Deck 15: Fluids, Electrolytes and Acid-Base Imbalance

Question 1

The nurse would assess specifically for metabolic alkalosis in which patient?

A) A patient admitted for treatment of bulimia
B) A patient who has been on dialysis for 2 months
C) A patient with a nonhealing venous stasis ulcer
D) A patient with newly diagnosed with COPD

Answer 1

A patient admitted for treatment of bulimia

Question 2

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

A) The body's natural compensatory mechanisms
B) Pharmacologic effects of a diuretic
C) Effects of rapidly infused intravenous fluids
D) Cardiac failure

Answer 2

The body's natural compensatory mechanisms

Question 3

An adult patient recovering from surgery has an indwelling urinary catheter. The nurse would contact the patient's primary health care provider with which 24-hour urine output volume?

A) 600 milliliters
B) 750 milliliters
C) 1,000 milliliters
D) 1,200 milliliters

Answer 3

600 milliliters

Question 4

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

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

Question 5

When caring for a patient diagnosed with hypocalcemia, the nurse would also assess for which other finding?

A) Other electrolyte disturbances
B) Hypertension
C) Visual disturbances
D) Drug toxicity

Question 6

An elderly patient reports having watery diarrhea for several days before coming to the clinic. This morning the patient is lethargic and confused. The nurse would assess this patient for which electrolyte imbalance?

A) Hypernatremia
B) Hyponatremia
C) Hypermagnesemia
D) Hyperkalemia

Question 7

The nurse is caring for a patient diagnosed with renal failure. Which compensation does the nurse expect 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 8

The nurse is planning care for a patient with fluid volume overload and hyponatremia. Which intervention 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.

Question 9

A patient's blood gases show a pH of 7.53 and bicarbonate level of 36 mEq/L. The nurse prepares to treat this patient for which acid-base disorder?

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

Question 10

A postoperative patient is diagnosed with fluid volume overload. Which assessment would the nurse attribute to this diagnosis?

A) The patient has poor skin turgor.
B) The patient has decreased urine output.
C) The patient reports sleeping on two pillows.
D) The patient's laboratory testing reveals concentrated hemoglobin and hematocrit levels.

Question 11

A clinic patient is short of breath and has ankle edema. Today's weight is 8 pounds heavier that last week's weight. The nurse determines that the patient could have retained ______ pints of fluid.

Question 12

An elderly 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 less than 30 minutes ago. This patient is most likely experiencing which acid-base disorder?

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

Question 13

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

A) Seizure precautions
B) Infection precautions
C) Neutropenic precautions
D) High-risk fall precautions

Question 14

A pregnant patient is admitted with excessive thirst, increased urination, and a medical diagnosis of diabetes insipidus. The nurse chooses which nursing diagnosis as most appropriate?

A) Risk for Imbalanced Fluid Volume
B) Excess Fluid Volume
C) Imbalanced Nutrition
D) Ineffective Tissue Perfusion

Question 15

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

A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hypocalcemia

Question 16

When analyzing an arterial blood gas report of a patient with COPD and respiratory acidosis, the nurse anticipates that compensation will develop through which mechanism?

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 17

An elderly patient does not complain of thirst. Which information would the nurse evaluate to determine if the patient is dehydrated?

A) Magnesium level
B) Chest X-ray
C) Urine osmolality
D) Brain scan

Question 18

When caring for an elderly patient who is intermittently confused, what is the nurse's primary concern regarding fluid and electrolytes?

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

Question 19

A patient is diagnosed with hypokalemia. Which medication order would the nurse anticipate?

A) Potassium 40 mEq IV push
B) Potassium 40 mEq added to the next liter of IV fluids
C) Potassium 40 mEq by rectal suppository
D) Potassium 40 mEq IM

Question 20

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 24) The nurse would anticipate which initial intervention to correct this problem?

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) Start an intravenous fluid bolus using isotonic fluids.
D) Administer intravenous sodium bicarbonate.

Question 21

A patient newly diagnosed with diabetes mellitus is admitted to the emergency department with nausea and vomiting. ABG results reveal a pH of 7.2 and a bicarbonate level of 20 mEq/L. Which other assessment findings would the nurse anticipate in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Abdominal pain
B) Visual changes
C) Dysrhythmias
D) Kussmaul respirations
E) Positive Chvostek's sign

Question 22

A 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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Bananas
B) Seafood
C) White rice
D) Lean red meat
E) Chocolate

Question 23

The nurse would assess for dehydration if the patient's urine specific gravity is higher than ________.

Question 24

A patient's arterial blood gases reveal a pH of 7.49. The nurse would continue to analyze these results based on which evaluation? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The patient may have respiratory acidosis.
B) The patient may have respiratory alkalosis.
C) The patient may have metabolic acidosis.
D) The patient may have metabolic alkalosis.
E) The patient has normal blood gases.

Question 25

Which patients would the nurse monitor most closely for the development of hypercalcemia? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) A patient with a malignancy
B) A patient taking lithium
C) A patient who uses sunscreen to excess
D) A patient with hyperparathyroidism
E) A patient on complete bed rest

Question 26

The patient has a serum phosphate level of 4.7 mg/dL. Which interdisciplinary treatments would the nurse expect for this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Correction of calcium level
B) Calcium-containing antacids
C) IV potassium phosphate
D) Higher milk intake
E) Increased vitamin D intake

Question 27

A patient was admitted to an acute care unit with weakness and complaints of dizziness. Dehydration is suspected as the cause. Which laboratory findings would the nurse evaluate as supporting that diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Hematocrit of 50%
B) Serum sodium of 132 mEq/L
C) Serum potassium of 5.1 mEq/L
D) Serum bicarbonate of 22 mEq/L
E) Serum osmolality of 320 mOsm/kg

Question 28

The nurse is discussing respiratory and metabolic acids and bases. Which statements would the nurse supervisor evaluate as indicating that the nurse needs more information? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "When water combines with carbon dioxide, carbonic acid is produced."
B) "Carbon dioxide is a potential acid that is excreted through the lungs."
C) "Body metabolism produces lactic acids, which are constantly eliminated in the lungs."
D) "Sodium bicarbonate buffers the blood by removing hydrogen ions from the blood."
E) "Carbonic acid dissociates into sodium and bicarbonate."

Question 29

The nurse is caring for a patient with diabetic ketoacidosis DKA) who presents with polyuria, abdominal pain, vomiting, and flushed skin. Which clinical manifestation suggests compensation for the acid-base disorder?

A) The patient presents with vomiting.
B) The patient has a respiratory rate of 28 with deep inspirations.
C) The patient has a urine output of 20 mL over the last hour.
D) The patient demonstrates shallow respirations and decreased excursion.

Question 30

A patient is found to be in respiratory acidosis. The nurse plans care based on which physiological processes? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The pH is low.
B) Carbon dioxide is low.
C) The kidneys are attempting to conserve bicarbonate.
D) Potassium is being displaced from cells.
E) A base excess exists.