Ch. 17 Fluid, Electrolyte, Acid-Base Imbalances

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1. Magnesium is absorbed by what system of the body? A. GI B. Hepatic C. Renal D. Lymphatic

23. A nurse is caring for a client who is hyperventilating. What should the nurse do to reduce the risk of respiratory alkalosis? 1. Teach the client breathing techniques. 2. Have the client breathe into a paper bag. 3. Encourage the client to try to remain calm. 4. Position the client in a high-Fowler position.

29. A client is receiving hydrochlorothiazide. When evaluating the client's response to hydrochlorothiazide, which common nontherapeutic response is important for the nurse to monitor? 1. Dysrhythmias 2. Impaired airway 3. Elevated glucose 4. Elevated blood pressure

30. A nurse is caring for a client who is receiving an intravenous piggyback medication intermittently via a primary intravenous infusion line. Which nursing intervention is most important to prevent infection associated with this therapy? 1. Wipe the port on the primary intravenous set with an alcohol sponge before connecting the intravenous piggyback. 2. Prime the tubing of an intravenous piggyback until a drop of solution appears at the distal end of the tubing. 3. Set the alarm on the electronic infusion device to alert the nurse if the tubing becomes obstructed. 4. Wear sterile gloves when preparing and administering parenteral solutions.

38. A client is receiving a potassium-sparing diuretic. For which nontherapeutic effect should the nurse assess the client? 1. Muscle weakness 2. Hypoactive reflexes 3. Respiratory depression 4. Dry sticky mucous membranes

44. A nurse is monitoring the most recent laboratory results for a group of clients. Which result should cause the most concern? 1. Serum potassium of 5.8 mEq/L for a client after cardiac surgery 2. Hemoglobin level of 10 mg/dL for a client with a history of anemia 3. Blood glucose of 124 mg/dL for a client with a history of type 1 diabetes 4. White blood cell count of 10,000/mm3 for a client who had a colon resection 3 days ago

A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for a fluid volume deficit? 1. A client with a colostomy 2. A client with congestive heart failure 3. A client on long-term corticosteroid therapy 4. A client receiving frequent wound irrigations

A patient is admitted with metabolic acidosis. Which system is not functioning normally? Renal system Buffer system Endocrine system Respiratory system

Renal system

2. A patient has a Magnesium level of 1.3 mg/dL. Which of the following is NOT a sign or symptom of this condition? A. Hypertension B. Torsades de pointes C. Positive Trousseau's Sign D. Absent deep tendon reflexes

Which nursing intervention is most appropriate when caring for a patient with dehydration? Monitor skin turgor every shift. Auscultate lung sounds every 2 hours. Monitor daily weight and intake and output. Encourage the patient to reduce sodium intake.

Monitor daily weight and intake and output.

A nurse is reading a physician's progress notes in the client's record and reads that the physician has documented "insensible fluid loss of approximately 800 mL daily." The nurse interprets that this type of fluid loss can occur through: 1. The skin 2. Urinary output 3. Wound drainage 4. The gastrointestinal tract

A nurse reviews a client's laboratory report and notes that the client's serum phosphorus level is 2 mg/dL. Which condition most likely caused this serum phosphorus level? 1. Alcoholism 2. Renal insufficiency 3. Hypoparathyroidism 4. Tumor lysis syndrome

A nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which of the following clinical manifestations would the nurse expect to note in the client? 1. Twitching 2. Hypoactive bowel sounds 3. Negative Trousseau's sign 4. Hypoactive deep tendon reflexes

1 Rationale: The normal serum calcium level is 8.6 to 10 mg/dL. A serum calcium level lower than 8.6 mg/dL indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea

A nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 3.2 mEq/L. Which of the following would the nurse note on the electrocardiogram as a result of the laboratory value? 1. U waves 2. Absent P waves 3. Elevated T waves 4. Elevated ST segment

1 Rationale: A serum potassium level lower than 3.5 mEq/L indicates hypokalemia. Potassium deficit is a common electrolyte imbalance and is potentially life-threatening. Electrocardiographic changes include inverted T waves, ST segment depression, and prominent U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client with atrial fibrillation.

24. Which independent nursing actions are appropriate for a client with deficient fluid volume? Select all that apply. 1. Lubricating the lips 2. Assessing skin turgor 3. Discontinuing diuretics 4. Increasing oral fluid intake 5. Providing intravenous fluids

1, 2

36. A nurse is monitoring several clients for clinical manifestations of either hyperkalemia or hypokalemia. Which clinical manifestations can occur with both imbalances? Select all that apply. 1. Irregular pulse 2. Muscle weakness 3. Facial nerve twitching 4. Increased bowel sounds 5. Flattened T wave on an electrocardiogram tracing

1, 2

16. A nurse is caring for a client who is receiving a 2-g sodium diet. Which food should the nurse teach the client to avoid? Select all that apply. 1. Processed cheese 2. Italian sausage 3. Canned soup 4. Tomatoes 5. Bananas 6. Eggs

1, 2, 3

42. A nurse is caring for a client who reports having an "upset stomach" with vomiting and a low-grade fever for several days. The nurse collects the following vital signs: Blood pressure 100/72 mm Hg, pulse 92 beats/minute and thready, respirations 24 breaths/minute, and temperature 100.6°F. Which additional clinical indicators are consistent with this cluster of data? Select all that apply. 1. Flat neck veins 2. Increased thirst 3. Peripheral edema 4. Dry mucous membranes 5. Red tongue with furrows 6. Decreased blood urea nitrogen

1, 2, 4,5

37. A nurse is taking a client's blood pressure. After the blood pressure cuff was inflated above the client's systolic pressure, the client's hand and wrist appeared as in the illustration. For which additional clinical indicator should the nurse assess the client? Select all that apply. 1. Irregular heart rate 2. Nonelastic skin turgor 3. Facial nerve twitching 4. Sticky mucous membranes 5. Decreased deep tendon reflexes

1, 3

11. A nurse is monitoring a client's IV located on the forearm just below the antecubital fossa. Which clinical manifestations alert the nurse that an infiltration may have occurred? Select all that apply. 1. A blood return does not occur when the insertion site is below the level of the intravenous solution bag. 2. A red line under the skin extends several inches above the insertion site. 3. The insertion site is surrounded with tissue swelling. 4. The skin feels cool around the insertion site. 5. A decrease in the flow rate.

1, 3, 4, 5

21. A nurse is caring for an older adult and suspects that the client may be experiencing hypovolemia. For which clinical indicators should the nurse assess the client that supports this conclusion? Select all that apply. 1. Decreased capillary refill 2. Distended neck veins 3. Amber colored urine 4. Bradycardia 5. Weak pulse

1, 3, 5

18. A nurse is obtaining a health history from a client who has a serum potassium level of 3.2 mEq. What client statements indicate a potential precipitating cause of this clinical manifestation? Select all that apply. 1. "I've had diarrhea for several days." 2. "We eat a lot of green leafy vegetables in our house." 3. "I take electrolyte supplements because I'm on a diuretic." 4. "I have been vomiting everything I drank or ate yesterday and today." 5. "My blood glucose has been very high lately because I have diabetes."

1, 4

3. A nurse is caring for a client with a serum calcium level of 7.5 mEq/L. What nursing intervention is important when caring for this client? Select all that apply. 1. Give the client the prescribed calcium supplement. 2. Teach the client to avoid foods high in calcium. 3. Prepare the client for hemodialysis. 4. Protect the client from injury. 5. Assess the client for tetany

1, 4, 5

43. A nurse is assessing a client for excess fluid volume. What questions should the nurse ask the client to obtain information specific to this problem? Select all that apply. 1. "Do your rings feel tighter lately?" 2. "How often do you need to urinate?" 3. "How much water do you drink a day?" 4. "Have you noticed an increase in thirst?" 5. "Did you gain weight in the last few days?"

1, 5

1. A nurse is caring for a client who has a prescription for a fluid restriction of 1,400 milliliters in 24 hours. The client is receiving medication in 50 milliliters of solution IVPB four times a day. How much fluid should the nurse allocate for oral intake during the day? 1. 400 milliliters 2. 800 milliliters 3. 1,000 milliliters 4. 1,300 milliliters

13. A nurse is monitoring a client's intravenous insertion site that is in the right forearm just below the antecubital fossa. The nurse identifies that an infiltration has occurred and removes the intravenous catheter. What should the nurse do next? 1. Keep the right arm dependent. 2. Restart the infusion in the client's left forearm. 3. Apply the standing prescribed warm soak to the right forearm. 4. Reinsert the infusion distal to the previous site in the client's right arm.

20. A nurse is implementing a medication prescription that is to be delivered using a hard plastic intravenous volume-controlled infusion set. Which nursing action is most important when providing a medication using this IV set? 1. Keep the upper fluid flow roller/slide clamp above the volume-control chamber in the open position throughout the infusion. 2. Drain solution from the primary container into the volume-control chamber equal in volume to the prescribed hourly rate. 3. Make certain that the volume-control chamber does not empty completely during the infusion. 4. Ensure that the air vent in the volume-control chamber is closed during the infusion.

25. A 58-year-old woman comes to the emergency department reporting multiple vague discomforts. The nurse obtains the client's history and performs an intake interview. The primary health-care provider performs a physical assessment and prescribes x-rays, an electrocardiogram, a complete blood count, a urinalysis, a metabolic panel, and a high-fiber diet. What is the most important nursing intervention while caring for this client? 1. Encouraging the client to increase the fiber in her diet 2. Handling the client carefully when completing the prescribed tests 3. Obtaining the blood specimens before sending the client for x-rays 4. Scheduling the electrocardiogram after determining if the client has a pacemaker

4. A nurse in the emergency room is caring for a client with a diagnosis of respiratory acidosis due to an asthma attack. Which medication should the nurse anticipate that the primary health-care provider probably will prescribe? 1. Diuretic 2. Bronchodilator 3. Sodium chloride 4. Sodium bicarbonate

8. A nurse is caring for a client who has a cardiac monitor. The client's serum potassium level is 5.9 mEq/L. The nurse should check the cardiac monitor for the presence of which altered cardiac tracing related to this client's potassium level? 1. Peaked P wave 2. Peaked T wave 3. Narrow QRS complex 4. Shortened PR interval

A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a sodium level of 130 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a sodium value at this level? 1. The client with Cushing's syndrome 2. The client who is taking diuretics 3. The client with hyperaldosteronism 4. The client who is taking corticosteroids

A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for fluid volume excess? 1. The client taking diuretics 2. The client with renal failure 3. The client with an ileostomy 4. The client who requires gastrointestinal suctioning

19. A nurse is caring for a client who is receiving a low-potassium diet. Which food should the nurse teach the client to avoid? Select all that apply. 1. Chicken liver 2. Tomato soup 3. Lima beans 4. Spinach 5. Carrots

2 3, 4

A nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client was at risk for developing the potassium deficit because the client: 1. Sustained tissue damage 2. Requires nasogastric suction 3. Has a history of Addison's disease 4. Is taking a potassium-sparing diuretic

2 Rationale: The normal serum potassium level is 3.5 mEq/L to 5.1 mEq/L. A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client taking a potassium-sparing diuretic are at risk for hyperkalemia

10. A client is admitted to the hospital after several days of diarrhea, nausea, and vomiting. Which clinical indicators should the nurse expect to identify when completing an admission nursing assessment? Select all that apply. 1. Adventitious breath sounds 2. Nonelastic skin turgor 3. Weak, thready pulse 4. Frothy sputum 5. Weight gain

2, 3

5. A nurse is caring for a client receiving digoxin to improve cardiac function. For the past few days, the client has been experiencing diarrhea and vomiting because of a gastrointestinal infection. For which clinical manifestations should the nurse assess the client? Select all that apply. 1. Orthostatic hypotension 2. Irregular heart rhythm 3. Visual disturbances 4. Increased pulse 5. Muscle cramps

2, 3

2. A nurse in the emergency department is caring for a variety of clients. Which clients should the nurse identify are at risk for a deficient fluid volume? Select all that apply. 1. Man with chronic kidney disease 2. Older adult with perfuse diaphoresis 3. Adolescent experiencing ketoacidosis 4. Infant experiencing diarrhea for 12 hours 5. Woman who is in the 8th month of gestation

2, 3, 4

34. A client who is scheduled for chemotherapy is receiving 1 L of fluid over a 2-hour period before receiving nephrotoxic chemotherapy. The nurse assesses the client frequently for hypervolemia during this 2-hour period. For what signs of hypervolemia should the nurse assess the client? Select all that apply. 1. Poor skin turgor 2. Dyspnea on exertion 3. Crackles in the lungs 4. Jugular vein distention 5. Decreased blood pressure

2, 3, 4

7. A nurse is preparing a class for a group of clients about what foods to eat when receiving a non-potassium sparing diuretic. Which foods should the nurse discuss in the class? Select all that apply. 1. Apples 2. Potatoes 3. Skim milk 4. Nonfat yogurt 5. Cranberry juice 6. Salad dressings

2, 3, 4

The nurse provides instructions to a client with a low potassium level about the foods that are high in potassium and tells the client to consume which foods? Select all that apply. 1. Peas 2. Raisins 3. Potatoes 4. Cauliflower 5. Cantaloupe 6. Strawberries

2, 3, 5, 6

33. A nurse is caring for a client admitted to the hospital with a diagnosis of heart failure and is retaining fluid. For what clinical indicators should the nurse assess the client that supports the presence of this condition? Select all that apply. 1. Dry skin 2. Weight gain 3. Hypertension 4. Hemodilution 5. Bounding pulse

2, 4, 5

6. A nurse is assessing a client with a diagnosis of hypocalcemia. Which client clinical manifestations support this diagnosis? Select all that apply. 1. Hypoactive reflexes 2. Carpopedal spasm 3. Relaxed muscles 4. Deep bone pain 5. Muscle cramps 6. Paresthesia

2, 5, 6

When planning the care of a patient with dehydration, what urine output would the nurse instruct the unlicensed assistive personnel to report? 60 mL in 90 minutes 1200 mL in 24 hours 300 mL per 8-hour shift 20 mL for 2 consecutive hours

20 mL for 2 consecutive hours

When planning care for stable adult patients, the oral intake that is adequate to meet daily fluid needs is: 500 to 1500 mL. 1200 to 2200 mL. 2000 to 3000 mL. 3000 to 4000 mL.

2000 to 3000 mL.

A patient was admitted for a paracentesis to remove ascites fluid. Five liters of fluid was removed. Which IV solution may be used to pull fluid into the intravascular space after the paracentesis? 0.9% sodium chloride 25% albumin solution Lactated Ringer's solution 5% dextrose in 0.45% saline

25% albumin solution

28. A nurse monitors the laboratory reports of a client with a fluid and electrolyte imbalance. Which laboratory value should the nurse report to the primary health-care provider? 1. 2.5 mEq/L magnesium 2. 4.5 mEq/L potassium 3. 158 mEq/L sodium 4. 5 mEq/L calcium

35. A nurse is caring for a client who is experiencing excess fluid volume evidenced by significant dependent edema. A 1,000-mL fluid restriction is prescribed. Which nursing intervention is most important? 1. Offer ice chips frequently. 2. Provide frequent mouth care. 3. Assess extent of edema daily. 4. Keep the legs lower than the heart.

A nurse is caring for a client with acute congestive heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia? 1. Extreme thirst 2. Decreased urinary output 3. Hyperactive bowel sounds 4. Increased specific gravity of the urine

A nursing student needs to administer potassium chloride intravenously as prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium? 1. Obtaining a controlled intravenous (IV) infusion pump 2. Monitoring urine output during administration 3. Preparing the medication for bolus administration 4. Diluting the medication in appropriate amount of normal saline

3 . 1 Rationale: A serum potassium level lower than 3.5 mEq/L indicates hypokalemia. Potassium deficit is a common electrolyte imbalance and is potentially life-threatening. Electrocardiographic changes include inverted T waves, ST segment depression, and prominent U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client with atrial fibrillation.

The nurse is caring for a client with congestive heart failure. On assessment, the nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present? 1. Weight loss 2. Flat neck and hand veins 3. An increase in blood pressure 4. A decreased central venous pressure (CVP)

3 Rationale: A fluid volume excess is also known as overhydration or fluid overload and occurs when fluid intake or fluid retention exceeds the fluid needs of the body. Assessment findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit. Options 1, 2, and 4 identify signs noted in fluid volume deficit

A nurse caring for a client with hypocalcemia would expect to note which of the following changes on the electrocardiogram? 1. Widened T wave 2. Prominent U wave 3. Prolonged QT interval 4. Shortened ST segment

3 Rationale: The normal serum calcium level is 8.6 to 10 mg/dL. A serum calcium level lower than 8.6 mg/dL indicates hypocalcemia. Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or QT interval. A shortened ST segment and a widened T wave occur with hypercalcemia. Prominent U waves occur with hypokalemia.

27. A nurse is caring for two clients, one with a diagnosis of excess fluid volume and one with deficient fluid volume. Which nursing interventions are unique to excess fluid volume that are unrelated to deficient fluid volume? Select all that apply. 1. Obtain a daily weight. 2. Record intake and output. 3. Auscultate for breath sounds. 4. Place the client in the mid-Fowler position. 5. Monitor laboratory values for renal function and electrolytes.

3, 4

A nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.4 mEq/L. Which of the following would the nurse expect to note on the electrocardiogram as a result of the laboratory value? 1. ST depression 2. Inverted T wave 3. Prominent U wave 4. Tall peaked T waves

Which serum potassium result best supports the rationale for administering a stat dose of IV potassium chloride 20 mEq in 200 mL of normal saline over 2 hours? 3.1 mEq/L 3.5 mEq/L 4.6 mEq/L 5.3 mEq/L

3.1 mEq/L

12. A nurse is caring for a client who reports having severe diarrhea and vomiting for the last few days. Other than these problems the client does not have a concurrent medical diagnosis. The client's laboratory results indicate that the client has a serum sodium level of 147 mEq/L. For which clinical indicator unique to this serum sodium level should the nurse assess the client? 1. Confusion 2. Headache 3. Agitation 4. Thirst

31. An older adult is admitted to the hospital via the emergency department for unexplained episodes of fainting. When the client arrives on the unit, the nurse reviews the primary health-care provider's prescriptions, obtains the client's vital signs, and performs a physical assessment. Which is most important for the nurse to do based on this information? 1. Offer a variety of fluids to keep at the client's bedside. 2. Hold the lunch tray until the client talks with the dietitian. 3. Teach the client how to collect a midstream urine specimen. 4. Have the client sit on the side of the bed for a minute before standing.

39. How much fluid should a nurse teach a female client to consume during 24 hours to maintain normal fluid balance? 1. 500 mL 2. 1,000 mL 3. 1,500 mL 4. 2,200 mL

40. A nurse is inserting a catheter to provide short-term intravenous therapy. Which site should the nurse use that is appropriate for short-term therapy but is not appropriate for long-term therapy? 1. Basilic vein 2. Cephalic vein 3. Subclavian vein 4. Metacarpal vein

9. A client receiving furosemide (Lasix) daily is admitted with a diagnosis of dehydration and hypokalemia. The client's IV fluid is 1,000 mL 0.9% normal saline with 20 mEq of potassium chloride infusing at 125 mL/hr. What is most important for the nurse to assess? 1. Food intake 2. Intravenous site 3. Respiratory rate 4. Serum potassium

A nurse caring for a client who has been receiving IV diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition? 1. Lung congestion 2. Decreased hematocrit 3. Increased blood pressure 4. Decreased central venous pressure (CVP)

A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a potassium value at this level? 1. The client with colitis 2. The client with Cushing's syndrome 3. The client who has been overusing laxatives 4. The client who has sustained a traumatic burn

4 Rationale: A serum potassium level higher than 5.1 mEq/L indicates hyperkalemia. Clients who experience cellular shifting of potassium in the early stages of massive cell destruction, such as with trauma, burns, sepsis, or metabolic or respiratory acidosis, are at risk for hyperkalemia. The client with Cushing's syndrome or colitis and the client who has been overusing laxatives are at risk for hypokalemia

A nurse is reviewing laboratory results and notes that a client's serum sodium level is 150 mEq/L. The nurse reports the serum sodium level to the physician and the physician prescribes dietary instructions based on the sodium level. Which food item does the nurse instruct the client to avoid? 1. Peas 2. Nuts 3. Cauliflower 4. Processed oat cereals

4 Rationale: The normal serum sodium level is 135 to 145 mEq/L. A serum sodium level of 150 mEq/L indicates hypernatremia. Based on this finding, the nurse would instruct the client to avoid foods high in sodium. Nuts, cauliflower, and peas are good food sources of phosphorus. Processed foods are high in sodium content.

10. Which of the following would you NOT expect to see with a phosphate level of 1.2 mg/dL? A. Positive Trousseau's Sign B. Anemia C. Confusion D. Osteomalacia

7. Which patient below is considered hypernatremic? A. A patient with a sodium level of 155 mEq/L B. A patient with a sodium level of 145 mEq/L C. A patient with a sodium level of 120 mEq/L D. A patient with a sodium level of 136 mEq/L

9. A patient's blood tests show they have a critically low parathyroid hormone (PTH). What effect would this have on phosphate and calcium levels in the blood? A. Phosphate levels high, calcium levels low B. Phosphate and calcium levels high C. Phosphate and calcium levels low D. Phosphate levels low, calcium levels high

The nurse on a medical-surgical unit identifies which patient as having the highest risk for metabolic alkalosis? A patient with a traumatic brain injury A patient with type 1 diabetes mellitus A patient with acute respiratory failure A patient with nasogastric tube suction

A patient with nasogastric tube suction

When a person's blood pressure drops, the kidneys respond by: A. secreting renin. B. producing aldosterone. C. slowing the release of ADH. D. increasing urine output.

A. Juxtaglomerular cells in the kidneys secrete renin in response to low blood flow or a low sodium level. The eventual effect of renin secretion is an increase in blood pressure.

Hydrostatic pressure, which pushes fluid out of the capillaries, is opposed by colloid osmotic pressure, which involves: A. reduced renin secretion. B. the pulling power of albumin to reabsorb water. C. an increase in ADH secretion. D. aldosterone production

B. Albumin in capillaries draws water toward it, a process called reabsorption.

Hypertonic solutions cause fluids to move from the: A. interstitial space to the intracellular space. B. intracellular space to the extracellular space. C. extracellular space to the intracellular space. D. extracellular space to the interstitial space

B. Hypertonic solutions, because of their increased osmolality, draw fluids out of the cells and into the extracellular space.

When assessing the patient with a multi-lumen central line, the nurse notices that the cap is off one of the lines. On assessment, the patient is in respiratory distress and the vital signs show hypotension and tachycardia. The nurse suspects that the patient may be experiencing what complication? Air embolism Catheter occlusion Insertion site trauma Precipitate build up in lumen

Air embolism

4. Stimulation of the facial nerve via the masseter muscle causes twitching of the nose/lips in hypocalcemia is known as? A. Trousseau's Sign B. Chvostek's Sign C. Homan's Sign D. Goodell's Sign

6. An EKG shows a shortened QT interval. Which lab value below would be indicative of this change? A. Calcium level of 8 mg/dL B. Calcium level of 12 mg/dL C. Calcium level of 8.7 mg/dL D. Calcium level of 9.2 mg/dL

The nurse is caring for a patient admitted to the medical unit with hypokalemia. The best foods to offer the patient are? (Select all that apply.) Apple Banana Orange juice Chocolate milk Cooked broccoli

Banana Orange juice Chocolate milk Cooked broccoli

8. A patient has a sodium level of 119 mEq/L. Which of the following is NOT related to this finding? A. Oversecretion of ADH (antidiuretic hormone) B. Low salt diet C. Inadequate water intake D. Hypotonic fluid infusion (overload)

Extravasation of I.V. fluid is associated with administration of which solution? A. Hypertonic fluid B. D5W C. An antineoplastic D. Normal saline solution

C. Antineoplastics are highly irritating to the veins and are typically administered using a steel needle. Extravasation is common in those situations

3. Which of the following patients is MOST at risk for hypermagnesemia? A. A patient with alcoholism B. A patient taking a proton-pump inhibitor C. A patient suffering from Crohn's Disease D. A patient with a magnesium level of 0.6 mg/dL receiving IV magnesium sulfate

5. A patient has a calcium level of 7.2 mg/dL. What sign below is indicative of this lab value? A. None this is a normal calcium level B. Shortened ST segment C. Hypoactive bowel sounds D. Prolonged QT interval on the EKG

The main extracellular cation is: A. calcium. B. potassium. C. magnesium. D. sodium

D. Sodium is the main extracellular cation. Among other things, it helps regulate fluid balance in the body.

Which action is most important for the nurse to take when caring for a patient with a subclavian triple-lumen catheter? Change the injection cap after the administration of IV medications. Use a 5-mL syringe to flush the catheter between medications and after use. During removal of the catheter, have the patient perform the Valsalva maneuver. If resistance is met when flushing, use the push-pause technique to dislodge the clot.

During removal of the catheter, have the patient perform the Valsalva maneuver.

When planning care for a patient with dehydration related to nausea and vomiting, the nurse would anticipate which fluid shift to occur because of the fluid volume deficit? Fluid movement from the blood vessels into the cells Fluid movement from the interstitial space into the cells Fluid movement from the interstitial spaces into the plasma Fluid movement from the blood vessels into interstitial spaces

Fluid movement from the interstitial spaces into the plasma

A 50-yr-old woman with hypertension has a serum potassium level that has acutely risen to 6.2 mEq/L. Which type of order, if written by the health care provider, should the nurse question? Limit foods high in potassium. Calcium gluconate IV piggyback. Give a potassium-sparing diuretic daily. Administer intravenous insulin and glucose.

Give a potassium-sparing diuretic daily.

You are caring for an older patient who is receiving IV fluids postoperatively. During the 8:00 AM assessment of this patient, you note that the IV solution, which was ordered to infuse at 125 mL/hr, has infused 950 mL since it was hung at 4:00 AM. What is the priority nursing intervention? Slow the rate to keep vein open until next bag is due at noon. Notify the health care provider and complete an incident report. Listen to the patient's lung sounds and assess respiratory status. Assess the patient's cardiovascular status by checking pulse and blood pressure.

Listen to the patient's lung sounds and assess respiratory status.

You are caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. You should hold a medication from which classification until you consult with the health care provider? Antibiotics Loop diuretics Bronchodilators Antihypertensives

Loop diuretics

A patient with dehydration is receiving a hypertonic solution. Which assessments must be done to avoid adverse risks associated with these solutions? (Select all that apply.) Lung sounds Bowel sounds Blood pressure Serum sodium level Serum potassium level

Lung sounds Blood pressure Serum sodium level

You are admitting a patient who reports abdominal pain, nausea, and vomiting. A proximal bowel obstruction is suspected. Which acid-base imbalance do you anticipate in this patient? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic alkalosis

When assessing a patient admitted with nausea and vomiting, which finding best supports the nursing diagnosis of deficient fluid volume? Polyuria Bradycardia Restlessness Difficulty breathing

Restlessness

You are caring for a patient admitted with a diagnosis of chronic obstructive pulmonary disease (COPD) who has the following arterial blood gas results: pH 7.33, PaO2 47 mm Hg, PaCO2 60 mm Hg, HCO3 32 mEq/L, and O2 saturation of 92%. What is the correct interpretation of these results? Fully compensated respiratory alkalosis Partially compensated respiratory acidosis Normal acid-base balance with hypoxemia Normal acid-base balance with hypercapnia

Partially compensated respiratory acidosis

You are caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would you identify as an adverse effect related to this therapy? Sodium falling to 138 mEq/L Potassium rising to 4.1 mEq/L Magnesium rising to 2.9 mg/dL Phosphorus falling to 2.1 mg/dL

Phosphorus falling to 2.1 mg/dL

Which statements are appropriate to include when teaching a patient about hypercalcemia? (Select all that apply.) Have patient restrict fluid intake to less than 2000 mL/day. Renal calculi may occur as a complication of hypercalcemia. Weight-bearing exercises can help keep calcium in the bones. The patient should increase daily fluid intake of 3000 to 4000 mL. Any heartburn can be managed with an as needed calcium-containing antacid.

Renal calculi may occur as a complication of hypercalcemia. Weight-bearing exercises can help keep calcium in the bones. The patient should increase daily fluid intake of 3000 to 4000 mL.

You receive a provider's prescription to change a patient's IV from 5% dextrose in 0.45% saline with 40 mEq KCl/L to 5% dextrose in 0.9% saline with 20 mEq KCl/L. Which serum laboratory values best support the rationale for this IV order change? Sodium, 136 mEq/L; potassium, 3.6 mEq/L Sodium, 145 mEq/L; potassium, 4.8 mEq/L Sodium, 135 mEq/L; potassium, 4.5 mEq/L Sodium, 144 mEq/L; potassium, 3.7 mEq/L

Sodium, 135 mEq/L; potassium, 4.5 mEq/L

You are caring for a patient admitted with diabetes, malnutrition, and a massive GI bleed. In analyzing the morning lab results, the nurse understands that a potassium level of 5.5 mEq/L could be caused by which factors in this patient? (Select all that apply.) The potassium level may be increased if the patient has nephropathy. The patient has been eating excessive amounts of foods that increase potassium levels. The patient may be excreting extra sodium and retaining potassium secondary to malnutrition. There may be excess potassium being released into the blood as a result of massive blood transfusion. The potassium level may be increased because of dehydration that accompanies high blood glucose levels.

The potassium level may be increased if the patient has nephropathy. There may be excess potassium being released into the blood as a result of massive blood transfusion. The potassium level may be increased because of dehydration that accompanies high blood glucose levels.

While caring for a patient with metastatic bone cancer, which clinical manifestations would alert the nurse to the possibility of hypercalcemia in this patient? (Select all that apply.) Weakness Paresthesia Facial spasms Muscle tremors Depressed reflexes

Weakness Depressed reflexes

14. A patient with abnormal sodium losses is receiving a house diet. To provide 1,600 mg of sodium daily, the nurse could supplement the patient's diet with: a. one beef cube and 8 oz of tomato juice. b. four beef cubes and 8 oz of tomato juice. c. one beef cube and 16 oz of tomato juice. d. one beef cube and 12 oz of tomato juice.

16. A nurse is directed to administer a hypotonic intravenous solution. Looking at the following labeled solutions, she should choose: a. 0.45% sodium chloride. b. 0.90% sodium chloride. c. 5% dextrose in water. d. 5% dextrose in normal saline solution.

2. A manifestation not associated with altered acid-base balance is: a. bradycardia. b. hypertension. c. lethargy. d. hypokalemia.

2. Rob has a history of using ecstasy. He is exhibiting symptoms of hypotension, nausea, diarrhea, personality change, diminished level of consciousness, and decreased deep tendon reflexes. Lab results confirm your suspicion of hyponatremia. Treatment would include: (a) water restriction. (b) 0.33 percent sodium chloride intravenously. (c) use of salt substitute. (d) calcium carbonate orally.

20. To supplement a diet with foods high in potassium, the nurse should recommend the addition of: a. fruits such as bananas and apricots. b. green leafy vegetables. c. milk and yogurt. d. nuts and legumes

3. A nursing plan of care for Harriet should include assessing blood pressure with the patient in the supine and upright positions. A diagnostic reading that should be recorded and reported is: a. supine, 140/90; sitting, 120/80; standing, 110/70 mm Hg. b. supine, 140/90; sitting, 130/90; standing, 130/90 mm Hg. c. supine, 140/90; sitting, 140/85; standing, 135/85 mm Hg. d. supine, 140/90; sitting, 140/90; standing, 130/90 mm Hg

3. In terms of cellular buffering response, the nurse should expect the major electrolyte disturbance to be: a. hyperkalemia. b. hypernatremia. c. hypocalcemia. d. hypokalemia.

32. The lungs regulate acid-base balance by all of the following mechanisms except: a. excreting HCO3- into the blood. b. slowing ventilation. c. controlling carbon dioxide levels. d. increasing ventilation.

35. Choose the condition that exhibits blood values with a low pH and a high PCO2. a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

4. Signs of lethargy, increasing intracranial pressure, and seizures may occur when the serum sodium level reaches: a. 115 mEq/L. b. 130 mEq/L. c. 145 mEq/l. d. 160 mEq/L.

6. The nurse notes that a patient's urine osmolality is 980 mOsm/kg. The nurse knows to assess for the possible cause of: a. acidosis. b. fluid volume excess. c. diabetes insipidus. d. hyponatremia.

8. A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory mechanisms associated with hypovolemia would cause all of the following symptoms except: a. hypertension. b. oliguria. c. tachycardia. d. tachypnea

A 22-yr-old man is admitted to the emergency department with a stab wound to the abdomen. The patient's vital signs are blood pressure 82/56 mm Hg, pulse 132 beats/min, respirations 28 breaths/min, and temperature 97.9° F (36.6° C). Which fluid, if ordered by the health care provider, should the nurse question? a. 0.45% saline b. 0.9% saline c. Packed red blood cells d. Lactated Ringer's solution

Isaac, 63 years old, was admitted to the hospital with a diagnosis of diabetes mellitus. On his admission, the nurse observed rapid respirations, confusion, and signs of dehydration. 1. Isaac's arterial blood gas values are pH, 7.27; HCO3, 20 mEq/L; PaO2, 33 mm Hg. These values are consistent with a diagnosis of compensated: a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

11. The nurse is admitting a patient to the clinical unit from surgery. Being alert to potential fluid volume alterations, what assessment data will be important for the nurse to monitor to identify early changes in the patient's postoperative fluid volume (select all that apply)? a. Intake and output b. skin turgor c. lung sounds d. respiratory rate e. LOC

a, b, c, d, e. All of these are important in assessing fluid balance in a postoperative patient. These assessments will provide data about potential fluid volume abnormalities

21. What are the characteristics of the carbonic acid-bicarbonate buffer system (select all that apply)? a. CO2 is eliminated by the lung b. Neutralizes HCl acid to yield carbonic acid and salt c. H2 CO3 formed by neutralization dissociates into H2 O and CO2 d. Shifts H+ in and out of cell in exchange for other cations such as potassium and sodium e. Free basic radicals dissociate into ammonia and OH- that combines with H+ to form water

a, b, c. Shifts of H+ in and out of the cell are characteristics of the cellular buffer system. Free basic radical dissociation is characteristic of the protein buffer system

22. What are characteristics of the phosphate buffer system (select all that apply)? a. Neutralizes a strong base to a weak base and water b. Resultant sodium biphosphate is eliminated by kidneys c. Free acid radicals dissociate into H+ and CO2, buffering excess base d. Neutralizes a strong acid to yield sodium biphosphate, a weak acid, and salt e. Shifts chloride in and out of red blood cells in exchange for sodium bicarbonate, buffering both acids and bases

a, b, d. Free acid radical dissociation is characteristic of the protein buffer system. Chloride shifting in and out of red blood cells is characteristic of the hemoglobin buffer system

3. Which statements about fluid in the human body are true (select all that apply)? a. The primary hypothalamic mechanism of water intake is thirst. b. Third spacing refers to the abnormal movement of fluid into interstitial spaces. c. A cell surrounded by hypoosmolar fluid will shrink and die as water moves out of the cell. d. A cell surrounded by hyperosmolar fluid will shrink and die as water moves out of the cell. e. Concentrations of Na+ and K+ in interstitial and intracellular fluids are maintained by the sodium-potassium pump

a, d, e. Third spacing is when fluid moves into spaces that normally have little or no fluid. A cell surrounded by hypoosmolar fluid will swell and burst as water moves into the cell. A cell surrounded by hyperosmolar fluid will shrink and die as water moves out of the cell.

33. A patient is scheduled to have a tunneled catheter placed for administration of chemotherapy for breast cancer. When preparing the patient for the catheter insertion, what does the nurse explain about this method of chemotherapy administration? a. Decreases the risk for extravasation at the infusion site b. Reduces the incidence of systemic side effects of the drug c. Does not become occluded as peripherally inserted catheters can d. Allows continuous infusion of the drug directly to the area of the tumor

a. Catheters tunneled to the distal end of the superior vena cava or the right atrium are vascular access devices inserted into central veins, which decrease the incidence of extravasation, provide for rapid dilution of chemotherapy, and reduce the need for venipunctures. Most right atrial catheters, except for a Groshong catheter, need to be flushed with heparin to prevent clotting in the tubing. Regional chemotherapy administration delivers the drug directly to the tumor and is the only administration route that can decrease the systemic effects of the drugs

29. To provide free water and intracellular fluid hydration for a patient with acute gastroenteritis who is NPO, the nurse would expect administration of which infusion? a. Dextrose 5% in water b. Dextrose 10% in water c. Lactated Ringer's solution d. Dextrose 5% in normal saline (0.9%)

a. Fluids such as 5% dextrose in water (D5 W) allow water to move from the extracellular fluid to the intracellular fluid. Although D5 W is physiologically isotonic, the dextrose is rapidly metabolized, leaving free water to shift into cells

1. Bernadette's morning lab results have just come in. Her serum potassium level is currently 5.4 mEq/L. You recognize this as: (a) hypokalemia. (b) hyperkalemia. (c) hypocalcemia. (d) hypercalcemia.

10. Laboratory findings consistent with hypovolemia in a female would include all of the following except: a. hematocrit level of >47%. b. BUN-serum creatinine ratio of >12:1. c. urine specific gravity of 1.027. d. urine osmolality of >450 mOsm/kg.

12. When assessing the weight of a patient who is on a sodium-restricted diet, the nurse knows that a weight gain of approximately 2 lb (2.2 lb = 1 kg) is equivalent to a gain of how much fluid? a. 0.5 L b. 1.0 L c. 1.5 L d. 2.0 L

13. Nursing intervention for a patient with a diagnosis of hyponatremia includes all of the following except: a. assessing for symptoms of nausea and malaise. b. encouraging the intake of low-sodium liquids, such as coffee or tea. c. monitoring neurologic status. d. restricting tap water intake.

17. An isotonic solution that contains electrolytes similar to the concentration used in plasma is: a. 5% dextrose in water. b. lactated Ringer's solution. c. 3% NaCl solution. d. 5% NaCl solution.

2. A febrile patient's fluid output is in excess of normal because of diaphoresis. The nurse should plan fluid replacement based on the knowledge that insensible losses in an afebrile person are normally not greater than: a. 300 mL/24 h. b. 600 mL/24 h. c. 900 mL/24 h. d. 1200 mL/24 h.

2. Manifestations of extracellular FVD include all of the following except: a. collapsed neck veins. b. decreased serum albumin. c. elevated hematocrit. d. weight loss.

21. If a patient has severe hyperkalemia, it is possible to administer calcium gluconate intravenously to: a. immediately lower the potassium (K+) level by active transport. b. antagonize the action of K+ on the heart. c. prevent transient renal failure (TRF). d. accomplish all of the above.

25. Management of hypocalcemia includes all of the following actions except administration of: a. fluid to dilute the calcium levels. b. the diuretic furosemide (Lasix), without saline, to increase calcium excretion through the kidneys. c. inorganic phosphate salts. d. intravenous phosphate therapy.

27. A patient is admitted with a diagnosis of renal failure. He also mentions that he has had stomach distress and has ingested numerous antacid tablets over the past 2 days. His blood pressure is 110/70 mm Hg, his face is flushed, and he is experiencing generalized weakness. Choose the most likely magnesium (Mg2+) value for this patient. a. 11 mEq/L b. 5 mEq/L c. 2 mEq/L d. 1 mEq/L

3. A patient's serum sodium concentration is within the normal range. The nurse estimates that the serum osmolality should be: a. less than 136 mOsm/kg. b. 275 to 300 mOsm/kg. c. greater than 408 mOsm/kg. d. 350 to 544 mOsm/kg.

3. Derek has recently converted his outdoor garage to a gym. He has been exercising frequently in his new gym due to the convenience, even in the extreme heat. He has started taking salt tablets. You think his current symptoms may be due to hypernatremia. You recognize these as: (a) cardiac arrhythmias, palpitations, and sinus arrest. (b) weakness, dizziness, abdominal distention, nausea, vomiting, and diarrhea. (c) weight gain, irritability, muscle twitching, and decreased myocardial contractility. (d) muscle cramps, malaise, constipation, rhabdomyolysis, and pupillary constriction

34. The nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory data for all of the following except: a. hypocalcemia. b. hypoglycemia. c. hypokalemia. d. hypoxemia.

4. Nursing intervention for George should include all of the following except: a. administering diuretics, as prescribed, to help remove excess fluid. b. assisting the patient to a recumbent position to minimize his breathing effort. c. inspecting for sacral edema to note the degree of fluid retention. d. teaching dietary restriction of sodium to help decrease water retention.

4. Nursing intervention for Harriet includes all of the following except: a. monitoring urinary output to assess kidney perfusion. b. placing the patient in the Trendelenburg position to maximize cerebral blood flow. c. positioning the patient flat in bed with legs elevated to maintain adequate circulating volume. d. teaching leg exercises to promote venous return and prevent postural hypotension when the patient stands.

6. To return a patient with hyponatremia to normal sodium levels, it is safer to restrict fluid intake than to administer sodium: a. in patients who are unconscious. b. to prevent fluid overload. c. to prevent dehydration. d. in patients who show neurologic symptoms.

7. Brendan has chronic obstructive pulmonary disease, causing a constant state of respiratory acidosis. He has a history of chronic trimethoprim and NSAID use, leading to hyperkalemia. Which of the following are associated with hyperkalemia? (a) Irritability, circumoral paresthesia, muscle spasms, tetany, abdominal pain, laryngospasm, and prolonged QT intervals. (b) Muscle cramps, malaise, diminished deep tendon reflexes, anorexia, constipation, palpitations, and rhabdomyolysis. (c) Cardiac arrhythmia, nausea, vomiting, constipation, dehydration, kidney stones, muscle weakness, and sinus arrest. (d) Weakness, dizziness, abdominal distention, nausea, vomiting, diarrhea, palpitations, and cardiac arrhythmias.

7. Hypernatremia is associated with a: a. serum osmolality of 245 mOsm/kg. b. serum sodium of 150 mEq/L. c. urine specific gravity lower than 1.003. d. combination of all of the above.

7. One of the best indicators of renal function is: a. blood urea nitrogen. b. serum creatinine. c. specific gravity. d. urine osmolality.

8. You are monitoring intravenous fluids for Tom who is currently being treated for metabolic acidosis. You monitor his signs and symptoms typical of metabolic acidosis which include: (a) elevated blood pressure, bradycardia, elevated respiratory rate, and muscle twitching. (b) hypotension, altered heart rate, elevated respiratory rate, and muscle weakness. (c) hypertension, tachycardia, slowed respiratory rate, and muscle spasms. (d) hypotension, hypoxia, irritability, and paresthesia.

9. Vince has been taking excessive amounts of over-the-counter antacid tablets. He has been exhibiting signs of irritability, anxiety, muscle cramping, and weakness, and has recently developed tetany. You have initiated seizure precautions. You recognize that the patient is being monitored and treated for: (a) hyperkalemia. (b) hyperphosphatemia. (c) metabolic acidosis. (d) metabolic alkalosis

George, 88 years old, is suffering from congestive heart failure. He was admitted to the hospital with a diagnosis of extracellular fluid volume excess. He was frightened, slightly confused, and dyspneic on exertion. 1. During the assessment process, the nurse expects to identify all of the following except: a. a full pulse. b. decreased central venous pressure. c. edema. d. neck vein distention.

Harriet, 30 years old, has been admitted to the burn treatment center with full-thickness burns over 30% of her upper body. Her diagnosis is consistent with extracellular fluid volume deficit (FVD). 1. The major indicator of extracellular FVD can be identified by assessing for: a. a full and bounding pulse. b. a drop in postural blood pressure. c. an elevated temperature. d. pitting edema of the lower extremities.

10. While caring for an 84-year-old patient, the nurse monitors the patient's fluid and electrolyte balance, recognizing what as a normal change of aging? a. Hyperkalemia b. Hyponatremia c. Decreased insensible fluid loss d. Increased plasma oncotic pressures

b. A decrease in renin and aldosterone and an increase in antidiuretic hormone (ADH) and atrial natriuretic peptide (ANP) lead to decreased sodium reabsorption and increased water retention by the kidney, both of which lead to hyponatremia. Skin changes lead to increased insensible water loss and plasma oncotic pressure is more often decreased because of lack of protein intake

27. A patient with a pH of 7.29 has metabolic acidosis. Which value is useful in determining whether the cause of the acidosis is an acid gain or a bicarbonate loss? a. PaCO2 b. Anion gap c. Serum Na+ level d. Bicarbonate level

b. Calculation of the anion gap by subtracting the serum chloride and bicarbonate levels from the serum sodium level should normally be 10 to 14 mmol/L. The anion gap is increased in metabolic acidosis associated with acid gain (e.g., diabetic acidosis) but remains normal in metabolic acidosis caused by bicarbonate loss (e.g., diarrhea).

17. What is hyperkalemia frequently associated with? a. Hypoglycemia b. Metabolic acidosis c. Respiratory alkalosis d. Decreased urine potassium levels

b. In metabolic acidosis, hydrogen ions in the blood are taken into the cell in exchange for potassium ions as a means of buffering excess acids. This results in an increase in serum potassium until the kidneys have time to excrete the excess potassium

9. What stimulates aldosterone secretion from the adrenal cortex? a. Excessive water intake b. Increased serum osmolality c. Decreased serum potassium d. Decreased sodium and water

d. Aldosterone is secreted by the adrenal cortex in response to a decrease in plasma volume (loss of water), serum sodium, or renal perfusion. It is also secreted in response to an increase in serum potassium.

34. The nurse is reviewing a patient's morning laboratory results. Which result is of greatest concern? a. Serum Na+ of 150 mEq/L b. Serum Mg2+ of 1.1 mEq/L c. Serum PO4 3- of 4.5 mg/dL d. Serum Ca2+ (total) of 8.6 mg/dL

b. With a low magnesium level there is an increased risk for hypokalemia and hypocalcemia as well as altered sodium-potassium pump and altered carbohydrate and protein metabolism. Hypokalemia could lead to dysrhythmias and severe muscle weakness. The sodium and phosphate levels are also not within normal limits. However, the implications are not as life-threatening. The calcium level is normal.

1. The average daily urinary output in an adult is: a. 0.5 L b. 1 L c. 1.5 L d. 2.5 L.

11. The nurse should expect that a patient with mild fluid volume excess would be prescribed a diuretic that blocks sodium reabsorption in the distal tubule, such as: a. Bumex. b. Demadex. c. HydroDIURIL. d. Lasix

15. One of the dangers of treating hypernatremia is: a. red blood cell crenation. b. red blood cell hydrolysis. c. cerebral edema. d. renal shutdown

18. A patient is admitted who has had severe vomiting for 24 hours. She states that she is exhausted and weak. The results of an admitting electrocardiogram (ECG) show flat T waves and ST-segment depression. Choose the most likely potassium (K+) value for this patient. a. 4.0 mEq/L b. 8.0 mEq/L c. 2.0 mEq/L d. 2.6 mEq/L

19. The ECG change that is specific to hypokalemia is: a. a depressed ST segment. b. a flat T wave. c. an elevated U wave. d. an inverted T wave

20. What is the normal pH range of the blood and what ratio of base to acid does this reflect? a. 7.32 to 7.42; 25 to 2 b. 7.32 to 7.42; 28 to 2 c. 7.35 to 7.45; 20 to 1 d. 7.35 to 7.45; 30 to 1

24. A patient complains of tingling in his fingers. He has positive Trousseau's and Chvostek's signs. He says that he feels depressed. Choose the most likely serum calcium (Ca2+) value for this patient. a. 11 mg/dL b. 9 mg/dL c. 7 mg/dL d. 5 mg/dL

28. Management of the foregoing patient should include: a. a regular diet with extra fruits and green vegetables. b. potassium-sparing diuretics. c. discontinuance of any oral magnesium salts. d. all of the above measures.

31. The kidneys regulate acid-base balance by all of the following mechanisms except: a. excreting hydrogen ions (H+). b. reabsorbing or excreting HCO3- into the blood. c. reabsorbing carbon dioxide into the blood. d. retaining hydrogen ions (H+).

33. Choose the condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration. a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

4. The nurse expects that a decrease in serum osmolality would occur with: a. diabetes insipidus. b. hyperglycemia. c. renal failure. d. uremia

4. The nurse should anticipate that the physician will attempt to reverse this acid-base imbalance by prescribing intravenous administration of: a. potassium chloride. b. potassium iodide. c. sodium bicarbonate. d. sodium chloride.

5. In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours? a. 400 b. 600 c. 800 d. 1,200

5. When performing a neurological assessment on Ken, you notice that there is contraction of his facial muscle after tapping the facial nerve anterior to his ear. You recognize this as Chvostek's sign. This is seen in: (a) hyponatremia. (b) hypokalemia. (c) hypocalcemia. (d) hypomagnesemia.

6. Grace was diagnosed with hyperparathyroidism after a work-up to determine the cause of her elevated calcium levels. The greatest concern in a patient with hypercalcemia would be: (a) cardiac arrhythmia and sinus arrest. (b) nausea and vomiting. (c) constipation and dehydration. (d) kidney stones and muscle weakness.

8. A semiconscious patient presents with restlessness and weakness. He has a dry, swollen tongue. His body temperature is 99.3 F, and his urine specific gravity is 1.020. Choose the most likely serum sodium (Na+) value for this patient. a. 110 mEq/L b. 140 mEq/L c. 155 mEq/L d. 165 mEq/L

6. As fluid circulates through the capillaries, there is movement of fluid between the capillaries and the interstitium. What describes the fluid movement that would cause edema (select all that apply)? a. Plasma hydrostatic pressure is less than plasma oncotic pressure. b. Plasma oncotic pressure is higher than interstitial oncotic pressure. c. Plasma hydrostatic pressure is higher than plasma oncotic pressure. d. Plasma hydrostatic pressure is less than interstitial hydrostatic pressure. e. Interstitial hydrostatic pressure is lower than plasma hydrostatic pressure.

c, e. At the arterial end of the capillary, capillary hydrostatic pressure exceeds plasma oncotic pressure and fluid moves into the interstitial space

13. In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system? a. Kidneys b. Cardiovascular system c. Musculoskeletal system d. Central nervous system

d. As water shifts into and out of cells in response to the osmolality of the blood, the cells that are most sensitive to shrinking or swelling are those of the brain, resulting in neurologic symptoms.

30. What is an example of an IV solution that would be appropriate to treat an extracellular fluid volume deficit? a. D5 W b. 3% saline c. Lactated Ringer's solution d. D5 W in ½ normal saline (0.45%)

c. An isotonic solution does not change the osmolality of the blood and does not cause fluid shifts between the extracellular fluid and intracellular fluid. In the case of extracellular fluid loss, an isotonic solution, such as lactated Ringer's solution, is ideal because it stays in the extracellular compartment. A hypertonic solution would pull fluid from the cells into the extracellular compartment, resulting in cellular fluid loss and possible vascular overload

19. A patient with chronic kidney disease has hyperphosphatemia. What is a commonly associated electrolyte imbalance? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypomagnesemia

c. Kidneys are the major route of phosphate excretion, a function that is impaired in renal failure. A reciprocal relationship exists between phosphorus and calcium and high serum phosphate levels of kidney failure cause low calcium concentration in the serum.

16. A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication? a. Seizures b. Paralysis c. Dysrhythmias d. Acute kidney injury

c. Potassium maintains normal cardiac rhythm, transmission and conduction of nerve impulses, and contraction of muscles. Cardiac cells demonstrate the most clinically significant changes with potassium imbalances because of changes in cardiac conduction. Although paralysis may occur with severe potassium imbalances, cardiac changes are seen earlier and much more commonly

23. A patient who has a large amount of carbon dioxide in the blood also has what in the blood? a. Large amount of carbonic acid and low hydrogen ion concentration b. Small amount of carbonic acid and low hydrogen ion concentration c. Large amount of carbonic acid and high hydrogen ion concentration d. Small amount of carbonic acid and high hydrogen ion concentration

c. The amount of carbon dioxide in the blood directly relates to carbonic acid concentration and subsequently hydrogen ion concentration. The carbon dioxide combines with water in the blood to form carbonic acid and in cases in which carbon dioxide is retained in the blood, acidosis occurs

10. Liz is an elderly woman brought in by concerned family members. After physical examination, she was diagnosed with dehydration. What assessment findings would you expect to see? (a) Bradycardia, slowed respirations, low body temperature, and weight gain. (b) Rales, peripheral edema, palpitations, and diaphoresis. (c) Tachypnea, tachycardia, hypotension, poor skin turgor, and decreased urinary output. (d) Malaise, lymphadenopathy, fever, shortness of breath, and nausea.

2. A manifestation of extracellular volume excess is: a. altered serum osmolality. b. hyponatremia. c. increased hematocrit when volume excess develops quickly. d. rapid weight gain.

22. Cardiac effects of hyperkalemia are usually present when the serum potassium level reaches: a. 5 mEq/L. b. 6 mEq/L. c. 7 mEq/L. d. 8 mEq/L.

23. The most characteristic manifestation of hypocalcemia and hypomagnesemia is: a. anorexia and nausea. b. constipation. c. lack of coordination. d. tetany

26. Cardiac arrest will probably occur with a serum calcium level of: a. 9 mg/dL. b. 12 mg/dL. c. 15 mg/dL. d. 18 mg/dL

29. A clinical indication of hypophosphatemia is: a. bone pain. b. paresthesia. c. seizures. d. tetany

3. A nursing plan of care for George should include: a. auscultating for abnormal breath sounds. b. inspecting for leg edema. c. weighing the patient daily. d. all of the above.

30. The most common buffer system in the body is the: a. plasma protein buffer system. b. hemoglobin buffer system. c. phosphate buffer system. d. bicarbonate-carbonic acid buffer system.

36. A normal oxygen saturation value for arterial blood is: a. 65%. b. 75%. c. 85%. d. 95%.

4. Rocco was admitted to the hospital with a diagnosis of hypomagnesemia. He is complaining of painful paresthesia. Which of the following do you recognize as part of his treatment plan? (a) Dialysis and removal of legumes and whole grains from the diet. (b) Monitoring cardiac rhythm and checking deep tendon reflexes. (c) Monitoring urinary output and auscultating bowel sounds. (d) Palpating peripheral pulses and checking pupil reactions.

5. A nurse can estimate that a patient has a serum osmolality of ______________ if the patient's serum sodium is 140 mEq/L. a. 70 mOsm/kg b. 140 mOsm/kg c. 210 mOsm/kg d. 280 mOsm/kg

9. A clinical manifestation not found in hypovolemia is: a. muscle weakness. b. oliguria. c. postural hypotension. d. bradycardia

12. Which patient is at risk for hypernatremia? a. Has a deficiency of aldosterone b. Has prolonged vomiting and diarrhea c. Receives excessive IV 5% dextrose solution d. Has impaired consciousness and decreased thirst sensitivity

d. A major cause of hypernatremia is a water deficit, which can occur in those with a decreased sensitivity to thirst, the major protection against hyperosmolality. All other conditions lead to hyponatremia

15. A patient is taking diuretic drugs that cause sodium loss from the kidney. Which fluid or electrolyte imbalance is most likely to occur in this patient? a. Hyperkalemia b. Hyponatremia c. Hypocalcemia d. Hypotonic fluid loss

d. Because of the osmotic pressure of sodium, water will be excreted with the sodium lost with the diuretic. A change in the relative concentration of sodium will not be seen but an isotonic fluid loss will occur

18. In a patient with a positive Chvostek's sign, the nurse would anticipate the IV administration of which medication? a. Calcitonin b. Vitamin D c. Loop diuretics d. Calcium gluconate

d. Chvostek's sign is a contraction of facial muscles in response to a tap over the facial nerve. This indicates the neuromuscular irritability of low calcium levels and IV calcium is the treatment used to prevent laryngeal spasms and respiratory arrest. Calcitonin is indicated for treatment of high calcium levels and loop diuretics may be used to decrease calcium levels. Oral vitamin D supplements are part of the treatment for hypocalcemia but not for impending tetany.

25. What is a compensatory mechanism for metabolic alkalosis? a. Shifting of bicarbonate into cells in exchange for chloride b. Kidney conservation of bicarbonate and excretion of hydrogen ions c. Deep, rapid respirations (Kussmaul respirations) to increase CO2 excretion d. Decreased respiratory rate and depth to retain CO2 and kidney excretion of bicarbonate

d. Shifting of bicarbonate for Cl- may buffer acute respiratory alkalosis. The kidney conserves bicarbonate and excretes hydrogen to compensate for respiratory acidosis. Kussmaul respirations occur with metabolic acidosis to compensate

31. Priority Decision: On assessment of a central venous access device (CVAD) site, the nurse observes that the transparent dressing is loose along two sides. What should the nurse do immediately? a. Wait and change the dressing when it is due. b. Tape the two loose sides down and document. c. Apply a gauze dressing over the transparent dressing and tape securely. d. Remove the dressing and apply a new transparent dressing using sterile technique.

d. The greatest risk with CVAD is systemic infection. Dressings that are loose should be changed immediately to reduce this risk.

You are caring for a patient admitted with an exacerbation of asthma. After several treatments, the ABG results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, and O2 saturation of 99%. You interpret these results as: metabolic acidosis. respiratory acidosis. respiratory alkalosis. within normal limits.

Ch. 17 Fluid, Electrolyte, Acid-Base Imbalances

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