Chapter 39: Fluid, Electrolytes, and Acid-Base Balance Review Questions (End of chapter and online)

2. The patient is to receive potassium 20 mEq every morning. Which of the following orders would the nurse question? (Select all that apply.) a. Potassium 10 mEq capsules. Administer 2 capsules PO. b. Potassium 15 mEq/5 mL liquid. Administer 10 cc of liquid PO. c. IV Lactated Ringers with 2mEq/mL potassium to run at 50 mL/hour. d. Potassium 5 mEq/1 mL solution. Administer 4 cc IV over 10 minutes. e. IV Normal saline 1000 mL with 20 mEq potassium to run at 100 mL/hour

2. ANS: B, D, E The liquid dose of potassium is too high at 30 mEq, potassium is NEVER administered as an IV push or bolus medication. The patient needs a supplement each morning; the IV will take 10 hours to infuse and there is no information that the patient cannot take an oral supplement.

3. For a patient with a nursing diagnosis of Dehydration, the nurse is alert to which signs and symptoms? (Select all that apply). a. Hypertension b. Flushed skin c. Dry mucous membranes d. Weak, thready pulse e. Pale yellow urine

Answers: b. Flushed skin c. Dry mucous membranes d. Weak, thready pulse Depending on the severity of fluid volume deficit, the patient may have hypotension. The skin is flushed and dry, the mucous membranes are dry, and the pulse is weak and thready. Hypertension occurs with fluid volume overload. For patients with fluid volume deficit, the urine is dark yellow and concentrated.

1. At 0900, the nurse hangs an IV of 1000 mL D5LR to infuse at 125 mL/hr. What time will the nurse need to hang a new bag of IV fluid? Provide your answer in military time: _____ hours.

1. ANS: 1700 1000mL/125mL = 8 hours. If the IV was hung at 0900, it will be infused 8 hours later, which is 1700 or 5:00 p.m.

1. Which of the following findings would indicate effectiveness of fluid replacement for a patient admitted with dehydration? (Select all that apply.) a. Blood urea nitrogen—18 mg/dL b. Pulse—82 c. Blood pressure—140/90 d. Urine specific gravity—1.033 e. 24-hour fluid balance - +200

1. ANS: A, B, E Blood urea nitrogen will be elevated with dehydration and return to normal levels with hydration. Normal pulse rate and positive fluid balance also indicate adequate fluid levels. An increased urine specific gravity is an indication of dehydration while an increased blood pressure can indicate fluid volume excess.

1. A nurse is caring for a patient who is receiving furosemide for hypertension. The patient reports taking bisacodyl daily. The nurse assesses the patient for possible symptoms of: a. hypoglycemia. b. hypoparathyroidism. c. hypokalemia. d. hypocalcemia.

1. ANS: C Loop diuretics act on the loop of Henle to block reabsorption of sodium and potassium and are considered potassium-wasting diuretics. Daily use of laxatives such as bisacodyl can lead to increased potassium loss through stool.

2. The physician has ordered 1000 mL of D5NS to infuse over 6 hours. The IV tubing has a drop factor of 10 gtts/min. Calculate the flow rate in cc/mL and gtts/min. Round to the nearest whole number for each calculation: ___________ mL/hr; ___________ gtts/min.

2. ANS: 167; 28 1000 mL/6 hours = 166.6 or 167 mL/hr 1000mL/6 hours x 1 hour/60 minutes x 10,000/360 = 27.7 or 28 gtts/min

2. A nurse is caring for an adult patient who has gastric suction following abdominal surgery. The patient reports tingling in the fingers and toes. Which acid-base imbalance is the patient most likely experiencing? a. Respiratory alkalosis b. Metabolic acidosis c. Respiratory acidosis d. Metabolic alkalosis

2. ANS: D In metabolic alkalosis, there is an excess of bicarbonate ions, which raises the pH above 7.45 and produces bicarbonate levels greater than 26 mEq/L. This occurs as a result of loss of gastric acids through vomiting or nasogastric suctioning, among other causes. Clinical manifestations include numbness and tingling in the fingers and toes.

3. Which of the following statements would be considered incorrect when transfusing packed red blood cells (RBCs)? (Select all that apply.) Which of the following actions would cause the nursing faculty to intervene when a student nurse is transfusing packed red blood cells (RBCs)? (Select all that apply.)[AQ1] a. Adjust the infusion rate to ensure unit is infused within 6 hours. b. Begin an infusion of D5W prior to the packed RBCs. c. Obtain baseline vital signs, including temperature and pulse oximetry. d. Verify the patient ID and blood unit number with another nurse prior to administration. e. Takes vital signs per agency policy. [AQ1]The two questions are provided. Kindly check and confirm this.

3. ANS: A, B The unit must be infused within 4 hours after leaving the laboratory. Only normal saline should be used with whole blood or packed RBCs. Use of any other IV solution can cause lysis or destruction of the red blood cells.

3. Which of the following IV solutions is considered hypertonic? a. Lactated Ringers b. D5W c. D5 0.45% NS d. 0.9% normal saline

3. ANS: C D5 0.45% NS is considered hypertonic because the osmolarity is greater than 290 mOsm/L. The other fluids are considered isotonic. D5W is hypotonic when infused because the glucose is metabolized rapidly.

4. The student nurse is preparing to insert an IV catheter with an intermittent infusion device (IID) into an older patient for medication administration. Which of the following actions would require the faculty member to intervene? a. Inserts the IV catheter into nondominant hand/arm. b. Uses a 16- or 18-gauge over-the-needle catheter. c. Releases the tourniquet before attaching the IID. d. Flushes the IID with 2 to 3 mL normal saline after insertion.

4. ANS: B With IV catheters, the higher the number, the smaller the gauge. For an older person who needed IV access for medication administration, a smaller gauge such as a 22 or 24 would be more appropriate. 16- or 18-gauge needles are used with high volume IV infusions.

5. Which of the following would the nurse expect to be included in the plan of care for a patient receiving total parenteral nutrition (TPN)? a. Blood sugar levels q.i.d b. Maintaining NPO status c. Hourly urine output d. Vital signs every 4 hours

5. ANS: A The usual composition of TPN begins with a high glucose solution (usually 25% glucose) and an amino acid solution. Because of the high glucose content, patients with TPN may develop hyperglycemia. Frequent monitoring of blood glucose can detect this increase. TPN can be used when the patient is NPO but can also be used as a supplement when oral intake is inadequate. Hourly outputs and frequent vital signs are not required for TPN infusions.

2. A nurse caring for a hospitalized patient with diarrhea and dehydration is told in the shift report that the patient's laboratory results have just come in. Which abnormal laboratory values should be reported to the primary care provider? (Select all that apply). a. Sodium (Na) level 150 mEq/L b. Potassium (K) level 3.3 mEq/L c. Calcium (Ca) level 9.5 mg/dL d. Magnesium (Mg) level 1.0 mEq/L e. Chloride (Cl) level 101 mEq/L

Answer: a. Sodium (Na) level 150 mEq/L b. Potassium (K) level 3.3 mEq/L d. Magnesium (Mg) level 1.0 mEq/L The sodium, potassium, and magnesium levels are all abnormal levels that often can be seen in dehydrated clients with prolonged diarrhea. Normal sodium levels for adults range from 135 to 145 mEq/L. Normal potassium levels for adults range from 3.5 to 5 mEq/L. Normal magnesium levels for adults range from 1.3 to 2.1 mEq/L. The calcium and chloride values are within normal limits.

9. Which activity is important to include in the plan of care for a client with a peripherally inserted central catheter (PICC)? a. Use sterile technique when changing the PICC dressing. b. Change the IV tubing every 72 hours. c. Take blood pressure in the arm with the PICC line. d. Use only macrodrip tubing with IV infusions through the PICC line.

Answer: a. Use sterile technique when changing the PICC dressing. Because a PICC enters the body through a peripheral vein and is threaded up to the superior vena cava, resting just outside the right atrium of the heart, strict sterile technique is used during insertion and care of PICCs to prevent entrance of bacteria into the line. PICC tubing is usually changed every 24 hours. Never take blood pressure in an arm with a PICC. Macrodrip or microdrip tubing can be used for infusions through a PICC.

5. A nurse in the emergency department is caring for an adult patient with numerous draining wounds from gunshots. The patient's pulse rate has increased from 100 to 130 beats/min over the past hour, and the patient is experiencing orthostatic hypotension. For which imbalance should the nurse assess? a. Respiratory acidosis b. Extracellular fluid volume deficit c. Metabolic alkalosis d. Intracellular fluid volume excess

Answer: b. Extracellular fluid volume deficit The draining wounds indicate hypovolemia, or extracellular fluid volume deficit. As circulating blood volume decreases, the heart rate increases to maintain normal cardiac output, and the patient may experience orthostatic hypotension and lightheadedness with position changes. Respiratory acidosis and metabolic alkalosis do not have as a symptom a rapidly increasing pulse rate. Intracellular fluid volume excess causes pulmonary congestion and cerebral edema.

4. The nurse is caring for a patient with hypocalcemia who does not like milk. Which food should the nurse encourage the patient to consume? a. Cod b. Eggs c. Spinach d. Tomatoes

Answer: c. Spinach Dark leafy vegetables such as spinach, kale, turnip greens, broccoli, Brussels sprouts, and cabbage are sources high in calcium.

8. The nurse is assessing the intravenous (IV) site in the right forearm and notices the area about 1 inch around it is cool, swollen, firm, and tender to touch. Which action should the nurse take first? a. Take patient's temperature b. Apply an ice pack to site c. Stop infusion and remove IV catheter d. Call the primary care provider immediately

Answer: c. Stop infusion and remove IV catheter The area around an IV infiltration is cool, swollen, firm, and tender to touch. The first intervention to take for an infiltrated IV is to stop the infusion and discontinue the IV by removing the catheter. Applying cold compresses may be appropriate for hyperosmolar fluids, but only after the IV infusion has been stopped. Taking the temperature would be an assessment to make if the complication of infection is suspected. The primary care provider does not need to be notified unless grade 3 or 4 infiltrations are noted (>6 inches edema).

6. A 65-year-old female patient is a two-pack-a-day cigarette smoker with a history of chronic obstructive pulmonary disease (COPD). What is the interpretation of her arterial blood gas values (pH 7.34, PCO2 55, PO2 82, HCO3− 32)? a. Partially compensated respiratory alkalosis b. Uncompensated metabolic acidosis c. Uncompensated respiratory alkalosis d. Partially compensated respiratory acidosis

Answer: d. Partially compensated respiratory acidosis Patients with COPD tend to have chronic carbon dioxide retention. The patient is slightly acidotic (i.e., arterial pH below 7.35) with a higher than normal partial pressure of carbon dioxide (PCO2), which is inverse and therefore a respiratory issue. The compensatory response to respiratory acidosis is buffering, as indicated by the higher than normal bicarbonate (HCO3−) level. The increase in bicarbonate only partially shifts the pH toward normal, but partial compensation prevents the acid-base imbalance from becoming life-threatening. The kidneys will continue to compensate in an attempt to bring the pH into the normal range.

7. A patient with a continuous IV of D5 0.9% NS running at 150 mL/hr begins to exhibit hallucinations and confusion. Which laboratory value should the nurse expect to check? a. Calcium b. Carbon dioxide c. Magnesium d. Sodium

Answer: d. Sodium Hypernatremia can be caused by hypertonic IV solutions such as D5 0.9% NS. Symptoms of severe hypernatremia include confusion, irritability, decreased level of consciousness, hallucinations, and seizures.

1. A patient has reported a 2-kg (4.4-lb) weight gain over the past 3 days. Which dietary factor should the nurse assess? a. Protein intake b. Potassium intake c. Calorie intake d. Sodium intake

Answer: d. Sodium intake A weight gain of 2 kg in 3 days suggests fluid retention. Increased sodium intake leads to increased fluid retention. Although it is important to ask the patient about intake of all nutrients, the other options cannot cause this much weight gain in 3 days.

10. The nurse has just begun an infusion of packed red blood cells (PRBC). Which of the following changes would indicate a transfusion reaction and warrants stopping the infusion? a. Respirations increased from 16/min to 20/min. b. Urine output in Foley catheter bag has 50 mL/h output of dark yellow urine. c. Heart rate decreased from 77 beats/min to 62 beats/min. d. Temperature increased from 100° degrees to 102.2° F

Answer: d. Temperature increased from 100° degrees to 102.2° F An increased temperature of more than 2 degrees Fahrenheit indicates a febrile nonhemolytic reaction, and the infusion should be stopped. The primary care provider and blood bank should be notified. The urine output is an adequate hourly amount. The heart rate is normal. The respiratory rate is not a significant change