Fluid, Electrolyte & Acid-base balance
3.5 - 5.0 mEq/L; Maintains resting membrane potential of skeletal, smooth, and cardiac muscle, allowing for normal muscle function: A. Potassium B. Ionized Calcium C. Magnesium D. Phosphate
A
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? A. Urine output of 250 ml/24 hr B. Temperature of 100.2 F (37.8 C) C. Serum creatinine level of 1.2 mg/dl D. Blood urea nitrogen (BUN) level of 22 mg/dl
A
A elderly patient with peripheral neuropathy has been taking magnesium supplements. The nurse realizes that which of the following symptoms can indicate hypomagnesaemia? A. Hypotension, warmth, & sweating B. Nausea & vomiting C. Hyperreflexia D. excessive urination
A
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? A. Acute glomerulonephritis B. Acute renal failure C. Nephrotic syndrome D. Chronic renal failure
A
A nurse assesses the following patients. Which patient is at greatest risk for the development of hypocalcemia? A. 56 year old with acute renal failure B. 40 year old with systemic lupus erythematousus C. 28 year old who has just undergone a total thyriodectomy D. 65 year old with hypertension taking beta-adrenergic blockers
A
A nurse is caring for a patient diagnosed with renal failure. Which of the following does the nurse recognize as compensation for the acid-base disturbance found in patients with renal failure? A. The patient breathes rapidly to eliminate carbon dioxide B. The patient will retain bicarbonate in excess of normal C. The pH will decrease from the present value D. The patients oxygen saturation level will improve
A
A nurse is caring for a patient who is anxious & dizzy following a traumatic event. The arterial blood gas findings are: pH 7.48, PaO2 110, PaCo2 25, & HCO3 24. The nurse should anticipate which initial intervention to correct this problem? A. Encourage the patient to breathe in & out slowly into a paper bag B. Immediately administer oxygen via a mask & monitor oxygen saturation C. Prepare to start an IV fluid bolus using isotonic fluids D. Anticipate the administration of intravenous sodium bicarbonate
A
A nurse is planning care for a patient with severe burns. Which of the following is this patient at risk for developing? A. Intracellular fluid deficit B. Intracellular fluid overload C. Extracellular fluid deficit D. Interstitial fluid deficit
A
A nurse is planning care for her patient with fluid volume overload and hyponatremia. Which of the following should be included in this patients plan of care? A. Restrict fluids B. Administer IV fluids C. Provide Kayexalate D. Administer IV normal saline with furosemide
A
A nursing student studies acid-base balance. Which two organs are responsible for acid excretion, which helps maintain acid-base balance? A. Lungs and kidneys B. Kidneys and liver C. Bladder and bowel D. Lungs and bladder
A
A nursing student studies the difference between metabolic acidosis and alkalosis. Which increases blood HCO-3? A. Metabolic alkalosis B. Metabolic acidosis
A
A patient has hypokalemia. After reviewing the patients medications list, which of the following might the nurse suspect contributed to the patients health problem? A. Corticosteroid B. Thiazide diuretic C. Narcotic D. Muscle relaxer
A
A patient is diagnosed with hyperphosphatemia. The nurse realizes that this patient might also have an imbalance of which of the following electrolytes? A. Calcium B. Sodium C. Potassium D. Chloride
A
A patient is diagnosed with severe hyponatremia. The nurse realizes this patient will most likely need which of the following precautions implemented? A. Seizure B. Infection C. Neutropenic D. High-risk falls
A
A patient is experiencing multisystem fluid volume deficit, is tachycardic, pale, cool skinned and has a decreased urine output. His nurse realizes these findings are most likely a direct result of which of the following? A. The body's natural compensatory mechanisms B. Pharmacological effects of a diuretic C. Effects of rapidly infused IV fluids D. Cardiac failure
A
A patient is getting IV fluids postoperatively following cardiac surgery. What posoperative complication potential should the nurse focus their assessment on? A. Fluid volume excess B. Fluid volume deficit C. Seizure activity D. Liver failure
A
A patient prescribed spironolactone is demonstrating ECG changes & complaining of muscle weakness. The nurse realizes this patient is exhibiting signs of which of the following? A. Hypokalemia B. Hypokalemia C. Hypercalcemia D. Hypocalcemia
A
A patient who is comatose is admitted to the hospital with an unknown history. Respirations are deep and rapid. Arterial blood gas levels on admission are pH, 7.20; PaCO2, 21 mm Hg; PaO2, 92 mm Hg; and HCO3-, 8. You interpret these laboratory values to indicate: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
A
A patient who is recovering from surgery has an indwelling urinary catheter. The nurse would contact the patients physician with which of the following 24 hour urine output volumes? A. 600 mL B. 750 mL C. 1000 mL D. 1200 mL
A
A patient who is taking digoxin is admitted with possible hypokalemia. Which of the following does the nurse realize might occur with this patient? A. Digoxin toxicity may occur B. A higher dose of digoxin may be needed C. A diuretic may be needed. D. Fluid volume deficit may occur
A
A patient with a history of stomach ulcers is diagnosed with hypophosphatemia. Which of the following interventions should the nurse include into the patients plan of care? A. Request a dietitian consult for selecting foods high in phosphorous B. Provide aluminum hydroxide antacids as prescribed C. Instruct patient to avoid poultry, peanuts & seeds D. Instruct patient to avoid the intake of sodium phosphate.
A
A pregnant patient is complaining of excessive thirst, increased urination and has a medical diagnosis of diabetes insipidus. The nurse chooses which of the following nursing diagnoses as most appropriate for her? A. Risk for imbalanced fluid volume B. Excess fluid volume C. Imbalanced nutrition D. Ineffective tissue perfusion
A
An elderly patient is at home after being diagnosed with fluid volume overload. Which of the following should the home care nurse instruct this patient to do? A. Wear support hose B. Keep legs in a dependent position C. Avouid wearing shoes while in the home D. Try to sleep without extra pillows
A
An elderly patient who is being medicated for pain had an episode of incontinence. The nurse realizes that this patient is at risk for developing: A. Dehydration B. Over-hydration C. Fecal incontinence D. A stroke
A
An elderly postoperative patient is demonstrating lethargy, confusion, & a respiration rate of 8 per minute. The nurse sees that the last dose of pain medication administered via a patient controlled anesthesia (PCA) pump was within 30 minutes. Which of the following acid-base disorders might this patient be experiencing? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis
A
An elderly woman was admitted to the medical unit with dehydration. A clinical indication of this problem could be: A. Weight Loss B. Full bounding pulse C. Engorged neck veins D. Kussmaul respiration
A
Bilateral muscle weakness that begins in quadriceps and may ascend to respiratory muscles; abdominal distention; decreased bowel sounds; constipation; cardiac dysrhythmias; signs of digoxin toxicity at normal digoxin levels: A. Hypokalemia B. Hyperkalemia C. Hypocalcemia D. Hypercalcemia E. Hypomagnesemia F. Hypermagnesemia
A
Dextrose 5% in water, 0.9% sodium chloride (normal saline), lactated Ringers solution. A. Isotonic electrolyte solution B. Hypotonic electrolyte solution C. Hypertonic electrolyte solution
A
Edema that forms in clients with kidney disease is due to: A. Reduced plasma oncotic pressure, so that fluid is not drawn into the capillaries from interstitial tissues B. Decreased capillary hydrostatic pressures pushing fluid into the interstitial tissues C. Capillaries becoming less permeable, allowing fluid to escape into interstitial tissues D. Obstructed lymph flow that assists the movement of fluid from the interstitial tissues back into the vascular compartment
A
Following surgery, the client requires a blood transfusion. The main reason the nurse wants to complete the unit transfusion within a four-hour period that blood: A. Hanging for longer than four hours creates an increased risk of sepsis B. May clot in the bag C. May evaporate D. May not clot in the recipient after this time period
A
Headache, lightheadedness, decreased level of consciousness (confusion, lethargy, coma), cardiac dysrhythmias. pH < 7.35, PaCO2 > 45 mm Hg (6.0 kPa), HCO3- level normal if uncompensated or >26 mEq/L (>26 mmol/L) if compensated. A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis
A
Health promotion activities for fluid and electrolyte imbalance focuses primarily on what? A. Patient teaching B. Dietary intake C. Medication D. Physician involvement in care
A
If PaCO2 and CO2 are outside of normal ranges what is the indication of the imbalance in the electrolytes? A. Repiratory (Lungs) B. Metabolic (Kidneys)
A
If a patient has a pH level of 7.0, PaCO2 of 75, CO2 of 37 and HCO-3 of 29 what is this classified as? A. Metabolic Acidosis B. Respiratory Acidosis C. Metabolic Alkolosis D. Repiratory Alkolosis
A
If the blood plasma has a higher osmolality than the fluid within a red blood cell, the mechanism involved in equalizing the fluid concentration is: A. Osmosis B. Diffusion C. Active transport D. Facilitated diffusion
A
If the pH level is less than 7.35 what is the electrolyte balance? A. Acidic B. Alkolitic
A
Many factors are intially controlled for the IV insertion procedure. The nurse understands this begins with: A. Hand washing B. Checking sterility of supplies C. 6 med rights D. Checking IV order
A
Measurements related to fluid balance of clients that a nurse can initiate without a physician's order include: A. Daily weights, vital signs, and fluid intake and output B. Daily weights, diuretics, and waist measurement C. Monitoring temperature, fluid intake and output, and calorie count D. Auscultating lung sounds, monitoring color of urine, and placing a Foley catheter into the client
A
Measures the hydrogen ion concentration in the body fluids (7.35 - 7.45). A. pH B. PaCO2 C. PaO2 D. Oxygen saturation E. Base Excess F. Bicarbonate
A
Mr. Frank is an 82-year-old patient who has had a 3-day history of vomiting and diarrhea. Which symptom would you expect to find on a physical examination? A. Tachycardia B. Hypertension C. Neck vein distention D. Crackles in the lungs
A
One of the most common electrolyte imbalances is: A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypermagnesemia
A
Patients who retain fluids and have fluid volume excess require what? A. Restriction of fluids B. Parenteral replacement of fluids & electrolytes C. Total parenteral nutrition (TPN) D. Intravenous (IV) therapy E. Vascular access devices (VAD)
A
The lungs act as an acid-base buffer by: A. Increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. B. Increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load. C. Decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. D. Decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load.
A
The nurse anticipates that the patient with hyperphosphatemia secondary to renal failure will require what? A. Calcium supplements B. Potassium supplements C. Magnesium supplements D. Fluid replacement therapy
A
The nurse assesses a patients weight loss as being 22 lbs. How many liters of fluid did this patient lose? A. 10 L (1kg or 2.2 lbs) B. 15 L (1.5kg or 3 lbs)
A
The patient has been placed on a 1200 mL daily fluid restriction. The patients IV is infusing at a keep open rate of 10 mL/hr. The patient has no additional IV medications. How much fluid should the patient be allowed from 0700 until 1500 daily? A. 540 mL B. 960 ml C. 1200 mL D. 10 mL
A
The physician has ordered that a patient with hypertension begin receiving a thiazide diuretic. The nurse knows that she needs to now closely monitor the client for what condition? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypermagnesemia
A
What IV solutions will move fluids into cells, causing them to enlarge? A. Hypotonic (0.45 sodium chloride) B. Hypertonic (3% sodium chloride) C. Isotonic (0.9% sodium chloride) D. Lactated Ringers
A
What electrolyte can be easily absorbed by eating fruits, potatoes, instant coffee, molasses, and brazil nuts? A. Potassium (K+) B. Calcium (Ca2+) C. Magnesium (Mg2+) D. Phosphate (PO4)
A
What is the normal range in adult arterial blood lab measurements for HCO-3 (bicarbonate)? A. 22 - 26 mEq/L B. 15 - 20 mEq/L C. 25 - 30 mEq/L D. 10 - 17 mEq/L
A
What is the nurse's primary concern regarding fluid & electrolytes when caring for an elderly patient who is intermittently confused? A. Risk of dehydration B. Risk of kidney damage C. Risk of stroke D. Risk of bleeding
A
What keeps the blood from becoming too acidic? A. Buffers B. Hydrogen ions C. Oxygen D. Potassium
A
When analyzing an arterial blood gas report of a patient with COPD & respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms? A. The kidneys retain bicarbonate B. The kidneys excrete bicarbonate C. The lungs will retain carbon dioxide D. The lungs will excrete carbon dioxide
A
When caring for a group of patients, the nurse realizes that which of the following health problems increases the risk for metabolic alkalosis? A. Bulimia B. Dialysis C. Venous stasis ulcer D. COPD
A
When caring for a patient with hypocalcemia, which of the following symptoms should the nurse additionally assess in the patient? A. Other electrolyte disturbances B. Hypertension C. Visual disturbances D. Drug toxicity
A
Which electrolyte maintains resting membrane potential of skeletal, smooth, and cardiac muscle, allowing for normal muscle function? A. Potassium (K+) B. Calcium (Ca2+) C. Magnesium (Mg2+) D. Phosphate (PO4)
A
Which is an example of sensible water loss? A. Diarrhea B. Cough C. Runny Nose E. Sweating
A
Which of the following assessments do you perform routinely when an older adult patient is receiving intravenous 0.9% NaCl? A. Auscultate dependent portions of lungs B. Check color of urine C. Assess muscle strength D. Check skin turgor over sternum or shin
A
You are caring for a patient with hyponatremia. Your nursing care plan might include what? A. Fluid restriction B. Administration of hypotonic IV fluids C. Administration of a cation exchange resin D. Increased water intake for patients on nasogastric suction
A
The patient has a serum phospate level of 4.7 mg/dL. Which interdisciplinary treatments would the nurse expect for this patient? (Select all that apply) A. IV normal saline B. Calcium containing antacids C. IV potassium phosphate D. Encouraging milk intake E. Increasing vitamin D intake
A, B
Which patients are at risk for the development of hypercalcemia? (Select all that apply) A. The patient with a malignancy B. The patient taking lithium C. The patient who uses sunscreen to excess D. The patient with hyperparathyroidism E. The patient who overuses antacids
A, B, D, E
The patient who has a serum magnesium level of 1.4 mg/dL is being treated with dietary modification. Which foods should the nurse suggest for this patient? (Select all that apply) A. Bananas B. Seafood C. White rice D. Lean red meat E. Chocolate
A, B, E
Which of the following activities can you delegate to nursing assistive personnel (NAP)? (Select all that apply.) A. Measuring oral intake and urine output B. Preparing intravenous (IV) tubing for routine change C. Reporting an IV container that is low in fluid D. Changing an IV fluid container
A, C
The nurse is reviewing a patients blood pH level. Which of the systems in the body regulate blood pH? (Select all that apply) A. Renal B. Cardiac C. Buffers D. Respiratory
A, C, D
Which of the following would be included in a recording of output on and I/O sheet? (Select all that apply) A. Urine B. Sweat C. Diarrhea D. Vomit E. Gastric suction F. Sputum G. Wound drainage
A, C, D, E, G
Assessment findings consistent with intravenous (IV) fluid infiltration include: (Select all that apply.) A. Edema and pain B. Streak formation C. Pain and erythema D. Pallor and coolness E. Numbness and pain
A, D
0.45% sodium chloride (half normal saline), 0.33% sodium chloride (one-third normal saline). A. Isotonic electrolyte solution B. Hypotonic electrolyte solution C. Hypertonic electrolyte solution
B
4.5 - 5.3 mg/dL; Influences excitability of nerve and muscle cells, necessary for muscle contraction: A. Potassium B. Ionized Calcium C. Magnesium D. Phosphate
B
A client suffering from a narcotic overdose is seen in the Emergency Department. The client is confused, with warm, flushed skin, headache, and weakness. Vital signs are T 102.6, HR 128, R 24, and BP 130/86. A blood gas analysis sample was drawn on room air, and the results are as follows: pH 7.33, PaCO2 53, PaO2 72, HCO3 24. This client is at risk for: A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
B
A client taking lasix (furosemide) for congestive heart failure is seeing the physician for a potassium value of 3.0. An order for oral potassium taken daily is written and discussed with the client. In addition, potassium-rich foods should be eaten. The nurse educator meets with this client and has the client identify all of the following foods as potassium-rich except: A. Baked potato B. White bread C. Apricot D. Orange juice
B
A nurse inserts a nasogastric tube, and it immediately drains 1000 mL of fluid. Which of the following electrolyte levels should she be most concerned with at this time? A. Na B. K C. Cl D. CO2
B
A nurse is collecting a sample for a blood gas analysis from a patients left wrist. After drawing the blood into the syringe, the nurse: A. Adds a drop of heparin to the sample to prevent clotting B. Seals the end of the syringe and places it in a cup of crushed ice and water C. Places the syringe of blood in a dark bag to protect the specimen from light D. Seals the syringe in a zip-lock bag and places the specimen in the out box for lab pickup
B
A patient is admitted with burns over 50% of his body. The nurse realizes that this patient is at risk for which of the following electrolyte imbalances? A. Hypercalcemia B. Hypophosphatemia C. Hypernatremia D. Hypermagnesemia
B
A patient is prescribed 20 mEq of potassium chloride. The nurse realizes that the reason the patient is receiving this replacement is: A. To sustain respiratory function B. To help regulate acid-base balance C. To keep a vein open D. To encourage urine output
B
A patient is prescribed 40 mEq potassium as a replacement. The nurse realizes that this replacement should be administered: A. Directly into the venous access line B. Mixed in the prescribed IV fluid C. Via a rectal suppository D. Via intramuscular injection
B
A patient with fluid retention related to renal problems is admitted to the hospital. The nurse realizes that this patient could possibly have which of the following electrolyte imbalances? A. Hypokalemia B. Hypernatremia C. Carbon Dioxide D. Magnesium
B
An elderly patient comes into the clinic with a complaint of watery diarrhea for several days with abdominal & muscle cramping. The nurse realizes that this patient is demonstrating which of the following? A. Hypernatremia B. Hyponatrema C. Fluid volmue excess D. Hyperkalemia
B
An elderly patient was hydrated with lactated Ringer's solution in the emergency room for the last hour. During the most recent evaluation of the patient by the nurse, a finding of a rapid bounding pulse and shortness of breath were noted. Reporting this episode to the physician, the nurse suspects that the patient now shows signs of: A. Hypovolemia, and needs more fluids B. Hypervolemia, and needs the fluids adjusted C. An acid-base disturbance D. Needing no adjustment in fluid administration
B
Bilateral muscle weakness in quadriceps, transient abdominal cramps and diarrhea, cardiac dysrhythmias, cardiac arrest: A. Hypokalemia B. Hyperkalemia C. Hypocalcemia D. Hypercalcemia E. Hypomagnesemia F. Hypermagnesemia
B
Hypercalcemia and hypermagnesemia increase neuromuscular excitability. A. True B. False
B
Hyperkalemia may be the result of chronic diarrhea. A. True B. False
B
If HCO-3 is outside of normal ranges what is the indication of the imbalance in the electrolytes? A. Repiratory (Lungs) B. Metabolic (Kidneys)
B
If the pH level is more than 7.45 what is the electrolyte balance? A. Acidic B. Alkolitic
B
Includes TPN, crystalloids, and colloids. A. Restriction of fluids B. Parenteral replacement of fluids & electrolytes C. Total parenteral nutrition (TPN) D. Intravenous (IV) therapy E. Vascular access devices (VAD)
B
Increased rate & depth of respirations (hyperventilation), lightheadedness, numbness & tingling of extremeties and circumoral region (parasthesias), excitement and confusion possibly followed by decreased level of consciousness, cardiac dysrhythmias. pH > 7.45, PaCO2 <35 mm Hg (< 4.7 kPa), HCO3- level normal if short lived or uncompensated or < 22 mEq/L (< 22 mmol/L) if compensated, K+ level may be decreased (< 3.5 mEq/L) Ionized Ca++ level may be decreased (< 4.5 mg/dL). A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis
B
Is an antigen-antibody reaction and can range from mild response to a severe anaphylactic shock, which can be life threatening: A. ABO system B. Transfusion reaction C. Autotransfusion D. Venipuncture
B
Is the partial pressure carbon dioxide in arterial blood (35-45). A. pH B. PaCO2 C. PaO2 D. Oxygen saturation E. Base Excess F. Bicarbonate
B
One reason older adults experience fluid and electrolyte imbalance and acid-base imbalances, is they: A. Eat poor quality foods B. Have a decreased thirst sensation C. Have more stress response D. Have an overly active thirst response
B
The health care provider's order is 1000 mL 0.9% NaCl IV over 6 hours. Which rate do you program into the infusion pump? A. 125 mL/hr B. 167 mL/hr C. 200 mL/hr D. 1000 mL/hr
B
The majority of the body's water is contained in which of the following fluid compartments? A. Interstitial B. Intracellular C. Extracellular D. Intravascular
B
The nurse observes a patients respirations and notes that the rate is 30 per minute & the respirations are very deep. The metabolic disorder this patient might be demonstrating is which of the following? A. Hypernatremia B. Increasing carbon dioxide in the blood C. Hypertension D. Pain
B
The results of an arterial blood gas are as follows: pH: 7.5, PaCO2: 50, PaO2: 88, HCO3: 28; Base excess: +5. Evaluate the acid-base imbalance. A. Metabolic Acidosis with base compensation B. Metabolic Alkalosis with a respiratory compensation C. Respiratory Acidosis with a base compensation D. Respiratory Acidosis with a respiratory compensation
B
The topical fluid replacement for the patient with an ICF fluid volume deficit is: A. Isotonic B. Hypotonic C. Hypertonic D. A plasma expander
B
What IV solution will pull fluid from cells, causing them to shrink? A. Hypotonic (0.45 sodium chloride) B. Hypertonic (3% sodium chloride) C. Isotonic (0.9% sodium chloride) D. Lactated Ringers
B
What body organ produces the base (bicargonates) to balance the acids in the body? A. Liver B. Kidney C. Pancreas D. Lungs
B
What can starvation diets, diets with high fat and no carbohydrate content lead to? A. Metabolic Alkolosis B. Metabolic Acidosis C. Cardiac arrest D. Dehydration
B
What electrolyte requires vitamin D for best absorbtion and absorbtion of it can be hindered by undigested fat? It is best obtained by eating dairy products, canned fish with bones, broccoli and oranges. A. Potassium (K+) B. Calcium (Ca2+) C. Magnesium (Mg2+) D. Phosphate (PO4)
B
What is the normal range in adult arterial blood lab measurements for Base Excess (buffer capacity)? A. 0 - 2 mmol/L B. -2 to +2 mmol/L C. -1 to +1 mmol/L D. 0 - 5 mmol/L
B
What is the normal range in adult arterial blood lab measurements for pH? A. 7.0 - 7.5 B. 7.35 - 7.45 C. 7.25 - 7.35 D. 7.5 - 8.0
B
Where must the ABGs be drawn from to insure accuracy? A. Finger stick B. Radial artery C. Pulmonary artery D. Ulnar vein
B
Which electrolyte influences excitability of nerve and muscle cells; necessary for muscle contraction? A. Potassium (K+) B. Calcium (Ca2+) C. Magnesium (Mg2+) D. Phosphate (PO4)
B
Which individual would least likely suffer from a disturbance in fluid volume, electrolyte, or acid-base balance? A. An infant suffering from gastroenteritis for three days B. An elderly client suffering from a type I decubitus C. Adults with impaired cardiac function D. Clients who are confused
B
Which of these patients do you expect will need teaching regarding dietary sodium restriction? A. An 88-year-old with a fractured femur scheduled for surgery B. A 65-year-old recently diagnosed with heart failure C. A 50-year-old recently diagnosed with asthma and diabetes D. A 20-year-old with vomiting and diarrhea from gastroenteritis
B
You teach patients to replace sweat, vomiting, or diarrhea fluid losses with which type of fluid? A. Tap water or bottled water B. Fluid that has sodium (salt) in it C. Fluid that has K+ and HCO3- in it D. Coffee or tea, whichever they prefer
B
Your patient who has diabetic ketoacidosis is breathing rapidly and deeply. Intravenous (IV) fluids and other treatments have just been started. What should you do about this patient's breathing? A. Notify her health care provider that she is hyperventilating B. Provide frequent oral care to keep her mucous membranes moist C. Ask her to breathe slower and help her to calm down and relax D. Assess her for pain and request an order for a sedative
B
The patient, newly diagnosed with diabetes mellitus, is admitted to the emergency department with nausea, vomiting, and abdominal pain. ABG results reveal a pH of 7.2 & a bicarbonate level of 20 mEq/L. Which other assessment findings would the nurse anticipate in this patient? (Select all that apply) A. Tachycardia B. Weakness C. Dysrhythmias D. Kussmaul's respirations E. Cold, Clammy skin
B, C, D
The patient is receiving IV potassium (KCL). Which nursing actions are required? (Select all that apply) A. Administer the dose IV push over 3 minutes B. Monitor the injection site for redness C. Add the ordered dose to the IV hanging. D. Use an infusion controller for the IV E. Monitor fluid intake & output
B, D, E
1.5 - 2.5 mEq/L; Influences function of neuromuscular junctions and is a cofactor for numerous enzymes: A. Potassium B. Ionized Calcium C. Magnesium D. Phosphate
C
A 35 year old female comes into the clinic postoperative parathyroidectomy. Which of the following should the nurse instruct the patient? A. Drink one glass of red wine per day. B. Avoid the sun. C. Milk & milk-based products will ensure an adequate calcium intake. D. Red meat is the protein source of choice.
C
A client with a history of cardiac disease is taking a potassium-wasting diuretic (furosemide) and is seen in the ER for complaints of weakness. Her nurse should expect to evaluate which laboratory values? A. Albumin and protein levels B. Sodium and chloride levels C. Potassium and blood glucose levels D. Hemoglobin level and hematocrit
C
A nurse is caring for a patient receiving a loop diuretic. The nurse should be alert for which of the following symptoms? A. Restlessness and agitation B. Paresthesis and irritability C. Weak, irregular pulse and poor muscle tone D. Increased blood pressure and muscle spasms
C
A nurse is conducting an assessment of a patient who has an IV via a central line. The tubing is dated 4 days ago. The nurse knows that the tubing: A. Is good for 3 more days, for a total of 7 days B. Can remain in place as long as there is not a disconnection C. Needs changing because it is beyond the 3 day recommended limit D. Needs changing, including the IV port, because they have been in place for 4 days
C
A patient is admitted with hypernatremia caused by being stranded on a boat in the Atlantic Ocean for five days without a fresh water source. Which of the following is this patient at risk for developing? A. Pulmonary edema B. Atrial dysrhythmias C. Cerebral bleeding D. Stress fractures
C
A postoperative patient is diagnosed with fluid volume overload. Which of the following should the nurse assess in this patient? A. Poor skin turgor B. Decreased urine output C. Distended neck veins D. Concentrated hemoglobin & hematocrit levels
C
A postoperative patient with a fluid volume deficit is prescribed progressive ambulation yet is weak from an inadepuate fluid status. What can the nurse do to help this patient? A. Assist the patient to maintain a standing positions for several minutes B. This patient should be on bed rest C. Assist the patient to move into different positions in stages D. Contact physical therapy to provide a walker
C
An elderly patient does not complain of thirst. What should the nurse do to assess that this patient is not dehydrated? A. Ask the physician for an order to begin IV fluid replacement B. Ask the physician to order a chest x-ray C. Assess the urine for osmolality D. Ask the physician for an order for a brain scan
C
Clinical assessment of dehydration can be confirmed with what findings? A. 1 lb weight loss B. Engorged neck vessels C. Dry mucous membranes D. Full bounding radial pulse
C
Decreased level of consciousness (lethargy, confusion, coma), abdominal pain, cardiac dysrhythmias, increased rate and depth of respirations (compensatory hyperventilation). pH <7.35, PaCO2 normal if uncompensated or < 35 mm Hg (4.7 kPa) if compensated HCO3 level < 22 mEq/L (< 22 mmol/L) Anion gap normal or high, depending on cause. K+ level may be elevated (> 5.0 mEq/L), depending on cause. A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis
C
Dextrose 10% in water, 3% to 5% sodium chloride, dextrose 5% in 0.9% sodium chloride, dextrose 5% in 0.45% sodium chloride, dextrose 5% in lactated Ringer's solution. A. Isotonic electrolyte solution B. Hypotonic electrolyte solution C. Hypertonic electrolyte solution
C
Is a nutritionally adequate hypertonic solution consisting of glucose, nurtients, and electrolytes administered centrally or peripherally; it is formulated to meet a patient's needs. A. Restriction of fluids B. Parenteral replacement of fluids & electrolytes C. Total parenteral nutrition (TPN) D. Intravenous (IV) therapy E. Vascular access devices (VAD)
C
Is the collection and reinfusion of a patient's own blood: A. ABO system B. Transfusion reaction C. Autotransfusion D. Venipuncture
C
Is the partial pressure of oxygen in the blood (80 - 100). A. pH B. PaCO2 C. PaO2 D. Oxygen saturation E. Base Excess F. Bicarbonate
C
It is especially important for the nurse to assess for which of the following in a patient who has just undergone a total thyroidectomy? A. Weight gain B. Depressed reflexes C. Positive Chvostek's sign D. Confusion and personality changes
C
Mrs. Green's arterial blood gas results are as follows: pH 7.32; PaCO2 52 mm Hg; PaO2 78 mm Hg; HCO3- 24 mEq/L. Mrs. Green has: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkolosis
C
The blood gases of a patient with an acid-base disorder show a blood pH outside of normal limits. The nurse realizes that this patient is: A. Fully compensated B. Demonstrating anaerobic metabolism C Partially compensated D. In need of intravenous fluids.
C
The following clients are all at risk for fluid volume excess. Which of them should you see first? A. 88 year old patient with a fractured femur scheduled for surgery B. 20 year old patient with a 6 year history of type 1 diabetes mellitus C. 65 year old patient recently diagnosed with congestive heart failure D. 50 year old patient with second degree burns on the ankles and feet
C
The nurse is admitting a new client, 80 years old, with congestive heart failure into your home health agency. The following assessment findings have been determined after meeting the client: overweight but no gain since the client left the hospital two days ago; VS: T 99.0, HR 100, R 22, BP 130/86. Foods eaten include canned soup at each meal, ham, and cheese. When completing the care plan for this client, the nurse should include which of the following nursing diagnosis: A. Improved Gas Exchange B. Risk for Fluid Volume Deficit C. Risk for Fluid Volume Imbalance D. Impaired Skin Integrity
C
The universal blood donor is: A. Type A B. Type B C. Type O D. Type AB
C
What electrolytes absorbtion is hindered by undigested fat and can be obtained by eating dark green leafy vegetables and whole grains? A. Potassium (K+) B. Calcium (Ca2+) C. Magnesium (Mg2+) D. Phosphate (PO4)
C
What is the normal range in adult arterial blood lab measurements for PaCO2 (partial pressure of carbon dioxide)? A. 4.7 - 6 mm Hg B. 15.1 - 20.0 mm Hg C. 35 - 45 mm Hg D. 30 - 50 mm Hg
C
What is the normal range in adult arterial blood lab measurements for SaO2 (oxygen saturation)? A. 88% - 100% B. 90% - 95% C. 95% - 100% D. 80% - 100%
C
Which electrolyte influences function of neuromuscular junctions and is a cofactor for numerous enzymes? A. Potassium (K+) B. Calcium (Ca2+) C. Magnesium (Mg2+) D. Phosphate (PO4)
C
Which is an example of insensible water loss? A. Urination B. Vomiting C. Sweating D. Crying
C
Which of the following defi ning characteristics is consistent with fluid volume deficit? A. A 1-lb (0.5 kg) weight loss, pale yellow urine B. Engorged neck veins when upright, bradycardia C. Dry mucous membranes, thready pulse, tachycardia D. Bounding radial pulse, fl at neck veins when supine
C
Which of the following is most likely to result in respiratory alkolosis? A. Steroid use B. Fad dieting C. Hyperventilation D. Chronic alcoholism
C
Which of the following patients would be at the greatest risk for the potential development of hypermagnesemia? A. 83 year old man with lung cancer and hypertension B. 65 year old woman with hypertension, taking adrenergic blockers C. 42 year old woman with systemic lupus erythmatosus and renal failure D. 50 year old man with benign prostatic hyperplasia and a urinary tract infection
C
You assess four patients. Which patient is at greatest risk for the development of hypocalcemia? A. 56-year-old with acute kidney renal failure B. 40-year-old with appendicitis C. 28-year-old who has acute pancreatitis D. 65-year-old with hypertension and asthma
C
Your patient had 200 mL of ice chips and 900 mL intravenous (IV) fluid during your shift. Which total intake should you record? A. 700 mL B. 900 mL C. 1000 mL D. 1100 mL
C
2.7 - 4.5 mg/dL; Necessary for production of ATP, the energy source for cellular metabolism: A. Potassium B. Ionized Calcium C. Magnesium D. Phosphate
D
A 28 year old male patient is admitted with diabetic ketoacidosis. The nurse realizes that this patient will have a need for which of the following electrolytes? A. Sodium B. Potassium C. Calcium D. Magnesium
D
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? A. Therapeutic index B. GI absorption rate C. Liver function studies D. Creatinine clearance
D
A nurse is admitting a patient who was diagnosed with acute renal failure. Which of the following electrolytes will be most affected with this disorder? A. Calcium B. Magnesium C. Phosphorous D. Potassium
D
A nursing student learns the difference between Chvostek's and Trousseau's signs. A positive Chvostek's sign elicits which of the following? A. Bilateral muscle weakness in the quadriceps B. Bilateral muscle weakness of the respiratory muscles C. Carpal spasm with hypoxia D. Contraction of facial muscles when a facial nerve is tapped
D
A patient is admitted for treatment of hypercalcemia. The nurse realizes that this patients IV fluids will most likely be which of the following? A. Dextrose 5% & water B. Dextrose 5% & ? normal saline C. Dextrose 5% & 95% normal saline D. Normal saline
D
A patient is diaphoretic and has an oral temperature of 104 F. These are classic signs of what? A. ADH Deficit B. Extracellular fluid loss C. Insensible water loss D. Sensible water loss
D
A patient with a cardiac history is taking the diuretic furosemide (Lasix) and is seen in the emergency department for muscle weakness. Which laboratory value do you assess first? A. Serum albumin B. Serum sodium C. Hematocrit D. Serum potassium
D
A patients blood gases show a pH greater than 7.53 & bicarbonate level of 35 mEq/L. The nurse realizes that the acid-base disorder this patient is demonstrating is which of the following? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis
D
An elderly patient with a history of sodium retention arrives to the clinic with the complaints of "heart skipping beats" and leg tremors. Which of the following should the nurse ask this patient regarding these symptoms? A. "Have you stopped taking your digoxin medication?". B. "When was the last time you had a bowel movement?" C. "Were you doing any unusual phyical activity?" D. "Are you using a solt substiture
D
How much fluid does the average human body hold? A. 6 L B. 15 L C. 7.5 L D. 42 L
D
If a patient has adequate kidney function but is unable to take anything by mouth what should be added to the IV to prevent hypokalemia? A. Calcium B. Magnesium C. Sodium D. Potassium
D
Is a technique in which a vein is punctured through the skin by a rigid stylet (butterfly), a stylet covered with a plastic cannula (ONC), or a needle attached to a syringe: A. ABO system B. Transfusion reaction C. Autotransfusion D. Venipuncture
D
Is the point at which hemoglobin is saturated by oxygen (95% - 99%). A. pH B. PaCO2 C. PaO2 D. Oxygen saturation E. Base Excess F. Bicarbonate
D
Is used to correct or prevent fluid and electrolyte imbalances. A. Restriction of fluids B. Parenteral replacement of fluids & electrolytes C. Total parenteral nutrition (TPN) D. Intravenous (IV) therapy E. Vascular access devices (VAD)
D
Lightheadedness, numbness and tingling of fingers, toes and circumoral region (paesthesias); possible excitement and confusion followed by decreased level of conscious, cardiac dysrhythmias (may be attributable to hypokalemia). pH >7.45, PaCO2 normal if uncompensated or > 45 mm Hg (> 6.0 kPa) if comensated HCO-3 >26 mEq/L (>26 mEq/L (>26 mmol/L), K+ level often decreased (< 3.5 mEq/L) Ionized Ca++ level may be decreased (< 4.5 mg/dL). A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis
D
Nurse would be most concerned about which lab values obtained fro ma client receiving furosemide (Lasix) therapy? A. BUN 20 B. K 3.4 C. Creatinine 1.1 D. K 3.2
D
The WBC count of a patient is 18,000 which the nurse attributes to which of the following health problems? A. Arthritis B. Alcoholism C. Viral infection D. Wound dehisience
D
The body fluids constituting the interstitial fluid and blood plasma are: A. Hypotonic B. Hypertonic C. Intracellular D. Extracellular
D
The health care provider's order is 1000 mL 0.9% NaCl with 20 mEq K+ intravenously over 8 hours. Which assessment finding causes you to clarify the order with the health care provider before hanging this fluid? A. Flat neck veins B. Tachycardia C. Hypotension D. Oliguria
D
The nurse anticipates that the physician will order what kind of intravenous (IV) fluid for a patient who is dehydrated? A. Ringer's lactate B. 3% sodium chloride C. 0.9% sodium chloride D. 0.45% sodium chloride
D
The nurse has been invited to discuss "the importance of promoting a good fluid and electrolyte balance in children" for a group of parents at the local school parents club meeting. Of the following actions, which is not representative of this topic? A. Recognizing possible risk factors for fluid and electrolyte balance, such as prolonged or repeated vomiting, frequent watery stools, or inability to consume fluids B. Increasing fluid intake before, during, and after strenuous exercise, particularly when the environmental temperature is high, and replacing lost electrolytes from excessive perspiration as needed with commercial electrolyte solutions C. Consuming six to eight glasses of water daily D. Encouraging excessive amounts of foods or fluids high in salt or caffeine
D
The nurse should observe for a Trousseau sign (a carpopedal spasm) in her patient with which of the following electrolyte abnormalities? A. Hypokalemia B. Hyponatremia C. Hypochloremia D. Hypocalcemia
D
The universal blood recipeint is: A. Type A B. Type B C. Type O D. Type AB
D
What electrolytes absorbtion is hindered by aluminum antacids and can be obtained by drinking milk and from processed foods? A. Potassium (K+) B. Calcium (Ca2+) C. Magnesium (Mg2+) D. Phosphate (PO4)
D
What is a common symtom of electrolyte imbalances? A. Fever B. Temperature C. Lethargy D. Cardiac Arrythmias
D
What is the normal range in adult arterial blood lab measurements for PaO2 (partial pressure of oxygen)? A. 60 - 100 mm Hg B. 50 - 75 mm Hg C. 80 - 120 mm Hg D. 80 - 100 mm Hg
D
Which electrolyte necessary for production of ATP, the energy source for cellular metabolism? A. Potassium (K+) B. Calcium (Ca2+) C. Magnesium (Mg2+) D. Phosphate (PO4)
D
Which of the following patients is most at risk for fluid volume defecit (FVD)? A. Elder adult B. Adult C. Child D. Infant
D
While receiving a blood transfusion, your patient develops chills, tachycardia, and flushing. What is your priority action? A. Notify a health care provider B. Insert an indwelling catheter C. Alert the blood bank D. Stop the transfusion
D
Are catheters, cannulas, or infusion ports designed for repeated access to the vascular system. A. Restriction of fluids B. Parenteral replacement of fluids & electrolytes C. Total parenteral nutrition (TPN) D. Intravenous (IV) therapy E. Vascular access devices (VAD)
E
Is the amount of blood buffer (hemoglobin and bicarbonate) that exists (+2). A. pH B. PaCO2 C. PaO2 D. Oxygen saturation E. Base Excess F. Bicarbonate
E
Is the major component in the bicarbonate buffer system, which buffers metabolic acids. A. pH B. PaCO2 C. PaO2 D. Oxygen saturation E. Base Excess F. Bicarbonate
F
Place the following steps for intravenous (IV) catheter insertion in the correct order: A. Perform hand hygiene B. Open and pprepare infusion set C. Select appropriate vein and insert catheter D. Use two identifiers to ensure correct patient E. Assess for risk factors such as age or platelet count F. Carefully check the health care provider's order for the IV therapy
F, E, D, A, B, C
