Chapter 42 Practice Questions - Fluid, Electrolyte, and Acid-Base Balance

Question 1

A patient is experiencing dehydration. While planning care, the nurse considers that the majority of the patient’s total water volume exists in with compartment?

a. Intracellular
b. Extracellular
c. Intravascular
d. Transcellular

Answer 1

a. Intracellular

Question 2

The nurse is teaching about the process of passively moving water from an area of lower particle concentration to an area of higher particle concentration. Which process is the nurse describing?

a. Osmosis
b. Filtration
c. Diffusion
d. Active transport

Answer 2

a. Osmosis

Question 3

The nurse observes edema in a patient who is experiencing venous congestion as a result of right heart failure. Which type of pressure facilitated the formation of the patient’s edema?

a. Osmotic
b. Oncotic
c. Hydrostatic
d. Concentration

Answer 3

c. Hydrostatic

Question 4

The nurse administers an intravenous (IV) hypertonic solution to a patient expects the fluid shift to occur in what direction?

a. From intracellular to extracellular
b. From extracellular to intracellular
c. From intravascular to intracellular
d. From intravascular to interstitial

Answer 4

a. From intracellular to extracellular

Question 5

A nurse is preparing to start peripheral intravenous (IV) therapy. In which order will the nurse perform the steps starting with the first one?

1. Clean site.
2. Select vein.
3. Apply tourniquet.
4. Release tourniquet.
5. Reapply tourniquet.
6. Advance and secure.
7. Insert vascular access device.

a. 1, 3, 2, 7, 5, 4, 6
b. 1, 3, 2, 5, 7, 6, 4
c. 3, 2, 1, 5, 7, 6, 4
d. 3, 2, 4, 1, 5, 7, 6

Answer 5

d. 3, 2, 4, 1, 5, 7, 6

Question 6

The nurse is laboratory blood results will expect to observe which cation in the most abundance?

a. Sodium
b. Chloride
c. Potassium
d. Magnesium

Answer 6

a. Sodium

Question 7

The nurse receives the patient’s most recent blood work results. Which laboratory value is of greatest concern?

a. Sodium of 145 mEq/L
b. Calcium of 15.5 mg/dL
c. Potassium of 3.5 mEq/L
d. Chloride of 100 mEq/L

Answer 7

b. Calcium of 15.5 mg/dL

Question 8

The nurse observes that the patient’s calcium is elevated. When checking the phosphate level, what does the nurse expect to see?

a. An increase
b. A decrease
c. Equal to calcium
d. No change in phosphate

Answer 8

b. A decrease

Question 9

Four patients arrive at the emergency department at the same time. Which patient will the nurse see first?

a. An infant with temperature of 102.2° F and diarrhea for 3 days
b. A teenager with a sprained ankle and excessive edema
c. A middle-aged adult with abdominal pain who is moaning and holding her stomach
d. An older adult with nausea and vomiting for 3 days with blood pressure 112/60

Answer 9

a. An infant with temperature of 102.2° F and diarrhea for 3 days

Question 10

The patient has an intravenous (IV) line and the nurse needs to remove the gown. In which order will the nurse perform the steps, starting with the first one?

1. Remove the sleeve of the gown from the arm without the IV.
2. Remove the sleeve of the gown from the arm with the IV.
3. Remove the IV solution container from its stand.
4. Pass the IV bag and tubing through the sleeve.

a. 1, 2, 3, 4
b. 2, 3, 4, 1
c. 3, 4, 1, 2
d. 4, 1, 2, 3

Answer 10

a. 1, 2, 3, 4

Question 11

A 2-year-old child has ingested a quantity of a medication that causes respiratory depression. For which acid-base imbalance will the nurse most closely monitor this child?

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

Answer 11

b. Respiratory acidosis

Question 12

A patient is admitted for a bowel obstruction and has had a nasogastric tube set to low intermittent suction for the past 3 days. Which arterial blood gas values will the nurse expect to observe?

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

Answer 12

b. Metabolic alkalosis

Question 13

Which blood gas result will the nurse expect to observe in a patient with respiratory alkalosis?

a. pH 7.60, PaCO2 40 mm Hg, HCO3– 30 mEq/L
b. pH 7.53, PaCO2 30 mm Hg, HCO3– 24 mEq/L
c. pH 7.35, PaCO2 35 mm Hg, HCO3– 26 mEq/L
d. pH 7.25, PaCO2 48 mm Hg, HCO3– 23 mEq/L

Answer 13

b. pH 7.53, PaCO2 30 mm Hg, HCO3– 24 mEq/L

Question 14

A nurse is caring for a patient whose electrocardiogram (ECG) presents with changes characteristic of hypokalemia. Which assessment finding will the nurse expect?

a. Dry mucous membranes
b. Abdominal distention
c. Distended neck veins
d. Flushed skin

Answer 14

b. Abdominal distention

Question 15

In which patient will the nurse expect to see a positive Chvostek’s sign?

a. A 7-year-old child admitted for severe burns
b. A 24-year-old adult admitted for chronic alcohol abuse
c. A 50-year-old patient admitted for an acute exacerbation of hyperparathyroidism
d. A 75-year-old patient admitted for a broken hip related to osteoporosis

Answer 15

b. A 24-year-old adult admitted for chronic alcohol abuse

Question 16

A patient is experiencing respiratory acidosis. Which organ system is responsible for compensation in this patient?

a. Renal
b. Endocrine
c. Respiratory
d. Gastrointestinal

Answer 16

a. Renal

Question 17

A nurse is caring for a patient prescribed peripheral intravenous (IV) therapy. Which task will the nurse assign to the nursing assistive personnel?

a. Recording intake and output
b. Regulating intravenous flow rate
c. Starting peripheral intravenous therapy
d. Changing a peripheral intravenous dressing

Answer 17

a. Recording intake and output

Question 18

The nurse is caring for a diabetic patient in renal failure who is in metabolic acidosis. Which laboratory findings are consistent with metabolic acidosis?

a. pH 7.3, PaCO2 36 mm Hg, HCO3– 19 mEq/L
b. pH 7.5, PaCO2 35 mm Hg, HCO3– 35 mEq/L
c. pH 7.32, PaCO2 47 mm Hg, HCO3– 23 mEq/L
d. pH 7.35, PaCO2 40 mm Hg, HCO3– 25 mEq/L

Answer 18

a. pH 7.3, PaCO2 36 mm Hg, HCO3– 19 mEq/L

Question 19

The nurse is assessing a patient and notes crackles in the lung bases and neck vein distention. Which action will the nurse take first?

a. Offer calcium-rich foods.
b. Administer diuretic.
c. Raise head of bed.
d. Increase fluids.

Answer 19

c. Raise head of bed.

Question 20

A patient receiving chemotherapy has gained 5 pounds in 2 days. Which assessment question by the nurse is most appropriate?

a. “Are you following any weight loss program?”
b. “How many calories a day do you consume?”
c. “Do you have dry mouth or feel thirsty?”
d. “How many times a day do you urinate?”

Answer 20

d. “How many times a day do you urinate?”

Question 21

The health care provider has ordered a hypotonic intravenous (IV) solution to be administered. Which IV bag will the nurse prepare?

a. 0.45% sodium chloride (1/2 NS)
b. 0.9% sodium chloride (NS)
c. Lactated Ringer’s (LR)
d. Dextrose 5% in Lactated Ringer’s (D5LR)

Answer 21

a. 0.45% sodium chloride (1/2 NS)

Question 22

The health care provider asks the nurse to monitor the fluid volume status of a heart failure patient and a patient at risk for clinical dehydration. Which is the most effective nursing intervention for monitoring both of these patients?

a. Assess the patients for edema in extremities.
b. Ask the patients to record their intake and output.
c. Weigh the patients every morning before breakfast.
d. Measure the patients’ blood pressures every 4 hours.

Answer 22

c. Weigh the patients every morning before breakfast.

Question 23

A nurse is caring for a patient diagnosed with cancer who presents with anorexia, blood pressure 100/60, and elevated white blood cell count. Which primary purpose for starting total parenteral nutrition (TPN) will the nurse add to the care plan?

a. Stimulate the patient’s appetite to eat.
b. Deliver antibiotics to fight off infection.
c. Replace fluid, electrolytes, and nutrients.
d. Provide medication to raise blood pressure.

Answer 23

c. Replace fluid, electrolytes, and nutrients.

Question 24

A patient presents to the emergency department with reports of vomiting and diarrhea for the past 48 hours. The health care provider orders isotonic intravenous (IV) therapy. Which IV will the nurse prepare?

a. 0.225% sodium chloride (1/4 NS)
b. 0.45% sodium chloride (1/2 NS)
c. 0.9% sodium chloride (NS)
d. 3% sodium chloride (3% NaCl)

Answer 24

c. 0.9% sodium chloride (NS)

Question 25

A nurse administering a diuretic to a patient is teaching about foods to increase in the diet. Which food choices by the patient will best indicate successful teaching? a. Milk and cheese b. Potatoes and fresh fruit c. Canned soups and vegetables d. Whole grains and dark green leafy vegetables

Answer 25

b. Potatoes and fresh fruit

Question 26

The nurse is evaluating the effectiveness of the intravenous fluid therapy in a patient with hypernatremia. Which finding indicates goal achievement? a. Urine output increases to 150 mL/hr. b. Systolic and diastolic blood pressure decreases. c. Serum sodium concentration returns to normal. d. Large amounts of emesis and diarrhea decrease.

Answer 26

c. Serum sodium concentration returns to normal.

Question 27

The nurse is calculating intake and output on a patient. The patient drinks 150 mL of orange juice at breakfast, voids 125 mL after breakfast, vomits 250 mL of greenish fluid, sucks on 60 mL of ice chips, and for lunch consumes 75 mL of chicken broth. Which totals for intake and output will the nurse document in the patient’s medical record? a. Intake 255; output 375 b. Intake 285; output 375 c. Intake 505; output 125 d. Intake 535; output 125

Answer 27

a. Intake 255; output 375

Question 28

Which assessment finding should cause a nurse to further assess for extracellular fluid volume deficit? a. Moist mucous membranes b. Postural hypotension c. Supple skin turgor d. Pitting edema

Answer 28

b. Postural hypotension

Question 29

A patient is to receive 1000 mL of 0.9% sodium chloride intravenously at a rate of 125 mL/hr. The nurse is using microdrip gravity drip tubing. Which rate will the nurse calculate for the minute flow rate (drops/min)? a. 12 drops/min b. 24 drops/min c. 125 drops/min d. 150 drops/min

Answer 29

c. 125 drops/min

Question 30

A nurse begins infusing a 250-mL bag of IV fluid at 1845 on Monday and programs the pump to infuse at 50 mL/hr. At what time should the infusion be completed? a. 2300 Monday b. 2345 Monday c. 0015 Tuesday d. 0045 Tuesday

Answer 30

b. 2345 Monday

Question 31

A nurse caring for a diabetic patient with a bowel obstruction has orders to ensure that the volume of intake matches the output. In the past 4 hours, the patient received dextrose 5% with 0.9% sodium chloride through a 22-gauge catheter infusing at 150 mL/hr and has eaten 200 mL of ice chips. The patient also has an NG suction tube set to low continuous suction that had 300-mL output. The patient has voided 400 mL of urine. After reporting these values to the health care provider, which order does the nurse anticipate? a. Add a potassium supplement to replace loss from output. b. Decrease the rate of intravenous fluids to 100 mL/hr. c. Administer a diuretic to prevent fluid volume excess. d. Discontinue the nasogastric suctioning.

Answer 31

a. Add a potassium supplement to replace loss from output.

Question 32

A nurse is caring for a patient who is receiving peripheral intravenous (IV) therapy. When the nurse is flushing the patient’s peripheral IV, the patient reports pain. Upon assessment, the nurse notices a red streak that is warm to the touch. What is the nurse’s initial action? a. Record a phlebitis grade of 4. b. Assign an infiltration grade. c. Apply moist compress. d. Discontinue the IV.

Answer 32

d. Discontinue the IV.

Question 33

A nurse is assisting the health care provider in inserting a central line. Which action indicates the nurse is following the recommended bundle protocol to reduce central line-associated bloodstream infections (CLABSI)? a. Preps skin with povidone-iodine solution. b. Suggests the femoral vein for insertion site. c. Applies double gloving without hand hygiene. d. Uses chlorhexidine skin antisepsis prior to insertion.

Answer 33

d. Uses chlorhexidine skin antisepsis prior to insertion.

Question 34

The nurse is caring for a group of patients. Which patient will the nurse see first? a. A patient with D5W hanging with the blood b. A patient with type A blood receiving type O blood c. A patient with intravenous potassium chloride that is diluted d. A patient with a right mastectomy and an intravenous site in the left arm

Answer 34

a. A patient with D5W hanging with the blood

Question 35

A nurse is administering a blood transfusion. Which assessment finding will the nurse report immediately? a. Blood pressure 110/60 b. Temperature 101.3° F c. Poor skin turgor and pallor d. Heart rate of 100 beats/min

Answer 35

b. Temperature 101.3° F

Question 36

A nurse has just received a bag of packed red blood cells (RBCs) for a patient. What is the longest time the nurse can let the blood infuse? a. 30 minutes b. 2 hours c. 4 hours d. 6 hours

Answer 36

c. 4 hours

Question 37

A patient has an acute intravascular hemolytic reaction to a blood transfusion. After discontinuing the blood transfusion, which is the nurse’s next action? a. Discontinue the IV catheter. b. Return the blood to the blood bank. c. Run normal saline through the existing tubing. d. Start normal saline at TKO rate using new tubing.

Answer 37

d. Start normal saline at TKO rate using new tubing.

Question 38

A nurse assessing a patient who is receiving a blood transfusion finds that the patient is anxiously fidgeting in bed. The patient is afebrile but dyspneic. The nurse auscultates crackles in both lung bases and sees jugular vein distention. On which transfusion complication will the nurse focus interventions? a. Fluid volume excess b. Hemolytic reaction c. Anaphylactic shock d. Septicemia

Answer 38

a. Fluid volume excess

Question 39

A nurse preparing to start a blood transfusion will use which type of tubing? a. Two-way valves to allow the patient’s blood to mix and warm the blood transfusing b. An injection port to mix additional electrolytes into the blood c. One with a filter to ensure that clots do not enter the patient d. An air vent to let bubbles into the blood

Answer 39

c. One with a filter to ensure that clots do not enter the patient

Question 40

The nurse is caring for a patient with hyperkalemia. Which body system assessment is the priority? a. Gastrointestinal b. Neurological c. Respiratory d. Cardiac

Answer 40

d. Cardiac

Question 41

Which assessment finding will the nurse expect for a patient with the following laboratory values: sodium 145 mEq/L, potassium 4.5 mEq/L, calcium 4.5 mg/dL? a. Weak quadriceps muscles b. Decreased deep tendon reflexes c. Light-headedness when standing up d. Tingling of extremities with possible tetany

Answer 41

d. Tingling of extremities with possible tetany

Question 42

While the nurse is taking a patient history, the nurse discovers the patient has a type of diabetes that results from a head injury and does not require insulin. Which dietary change should the nurse share with the patient? a. Reduce the quantity of carbohydrates ingested to lower blood sugar. b. Include a serving of dairy in each meal to elevate calcium levels. c. Drink plenty of fluids throughout the day to stay hydrated. d. Avoid foods high in acid to avoid metabolic acidosis.

Answer 42

c. Drink plenty of fluids throughout the day to stay hydrated.

Question 43

A nurse is selecting a site to insert an intravenous (IV) catheter on an adult. Which actions will the nurse take? (Select all that apply.) a. Check for contraindications to the extremity. b. Start proximally and move distally on the arm. c. Choose a vein with minimal curvature. d. Choose the patient’s dominant arm. e. Select a vein that is rigid. f. Avoid areas of flexion.

Answer 43

a. Check for contraindications to the extremity. c. Choose a vein with minimal curvature. f. Avoid areas of flexion.

Question 44

Which assessments will alert the nurse that a patient’s IV has infiltrated? (Select all that apply.) a. Edema of the extremity near the insertion site b. Reddish streak proximal to the insertion site c. Skin discolored or pale in appearance d. Pain and warmth at the insertion site e. Palpable venous cord f. Skin cool to the touch

Answer 44

a. Edema of the extremity near the insertion site c. Skin discolored or pale in appearance f. Skin cool to the touch

Question 45

A nurse is discontinuing a patient’s peripheral IV access. Which actions should the nurse take? (Select all that apply.) a. Wear sterile gloves and a mask. b. Stop the infusion before removing the IV catheter. c. Use scissors to remove the IV site dressing and tape. d. Apply firm pressure with sterile gauze during removal. e. Keep the catheter parallel to the skin while removing it. f. Apply pressure to the site for 2 to 3 minutes after removal.

Answer 45

b. Stop the infusion before removing the IV catheter. e. Keep the catheter parallel to the skin while removing it. f. Apply pressure to the site for 2 to 3 minutes after removal.

Question 46

A patient has 250 mL of a jejunostomy feeding with 30 mL of water before and after feeding and 200 mL of urine. Thirty minutes later the patient has 100 mL of diarrhea. At 1300 the patient receives 150 mL of blood and voids another 200 mL. Calculate the patient’s intake. Record your answer as a whole number. _____ mL

Answer 46

ANS: 460

Question 47

A nurse is monitoring patients for fluid and electrolyte and acid-base imbalances. Match the body’s regulators to the function it provides. a. Increases excretion of sodium and water. b. Reduces excretion of sodium and water. c. Reduces excretion of water. d. Major buffer in the extracellular fluid. e. Vasoconstricts and stimulates aldosterone release. 1. Antidiuretic hormone 2. Angiotensin II 3. Aldosterone 4. Atrial natriuretic peptide 5. Bicarbonate

Answer 47

1. C 2. E 3. B 4. A 5. D