Deck 10: Nursing Care of Patients With Altered Fluid, Electrolyte, and Acidbase Balance

Question 1

The nurse is planning care for a patient with severe burns. What condition should the nurse realize that this patient could develop?

A) intracellular fluid deficit
B) intracellular fluid overload
C) extracellular fluid deficit
D) interstitial fluid deficit

Answer 1

intracellular fluid deficit

Question 2

A patient is diagnosed with hypokalemia. After reviewing the patient's current medications, which drug should the nurse consider that might have contributed to the patient's health problem?

A) corticosteroid
B) thiazide diuretic
C) narcotic
D) muscle relaxer

Answer 2

corticosteroid

Question 3

The nurse is planning care for a patient with fluid volume overload and hyponatremia. What should be included in this patient's plan of care?

A) Restrict fluids.
B) Administer intravenous fluids.
C) Provide Kayexalate.
D) Administer intravenous normal saline with furosemide.

Answer 3

Restrict fluids.

Question 4

The nurse is caring for a patient diagnosed with hypocalcemia. What additional assessments should the nurse include when caring for this patient?

A) other electrolyte disturbances
B) hypertension
C) visual disturbances
D) drug toxicity

Question 5

The nurse is reviewing the health problems for a group of assigned patients. Which patient does the nurse recognize as being at increased risk for developing metabolic alkalosis?

A) patient with bulimia
B) patient on dialysis
C) patient with venous stasis ulcer
D) patient with COPD

Question 6

The nurse is analyzing an arterial blood gas report of a patient with COPD and respiratory acidosis. Through which mechanism should the nurse expect compensation to occur?

A) The kidneys retain bicarbonate.
B) The kidneys excrete bicarbonate.
C) The lungs will retain carbon dioxide.
D) The lungs will excrete carbon dioxide.

Question 7

The nurse assesses a patient's weight loss as being 22 lbs. How many liters of fluid did this patient lose?

Question 8

A patient is receiving intravenous fluids postoperatively following cardiac surgery. On which potential postoperative complication should the nurse focus the assessment of this patient?

A) fluid volume excess
B) fluid volume deficit
C) seizure activity
D) liver failure

Question 9

A patient prescribed spironolactone is demonstrating ECG changes and complaining of muscle weakness. The nurse realizes this patient is exhibiting signs of which electrolyte imbalance?

A) hyperkalemia
B) hypokalemia
C) hypercalcemia
D) hypocalcemia

Question 10

A patient is prescribed 20 mEq of potassium chloride. The nurse realizes that the reason the patient is receiving this replacement is

A) to sustain respiratory function.
B) to help regulate acid‒base balance.
C) to keep a vein open.
D) to encourage urine output.

Question 11

An elderly patient does not complain of thirst. What should the nurse do to assess that this patient is not dehydrated?

A) Ask the physician for an order to begin intravenous fluid replacement.
B) Ask the physician to order a chest x-ray.
C) Monitor serum osmolality level.
D) Ask the physician for an order for a brain scan.

Question 12

The nurse is caring for a patient diagnosed with renal failure. What should the nurse recognize as compensation for the acid‒base disturbance found in patients with renal failure?

A) The patient breathes rapidly to eliminate carbon dioxide.
B) The patient will retain bicarbonate in excess of normal.
C) The pH will decrease from the present value.
D) The patient's oxygen saturation level will improve.

Question 13

A patient recovering from surgery has an indwelling urinary catheter. For which 24-hour urine output volumes should the nurse notify the patient's healthcare provider?

A) 600 milliliters
B) 750 milliliters
C) 1000 milliliters
D) 1200 milliliters

Question 14

The nurse is caring for a patient who is anxious and dizzy following a traumatic experience. The arterial blood gas findings include: pH 7.48, PaO₂ 110, PaCO₂ 25, and HCO₃ 2

A) Encourage the patient to breathe in and out slowly into a paper bag.
B) Immediately administer oxygen via a mask and monitor oxygen saturation.
C) Prepare to start an intravenous fluid bolus using isotonic fluids.
D) Anticipate the administration of intravenous sodium bicarbonate.
E) Which intervention should the nurse expect to be prescribed to correct this problem?

Question 15

A pregnant patient is admitted with excessive thirst and increased urination. For which problem should the nurse focus the care of this patient?

A) imbalanced fluid
B) fluid overload
C) nutritional deficiency
D) insufficient blood flow

Question 16

A patient with a history of stomach ulcers is diagnosed with hypophosphatemia. What intervention should the nurse include in this patient's plan of care?

A) Request a dietitian consult for selecting foods high in phosphorous.
B) Provide aluminum hydroxide antacids as prescribed.
C) Instruct patient to avoid poultry, peanuts, and seeds.
D) Instruct to avoid the intake of sodium phosphate.

Question 17

A patient experiencing multisystem fluid volume deficit has tachycardia; pale, cool skin; and decreased urine output. The nurse realizes these findings are most likely a direct result of which process?

A) the body's natural compensatory mechanisms
B) pharmacological effects of a diuretic
C) effects of rapidly infused intravenous fluids
D) cardiac failure

Question 18

The nurse is caring for an older patient who is occasionally confused. What should be the nurse's primary concern regarding fluid and electrolytes when caring for this patient?

A) risk of dehydration
B) risk of kidney damage
C) risk of stroke
D) risk of bleeding

Question 19

An elderly patient who is being medicated for pain had an episode of incontinence. The nurse realizes that this patient is at risk for developing

A) dehydration.
B) over-hydration.
C) fecal incontinence.
D) a stroke.

Question 20

A patient is diagnosed with severe hyponatremia. The nurse realizes this patient will mostly likely need precautions implemented for what event?

A) seizure
B) infection
C) neutropenia
D) high-risk fall

Question 21

A 35-year-old female patient is recovering from a parathyroidectomy. What should the nurse include when teaching health promotion activities to this patient?

A) Drink one glass of red wine per day.
B) Avoid the sun.
C) Milk and milk-based products will ensure an adequate calcium intake.
D) Red meat is the protein source of choice.

Question 22

A 28-year-old male patient is admitted with diabetic ketoacidosis. Which electrolyte should the nurse expect to be replaced in this patient?

A) sodium
B) potassium
C) calcium
D) magnesium

Question 23

A patient is diagnosed with hyperphosphatemia. The nurse realizes that this patient might also have an imbalance of what electrolyte?

A) calcium
B) sodium
C) potassium
D) chloride

Question 24

A postoperative patient is diagnosed with fluid volume overload. What should the nurse expect to assess in this patient?

A) poor skin turgor
B) decreased urine output
C) distended neck veins
D) concentrated hemoglobin and hematocrit levels

Question 25

A patient is admitted for treatment of hypercalcemia. Which type of intravenous fluid should the nurse expect to be prescribed for this patient?

A) dextrose 5% and water
B) dextrose 5% and 0.9% normal saline
C) dextrose 5% and 0.45% normal saline
D) normal saline

Question 26

A patient is prescribed 40 mEq potassium as a replacement. How should the nurse plan to administer this medication?

A) directly into the venous access line
B) mixed in the prescribed intravenous fluid
C) via a rectal suppository
D) via intramuscular injection

Question 27

An older patient comes into the clinic complaining of watery diarrhea for several days with abdominal and muscle cramping. The nurse realizes that this patient is demonstrating which imbalance?

A) hypernatremia
B) hyponatremia
C) fluid volume excess
D) hyperkalemia

Question 28

A patient's respiration rate is 30 per minute and very deep. What disorder should the nurse suspect is occurring in this patient?

A) hypernatremia
B) increased carbon dioxide in the blood
C) hypertension
D) pain

Question 29

A patient with fluid retention related to renal problems is admitted to the hospital. The nurse realizes that this patient could possibly have which electrolyte imbalance?

A) hypokalemia
B) hypernatremia
C) carbon dioxide
D) magnesium

Question 30

A postoperative patient with a fluid volume deficit is prescribed progressive ambulation, yet is weak from an inadequate fluid status. What should the nurse do to help this patient?

A) Assist the patient to maintain a standing position for several minutes.
B) Recommend that this patient be on bed rest.
C) Assist the patient to move into different positions in stages.
D) Contact physical therapy to provide a walker.

Question 31

A patient is admitted with burns over 50% of his body. The nurse realizes that this patient is at risk for which electrolyte imbalances?

A) hypercalcemia
B) hypophosphatemia
C) hypernatremia
D) hypermagnesemia

Question 32

A patient is admitted with hypernatremia caused by being stranded on a boat in the Atlantic Ocean for five days without a fresh water source. What is this patient at risk for developing?

A) pulmonary edema
B) atrial dysrhythmias
C) cerebral bleeding
D) stress fractures

Question 33

An older patient with a history of sodium retention arrives to at the clinic with the complaints of "heart skipping beats" and leg tremors. What should the nurse ask this patient regarding these symptoms?

A) "Have you stopped taking your digoxin medication?"
B) "When was the last time you had a bowel movement?"
C) "Were you doing any unusual physical activity?"
D) "Are you using a salt substitute?"

Question 34

A patient who is taking digoxin (Lanoxin) is admitted with possible hypokalemia. What should the nurse realize might occur with this patient?

A) Digoxin toxicity may occur.
B) A higher dose of digoxin (Lanoxin) may be needed.
C) A diuretic may be needed.
D) Fluid volume deficit may occur.

Question 35

The nurse is reviewing a patient's blood pH level. What systems in the body does the nurse recognize as contributing to the regulation of blood pH?

A) renal
B) cardiac
C) buffers
D) respiratory
E) integument

Question 36

An older patient with peripheral neuropathy has been taking magnesium supplements. The nurse realizes that which symptoms indicate hypermagnesemia?

A) hypotension, warmth, and sweating
B) nausea and vomiting
C) hyperreflexia
D) excessive urination

Question 37

An older patient is at home after being diagnosed with fluid volume overload. What should the home care nurse instruct this patient to do?

A) Wear support hose.
B) Keep legs in a dependent position.
C) Avoid wearing shoes while in the home.
D) Try to sleep without extra pillows.

Question 38

The blood gases of a patient with an acid‒base disorder show a blood pH outside of normal limits. The nurse realizes that this patient is

A) fully compensated.
B) demonstrating anaerobic metabolism.
C) partially compensated.
D) in need of intravenous fluids.

Question 39

A patient's blood gases show a pH of 7.53 and bicarbonate level of 36 mEq/L. The nurse realizes that the patient is demonstrating which acid‒base disorder?

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

Question 40

The nurse is admitting a patient who was diagnosed with acute renal failure. Which electrolyte should the nurse expect to be most affected with this disorder?

A) calcium
B) magnesium
C) phosphorous
D) potassium

Question 41

Type: MCMR A patient with fluid overload is prescribed furosemide (Lasix) 20 mg by mouth each day. What should the nurse include when teaching the patient about this medication?

A) Expect urination to increase.
B) Expect to feel weak and dizzy.
C) Measure body weight every day.
D) Report swelling of the face or hands.
E) Take the medication before going to sleep.

Question 42

The nurse is reviewing care needs for a group of assigned patients. Which patients should the nurse identify as being at risk for the development of hypercalcemia?

A) the patient with a malignancy
B) the patient taking lithium
C) the patient who uses sunscreen to excess
D) the patient with hyperparathyroidism
E) the patient who overuses antacids

Question 43

Type: MCMR A patient with chronic renal failure has an occluded arteriovenous fistula, and routine hemodialysis is delayed. However, the patient's serum potassium level is 6.0 mEq/L. What should the nurse expect to be prescribed for this patient?

A) insulin
B) dextrose 10%
C) furosemide (Lasix)
D) sodium bicarbonate
E) sodium polystyrene sulfonate (Kayexalate)

Question 44

A patient newly diagnosed with diabetes mellitus is admitted to the emergency department with nausea, vomiting, and abdominal pain. ABG results reveal a pH of 7.2 and a bicarbonate level of 20 mEq/L. What other assessment findings should the nurse anticipate in this patient?

A) tachycardia
B) weakness
C) dysrhythmias
D) Kussmaul respirations
E) cold, clammy skin

Question 45

An older postoperative patient is demonstrating lethargy, confusion, and a respiratory rate of 8 per minute. The nurse sees that the last dose of pain medication administered via a patient controlled anesthesia (PCA) pump was within 30 minutes. Which acid‒base disorder might this patient be experiencing?

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

Question 46

The patient is prescribed to receive intravenous potassium chloride (KCL). Which actions should the nurse take when administering this medication?

A) Administer the dose IV push over 3 minutes.
B) Monitor the injection site for redness.
C) Add the ordered dose to the IV hanging.
D) Use an infusion controller for the IV.
E) Monitor fluid intake and output.

Question 47

A patient weighing 176 lbs. is recovering from mild dehydration. The patient is awake, alert, and can safely take oral fluids. How many mL of fluid should the nurse instruct the patient to consume every day?

Question 48

Type: MCMR The nurse is concerned that a patient recovering from a thyroidectomy is developing hypocalcemia. What findings did the nurse use to come to this conclusion?

A) heart rate 88 and regular
B) complaints of fingers tingling
C) contraction of the facial muscle
D) asked when the foot numbness would go away
E) carpal spasm with blood pressure measurement

Question 49

The patient who has a serum magnesium level of 1.4 mg/dL is being treated with dietary modification. Which foods should the nurse suggest for this patient?

A) romaine lettuce
B) seafood
C) white rice
D) lean red meat
E) almonds

Question 50

A patient has a serum phosphate level of 4.7 mg/dL. Which treatments should the nurse expect to be prescribed for this patient?

A) IV normal saline
B) calcium-containing antacids
C) IV potassium phosphate
D) additional milk intake
E) increased vitamin D intake

Question 51

A patient has been placed on a 1200 mL daily fluid restriction. The patient's IV is infusing at a keep open rate of 10 mL/hr. The patient has no additional IV medications. How much fluid should the patient be permitted from 0700 until 1500? Standard Text:

Question 52

A patient has a serum sodium level of 145 mEq/L, serum chloride level of 114 mEq/L, and serum bicarbonate level of 20 mEq/L. What should the nurse calculate as being this patient's anion gap?

Question 53

The nurse is caring for a patient with serum potassium of 5.9 mEq/L. Which electrocardiogram tracing should the nurse expect to observe in this patient? Place an "X" on the tracing that is most likely to represent the patient's cardiac electrical activity.