Question 1

A nurse notes that a client admitted with renal failure has a serum phosphorus level of 7.0 mg/dL. Which medication should a nurse expect to be prescribed for this client?

Accepted Answer

Aluminum hydroxide gel (Amphojel) is a phosphate binder that is commonly prescribed for clients with renal failure who have elevated serum phosphorus levels. It works by binding with phosphorus in the gastrointestinal tract and preventing its absorption into the bloodstream. Calcium gluconate and calcium chloride are not indicated for the treatment of elevated serum phosphorus levels. Calcitonin (Calcimar) is a hormone that is sometimes used to treat hypercalcemia, but it is not effective for lowering serum phosphorus levels.

Question 2

A nurse is caring for a client with an ileostomy. Which acid-base imbalance will this client most likely experience?

Accepted Answer

Clients with an ileostomy experience a loss of bicarbonate-rich fluid that would normally be reabsorbed in the colon, leading to an increase in acid production and a potential for metabolic acidosis.

Question 3

A client presents to an emergency department with confusion, a respiratory rate of 30 breaths per minute, blood pressure 100/70 mm Hg, and a previous admission for renal failure. The client's arterial blood gases reveal a pH of 7.32, an HCO₃ of 20 mEq/L, and a PaCO₂ of 34 mm Hg. Which acid-base imbalance should a nurse suspect?

Accepted Answer

The client's arterial blood gases show a low pH (7.32, indicating acidosis), a low bicarbonate level (HCO3- of 20 mEq/L, indicating a metabolic cause), and a slightly low PaCO2 (34 mm Hg, which is a compensatory mechanism). These findings are consistent with metabolic acidosis.

Question 4

A client in a critical-care unit is experiencing drastic fluctuations in serum potassium. Which sentinel event can occur if the client's serum potassium level is less than 2.5 mEq/L or greater than 7.0 mEq/L?

Accepted Answer

Extremely low or high serum potassium levels can cause dangerous cardiac arrhythmias and potentially lead to cardiac arrest. Embolic stroke, atrial fibrillation, and intracranial hemorrhage are not directly related to potassium levels.

Question 5

A nurse is caring for an elderly, hospitalized client diagnosed with emphysema. The client's arterial blood gases reveal that the blood chemistry is slightly alkaline but is considered physiologically neutral. To be considered physiologically neutral, or normal, what is the client's serum pH?

Accepted Answer

The normal, physiologically neutral serum pH ranges from 7.35 to 7.45, with a slightly alkaline pH of 7.4 being considered the ideal value. Therefore, option C is the correct answer, indicating a serum pH of 7.4.

Question 6

A nurse assesses a newly admitted client and notes fatigued muscles, reports of nausea and anorexia, irritability, and diminished deep tendon reflexes. The nurse reviews the client's laboratory reports that reveal a serum chloride level of 92 mEq/L, a serum potassium level of 3.1 mEq/L, and a serum sodium level of 135 mEq/L. Which treatment should the nurse anticipate for this electrolyte imbalance?

Accepted Answer

The client's potassium level is low (hypokalemia) and this can cause muscle weakness and diminished deep tendon reflexes. The treatment for hypokalemia is replacement therapy with potassium chloride. The other electrolyte levels are within the normal range; therefore, treatment with sodium bicarbonate or replacement therapy with sodium and chloride is not indicated. Changing the infusion to 5% dextrose in water would not correct the electrolyte imbalance.

Question 7

A nurse is assessing an older adult client who is disoriented to time and place. The nurse notes that the client's eyes are sunken, the mouth is coated, the tongue has an extra longitudinal furrow, and the client's lips are cracked. The client's hand vein filling takes more than 5 seconds; tenting is apparent over the sternum; and the vital signs are BP 110/60 mm Hg, pulse 62, and respiratory rate of 12. Based on these assessment findings, which fluid or electrolyte imbalance should the nurse suspect?

Accepted Answer

The client's symptoms suggest fluid volume deficit, also known as dehydration. Sunken eyes, coated mouth, cracked lips, and a furrowed tongue are signs of dehydration. Poor skin turgor, as evidenced by tenting over the sternum and delayed hand vein filling, are also signs of dehydration. The client's vital signs are within normal limits for an older adult, but reflect compensatory mechanisms to maintain blood pressure and circulation. There are no other symptoms to suggest sodium excess or magnesium deficit.

Question 8

A nurse prepares to assess a client who has been vomiting for several days. For which signs of fluid volume deficit (FVD) should the nurse assess?

Accepted Answer

Increased pulse rate, decreased blood pressure, and poor skin turgor are signs of fluid volume deficit (FVD). Bounding pulse and moist crackles are signs of fluid volume excess (FVE), while dyspnea, jugular vein distention, and sternum fingerprinting are signs of heart failure. Increased respiratory rate, warm moist skin, and decreased body temperature are signs of hypothermia.

Question 9

A nursing instructor is teaching a group of nursing students about the intracellular and extracellular fluid compartments of the cell. Which is the major electrolyte in the intracellular compartment?

Accepted Answer

The major electrolyte in the intracellular compartment is potassium. The extracellular fluid compartment is primarily composed of sodium and chloride. Calcium is important for bone health and muscle function, while bicarbonate is involved in acid-base balance.

Question 10

An intensive care nurse is implementing orders for an elderly client diagnosed with hypermagnesemia. What is the most likely cause of hypermagnesemia in this client?

Accepted Answer

Renal failure is the most likely cause of hypermagnesemia because the kidneys are responsible for filtering and excreting magnesium from the body. If the kidneys are not functioning properly, magnesium can accumulate in the blood leading to hypermagnesemia. Nasogastric tubes to suction and the use of mechanical ventilators are not typically associated with hypermagnesemia. Overzealous administration of I.V. potassium chloride can lead to hyperkalemia, but not hypermagnesemia.

Question 11

A nursing instructor is teaching a group of nursing students about the intracellular and extracellular fluid compartments of the cell. Which electrolyte is the second most plentiful cation in the intracellular fluid compartment?

Accepted Answer

Magnesium is the second most plentiful cation in the intracellular fluid compartment after potassium. Calcium is more abundant in the extracellular fluid compartment. Sodium and chloride are major electrolytes in the extracellular fluid compartment.

Question 12

A nurse is administering I.V. potassium at a rate of 15 mEq/hr via a peripheral vein. When infusing potassium at this rate via this route, for which imbalance should the nurse monitor?

Accepted Answer

The nurse should monitor for hyperkalemia, which can occur when administering high levels of potassium through an IV. Hypernatremia (excess sodium), hypercalcemia (excess calcium), and hyperglycemia (excess glucose) are not associated with the administration of potassium through an IV.

Question 13

A 3-year-old child is hospitalized because of persistent vomiting. For which condition should a nurse carefully monitor the child?

Accepted Answer

Persistent vomiting can lead to loss of stomach acid, which results in metabolic alkalosis, a condition where the blood becomes too alkaline.

Question 14

A nurse assesses a newly admitted client and notes fatigued muscles, reports of nausea and anorexia, irritability, and diminished deep tendon reflexes. The nurse reviews the client's laboratory reports, which reveal a serum chloride level of 92 mEq/L, a serum potassium level of 3.1 mEq/L, and a serum sodium level of 135 mEq/L. Which electrolyte imbalance should the nurse suspect?

Accepted Answer

The symptoms of fatigued muscles, nausea and anorexia, irritability, and diminished deep tendon reflexes suggest a deficiency in potassium levels. Additionally, the serum potassium level of 3.1 mEq/L is below the normal range of 3.5-5.0 mEq/L. While the serum chloride level is elevated, it is not likely the cause of the client's symptoms. The serum sodium level is within normal range, so the client does not have hypernatremia.

Question 15

A pediatric nurse is thinking critically to determine the best methods for assessing an infant's 24-hour fluid needs. Which three methods for assessment of 24-hour fluid needs in an infant should the nurse consider?

Accepted Answer

The nurse should consider the meter square, body weight, and caloric methods as they are standard methods for assessing an infant's fluid needs. These methods take into account the infant's size, weight, and energy requirements.

Question 16

A nurse is caring for a client who has been experiencing prolonged vomiting prior to being admitted to a hospital. The client has experienced development of metabolic alkalosis. Which of the following are manifestations of alkalosis (bicarbonate excess)?

Accepted Answer

Metabolic alkalosis can cause symptoms such as dizziness, tingling of fingers and toes, and carpopedal spasm due to increased bicarbonate levels and decreased ionized calcium.

Question 17

A nurse assesses a client who has moist crackles (rales) in the lung bases, an increased respiratory rate, dyspnea, and 3+ edema of the ankles. Which is the most accurate nursing diagnosis for this client?

Accepted Answer

The client's symptoms indicate fluid volume excess, which is characterized by crackles in the lungs, edema, and dyspnea. The increased respiratory rate is likely due to the body's attempt to compensate for the excess fluid. There is no indication of fluid volume deficit, impaired tissue integrity, or altered tissue perfusion, renal in this case.

Question 18

A nurse educator is conducting an in-service presentation on electrolytes. Which group of electrolytes should the educator refer to as being "positively charged"?

Accepted Answer

Potassium, sodium, and calcium are all positively charged electrolytes, also known as cations.

Question 19

A nurse analyzes a client's laboratory report that shows a serum potassium level of 5.7 mEq/L. Which client's laboratory report is the nurse most likely reviewing?

Accepted Answer

The client who has sustained a traumatic burn is most likely to have a serum potassium level of 5.7 mEq/L due to the release of intracellular potassium into the bloodstream following cell damage.

Question 20

Which nursing action would be most important after adding 20 mEq potassium chloride to an I.V. bag of 1000 mL of 5% dextrose in water?

Accepted Answer

Rotating the bag gently ensures that the potassium chloride is evenly distributed throughout the solution, preventing any concentrated doses from being administered to the patient.

Quiz 3: Fundamentals of Fluid and Electrolyte Balance