Chapter 41: Fluid, Electrolyte, and Acid-Base Balance

Which IV solutions would the nurse expect to be ordered for a client who has hypovolemia? Select all that apply. - 5% dextrose in 0.9% NaCl - 0.45% NaCl (½-strength normal saline) - 5% dextrose in water (D5W) - 10% dextrose in water (D10W) - Lactated Ringer's solution - 0.9% NaCl (normal saline)

- 5% dextrose in 0.9% NaCl - Lactated Ringer's solution - 0.9% NaCl (normal saline)

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. - Deciding the location of the IV catheter - Administering the IV solution - Prescribing the kind of IV solution - Deciding the size of the IV catheter - Determining the amount of IV solution

- Deciding the location of the IV catheter - Administering the IV solution - Deciding the size of the IV catheter

What signs of complications and their probable causes may occur when administering an IV solution to a client? Select all that apply. - A pounding headache, fainting, rapid pulse rate, increased blood pressure, chills, back pains, and dyspnea occur when an air embolus is present - Bleeding at the site when the IV is discontinued indicates an infection is present - Engorged neck veins, increased blood pressure, and dyspnea occur when a thrombus is present - Local or systemic manifestations may indicate an infection is present at the site - Swelling, pain, coolness, or pallor at the insertion site may indicate infiltration of the IV - Redness, swelling, heat, and pain at the site may indicate phlebitis

- Local or systemic manifestations may indicate an infection is present at the site - Swelling, pain, coolness, or pallor at the insertion site may indicate infiltration of the IV - Redness, swelling, heat, and pain at the site may indicate phlebitis

The primary extracellular electrolytes include which of the following?

Sodium, chloride, and bicarbonate

A client admitted to the facility is diagnosed with metabolic alkalosis based on arterial blood gas values. When obtaining the client's history, which statement would the nurse interpret as a possible underlying cause? a) "I've been taking antacids almost every 2 hours over the past several days." b) "I've had a fever for the past 3 days that just doesn't seem to go away." c) "I was breathing so fast because I was so anxious and in so much pain." d) "I've had a GI virus for the past 3 days with severe diarrhea."

a) "I've been taking antacids almost every 2 hours over the past several days."

A health care provider 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) 60 drops/mL b) 30 drops/mL c) 120 drops/mL d) 90 drops/mL

a) 60 drops/mL

The nurse is calculating an infusion rate for the following order: Infuse 1,000 mL of 0.9% NaCl over 12 hours using an electronic infusion device. What is the infusion rate? a) 83 mL/hr b) 13 mL/hr c) 103 gtts/hr d) 100 mL/hr

a) 83 mL/hr

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) A hypotonic solution b) A hypertonic solution c) Packed red blood cells d) An isotonic solution

a) A hypotonic solution

Edema happens when there is which fluid volume imbalance? a) Extracellular fluid volume excess b) Water excess c) Water deficit d) Extracellular fluid volume deficit

a) Extracellular fluid volume excess

During a blood transfusion, a client displays signs of immediate onset facial flushing, hypotension, tachycardia, and chills. Which transfusion reaction should the nurse suspect? a) Hemolytic transfusion reaction: incompatibility of blood product b) Bacterial reaction: bacteria present in the blood c) Allergic reaction: allergy to transfused blood d) Febrile reaction: fever develops during infusion

a) Hemolytic transfusion reaction: incompatibility of blood product

The nurse is caring for a client who has had partial removal of the parathyroid gland. The client reports numbness and tingling of the hands and fingers as well as showing signs of tetany. Which imbalance does the nurse suspect? a) Hypocalcemia b) Hypokalemia c) Hypophosphatemia d) Hypermagnesemia

a) Hypocalcemia

A client is admitted to the facility after experiencing uncontrolled diarrhea for the past several days. The client is exhibiting signs of a fluid volume deficit. When reviewing the client's laboratory test results, which electrolyte imbalance would the nurse likely to find? a) Hypokalemia b) Hyperphosphatemia c) Hypomagnesemia d) Hyperchloremia

a) Hypokalemia

A client is admitted to the facility after experiencing uncontrolled diarrhea for the past several days. The client is exhibiting signs of a fluid volume deficit. When reviewing the client's laboratory test results, which electrolyte imbalance would the nurse likely to find? a) Hypokalemia b) Hyperphosphatemia c) Hyperchloremia d) Hypomagnesemia

a) Hypokalemia

A nurse is preparing an education plan for a client with heart failure who is experiencing edema. As part of the plan, the nurse wants to describe the underlying mechanism for why the edema develops. Which mechanism will nurse likely address? a) Increased hydrostatic pressure b) Decreased colloid oncotic pressure c) Blockage of the lymph nodes d) Increased capillary permeability

a) Increased hydrostatic pressure

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) Respiratory acidosis c) Respiratory alkalosis d) Metabolic acidosis

a) Metabolic alkalosis

An adult client has developed gastric esophageal reflux disease and is treating it with frequent doses of antacids. The nurse will assess for what acid-base disorder? a) Metabolic alkalosis b) Respiratory acidosis c) Respiratory alkalosis d) Metabolic acidosis

a) Metabolic alkalosis

A client's blood pressure has dropped from 146/92 mmHg to 107/68 mmHg over the course of several minutes. Increased levels of which of the following will be released into the client's bloodstream? a) Renin b) Insulin c) Erythropoietin d) Protein

a) Renin

An intravenous hypertonic solution containing dextrose, proteins, vitamins, and minerals is known as: a) Total parenteral nutrition b) Blood transfusion therapy c) Cellular hydration d) Volume expander

a) Total parenteral nutrition

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) "As long as you did not receive any blood transfusions while living in South America, you may donate blood." b) "Because you lived in South America for more than 3 months, there is risk of transmitting the Zika virus through blood transfusions." c) "While living in South America, you may have been exposed to a lot of different diseases, which makes you ineligible to donate blood." d) "To prevent the spread of microorganisms, anyone who has lived out of the country for over 6 months is unable to donate blood."

b) "Because you lived in South America for more than 3 months, there is risk of transmitting the Zika virus through blood transfusions."

The student nurse asks, "What is interstitial fluid?" What is the appropriate nursing response? a) "Fluid outside cells." b) "Fluid in the tissue space between and around cells." c) "Watery plasma, or serum, portion of blood." d) "Fluid inside cells."

b) "Fluid in the tissue space between and around cells."

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) "We now have artificial blood products, so giving your own blood is not necessary." b) "Let me refer you to the blood bank so they can provide you with information." c) "This surgery has a very low chance of hemorrhage, so you will not need blood." d) "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."

What is the lab test commonly used in the assessment and treatment of acid-base balance? a) Basic metabolic panel b) Arterial blood gas c) Urinalysis d) Complete blood count

b) Arterial blood gas

A client's most recent blood work indicates a K+ level of 7.2 mEq/L (7.2 mmol/L), a finding that constitutes hyperkalemia. For what signs and symptoms should the nurse vigilantly monitor? a) Muscle weakness b) Cardiac irregularities c) Increased intracranial pressure (ICP) d) Metabolic acidosis

b) Cardiac irregularities

A nurse is obtaining an arterial blood specimen from a client to assess acid-base status. Which value is expected for a client with normal status? a) SaO2: 89% b) HCO3: 25 mEq/L (25 mmol/L) c) PaCO2: 48 mm Hg (6.38 kPa) d) pH: 6.45

b) HCO3: 25 mEq/L (25 mmol/L)

An older adult client who takes diuretics for management of hypertension, informs the nurse that they take laxatives daily to promote bowel movements. The nurse assesses the client for possible symptoms of what health problem? a) Hypoglycemia b) Hypokalemia c) Hypothyroidism d) Hypocalcemia

b) Hypokalemia

A client is admitted to the nursing unit from the emergency department with a diagnosis of hypokalemia. Laboratory results show a serum potassium of 3.2 mEq/l (3.2 mmol/l). For what set of manifestations should the nurse be alert? a) Nausea, vomiting, and constipation b) Muscle weakness, fatigue, and arrythmias c) Diminished cognitive ability and hypertension d) Muscle weakness, fatigue, and constipation

b) Muscle weakness, fatigue, and arrythmias

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) AB negative b) O negative c) A positive d) B positive

b) O negative

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) O negative c) A positive d) B positive

b) O negative

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) Phlebitis c) Rapid fluid administration d) A systemic blood infection

b) Phlebitis

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) Plasma c) Granulocytes d) Normal saline solution

b) Plasma

The nurse is preparing to administer fluid replacement to a client. Which action should the nurse take first? a) Calculate the number of drops per minute b) Verify the prescription for type of solution and amount of infusion c) Regulate the rate of administration d) Check for the availability of an IV pump

b) Verify the prescription for type of solution and amount of infusion

What commonly used intravenous solution is hypotonic? a) Lactated Ringer's b) 0.9% NaCl c) 0.45% NaCl d) 10% dextrose in water

c) 0.45% NaCl

A client has been diagnosed with a gastrointestinal bleed and the health care provider has ordered a transfusion. At what rate should the nurse administer the client's packed red blood cells? a) As fast as the client can tolerate b) 200 mL/hr c) 1 unit over 2 to 3 hours, no longer than 4 hours d) 75 mL/hr for the first 15 minutes, then 200 mL/hr

c) 1 unit over 2 to 3 hours, no longer than 4 hours

A client with a diagnosis of colon cancer has opted for a treatment plan that will include several rounds of chemotherapy. What vascular access device is most likely to meet this client's needs? a) A peripheral venous catheter inserted to the cephalic vein b) A peripheral venous catheter inserted to the antecubital fossa c) An implanted central venous access device (CVAD) d) A midline peripheral catheter

c) An implanted central venous access device (CVAD)

A nurse is reviewing the dietary intake of a client prescribed a potassium-sparing diuretic. The client tells the nurse that they had a banana, yogurt, and bran cereal for breakfast and a turkey sandwich with a glass of milk for lunch. The intake of which food would be a cause for concern? a) Milk b) Yogurt c) Banana d) Turkey

c) Banana

Which is a common anion? a) Calcium b) Potassium c) Chloride d) Magnesium

c) Chloride

A client who is NPO prior to surgery reports feeling thirsty. What is the physiologic process that drives the thirst factor? a) Increased blood volume and intracellular dehydration b) Decreased blood volume and extracellular overhydration c) Decreased blood volume and intracellular dehydration d) Increased blood volume and extracellular overhydration

c) Decreased blood volume and intracellular dehydration

A nurse is inspecting the IV site of a client and notices that the site is swollen, red, warm to the touch, and painful. Which action by the nurse is appropriate? a) Call the health care provider and ask if anti-inflammatory drugs should be administered b) Cleanse the site with chlorhexidine solution using a circular motion and continue to monitor the site every 15 minutes for 6 hours c) Discontinue the IV and relocate it to another spot d) Cleanse the site with alcohol and apply transparent polyurethane dressing over the entry site.

c) Discontinue the IV and relocate it to another spot

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) Hypermagnesemia c) Hypokalemia d) Hypercalcemia

c) Hypokalemia

A client is diagnosed with metabolic acidosis. The nurse develops a plan of care for this client based on the understanding that the body compensates for this condition by: a) Preventing excretion of acids into the urine b) Increasing the excretion of HCO3− into the urine c) Increasing ventilation through the lungs d) Decreasing the excretion of H+ ion into the urine

c) Increasing ventilation through the lungs

A client who recently had surgery is bleeding. What blood product does the nurse anticipate administering for this client? a) Granulocytes b) Cryoprecipitate c) Platelets d) Albumin

c) Platelets

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) Position the client on the left side b) Elevate the client's head c) Restart infusion in another vein and apply a warm compress d) Apply antiseptic and a dressing.

c) Restart infusion in another vein and apply a warm compress

During a blood transfusion of a client, the nurse observes the appearance of rash and flushing in the client, although the vital signs are stable. Which intervention should the nurse perform for this client first? a) Administer oxygen b) Prepare to give an antihistamine. c) Stop the transfusion immediately d) Infuse saline at a rapid rate

c) Stop the transfusion immediately

The nurse is caring for a client with metabolic alkalosis whose breathing rate is 8 breaths/min. Which arterial blood gas data does the nurse anticipate finding? a) pH: 7.32; PaCO2: 28 mm Hg (3.72kPa); HCO3: 24 mEq/l (24 mmol/l) b) pH: 7.32; PaCO2: 26 mm Hg (3.46 kPa); HCO3: 18 mEq/l (18 mmol/l) c) pH: 7.60; PaCO2: 64 mm Hg (8.51 kPa); HCO3: 42 mEq/l (42 mmol/l) d) pH: 7.28; PaCO2: 52 mm Hg (6.92 kPa); HCO3: 32 mEq/l (32 mmol/l)

c) pH: 7.60; PaCO2: 64 mm Hg (8.51 kPa); HCO3: 42 mEq/l (42 mmol/l)

A health care provider orders an infusion of 250 mL of NS in 100 minutes. The set is 20 gtt/ml What is the flow rate? a) 30 gtt/min b) 40 gtt/min c) 20 gtt/min d) 50 gtt/min

d) 50 gtt/min

A health care provider orders a bolus infusion of 250 mL of normal saline to run over 1 hour. The set delivers 20 gtt/mL. What is the flow rate in gtt/min? a) 5,000 gtt/min b) 167 gtt/min c) 42 gtt/min d) 83 gtt/min

d) 83 gtt/min

Which client is at a greater risk for fluid volume deficit related to the loss of total body fluid and extracellular fluid? a) A woman age 45 years b) A man age 50 years c) An adolescent age 17 years d) An infant age 4 months

d) An infant age 4 months

The nurse is planning to discontinue a peripherally inserted central catheter (PICC) for a client who is prescribed warfarin therapy. Which intervention will individualize care for this client? a) Apply petroleum-based ointment and sterile occlusive dressing b) Ask client to perform Valsalva maneuver c) Instruct client to remain flat for 30 minutes d) Apply pressure to insertion site for at least 3 minutes

d) Apply pressure to insertion site for at least 3 minutes

The nurse is providing care for several clients on a busy floor. The nurse receives a prescription to administer a transfusion of packed red blood cells for a client with decreased hemoglobin. Which action should the nurse take before entering the client's room to begin the transfusion? a) Prime the blood administration set with dextrose 5% normal saline solution b) Verify the client's name and date of birth with another nurse c) Review the client's most recent vital signs d) Arrange for another nurse to monitor the nurse's other assigned clients

d) Arrange for another nurse to monitor the nurse's other assigned clients

A home care nurse is visiting a client with acute kidney injury 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) Use regular gum and hard candy b) Use an alcohol-based mouthwash to moisten your mouth c) Eat crackers and bread d) Avoid salty or excessively sweet fluids

d) Avoid salty or excessively sweet fluids.

A nurse inspecting a client's IV site notices redness and swelling at the site. What would be the most appropriate nursing intervention for this situation? a) Stop the infusion, cleanse the site with alcohol, and apply transparent polyurethane dressing over the entry site b) Call the primary care provider to see whether anti-inflammatory drugs should be administered c) 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 d) Discontinue the IV and relocate it to another site.

d) Discontinue the IV and relocate it to another site.

When providing chemotherapeutic agents, which catheter is accessed with a non-coring needle? a) Groshong catheter b) Peripheral central catheter c) Hickman catheter d) Implanted venous access catheter

d) Implanted venous access catheter

The nurse is administering intravenous (IV) therapy to a client. The nurse notices acute tenderness, redness, warmth, and slight edema of the vein above the insertion site. Which complication related to IV therapy should the nurse most suspect? a) Air embolism b) Sepsis c) Infiltration d) Phlebitis

d) Phlebitis

A 50-year-old client with hypertension is being treated with a diuretic. The client reports muscle weakness and fatigue and the nurse's assessment reveals an irregular heart rate. The nurse should assess the client's levels of which electrolyte? a) Calcium b) Phosphorous c) Chloride d) Potassium

d) Potassium

A client has been diagnosed with excessive levels of aldosterone. The nurse's assessment will include what value? a) Calcium level b) Thirst c) Acid-base balance d) Potassium level

d) Potassium level

A client is diagnosed with hypovolemia after significant blood loss. Which action will the nurse take? a) Give the client a glass of orange juice with added sugar b) Allow nothing by mouth c) Encourage fluid intake d) Start an IV of normal saline as prescribed

d) Start an IV of normal saline as prescribed

Which statement most accurately describes the process of osmosis? a) Water shifts from high-solute areas to areas of lower solute concentration b) Solutes pass through semipermeable membranes to areas of lower concentration c) Plasma proteins facilitate the reabsorption of fluids into the capillaries d) Water moves from an area of lower solute concentration to an area of higher solute concentration

d) Water moves from an area of lower solute concentration to an area of higher solute concentration