Fluid & Electrolyte Review Questions

When individuals are in a well or healthy state, their fluid output should be: A. Approximately the same as their fluid intake B. Correlated very little with their fluid intake C. Higher than their fluid intake D. Lower than their fluid intake

A. Approximately the same as their fluid intake

What are the principal ions found in the extracellular fluids? A. Sodium and chloride B. Potassium and phosphate C. Sodium and potassium D. Potassium and protein

A. Sodium and chloride

A client hospitalized for a GI bleed has orders for NGT placement with irrigation until the returns are clear. Which of the following solutions should the nurse plan on using? A) 3% Sodium chloride (NaCl) B) 5% Dextrose in Water (D5W) C) 0.9% Sodium chloride (NS) D) Sterile water

A) 3% Sodium chloride (NaCl) NaCl is isotonic 3% - hypertonic - pull water out of GI tract D5W, H20 - hypotonic - pull water into GI tract, dilute electrolytes

A client involved in a motor vehicle crash presents to the ED with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates that which IV solution will most likely be prescribed to increase intravascular volume, replace immediate blood loss volume, and increase blood pressure? a. 5% dextrose in Lactated Ringers b. 0.33% sodium chloride c. 0.225% sodium chloride d. 0.45% sodium chloride

A) 5% dextrose in Lactated Ringers B,C, and D are hypotonic solutions.

The nurse determines that which of the following clients is at risk for developing a fluid-volume deficit? A) A 76-year old client who has an NG tube to low continuous suction following surgery for colon cancer. B) A thin 55-year-old client who smokes and takes glucocorticoids for chronic lung disease. C) A 1-year-old child being treated in a clinic for runny nose and ear infection. D) A 30-year-old client jogging in 50-degree weather.

A) A 76-year old client who has an NG tube to low continuous suction following surgery for colon cancer. 76 year old - elderly person has two risk factors (age, volume loss

The nurse is instructing a client receiving furosemide (Lasix) to report which of the following symptoms to the healthcare provider: A) Leg cramps and muscle weakness B) Muscle weakness and diarrhea C) Fatigue and irritability D) Nausea and irritability

A) Leg cramps and muscle weakness Lasix is potassium wasting

A 28-year-old client is admitted with severe bleeding from a fractured femur. What IV fluid does the nurse anticipate as the most appropriate for use to replace potential fluid losses? A) NS (0.9% NaCl) B) 3% Sodium Chloride (3% NaCl) C) D5W (5% Dextrose in water) D) D5 1/4NS (5% Dextrose in 0.225% sodium chloride)

A) NS (0.9% NaCl) NS - replace volume loss 3% - hyper D5W, D51/4 - hypo

The nurse evaluates the hydration status of a client who has been receiving IV fluids at 150 ml/hr. The nurse identifies that the client has excess fluid volume after assessing which of the following? (Select all that apply) A) Neck veins are distended when HOB is elevated 45 degrees B) Hand veins empty when the hand is raised above the heart C) Peripheral pulses are weak and rapid D) Client becomes SOB when ambulating E) Pitting edema present over tibia

A) Neck veins are distended when HOB is elevated 45 degrees D) Client becomes SOB when ambulating E) Pitting edema present over tibia

The nurse notes that the site of a client's PIV catheter is reddened, warm, painful, and slightly edematous proximal to the insertion point of the IV catheter. After taking appropriate steps to care for the client, the nurse documents in the medical record that the client experienced: a. Phlebitis of the vein b. Infiltration of the IV line c. Hypersensitivity to the IV solution d. Allergic reaction to the IV catheter material

A) Phlebitis of the vein If phlebitis occurs, the nurse should discontinue the IV line and insert a new IV line at a different site. Coolness at the site would be noted if the catheter was infiltrated. An allergic reaction produces a rash and itching.

A nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which of the following clinical manifestations would the nurse expect to note in the client? a. twitching b. hypoactive bowel sounds c. negative Trousseau's sign d. hypoactive deep tendon reflexes

A) twitching Signs of Hypocalcemia include paresthesia's followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's sign or chvostek's sign.

For an individual experiencing an intracellular fluid deficit, an appropriate intervention would be: A. Restrict fluids B. Administer diuretics as ordered C. Observe for an increase in temperature D. Observe for dyspnea and shortness of breath

C. Observe for an increase in temperature

Which of the following clients is most at risk for fluid imbalance? A. An infant with diarrhea B. An adolescent mowing the lawn on a hot day C. A healthy 70-year-old man with a fractured wrist D. A middle-aged woman who is vomiting

A. An infant with diarrhea

A 45-year-old client with excess fluid volume because of acute kidney dysfunction is placed on a 1,000 ml / 24 hour fluid restriction. The client asks the nurse, "Why is there such a severe fluid restriction when I already have dry lips and mouth?" A) "The doctor ordered the fluid restriction, so it is important for us to follow this." B) "Your kidneys cannot eliminate extra fluid right now, so intake must be limited to protect your heart and lungs from being overloaded with fluid." C) "You probably drank too much fluid before you got sick, so you can't compare your usual intake to your intake now that your kidneys aren't working as well." D) "Too much fluid will cause your heart to fail and your lungs to fill with water, which could be fatal."

B) "Your kidneys cannot eliminate extra fluid right now, so intake must be limited to protect your heart and lungs from being overloaded with fluid." Kidneys cannot eliminate. While the last choice is technically true, it is stated in a very abrupt manner.

A 17-year-old client who sustained a head injury in a motorcycle collision 2 days ago is responsive only to pain. Which IV fluid order would the nurse question? A) Ringer's Solution B) 5% Dextrose in Water (D5W) C) 0.9% Sodium chloride (0.9% NaCl) D) Lactated Ringer's solution

B) 5% Dextrose in Water (D5W) D5W - hypo - free water to cells increasing cerebral edema Others are iso (remain mostly in EC space)

Which of the following interventions does the nurse complete when caring for a patient with a serum sodium of 152mEq/L? A) Provide extra blankets for warmth. B) Observe the client for nausea and malaise. C) Observe and prepare for possible seizures. D) Restrict fluids to 1,200 ml/day.

B) Observe and prepare for potential seizures Malaise and nausea - hyponatremia

A nurse is assigned to care for a group of clients. On review of the client's medical records, the nurse determines that which client is at risk for fluid volume excess? a. the client taking diuretics b. the client with renal failure c. the client with an ileostomy d. the client who requires gastrointestinal suctioning

B) the client with renal failure The causes of fluid volume excess include decreased kidney functions, CHF, use of hypotonic fluids to replace isotonic fluid losses excessive irrigation of wounds and body cavities, and excessive ingestion of sodium. The client taking diuretics, the client with ileostomy, and the client who requires gastrointestinal suctioning are at risk for fluid volume deficit.

A client's weight has increased in one day by approximately two pounds. The nurse knows that this increase in weight should equal approximately how much fluid? A. 500 cc B. 1 L C. 300 ml D. 2 L

B. 1 L

Fluids in the interstitial spaces are called: A. Intracellular fluids B. Extracellular fluids C. Electrolytes D. Intravascular fluids

B. Extracellular fluids

The nurse is preparing to administer a unit of packed red blood cells to a client. Which type of IV fluid should be used to facilitate the infusion of blood for this client? A. Lactated Ringer's B. Normal saline C. Dextrose 5% and water D. Dextrose 5% and normal saline

B. Normal saline

The nurse is caring for a client with CHF. On assessment, the nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present? A) Weight loss B) Flat neck and hand veins C) An increase in blood pressure D) A decrease central venous pressure

C) An increase in bloop pressure A fluid volume excess is also known as over hydration or fluid overload and occurs when fluid intake or fluid retention exceeds the fluid needs of the body. Assessment findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand veins distention, altered LOC and decreased hematocrit.

An adult client in the clinic complains of a cough, fever, nausea and vomiting for three days. Examination reveals dry tongue and oral mucosa, and concentrated urine. The client also reports feeling weak and dizzy. To best assess the client's fluid status, the nurse checks which of the following parameters? A) Temperature B) Respiratory rate and depth C) BP and pulse in lying and standing positions D) Pulse oximetry reading at rest

C) BP and pulse in lying and standing positions Orthostatic hypotension

Which of the following serum electrolyte imbalances would the nurse assess for in a client admitted with a high fever and severe dehydration? A) Hypercalcemia and hypophosphatemia B) Hypokalemia and hyponatremia C) Hypernatremia and hyperchloremia D) Hypophosphatemia and hypocalcemia

C) Hypernatremia and hyperchloremia (insensible volume loss with little electrolytes) - hypertonic dehydration Ca usually decreases in dehydration Phos usually increases in dehydration K can generally remain normal in the serum

The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should immediately be taken next? a. Remove the IV b. Run a solution of 5% dextrose in water c. Run Normal Saline solution to keep open the vein d. Obtain a culture of the tip of the catheter device removed from the client

C) Run normal saline to keep open the vein Do not remove the IV line The nurse stops the transfusion and infuses normal saline until pending further physician orders.

Plasma proteins help contain blood within the blood vessels by exerting: A. Filtration pressure B. Hydrostatic pressure C. Colloid osmotic pressure D. Diffusion pressure

C. Colloid osmotic pressure

The movement of particles from an area of high solute concentration to an area of lower solute concentration is: A. Filtration B. Hydrostatic pressure C. Diffusion D. Osmosis

C. Diffusion

A client is semiconscious, restless and exhibits tremors and muscle weakness. Physical exam reveals a dry, swollen tongue, body temp of 99.8F. The nurse anticipates that the serum sodium is most likely to be which of the following? A) 120 mEq/L B) 132 mEq/L C) 142 mEq/L D) 155 mEq/L

D) 155 mEq/L Normal serum Na is 135-145. Pt is hypernatremic.

Which of the following outcomes would the nurse anticipate after infusion of 25% albumin to a hypovolemic patient? A) Increase in HR B) Decrease in temp C) Decrease in peripheral perfusion D) Increase in BP

D) Increase in BP Albumin is a hypertonic colloid (pulling pressure pulls fluid INTO vasculature, expanding plasma volume)

A nurse is reviewing laboratory results ad notes that a client's serum sodium level is 150 mEq/l. The nurse reports the serum sodium level to the physician and the physician prescribes dietary instructions based on the sodium level. Which food item does the nurse instruct the client to avoid? A) Peas B) Nuts C) Cauliflower D) Processed oat cereals

D) Processed oat cereals 145 mEq/L indicates hypernatremia. Based on the findings, the nurse would instruct the client to avoid foods high in sodium. Nuts, cauliflower, and peas are good food sources for phosphorus. Processed foods are high in sodium content.

A 70-year-old hospitalized client with a past medical history of HTN and MI is post-op following stomach surgery. VS have been stable and an IV of D5 1/2NS is infusing at 100ml/hr. The client now complains of trouble breathing, has a moist cough, and the pulse ox reading has fallen to 92% What action should the nurse take first? A) Measure the BP and HR B) Assess the legs and arms for pitting edema C) Notify the MD D) Slow the IV rate to 10 to 20 ml/hr

D) Slow the IV rate from 10 to 20 ml/hr Slowing the rate will stop the problem from getting worse

Which of the following stimulates the thirst center in the hypothalamus? A. High blood pressure B. Decreased release of angiotensin II C. Release of antidiuretic hormone from the pituitary gland D. Decreased blood volume

D. Decreased blood volume

A client has been admitted with a medical diagnosis of dehydration secondary to diuretic therapy. What nursing physical assessment criteria would the nurse expect to find? A. Distended neck and peripheral veins B. Increased BP with clear breath sounds C. Fill bounding pulse with increased rate D. Dry mucous membranes with decreased salivation

D. Dry mucous membranes with decreased salivation

A client is diagnosed with third space syndrome. What does this mean? A. Fluid has shifted into the vascular space. B. There is an isotonic fluid volume excess. C. The client had a 10 lb. water weight loss. D. The client could have fluid in his peritoneal cavity.

D. The client could have fluid in his peritoneal cavity.