Prep U questions Chapter 40: Fluid, Electrolyte, and Acid-Base Balance

A client is admitted to the unit with a diagnosis of intractable vomiting for 3 days. What acid-base imbalance related to the loss of stomach acid does the nurse observe on the arterial blood gas (ABG)? A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory alkalosis D. Respiratory acidosis

A.

A client who is admitted to the health care facility has been diagnosed with cerebral edema. Which intravenous solution needs to be administered to this client? A. hypertonic solution B. colloid solution C. hypotonic solution D. isotonic solution

A.

A home care nurse is visiting a client with renal failure who is on fluid restriction. The client tells the nurse, "I get thirsty very often. What might help?" What would the nurse include as a suggestion for this client? A. Avoid salty or excessively sweet fluids. B. Use an alcohol-based mouthwash to moisten your mouth. C. Use regular gum and hard candy. D. Eat crackers and bread.

A.

A nurse is changing a client's peripheral venous access dressing. The nurse finds that the site is bleeding and oozing. Which type of dressing should the nurse use for this client? A. Gauze dressing B. Occlusive dressing C. Transparent semipermeable membrane dressing D. Sealed IV dressing

A.

A nurse needs to select a venipuncture site to administer a prescribed amount of IV fluid to a client. The nurse looks for a large vein when using a needle with a large gauge. What explains the nurse's action? A. to prevent compromising circulation B. to prevent pain and discomfort C. to avoid restriction of mobility D. to reduce the potential for blood clots

A.

A nurse who has diagnosed a client as having "fluid volume excess" related to compromised regulatory mechanism (kidneys) may have been alerted by what symptom? A. distended neck veins B. nausea and vomiting C. fingerprinting over sternum D. muscle twitching

A.

A young man has developed gastric esophageal reflux disease. He is treating it with antacids. Which acid-base imbalance is he at risk for developing? A. Metabolic alkalosis B. Respiratory alkalosis C. Metabolic acidosis D. Respiratory acidosis

A.

A client who recently had surgery is bleeding. What blood product does the nurse anticipate administering for this client? A. cryoprecipitate B. platelets C. granulocytes D. albumin

B.

A client with protracted nausea and vomiting has been receiving intravenous solution at 125 ml/h for the past several hours. The administration of this solution has resulted in an increase in blood pressure because the water in the solution has passed through the semipermeable membrane of blood cells, causing them to swell. What type of solution has the client been receiving? A. An isotonic solution B. A hypotonic solution C. A hypertonic solution D. Packed red blood cells

B.

A nurse assessing the IV site of a client observes swelling and pallor around the site and notes a significant decrease in the flow rate. The client complains of coldness around the infusion site. What is the nurse's most appropriate action? A. Attempt to aspirate. B. Discontinue the IV. C. Flush with 3-mL normal saline. D. Slow the rate of infusion by 50%.

B.

After surgery, a client is on IV therapy for the next 4 days. How often should the nurse change the IV tubing for this client? A. every 12 hours B. every 72 hours C. every 36 hours D. every 24 hours

B.

The nurse is caring for a client who had a parathyroidectomy. Upon evaluation of the client's laboratory studies, the nurse would expect to see imbalances in which electrolytes related to the removal of the parathyroid gland? A. chloride and magnesium B. calcium and phosphorus C. potassium and sodium D. potassium and chloride

B.

The nurse is preparing to administer fluid replacement to a client. Which action related to intravenous therapy does the nurse identify as out of scope nursing practice? A. preparing solution for administration B. ordering type of solution, additive, amount of infusion, and duration C. performing venipuncture D. regulating the rate of administration

B.

A client is taking a diuretic such as furosemide. When implementing client education, what information should be included? A. Increased potassium levels B. Increased sodium levels C. Decreased potassium levels D. Decreased oxygen levels

C.

Upon assessment of a client's peripheral intravenous site, the nurse notices the area is red and warm. The client complains of pain when the nurse gently palpates the area. These signs and symptoms are indicative of: A. an infiltration. B. rapid fluid administration. C. phlebitis. D. a systemic blood infection.

C.

The nurse is monitoring fluid intake and output (I&O) for a client who has diarrhea. What will the nurse document as input on the record? Select all that apply. A. bowl of chili B. barbecue sandwich C. infusion of intravenous solution D. serving of jello E. cup of ice cream F.100 ml from melted ice chips

C. D. E. F.

A client sustained severe trauma in a motor vehicle accident and has had 26 units of packed red blood cells infused since admission 2 days previously. What does the nurse predict will be prescribed to replace the clotting factors lost with the infusion of large amounts of packed red blood cells? A. albumin B. normal saline solution C. granulocytes D. plasma

D.

A nurse is calculating the output of a client with renal failure and takes into account all modes of fluid loss. When addressing the client's insensible fluid loss via respiration, which amount would the nurse anticipate as the usual average? A. 1500 mL/day B. 100 to 200 mL/day C. 200 mL/day D. 300 mL/day

D.

Which is a common anion? A. magnesium B. potassium C. calcium D. chloride

D.

Which is a common anion? A. potassium B. magnesium C. calcium D. chloride

D.

A nurse is administering a blood transfusion to a client. After 15 minutes, the client reports difficulty breathing. What is the first action by the nurse? A. Stop the transfusion and infuse normal saline using a new administration set. B. Notify the health care provider of the client's response. C. Check the client's vital signs. D. Stop the transfusion and infuse normal saline using the blood tubing.

A.

An older adult has fluid volume deficit and needs to consume more fluids. Which approach by the nurse demonstrates gerontologic considerations? A. Offer small amounts of preferred beverage frequently. B. Have a loved one tell the client to drink more. C. Ask the client every hour to drink more fluid. D. Leave water on the bedside table.

A.

The nurse is administering 1,000 mL 0.9 normal saline over 10 hours (set delivers 60 gtt/1 mL). Using the formula below, the flow rate would be: gtt/min = milliliters per hour x drop factor (gtt/mL) ÷ 60 min/hr A. 100 gtt/min B. 60 gtt/min C. 160 gtt/min D. 600 gtt/min

A.

The nurse is caring for a client whose blood type is A negative. Which donor blood type does the nurse confirm as compatible for this client? A. O negative B. AB negative C. A positive D. B positive

A.

The nursing instructor is quizzing a group of students about fluid and electrolyte balance. Which statements made by the students indicate an understanding of the efforts of the organs to maintain fluid and electrolyte balance? Select all that apply. A. "The kidneys regulate pH of extracellular fluid by excreting and retaining hydrogen ions." B. "The nervous system regulates oral intake by sensing intracellular dehydration, which in turn stimulates thirst." C. "The adrenal glands regulate blood volume by secreting aldosterone." D. "The kidneys react to hypovolemia by stimulating fluid retention." E. "The kidneys regulate extracellular fluid volume by retention and excretion of body fluids."

A. B. C. E.

Which nursing interventions would be appropriate for a client diagnosed with deficient fluid volume? Select all that apply. A. Nutrition management B. Electrolyte management C. Hypervolemia management D. Monitoring edema E. Fluid restriction F. Intravenous therapy

A. B. F.

A nurse is providing care to a client who has been vomiting for the past 2 days. The nurse would assess this client for which imbalance? Select all that apply. A. Hypokalemia B. Hypercalcemia C. Respiratory acidosis D. Metabolic alkalosis E. Hypernatremia

A. D.

Mr. Jones is admitted to the nursing unit from the emergency department with a diagnosis of hypokalemia. His laboratory results show a serum potassium of 3.2 mEq/L (3.2 mmol/L). For what manifestations should the nurse be alert? A. Nausea, vomiting, and constipation B. Muscle weakness, fatigue, and dysrhythmias C. Muscle weakness, fatigue, and constipation D. Diminished cognitive ability and hypertension

B.

The nurse is assuming care for a client who is receiving an infusion of packed red blood cells (PRBCs). The PRBCs were hung 4 hours ago, and 100 mL is left to infuse. Which action is most appropriate? A. Insert a larger gauge IV catheter and transfer the infusion to the new insertion site. B. Discontinue the infusion and record the volume left in the blood bag. C. Fully open the roller clamp on the infusion set and infuse the remaining PRBCs as rapidly as possible. D. Continue to infuse the PRBCs until they are completely infused.

B.

The nurse is caring for a client who will be undergoing surgery in several weeks. The client states, "I would like to give my own blood to be used in case I need it during surgery." What is the appropriate nursing response? A. "Unfortunately, your own blood cannot be reinfused during surgery." B. "Let me refer you to the blood bank so they can provide you with information." C. "We now have artificial blood products, so giving your own blood is not necessary." D. "This surgery has a very low chance of hemorrhage, so you will not need blood." SUBMIT ANSWER

B.

The oncoming nurse is assigned to the following clients. Which client should the nurse assess first? A. a 20-year-old, 2 days postoperative open appendectomy who refuses to ambulate today B. a newly admitted 88-year-old with a 2-day history of vomiting and loose stools C. a 47-year-old who had a colon resection yesterday and is reporting pain D. a 60-year-old who is 3 days post-myocardial infarction and has been stable.

B.

When caring for a client who is on intravenous therapy, the nurse observes that the client has developed redness, warmth, and discomfort along the vein. Which intervention should the nurse perform for this complication? A. Apply antiseptic and a dressing. B. Restart infusion in another vein and apply a warm compress. C. Position the client on the left side. D. Elevate the client's head.

B.

When providing chemotherapeutic agents, which catheter is accessed with a non-coring needle? A. Groshong catheter B. Implanted venous access catheter C. Hickman catheter D. Peripheral central catheter

B.

Which client would be a candidate for total parenteral nutrition? A. a client with diabetic ketoacidosis B. a client with colitis and bloody diarrhea C. a client receiving intravenous antibiotics D. a postoperative appendectomy client

B.

The nurse has just successfully inserted an intravenous (IV) catheter and initiated IV fluids. Which items should the nurse document? Select all that apply. A. Manufacturer of the IV catheter B. Gauge and length of the IV catheter C. Rate of the IV solution D. Client's reaction to the procedure E. Type of IV solution F. Location of the IV catheter access

B. C. D. E. F.

A nurse is caring for a client who requires intravenous (IV) therapy. The nurse understands that which actions are the nurse's responsibilities related to this therapy? Select all that apply. A. Determining the amount of IV solution. B. Administering the IV solution. C. Deciding the location of the IV catheter. D. Prescribing the kind of IV solution. E. Deciding the size of the IV catheter.

B. C. E.

A client age 80 years, who takes diuretics for management of hypertension, informs the nurse that she takes laxatives daily to promote bowel movements. The nurse assesses the client for possible symptoms of: A. hypothyroidism. B. hypocalcemia. C. hypokalemia. D. hypoglycemia.

C.

A client who is NPO prior to surgery reports feeling thirsty. What is the physiologic process that drives the thirst factor? A. decreased blood volume and extracellular overhydration B. increased blood volume and extracellular overhydration C. decreased blood volume and intracellular dehydration D. increased blood volume and intracellular dehydration

C.

A nurse inspecting the IV site of a client notices signs of phlebitis (inflammation). What would be the appropriate nursing intervention for this situation? A. Call the physician and ask if anti-inflammatory drugs should be administered. B. Cleanse the site with alcohol and apply transparent polyurethane dressing over the entry site. C. Discontinue the IV and relocate it to another spot. D. Cleanse the site with chlorhexidine solution using a circular motion and continue to monitor the site every 15 minutes for 6 hours before removing the IV.

C.

A nurse is assessing clients across the lifespan for fluid and electrolyte balance. Which age group would the nurse identify as having the greatest risk for these imbalances? A. School-age children B. Adolescents C. Infants D. Toddlers

C.

A nurse is caring for four different pediatric clients, all of whom require insertion of an intravenous (IV) catheter. For which client would it be appropriate to insert the IV into the foot? A. Toddler B. Preschool-aged child C. Infant D. School-aged child

C.

A nurse is reviewing the client's serum electrolyte levels which are as follows:Sodium: 138 mEq/L (138 mmol/L)Potassium: 3.2 mEq/L (3.2 mmol/L)Calcium: 10.0 mg/dL (2.5 mmol/L)Magnesium: 2.0 mEq/L (1.0 mmol/L)Chloride: 100 mEq/L (100 mmol/L)Phosphate: 4.5 mg/dL (2.6 mEq/L)Based on these levels, the nurse would identify which imbalance? A. hyponatremia B. hypokalemia C. hypercalcemia D. hypermagnesemia

C.

A nursing student is teaching a healthy adult client about adequate hydration. Which statement by the client indicates understanding of adequate hydration? A. "I should drink 1,500 mL/day of fluid." B. "I need to drink no more than 1,000 mL/day" C. "I should drink 2,500 mL/day of fluid." D. "I should drink more than 3,500 mL/day of fluid."

C.

A physician has asked the nurse to use microdrip tubing to administer a prescribed dosage of IV solution to a client. What is the standard drop factor of microdrip tubing? A. 30 drops/mL B. 120 drops/mL C. 60 drops/mL D. 90 drops/mL

C.

A physician orders an infusion of 250 mL of NS in 100 minutes. The set is 20 gtt/ml What is the flow rate? A. 40 gtt/min B. 20 gtt/min C. 50 gtt/min D. 30 gtt/min

C.

A registered nurse is overseeing the care of numerous clients on a busy acute medicine unit. Which task would be most safe to delegate to a licensed practical nurse (LPN)? A. Removing a client's PICC in anticipation of the client's discharge B. Initiating a client's transfusion of packed red blood cells C. Changing the dressing on a client's peripheral IV site D. Deaccessing a client's implanted port

C.

A woman aged 58 years is suffering from food poisoning after eating at a local restaurant. She has had nausea, vomiting, and diarrhea for the past 12 hours. Her blood pressure is 88/50 and she is diaphoretic. She requires: A. an access route to replace fluids in combination with blood products. B. an access route to administer medications intravenously. C. replacement of fluids for those lost from vomiting and diarrhea. D. intravenous fluids to be administered on an outpatient basis.

C.

Arterial blood gases reveal that a client's pH is 7.20. What physiologic process will contribute to a restoration of correct acid-base balance? A. hypoventilation B. increased excretion of bicarbonate ions by the kidneys C. increased respiratory rate D. renal retention of H ions

C.

Endurance athletes who exercise for long periods of time and consume only water may experience a sodium deficit in their extracellular fluid. This electrolyte imbalance is known as: A. hypernatremia. B. hyperkalemia. C. hyponatremia. D. hypokalemia.

C.

The nurse is caring for a client who will be undergoing surgery in several weeks. The client states, "I would like to give my own blood to be used in case I need it during surgery." What is the appropriate nursing response? A. "Unfortunately, your own blood cannot be reinfused during surgery." B. "We now have artificial blood products, so giving your own blood is not necessary." C. "Let me refer you to the blood bank so they can provide you with information." D. "This surgery has a very low chance of hemorrhage, so you will not need blood."

C.

The nurse is caring for a client whose blood type is B negative. Which donor blood type does the nurse confirm as compatible for this client? A. AB negative B. A positive C. O negative D. B positive

C.

The primary extracellular electrolytes are: A. potassium, phosphate, and sulfate. B. phosphorous, calcium, and phosphate. C. sodium, chloride, and bicarbonate. D. magnesium, sulfate, and carbon.

C.

Which statement most accurately describes the process of osmosis? A. Plasma proteins facilitate the reabsorption of fluids into the capillaries. B. Water shifts from high-solute areas to areas of lower solute concentration. C. Water moves from an area of lower solute concentration to an area of higher solute concentration. D. Solutes pass through semipermeable membranes to areas of lower concentration.

C.

A nurse who has diagnosed a client as having "fluid volume excess" related to compromised regulatory mechanism (kidneys) may have been alerted by what symptom? A. nausea and vomiting B. fingerprinting over sternum C. muscle twitching D. distended neck veins

D.

As observed the nurse changing a peripheral venous access site dressing is demonstrating inappropriate technique by implementing which action? A. By applying stabilizing pressure to the catheter B. Not performing the intervention under sterile conditions C. By pulling the dressing toward the insertion site D. Not wearing gloves when performing the intervention

D.

Mr. Jones is admitted to the nurse's unit from the emergency department with a diagnosis of hypocalcemia. His laboratory results show a serum calcium level of 8.2 mg/dL (2.05 mmol/L). For what assessment findings will the nurse be looking? A. muscle weakness, fatigue, and constipation B. nausea, vomiting, and constipation C. diminished cognitive ability and hypertension D. muscle cramping and tetany

D.

The nurse is assessing a client's intravenous line and notes small air bubbles within the tubing. What is the priority nursing action? A. Twist the tubing around a pencil. B. Tap the tubing below the air bubbles. C. Milk the air in the direction of the drip chamber. D. Tighten the roller clamp to stop the infusion.

D.

The nurse is assessing for the presence of edema in a client who is confined to bed and who often lies supine. The nurse would pay particular attention to which area? A. Face B. Hands C. Abdomen D. Sacral area

D.

The nurse is teaching a healthy adult client about adequate hydration. How much average daily intake does the nurse recommend? A. 3,500 mL/day B. 1,500 mL/day C. 1,000 mL/day D. 2,500 mL/day

D.

The nurse working at the blood bank is speaking with a potential blood donor client. The client has been living in South America where there was a Zika outbreak. Which statement by the nurse is most appropriate? A. "To prevent the spread of microorganisms, anyone who has lived out of the country for over 6 months is unable to donate blood." B. "While living in South America, you may have been exposed to a lot of different diseases, which makes you ineligible to donate blood." C. "As long as you did not receive any blood transfusions while living in South America, you may donate blood." D. "Because you lived in South America for more than 3 months, there is risk of transmitting the Zika virus through blood transfusions."

D.