Fluid & Electrolyte Prep U Ch 10

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? A. Provides long-term pH regulation B. No effect C. Decreases arterial pH D. Increases arterial pH

ANSWER D INCREASES PH

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

ANSWER D ORAL

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. 250 mOsm/kg. B. 230 mOsm/kg. C. 280 mOsm/kg. D. 210 mOsm/kg.

ANSWER C 280

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. 1. Document presenting signs and symptoms. 2. Compare ABG findings with previous results. 3. Administer IV bicarbonate. 4. Maintain intake and output records. 5. Suction the client's airway.

ANSWER 1,2,4

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. "I will take a potassium supplement daily as prescribed." C. "I will be sure to buy frozen vegetables when I grocery shop." D. "A good breakfast for me will include milk and a couple of bananas."

ANSWER A

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

Answer B 0.9% NS

What percentage of potassium excreted daily leaves the body by way of the kidneys? A. 60 B. 20 C. 40 D. 80

ANSWER D 80%

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

ANSWER D POTASSIUM

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

ANSWER D ELEVATED BP

The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? A. Bicarbonate B. PO2 C. PaO2 D. Carbonic acid

ANSWER A BICARB

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. Hallucinations D. Nausea

ANSWER A CONFUSION

Oral intake is controlled by the thirst center, located in which of the following cerebral areas? A. Hypothalamus B. Cerebellum C. Thalamus D. Brainstem

ANSWER A HYPOTHALAMUS

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

ANSWER A, 52 YO WITH DIARRHEA

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. 135 mEq/L B. 114 mEq/L C. 130 mEq/L D. 148 mEq/L

ANSWER B 114

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

ANSWER B BICARBONATE CARBONIC ACID BUFFER SYSTEM

A client with emphysema is at a greater risk for developing which acid-base imbalance? A. respiratory alkalosis B. chronic respiratory acidosis C. metabolic acidosis D. metabolic alkalosis

ANSWER B CHRONIC RESP ACIDOSIS

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

ANSWER B CONFUSION AND SEIZURES

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

ANSWER A JVD

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

ANSWER A METABOLIC ACIDOSIS

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

ANSWER A RESP ALKALOSIS

A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting? A. third-spacing B. anasarca C. hypovolemia D. pitting edema

ANSWER A THIRD SPACING

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

ANSWER A, BICARB OF 28

Clients diagnosed with hypervolemia should avoid sweet or dry food because it? A. can lead to weight gain. B. increases the client's desire to consume fluid. C. can cause dehydration. D. obstructs water elimination.

ANSWER B

Which set of arterial blood gas (ABG) results requires further investigation? A. 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 C. pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L D. 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

ANSWER B

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

ANSWER B ELEVATED HCT LEVELS

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. Opioid overdose B. Extreme anxiety C. Type 1 diabetes mellitus D. Myasthenia gravis

ANSWER B EXTREME ANXIETY

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 had a liver transplant 2 years ago. C. The client works in a health insurance office. D. The client has never traveled outside of the country.

ANSWER B LIVER TRANSPLANT

The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely? A. Phosphorus B. Magnesium C. Potassium D. Calcium

ANSWER B MAGNESIUM

A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the A. client has a history of alcohol abuse. B. malignancy is causing the electrolyte imbalance. C. client may be developing hyperaldosteronism. D. client's diet is lacking in calcium-rich food products.

ANSWER B MALIGNANCY CAUSING EMBALANCE

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. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis

ANSWER B METABOLIC ACIDOSIS

The nurse is caring for a client with an acid-base imbalance. For which imbalance will the nurse calculate the anion gap? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis

ANSWER B METABOLIC ACIDOSIS

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

ANSWER B METABOLIC ALKALOSIS

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. active transport B. osmosis C. evaporation D. filtration

ANSWER B OSMOSIS

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? A. Sodium: 138 mEq/L B. Potassium: 5.8 mEq/L C. Magnesium:2 mEq/L D. Calcium: 10 mg/dL

ANSWER B POTASSIUM 5.8

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. Pulse C. Respirations D. Temperature

ANSWER B PULSE

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. "Bananas have a lot of potassium in them; I'll stop buying them." B. "I will not salt my food; instead I'll use salt substitute." 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."

ANSWER B SALT

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

ANSWER B, PREPARE TO ASSIST WITH VENTILATION

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? A. pH, 7.35; PaCO2 40 mm Hg B. pH, 7.5; PaCO2 30 mm Hg C. pH, 7.25; PaCO2 50 mm Hg D. pH, 7.40; PaCO2 35 mm Hg

ANSWER C

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? A. Give medications that promote fluid retention. B. Assess for dehydration. C. Limit sodium and water intake. D. Teach client behaviors that decrease urination.

ANSWER C

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

ANSWER C 0.45 % NS

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)

ANSWER C 158

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

ANSWER C 275-300

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

ANSWER C CHEST PAIN

Upon shift report, the nurse states the following laboratory values: pH, 7.44; PCO2, 30 mm Hg; and HCO3, 21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance do both nurses agree is the client's current state? A. Compensated metabolic acidosis B. Compensated metabolic alkalosis C. Compensated respiratory alkalosis D. Uncompensated respiratory alkalosis

ANSWER C COMPENSATED RESP ALKALOSIS

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. metolazone B. hydrochlorothiazide C. furosemide D. spironolactone

ANSWER C FUROSEMIDE

A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for: A. Dehydration. B. Hyperglycemia. C. Hyponatremia. D. Acidosis.

ANSWER C HYPONATREMIA

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 acidosis B. respiratory acidosis C. metabolic alkalosis D. respiratory alkalosis

ANSWER C METABOLIC ALKALOSIS

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. respiratory acidosis. B. metabolic acidosis. C. respiratory alkalosis. D. metabolic alkalosis.

ANSWER C RESP ALKALOSIS

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 6 mEq/L C. Sodium level of 150 mEq/L D. Potassium level of 3.8 mEq/L

ANSWER C SODIUM OF 150

Which of the following may be the first sign of respiratory acidosis in anesthetized patients? A. Increased pulse B. Dull headache C. Ventricular fibrillation D. Mental cloudiness

ANSWER C V-FIB

Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? A. pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15 B. pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34 C. pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 D. pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21

ANSWER C pH 7.55

A patient is admitted with severe vomiting for 24 hours as well as weakness and "feeling exhausted." The nurse observes flat T waves and ST-segment depression on the electrocardiogram. Which potassium level does the nurse observe when the laboratory studies are complete? A. 5.5 mEq/L B. 3.5 mEq/L C. 4.5 mEq/L D. 2.5 mEq/L

ANSWER D 2.5

Which of the following measurable urine outputs indicates the client is maintaining adequate fluid intake and balance? A. A patient with a minimal urine output of 50 mL/hour B. A patient with a minimal urine output of 10 mL/hour C. A patient with a minimal urine output of 20 mL/hour D. A patient with a minimal urine output of 30 mL/hour

ANSWER D 30ML/HR IS NORMAL

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. Change the lactated Ringer solution to 2.5% dextrose. B. Increase the rate of the intravenous lactated Ringer solution. C. Change the lactated Ringer solution to 3% saline. D. Discontinue the intravenous lactated Ringer solution.

ANSWER D DISCONTINUE FLUIDS

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

ANSWER D LACTATED RINGERS

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

ANSWER D OSMOTIC PRESSURE EXERTED BY PROTEINS

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant? A. Monitor for signs and symptoms of dehydration. B. Teach the client about increased fluid intake. C. Assess the client's weight daily for trends. D. Provide oral care every 2-3 hours.

ANSWER D PROVIDE ORAL CARE

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

ANSWER D SODIUM 124

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. hypertension B. flank pain C. polyuria D. tingling sensation in the fingers

ANSWER D TINGLING SENSATION IN THE FINGERS

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? A. O saturation 95% B. HCO 21 mEq/L C. PaCO 36 D. pH 7.48

ANSWER D pH 7.48

A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following? A. Metabolic alkalosis B. Respiratory acidosis C. Altered blood urea nitrogen (BUN) value D. Extracellular fluid volume deficit

ANSWER D, EXTRACELLULAR FLUID VOLUME DEFICIT

A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family?

Drink at least eight glasses of fluid each day. Respond to thirst Drink water as an inexpensive way to meet fluid needs.

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results?

PaCO2 HCO3 pH