Deck 3: Fundamentals of Fluid and Electrolyte Balance

Question 1

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?

A) Meter square, diaper weight, and urinary output
B) Meter square, body weight, and caloric methods
C) Meter square, specific gravity of urine, and urinary output
D) Diaper weight, urinary output, and caloric needs

Answer 1

B

Question 2

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?

A) Calcium
B) Sodium
C) Potassium
D) Bicarbonate

Answer 2

C

Question 3

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?

A) Hypernatremia
B) Hypercalcemia
C) Hyperkalemia
D) Hyperglycemia

Answer 3

C

Question 4

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

A) Diarrhea
B) Metabolic acidosis
C) Metabolic alkalosis
D) Hyperactive bowel

Question 5

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

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

Question 6

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?

A) Fluid volume deficit
B) Fluid volume excess
C) Impaired tissue integrity
D) Altered tissue perfusion, renal

Question 7

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

A) Potassium, sodium, calcium
B) Potassium, sodium, bicarbonate
C) Bicarbonate, phosphate, chloride
D) Chloride, magnesium, bicarbonate

Question 8

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?

A) Hyponatremia
B) Hypokalemia
C) Hyperchloremia
D) Hypernatremia

Question 9

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?

A) Calcium gluconate
B) Calcium chloride
C) Calcitonin (Calcimar)
D) Aluminum hydroxide gel (Amphojel)

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?

A) Renal failure
B) Nasogastric tubes to suction
C) Use of mechanical ventilators
D) Overzealous administration of I.V. potassium chloride

Question 11

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?

A) Treatment with sodium bicarbonate
B) Change of infusion to 5% dextrose in water
C) Replacement therapy with potassium chloride
D) Replacement therapy with sodium and chloride

Question 12

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)?

A) Tetany, soft tissue calcification
B) Dizziness, tingling of fingers and toes, carpopedal spasm
C) Kussmaul respirations, confusion, increased respiratory rate
D) Impaired mentation, tingling of fingers and toes, depressed respirations

Question 13

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?

A) Embolic stroke
B) Cardiac arrest
C) Atrial fibrillation
D) Intracranial hemorrhage

Question 14

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?

A) Calcium
B) Sodium
C) Chloride
D) Magnesium

Question 15

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?

A) 7.2
B) 7.3
C) 7.4
D) 7.5

Question 16

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?

A) Sodium excess
B) Magnesium deficit
C) Fluid volume deficit
D) Fluid volume excess

Question 17

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?

A) Bounding pulse, decreased blood pressure, and moist crackles
B) Dyspnea, jugular vein distention, and sternum fingerprinting
C) Increased pulse rate, decreased blood pressure, and poor skin turgor
D) Increased respiratory rate; warm, moist skin; and decreased body temperature

Question 18

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?

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

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?

A) The client with ulcerative colitis
B) The client with Cushing's syndrome
C) The client who has overused laxatives
D) The client who has sustained a traumatic burn

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?

A) Rotate the bag gently.
B) Attach the tubing to the client.
C) Check the solution for particles.
D) Place the time-tape on the I.V. bag.

Question 21

A client presents to an emergency department and is diagnosed with respiratory acidosis. A nurse caring for the client knows that respiratory acidosis may be caused by which conditions? SELECT ALL THAT APPLY.

A) Asthma
B) Diabetes
C) Pneumonia
D) Emphysema

Question 22

A client is admitted with a diagnosis of hypocalcemia. Which clinical manifestations are indicative of this diagnosis? SELECT ALL THAT APPLY.

A) Tingling sensations
B) Hyperactive reflexes
C) Hypotonicity of the muscles
D) Positive Trousseau's sign

Question 23

A nurse is caring for multiple clients on a medical-surgical unit. Which clients should a nurse identify as being at risk for developing "third spacing?" SELECT ALL THAT APPLY.

A) Client with cirrhosis
B) Client with diabetes mellitus
C) Client with sepsis
D) Client with renal failure

Question 24

A nurse analyzes a client's laboratory data and notes an increase in serum sodium, a decrease in potassium, an elevated hematocrit, and an increase in blood urea nitrogen. Based on this information, which condition should the nurse anticipate in this client? SELECT ALL THAT APPLY.

A) Fluid volume excess
B) Fluid volume deficit
C) Decreased urinary output
D) Increased urinary output

Question 25

The nurse understands that insensible fluid loss occurs through which routes? SELECT ALL THAT APPLY.

A) Skin
B) Lungs
C) Urinary output
D) Gastrointestinal tract

Question 26

A physician orders that a client receives 0.9% sodium chloride intravenously at 150 mL/hr. Which are characteristics of this I.V. solution? SELECT ALL THAT APPLY.

A) The solution is isotonic with the plasma.
B) The solution is hypotonic with the plasma.
C) The solution does not affect the plasma's osmolarity.
D) The solution contains only sodium and chloride ions.

Question 27

A nurse in a long-term care facility is assessing the fluid volume status of clients. Which are acceptable methods of assessing fluid volume status in an elderly adult client? SELECT ALL THAT APPLY.

A) Skin turgor
B) Presence of bowel sounds
C) Blood pressure
D) Rate and filling of veins of the hand

Question 28

A multidisciplinary health-care team is caring for a client diagnosed with hypercalcemia. Which treatments would be appropriate when treating this imbalance? SELECT ALL THAT APPLY.

A) Calcitonin
B) Inorganic phosphates
C) Calcium gluconate I.V.
D) Infusion of 0.45% or 0.9% sodium chloride

Question 29

A client, who has been experiencing vomiting and diarrhea for several days, is admitted to a hospital with a fluid volume deficit and numerous electrolyte imbalances. Which organs are involved in the regulation of fluid and electrolyte balance in the client's body? SELECT ALL THAT APPLY.

A) Kidney
B) Lung
C) Pancreas
D) Thyroid gland