Davis- Chapter 38: Fluids, Electrolytes, & Acid-Base Balance

Identify the normal range of pH. 1. 7.35 - 7.45 2. 7.00 - 7.20 3. 7.50 - 7.55 4. 7.70 - 7.75

1. 7.35 - 7.45 [WRONG] 2. 7.00 - 7.20 (below 7.35 indicates acidosis) 3. 7.50 - 7.55 (above 7.45 indicates alkalosis) 4. 7.70 - 7.75 (above 7.45 indicates alkalosis)

Which movement of fluids and solutes requires energy? 1. Active transport 2. Osmosis 3. Diffusion 4. Filtration

1. Active transport

Which are types of reactions clients may have to administration of blood and blood products? Select all that apply. 1. Allergic 2. Hypotensive 3. Fluid volume overload 4. Febrile 5. Decreased urine output 6. Thrombus[

1. Allergic (can occur to blood and blood products) 3. Fluid volume overload (occur when administering blood and blood products to a client) 4. Febrile

Which hormone causes the kidneys to retain fluid? 1. Antidiuretic hormone 2. Renin 3. Thyroid hormone 4. Aldosterone

1. Antidiuretic hormone (decrease volume in the cardiovascular system stimulates the release of ADH, which causes the kidneys to retain fluid) [WRONG] 2. Renin (is an enzyme that converts angiotensin to angiotensin II) 3. Thyroid hormone (influences the cardiac output) 4. Aldosterone (stimulates the distal tubules of the kidney to reabsorb sodium and excrete potassium)

Which factors should the nurse consider prior to selecting a vein for an intravenous (IV) catheter insertion? Select all that apply. 1. Client's age 2. Client's gender 3. Type of solution 4. Speed of infusion 5. Length of hospital stay

1. Client's age (age of the client should be considered prior to selecting a vein. Older and younger clients have more fragile veins and smaller IV catheters should be used) 3. Type of solution (larger vein should be chosen for blood transfusion and medications with low pH) 4. Speed of infusion (larger veins should be selected for fluids that need to infuse at a faster rate. This prevents damage to smaller veins)

When the carbonic acid portion of the buffering system is out of balance, which of the following occurs? Select all that apply. 1. Respiratory Alkalosis 2. Metabolic Alkalosis 3. Respiratory Acidosis 4. Metabolic Acidosis 5. Compensation

1. Respiratory Alkalosis (a respiratory disturbance alters the carbonic acid portion of the buffering system and the resulting imbalance is labeled respiratory acidosis or respiratory alkalosis) 3. Respiratory Acidosis (a respiratory disturbance alters the carbonic acid portion of the buffering system and the resulting imbalance is labeled respiratory acidosis or respiratory alkalosis)

Which acid-base imbalance is present when a client's ABG shows a pH of 7.27, PCO2 of 55, and HCO3 of 24? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

1. Respiratory acidosis (is indicated by a low pH, high PCO2, and normal HCO3) [WRONG] 2. Respiratory alkalosis (alkalosis is reflected by a pH of over 7.45) 3. Metabolic acidosis (HCO3 is normal, which shows the acidosis is not metabolic) 4. Metabolic alkalosis (the condition described is not metabolic or alkalosis)

The nurse is caring for a client with asthma and pneumonia who is hyperventilating. Which acid-base imbalance would be anticipated? 1. Respiratory alkalosis 2. Metabolic acidosis 3. Respiratory acidosis 4. Metabolic alkalosis

1. Respiratory alkalosis

Which are examples of electrolytes? Select all that apply. 1. Sodium 2. Iron 3. Potassium 4. Oxygen 5. Calcium

1. Sodium (develop an electrical charge when dissolved in water) 3. Potassium (electrolyte associated with an electrical charge) 5. Calcium (has an electrical charge when dissolved in water)

What happens to pH when there is full compensation? 1. The pH returns to normal. 2. The pH becomes acidotic. 3. The pH becomes alkalotic. 4. The pH does not move in compensation.

1. The pH returns to normal. (for the body to return to the homeostasis the pH must be in the normal range)

Which describe symptoms of dehydration? Select all that apply. 1. Thirst 2. Increased blood pressure 3. Rapid pulse 4. Muscle fatigue 5. Increased respirations

1. Thirst (initial symptom of dehydration) 3. Rapid pulse (rapid, weak pulse is associated with dehydration) 4. Muscle fatigue (symptom of moderate dehydration)

The nurse is assessing a client after surgery who is dehydrated and experiencing hypotension, tachycardia, and decreased urine output. What additional assessment should the nurse perform? 1. Tongue and skin turgor 2. Bowel sounds 3. Lung sounds 4. Pupillary response

1. Tongue and skin turgor

Which are sources of fluid loss in the body? Select all that apply. 1. Urine 2. Skin 3. Lungs 4. Spinal cord 5. Bone

1. Urine (urine accounts for the greatest amount of fluid loss in the body) 2. Skin (fluid is lost through the skin via perspiration and heat) 3. Lungs (water is exhaled through each breath)

Locations of fluid loss 1. Urine 2. Brain 3. Liver 4. Feces 5. Skin 6. Sputum 7. Lungs 8. Mucous membranes

1. Urine 4. Feces 5. Skin 7. Lungs Fluid output is a result of sensible (measurable) and insensible (unmeasurable) fluid loss. Sensible loss includes urine, feces, diarrhea, ostomy, and gastric drainage. Insensible loss occurs from diffusion and evaporation through the skin and lungs, and increases with open wounds, burns, or breaks in the skin.

Which is a sensible fluid loss? 1. Urine output 2. Perspiration 3. Weeping edema 4. Moisture in exhalation

1. Urine output

Partially Compensated Metabolic Acidosis 1. pH < 7.35 2. pH > 7.45 3. pH 7.35-7.45 4. Pco2 < 35 mm Hg 5. Pco2 > 45 mm Hg 6. HCO3 < 22 mEq/L 7. HCO3 > 26 mEq/L 8. HCO3 22-26 mEq/L

1. pH < 7.35 4. Pco2 < 35 mm Hg 6. HCO3 < 22 mEq/L In this situation, the body is in a metabolic acidosis (renal impairment, starvation, diabetic ketoacidosis) and has not compensated enough for the pH to normalize. Compensation in metabolic acidosis would occur with hyperventilation as the body tries to blow off carbon dioxide (acid).

Uncompensated Respiratory Acidosis 1. pH < 7.35 2. pH > 7.45 3. pH 7.35-7.45 4. Pco2 < 35 mm Hg 5. Pco2 > 45 mm Hg 6. HCO3 < 22 mEq/L 7. HCO3 > 26 mEq/L 8. HCO3 22-26 mEq/L

1. pH < 7.35 5. Pco2 > 45 mm Hg 8. HCO3 22-26 mEq/L In uncompensated respiratory acidosis, the client should demonstrate an increased respiratory rate in an attempt to compensate for the acidosis. If the client cannot increase the respiration rate (e.g., because of oversedation, brain injury, or airway obstruction) the body will retain more acid, eventually causing cardiac arrest.

Uncompensated Metabolic Acidosis 1. pH < 7.35 2. pH > 7.45 3. pH 7.35-7.45 4. Pco2< 35 mm Hg 5. Pco2 > 45 mm Hg 6. Pco2 35-45 mm Hg 7. HCO3 < 22 mEq/L 8. HCO3 > 26 mEq/L

1. pH < 7.35 6. Pco2 35-45 mm Hg 7. HCO3 < 22 mEq/L In uncompensated metabolic acidosis, the client has not begun compensating for the acid-base imbalance. The underlying problem must be corrected before the condition deteriorates.

Partially Compensated Respiratory Acidosis 1. pH < 7.35 2. pH > 7.45 3. pH 7.35-7.45 4. Pco2 < 35 mm Hg 5. Pco2 > 45 mm Hg 6. HCO3 < 22 mEq/L 7. HCO3 > 26 mEq/L 8. HCO3 22-26 mEq/L

1. pH < 7.35 7. HCO3 > 26 mEq/L 5. Pco2 > 45 mm Hg In partially compensated respiratory acidosis, the client is beginning to compensate for the retention of acid from inadequate ventilation. Aggressive pulmonary toileting is needed to prevention further problems and improve the acid-base imbalance.

Which is the greatest determinant of intracellular osmolality? 1. Sodium 2. Potassium 3. Calcium 4. Glucose

2. Potassium (lives inside a cell and is the greatest determinant of intracellular osmolality) [WRONG] 1. Sodium (sodium is the greatest determinant of extracellular osmolality) 3. Calcium (helps facilitate the sodium-potassium exchange in cells) 4. Glucose (glucose helps determine osmolarity inside and outside of cells)

Which action should the nurse take if it is discovered that an IV infusion has been running too fast for the past hour? 1. Stop the IV infusion for an hour. 2. Slow the infusion and assess for fluid volume excess. 3. Discontinue the IV. 4. If the client appears stable, leave the infusion at the faster rate.

2. Slow the infusion and assess for fluid volume excess. (should be slowed to the appropriate ordered rate and the client assessed)

Which are the purposes of administering hypertonic IV solutions? Select all that apply. 1. Increase blood volume following trauma. 2. Stabilize blood pressure. 3. Reduce edema. 4. Increase intracranial pressure. 5. Increase urine output.

2. Stabilize blood pressure. (hypertonic solution are used to stabilize blood pressure in hypovolemia) 3. Reduce edema. (hypertonic solution reduce edema by pulling fluids into the intravascular areas) 5. Increase urine output. (hypertonic IV solutions increase urine output)

The nurse initiates a transfusion of packed red blood cells to a client. Ten minutes later, the client develops fever, chills, shortness of breath, and a heart rate of 120 beats per minute. What should be the nurse's first intervention? 1. Notify the health-care provider. 2. Stop the transfusion immediately. 3. Flush the intravenous tubing with 0.9% normal saline. 4. Administer an antihistamine to stop the reaction.

2. Stop the transfusion immediately. (immediately discontinue the transfusion and then infuse 0.9% normal saline with new tubing. This would prevent further infusion of contaminated blood into the client)

If a peripheral IV access attempt is unsuccessful, what action should the nurse take? 1. Withdraw the needle and attempt to reinsert it. 2. Withdraw the needle and attempt IV access using another needle and another site. 3. Have a more experienced colleague attempt to reinsert it. 4. Leave the needle in the site to anchor the vein and attempt with another needle.

2. Withdraw the needle and attempt IV access using another needle and another site. (should withdraw the needle, apply pressure to the site, and attempt a second site using another needle)

A student nurse is discussing the diet required in client with hypertension who is also at risk for osteoporosis and takes a diuretic. Which dietary change designed to control electrolytes and fluids in this client noted by the nurse indicates a need for further teaching? Select all that apply. 1. "Sodium intake must be limited in hypertensive clients." 2. "This client should increase her calcium intake." 3. "Clients with hypertension should follow a very low-carbohydrate diet." 4. "Hypertensive clients should ensure minimal phosphorus intake." 5. "This client should increase consumption of potassium."

3. "Clients with hypertension should follow a very low-carbohydrate diet." Rationale: Carbohydrate intake should be controlled in clients with diabetes mellitus, not hypertension. This will not control fluid and electrolyte balances. 4. "Hypertensive clients should ensure minimal phosphorus intake." Rationale: There is no need to advise a hypertensive client to limit phosphorus intake, as phosphorus is required for bone strength and does not affect fluids. [WRONG] 1. "Sodium intake must be limited in hypertensive clients." Rationale: Clients with hypertension should be advised to limit sodium intake. Water follows sodium, and decreased sodium means decreased fluid volume. 2. "This client should increase hercalcium intake." Rationale: Clients who are at risk for osteoporosis should be advised to increase calcium intake in order to maintain normal serum calcium and phosphorus levels. 5. "This client should increase consumption of potassium." Rationale: Diuretics can trigger the loss of potassium.

Symptoms of dehydration 1. Dry skin 2. Thirst 3. Decreased urine output 4. Increased heart rate 5. Increased blood pressure 6. Hypothermia 7. Orthostatic hypotension 8. Protruding neck veins

1. Dry skin 2. Thirst 3. Decreased urine output 4. Increased heart rate 5. Increased blood pressure 7. Orthostatic hypotension The initial sign of dehydration is thirst. If a person is unable to meet his or her body's fluid requirements at this point, the symptoms will worsen and the client's status will deteriorate (hypovolemic shock) if not corrected. After thirst, blood pressure and heart rate will increase as the body tries to compensate. Urine output will decrease, neck veins will flatten, and the client will become weak, fatigued, and hot. Cellular dehydration is demonstrated by dry skin and mucous membranes and decreased tongue and skin turgor.

The nurse is concerned that a client is in uncompensated respiratory acidosis. Which are possible reasons why the body is not compensating? Select all that apply. 1. Excess sedation medication 2. Brain injury from a bleed 3. Blockage of the airway 4. Kidney failure 5. Dehydration

1. Excess sedation medication 2. Brain injury from a bleed 3. Blockage of the airway

Clients at risk for hypervolemia 1. Excessive IV fluid administration 2. Excess salt intake 3. Poor kidney functioning 4. Oversedation 5. Diarrhea 6. Overdose of a diuretic 7. Decreased cardiac output 8. Liver failure

1. Excessive IV fluid administration 2. Excess salt intake 3. Poor kidney functioning 7. Decreased cardiac output 8. Liver failure Hypervolemia, or fluid volume excess, is a result of excess retention of sodium and water in the extracellular fluid. It can be caused from (1) excessive intake of fluids (IV or orally), (2) inability to excrete fluids (excess salt intake, poor kidney function, and decreased cardiac output), and (3) excess fluids outside the vascular space (liver failure).

Which are uses of IV therapy? Select all that apply. 1. Expand intravascular volume. 2. Increase blood concentration. 3. Correct underlying fluid or electrolyte imbalances. 4. Compensate for an underlying problem affecting fluids and electrolytes. 5. Provide caloric intake.

1. Expand intravascular volume. (IV fluids are given to expand the volume within blood vessels) 3. Correct underlying fluid or electrolyte imbalances. (IV fluids can be given to normalize electrolytes and acid-base balance) 4. Compensate for an underlying problem affecting fluids and electrolytes. (IV therapy is used to compensate for underlying metabolic problems that affect fluid and electrolyte status)

Symptoms of fluid overload 1. Hypertension 2. Tachycardia 3. Reddened, warm skin 4. Jugular venous distention (JVD) 5. Bounding pulses 6. Tachypnea 7. Weight loss 8. Sunken eyes

1. Hypertension 2. Tachycardia 4. Jugular venous distention (JVD) 5. Bounding pulses 6. Tachypnea The symptoms of fluid overload in the vascular space include hypertension, bounding pulses with tachycardia, tachypnea with shallow breathing, JVD, and an increase in dilute urine. If the fluids are in the extracellular location, symptoms include edema and cool, pale skin. Weight gain will occur, and the client may have trouble with oxygenation from fluid around the lungs.

James is experiencing water intoxication as a result of psychogenic polydipsia, a condition compelling him to drink excessive amounts of water. He is weak, lethargic, and confused. The nurse is concerned about seizures.Which electrolyte imbalance is causing the problem? 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

1. Hyponatremia Sodium regulates fluid volume. When sodium is reabsorbed, so are water and potassium. Common causes of hyponatremia include diuretics, GI fluid loss, adrenal insufficiency, excessive intake of hypotonic IV solutions and water, and syndrome of inappropriate ADH release. The greatest risk for a client with hyponatremia is seizures, so safety standards should be initiated.

The nurse is caring for a client in metabolic acidosis. With this condition, the nurse would anticipate which arterial blood gas changes? Select all that apply. 1. Increase in CO2 2. Increase in HCO3 3. Decrease in HCO3 4. Increase in pH 5. Decrease in pH

1. Increase in CO2 3. Decrease in HCO3 5. Decrease in pH

The nurse is caring for a client whose intravenous infusion ran in quickly over a short amount of time, placing the client in fluid overload. What symptoms should the nurse anticipate? Select all that apply. 1. Increased pulse rate 2. Increased pulse strength 3. Reddened, warm skin 4. Elevated blood pressure 5. Sunken eyes

1. Increased pulse rate 2. Increased pulse strength 4. Elevated blood pressure

Which are complications of IV therapy? Select all that apply. 1. Infiltration 2. Infection 3. Blood loss 4. Allergic reaction 5. Thrombus

1. Infiltration (occurs when IV solution leaks out of the vessel and into surrounding tissues) 2. Infection (can occur in insertion sites if the site is not kept clean) 5. Thrombus (small clot that dislodges in a vein as a result of the IV catheter) [WRONG] 3. Blood loss (Not a problem related to IV therapy) 4. Allergic reaction (can occur as a result of a particular solution or medication, but it is not a common complication of IV therapy itself)

A client with impaired renal function is in diabetic ketoacidosis. What acid-base imbalance would be anticipated? 1. Metabolic acidosis 2. Respiratory alkalosis 3. Respiratory acidosis 4. Metabolic alkalosis

1. Metabolic acidosis

Clients at risk for hypovolemia 1. Motor vehicle accident with trauma 2. Poor myocardial functioning 3. Uterine rupture during childbirth 4. Increased secretion of antidiuretic hormone (ADH) 5. Significant burns to the body 6. Hiker without water supply 7. Increased release of aldosterone 8. Vomiting from a viral infection

1. Motor vehicle accident with trauma 3. Uterine rupture during childbirth 5. Significant burns to the body 6. Hiker without water supply 8. Vomiting from a viral infection Hypovolemia, or deficient fluid volume, occurs when there is a proportional loss of fluid and electrolytes from the extracellular fluid. This can be caused by: (1) insufficient intake of fluids (hiker), (2) excessive fluid loss (trauma, rupture, and vomiting), and (3) fluid shifts (burns). Poor myocardial functioning, increased secretion of ADH, and increased release of aldosterone would increase fluid retention.

Christina is on chemotherapy for breast cancer. She is experiencing tetany symptoms with tingling of the extremities. She has been started on aluminum hydroxide with meals. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

10. Hyperphosphatemia High phosphate is the result of renal failure, hyperthyroidism, chemotherapy, and excessive use of phosphate-based laxatives. Many of its symptoms are similar to those of hypocalcemia because they are inverse electrolytes. Aluminum hydroxide is a phosphate binder and removes excess phosphate from the blood.

Hormones controlling fluid balance 1. Insulin 2. Brain natriuretic peptide 3. C-type natriuretic peptide 4. Atrial natriuretic peptide 5. Thyroid hormone 6. Aldosterone 7. Renin-angiotensin 8. Antidiuretic hormone

2. Brain natriuretic peptide 3. C-type natriuretic peptide 4. Atrial natriuretic peptide 5. Thyroid hormone 6. Aldosterone 7. Renin-angiotensin 8. Antidiuretic hormone The kidneys are the primary regulator of fluid balance, but several things influence their ability to create this balance. Antidiuretic hormone from the pituitary causes the kidneys to retain fluid. Renin-angiotensin receptors respond to decreased perfusion and impact sodium regulation. Aldosterone is released, causing the reabsorption of sodium. Thyroid hormone influences cardiac output and, therefore, glomerular filtration rates. Peptides impact the cardiovascular and renal systems in regulation of fluid maintenance.

Which electrolyte is often given as a supplement to elderly people to reduce the risk of fractures and osteoporosis? 1. Sodium 2. Calcium 3. Potassium 4. Zinc

2. Calcium (provides strength and structure for bones and is given to prevent bone loss) [WRONG] 1. Sodium (not given to reduce the incidence of fractures and osteoporosis) 3. Potassium (potassium is often given as a supplement but is not protective of bone health) 4. Zinc (not given for bone health)

The nurse is concerned about fluid loss for the at-risk client. What should be included in the output measurement? Select all that apply. 1. Wound drainage 2. Emesis 3. Sweat 4. Urine 5. Sputum

2. Emesis 4. Urine

Which occurs with the hematocrit level in the blood while IV solution is administered? 1. Hematocrit increases 2. Hematocrit decreases 3. Hematocrit remains unchanged 4. Depends on the osmolality of the solution

2. Hematocrit decreases (because the blood becomes less concentrated) [WRONG] 1. Hematocrit increases (does not increase with the administering of IV fluids) 3. Hematocrit remains unchanged (is affected by the administration of the IV solution) 4. Depends on the osmolality of the solution (hypertonic, hypotonic, and isotonic fluids have similar effects on the serum hematocrit)

The nurse is caring for a client with severe diabetic ketoacidosis. Which electrolyte imbalance will occur as a result of the acidotic state? 1. Hypercalcemia 2. Hyperkalemia 3. Hypermagnesemia 4. Hypernatremia

2. Hyperkalemia

Kimberly went on a hike with friends on a hot summer day. She did not take adequate amounts of water and is brought to the emergency department with a high fever, dry mouth, sticky mucous membranes, and hallucinations. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

2. Hypernatremia Hypernatremia occurs with excessive sodium intake (orally or intravenously), water deprivation, increased water loss via sweating, heat stroke, or diabetes insipidus and the administration of hypertonic tube feedings. The greatest risk for clients with hypernatremia is seizures.

The nurse is caring for a client with a hypotonic fluid ordered for infusion. What would be the reason for this type of fluid being used? Select all that apply. 1. Intracellular space is swollen. 2. Intracellular space is dry. 3. Both extracellular and intracellular space is equal. 4. Extracellular spaces are dry. 5. Extracellular spaces are swollen.

2. Intracellular space is dry. 5. Extracellular spaces are swollen.

An 18-year-old client is brought to the emergency department following a motorcycle accident. The client has lost a large volume of blood and nurses are unable to establish IV access using a peripheral vein. His or her blood pressure is barely palpable. Which is the best IV route for immediate fluid resuscitation? 1. PICC Line 2. Intraosseous catheter 3. Central venous line 4. Implanted port 5. 8918

2. Intraosseous catheter (is direct access within the bone, used in emergency situations) [WRONG] 1. PICC Line (used for long term repeated IV infusions) 3. Central venous line (time consuming procedure, not an immediate emergency resuscitation measure) 4. Implanted port (done in a procedure lab and is not used in emergency situations) 5. 8918

Which body systems will attempt to keep the body in homeostasis if acid-base imbalance continues for an extended period of time? 1. Heart 2. Kidneys 3. Lungs 4. Spleen 5. Liver

2. Kidneys (will try to buffer the imbalance if breathing is the problem) 3. Lungs (will try to buffer the imbalance by breathing faster and deeper or more shallow and slower)

Acid-base balance is reflected through which arterial blood gas values? Select all that apply. 1. PO2 2. PCO2 3. pH 4. HCO3 5. HGB

2. PCO2 (partial pressure of carbon dioxide (PCO2) is a determinant of acid base balance) 3. pH (is the acidity of arterial blood and is a determinant of acid base balance) 4. HCO3 (bicarbonate is a determinant of acid base balance)

The nurse notes an increase in the fluids removed with gastric suctioning. What electrolyte should be monitored more closely as a result? 1. Sodium 2. Potassium 3. Calcium 4. Phosphorus

2. Potassium

The health-care provider prescribes 0.9% sodium chloride to infuse at 100 mL/hour. The nurse hangs a new 1 liter bag at 0800. The nurse returns to the room at 1200 and notices only 200 mL of the solution has infused. What is the most appropriate intervention for the nurse to perform? 1. Increase the rate of infusion to make up the difference. 2. Change the prescription to reflect the rate of 50 mL/hour. 3. Adjust the rate of infusion to 100 mL/hour and document the intake. 4. Notify the health-care provider of the error and document the error in the medical record.

3. Adjust the rate of infusion to 100 mL/hour and document the intake. (the nurse should adjust the rate of infusion to the prescribed rate of 100mL/hour and document the fluid volume that infused)

Upon assessment, the nurse identified a positive Trousseau's sign. What electrolyte is of concern? 1. Potassium 2. Phosphorus 3. Calcium 4. Sodium

3. Calcium

Which electrolyte is found primarily in bones and teeth? 1. Potassium 2. Sodium 3. Calcium 4. Iron

3. Calcium (approx. 99% of calcium in body is found in the teeth and bone) [WRONG] 1. Potassium (is an intracellular electrolyte) 2. Sodium (extracellular electrolyte) 4. Iron (is a mineral that is key to the oxygen-carrying capacity of red blood cells)

Which imbalance would be reflected by the ABG result of pH 7.35, PCO2 38, HCO3 18? 1. Uncompensated respiratory acidosis 2. Compensated respiratory alkalosis 3. Compensated metabolic acidosis 4. Uncompensated metabolic alkalosis

3. Compensated metabolic acidosis

Maddie, an older adult, takes a loop diuretic twice a day for congestive heart failure. She tells her daughter that she's very tired and weak, feels nauseated, and notices heart palpitations. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

3. Hypokalemia Potassium is important for ICF osmolality, cardiac conduction, acid-base balance, and electrical impulse transmission. Causes of hypokalemia include diuretics, GI fluid loss from vomiting, gastric suction or diarrhea, steroid administration, hyperaldosteronism, anorexia, and bulimia. The greatest concern with low potassium is dysthymias that can cause cardiac arrest.

Edema is caused by an excess of which type of fluid? 1. Intracellular 2. Extracellular 3. Interstitial 4. Transcellular

3. Interstitial (lies between cells and excess interstitial fluid results in edema) [WRONG] 1. Intracellular (fluid inside the cells; an excess of this type of fluid causes cell to burst) 2. Extracellular (outside of the cells and carries wastes products from the cell) 4. Transcellular (they are specialized fluids contained in body spaces)

The nurse receives hand-off report on each of these clients. Who is at the greatest risk for fluid volume excess? 1. The client recovering from a large abdominal surgery. 2. The client with diarrhea for the past three days 3. The client with heart failure 4. The client who's semiconscious and unable to drink water

3. The client with heart failure

Normal Arterial Blood Gasses 1. pH 7.25-7.35 2. pH 7.30-7.40 3. pH 7.35-7.45 4. Pco2 32-49 mm Hg 5. Pco2 35-45 mm Hg 6. HCO3 18-22 mEq/L 7. HCO3 18-28 mEq/L 8. HCO3 22-26 mEq/L

3. pH 7.35-7.45 5. Pco2 35-45 mm Hg 8. HCO3 22-26 mEq/L Normal acid-base balance would include each of these parameters.

Fully Compensated Metabolic Alkalosis 1. pH < 7.35 2. pH > 7.45 3. pH 7.35-7.45 4. Pco2 < 35 mm Hg 5. Pco2 > 45 mm Hg 6. HCO3 < 22 mEq/L 7. HCO3 > 26 mEq/L 8. HCO3 22-26 mEq/L

3. pH 7.35-7.45 5. Pco2 > 45 mm Hg 7. HCO3 > 26 mEq/L Fully compensated metabolic alkalosis means that the client was in uncompensated metabolic alkalosis (acid loss from vomiting, gastric suction, excessive diuretics) and the body has not compensated by hypoventilation or correcting the underlying problem.

For which client would a long-term central venous device be most appropriate? 1. A 45-year-old client who has multiple traumas requiring several surgeries 2. An 85-year-old client with fluid volume deficit 3. A 7-year-old female client with dehydration following severe diarrhea 4. A 55-year-old client having twice-weekly chemotherapy treatments

4. A 55-year-old client having twice-weekly chemotherapy treatments (Chemotherapy over the long term is most appropriate with central venous process)

Which imbalance is present with the following ABG values: pH 7.40, PCO2 51, HCO3 34? 1. Compensated metabolic acidosis 2. Uncompensated metabolic alkalosis 3. Uncompensated metabolic acidosis 4. Compensated metabolic alkalosis

4. Compensated metabolic alkalosis (the PCO2 and HCO3 are elevated, but the pH is within normal limits, which means this is compensated)

According to the Centers for Disease Control (CDC), how often should the nurse change the intravenous (IV) tubing for a continuous infusion? 1. Every 24 hours 2. Every 48 hours 3. Every 72 hours 4. Every 96 hours

4. Every 96 hours (the nurse should change the IV tubing to a continuous infusion every 96 hours, according to CDC)

Mark has chronic renal failure. He missed dialysis yesterday and today he feels weak with intestinal colic. His ECG shows dysrhythmias with tall T waves. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

4. Hyperkalemia With hyperkalemia, the heart muscle becomes irritable and the client is at risk for ECG abnormalities and dysrhythmias that can lead to cardiac arrest. Causes include renal failure, potassium-sparing diuretics, hypoaldosteronism, acidosis, and major trauma.

As the nurse is assessing the hypotonic intravenous fluids, he realizes that the rate was not properly regulated and the client received 1,000 mL over 2 hours. What electrolyte imbalance is of greatest concern? 1. Hypernatremia 2. Hypokalemia 3. Hyperkalemia 4. Hyponatremia

4. Hyponatremia

The client's arterial blood gases are pH 7.36; PCO2 37; HCO3- 24. How would the nurse describe these gases? 1. Respiratory acidosis 2. Metabolic alkalosis 3. Respiratory alkalosis 4. Normal

4. Normal

Which electrolytes are inversely related to each other? 1. Potassium and phosphorous 2. Calcium and magnesium 3. Magnesium and sodium 4. Phosphorous and calcium

4. Phosphorous and calcium

Anna is recovering from a thyroidectomy in which her parathyroid gland was also removed. She tells the nurse she has muscle cramping as well as numbness and tingling in her fingers and toes. The nurse assesses a positive Chvostek's sign. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

5. Hypocalcemia Calcium is responsible for bone health and neuromuscular and cardiac functions. It is also involved in clotting. When the serum calcium is low, the calcium can leach from the bones to compensate, which weakens them. Reasons for hypocalcemia include hypoparathyroidism, malabsorption, pancreatitis, alkalosis, and vitamin D deficiency as seen in renal failure.

Fully Compensated Respiratory Alkalosis 1. Pco2 > 45 mm Hg 2. HCO3 > 26 mEq/L 3. Pco2 35-45 mm Hg 4. pH 7.35 -7.40 5. pH 7.40-7.45 6. Pco2 < 35 mm Hg 7. HCO3 < 22 mEq/L 8. HCO3 22-26 mEq/L

5. pH 7.40-7.45 6. Pco2 < 35 mm Hg 7. HCO3 < 22 mEq/L With respiratory alkalosis, the client is likely hyperventilating, often from fear or anxiety. In a compensated situation, the kidneys have excreted enough buffer to allow for compensation.

Vic is in the final stages of cancer with metastatic bone disease. He is weak and constipated with anorexia, nausea, and vomiting. He is very thirsty and urinating often. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

6. Hypercalcemia Hypercalcemia is less common than hypocalcemia. Causes include hyperparathyroidism, malignant bone disease, prolonged immobilization, excess calcium supplementation, and thiazide diuretics.

Eric has been an alcoholic for 10 years. He drinks daily and consumes the majority of his caloric intake this way. He is disoriented, irritable, and showing dysrhythmias on the cardiac monitor. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

7. Hypomagnesemia Low magnesium levels are often a result of chronic alcoholism, malabsorption, diabetic ketoacidosis, and prolonged gastric suctions. The loss of magnesium can cause irritability to the neuromuscular and cardiac systems.

Iliana has been dealing with adrenal insufficiency for 5 years. She has hypotension, feels warm to touch, and is lethargic. Her reflexes are hypoactive. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

8. Hypermagnesemia Hypermagnesemia is a result of excessive magnesium. Causes include renal failure, adrenal insufficiency, and excessive magnesium replacement. The body systems slow down with hypermagnesium, and the patient can experience hypotension, drowsiness, hypoactive reflexes, and depressed respirations.

Santos has been without food for almost 2 weeks as a result of digestive problems. He has been started on a meal and is eager to clean his plate. After eating, he experiences joint stiffness and paresthesia of the extremities. 1. Hyponatremia 2. Hypernatremia 3. Hypokalemia 4. Hyperkalemia 5. Hypocalcemia 6. Hypercalcemia 7. Hypomagnesemia 8. Hypermagnesemia 9. Hypophosphatemia 10. Hyperphosphatemia

9. Hypophosphatemia Phosphate exists in an inverse relationship with calcium, so in hypophosphatemia, the client will likely have hypercalcemia. Causes of low phosphate include refeeding after starvation, alcohol withdrawal, diabetic ketoacidosis, and respiratory acidosis.