Fluid, Electrolyte, and Acid-Base Balance Prep U Questions- Foundations

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. 120 drops/mL b. 90 drops/mL c. 30 drops/mL d. 60 drops/mL

d. 60 drops/mL

A student has joined the marching band at high school and the band begins practicing outside during hot summer weather. Which health promotion guidance will the school nurse teach the student? a. Ensure adequate glucose intake on practice days b. Eat high-potassium foods on the morning of practices c. Avoid drinking when not thirsty to prevent hyponatremia d. Consume commercial oral rehydration drinks on practice days.

d. Consume commercial oral rehydration drinks on practice days.

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. 83 gtt/min b. 42 gtt/min c. 5,000 gtt/min d. 167 gtt/min

a. 83 gtt/min

A healthy client eats a regular, balanced diet and drinks 3,000 mL of liquids during a 24-hour period. In evaluating this client's urine output for the same 24-hour period, the nurse realizes that it should total approximately how many mL? a. 3,750 b. 3,000 c. 1,000 d. 500

b. 3,000

The nurse is administering 1,000 mL 0.9 normal saline over 10 hours (set delivers 60 gtt/1 mL). Using the formula below, the flow rate would be: gtt/min = milliliters per hour x drop factor (gtt/mL) ÷ 60 min/hr a. 600 gtt/min b. 60 gtt/min c. 100 gtt/min d. 160 gtt/min

c. 100 gtt/min

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

c. O negative

The nursing instructor is explaining how the respiratory system is involved in hydrogen ion regulation to maintain normal pH. Place the steps in order once the CO2 in the blood has increased, resulting in increased respirations to eliminate CO2.

H2CO3 levels in the blood decreases pH becomes more alkaline blood level of CO2 decreases decreased respirations carbon dioxide retention carbonic acid formed

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. 100 mL/hr c. 13 mL/hr d. 103 gets/hr

a. 83 mL/hr

What is the lab test commonly used in the assessment and treatment of acid-base balance? a. arterial blood gas b. urinalysis c. complete blood count d. basic metabolic panel

a. arterial blood gas

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. "This surgery has a very low chance of hemorrhage, so you will not need blood." b. "Let me refer you to the blood bank so they can provide you with information." c. "Unfortunately, your own blood cannot be reinfused during surgery." d. "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."

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. 40 get/min b. 50 gtt/min c. 20 gtt.min d. 30 gtt/min

b. 50 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 man age 50 years b. a woman age 45 years c. an infant age 4 months d. an adolescent age 17 years

c. an infant age 4 months

The nurse is caring for a client receiving intravenous fluids through a peripheral intravenous catheter (IV). On rounds, the nurse notes that the client's IV site and arm are swollen and cool to the touch. Based on these assessment findings, what will the nurse do next? a. elevate the swollen extremity on a pillow b. decrease the rate of the intravenous fluids c. remove the peripheral intravenous catheter d. place a warm compress over the swollen site

c. remove the peripheral intravenous catheter

The primary extracellular electrolytes include which of the following? a. magnesium, sulfate, and carbon b. potassium, phosphate, and sulfate c. sodium, chloride, and bicarbonate d. phosphorous, calcium, and phosphate

c. sodium, chloride, and bicarbonate

The health care provider is concerned that the client has hypokalemia. During the physical examination, which question should the nurse ask the client? a. "have you been experiencing difficulty breathing?" b. "have you been having diarrhea?" c. "have you been experiencing chest pain?" d. "have you been experiencing muscle weakness or leg cramps?"

d. "have you been experiencing muscle weakness or leg cramps?"

Which client with a recent history of diarrhea should the nurse monitor most closely for fluid and electrolyte imbalances? a. School-age child with low body mass index b. Adult client with diabetes c. Adolescent with obesity d. Nine-month old infant

d. Nine-month old infant

A nurse is assessing clients across the lifespan for fluid and electrolyte balance. Which age group would the nurse identify as having the greatest risk for these imbalances? a. school-aged children b. adolescents c. toddlers d. infants

d. infants

The oncoming nurse is assigned to the following clients. Which client should the nurse assess first? a. a newly admitted 88-year-old with a 2-day history of vomiting and loose stools b. a 47-year-old who had a colon resection yesterday and is reporting pain c. a 20-year-old, 2 days postoperative open appendectomy who refuses to ambulate today d. a 60-year-old who is 3 days post-myocardial infarction and has been stable

a. a newly admitted 88-year-old with a 2-day history of vomiting and loose stools

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 pressure to insertion site for at least 3 minutes b. instruct client to remain flat for 30 minutes c. ask client to perform Valsalva maneuver d. apply petroleum-based ointment and sterile occlusive dressing

a. apply pressure to insertion site for at least 3 minutes

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. hyperchloremia c. hypomagnesemia d. hyperphosphatemia

a. hypokalemia

During an assessment of an older adult client, the nurse notes an increase in pulse and respiration rates, and notes that the client has warm skin. The nurse also notes a decrease in the client's blood pressure. Which medical diagnosis may be responsible? a. hypovolemia b. hypervolemia c. circulatory overload d. edema

a. hypovolemia

The client has a sodium level of 131 mEq/L and has been placed on fluid restrictions of 1,000 mL per day. What interventions would the nurse include in the plan of care to assist the client in adhering to the fluid restriction? Select all that apply. a. offer the client fluids in small container b. provide a moisturizer for the lips and mouth c. provide hard candies for the client to suck on d. remove the water pitcher from the client's bedside e. limit frequent oral hygiene for the client

a. offer the client fluids in small container b. provide a moisturizer for the lips and mouth d. remove the water pitcher from the client's bedside

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. potassium b. phosphorous c. calcium d. chloride

a. potassium

A client has been receiving intravenous (IV) fluids that contain potassium. The IV site is red and there is a red streak along the vein that is painful to the client. What is the priority nursing action? a. remove the IV b. apply a warm compress c. slow the rate of IV fluids d. elevate the arm

a. remove the IV

The nurse is performing an assessment for an older adult client admitted with dehydration. When assessing the skin turgor of this client, which area of the body will be best for the nurse to assess? a. sternum b. thigh c. hand d. abdomen

a. sternum

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. Respiratory alkalosis b. Metabolic alkalosis c. Respiratory acidosis d. Metabolic acidosis

b. Metabolic alkalosis

A nurse is providing care to a client who is on fluid restriction. Which action by the nurse would be most appropriate? a. Apply a petroleum-based gel to the client's lips to prevent cracking. b. Offer the client sugar-free candy to help combat thirst. c. Give the client a fluid containing additional sodium to enhance the feeling of fullness. d. Have the client use an alcohol-based mouthwash every 2 hours to reduce the thirst sensation.

b. Offer the client sugar-free candy to help combat thirst.

Which nursing concern will the nurse identify based on the effects of a fluid and electrolyte imbalance on human functioning? a. constipation due to immobility b. acute confusion due to cerebral edema c. infection risk due to inadequate personal hygiene d. pain due to surgical incision

b. acute confusion due to cerebral edema

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 antecubital fossa b. an implant central venous access device (CVAD) c. a midline peripheral catheter d. a peripheral venous catheter inserted to the cephalic vein

b. an implant central venous access device (CVAD)

A client is taking a diuretic such as furosemide. When implementing client education, what information should be included? a. decreased oxygen levels b. decreased potassium levels c. increased potassium levels d. increased sodium levels

b. decreased potassium levels

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. 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 b. discontinue the IV and relocate it to another site c. stop the infusion, cleanse the skin with alcohol, and apply transparent polyurethane dressing over the entry site d. call the primary care provider to see whenever anti-inflammatory drugs should be administered

b. discontinue the IV and relocate it to another site

The nurse has received the arterial blood gas (ABG) results. The ABG was drawn on a client who has been receiving oxygen via partial rebreather mask. Which assessment findings could indicate oxygen toxicity? Select all that apply. a. tachycardia b. headache c. nasal flaring d. fatigue e. sore throat

b. headache d. fatigue e. sore throat

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. phlebitis c. infiltration d. sepsis

b. phlebitis

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. start an IV of normal saline as prescribed c. encourage fluid intake d. allow nothing by mouth

b. start an IV of normal saline as prescribed

What is the priority goal for the activity in which the nurse is engaging, related to the administration of a prescribed IV solution? a. To demonstrate effective nursing care in the administration of the prescribed IV solution b. To assure effective administration of the prescribed IV solution c. To assure the IV solution is appropriate for this administration d. To provide for effective time management in the administration of the prescribed IV solution

c. To assure the IV solution is appropriate for this administration

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. turkey b. yogurt c. banana d. milk

c. banana

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. hypothyroidism c. hypokalemia d. hypocalcemia

c. hypokalemia

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 acidosis b. respiratory acidosis c. metabolic alkalosis d. respiratory alkalosis

c. metabolic alkalosis

A student nurse is selecting a venipuncture site for an adult client. Which action by the student would cause the nurse to intervene? a. asking the client to pump their fist several times b. palpating the veins on the non dominant hand c. placing the tourniquet on the upper arm for 2 minutes d. asking if the client is right or left handed

c. placing the tourniquet on the upper arm for 2 minutes

When considering client safety, what is the primary purpose of the action demonstrated by the nurse involved in preparing for the administration of a prescribed IV solution? a. introducing solution into the tubing b. visually assessing solution c. preventing embolus d. priming of IV tubing

c. preventing embolus

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. apply antiseptic and a dressing c. restart infusion in another vein and apply a warm compress d. elevate the client's head

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. infuse saline at a rapid rate c. stop the transfusion immediately d. prepare to give an antihistamine

c. stop the transfusion immediately

The nurse is preparing a packed red blood cell transfusion for a client. The nurse checks the client's blood type in the electronic medical record (EMR) and notes that it is blood type B. What does this mean? a. the client has anti-B antibodies b. the client has both anti-A and anti-B antibodies c. the client has anti-A antibodies d. the client is a universal donor

c. the client has anti-A antibodies

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. 75 mL/hr for the first 15 minutes, then 200 mL/hr b. 200 mL/hr c. as fast as the client can tolerate d. 1 unit over 2 to 3 hours, no longer than 4 hours

d. 1 unit over 2 to 3 hours, no longer than 4 hours

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. eat crackers and bread c. use an alcohol-based mouthwash to moisten your mouth d. avoid salty or excessively sweet fluids

d. avoid salty or excessively sweet fluids

An older adult has fluid volume deficit and needs to consume more fluids. Which approach by the nurse demonstrates gerontologic considerations? a. have a loved one tell the client to drink more b. leave water on the bedside table c. ask the client to drink more fluid d. offer small amounts of preferred beverage frequently

d. offer small amounts of preferred beverage frequently

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. a systemic blood infection b. rapid fluid administration c. an infiltration d. phlebitis

d. phlebitis