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

Question 1

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

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

Answer 1

generalized weakness.

Question 2

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

Answer 2

Absence of peripheral edema

Question 3

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 bed rest.
B) auscultating lung sounds every 4 hours.
C) monitoring for Trousseau's and Chvostek's signs.
D) encouraging fluid intake up to 4000 ml every day.

Answer 3

encouraging fluid intake up to 4000 ml every day.

Question 4

A patient who has an infusion of 50% dextrose prescribed asks the nurse why a peripherally inserted central catheter must be inserted. Which explanation by the nurse is correct?

A) The prescribed infusion can be given much more rapidly when the patient has a central line.
B) There is a decreased risk for infection when 50% dextrose is infused through a central line.
C) The 50% dextrose is hypertonic and will be more rapidly diluted when given through a central line.
D) The required blood glucose monitoring is more accurate when samples are obtained from a central line.

Question 5

A patient has the following arterial blood gas (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) metabolic acidosis.
B) metabolic alkalosis.
C) respiratory acidosis.
D) respiratory alkalosis.

Question 6

When caring for a patient admitted with hyponatremia, which actions will the nurse anticipate taking?

A) Restrict patient's oral free water intake.
B) Avoid use of electrolyte-containing drinks.
C) Infuse a solution of 5% dextrose in 0.45% saline.
D) Administer vasopressin (antidiuretic hormone, [ADH]).

Question 7

The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take?

A) Notify the patient's health care provider.
B) Give the prescribed PRN lorazepam (Ativan).
C) Start the prescribed PRN oxygen at 2 to 4 L/min.
D) Encourage the patient to take deep, slow breaths.

Question 8

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

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

Question 9

A postoperative patient who has been receiving nasogastric suction for 3 days has a serum sodium level of 125 mEq/L (125 mmol/L). Which of these prescribed therapies that the patient has been receiving should the nurse question?

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

Question 10

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

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

Question 11

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

Question 12

A patient who has been receiving diuretic therapy is admitted to the emergency department 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) oral digoxin (Lanoxin) 0.25 mg daily.
B) ibuprofen (Motrin) 400 mg every 6 hours.
C) metoprolol (Lopressor) 12.5 mg orally daily.
D) lantus insulin 24 U subcutaneously every evening.

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

Question 14

A patient who has required prolonged mechanical ventilation has the following arterial blood gas results: pH 7.48, PaO₂ 85 mm Hg, PaCO₃ 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 15

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

Question 16

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 will try to drink at least 8 glasses of water every day."
B) "I will use a salt substitute to decrease my sodium intake."
C) "I will increase my intake of potassium-containing foods."
D) "I will drink apple juice instead of orange juice for breakfast."

Question 17

When the nurse is evaluating the fluid balance for a patient admitted for hypovolemia associated with multiple draining wounds, the most accurate assessment to include is

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

Question 18

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

A) daily alcohol intake.
B) intake of dietary protein.
C) multivitamin/mineral use.
D) use of over-the-counter ( OTC ) laxatives.

Question 19

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

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

Question 20

Intravenous potassium chloride (KCl) 60 mEq is prescribed for treatment of a patient with severe hypokalemia. Which action should the nurse take?

A) Administer the KCl as a rapid IV bolus.
B) Infuse the KCl at a rate of 20 mEq/hour.
C) Give the KCl only through a central venous line.
D) Add no more than 40 mEq/L to a liter of IV fluid.

Question 21

Which assessment finding about a patient who has a serum calcium level of 7.0 mEq/L is most important for the nurse to report to the health care provider?

A) The patient is experiencing laryngeal stridor.
B) The patient complains of generalized fatigue.
C) The patient's bowels have not moved for 4 days.
D) The patient has numbness and tingling of the lips.

Question 22

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

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

Question 23

A patient receiving isoosmolar continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory result is most important to report to the health care provider?

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) PO4-3 4.8 mg/dl (1.55 mmol/L)

Question 24

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

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

Question 25

Which of these actions can the nurse who is caring for a critically ill patient with multiple intravenous (IV) lines delegate to an experienced LPN?

A) Administer IV antibiotics through the implantable port.
B) Monitor the IV sites for redness, swelling, or tenderness.
C) Remove the patient's nontunneled subclavian central venous catheter.
D) Adjust the flow rate of the 0.9% normal saline in the peripheral IV line.

Question 26

The following data are obtained by the nurse when assessing a pregnant patient with eclampsia who is receiving IV magnesium sulfate. Which finding is most important to report to the health care provider immediately?

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

Question 27

Which action will the nurse include in the plan of care for a patient who has a central venous access device ( CVAD )?

A) Avoid using friction when cleaning around the CVAD insertion site.
B) Use the push-pause method to flush the CVAD after giving medications.
C) Obtain an order from the health care provider to change CVAD dressing.
D) Have the patient turn the head toward the CAVD during injection cap changes.

Question 28

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

Question 29

A patient who has been hospitalized for 2 days has been receiving normal saline IV at 100 ml/hr, has a nasogastric tube to low suction, and is NPO. Which assessment finding by the nurse is the priority to report to the health care provider?

A) Serum sodium level of 138 mEq/L ( 138 mmol/L )
B) Gradually decreasing level of consciousness ( LOC )
C) Oral temperature of 100.1° F with bibasilar lung crackles
D) Weight gain of 2 pounds ( 1 kg ) above the admission weight

Question 30

A patient with renal failure who has been taking aluminum hydroxide/magnesium hydroxide suspension (Maalox) at home for indigestion is somnolent and has decreased deep tendon reflexes. Which action should the nurse take first?

A) Notify the patient's health care provider.
B) Withhold the next scheduled dose of Maalox.
C) Review the magnesium level on the patient's chart.
D) Check the chart for the most recent potassium level.

Question 31

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

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

Question 32

A postoperative patient who is receiving nasogastric suction is complaining of anxiety and incisional pain. The patient's respiratory rate is 32 breaths/minute and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first?

A) Discontinue the nasogastric suctions for a few hours.
B) Notify the health care provider about the ABG results.
C) Teach the patient about the need to take slow, deep breaths.
D) Give the patient the PRN morphine sulfate 4 mg intravenously.