Fluids and Electrolytes, Acids and Bases - Adaptive Quiz

A nurse weighs a client. Which principle should the nurse remember? 1 liter of water weighs 2.2 lb (1 kg). 2 liters of water weigh 2.2 lb (1 kg). 3 liters of water weigh 2.2 lb (1 kg). 4 liters of water weigh 2.2 lb (1 kg).

*1 liter of water weighs 2.2 lb (1 kg).* 1 liter of water weighs 2.2 lb (1 kg). Thus 2 liters would weigh 4.4 lb (2 kg); 3 liters would weigh 6.6 lb (3 kg); and 4 liters would weight 8.8 lb (4 kg). p. 114

When planning care for a normal adult male client, what percentage of body weight is total body water? 40% 60% 80% 100%

*40%* Total body water is about 60% of body weight in a normal adult male client; 40% is too low, and 80% and 100% are too high. pp. 114

While the nurse is reviewing arterial blood gas results, which finding would indicate the adult client has a normal arterial blood pH? 2.0 5.5 7.4 8.0

*7.4* An acceptable range for arterial blood pH is 7.35 to 7.45; thus, 7.4 is normal. Gastric juices have a pH of 1.0 to 3.0. Urine pH is 5.0 to 6.0. Pancreatic fluid pH is 7.8 to 8.0. p. 127

A client has hyperkalemia. Which actions will the nurse take? Administer glucose Administer calcium gluconate Administer sodium bicarbonate Administer cation exchange resins Administer potassium supplements

*Administer glucose, Administer calcium gluconate, Administer sodium bicarbonate, Administer cation exchange resins* Calcium gluconate can be administered to restore normal neuromuscular irritability when serum potassium levels are dangerously high. Administration of glucose (which readily stimulates insulin secretion) or administration of both glucose and insulin for diabetic individuals facilitates cellular entry of potassium. Sodium bicarbonate corrects metabolic acidosis and lowers serum potassium concentration. Oral or rectal administration of cation exchange resins, which exchange sodium for potassium in the intestine, can be effective. Administration of potassium supplements is for hypokalemia. Administration of potassium supplements will make hyperkalemia worse. p. 125

The nurse plans care for a client with a serum potassium level of 3.0 mEq/L. The care should include which treatments? Administer insulin intravenously at 30 units/hr Administer sodium intravenously at 50 mEq/hr Administer cation exchange resin at 10 units/hr Administer potassium intravenously at 20 mEq/hr

*Administer potassium intravenously at 20 mEq/hr* A maximal safe rate of intravenous potassium replacement is 20 mEq/hr. A potassium level of 3.0 is hypokalemia. Administering insulin and cation exchange resin (which is not given in units) would cause the potassium to lower even further; in fact, these treatments are contraindicated for hypokalemia. Sodium would not help with hypokalemia. p. 124

When a client's body releases natriuretic peptides, which piece of equipment should the nurse obtain to determine a therapeutic effect? Thermometer Reflex hammer Stool specimen kit Blood pressure cuff

*Blood pressure cuff* Natriuretic peptides cause vasodilation and increase sodium and water excretion, decreasing blood pressure. Temperature, reflexes, and stools are not affected. p. 117

A nurse is caring for a client with hypernatremia. Which central nervous system assessment findings will the nurse typically observe? Coma Insomnia Confusion Convulsions Hallucinations

*Coma Confusion Convulsions* Hypernatremia causes osmotic shrinking of brain cells, which manifests as coma or confusion or convulsions. Hypernatremia does not usually cause insomnia or hallucinations. p. 120

Which clinical condition will cause the nurse to closely monitor a client for hypernatremia? Compulsive water drinking Excessive dietary potassium Decreased aldosterone secretion Decreased antidiuretic hormone secretion

*Decreased antidiuretic hormone secretion* Decreased antidiuretic hormone secretion is a cause of diabetes insipidus, which prevents water reabsorption in the kidneys, creating large volumes of dilute urine and leading to hypernatremia. Compulsive water drinking leads to water intoxication and hyponatremia. Excessive dietary potassium would not affect the serum sodium concentration. Oversecretion of aldosterone, not a decrease in aldosterone secretion, causes hypernatremia. p. 119

If a client in liver failure has a decreased production of protein, what pathophysiologic process will occur, resulting in edema? Increased release of aquaporins Decreased plasma oncotic pressure Increased production of volatile gases Decreased capillary membrane permeability

*Decreased plasma oncotic pressure* Lost or diminished plasma albumin production (e.g., from liver disease or protein malnutrition) contributes to decreased plasma oncotic pressure, leading to edema. Decreased capillary membrane permeability is not affected by a lack of protein; increased capillary membrane permeability occurs with inflammation and immune responses, leading to edema. Aquaporins are water channel proteins that provide permeability to water located on the cell membrane; therefore, aquaporins are not released. Volatile gases can be eliminated as carbon dioxide and do not relate to loss of protein. p. 116

Which situation will cause the nurse to closely monitor a client for hypokalemia? Diarrhea Oliguric renal failure Hyperparathyroidism Diabetic ketoacidosis

*Diarrhea* Diarrhea increases the amount of potassium lost in the feces, making one predisposed to hypokalemia. In diabetic ketoacidosis, extracellular hydrogen ions move into the cell in exchange for intracellular potassium, which results in hyperkalemia. Oliguric renal failure decreases potassium excretion and leads to hyperkalemia. Parathyroid hormone regulates changes in calcium concentration, not potassium concentration. p. 123

A client is receiving intravenous magnesium sulfate to prevent seizures. What assessment finding would indicate to the nurse that the infusion rate is too fast? Dry skin Sunken eyeballs Low serum magnesium levels Diminished deep tendon reflexes

*Diminished deep tendon reflexes* Hypermagnesemia causes decreased deep tendon reflexes. A low serum magnesium level, hypomagnesemia, would indicate that the rate is too slow, not too fast. Sunken eyeballs and dry skin occur with fluid deficit. p. 126

A client experiencing an isotonic fluid excess would have which clinical manifestations when the nurse performs an assessment? Edema Dry skin Weight gain Increased hematocrit Distended neck veins Decreased urinary output

*Edema Weight gain Distended neck veins* Edema, weight gain, and distended neck veins are signs of isotonic fluid excess. Decreased hematocrit, not increased, is a sign of hypervolemia. Decreased urinary output and dry skin are signs of hypovolemia or isotonic fluid loss. p. 119

Which change in laboratory values will the nurse assess as evidence of renal compensation for a client's respiratory acidosis? Elevated carbon dioxide Decreased carbon dioxide Elevated bicarbonate ion concentration Decreased bicarbonate ion concentration

*Elevated bicarbonate ion concentration* Renal compensation or respiratory acidosis occurs by elimination of hydrogen ions and retention of bicarbonate. Elevated carbon dioxide is evidence of respiratory acidosis, not of compensation for it. The lungs manage the carbon dioxide concentration. Decreased bicarbonate ion concentration would make the acidosis worse. p. 129

A client has a significant water deficit. Which assessment findings of dehydration will the nurse observe? Headache Increased skin turgor Decreased heart rate Decreased urine volume Increased blood pressure

*Headache Decreased urine volume* Clinical manifestations of dehydration include headache and decreased urine output. Heart rate increases with water deficits. Skin turgor decreases in dehydration. Blood pressure decreases in dehydration from a water deficit. p. 119

A client with oliguria from renal failure should be closely monitored by the nurse for which electrolyte imbalance? Hypokalemia Hyperkalemia Hypercalcemia Hypophosphatemia

*Hyperkalemia* The oliguric phase of renal failure decreases potassium excretion, which causes hyperkalemia. Hypokalemia would not occur in renal failure. Hypocalcemia and hyperphosphatemia occur in clients with chronic renal failure. p. 124

Which electrolyte imbalance is the client experiencing (see chart)?

*Hypocalcemia* Hypocalcemia is a low blood calcium level (less than 8.5 mg/dl) and causes increased neuromuscular excitability, tingling, and muscle spasms. Vital signs are normal. The potassium level is normal (3.5 to 5.0 mEq/L). Hypercalcemia would be a high blood calcium level (greater than 10 to 12 mg/dl) and would cause other signs and symptoms. p. 126

A client has metabolic alkalosis. The nurse should monitor for which electrolyte imbalance? Hypokalemia Hyperkalemia Hyponatremia Hypernatremia

*Hypokalemia* Potassium shifts from the extracellular fluid to the intracellular fluid in exchange for hydrogen to maintain plasma acid-base balance during respiratory or metabolic alkalosis. Metabolic alkalosis can lead to hypokalemia, not hyperkalemia. Metabolic alkalosis is not often associated with hyponatremia or hypernatremia. p. 123

A client has an acid-base imbalance. The nurse would expect the client's renal buffering system to respond in which manner? If metabolic alkalosis exists, the kidneys eliminate CO 2. If metabolic acidosis exists, the kidneys eliminate CO 2. If metabolic acidosis exists, the kidneys conserve H +ions. If metabolic alkalosis exists, the kidneys conserve H +ions.

*If metabolic alkalosis exists, the kidneys conserve H +ions.* If metabolic alkalosis exists in the body, the kidneys conserve H +ions to allow acid to accumulate to normal levels. If metabolic acidosis exists in the body, the kidneys do not conserve H +ions; they eliminate them. The lungs control the level of CO 2, not the kidneys. p. 126-127

A nurse is talking about alterations in calcium, phosphate, and magnesium. What is the nurse discussing? Imbalances in a client's acid levels Imbalances in a client's anion levels Imbalances in a client's glucose levels Imbalances in a client's electrolyte levels

*Imbalances in a client's electrolyte levels* Calcium, phosphate, and magnesium are all cations (positively charged) and electrolytes. The acid level is the amount of hydrogen in the body, which is indicated by carbonic acid levels. The anions are the negatively charged particles in the body. Glucose is a nonelectrolyte. p. 125

When a client begins to develop metabolic acidosis, the nurse expects to assess which breathing pattern? Increased rate and shallow depth Decreased rate and shallow depth Increased rate and increased depth Decreased rate and increased depth

*Increased rate and increased depth* The respiratory system adjusts the amount of carbonic acid that remains in the body when there is an excess of metabolic acids; therefore the rate and depth of respirations will increase (resulting in Kussmaul respirations) so that excess carbonic acid is removed. Increased respiratory rate with decreased depth does not occur; it would not resolve the existing problem. Decreased respiratory rate with increased depth does not occur; it would not resolve the existing problem. If too little carbonic acid is present in the blood, the rate and depth of the respirations will decrease to retain carbonic acid until it is once more present in normal amounts. p. 127

A nurse is assessing an infant who has dehydration. Which assessment findings will support this condition? Irritability Sunken fontanels Decreased heart rate Decreased urine output Decreased skin elasticity

*Irritability Sunken fontanels Decreased urine output Decreased skin elasticity* Symptoms of dehydration in infants include increased thirst, decreased urine output, decreased body weight, decreased skin elasticity, sunken fontanels, absent tears, dry mucous membranes, increased (not decreased) heart rate, and irritability. p. 131

Which information from the nurse indicates a correct understanding of the physiologic factor that has the most impact on the reabsorption of water into the client's capillary space from the interstitial space? It is capillary oncotic pressure. It is interstitial oncotic pressure. It is capillary hydrostatic pressure. It is interstitial hydrostatic pressure.

*It is capillary oncotic pressure.* Capillary oncotic pressure attracts water from the interstitial space back into the capillary. Interstitial oncotic pressure attracts water from the capillary into the interstitial space. Capillary hydrostatic pressure facilitates the outward movement of water from the capillary to the interstitial space. Interstitial hydrostatic pressure facilitates about 10% of the movement of fluid from the interstitial space into the vascular space. pp. 115

Which assessment findings are early manifestations of uncompensated metabolic acidosis in a client? Coma Lethargy Headache Muscle cramps Rapid respirations

*Lethargy Headache* Lethargy and headache are early manifestations of metabolic acidosis. Coma is a very late symptom of metabolic acidosis. Muscle cramps are not characteristic of metabolic acidosis. Deep rapid respirations are the compensatory mechanism for metabolic acidosis. p. 127

A nurse is teaching a client about magnesium. Which information should the nurse include? Magnesium is mainly stored in the bones. The normal serum magnesium level is 3.5 to 5.0 mEq/L. Alcohol-related diseases frequently cause low magnesium levels. Magnesium has an important role in smooth muscle contraction and relaxation. Vomiting is one symptom characteristic of decreased magnesium levels.

*Magnesium is mainly stored in the bones. Alcohol-related diseases frequently cause low magnesium levels. Magnesium has an important role in smooth muscle contraction and relaxation.* Chronic alcoholism is a major risk factor for hypomagnesemia, because it is associated with decreased magnesium intake. Magnesium has an important role in smooth muscle contraction and relaxation. About 40% to 60% of the body's magnesium is stored in the bone. The normal serum level is 1.8 to 3.0 mEq/L. Potassium is the element whose normal serum level is 3.5 to 5.0 mEq/L. Vomiting is characteristic of hypermagnesemia. p. 126

Which conditions would require the nurse to administer magnesium replacement therapy? Malnutrition Chronic alcoholism Adrenal insufficiency Hyperparathyroidism Malabsorption syndromes

*Malnutrition Chronic alcoholism Malabsorption syndromes* Hypomagnesemia is common with malnutrition, malabsorption syndromes, and chronic alcoholism, which require replacement therapy. Adrenal insufficiency is a cause of hypermagnesemia. Hyperparathyroidism causes hypercalcemia and has no direct effect on magnesium levels. p. 123

A client's laboratory test results reveal decreased arterial pH and bicarbonate levels. The nurse interprets these results to determine that the client is experiencing which acid-base imbalance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

*Metabolic acidosis* Decreases in arterial pH and bicarbonate occur with metabolic acidosis. Metabolic alkalosis occurs if pH and bicarbonate levels are elevated. Respiratory acidosis occurs when pH is decreased and carbon dioxide is elevated, whereas respiratory alkalosis occurs when pH is elevated and carbon dioxide is decreased. pp. 127

The nurse assesses a client with diarrhea for clinical manifestations of which acid-base imbalance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

*Metabolic acidosis* Diarrhea causes metabolic acidosis through bicarbonate excretion. Vomiting can cause metabolic alkalosis. Diarrhea causes a metabolic acid-base imbalance rather than a respiratory one. p. 127

A client has respiratory alkalosis and develops carpopedal spasms. What will the nurse observe upon assessment? Muscle spasms in the face and neck Muscle spasms in the fingers and toes Muscle spasms in the abdomen and back Muscle spasms in the chest and shoulders

*Muscle spasms in the fingers and toes* Carpopedal spasms are spasms of muscles in the fingers and toes. The spasms do not occur in the face, neck, abdomen, back, chest, or shoulders. p. 130

Which client should the nurse monitor carefully for signs of metabolic acidosis? One that has had diarrhea for over a week One that has paralysis of the respiratory muscles One that has depression of the respiratory center One that has had vomiting for over a 3-day period

*One that has had diarrhea for over a week* Diarrhea causes increased excretion of the base bicarbonate, which can lead to metabolic acidosis. Vomiting would lead to metabolic alkalosis. Depression of the respiratory center and paralysis of the respiratory muscles would lead to respiratory, not metabolic, acidosis. p. 127

A client's osmoreceptors are stimulated. Which action should the nurse take? Provide oxygen Provide quiet time Provide salty foods Provide a glass of water

*Provide a glass of water* Increased osmolality stimulates hypothalamic osmoreceptors. In addition to causing thirst, these osmoreceptors signal the posterior pituitary gland to release antidiuretic hormone. Thirst stimulates water drinking. Salty foods would make the situation worse. Quiet time and oxygen are not needed. p. 118-119

A child is diagnosed with starvation ketoacidosis (a metabolic acidosis). What clinical manifestations should the nurse anticipate when assessing the child? Rapid, deep breathing, lethargy, abdominal pain Rapid, deep breathing, tremors, attention deficit disorder Slow, shallow breathing, belligerence, hyperexcitability Slow, shallow breathing, numbness and tingling around the mouth

*Rapid, deep breathing, lethargy, abdominal pain* Rapid, deep breathing, lethargy, and abdominal pain are clinical manifestations of metabolic acidosis and its respiratory compensation. Slow, shallow breathing, belligerence, hyperexcitability, attention deficit disorder, and numbness and tingling around the mouth are not clinical manifestations of metabolic acidosis and its respiratory compensation. Tremors and elevated blood pressure are not clinical manifestations of metabolic acidosis. p. 127

A client's serum sodium level is 150 mEq/L. The nurse expects which changes in the client's serum chloride and bicarbonate levels? Serum chloride, 92 mEq/L Serum chloride, 115 mEq/L Serum chloride, 100 mEq/L Serum bicarbonate, 30 mEq/L Serum bicarbonate, 18 mEq/L Serum bicarbonate, 25 mEq/L

*Serum chloride, 115 mEq/L Serum bicarbonate, 18 mEq/L* A serum sodium level greater than 145 mEq/L is hypernatremia. Increased serum chloride levels (greater than 105 mEq/L) and decreased serum bicarbonate levels (less than 24 mEq/L) occur in clients with hypernatremia. Chloride changes follow a direct relationship to changes in serum sodium. Bicarbonate levels are decreased in this situation, especially if the client is experiencing metabolic acidosis. Normal serum chloride is 103 mEq/L. Normal serum bicarbonate is 24 mEq/L. p. 119

A nurse is assessing a client. Which findings will cause a shift of potassium into the client's cells? The client has alkalosis. The client received insulin. Aldosterone is released in the client's body. Epinephrine is released in the client's body. Strenuous exercise is performed by the client.

*The client has alkalosis. The client received insulin. Aldosterone is released in the client's body. Epinephrine is released in the client's body.* Insulin, aldosterone, epinephrine, and alkalosis facilitate the shift of potassium into cells. Insulin deficiency, aldosterone deficiency, acidosis, cell lysis, and strenuous exercise facilitate the shift of potassium out of cells. p. 122

A nurse is asked by a client what regulates potassium levels. How should the nurse respond? The lungs The glands The kidneys The stomach

*The kidneys* Although potassium is found in most body fluids, the kidney is the most efficient regulator of potassium balance. The lungs regulate carbon dioxide. The glands regulate hormones. The stomach regulates acid release for digestion. p. 122

The nurse plans care to manage edema for a client with which conditions? Fever Dehydration Thrombophlebitis Protein malnutrition Cirrhosis of the liver

*Thrombophlebitis Protein malnutrition Cirrhosis of the liver* Edema formation occurs in thrombophlebitis owing to venous obstruction and increased capillary hydrostatic pressure. Protein malnutrition is associated with decreased plasma oncotic pressure and edema formation. Edema occurs in cirrhosis of the liver as a result of sodium and water retention leading to increased capillary hydrostatic pressure. Cirrhosis also contributes to decreased plasma proteins and decreased plasma oncotic pressure, causing edema formation. Fever and dehydration cause fluid volume deficits and do not contribute to edema formation. p. 115-116

A nurse is teaching the staff about body fluid movement. Which information should the nurse include in the teaching session? Potassium is the most abundant extracellular fluid (ECF) ion. Aquaporins block water movement across the membrane. Water moves between ICF and ECF compartments by osmotic forces. Sodium maintains the osmotic balance of the intracellular fluid (ICF) space.

*Water moves between ICF and ECF compartments by osmotic forces.* Water moves between ICF and ECF compartments primarily as a function of osmotic forces. Aquaporins are a family of water channel proteins that provide permeability to water at the capillary membrane. Sodium is the major ECF cation, and potassium is the major ICF cation. Potassium maintains the ICF osmotic balance. p. 115

Which individual has the highest percentage of total body water (TBW) in relation to body weight? Newborn Obese man Obese child Lean woman

*newborn* In newborns, TBW is about 70% to 80% of body weight, because newborns store less fat. TBW is 50% for an obese child, 50% for an obese man, and 60% for a lean woman. p.115

A nurse is teaching about the process responsible for movement of water between the client's interstitial and intracellular compartments. Which process is the nurse describing? Diffusion Osmosis Filtration Active transport

*osmosis* Movement of water between the interstitial and intracellular compartments occurs by the process of osmosis. Filtration is responsible for the distribution of fluid between the vascular and interstitial compartments. Diffusion involves movement of particles, not movement of water. Active transport moves ions across membranes, but it does not move water. p. 131

Which cation does aldosterone regulate in a client's body? Sodium Calcium Chloride Magnesium

*sodium* Hormonal regulation of sodium (and potassium) balance is mediated by aldosterone, a mineralocorticoid synthesized and secreted from the adrenal cortex as a component of the renin-angiotensin-aldosterone system. Sodium is a cation. Chloride is an anion. Calcium is a cation, but it is regulated not by aldosterone but by parathyroid hormone. Magnesium is not regulated by aldosterone. p. 117

A nurse is monitoring a client's intake and output. Which area should have the highest volume of daily fluid loss? Skin Stool Urine Lungs

*urine* The largest volume of fluid is excreted in the urine (1400 to 1800 ml/day). Fluid loss via the skin is 300 to 500 ml/day. The lung's loss is 600 to 800 ml/day. About 100 ml/day is lost via the stool. p. 119