Deck 6: Nursing Care of Patients With Fluid,Electrolyte,and Acid–Base Imbalances

Question 1

A patient with a history of renal failure is admitted to the hospital because of decreasing urine output and a potassium level of 5.9 mEq/L.Which food should the nurse teach the patient to avoid?

A) Gelatin
B) Potatoes
C) Zucchini
D) White bread

Answer 1

Potatoes

Question 2

A student nurse is reviewing the use of intravenous (IV)fluids for a school paper.Which definition should the student use to explain the process of diffusion?

A) The expenditure of energy to transport a solute
B) The movement of solute and water caused by hydrostatic pressure differences
C) Movement of a solute from an area of higher concentration to an area of lesser concentration
D) Movement of water from an area of lesser concentration to an area of higher concentration

Answer 2

Movement of a solute from an area of higher concentration to an area of lesser concentration

Question 3

While assessing an older adult patient with fluid excess,the nurse notes the following: T = 98.6°F,P = 92,R = 18,BP = 166/88 mm Hg,bilateral crackles,oxygen saturation = 95%.Which action should the nurse take first?

A) Provide oxygen at 2 L per nasal cannula.
B) Place the patient in a high Fowler's position.
C) Provide a urinal and encourage the patient to void.
D) Lay the patient flat in bed to listen to bowel sounds.

Answer 3

Place the patient in a high Fowler's position.

Question 4

An older patient with a colostomy was admitted for weakness,nausea,vomiting,and loose stools.Which action should the nurse take first to determine the effectiveness of this patient's care?

A) Weigh the patient.
B) Measure urine specific gravity.
C) Check a pulse oximetry reading.
D) Determine the creatinine clearance.

Question 5

A patient is prescribed furosemide (Lasix).Which electrolyte should the nurse monitor carefully because of this medication?

A) Calcium
B) Potassium
C) Phosphate
D) Magnesium

Question 6

A patient with acute abdominal pain has a serum potassium level of 2 mEq/L.What should the nurse do first?

A) Call the physician STAT.
B) Administer a Kayexalate enema.
C) Document the result on the chart.
D) Notify the physician during morning rounds.

Question 7

An older adult with gastroenteritis is disoriented and weak and has the following laboratory test results:
Hct 56% (normal 40% to 51%)
BUN 32 mg/dL (normal 6 mg/dL to 20 mg/dL)
Which nursing diagnosis should the nurse select for this patient?

A) Risk for injury
B) Excess fluid volume
C) Deficient fluid volume
D) Impaired skin integrity

Question 8

The nurse is concerned that a patient has a high volume of insensible water loss.What is the patient experiencing that is causing the nurse this concern?

A) Diarrhea
B) Vomiting
C) Urination
D) Perspiration

Question 9

A patient with severe diarrhea has a potassium imbalance.Which symptoms should the nurse expect the patient to demonstration because of this imbalance?

A) Shallow respirations, lethargy, nausea
B) Pitting edema, confusion, bounding pulse
C) Apathy, weakness, positive Chvostek's sign
D) Kussmaul's breathing, thirst, furrowed tongue

Question 10

A 22-year-old patient with inflammatory bowel disease has been having 16 or more stools per day.Which symptom should the nurse expect to find during the assessment?

A) Dyspnea and crackles in the lungs
B) Decreased hemoglobin and hematocrit
C) Bounding pulse and increased blood pressure
D) Furrows of the tongue and sticky mucous membranes

Question 11

A patient with hypertension is placed on a low-sodium diet.The nurse recognizes that further teaching is necessary if the patient chooses which menu?

A) Pork chop, steamed brown rice, and fruit cocktail
B) Broiled salmon, mashed sweet potato, broccoli, and pumpkin pie
C) Tomato soup, grilled cheese sandwich, salad, and chocolate chip cookie
D) Grilled chicken, boiled potatoes, frozen green beans, and gelatin dessert

Question 12

The nurse is testing a patient for the presence of Trousseau's sign.Which patient response should the nurse recognize as a positive result?

A) Weakness of the arm
B) Pain in the arm and hand
C) Spasticity of the arm and fingers
D) Redness of the arm below the cuff

Question 13

The nurse is concerned that an older patient is at risk for dehydration.What reduced function did the nurse assess in this patient?

A) Filtration
B) Kidney function
C) Sensation of thirst
D) Cardiac contractility

Question 14

A patient develops an irregular heart rate,abdominal cramping,and diarrhea after a thyroidectomy.Which emergency medication should the nurse anticipate being prescribed for this patient?

A) Furosemide (Lasix)
B) Calcium gluconate
C) Potassium chloride
D) Diazepam (Valium)

Question 15

The nurse is preparing diet teaching for a female patient who is postmenopausal,weighs 100 lbs.and is 5 feet 1 inch tall.Which food should the nurse encourage the patient consume?

A) Red meat
B) Fresh fruits
C) Whole grains
D) Dairy products

Question 16

An older patient is admitted for treatment of fluid volume excess.For which serious respiratory complication of fluid volume excess should the nurse assess this patient?

A) Pulmonary edema
B) Pulmonary infarction
C) Pulmonary fibrosis
D) Pulmonary embolism

Question 17

A patient is diagnosed with an abnormal potassium level.Which complication should the nurse assess for in this patient?

A) Cardiac arrest
B) Fluid overload
C) Internal bleeding
D) Tetany with laryngospasm

Question 18

A patient is prescribed an electrolyte replacement.How should the nurse explain the purpose of an electrolyte to the patient?

A) Any substance that enhances a chemical reaction
B) A chemical that can conduct electricity when dissolved in water
C) A substance that uses electrical current to attach to receptor sites
D) A substance secreted by a gland and carries messages to target tissues

Question 19

The nurse is preparing to provide a patient with an IV fluid that has a lower osmolarity than blood.Which type of fluid should the nurse document that the patient is going to receive?

A) Isotonic
B) Hypotonic
C) Hypertonic
D) Hydrophobic

Question 20

An older adult patient has an IV infusion of 0.45% normal saline infusing at 150 mL/hr.Which assessment finding should cause the nurse to be most concerned?

A) Tenderness at the IV site
B) Capillary refill is <3 seconds
C) Urine specific gravity is 1.018
D) Newly noted crackles in the lungs

Question 21

The nurse is preparing to assess an older patient for fluid balance.Which areas of the body should the nurse use to assess for skin turgor? (Select all that apply.)

A) Hand
B) Sternum
C) Forearm
D) Forehead
E) Upper thigh

Question 22

During an assessment,the nurse learns that an older patient has been taking twice the prescribed amount of calcium supplements.Which physical assessment findings should the nurse identify as being consistent with this patient's intake of calcium? (Select all that apply.)

A) Muscle weakness
B) Faint bowel sounds
C) Increased heart rate
D) Elevated blood pressure
E) Dry mucous membranes

Question 23

The nurse is reviewing the composition of the body cells with a young adult patient admitted for treatment of type 1 diabetes mellitus.The nurse should teach the patient that which of the following is an approximate percentage of water in the young adult body?

A) 50%
B) 60%
C) 70%
D) 80%

Question 24

The nurse instructs a patient on how to safely take 20 mEq of an oral potassium supplement.Which patient statement indicates that teaching has been successful?

A) "I should crush the potassium tablets."
B) "I should mix this medication in 4 ounces of juice."
C) "I should use a salt substitute while taking this medication."
D) "I should expect to be nauseated and vomit when taking this medication."

Question 25

A patient with hypertension is advised to follow a low-sodium diet.If chosen by the patient,which foods indicate further teaching is necessary? (Select all that apply.)

A) Coffee
B) Pretzels
C) Lemonade
D) Applesauce
E) Tomato juice
F) Dried black beans

Question 26

A patient has a history of low calcium levels.Which foods should the nurse include when teaching a patient how to increase dietary calcium? (Select all that apply.)

A) Milk
B) Carrots
C) Spinach
D) Oatmeal
E) Peaches
F) Cauliflower

Question 27

A patient is hypoventilating and retaining carbon dioxide.On which acid-base imbalance should the nurse focus when caring for this patient?

A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis

Question 28

A patient having a severe anxiety attack has an arterial blood gas result showing respiratory alkalosis.Which nursing action should the nurse take first?

A) Administer nasal oxygen at 6 L/min.
B) Give the patient a glass of orange juice.
C) Place the patient in high Fowler's position.
D) Have the patient rebreathe air from a paper bag.

Question 29

The nurse suspects a patient is experiencing fluid volume excess.What did the nurse most likely assess in this patient? (Select all that apply.)

A) Thirst
B) Bounding pulse
C) Shallow respirations
D) Distended neck veins
E) Pitting edema of the feet

Question 30

A patient with uncontrolled diabetes mellitus develops metabolic acidosis.Which assessment finding indicates that the patient's compensatory mechanisms are working?

A) Vomiting
B) Excessive thirst
C) Watery diarrhea
D) Deep rapid breathing

Question 31

A patient has been prescribed furosemide (Lasix).Which foods should the nurse recommend the patient consume while taking this medication?

A) Eggs and broths
B) Potatoes and fruits
C) Breads and cereals
D) Pasta and cream soups

Question 32

The nurse is planning care for a patient with a fluid volume excess and a serum sodium level of 125 mg/dL.Which interventions should the nurse include in this patient's plan of care? (Select all that apply.)

A) Weigh daily.
B) Monitor strict intake and output.
C) Administer diuretics as prescribed.
D) Implement fluid restriction as prescribed.
E) Administer IV saline as prescribed.

Question 33

Place the following individuals in order (1-4)related to their risk for dehydration,ranking from highest to lowest.

A) ___ A 28-year-old patient who is nothing by mouth (NPO) prior to an endoscopy
B) ___ An 8-year-old patient who has had diarrhea for 16 hours
C) ___ A 64-year-old patient who is taking potassium supplements
D) ___ A 72-year-old patient who has had a fever and anorexia for 48 hours

Question 34

After an assessment,the nurse determines that a patient is at risk for respiratory acidosis.Which health problem did the nurse assess to come to this conclusion?

A) Anxiety
B) Diabetes
C) Kidney failure
D) Chronic lung disease

Question 35

The nurse learns that a patient's serum pH is less than 6.35.The nurse should plan care for which of the following health problems?

A) Acidosis
B) Alkalosis
C) Fluid volume excess
D) Fluid volume deficit

Question 36

The nurse is caring for a patient who is being treating for fluid volume excess.Which assessment finding indicates that treatment has been effective?

A) Respiratory rate 24/min
B) Output 1500 mL in 24 hours
C) Blood pressure 132/80 mm Hg
D) Weight loss of 5 lb in 24 hours