Texarkana College: Custom Fluid & Electrolyte, Acid-Base Practice Test with NCLEX Next-Gen

A nurse is caring for a client who has hypernatremia and requires IV fluid therapy due to his NPO status. Which of the following solutions should the nurse prepare to infuse for this client?

0.45% sodium chloride Rationale: A client who has an elevated sodium level and is NPO requires a hypotonic IV solution, such as 0.45% sodium chloride or 0.225% sodium chloride.

A nurse is reviewing the medical records for four clients who have an acid-base imbalance. The nurse should recognize that which of the following clients is at risk for metabolic acidosis.

A client who has diarrhea Rationale: Diarrhea can cause metabolic acidosis due to the loss of bicarbonate.

A nurse is admitting a client who has type 1 diabetes mellitus. Check the 7 findings that require immediate attention.

Bicarbonate level Sodium level Blood pressure results Client self-monitoring of blood glucose IV access Glasgow coma scale ECG findings

A nurse is caring for a client who has a postoperative ileus and an NG tube that has drained 2,500 mL in the past 6 hr. Which of the following electrolyte imbalances should the nurse monitor the client for?

Decreased potassium level Rationale: Hypokalemia is an electrolyte imbalance in which the serum potassium level is less than 3.5 mEq/L. Hypokalemia may be the result of diuretic use, diarrhea, vomiting, and prolonged nasogastric suctioning.

A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication?

Drink a glass of water after taking the medication. Rationale: Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium carbonate may also be used as an antacid to relieve heartburn, acid indigestion, and stomach upset. The client should drink a full glass of water after taking an antacid to enhance its effectiveness.

A nurse is reviewing laboratory data on a client who is recovering from surgery. Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client is as risk for developing ______ due to _____.

Dysrhythmias :: Potassium Rationale: The client's potassium level is below the expected reference range, which places them at risk for dysrhythmias.

A nurse is caring for a client who has a urinary tract infection. Drag words from the choices below to fill in each blank in the following sentence. The client is at an increased risk for developing ____ and ____.

Fluid volume deficit :: hypokalemia Rationale: Furosemide, a loop diuretic, can result in potassium loss in the urine. The client also has diarrhea, which can result in potassium loss in the stool. Therefore, the client is at an increased risk for hypokalemia & fluid volume deficit.

A nurse is reviewing the laboratory test results from a client who has prerenal acute kidney injury (AKI). Which of the following electrolyte imbalances should the nurse expect?

Hyperkalemia Rationale: AKI is a loss of renal function that results in a failure to maintain homeostasis. Fluid and electrolyte balance, as well as acid-base balance, are disrupted. The nurse should expect the client to have hyperkalemia due to protein breakdown and the subsequent release of intracellular potassium in to the circulation. The kidneys' inability to filter and excrete potassium results in hyperkalemia.

A nurse is assessing a client who has respiratory acidosis. Which of the following findings should the nurse expect?

Lethargy Rationale: Manifestations of respiratory acidosis can include anxiety, confusion, and lethargy.

A nurse is caring for a client who has the following arterial blood gas results: HCO3 18 mEq, PaCO2 28 mm Hg and pH 7.30. The nurse recognizes the client is experiencing which of the following acid base imbalances?

Metabolic acidosis Rationale: A client experiencing metabolic acidosis would have a decreased pH, a decreased HCO3 and a decreased PaCO2.

A nurse is admitting a client who has influenza and is reporting numbness and tingling of the toes and fingers. The nurse should recognize the client is experiencing which of the following acid-base imbalances?

Metabolic alkalosis Rationale: A client who has influenza has experienced excessive vomiting leading to metabolic alkalosis. Manifestations include dizziness, Circumoral paresthesias, and numbness and tingling of the extremities.

A nurse is caring for a client who has nausea and is vomiting. The nurse should identify the client is at risk for which of the following acid-base imbalances?

Metabolic alkalosis Rationale: Clients who have nausea and vomiting are at risk for metabolic alkalosis due to loss of metabolic acid.

A nurse is assessing a preschooler who has a calcium level of 8.0 mg/dL. Which of the following findings should the nurse expect?

Muscle tremors Rationale: A serum calcium level of 8.0 mg/dL is below the expected reference range. A preschooler who has hypocalcemia is likely to have muscle tremors and cramps that can progress to tetany and convulsions.

A nurse is assessing a client who has a sodium level of 116 mEq/L. Which of the following findings should the nurse expect?

Nausea and vomiting Rationale: A sodium level of 116 mEq/L is a critical value indicating hyponatremia. Nausea and vomiting are expected findings for a client with this sodium level.

A nurse is reviewing the laboratory values of a client who has respiratory acidosis. Which of the following findings should the nurse expect?

PaCO2 50 mm Hg Rationale: This laboratory value is an expected finding for a client who has respiratory acidosis.

A nurse is reviewing the serum laboratory findings for a client who has hypertension and is prescribed hydrochlorothiazide. Which of the following findings should the nurse report to the provider?

Potassium 2.3 mEq/L Rationale: A serum potassium below 3 mEq/L is a critical laboratory value. The nurse should report this finding to the provider immediately and monitor the client for dysrhythmias.

A nurse is caring for a client who has severe right wrist pain. The nurse has completed the assessment of the client. Drag words from the choices below to fill in each blank in the following sentence. The client is at risk for developing ____ and ____.

Respiratory Acidosis :: Hypervolemia Rationale: An adverse reaction to morphine sulfate is respiratory depression. The client's respiratory rate has decreased from 20/min to 10/min and is now shallow. Respiratory acidosis occurs when there is impaired respiratory function, causing reduced oxygen and carbon dioxide exchange, which leads to carbon dioxide retention. The client is at risk for hypervolemia because of their history of congestive heart failure and the rate at which the IV solution is running.

A nurse is reviewing the arterial blood gas values for a client. The pH is 7.32, PaCO2 48 mm Hg and the HCO3 is 23 mEq/L. The nurse should recognize that these findings indicate of which of the following acid base balances?

Respiratory acidosis Rationale: A number of conditions can lead to respiratory acidosis, including COPD and pneumonia. In the presence of respiratory acidosis, the client's blood gas values meet the following criteria: a pH less than 7.35, a PaCO2 greater than greater 45 mg/Hg, and a HCO3 that is normal or slightly elevated (22 to 26 mEq/mL).

A nurse is caring for a client who has COPD. The nurse should identify the client is at risk for which of the following acid-base imbalances?

Respiratory acidosis Rationale: Clients who have COPD, atelectasis, pneumonia, or central nervous system depression, are at risk for respiratory acidosis due to an increased PCO2 from hypoventilation.

A client is admitted to the emergency room with a respiratory rate of 7/min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs? pH 7.22 PaCO2 68 mm Hg Base excess -2 PaO2 78 mm Hg Saturation 80% Bicarbonate 26 mEq/L

Respiratory acidosis Rationale: Respiratory acidosis occurs when there is retention of CO2 due to an impairment of respiratory function. It can be the result of respiratory depression, seen with anesthesia or opioid administration; inadequate chest expansion, due to a weakness of the respiratory muscles or constriction to the thorax; an obstruction of the airway, seen in aspiration, bronchoconstriction, or laryngeal edema; or from an inability of the lungs to adequately diffuse gases (O2 and CO2), resulting from conditions such as pneumonia, COPD, chest trauma, or pulmonary emboli. Arterial blood gases will reveal a pH that is lower than the normal reference range (7.35 - 7.45) and a CO2 level that is higher than the normal reference range (35 - 45 mm Hg).

A nurse is caring for a client who is postoperative and whose respirations are shallow and 9/min. Which of the following acid-based imbalances should the nurse identify the client as being at risk for developing initially?

Respiratory acidosis Rationale: Respiratory acidosis represents an increase in the acid component, carbon dioxide, due to inadequate excretion of it, and an increase in the hydrogen ion concentration (decreased pH) of the arterial blood. A major cause of this imbalance is hypoventilation from anesthetics or opioids.

A nurse is caring for a client whose arterial blood gas results show a pH of 7.3 and a PaCO2 of 50 mm Hg. The nurse should identify that the client is experiencing which of the following acid-base imbalances?

Respiratory acidosis Rationale: With uncompensated respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg.

A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload.

The client has a 5 lb weight gain since yesterday. Rationale: The nurse should identify that a gain of 2 lb per day is stable. A gain of more than 2 lb per day or 5 lb per week is an indication of fluid overload.

A nurse is caring for a client on the medical surgical unit. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Upon recognizing and analyzing the client cues of a low arterial PH and high arterial CO2, with a history of COPD a new-onset pneumonia, the nurse's priority hypotheses is that this client is most likely experiencing respiratory acidosis. It is important to generate solutions and take actions that will improve ventilation and treat the underlying cause of inadequate ventilation. Therefore, the nurse should anticipate administering IV antibiotics and request a prescription for a bronchodilator. To evaluate these interventions, the nurse should monitor the client's PaCO2 and the development of papilledema which can indicate a worsening in the client's condition. If respiratory acidosis is severe, intracranial pressure can increase resulting in papilledema.

A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see?

pH below 7.35 Rationale: With acidosis, the pH is below 7.35. However, the pH alone does not indicate whether the problem is metabolic or respiratory. A pH above 7.45 indicates alkalosis.