Quiz - Fluid & Electrolyte & Acid-Base Balance - Med Surg

A client with renal failure enters the emergency room after skipping three dialysis treatments to visit family out of town. Which set of ABGs would indicate to the nurse that the client is in a state of metabolic acidosis? a. pH of 7.33, pCO2 of 35, HCO3 of 17 b. pH of 7.43, pCO2 of 36, HCO3 of 26 c. pH of 7.41, pCO2 of 49, HCO3 of 30 d. pH of 7.25, pCO2 of 56, HCO3 of 28

ans: a A pH of 7.33, PCO2 of 35, and HCO3 of 17 and a pH of 7.25, PCO2 of 56, and HCO3 of 28 both indicate acidosis. The pH of 7.25 is a respiratory acidosis. A pH of 7.41, PCO2 of 49, and HCO3 of 30 is a compensated metabolic alkalosis. A pH of 7.43, PCO2 of 36, and HCO3 of 26 is normal.

The nurse evaluates which of the following clients to be at higher risk for developing hypernatremia? a. 50-year-old with pneumonia, diaphoresis, and high fevers b. 62-year-old with congestive heart failure taking loop diuretics c. 39-year-old with diarrhea and vomiting d. 60-year-old with lung cancer and syndrome of inappropriate antidiuretic hormone (SIADH)

ans: a Diaphoresis and a high fever can lead to free water loss through the skin, resulting in hypernatremia. Loop diuretics are more likely to result in a hypovolemic hyponatremia. Diarrhea and vomiting cause both sodium and water losses. Clients with syndrome of inappropriate antidiuretic hormone (SIADH) have hyponatremia, due to increased water reabsorption in the renal tubules.

What two organs in the body serve as a compensatory function to maintain acid base balance? a. Kidneys and Lungs b. Lungs and Spleen c. Heart and Liver d. Gallbladder and Appendix

ans: a The carbonic acid concentration is controlled by the amount of carbon dioxide excreted by the lungs. The bicarbonate concentration is controlled by the kidneys, which selectively retain or excrete bicarbonate in response to the body's needs.

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

ans: a 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.

Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment? a. Metabolic Acidosis, Partially, Compensated b. Respiratory Acidosis, Partially Compensated c. Respiratory Acidosis, Uncompensated d. Metabolic Alkalosis, Uncompensated

ans: a The student was diagnosed having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).

Which of the following should the nurse include in the diet teaching for a client with a sodium level of 158 mEq/L? a. Baked chicken b. Pretzels c. Chicken bouillon d. Baked potato e. Baked ham

ans: a, d Normal serum sodium is between 135 and 145 mEq/L. A sodium level of 158 mEq/L is elevated and a low sodium diet should be prescribed. A peanut butter sandwich, pretzels, chicken bouillon, and baked ham are all foods high in sodium content. Baked chicken and baked potato are low-sodium food choices.

The nurse writes the nursing problem of "fluid volume excess" (FVE). Which intervention should be included in the plan of care? a. Change the IV fluid from 0.9% NS to D5W. b. Restrict the client's sodium in the diet. c. Monitor blood glucose levels. d. prepare the client for hemodialysis

ans: b Fluid volume excess refers to an isotonic expansion of the extracellular fluid by an abnormal expansion of water and sodium. Therefore sodium is restricted to allow the body to excrete the extra volume.

You are admitting an elderly client to the medical unit. Which factor indicates that this client has a risk for acid-base imbalances? a. Myocardial infarction 1 year ago b. Chronic renal insufficiency c. Occasional use of antacids d. Shortness of breath with extreme exertion

ans: b Risk factors for acid-base imbalances in the older adult include chronic renal disease and pulmonary disease. Occasional antacid use will not cause imbalances, although antacid abuse is a risk factor for metabolic alkalosis.

A client recently diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) complains of headache, weight gain, and nausea. Which of the following is an appropriate nursing diagnosis for this client? a. Deficient fluid volume related to decreased fluid intake b. Excess fluid volume related to increased water retention c. Deficient fluid volume related to excessive fluid loss d. Risk for injury related to fluid volume loss

ans: b The client exhibits signs of excess fluid volume. Syndrome of inappropriate antidiuretic hormone (SIADH) is the release of excess ADH by the pituitary gland, which results in hypervolemic

A client with a serum sodium of 115 mEq/L has been receiving 3% NS at 50 ml/hr for 16 hours. This morning the client feels tired and short of breath. Which of the following interventions is a priority? a. Turn down the infusion b. Check the latest sodium level c. Assess for signs of fluid overload d. Place a call to the physician

ans: c

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition would be a cause for these findings? a. overhydration b. anemia c. dehydration d. renal failure

ans: c Dehydration results in concentrated serum that causes lab values to increase because the blood has normal constituents but not enough volume to dilute the values to within normal range or possibly lower.

A client who is admitted with malnutrition and anorexia secondary to chemotherapy is also exhibiting generalized edema. The client asks the nurse for an explanation for the edema. Which of the following is the most appropriate response by the nurse? a. "The fluid is an adverse reaction to chemotherapy." b. "A decrease in activity has allowed extra fluid to accumulate in the tissues." c. "Poor nutrition has caused decreased blood protein levels, and fluid has moved from the blood vessels into the tissues." d. "Chemotherapy has increased your blood pressure, and fluid was forced out into the tissues."

ans: c Generalized edema, or anasarca, is often seen in clients with low albumin levels secondary to poor nutrition. Decreased oncotic pressure within the blood vessels allows fluid to move from the intravascular space to the interstitial space.

The nurse evaluates which of the following clients to have hypermagnesemia? a. A client who has chronic alcoholism and a magnesium level of 1.3 mEq/L b. A client who has hyperthyroidism and a magnesium level of 1.6 mEq/L c. A client who has renal failure, takes antacids, and has a magnesium level of 2.9 mEq/L d. A client who has congestive heart disease, takes a diuretic, and has a magnesium level of 2.3 mEq/L

ans: c Normal serum magnesium is 1.5 to 2.5 mEq/L. Clients who have chronic alcoholism and hyperthyroidism are prone to hypomagnesemia. A client who has congestive heart failure, takes a diuretic, and has a magnesium level of 2.3 mEq/L falls within the normal magnesium range.

ABG interpretation: pH: 7.33 pCO2: 22 HCO3: 21 a. Partially compensated respiratory acidosis b. Normal ABG results c. Uncompensated metabolic acidosis d. Partially compensated metabolic acidosis

ans: d

A client with chronic renal failure reports a 10 pound weight loss over 3 months and has had difficulty taking calcium supplements. The total calcium is 6.9 mg/dl. Which of the following would be the first nursing action? a. Assess for depressed deep tendon reflexes b. Call the physician to report calcium level c. Place an intravenous catheter in anticipation of administering calcium gluconate d. Check to see if a serum albumin level is available

ans: d A client with chronic renal failure who reports a 10 pound weight loss over 3 months and has difficulty taking calcium supplements is poorly nourished and likely to have hypoalbuminemia. A drop in serum albumin will result in a false low total calcium level. Placing an IV is not a priority action. Depressed reflexes are a sign of hypercalcemia. Normal serum calcium is 9 to 11 mg/dl

The nurse is evaluating the serum laboratory results on the following four clients. Which of the following laboratory results is a priority for the nurse to report first? a. A client with osteoporosis and a calcium level of 10.6 mg/dl b. A client with renal failure and a magnesium level of 2.5 mEq/L c. A client with bulimia and a potassium level of 3.6 mEq/L d. A client with dehydration and a sodium level of 149 mEq/L

ans: d Although a client with acute osteoporosis may have a high serum calcium, a level of 10.6 mg/dl is normal. Normal serum calcium is 9 to 11 mg/dl. Normal serum magnesium is 1.5 to 2.5 mEq/L. A client who has renal failure is prone to hypermagnesemia, but a level of 2.5 mEq/L is at the upper limit of normal. A client who has bulimia generally vomits enough to result in a low potassium level, but a potassium level of 3.6 mEq/L is low normal. Normal serum potassium is 3.5 to 5.5 mEq/L. Normal serum sodium is 135 to 145 mEq/L. The sodium level generally goes up with dehydration. A sodium level of 149 mEq/L is elevated.

A client with COPD feels short of breath after walking to the bathroom on 2 liters of oxygen nasal cannula. The morning's ABGs were pH of 7.36, PaCO2 of 62, HCO3 of 35 mEq/L, O2 at 88% on 2 liters. Which of the following should be the nurse's first intervention? a. Call the physician and report the change in client's condition b. Turn the client's O2 up to 4 liters nasal cannula c. Encourage the client to sit down and to take deep breaths d. Encourage the client to rest and to use pursed-lip breathing technique

ans: d Clients with COPD, especially those who are in a chronic compensated respiratory acidosis, are very sensitive to changes in O2 flow, because hypoxemia rather than high CO2 levels stimulates respirations. Deep breaths are not helpful, because clients with COPD have difficulty with air trapping in alveoli. There is no need to call the physician, since this client is presently most likely at baseline.

A client with pancreatitis has been receiving potassium supplementation for four days since being admitted with a serum potassium of 3.0 mEq/L. Today the potassium level is 3.1 mEq/L. Which of the following laboratory values should the nurse check before notifying the physician of the client's failure to respond to treatment? a. Sodium b. Phosphorus c. Calcium d. Magnesium

ans: d Low serum magnesium levels can inhibit potassium ions from crossing cell membranes, resulting in potassium loss through the urine. Generally, low magnesium levels must be corrected before potassium replacement is effective.

A client with chronic renal failure receiving dialysis complains of frequent constipation. When performing discharge teaching, which over-the-counter products should the nurse instruct the client to avoid at home? a. Bisacodyl (Dulcolax) suppository b. Fiber supplements c. Docusate sodium d. Milk of magnesia

ans: d Milk of magnesia contains magnesium, an electrolyte that is excreted by kidneys. Clients with renal failure are at risk for hypermagnesemia, since their bodies cannot excrete the excess magnesium. The client should avoid magnesium-containing laxatives.

A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results? pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

ans: d The pH indicates that the patient has alkalosis and the low PaCO2 indicates a respiratory cause. The other responses are incorrect based on the pH and the normal HCO3.