Deck 17: Fluid, Electrolyte, and Acid-Base Imbalances

Question 1

When assessing a patient with increased extracellular fluid (ECF) osmolality, the priority assessment for the nurse to obtain is

A) mental status.
B) skin turgor.
C) capillary refill.
D) heart sounds.

Answer 1

mental status.

Question 2

When caring for an alert and oriented elderly patient with a history of dehydration, the home health nurse will teach the patient to increase fluid intake

A) when the patient feels thirsty.
B) in the late evening hours.
C) as soon as changes in LOC occur.
D) if the oral mucosa feels dry.

Answer 2

if the oral mucosa feels dry.

Question 3

The nurse obtains all of the following assessment data about a patient with fluid-volume deficit caused by a massive burn injury. Which of the following assessment data will be of greatest concern?

A) Oral fluid intake is 100 ml for the last 8 hours.
B) The blood pressure is 90/40 mm Hg.
C) Urine output is 30 ml over the last hour.
D) There is prolonged skin tenting over the sternum.

Answer 3

The blood pressure is 90/40 mm Hg.

Question 4

A patient is receiving 3% NaCl solution for correction of hyponatremia. During administration of the solution, the most important assessment for the nurse to monitor is

A) peripheral pulses.
B) lung sounds.
C) peripheral edema.
D) urinary output.

Question 5

When evaluating the response to treatment for a patient with a fluid imbalance, the most important assessment to include is

A) skin turgor.
B) presence of edema.
C) hourly urine output.
D) daily weight.

Question 6

A patient is taking hydrochlorothiazide, a potassium-wasting diuretic, for treatment of hypertension. The nurse will teach the patient to report symptoms of adverse effects such as

A) generalized weakness.
B) facial muscle spasms.
C) frequent loose stools.
D) personality changes.

Question 7

Spironolactone (Aldactone), an aldosterone antagonist, is prescribed for a patient as a diuretic. Which statement by the patient indicates that the teaching about this medication has been effective?

A) "I can have low-fat cheese."
B) "I will have apple juice instead of orange juice."
C) "I will drink at least 8 glasses of water every day."
D) "I can use a salt substitute."

Question 8

When developing a care plan for a patient with syndrome of inappropriate antidiuretic hormone (SIADH), an intervention that will be important for the nurse to include is

A) monitor intake and output hourly.
B) restrict oral free water intake.
C) ambulate patient at least once per shift.
D) use incentive spirometer every 2 hours.

Question 9

Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." The nurse will immediately check for

A) elevated serum potassium level.
B) decreased thyroid hormone level.
C) bleeding on the patient's dressing.
D) the presence of Chvostek's sign.

Question 10

A patient with renal insufficiency develops lethargy and somnolence with a blood pressure of 100/60, pulse 62, and respirations 10. The nurse notes that the patient has been taking an aluminum hydroxide/magnesium hydroxide suspension (Maalox) for indigestion. The nurse anticipates that management of the patient will include IV administration of

A) magnesium sulfate.
B) potassium chloride.
C) calcium gluconate.
D) sodium chloride.

Question 11

The home health nurse notes that an elderly patient has a low serum protein level. The nurse will plan to assess for

A) confusion.
B) restlessness.
C) edema.
D) pallor.

Question 12

Intravenous potassium chloride (KCl) 40 mEq is ordered for treatment of a patient with hypokalemia. In administering the potassium solution, the nurse is aware that

A) the KCl should be administered as an IV bolus so that the hypokalemia will be corrected before complications occur.
B) the amount of KCl added to IV fluids should not exceed 20 mEq/L to prevent hyperkalemia from developing.
C) the KCl should be given only through central lines to avoid venospasm and inflammation at the IV insertion site.
D) to reduce the risk for cardiac dysrhythmia, the maximum amount of KCl to be administered in 1 hour is 20 mEq.

Question 13

A recently admitted patient has a small-cell carcinoma of the lung, which is causing the syndrome of inappropriate antidiuretic hormone (SIADH). The nurse will monitor carefully for

A) rapid and unexpected weight loss.
B) increased total urinary output.
C) decreased serum sodium level.
D) elevation of serum hematocrit.

Question 14

Following bowel surgery 2 days ago, a patient has been receiving normal saline intravenously at 100 ml/hr, has a nasogastric tube to low, intermittent suction, and is NPO. An assessment finding that indicates a need to contact the health care provider immediately is a

A) weight gain of 2 pounds above the preoperative weight.
B) an oral temperature of 100.1° F with bibasilar lung crackles.
C) gradually decreasing level of consciousness (LOC).
D) serum sodium level of 138 mEq/L (138 mmol/L).

Question 15

A patient who has required prolonged mechanical ventilation has the following arterial blood gas results: pH 7.48, PaO₂ 85 mm Hg, PaCO₂ 32 mm Hg, and HCO₃ 25 mEq/L. The nurse interprets these results as

A) metabolic acidosis.
B) metabolic alkalosis.
C) respiratory acidosis.
D) respiratory alkalosis.

Question 16

A patient receiving iso-osmolar continuous tube feedings develops restlessness, agitation, and weakness. The laboratory data that will be of most concern to the nurse is

A) K+ 3.4 mEq/L (3.4 mmol/L).
B) Ca+2 7.8 mg/dl (1.95 mmol/L).
C) Na+ 154 mEq/L (154 mmol/L).
D) HPO4- 3 4.8 mg/dl (1.55 mmol/L).

Question 17

To prevent laryngeal spasms and respiratory arrest in a patient who is at risk for hypocalcemia, an early sign of hypocalcemia the nurse should assess for is

A) weak hand grips.
B) confusion.
C) constipation.
D) lip numbness.

Question 18

A diabetic patient with poor glucose control develops diabetic ketoacidosis. The nurse notes that a patient with diabetic ketoacidosis has rapid, deep respirations. Which collaborative intervention will the nurse anticipate implementing?

A) Oxygen at 2 to 4 L/min
B) IV sodium bicarbonate 50 mEq
C) IV 50% dextrose 50 ml
D) IV lorazepam (Ativan) 1 mg

Question 19

A postoperative patient with a nasogastric tube connected to low, intermittent suction is complaining of anxiety and severe incisional pain. The patient has a respiratory rate of 32 breaths per minute. The arterial blood gases (ABG) are pH 7.50, PaO₂ 90 mm Hg, PaCO₂ 30 mm Hg, and HCO₃ 23 mm Hg. Which intervention is most appropriate for the nurse to implement?

A) Disconnect the nasogastric tube until the pH is within the normal range.
B) Administer the prescribed sodium bicarbonate 50 mEq intravenously.
C) Teach the patient about the importance of taking slow, deep breaths.
D) Give the patient the ordered morphine sulfate 4 mg intravenously.

Question 20

A patient who has been NPO with gastric suction and IV fluid replacement for 3 days following surgery develops nausea and vomiting, weakness, and confusion and has a serum sodium level of 125 mEq/L (125 mmol/L). The nurse reviews the health care provider's postoperative medication and IV orders. Which health care provider order should the nurse question?

A) Administer 3% saline if serum sodium drops to less than 128 mEq/L.
B) IV morphine sulfate 4 mg every 2 hours prn.
C) Infuse 5% dextrose in water at 125 ml/hr.
D) Give IV metoclopramide (Reglan) 10 mg every 6 hours prn nausea.

Question 21

A patient has the following ABG results: pH 7.32, PaO₂ 88 mm Hg, PaCO₂ 37 mm Hg, and HCO₃ 16 mEq/L. The nurse interprets these results as

A) respiratory acidosis.
B) respiratory alkalosis.
C) metabolic acidosis.
D) metabolic alkalosis.

Question 22

The IV therapy nurse is inserting a peripherally inserted central catheter (PICC) so that a patient can receive an IV solution containing 50% dextrose. When explaining the need for the PICC, the nurse will include the information that

A) to give adequate doses of IV insulin, a centrally located IV catheter is needed.
B) blood glucose testing is more accurate when samples are obtained from a central line.
C) infusion of the IV solution through a PICC line will allow rapid dilution of 50% dextrose.
D) the 50% dextrose is less likely to produce infection when given through a PICC line.

Question 23

The nurse in the outpatient clinic who notes that a patient has a decreased magnesium level will ask the patient about

A) intake of dietary protein.
B) use of OTC laxatives.
C) multivitamin/mineral use.
D) daily alcohol intake.

Question 24

A patient who has been receiving diuretic therapy is admitted to the ED with a serum potassium level of 3.1 mEq/L. Of the following medications that the patient has been taking at home, the nurse will be most concerned about

A) metoprolol (Lopressor) 12.5 mg orally daily.
B) lantus insulin 24 U subcutaneously every evening.
C) oral digoxin (Lanoxin) 0.25 mg daily.
D) ibuprofen (Motrin) 400 mg every 6 hours.

Question 25

A patient with hypercalcemia is being cared for on the medical unit. Nursing actions included on the care plan will include

A) maintaining the patient on bedrest to prevent pathologic fractures.
B) monitoring for Trousseau's and Chvostek's signs.
C) encouraging fluid intake up to 4000 ml every day.
D) auscultate breath sounds every 4 hours.

Question 26

The nurse working in the emergency department (ED) admits a patient with renal failure and a serum potassium level of 8.0 mEq/L. All these orders are received from the health care provider. Which order will the nurse implement first?

A) Place the patient on a cardiac monitor.
B) Insert a retention catheter.
C) Administer Kayexalate 15 g orally.
D) Give IV furosemide (Lasix) 40 mg.

Question 27

The nurse has administered 3% saline to a patient with hyponatremia. Which one of these assessment data will require the most rapid response by the nurse?

A) There are crackles audible throughout both lung fields.
B) The patient's radial pulse is 105 beats/minute.
C) The blood pressure increases from 120/80 to 142/94.
D) There is sediment and blood in the patient's urine.

Question 28

The long-term-care nurse is evaluating the effectiveness of protein supplements on a patient who has low serum total protein level. Which of these data indicate that the patient's condition has improved?

A) Absence of peripheral edema
B) Good skin turgor
C) Hematocrit 28%
D) Blood pressure 110/72 mm Hg

Question 29

A patient with advanced lung cancer is admitted to the ED with urinary retention caused by renal calculi. Which of these laboratory values will require the most immediate action by the nurse?

A) Arterial oxygen saturation 91%
B) Serum potassium is 5.1 mEq/L
C) Arterial blood pH is 7.32
D) Serum calcium is 18 mEq/L

Question 30

When teaching a patient with renal failure about a low-phosphate diet, the nurse will include information to restrict

A) intake of green, leafy vegetables.
B) the amount of high-fat foods.
C) ingestion of dairy products.
D) the quantity of fruits and juices.

Question 31

The nurse assesses a pregnant patient with eclampsia who is receiving IV magnesium sulfate and obtains all the following information. Which of these assessment data is most important to report to the health care provider immediately?

A) The patient reports feeling "sick to my stomach."
B) The patellar and triceps reflexes are absent.
C) The patient has been sleeping most of the day.
D) The bibasilar breath sounds are decreased.