ac exam 3

What is the expected lab value for sodium?

135-145

Fluid that has the same osmolality as the cell's interior would be identified as which of the following fluids? a. isotonic fluid b. hypotonic fluid c. hypertonic fluid d. latrogenic fluid

a

An arterial blood gas report indicates the client's pH is 7.25 (acidosis decreased), PCO2 is 35 (normal), HCO3 is 20 (decreased). Which disturbance would the nurse identify based on these results a) metabolic acidosis b) metabolic alkalosis c) respiratory acidosis d) respiratory alkalosis

a (low pH and low HCO3)

What is the fluid between cells and tissues called? a. plasma b. interstitial fluid c. intracellular fluid d. floating fluid

b

Which of the following is the movement of molecules low to high concentration? a. diffusion b. osmosis c. hydrostatic pressure d. oncotic pressure

b

Which diagnosis is suspected by the nurse when the laboratory data for a client with prolonged vomitting reveal arterial blood gases of pH 7.51 (alkalosis), a PCO2 of 45 (normal), HCO3 of 59 (elevated), and a serum potassium level or 3.8 (normal) a) hypocapnia b) hyperkalemia c) metabolic alkalosis d) respiratory acidosis

c (Elevated plasma pH and elevated bicarbonate levels support metabolic alkalosis. The arterial carbon dioxide level of 50 mm Hg is elevated more than the expected value of 35 to 45 mm Hg; hypercapnia, not hypocapnia, is present. The client's serum potassium level is within the expected level of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). With respiratory acidosis the pH will be less than 7.35.)

Identify each of the following manifestations as a manifestation related to hypovolemia a. Splenomegaly b. Edema c. Decreased skin turgor d. Decreased blood pressure e. Sunken fontanels (in an infant) e. JVD g. Crackles

c, d, e

Normal homeostasis of fluid is an example of which of the following fluid spacing? a. 1st spacing b. 2nd spacing c. 3rd spacing d. 4th spacing

a

What is the fluid left over in the blood if you remove WBC, RBC, and platelets and where antibodies and electrolytes are found? a. plasma b. interstitial fluid c. intracellular fluid d. floating fluid

a

Which of the following would the nurse be sure to include in the patient's fluid intake and output. Select all that apply a. Jell-O b. Pudding c. Chicken pot pie d. Emesis e. Formed stool f. IV meds g. Rice h. Enteral feedings

a, b, d, f, h

Identify each of the following manifestations as a manifestation related to hypervolemia a. Splenomegaly b. Edema c. Decreased skin turgor d. Decreased blood pressure e. Sunken fontanels (in an infant) e. JVD g. Crackles

a, b, f, g

Which mineral deficiency would a nurse suspect in a client who reports tingling in the fingers and around the mouth and exhibits carpopedal spasms and tremors after a surgical thyroidectomy? a) potassium b) calcium c) magnesium d) sodium

b (hypocalcemia when no parathyroid glands. calcium gluconate is antidote for hypocalcemia)

When monitoring a client for hyponatremia, which assessment findings would the nurse consider significant? a) thirst b) seizures c) erythema d) confusion e) constipaion

b, d (Confusion and seizures are associated with hyponatremia. Cellular swelling and cerebral edema are associated with hyponatremia; as extracellular sodium level decreases, the cellular fluid becomes relatively more concentrated and pulls water into cerebral cells, leading to confusion and seizures. Thirst is a symptom of hyper-natremia; it may indicate dehydration. Erythema is not associated with hyponatremia. Diarrhea, not constipation, is associated with hyponatremia)

Which fluid shift would the nurse anticipate when administering albumin intravenously? a) interstitial compartment to the intracellular compartment b) intravascular compartment to the interstitial compartment c) interstitial compartment to the intravascular compartment d) extracellular compartment to the intracellular compartment

c (IV albumin increases colloid osmotic pressure

Which of the following bodily mechanisms allows fluid to stay in the intravascular space and out of the interstitial fluid space through the force generated by plasma proteins (such as albumin) a. diffusion b. osmosis c. hydrostatic pressure d. oncotic pressure

d

Which assessment finding in a client signifies a mild form of hypocalcemia? a) seizures b) hand spasms c) severe muscle cramps d) numbness around the mouth

d (A numbness or tingling sensation around the mouth or in the hands and feet indicates mild-to-moderate hypocalcemia. Seizures, hand spasms, and severe muscle cramps are associated with severe hypocalcemia._

Which arterial blood gas report is indicative of diabetic ketoacidosis (metabolic acidosis) a) PCO2 49, HCO3 32, pH 7.5 b) PCO2 26, HCO3 20, pH 7.52 c) PCO2 54 (elevated), HCO3 28 (elevated), pH 7.30 (acidosis decreased) d) PCO2 28 (decreased), HCO3 18 (decreased, pH 7.28 (decreased)

d (Decreased pH and bicarbonate values reflect metabolic acidosis; a decreased PCO 2 value indicates compensatory hyperventilation. Increased pH and bicarbonate values reflect metabolic alkalosis; an increased PCO 2 value indicates compensatory hypoventilation. Increased pH and decreased PCO 2 values reflect hyperventilation and respiratory alkalosis. Decreased pH and increased PCO 2 values reflect hypoventilation and respiratory acidosis.)

Which electrolyte found in intracellular fluid would the nurse consider most important? a) sodium b) calcium c) chloride d) potassium

d (The concentration of potassium is greater inside the cell and is important in establishing a membrane potential, a critical factor in the cell's ability to function. sodium is the most abundant cation of the extracellular compartment. calcium is the most abundant electrolyte in the body 99% concentrated in the teeth and bones and only 1% is available for bodily functions. chloride is extracellular not intracellular anion)

The arterial blood gases for a client with acute respiratory distress are pH 7.30 (decreased acidosis), PaO2 80 (normal), PaCO2 55 (elevated), and HCO3 23 (normal). How would the nurse interpret these findings? a) hypoxemia b) hypocapnia c) compensated metabolic acidosis d) uncompensated respiratory acidosis

d (increased PaCO2 indicates respiratory acidosis and the low pH and normal HCO3 indicates that it's uncompensated.)

The nurse caring for a client receiving magnesium sulfate observes respirations of 10 breaths/minute, heart rate of 68 beats/minute, and blood pressure of 88/50 mm Hg. After discontinuing the magnesium sulfate, which priority action would the nurse take? a) administer oxygen b) initiate rescue breathing c) initiate a bolus of intravenous (IV) fluid d) administer calcium gluconate

d (the client is experiencing magnesium sulfate toxicity, which can be reversed with calcium gluconate. if left untreated, magensium sulfate toxicity can result in respiratory or cardiac arrest. oxygen, rescue breathing, and and IV fluid bolus will not reverse the effect of the magnesium sulfate)

Which baseline assessment data would the nurse obtain on a client with preeclampsia before initiation of a magnesium sulfate infusion? a) patellar reflex b) urine outpout c) respiratory pressure d) blood pressure e) urine specific gravity

(A baseline measurement of the patellar reflex should be obtained, because magnesium sulfate is a central nervous system depressant; an absence of patellar reflexes indicates magnesium sulfate toxicity. Magnesium sulfate is excreted by way of the kidneys; adequate urine output is necessary to prevent toxicity. Magnesium sulfate is a central nervous system depressant; a slowed respiratory rate is a sign of magnesium sulfate toxicity. Magnesium sulfate may cause a decrease in blood pressure in high doses. The urine specific gravity test is not used before, during, or after magnesium sulfate therapy.)

Which client would a nurse recognize as having an age-related impairment of the thirst mechanism when reviewing the laboratory reports of a group of older adult clients? a) Na 167 b Na 143 c) Na 118 d) Na 101

a (Older adult clients are at greater risk Offluid and electrolyte imbalances such as dehydration and hypernatremia due to age—related impairment of the thirst mechanism. The normal serum sodium concentration is between 135 and 145 mEq/L. ClientA has a serum sodium concentration Of 167 mEq/L, which is higher than normal, thereby indicating hypernatremia. Client B has a serum sodium concentration of 143 mEq/L, which is a normal value. The serum sodium concentration of client C is 136 mEq/L, which is a normal value. Client D has a serum sodium concentration of 140 mEq/L, which is in the normal range.)

Which ion is the regulator of extracellular osmolarity? a) sodium b) potassium c) chloride d) calcium

a (Rationale: Sodium is the most abundant extracellular fluid cation and regulates serum (extracellular) osmolarity, as well as nerve impulse transmission and acid-base balance. Potassium is the major intracellular osmolarity regulator, and it also regulates metabolic activities, transmission and conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction. Chloride is a major extracellular fluid anion and follows sodium. Calcium is an extracellular cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac conduction, transmission of nerve impulses, and muscle contraction)

Which nursing action is the priority for a client who has a serum potassium level of 6.7? a) monitor for cardiac dysrythmias b) inquire about changes in bowel patterns c) assess for leg muscle twitching or weakness d) assess for signs and symptoms of dehydration

a (Severe bradycardia and slowing of the cardiac conduction system are the most severe complications of hyperkalemia and are the most common cause of death from hyperkalemia. Changes in bowel patterns, leg muscle twitching, and weakness are signs of hyperkalemia but are not life threatening. Dehydration may be a cause of hyperkalemia.)

The arterial blood gas for a 3 month old infant with diarrhea showed that the pH is 7.30 (decreased acidosis). PCO2 is 35 (normal), and HCO3 is 17 (decreased). a) metabolic acidosis b) metabolic alkalosis c) respiratory acidosis d) respiratory alkalosis

a (The blood pH indicates acidosis; the bicarbonate (HCO 3 -) level is further from the expected range than is the partial pressure of carbon dioxide (Pco 2), indicating a metabolic origin (losses from diarrhea), not a respiratory origin. The blood pH indicates acidosis, not alkalosis.)

A client is diagnosed with parathyroid dysfunction. Which serum calcium concentration supports the diagnosis? a) 7.8 b) 8.9 c) 9.7 d) 10.2

a (The normal serum calcium concentration ranges from 8.6 to 10.2 mg/dL. A serum calcium concentration below 8.6 mg/dL indicates hypocalcemia and a serum calcium concentration above 10.2 mg/dL indicates hypercalcemia. Parathyroid hormone maintains calcium balance in the body. Hypocalcemia reflects hypoparathyroidism and hypercalcemia suggests hyperparathyroidism. The serum calcium concentration of 7.8 mg/dL is below the normal range and indicates hypocalcemia. Therefore, the client may have hypoparathyroidism, which is a parathyroid dysfunction. Serum calcium concentrations of 8.9 mg/dL, 9.7 mg/dL, and 10.2 mg/dL are all normal findings.)

Which complication would the nurse suspect when the cardiac monitor shows the appearance of a U wave in a client being treated with intravenous fluids and insulin for diabetic ketoacidosis when the client develops peripheral paresthesias and shortness of breath? a) hypokalemia b) hypoglycemia c) hypernatremia d) hypercalcemia

a (These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Clinical manifestations of hyponatremia include nausea, malaise, and changes in mental status. Clinical manifestations of hyperglycemia include weakness, dry skin, flushing, polyuria, and thirst. Clinical manifestations of hypercalcemia include lethargy, nausea, vomiting, paresthesias, and personality changes.)

Which process is responsible for the shift of body fluids associated with intravenous administration of albumin? a) osmosis b) diffusion c) active transport d) hydrostatic pressure

a (albumin increases intravascular solute concentration. osmosis is the movement of fluid from an area of lesser solute concentration to an area of greater solute concentration. Hydrostatic pressure, the pressure exerted within a closed system, is known as filtration force. Filtration is the passage of fluid through a material that prevents the passage of certain constituents; hydrostatic pressure moves fluid by pressure and concentration gradients)

When arterial blood gas results for an alert client who is in the post anesthesia care unit (PACU) after abdominal surgery are pH 7.37, PaCO2 42, HCO3 25, PaO2 65 and SaO2 90, which action would the nurse take? a) increase the oxygen flow rate b) insert an oropharyngeal airway c) suction the oropharynx and upper trachea d) prepare to transfer the client out of the PACU

a (because the arterial blood gases indicate mild hypoxemia and normal acid-base balance, the nurse would increase the oxygen flow rate. insertion of an oropharyngeal airway is unnecessary and contraindicated in an alert client because it will activate the gag reflex. there is no indication that the client needs suctioning. because the client is hypoxemia, further monitoring and anesthesia recovery are needed before transferring from the PACU)

Which electrolyte disorder would the nurse consider when a client's telemetry monitor shows flattening T waves and peaked P waves? a) hypokalemia b) hypocalcemia c) hyponatremia d) hypomagnesemia

a (flattened or inverted T waves, peaked T waves, depressed ST segments, and elevated U waves are associated with hypokalemia. Prolongation in the QT interval may indicate hypocalcemia. Hyponatremia is not reflected in the heart's electrical condition. Although flattening of T waves may occur with hypomagnesemia, the ST segment may be shorted, and the PR and QRS intervals may be prolonged)

Which blood gas result would the nurse expect an adolescent with diabetic ketoacidosis to exhibit? a) pH 7.3, CO2 40, HCO3 20 b) pH 7.35, CO2 47, HCO3 24 c) pH 7.46, CO2 30, HCO3 24 d) pH 7.5, CO2 50, HCO3 22

a (metabolic acidosis. same signs, ph acidic. A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO 3 - will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO 2 ranges from 35 to 45 mm Hg, and HCO 3 - ranges from 22 to 26 (22 to 26 mmol/L). A pH of 7.35 and a CO 2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.)

Which arterial blood pH would the nurse expect a client in a state of uncompensated acidosis to have? a) 7.20 b) 7.35 c) 7.45 d) 7.48

a (the pH of blood is maintained within the narrow range of 7.35-7.45. When there is an increase in hydrogen ions, the respiratory, buffer, and renal systems attempt to compensate to maintain the pH. If compensation is not successful, acidosis results and is reflected in a lower pH)

which early sign of respiratory acidosis would the nurse exhibit the client with a restrictive airway disease to exhibit? select all that apply a) headache b) irritability c) restlessness d) hypertension e) lightheadedness

a, b, c (Headache is a symptom of cerebral hypoxia associated with early respiratory acidosis. Irritability is a sign of cerebral hypoxia associated with early respiratory acidosis. Restlessness is a sign of cerebral hypoxia associated with early respiratory acidosis. Hypotension, not hypertension, is a key feature of acidosis. Lightheadedness is a symptom of respiratory alkalosis, not acidosis.)

Which cation regulates intracellular osmolarity? a) sodium b) potassium c) calcium d) calcitonin

b (A decrease in serum potassium causes a decrease in the cell wall pressure gradient and results in water moving out of the cell. Besides intracellular osmolarity regulation, potassium also regulates metabolic activities, transmission and conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction. Sodium is the most abundant extracellular cation that regulates serum osmolarity as well as nerve impulse transmission and acid-base balance. Calcium is an extracellular cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac conduction, transmission of nerve impulses, and muscle contraction. Calcitonin is a hormone secreted by the thyroid gland and works opposite of parathormone to reduce serum calcium and keep calcium in the bones. Calcitonin does not have a direct effect on intracellular osmolarity.)

When the nurse is reviewing a client's arterial blood gas results, which finding would the nurse identify as being consistent with respiratory alkalosis? a) a decreased pH, elevated PCO2 b) an elevated pH, decreased PCO2 c) a decreased pH, decreased PCO2 d) an elevated pH, elevated partial pressure of carbon dioxide (PCO2)

b (In respiratory alkalosis the pH level is elevated because of loss of hydrogen ions; the PCO2 level is low because carbon dioxide is lost through hyperventilation. An elevated pH, elevated PCO2 is partially compensated metabolic alkalosis. A decreased pH, elevated PCO2 is respiratory acidosis. A decreased pH, decreased PCO2 is metabolic acidosis with some compensation.)

Which complication would a nurse try to avoid by slowly administering a parenteral predation of potassium? a) metabolic acidosis b) cardiac arrest c) seizure activity d) respiratory depression

b (Too rapid administration can cause hyperkalemia, which contributes to a long refractory period in the cardiac cycle, resulting in cardiac dysrhythmias and arrest. Although acidosis can cause hyperkalemia, hyperkalemia will not lead to acidosis. Hyperkalemia usually causes nausea, vomiting, and diarrhea, which may result in dehydration; in this instance, fluid will shift from interstitial spaces to the intravascular compartment. With edema, the fluid shift occurs in the opposite direction. Magnesium can cause respiratory depression)

Ascites, blisters, and burns are an example of which of the following fluid spacing? a. 1st spacing b. 2nd spacing c. 3rd spacing d. 4th spacing

c

Fluid that is more concentrated than the cell's interior, causing fluid to move out of the cell and the cell to shrink would be identified as which of the following fluids? a. isotonic fluid b. hypotonic fluid c. hypertonic fluid d. latrogenic fluid

c

What is the fluid inside the cell, where 2/3 of the body's fluid is found? a. plasma b. interstitial fluid c. intracellular fluid d. floating fluid

c

Which of the following is the force of fluid in a compartment/cell pushing against a cell membrane or vessel wall (blood pressure) a. diffusion b. osmosis c. hydrostatic pressure d. oncotic pressure

c

Which finding would the nurse expect when assessing a client with compensated metabolic acidosis? a) muscle twitching b) mental instability c) deep and rapid respirations d) tachycardia and cardiac dysrythmias

c (Deep rapid respirations are an adaptation to a decreased serum pH. Carbonic acid dissociates in the lungs to hydrogen ions and carbon dioxide, which helps increase the serum pH. Muscle twitching results from low serum calcium, not compensated metabolic acidosis. Mental confusion does not occur in compensated acidosis; confusion can occur in uncompensated metabolic acidosis. Tachycardia and cardiac dysthymias are associated with hyperthyroidism, not compensated metabolic acidosis.)

For a client admitted with metabolic acidosis, which 2 body systems would the nurse assess for compensatory changes a) skeletal and nervous b) circulatory and urinary c) respiratory and urinary d) muscular and endocrine

c (increased respirations blow off carbon dioxide (co2), which decreases the hydrogen ion concentration and the pH increases (less acidity). Decreased respirations result in CO2 buildup, which increases hydrogen ion concentration and the pH falls (more acidity). The kidneys either conserve or excrete bicarbonate and hydrogen ions, which helps adjust the body's pH. The buffering capacity of the renal system is greater than that of the pulmonary system, but the pulmonary system is quicker to respond. Although the circulatory system carries fluids and electrolytes to the kidneys, it does not interact with the urinary system to regulate plasma pH.)

A client is hospitalized after 4 days of epigastric pain, nausea, and vomiting. The nurse reviews the laboratory test results: plasma pH 7.51, pCO2 50, bicarbonate 58, chloride 55, sodium, 132, potassium 3.8. Which condition does the nurse determine the results indicate?

c (the normal plasma pH value is 7.35 to 7.45. the client is in alkalosis. the normal plasma bicarbonate value is 23-25. the client has an excess of base bicarbonate, indicating a metabolic cause for the alkalosis. sodium of 132 is hyponatremia. normal chloride is 95-105. 55 is hypochloremia because of vomitting of gastric secretions)

Which pressure chance does the nurse determine to be the cause of edema for a client with albuminuria? a) decrease in tissue hydrostatic pressure b) increase in plasma hydrostatic pressure c) increase in tissue colloid osmotic pressure d) decrease in plasma colloid oncotic pressure

d (because the plasma colloid oncotic pressure is the major force drawing fluid from the interstitial spaces back into the capillaries, a drop in colloid oncotic pressure caused by albuminuria results in edema. hydrostatic pressure is influenced by the volume of fluid and the diameter of the blood vessel, not directly by the presence of albumin. the osmotic pressure of tissues is unchanged.)

Which prescription would the nurse question when a client's serum sodium is 123? a) add table salt to each meal b) fluid restriction to 1000 mL per day c) assess neurological status every 2 hours d) provide 0.45% sodium chloride (NaCl) intravenously at 125 ml/h

d (it is a hypotonic solution which means it is contradindicated. It would build upon the issue instead of correcting it. Treatment for hyponatremia can include restricting fluid intake and increasing sodium intake either via oral intake or, in severe cases, IV fluids.)

Which statement is accurate regarding the effects of parathyroid hormone on bones for the maintenance of calcium balance? a) increased bicarbonate and sodium excretion b) enchances absorption of calcium and phosphorus c) increases reabsorption of calcium and magnesium d) increases net release of calcium into extracellular fluid

d (parathyroid hormone targets tissues like bone, kidney, and the GI tract. the effects on bones will be associated with release of calcium into extracellular fluid. kidneys are associated for increasing the HCO3 and Na excretion from the body. Action of parathyroid hormone on the gI tract would show effects such as enhanced absorption of calcium and phosphorus. Kidneys are responsible for increased reabsorption of calcium and magnesium.)

Which clinical finding would the nurse associate with hypokalemia? a) edema b) muscle spasms c) kussmal respirations d) muscle weakness

d (serum hypokalemia diminishes the magnitude of the neuronal and muscle cell resting potentials. this can result in muscle weakness. edema is associated with electrolyte imbalances, including sodium excess (hypernatremia). muscle spasms and twitching are often seen in the setting of hypocalcemia. kussmal respiration is a breathing pattern characterized by deep and labored breaths in response to metabolic acidosis, espcillay DKA)

Surgery is performed on a client with a parotid tumor. Postoperative arterial blood gas values are pH 7.32 (acidosis normal), PCO2 53 (elevated), and HCO3 25 (normal). Which action would the nurse take? a) Administer a potent diuretic b) obtain a prescription for an alkalinizing agent c) have the client breathe into a rebreather bag at a slow rate d) encourage the client to cough and then take deep breaths between coughs)

d The client is in respiratory acidosis, probably caused by depressant effects of the anesthetic or a plugged airway. Coughing clears the airway, and deep breaths blow off carbon dioxide. Administering a diuretic will not correct respiratory acidosis and may aggravate hypokalemia if present. An alkalinizing agent is not necessary if clearing the airway rectifies the problem. Having the client breathe into a rebreather bag at a slow rate is the appropriate treatment for respiratory alkalosis; the client is in respiratory acidosis.

Which of the following is the movement of molecules from high to low concentration? a. diffusion b. osmosis c. hydrostatic pressure d. oncotic pressure

a

Abnormal accumulation of interstitial fluid (edema) is an example of which of the following fluid spacing? a. 1st spacing b. 2nd spacing c. 3rd spacing d. 4th spacing

b

Fluid less concentrated than the cell's interior, causing fluid to move into the cell and the cell to swell, would be identified as which of the following fluids? a. isotonic fluid b. hypotonic fluid c. hypertonic fluid d. latrogenic fluid

b

Which of the following bodily mechanisms allows fluid to stay in the intravascular space and out of the interstitial fluid space through the force generated by plasma proteins (such as albumin) a. diffusion b. osmosis c. hydrostatic pressure d. oncotic pressure

c

Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? a) metabolic alkalosis caused by excessive production of acid metabolties b) respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide c) respiratory acidosis caused by impaired respirations and increased formation of carbonic acid d) metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation

c (The restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. As carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid; the result is respiratory acidosis. The problem basic to asthma is respiratory, not metabolic. Respiratory alkalosis is caused by the exhalation of large amounts of carbon dioxide; asthma attacks cause carbon dioxide retention. Asthma is a respiratory problem, not a metabolic one; metabolic acidosis can result from an increase of nonvolatile acids or from a loss of base bicarbonate.)