Fluid and Electrolytes
Which of the following is considered an isotonic solution? A) 0.45% normal saline B) 0.9% normal saline C) Dextran in normal saline D) 3% NaCl
0.9% normal saline
Below which serum sodium level may convulsions or coma can occur?
135 mEq/L
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:
280 mOsm/kg.
In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours?
800
It is important for a nurse to know how to calculate the corrected serum calcium level for a patient when hypocalcemia is seen along with low serum albumin levels. Calculate the corrected serum calcium when the serum calcium is 9 mg/dL and the serum albumin is 3 g/dL.
9.8 mg/dL
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? A) Cerebral edema B) Hypovolemic shock C) Tetany D) Severe hyperkalemia
A
A client is experiencing edema in the tissue. The nurse is correct in anticipating which tonicity of intravenous fluid? A) No intravenous solution B) Isotonic fluid C) Hypotonic solution D) Hypertonic solution
A
A client weighing 160 pounds diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the patient loses 1,000 mL of fluid in 24 hours. Choose the weight that would be consistent with this amount of fluid loss. A) 158 lbs B) 156 lbs C) 157 lbs D) 159 lbs
A
A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? A) Pulse B)Temperature C) Respirations D) Blood pressure
A
A client with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis? a) Shock b) Stroke c) Seizures d) Hyperglycemia
A
A nurse caring for a patient with metabolic alkalosis knows to assess for the primary, compensatory mechanism of: A) Increased PaCO2. B) Decreased PaCO2. C) Increased serum HCO3. D) Decreased serum HCO3.
A
A nurse is assessing a client who has hyperkalemia. Which of the following findings should the nurse expect? A. Decreased muscle strength B. Decreased gastric motility C. Increased heart rate D. Increased blood pressue
A
A nurse is assessing a client who has hypomagnesemia. Which of the following findings should the nurse expect? A. Hyperactive deep-tendon reflexes B. Increased bowel sounds C. Drowsiness D. Decreased blood pressure
A
A nurse is assessing a client who has respiratory acidosis. Which of the following findings should the nurse expect? A. Hypotension B. Peripheral edema C. Facial flushing D. Hyperreflexia
A
A nurse is assessing a client who is receiving hydrochlorothiazide and notes that the client is confused and lethargic. Which of the following laboratory values should the nurse report to the provider? A. Sodium 128 mEq/L B. Potassium 4.8 mEq/L C. Calcium 9.1 mg/dL D. Magnesium 2.0 mEq/L
A
A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? a) Urine pH of 3.0 b) Absence of protein c) Specific gravity of 1.02 d) Absence of glucose
A
A priority nursing intervention for a client with hypervolemia involves which of the following? a) Monitoring respiratory status for signs and symptoms of pulmonary complications. b) Establishing I.V. access with a large-bore catheter. c) Encouraging the client to consume sodium-free fluids. d) Drawing a blood sample for typing and crossmatching.
A
Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: A. Muscle weakness. B. Tremors. C. Diaphoresis. D. Constipation.
A
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? A) Lungs and kidney B) Pancreas and stomach C) Heart and lungs D) Kidney and liver
A
The nurse is caring for a patient who had a parathyroidectomy. Upon evaluation of the patient's laboratory studies, the nurse would expect to see imbalances in which electrolyte related to the removal of the parathyroid gland? A. Calcium and phosphorus B. Potassium and chloride C. Potassium and sodium D. Chloride and magnesium
A
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? A) Metabolic alkalosis B) Respiratory alkalosis C) Metabolic acidosis D) Respiratory acidosis
A
The nurse's morning assessment of a patient who has a history of heart failure reveals the presence of 2+ pitting edema in the patient's ankles and feet bilaterally. What is this assessment finding suggestive of? A. Fluid volume excess B. Hypovolemia C. Metabolic acidosis D. Hyponatremia
A
Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? A) pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 B) pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15 C) pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34 D) pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21
A
Which patient is at a greater risk for fluid volume deficit related to the loss of total body fluid and extracellular fluid? A. a 4-month-old infant B. a 45-year-old woman C. an 86-year-old man D. a 17-year-old adolescent
A
While reviewing a client's laboratory results, a nurse notes a serum calcium level of 8.0 mg/dL. Which of the following actions should the nurse take? A. Implement seizure precautions B. Administer phosphate C. Initiate diuretic therapy D. Prepare the client for hemodialysis
A
With which condition should the nurse expect that a decrease in serum osmolality will occur? A) Kidney failure B) Diabetes insipidus C) Uremia D) Hyperglycemia
A
The nurse is caring for a patient who was admitted with fluid volume excess (FVE). Which of the following nursing assessments should the nurse include in the ongoing monitoring of the patient? Select all that apply. a) Blood pressure, heart rate, and rhythm b) Intake and output, urine volume, and color c) Strength testing for muscle wasting d) Skin assessment for edema and turgor e) Nutritional status and diet
ABD
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. a) Document presenting signs and symptoms. b) Compare ABG findings with previous results. c) Suction the client's airway. d) Maintain intake and output records. e) Administer IV bicarbonate.
ABD
The nurse is assessing a patient for local complication of IV therapy. Local complications include which of the following? Select all that apply. a) Extravasation b) Infection c) Air embolism d) Hematoma e) Phlebitis
ADE
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) Metabolic alkalosis b) Metabolic acidosis c) Respiratory alkalosis d) Respiratory acidosis
B
A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her: a) respiratory rate. b) electrocardiogram (ECG) results. c) neuromuscular function. d) bowel sounds.
B
A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypotension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? A) hyperkalemia B) hypokalemia C) hypocalcemia D) hypercalcemia
B
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, 7.5; PaCO2 30 mm Hg b) pH, 7.25; PaCO2 50 mm Hg c) pH, 7.40; PaCO2 35 mm Hg d) pH, 7.35; PaCO2 40 mm Hg
B
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) Prepare for gastric lavage. b) Prepare to assist with ventilation. c) Monitor the client's heart rhythm. d) Obtain a urine specimen for drug screening.
B
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: A) hypercalcemia. B) hyperkalemia. C) hypokalemia. D) hypernatremia.
B
A nurse is caring for a client who has heart failure and is receiving furosemide. The client is experiencing irritability and anxiety. Which of the following actions should the nurse anticipate taking? A. Offer whole grain wheat breads with meals B. Recommend a potassium-sparing diuretic C. Give potassium 20 mEq/L by IV bolus D. Restrict oral fluids
B
A nurse is caring for a client who is experiencing respiratory distress as a result of acute pulmonary edema. Which of the following actions should the nurse take first? A. Assist with intubation B. Initiate high-flow oxygen therapy C. Administer a rapid-acting diuretic D. Administer morphine IV
B
A nurse is caring for a patient with acute renal failure and hypernatremia. Which of the following actions can be delegated to the nursing assistant? a) Teach the patient about increased fluid intake. b) Provide oral care every 2-3 hours. c) Assess the patient's daily weights for trends. d) Monitor for signs and symptoms of dehydration.
B
A nurse is planning care for a client who has a serum potassium level of 3.0 mEq/L. The nurse should plan to monitor the client for which of the following findings? A. Hyperactive deep-tendon reflexes B. Orthostatic hypotension C. Rapid, deep respirations D. Strong, bounding pulse
B
A nurse is reviewing the laboratory data on four clients. Which of the following serum laboratory values should the nurse expect off for the client who is experiencing 2+ pitting ankle edema? A. Sodium 138 mEq/L B. Hematocrit 34% C. BUN 22 mg/dL D. Protein 9 g/L
B
A patient complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patient's laboratory work has returned? A) Potassium B) Calcium C) Phosphorus D) Magnesium
B
A patient diagnosed with hypernatremia needs IV sodium replacement. Select the solution that is considered the safest to administer. A) 0.9% sodium chloride B) 0.45% sodium chloride C) 5% dextrose in water D) 5% dextrose in normal saline solution
B
A patient is being treated in the ICU 24 hours after having a radical neck dissection completed. The patient's serum calcium level is 7.6 mg/dL. Which of the following physical examination findings is consistent with this electrolyte imbalance? a) Slurred speech b) Presence of Trousseau's sign c) Muscle weakness d) Negative Chvostek's sign
B
A patient is being treated with loop diuretics; gastric suctioning has been initiated. The nurse understands the patient is at risk for developing which of the following electrolyte imbalances? a) Hypocalcemia b) Hypokalemia c) Hyponatremia d) Hypomagnesium
B
A patient who is NPO prior to surgery is complaining of thirst. What is the physiologic process that drives this thirst factor? A. increased blood volume and intracellular dehydration B. decreased blood volume and intracellular dehydration C. decreased blood volume and extracellular overhydration D. increased blood volume and extracellular overhydration
B
A patient with a magnesium level of 2.6 mEq/L is being treated on a medical-surgical unit. Which of the following treatments should the nurse anticipate will be used? a) Fluid restriction b) IV furosemide (Lasix) c) Dialysis d) Oral magnesium oxide (MagOx)
B
A patient with cancer is being treated on the oncology unit for bilateral breast cancer. The patient is undergoing chemotherapy. The nurse notes the patient's serum calcium level is 12.3 mg/ dL. Given this laboratory finding, the nurse should suspect which of the following statements? a) The patient has a history of alcohol abuse. b) The patient's malignancy is causing the electrolyte imbalance. c) The patient may be developing hyperaldosteronism. d) The patient's diet is lacking in calcium-rich food products.
B
A patient with severe hypervolemia is prescribed a loop diuretic. The nurse knows that this drug can cause a significant loss of sodium and has to be carefully monitored. Which of the following drugs is most likely the one that was prescribed? A) Zaroxolyn B) Lasix C) Mykrox D) Hydrodiuril
B
A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? A) Hyperglycemia B) Hyperkalemia C) Hypernatremia D) Hypercalcemia
B
A volume-depleted patient would present with which of the following diagnostic lab results? A) Urine specific gravity of 1.02 B) BUN-to-creatinine ratio of 24:1 C) Urinary output of 1.2 L/24 hours D) Capillary refill time of 3 seconds
B
Arterial blood gases reveal that a patient's pH is 7.20. What physiologic process will contribute to a restoration of correct acid-base balance? A. increased excretion of bicarbonate ions by the kidneys B. increased respiratory rate C. hypoventilation D. renal retention of H+ ions
B
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) Myasthenia gravis B) Extreme anxiety C) Opioid overdose D) Type 1 diabetes mellitus
B
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) Lactate B) Bicarbonate C) Nitrogen D) Carbonic acid
B
The nurse is assigned to care for a patient with a serum phosphorus level of 5.0 mg/dL. The nurse anticipates that the patient will also experience which of the following electrolyte imbalances? a) Hyperchloremia b) Hypocalcemia c) Hyponatremia d) Hypermagnesemia
B
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
B
The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration? A. Distended jugular veins B. Dark, concentrated urine C. Crackles in the lung fields D. Cool and pale skin
B
The nurse is caring for a patient in the intensive care unit (ICU) following a saltwater near-drowning event. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen dry tongue, flushed skin, and peripheral edema. The nurse anticipated that the patient's serum sodium value would be which of the following? a) 145 mEq/L b) 155 mEq/L c) 125 mEq/L d) 135 mEq/L
B
The nurse is caring for a patient with a serum potassium level of 6.0 mEq/L. The patient is ordered to receive oral sodium polystyrene sulfonate (Kayexelate) and furosemide (Lasix). What other orders should the nurse anticipate giving? a) Change the lactated Ringer's solution to 3% saline. b) Discontinue the IV lactated Ringer's solution. c) Increase the rate of the IV lactated Ringer's solution. d) Change the lactated Ringer's solution to 2.5% dextrose.
B
The nurse is caring for a patient with hypernatremia. What complication of hypernatremia should the nurse continuously monitor for? A) Red blood cell hydrolysis B) Cerebral edema C) Red blood cell crenation D) Renal failure
B
The nurse is caring for a patient with severe diarrhea. The nurse recognizes that the patient is at-risk for developing which of the following acid-base imbalances? a) Respiratory alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Metabolic alkalosis
B
When caring for a client who has risk factors for fluid and electrolyte imbalances, which assessment finding is the highest priority for the nurse to follow up? A) Blood pressure 96/53 mm Hg B) Irregular heart rate C) Weight loss of 4 lb D) Mild confusion
B
Which of the following is a factor affecting an increase in urine osmolality? A) Fluid volume excess B) Syndrome of inappropriate antidiuretic hormone release (SIADH) C) Myocardial infarction D) Alkalosis
B
Which of the following may be the first sign of respiratory acidosis in anesthetized patients? A) Increased pulse B) Ventricular fibrillation C) Dull headache D) Mental cloudiness
B
Which of the following would be a potential cause of respiratory acidosis? a) Diarrhea b) Hypoventilation c) Vomiting d) Hyperventilation
B
The nurse is caring for a patient with a diagnosis of hyponatremia. What nursing intervention is appropriate to include in the plan of care for this patient? (Select all that apply.) A) Encouraging the use of salt substitute instead of salt B) Assessing for symptoms of nausea and malaise C) Encouraging the intake of low-sodium liquids D) Monitoring neurologic status E) Restricting tap water intake
BDE
A group of nursing students are studying for a test over acid-base imbalance. One student asks another what the major chemical regulator of plasma pH is. What should the second student respond?
Bicarbonate-carbonic acid buffer system
A 73-year-old female patient with cirrhosis of the liver is evaluated for clinical manifestations of FVE. Which of the following signs are consistent with that diagnosis? Select all that apply.
Blood pressure of 140/110 Hematocrit level of 32% Crackles BUN of 8 mg/dL
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? A) Metabolic acidosis B) Respiratory acidosis C) Respiratory alkalosis D) Metabolic alkalosis
C
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? A) Serum blood urea nitrogen (BUN) level of 8.6 mg/dl B) Hematocrit of 52% C) Serum sodium level of 124 mEq/L D) Serum creatinine level of 0.4 mg/dl
C
A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should: A) insert a nasogastric tube (NG) as ordered. B) administer acetaminophen (Tylenol) as ordered. C) instruct the client to breathe into a paper bag. D) administer antibiotics as ordered.
C
A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? A) Blood urea nitrogen (BUN) level of 29 mg/dl B) Serum sodium level of 132 mEq/L C) Serum potassium level of 3 mEq/L D) Urine specific gravity of 1.025
C
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis
C
A nurse is caring for a client who has dehydration and is receiving IV fluids. When assessing for complications, the nurse should recognize which of the following manifestations as a sign of fluid overload? A. Increased urine specific gravity B. Hypoactive bowel sounds C. Bounding peripheral pulses D. Decreased respiratory rate
C
A nurse is caring for a client who is receiving furosemide daily. During the morning assessment, the client tells the nurse that he is "feeling weak in the legs." Which of the following actions should the nurse take first? A. Monitor the client's bowel sounds B. Review the client's daily laboratory results C. Auscultate the client's lungs D. Palpate the client's peripheral pulses
C
A nurse is preparing to administer oral potassium for a client who has a potassium level of 5.5 mEq/L. Which of the following actions should the nurse take first? A. Administer a hypertonic solution B. Repeat the potassium level C. Withhold the medication D. Monitor for paresthesia
C
A nurse is reviewing the medical record of a client who has diabetes mellitus and is receiving regular insulin by continuous IV infusion to treat diabetic ketoacidosis. Which of the following findings should the nurse report to the provider? A. Urine output of 30 mL/hr B. Blood glucose of 180 mg/dL C. Serum potassium 3.0 mEq/L D. BUN 18 mg/dL
C
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) Potassium level of 3.8 mEq/L B) Potassium level of 6 mEq/L C) Sodium level of 150 mEq/L D) Sodium level of 137 mEq/L
C
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) PO2 B) PaO2 C) Bicarbonate D) Carbonic acid
C
The nurse is analyzing the electrocardiographic (ECG) rhythm tracing of a patient experiencing hypercalcemia. Which of the following ECG changes is typically associated with this electrolyte imbalance? a) Elevated ST segments b) Peaked T waves c) Prolonged PR intervals d) Prolonged QT intervals
C
The nurse is caring for a patient undergoing alcohol withdrawal. Which of the following serum laboratory values should the nurse monitor most closely? a) Calcium b) Potassium c) Magnesium d) Phosphorus
C
The nurse is caring for a patient with a metabolic acidosis (pH 7.25). Which of the following values is useful to the nurse in determining whether the cause of the acidosis is due to acid gain or to bicarbonate loss? a) PaCO2 b) Serum sodium level c) Anion gap d) Bicarbonate level
C
The nurse is caring for a patient with a serum sodium level of 113 mEq/L. The nurse should monitor the patient for the development of which of the following? a) Hallucinations b) Nausea c) Confusion d) Headache
C
The nurse is instructing a patient with recurrent hyperkalemia about following a potassium-restricted diet. Which of the following patient statements indicates the need for additional instruction? a) "Bananas have a lot of potassium in them, I'll stop buying them." b) "I'll drink cranberry juice with my breakfast instead of coffee." c) "I will not salt my food, instead I'll use salt substitute." d) "I need to check if my cola beverage has potassium in it."
C
The nurse monitors a patient who is being evaluated for hyperkalemia. She is aware that ECG changes and serum potassium levels are diagnostic. Which of the following are the earliest changes that the nurse should report? A) K+ = 6 mEq/L; elevated ST segment B) K+ = 5 mEq/L; prolonged T waves C) K+ = 7 mEq/L; peaked T waves D) K+ = 8 mEq/L; shortened PR interval
C
The nurse should assess the patient for signs of lethargy, increasing intracranial pressure, and seizures when the serum sodium reaches what level? A) 145 mEq/L B) 130 mEq/L C) 115 mEq/L D) 160 mEq/L
C
The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? A) 1500 ml B) 500 ml C) 1 L D) 1250 ml
C
To evaluate a client for hypoxia, the physician is most likely to order which laboratory test? a) Total hemoglobin b) Sputum culture c) Arterial blood gas (ABG) analysis d) Red blood cell count
C
Upon shift report, the nurse states the following laboratory values: pH, 7.44; PCO2, 30mmHg; 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) Uncompensated respiratory alkalosis B) Compensated metabolic acidosis C) Compensated respiratory alkalosis D) Compensated metabolic alkalosis
C
When caring for a patient who has risk factors for fluid and electrolyte imbalances, which of the following assessment findings is the highest priority for the nurse to follow up? a) Blood pressure 96/53 mm Hg b) Mild confusion c) Irregular heart rate d) Weight loss of 4 lb
C
Which factor increases blood urea nitrogen (BUN)? A) Decreased protein intake B) Overhydration C) Gastrointestinal bleeding D) Hypothermia
C
Which of the following arterial blood gas (ABG) results would the nurse anticipate for a patient with a 3-day history of vomiting? a) pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 b) pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34 c) pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 d) pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15
C
In which of the following medical conditions would administering IV normal saline solution be INAPPROPRIATE Select all that apply. A) Burns B) Severe hemorrhage C) Renal impairment D) Heart failure E) Pulmonary edema
CDE
The nurse is assessing a client for local complications of intravenous therapy. Which are local complications? Select all that apply. A) Infection B) Air embolism C) Hematoma D) Extravasation E) Phlebitis
CDE
The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume? Select all that apply. A) A low urine specific gravity B) Absence of ketones in urine C) Electrolyte imbalance D) Low protein level in the urine E) An elevated hematocrit level
CE
The nurse is providing afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in hypervolemia status? a) Intake and output b) Vital signs c) Edema d) Weight
D
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) hypovolemia B) anasarca C) pitting edema D) third-spacing
D
A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? A) Respiratory acidosis B) Respiratory alkalosis C) Metabolic acidosis D) Metabolic alkalosis
D
A client with a magnesium concentration of 2.6 mEq/L (1.3 mmol/L) is being treated on a medical-surgical unit. Which treatment should the nurse anticipate will be used? A) Dialysis B) Fluid restriction C) Oral magnesium oxide (MagOx) D) Intravenous furosemide (Lasix)
D
A client with emphysema is at a greater risk for developing which acid-base imbalance? A) metabolic acidosis B) respiratory alkalosis C) metabolic alkalosis D) chronic respiratory acidosis
D
A dialysis unit nurse caring for a patient with renal failure will expect the patient to exhibit which fluid and electrolyte imbalances? A. fluid volume deficit and acidosis B. fluid volume excess and alkalosis C. fluid volume deficit and alkalosis D. fluid volume excess and acidosis
D
A nurse is assessing a client who has dehydration. Which of the following assessments is the priority? A. Skin turgor B. Urine output C. Weight D. Mental status
D
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) Altered blood urea nitrogen (BUN) value C) Respiratory acidosis D) Extracellular fluid volume deficit
D
A nurse is planning dietary teaching for a client who has hypermagnesemia. Which of the following food choices contains the most magnesium and is, therefore, a food the nurse should plan to instruct the client to avoid? A. Hard-boiled eggs B. Cheddar cheese C. Raw rhubarb D. Raw spinach
D
A nurse is providing teaching for a client who is at risk for developing respiratory acidosis following surgery. Which of the following statements by the client indicates an understanding of the teaching? A. "I should conserve energy by limiting my physical activity." B. "I will wait until my pain is at least 6 out of 10 before I use the PCA." C. "I will limit my daily fluid intake to 2 to 3 glasses." D. "I will use the incentive spirometer every hour."
D
A nurse is teaching nutritional strategies to a client who has a low serum calcium level and an allergy to milk. Which of the following statements by the client indicates an understanding of the teaching? A. "I will eat extra cheese because I can't drink milk." B. "I will need to avoid foods with vitamin D because I am allergic to milk." C. "I will stop taking my calcium supplements if they irritate my stomach." D. "I will add broccoli and kale to my diet.
D
A nurse is teaching nutritional strategies to a client who has a low serum calcium level and an allergy to milk. Which of the following statements by the client indicates an understanding of the teaching? A. "I will eat extra cheese because I can't drink milk." B. "I will need to avoid foods with vitamin D because I am allergic to milk." C. "I will stop taking my calcium supplements if they irritate my stomach." D. "I will add broccoli and kale to my diet."
D
A patient admitted with heart failure requires careful monitoring of his fluid status. What assessment parameter will provide the nurse with the best indication of the patient's fluid status? A. Intake and output measurements B. Daily BUN and serum creatinine monitoring C. Daily electrolyte monitoring D. Daily weights
D
A patient has been admitted to the hospital with a diagnosis of acute renal failure, a health problem the necessitates vigilant monitoring of the patient's fluid balance. What is the most accurate way that the care team can achieve this assessment goal? A. daily laboratory studies B. measurement of urine concentration C. daily assessment of the patient's skin turgor D. weighing the patient once per day
D
A patient is ordered to receive hypotonic IV solution to provide free water replacement. Which of the following solutions will the nurse anticipate administering? A) Lactated Ringer's solution B) 0.9% NaCl C) 5% NaCl D) 0.45% NaCl
D
A patient presents to the Emergency Department experiencing a severe anxiety attack and is hyperventilating. The nurse would expect the patient's pH value to be which of the following? a) 7.35 b) 7.30 c) 7.45 d) 7.50
D
A patient with a magnesium level of 2.6 mEq/L is being treated on a medical-surgical unit. Which of the following treatments should the nurse anticipate will be used? a) Oral magnesium oxide (MagOx) b) Dialysis c) Fluid restriction d) IV furosemide (Lasix)
D
Don't know A nurse is caring for a client who requires continuous cardiac monitoring. The nurse identifies a prolonged PR interval and a widened QRS complex. Which of the following laboratory values supports this finding? A. Sodium 152 mEq/L B. Chloride 102 mEq/L C. Magnesium 1.8 mEq/L D. Potassium 6.1 mg/L
D
Early signs of hypervolemia include A) moist breath sounds. B) a decrease in blood pressure. C) thirst. D) increased breathing effort and weight gain.
D
Hypokalemia can cause which of the following symptoms to occur? A) Increased release of insulin B) Production of concentrated urine C) Decreased sensitivity to digitalis D) Excessive thirst
D
The nurse has been assigned to care for the following patients. Which patient is at the highest risk for a fluid and electrolyte imbalance? a) A 45-year-old man who had a laparoscopic appendectomy 24 hours ago being advanced to a regular diet. b) A 79-year-old man admitted with a diagnosis of pneumonia. c) A 66-year-old woman who had an open cholecystectomy with a T-tube placed that is draining 125 mL of bile per shift. d) An 82-year-old woman who receives all nutrition via tube feedings. Her medications include carvedilol (Coreg) and torsemide (Demadex)
D
The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium level of 2.9 mEq/L. Which of the following statements made by the patient indicates the need for further teaching? a) "I will take a potassium supplement daily as prescribed." b) "I will be sure to buy frozen vegetables when I grocery shop." c) "A good breakfast for me will include milk and a couple of bananas." d) "I can use laxatives and enemas but only once a week."
D
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 7-year-old with a fracture tibia b) A 72-year-old with a total knee repair c) A 65-year-old with a myocardial infarction d) A 52-year-old with diarrhea
D
The nurse is participating in the care of a patient who had a peripherally inserted central catheter (PICC) inserted in the right arm. Following catheter placement, the nurse should complete which of the following actions? a) Administer the prescribed IV fluids. b) Assess the patient's blood pressure (BP) on the right arm. c) Obtain written consent for the procedure. d) Send the patient for a chest x-ray.
D
The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders? A) Magnesium:2 mEq/L B) Sodium: 138 mEq/L C) Calcium: 10 mg/dL D) Potassium: 5.8 mEq/L
D
What does the nurse recognize as one of the indicators of the patient's renal function? A) Blood urea nitrogen B) Urine osmolality C) Specific gravity D) Serum creatinine
D
Which condition leads to chronic respiratory acidosis in older adults? A) Erratic meal patterns B) Overuse of sodium bicarbonate C)Decreased renal function D) Thoracic skeletal change
D
Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? A) Flaccidity and thirst B) Tetany and increased blood urea nitrogen (BUN) levels C) Sunken eyeballs and spasticity D)Confusion and seizures
D
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) Low urine specific gravity C) Abnormal potassium level D) Elevated hematocrit level
D
Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality? A) Potassium B) Calcium C) Magnesium D) Sodium
D
Which set of arterial blood gas (ABG) results requires further investigation? a) 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 b) pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L c) pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L d) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
D
What foods can the nurse recommend for the patient with hypokalemia?
Fruits such as bananas and apricots
Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?
Instruct the client to breathe into a paper bag.
Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?
Jugular vein distention
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?
Metabolic alkalosis
A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client?
No, sodium intake should be restricted.
The calcium level of the blood is regulated by which mechanism?
PTH
Which of the following electrolytes is a major cation in body fluid?
Potassium
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L
Which medication does the nurse anticipate administering to antagonize the effects of potassium on the heart for a patient in severe metabolic acidosis?
Sodium bicarbonate
A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis?
The client had a liver transplant 2 years ago.
Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)?
Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? a) Restricting fluids to 800 ml/day b) Elevating the head of the client's bed to 90 degrees c) Restricting sodium intake to 1 gm/day d) Administering vasopressin as ordered
a
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?
acidic
The nurse is caring for a patient with a serum sodium level of 113 mEq/L. The nurse should monitor the patient for the development of which of the following?
confusion
A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance?
hypercalcemia
What effect does breathing faster have on arterial pH level?
increases pH
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
pH 7.48
The nurse is analyzing the arterial blood gas (AGB) results of a patient diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis?
pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L
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:
respiratory alkalosis.
