia d. Hyponatremia

a. Hypocalcemia

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

a. Hypothalamus

A patient with abnormal sodium losses is receiving a regular diet. How can the nurse supplement the patient's diet to provide 1,600 mg of sodium daily? a. One beef cube and 8 oz of tomato juice b. Four beef cubes and 8 oz of tomato juice c. One beef cube and 16 oz of tomato juice d. One beef cube and 12 oz of tomato juice

a. One beef cube and 8 oz of tomato juice

Which is considered an isotonic solution? a. 0.9% normal saline b. Dextran in normal saline c. 0.45% normal saline d. 3% NaCl

a. 0.9% normal saline

What foods can the nurse recommend for the patient with hyperkalemia? a. Apples and berries b. Green, leafy vegetables c. Milk and yogurt d. Melons

a. Apples and berries

The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. a. Compare ABG findings with previous results. b. Maintain intake and output records. c. Document presenting signs and symptoms. d. Administer IV bicarbonate. e. Suction the client's airway.

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

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. Confusion

The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L) and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving? a. Discontinue the intravenous lactated Ringer solution. b. Increase the rate of the intravenous lactated Ringer solution. c. Change the lactated Ringer solution to 3% saline. d. Change the lactated Ringer solution to 2.5% dextrose.

a. Discontinue the intravenous lactated Ringer solution.

An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? a. Hyperkalemia b. Hypokalemia c. Hypernatremia d. Hypophosphatemia

b. Hypokalemia

A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance? a. Presence of Trousseau sign b. Slurred speech c. Negative Chvostek sign d. Muscle weakness

a. Presence of Trousseau sign

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. Serum bicarbonate of 28 mEq/L

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. Serum sodium level of 124 mEq/L

Which of the following is a factor affecting an increase in urine osmolality? a. Syndrome of inappropriate antidiuretic hormone release (SIADH) b. Alkalosis c. Fluid volume excess d. Myocardial infarction

a. Syndrome of inappropriate antidiuretic hormone release (SIADH)

A client with emphysema is at a greater risk for developing which acid-base imbalance? a. chronic respiratory acidosis b. metabolic alkalosis c. metabolic acidosis d. respiratory alkalosis

a. chronic respiratory acidosis

A nurse evaluates a client's laboratory results. What is a factor that may be affecting an increase in serum osmolality? a. free water loss b. diuretic use c. overhydration d. hyponatremia

a. free water loss

A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypertension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypercalcemia

a. hypokalemia

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. Instruct the client to breathe into a paper bag.

Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? a. Tetanic contractions b. Jugular vein distention c. Weight loss d. Polyuria

b. Jugular vein distention

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. Lactated Ringer's solution

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. Metabolic alkalosis

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

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

A client with excess fluid volume and hyponatremia is in a comatose state. What are the nursing considerations concerning fluid replacement? a. Restrict fluids and salt for 24 hours. b. Correct the sodium deficit rapidly with salt. c. Administer small volumes of a hypertonic solution. d. Monitor the serum sodium for changes hourly.

c. Administer small volumes of a hypertonic solution.

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. Calcium

The nurse is caring for a client being treated with isotonic IV fluid for hypernatremia. What complication of hypernatremia should the nurse continuously monitor for? a. Red blood cell crenation b. Red blood cell hydrolysis c. Cerebral edema d. Renal failure

c. Cerebral edema

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. Metabolic acidosis

A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators? a. Sodium level of 137 mEq/L b. Potassium level of 3.8 mEq/L c. Sodium level of 150 mEq/L d. Potassium level of 6 mEq/L

c. Sodium level of 150 mEq/L

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 the health care provider 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 insurance office.

c. The client had a liver transplant 2 years ago.

A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client? a. 110 mEq/L b. 130 mEq/L c. 145 mEq/L d. 165 mEq/L

d. 165 mEq/L

A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of: a. 210 mOsm/kg. b. 230 mOsm/kg. c. 250 mOsm/kg. d. 280 mOsm/kg.

d. 280 mOsm/kg.

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. Hypercalcemia

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. Light-headedness or paresthesia

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

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. No, sodium intake should be restricted.

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? a. CO2 b. Sodium c. Chloride d. Potassium

d. Potassium

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

d. Pulse

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. Respiratory alkalosis

A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? a. Blood urea nitrogen (BUN) level of 29 mg/dl b. Serum sodium level of 132 mEq/L c. Urine specific gravity of 1.025 d. Serum potassium level of 3 mEq/L

d. Serum potassium level of 3 mEq/L

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? a. The lungs are unable to breathe in sufficient oxygen. b. The lungs are unable to exchange oxygen and carbon dioxide. c. The lungs have ineffective cilia from years of smoking. d. The lungs are not able to blow off carbon dioxide.

d. The lungs are not able to blow off carbon dioxide.

A client with hypervolemia asks the nurse by what mechanism the sodium-potassium pump will move the excess body fluid. What is the nurse's best answer? a. passive osmosis b. free flow c. passive elimination d. active transport

d. active transport

Which nerve is implicated in the Chvostek's sign?

facial