F/E and Acid-base Balance

Question 1

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?

a) Monitor the client’s heart rhythm.
b) Prepare to assist with ventilation.
c) Obtain a urine specimen for drug screening.
d) Prepare for gastric lavage.

Answer 1

b) Prepare to assist with ventilation.

Question 2

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which?

a) Lung function
b) Cardiovascular compromise
c) Insensible fluid loss
d) Summer allergies

Answer 2

c) Insensible fluid loss

Question 3

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?

a) Respiratory acidosis
b) Respiratory alkalosis
c) Metabolic alkalosis
d) Metabolic acidosis

Answer 3

c) Metabolic alkalosis

Question 4

Which of the following is considered an isotonic solution?

a) 3% NaCl
b) 0.9% normal saline
c) 0.45% normal saline
d) Dextran in NS

Answer 4

b) 0.9% normal saline

Question 5

Patients diagnosed with hypervolemia should avoid sweet or dry food because

a) it can cause dehydration.
b) it obstructs water elimination.
c) it increases the patient’s desire to consume fluid.
d) it can lead to weight gain.

Answer 5

c) it increases the patient’s desire to consume fluid.

Question 6

Which of the following arterial blood gas results would be consistent with metabolic alkalosis?

a) pH 7.26
b) Serum bicarbonate of 21 mEq/L
c) pH 7.30
d) Serum bicarbonate of 28 mEq/L

Answer 6

Serum bicarbonate of 28 mEq/L

Question 7

Which of the following are the insensible mechanisms of fluid loss?

a) Urination
b) Nausea
c) Bowel elimination
d) Breathing

Answer 7

d) Breathing

Question 8

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?

a) PaCO 36
b) pH 7.48
c) HCO 21 mEq/L
d) O saturation 95%

Answer 8

b) pH 7.48

Question 9

A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client?

a) No, sodium intake should be restricted.
b) No, start with the sodium chloride IV.
c) Yes, this will correct the sodium deficit.
d) Yes, along with the hypotonic IV.

Answer 9

a) No, sodium intake should be restricted.

Question 10

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

a) Nausea or vomiting
b) Abdominal pain or diarrhea
c) Hallucinations or tinnitus
d) Light-headedness or paresthesia

Answer 10

d) Light-headedness or paresthesia

Question 11

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?

a) Metabolic acidosis
b) Respiratory alkalosis
c) Metabolic alkalosis
d) Respiratory acidosis

Answer 11

a) Metabolic acidosis

Question 12

The nurse is instructing a patient with recurrent hyperkalemia about following a potassium-restricted diet. Which of the following patient statements indicates the need for additional instruction?

a) “Bananas have a lot of potassium in them, I’ll stop buying them.”
b) “I need to check if my cola beverage has potassium in it.”
c) “I will not salt my food, instead I’ll use salt substitute.”
d) “I’ll drink cranberry juice with my breakfast instead of coffee.”

Answer 12

c) “I will not salt my food, instead I’ll use salt substitute.”

Question 13

The nurse is caring for a patient diagnosed with hyperchloremia. Signs and symptoms of hyperchloremia include which of the following? Select all that apply.

a) Tachypnea
b) Hypotension
c) Dehydration
d) Lethargy
e) Weakness

Answer 13

a) Tachypnea
d) Lethargy
e) Weakness

Question 14

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client’s laboratory values.

Na + 130 mEq/L
K + 4.6 mEq/L
Cl - 94 mEq/L
Mg ++ 2.8 mg/dL
Ca ++ 13 mg/dL

Which of the following alterations is consistent with the client’s findings?

a) Hyperkalemia
b) Hyponatremia
c) Hypermagnesemia
d) Hypercalcemia

Answer 14

d) Hypercalcemia

Question 15

Which of the following is the most common cause of symptomatic hypomagnesemia?

a) IV drug use
b) Alcoholism
c) Sedentary lifestyle
d) Burns

Answer 15

b) Alcoholism

Question 16

Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism?

a) Hypertension
b) Chest pain
c) Slow pulse
d) Jaundice

Answer 16

b) Chest pain

Question 17

Which set of arterial blood gas (ABG) results requires further investigation?

a) pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L
b) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
c) pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L
d) pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L

Answer 17

b) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

Question 18

The calcium level of the blood is regulated by which mechanism?

a) Parathyroid hormone (PTH)
b) Androgens
c) Adrenal gland
d) Thyroid hormone (TH)

Answer 18

a) Parathyroid hormone (PTH)

Question 19

A patient’s most recent laboratory results show a slight decrease in potassium. The physician has opted to forego drug therapy but has suggested increasing the patient’s dietary intake of potassium. Which of the following would be a good source of potassium?

A) Apples

B) Asparagus

C) Carrots

D) Bananas

Answer 19

D) Bananas

Question 20

You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? Select all that apply.

A) Milk

B) Beef

C) Poultry

D) Green vegetables

E) Liver

Answer 20

A) Milk
C) Poultry
E) Liver

If the patient experiences mild hypophosphatemia, foods such as milk and milk products, organ meats, nuts, fish, poultry, and whole grains should be encouraged.

Question 21

The nurse is assessing the patient for the presence of a Chvostek’s sign. What electrolyte imbalance would a positive Chvostek’s sign indicate?

A) Hypermagnesemia

B) Hyponatremia

C) Hypocalcemia

D) Hyperkalemia

Answer 21

C) Hypocalcemia

Question 22

A client who is found unresponsive has arterial blood gases drawn and the results indicate dthe following: pH is 7.12, Pco2 is 90, and HCO3- is 22. the nurse interprets the results as indicating which condition?

1) Metabolic Acidosis with compensation
2) Respiratory Acidosis with compensation
3) Metabolic Acidosis without compensation
4) Respiratory Acidosis without compensation

Answer 22

4) Respiratory Acidosis without compensation

Rational: The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis the pH is decreased and the pco2 is elevated. The normal bicarbonate (HCO3-) level is 22-27. Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. Additionally, the pH is not within normal limits. Therefore the condition is without compensation. Options 1, 2, & 3 are incorrect interpretations.

Question 23

A nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which of the following validates the nurse’s findings?

1) pH 7.25, Pco2 50,
2) pH 7.35, Pco2 40
3) pH 7.50, Pco2 52
4) pH 7.52, Pco2 28

Answer 23

1) pH 7.25, Pco2 50
Rational: Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis, the pH is decreased and the Pco2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition. Option 4 identifies respiratory alkalosis.

Question 24

A nurse notes that a client's arterial blood gas reults reveal a pH of 7.50 and a Pco2 of 30. The nurse monitors the client for which clinical manifestations associated with these arterial blood gas results?
Select all the apply:
1) Nausea
2) Confusion
3) Bradypnea
4) Tachycardia
5) Hyperkalemia
6) Lightheadedness

Answer 24

1) Nausea
2) Confusion
4) Tachycardia
6) Lightheadedness

Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentrations that results from the accumulations of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of repirtory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemai, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs.

Question 25

A nurse is reviewing the laboratory results of a client who is dehydrated. Which of the following BUN lab values should the nurse report to the provider?

Answer 25

25mg/dL

Question 26

A nurse is caring for a client who has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor?

Answer 26

Hypokalemia

Question 27

A nurse is assessing a client who reports frequent vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect?

a) poor skin turgor

B) bradycardia

C) hypotension

D) pale yellow urine

E) flat neck veins

Answer 27

Poor skin turgor
hypotension
flat neck veins

Frequent vomiting and diarrhea causes dehydration which manifests as skin and lacks elasticity. Frequent vomiting and diarrhea causes dehydration which manifests as postural hypotension. And also manifest as flat neck beans when the client is laying supine. Urine color manifest as a dark yellow or concentrated color and tachycardia presents

Question 28

a nurse is assessing a preschooler who has a calcium lvel of 8.0 mg/dL. Which of the following findings should the nurse expect?

a. dry,sticky mucous membranes
b. Negative Chvostek’s sign
c. muscle tremors
d. polyuria

Answer 28

Muscle tremors

Question 29

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect?

Answer 29

Increased heart rate
increased blood pressure
increased respiratory rate

Question 30

A nurse is planning care for a client who has acute dysphagia. Which of the following nursing interventions should be included in the plan of care?

a. Placing the client in semi-fowlers position during meals
b. Providing a straw for consumption of liquids
c. Encourage larger bites
d. Instructing the client to tilt head forward when swallowing

Answer 30

d. Instructing the client to tilt head forward when swallowing

Question 31

A nurse is assessing a client who has a sodium level of 116mEq/L. Which of the following findings should the nurse expect?

Answer 31

Nausea and vomiting

Question 32

A nurse is performing an admission assessment on a client. Which of the following findings should the nurse identify as an indication that the client is dehydrated?

Answer 32

Skin tenting

Question 33

A nurse in an emergency department is assessing an infant who is dehydrated. Which of the following findings should the nurse expect?

Answer 33

Irritability

Question 34

A nurse is reviewing a client’s lab results. Which of the following lab values should the nurse report to the provider?

Answer 34

Sodium 126mEq/L

Question 35

A nurse is admitting a client who has a serum calcium level of 12.3 mg/dL and initiates cardiac monitoring. Which of the following findings should the nurse expect during the initial assessment?

Answer 35

Lethargy

Question 36

A nurse is preparing to administer potassium chloride (KCl) to a client who is receiving diuretic therapy. The nurse reviews the client’s serum potassium level results and discovers the client’s potassium level is 3.2 mEq/L. Which of the following actions should the nurse take?

Answer 36

Give the ordered KCl as prescribed

Question 37

A nurse in a community clinic is assessing an older adult client for manifestations of dehydration. Which of the following findings should the nurse expect?

Answer 37

Furrows in the tongue

Question 38

A nurse is assessing a client who has hypokalemia as a result of nausea, vomiting, and diarrhea. Which of the following findings should the nurse expect?

Answer 38

Weak, irregular pulse

Question 39

A nurse is caring for four hospitalized clients. Which of the following clients should the nurse identify as being at risk for fluid volume deficit?

Answer 39

The client who has gastroenteritis and is febrile.