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Adult Health Exam 1-Fluid & Electrolyte Balance, Acid-Base Balance, Care of the Older Adul, Exams of Nursing

Los Angeles Pierce CollegeNursing

Adult Health Exam 1-Fluid & Electrolyte Balance, Acid-Base Balance, Care of the Older Adult, Diabetes/Hypoglycemia, Ethical Reasoning, Skin Integrity & Burns, Acute Pain, & Perioperative Care Review Questions & Answers

Typology: Exams

2022/2023

Available from 08/15/2023

Peterr
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Adult Health Exam 1-Fluid & Electrolyte Balance, Acid-Base Balance, Care of the Older Adult,
Diabetes/Hypoglycemia, Ethical Reasoning, Skin Integrity & Burns, Acute Pain, & Perioperative Care
Review Questions & Answers
Fluid & Electrolyte Balance
1. You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your
patients most recent laboratory reports, you note that the patients magnesium levels are high. You should
prioritize assessment for which of the following health problems?
A. Diminished deep tendon reflexes
B. Tachycardia
C. Cool, clammy skin
D. Acute flank pain
Ans: A. To gauge a patients magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this
may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with
hypermagnesemia.
2. You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of
third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms
of what imbalance?
A. Metabolic alkalosis
B. Hypermagnesemia
C. Hypercalcemia
D. Hypovolemia
Ans: D. Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the
intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators of third-spacing
fluid shift. Burns typically cause acidosis, not alkalosis.
3. A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased
intracranial pressure. This solution will increase the number of dissolved particles in the patients blood, creating
pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best
described as which of the following?
A. Hydrostatic pressure
B. Osmosis and osmolality
C. Diffusion
D. Active transport
Ans: B. Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute
concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to
water pressure. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; the
solutes in an intact vascular system are unable to move so diffusion normally should not be taking place. Active
transport is the movement of molecules against the concentration gradient and requires adenosine triphosphate (ATP)
as an energy source; this process typically takes place at the cellular level and is not involved in vascular volume
changes.
4. You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a
thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She
tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone.
What electrolyte imbalance should you first suspect?
A. Hypophosphatemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyperkalemia
Ans: B. Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may
occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central
nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence.
Signs of hyperkalemia include paresthesias and anxiety.
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Download Adult Health Exam 1-Fluid & Electrolyte Balance, Acid-Base Balance, Care of the Older Adul and more Exams Nursing in PDF only on Docsity!

Adult Health Exam 1-Fluid & Electrolyte Balance, Acid-Base Balance, Care of the Older Adult,

Diabetes/Hypoglycemia, Ethical Reasoning, Skin Integrity & Burns, Acute Pain, & Perioperative Care

Review Questions & Answers

Fluid & Electrolyte Balance

  1. You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patients most recent laboratory reports, you note that the patients magnesium levels are high. You should prioritize assessment for which of the following health problems? A. Diminished deep tendon reflexes B. Tachycardia C. Cool, clammy skin D. Acute flank pain Ans: A. To gauge a patients magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with hypermagnesemia.
  2. You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance? A. Metabolic alkalosis B. Hypermagnesemia C. Hypercalcemia D. Hypovolemia Ans: D. Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators of third-spacing fluid shift. Burns typically cause acidosis, not alkalosis.
  3. A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patients blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? A. Hydrostatic pressure B. Osmosis and osmolality C. Diffusion D. Active transport Ans: B. Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to water pressure. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; the solutes in an intact vascular system are unable to move so diffusion normally should not be taking place. Active transport is the movement of molecules against the concentration gradient and requires adenosine triphosphate (ATP) as an energy source; this process typically takes place at the cellular level and is not involved in vascular volume changes.
  4. You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should you first suspect? A. Hypophosphatemia B. Hypocalcemia C. Hypermagnesemia D. Hyperkalemia Ans: B. Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence. Signs of hyperkalemia include paresthesias and anxiety.
  1. You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. During your assessment, you note the patient complains of a new onset of weakness with abdominal pain. Further assessment suggests that the patient likely has a fluid volume deficit. You should recognize that this patient may be experiencing what electrolyte imbalance? A. Hypernatremia B. Hypomagnesemia C. Hypophosphatemia D. Hypercalcemia Ans: D. The most common causes of hypercalcemia are malignancies and hyperparathyroidism. Anorexia, nausea, vomiting, and constipation are common symptoms of hypercalcemia. Dehydration occurs with nausea, vomiting, anorexia, and calcium reabsorption at the proximal renal tubule. Abdominal and bone pain may also be present. Primary manifestations of hypernatremia are neurologic and would not include abdominal pain and dehydration. Tetany is the most characteristic manifestation of hypomagnesemia, and this scenario does not mention tetany. The patients presentation is inconsistent with hypophosphatemia.
  2. You are called to your patients room by a family member who voices concern about the patients status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patients signs and symptoms? A. Hypocalcemia B. Hyponatremia C. Hyperchloremia D. Hypophosphatemia Ans: C. The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive ability; and hypertension occur. If untreated, hyperchloremia can lead to a decrease in cardiac output, dysrhythmias, and coma. A high chloride level is accompanied by a high sodium level and fluid retention. With hypocalcemia, you would expect tetany. There would not be edema with hyponatremia. Signs or symptoms of hypophosphatemia are mainly neurologic.
  3. The nurse is assessing the patient for the presence of a Chvosteks sign. What electrolyte imbalance would a positive Chvosteks sign indicate? A. Hypermagnesemia B. Hyponatremia C. Hypocalcemia D. Hyperkalemia Ans: C. You can induce Chvosteks sign by tapping the patients facial nerve adjacent to the ear. A brief contraction of the upper lip, nose, or side of the face indicates Chvosteks sign. Both hypomagnesemia and hypocalcemia may be tested using the Chvosteks sign.
  4. The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? A. Weight loss and dry skin B. Flat neck and hand veins and decreased urinary output C. An increase in blood pressure and increased respirations D. Weakness and decreased central venous pressure (CVP) Ans: C. A fluid volume excess is also known as overhydration or fluid overload and occurs when fluid intake or fluid retention exceeds the fluid needs of the body. Assessment findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit. Dry skin, flat neck and hand veins, decreased urinary output, and decreased CVP are noted in fluid volume deficit. Weakness can be present in either fluid volume excess or deficit.
  1. The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client is at risk for developing the potassium deficit because of which situation? A. Sustained tissue damage B. Requires nasogastric suction C. Has a history of Addison's disease D. A high uric acid level Ans: B. The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client with hyperuricemia are at risk for hyperkalemia. The normal uric acid level for a female is 2.7 to 7.3 mg/dL (16 to 0.43 mmol/L) and for a male is 4.0 to 8.5 mg/dL (0.24 to 0.51 mmol/L). Hyperuricemia is a cause of hyperkalemia.
  2. The nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 2.5 mEq/L (2. mmol/L). Which patterns should the nurse watch for on the electrocardiogram (ECG) as a result of the laboratory value? Select all that apply. A. U waves B. Absent P waves C. Inverted T waves D. Depressed ST segment E. Widened QRS complex Ans: A, C, E. The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level lower than 3.5 mEq/L (3.5 mmol/L) indicates hypokalemia. Potassium deficit is an electrolyte imbalance that can be potentially life-threatening. Electrocardiographic changes include shallow, flat, or inverted T waves; ST segment depression; and prominent U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client with atrial fibrillation, junctional rhythms, or ventricular rhythms. A widened QRS complex may be noted in hyperkalemia and in hypermagnesemia.
  3. The nurse provides instructions to a client with a low potassium level about the foods that are high in potassium and tells the client to consume which foods? Select all that apply. A. Peas B. Raisins C. Potatoes D. Cantaloupe E. Strawberries Ans: B,C, D, E. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Common food sources of potassium include avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes. Peas and cauliflower are high in magnesium.
  4. The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? A. Twitching B. Hypoactive bowel sounds C. Negative Trousseau’s sign D. Hypoactive deep tendon reflexes Ans: A. The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A serum calcium level lower than 9 mg/dL (2.25 mmol/L) indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.
  1. The nurse reviews a client's laboratory report and notes that the client's serum phosphorus (phosphate) level is 1.8 mg/dL (0.45 mmol/L). Which condition most likely caused this serum phosphorus level? A. Malnutrition B. Renal insufficiency C. Hypoparathyroidism D. Tumor lysis syndrome Ans: A. The normal serum phosphorus (phosphate) level is 3.0 to 4.5 mg/dL (0.97 to 1.45 mmol/L). The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide–based or magnesium-based antacids. Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia.
  2. The nurse is reading a health care provider's (HCP's) progress notes in the client's record and reads that the HCP has documented "insensible fluid loss of approximately 800 mL daily." The nurse makes a notation that insensible fluid loss occurs through which type of excretion? A. Urinary output B. Wound drainage C. Integumentary output D. GI tract Ans: C. Insensible losses may occur without the person's awareness. Insensible losses occur daily through the skin and the lungs. Sensible losses are those of which the person is aware, such as through urination, wound drainage, and gastrointestinal tract losses.
  3. The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit? A. A client with an ileostomy B. A client with heart failure C. A client on long-term corticosteroid therapy D. A client receiving frequent wound irrigations Ans: A. A fluid volume deficit occurs when the fluid intake is not sufficient to meet the fluid needs of the body. Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy. A client with heart failure or on long-term corticosteroid therapy or a client receiving frequent wound irrigations is most at risk for fluid volume excess.
  4. The nurse caring for a client who has been receiving intravenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition? A. Weight loss and poor skin turgor B. Lung congestion and increased heart rate C. Decreased hematocrit and increased urine output D. Increased respirations and increased blood pressure Ans: A. A fluid volume deficit occurs when the fluid intake is not sufficient to meet the fluid needs of the body. Assessment findings in a client with a fluid volume deficit include increased respirations and heart rate, decreased central venous pressure (CVP) (normal CVP is between 4 and 11 cm H 2 O), weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, increased hematocrit, and altered level of consciousness. Lung congestion, increased urinary output, and increased blood pressure are all associated with fluid volume excess.
  1. Which client is at risk for the development of a potassium level of 5.5 mEq/L (5.5 mmol/L)? A. The client with colitis B. The client with Cushing's syndrome C. The client who has been overusing laxatives D. The client who has sustained a traumatic burn Ans: D. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level higher than 5. mEq/L (5.0 mmol/L) indicates hyperkalemia. Clients who experience cellular shifting of potassium in the early stages of massive cell destruction, such as with trauma, burns, sepsis, or metabolic or respiratory acidosis, are at risk for hyperkalemia. The client with Cushing's syndrome or colitis and the client who has been overusing laxatives are at risk for hypokalemia.
  2. The nurse is performing an assessment on a client admitted to the hospital with a diagnosis of dehydration. Which assessment finding should the nurse expect to note? A. Bradycardia B. Elevated blood pressure C. Change in mental status D. Bilateral crackles in the lungs Ans: C. A client with dehydration is likely to be lethargic or complain of a headache. The client would also exhibit weight loss, sunken eyes, poor skin turgor, flat neck and peripheral veins, tachycardia, and a low blood pressure. The client who is dehydrated would not have bilateral crackles in the lungs because these are signs of fluid overload and an unrelated finding of dehydration.
  3. The nurse is caring for a client with a diagnosis of dehydration, and the client is receiving intravenous (IV) fluids. Which assessment finding would indicate to the nurse that the dehydration remains unresolved? A. An oral temperature of 98.8°F (37.1°C) B. A urine specific gravity of

C. A urine output that is pale yellow D. A blood pressure of 120/80 mm Hg Ans: B. The client who is dehydrated will have a urine specific gravity greater than 1.030. Normal values for urine specific gravity are 1.005 to 1.030. A temperature of 98.8°F (37.1°C) is only 0.2 point above the normal temperature and would not be as specific an indicator of hydration status as the urine specific gravity. Pale yellow urine is a normal finding. A blood pressure of 120/80 mm Hg is within normal range.

  1. The nurse is caring for a client with a diagnosis of severe dehydration. The client has been receiving intravenous (IV) fluids and nasogastric (NG) tube feedings. The nurse monitors fluid balance using which as the best indicator? A. Daily weight B. Urinary output C. IV fluid intake D. NG tube intake Ans: A. Daily weight is the best indicator of fluid balance.
  2. The nurse is updating the client's plan of care based on the new onset of hypokalemia. Which priorities of care should the nurse include? Select all that apply. A. Ensure adequate oxygenation B. Provide assistance to prevent falls. C. Monitor medication administration of diuretics. D. Monitor for numbness and tingling around the mouth. E. Prevent complications during potassium administration Ans: A,B,C,E. The priorities for nursing care of a client with hypokalemia are ensuring adequate oxygenation, client safety for fall prevention and potassium administration, and monitoring for complications related to diuretic therapy and client
  1. The nurse is caring for a client who needs a hypertonic intravenous (IV) solution. What solutions are hypertonic? Select all that apply. A. 10% dextrose in water B. 0.45% sodium chloride C. 5% dextrose in 0.9% saline D. 5% dextrose in 0.45% saline E. 5% dextrose in 0.225% saline F. 5% dextrose in lactated Ringer's solution Ans: A,C,D,F. Hypertonic fluids include 10% dextrose in water, 5% dextrose in 0.9% saline, 5% dextrose in 0.45% saline, and 5% dextrose in lactated Ringer's solution. The solutions of 0.45% sodium chloride and 5% dextrose in 0.225% saline are not hypertonic solutions.
  2. The nurse is reviewing a client's laboratory report and notes that the total serum calcium level is 6.0 mg/dL (1.66 mmol/L). The nurse understands that which condition most likely caused this serum calcium level? A. Prolonged bed rest B. Renal insufficiency C. Hyperparathyroidism D. Excessive ingestion of vitamin D Ans: A. The normal serum calcium level is 9.0 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A client with a serum calcium level of 6.0 mg/dL (1.66 mmol/L) is experiencing hypocalcemia. Prolonged bed rest is a cause of hypocalcemia. Although immobilization initially can cause hypercalcemia, the long-term effect of prolonged bed rest is hypocalcemia. End-stage renal disease, rather than renal insufficiency, is a cause of hypocalcemia. Hyperparathyroidism and excessive ingestion of vitamin D are causative factors associated with hypercalcemia.
  3. The nurse who is caring for a client with severe malnutrition reviews the laboratory results and notes that the client has a magnesium level of 1.0 mEq/L (0.5 mmol/L). Which electrocardiographic change should the nurse expect to observe based on the client's magnesium level? A. Prominent U waves B. Prolonged PR interval C. Depressed ST segment D. Widened QRS complexes Ans: C. The normal serum magnesium level is 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L). A magnesium level of 1.0 mEq/L (0.5 mmol/L) indicates hypomagnesemia. In hypomagnesemia, tall T waves and a depressed ST segment would be observed. Options 2 and 4 would be noted in a client experiencing hypermagnesemia. Prominent U waves occur with hypokalemia.
  4. During an assessment of a newly admitted client, the nurse notes that the client's heart rate is 110 beats/minute, his blood pressure shows orthostatic changes when he stands up, and his tongue has a sticky, paste-like coating. The client's spouse tells the nurse that he seems a little confused and unsteady on his feet. Based on these assessment findings, the nurse suspects that the client has which condition? A. Dehydration B. Hypokalemia C. Fluid overload D. Hypernatremia Ans: A. When a client is dehydrated, the heart rate increases in an attempt to maintain blood pressure. Blood pressure reflects orthostatic changes caused by the reduced blood volume, and when the client stands, he may experience dizziness because of insufficient blood flow to the brain. Alterations in mental status also may occur. The oral mucous membranes, usually moist, are dry and may be covered with a thick, pasty coating. These findings are not manifestations of the conditions noted in the other options
  1. The nurse is creating a plan of care for a client with hypokalemia. Which interventions should be included in the plan of care? Select all that apply. A. Ensure adequate fluid intake. B. Implement safety measures to prevent falls. C. Encourage low-fiber foods to prevent diarrhea. D. Instruct the client about foods that contain potassium. E. Encourage the client to obtain assistance to ambulate. Ans: A,B,D,E. Clients with hypokalemia will need instruction on potassium-rich foods, and all clients should maintain adequate hydration, Safety is also a priority because hypokalemia may cause muscle weakness, resulting in falls and injury. Hypokalemia is associated with constipation, not diarrhea, owing to decreased peristalsis.
  2. The nurse is monitoring a client who is attached to a cardiac monitor and notes the presence of prominent U waves. The nurse assesses the client and checks his or her most recent electrolyte results. The nurse expects to note which electrolyte value? A. Sodium 135 mEq/L (135 mmol/L) B. Sodium 140 mEq/L (140 mmol/L) C. Potassium 3.0 mEq/L (3.0 mmol/L) D. Potassium 5.0 mEq/L (5.0 mmol/L) Ans; C. The normal sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). The normal potassium level is 3.5 to 5. mEq/L (3.5 to 5.0 mmol/L). A serum potassium level lower than 3.5 mEq/L (3.5 mmol/L) is indicative of hypokalemia. In hypokalemia, the electrocardiographic (ECG) changes that occur include inverted T waves, ST segment depression, heart block, and prominent U waves.
  3. The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which cardiovascular manifestation would the nurse expect to note? A. Hypotension B. Increased heart rate C. Bounding peripheral pulses D. Shortened QT interval on electrocardiography (ECG) Ans: A. Cardiovascular manifestations that occur with hypocalcemia include decreased heart rate, diminished peripheral pulses, and hypotension. On the ECG, the nurse would note a prolonged ST interval and a prolonged QT interval.
  4. The nurse notes that a client's total serum calcium level is 6.0 mg/dL (1.5 mmol/L). Which assessment findings should be anticipated in this client? Select all that apply. A. Tetany B. Constipation C. Renal calculi D. Hypotension E. Prolonged QT interval F. Positive Chvostek's sign Ans: A.D.E.F. The normal total serum calcium level is 9.0 to 10.5 mg/dL (2.25 to 2.75 mmol/L); thus, the client's results are reflective of hypocalcemia. The most common manifestations of hypocalcemia are caused by overstimulation of the nerves and muscles; therefore, tetany and presence of Chvostek's sign would be expected. Calcium is needed by the heart for contraction. When the serum calcium level is decreased, cardiac contractility is decreased and the client will experience hypotension. A low serum calcium level could also lead to severe ventricular dysrhythmias and prolonged QT and ST intervals on the electrocardiogram.
  1. A patient has a sodium level of 123 and presents with confusion. The doctor diagnoses the patient with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Which type of hyponatremia is this? A. Hypovolemic B. Euvolemic C. Hypervolemic D. Antivolemic
  2. A patient with a sodium level of 178 is ordered to be started on 0.45% Saline. What is the most IMPORTANT nursing intervention for this patient? A. Maintain patent IV B. Give rapidly to ensure fluids levels are shifted properly C. Clarify doctor’s order because 0.45% saline is contraindicated in hypernatremia D. Give slowly and watch for signs and symptoms of cerebral edema Ans: D: Give slowly and watch for signs and symptoms of cerebral edema. The most important intervention is to give slowly and watch for S&S of cerebral edema because a hypotonic solution can cause rapid swelling of the cell. Maintain a patent IV is correct but not the most important option in this scenario.
  3. Which patient below is considered hypernatremic? A. A patient with a sodium level of 155 B. A patient with a sodium level of 145 C. A patient with a sodium level of 120 D. A patient with a sodium level of 136
  4. A patient with hypovolemic hyponatremia is started on IV fluids. Which of the following fluids do you expect the patient to be started on? A. 0.45% Saline B. 3% Saline C. D5W D. 0.33% Saline Ans: B: 3% Saline Patients with hypovolemic hyponatremia are started on a hypertonic solution (the circulatory system is dehydrated & and the cells are swollen…so a hypertonic solution will shrink the cells and increase fluid volume) and 3% Saline is the only hypertonic solutions. The other options are either hypotonic or isotonic.
  5. A patient has a sodium level of 119. Which of the following is NOT related to this finding? A. Over secretion of ADH (antidiuretic hormone) B. Low salt diet C. Inadequate water intake D. Hypotonic fluid infusion (overload)
  6. Which patient below is at risk for experiencing Hypovolemic Hyponatremia? A. Patient with congestive heart failure B. Patient with cirrhosis of the liver C. Patient on IV saline at 250 cc/hr D. Patient with nasogastric tube suction experiencing diarrhea
  7. Which of the following is not a cause of hypocalcemia? A. Low parathyroid hormone B. Crohn’s Disease C. Acute Pancreatitis D. Thiazide Diuretics
  1. Stimulation of the facial nerve via the masseter muscle causes twitching of the nose/lips in hypocalcemia is known as? A. Trousseau’s Sign B. Chvostek’s Sign C. Homan’s Sign D. Goodell’s Sign
  2. A patient has a calcium level of 7.2. What sign below is indicative of this lab value? A. None this is a normal calcium level B. Prolonged QT interval on the EKG C. Hypoactive bowel sounds D. Shortened ST segment
  3. A patient’s lab work shows that they have a high parathyroid hormone level. Which of the following conditions is the patient at risk for? A. Hypercalcemia B. Hypocalcemia C. Hypokalemia D. Hyperkalemia
  4. An EKG shows a shortened QT interval. Which of the following lab values would be indicative of this change? A. Calcium level of 8. B. Calcium level of 12. C. Calcium level of 8. D. Calcium level of 9.
  5. A patient has a calcium level of 12.5. Which medication will most likely be ordered for this patient? A. Calcitonin B. 10% Calcium Gluconate C. Calcium Chloride D. Hydrochlorothiazide
  6. Which of the following is not a hypertonic fluid? A. 3% Saline B. D5W C. 10% Dextrose in Water (D10W) D. 5% Dextrose in Lactated Ringer’s
  7. What type of fluid would a patient with severe hyponatremia most likely be started on? A. Hypotonic B. Hypertonic C. Isotonic D. Colloid
  8. When administering a hypertonic solution the nurse should closely watch for? A. Signs of dehydration B. Pulmonary Edema C. Fluid volume deficient D. Increased Lactate level
  1. Which of the following is not a symptom of hyperkalemia? A. Positive Chvostek’s sign B. Decreased blood pressure C. Muscle twitches/cramps D. Weak and slow heart rate
  2. Tall peaked T waves, flat P waves, prolonged PR intervals and widened QRS complexes can present in which of the following conditions? A. Hypocalemia B. Hypokalemia C. Hypercalemia D. Hyperkalemia
  3. Which of the following is indicative of an EKG change in a case of hypokalemia? A. Tall T waves and depressed ST segment B. Prolonged ST interval and Widened T wave C. ST depression and inverted T wave D. Widened QRS complex and prolonged PR interval
  4. On morning assessment of your patient who has severe burns. You notice that fluid is starting to accumulate in his abdominal tissue. You note that his weight has not changed and his intake and output is equal. What do you suspect? A. Third spacing B. This is normal and expected after a burn and it is benign C. Document this finding as non-pitting abdominal edema. D. Intravascular compartment syndrome Ans: A. You would suspect third spacing. Third-spacing is the accumulation of trapped extracellular fluid in a body space as a result in this case of a burn. Third spacing can occur in body spaces such as the pericardial, pleural, peritoneal, and joint cavities, bowel, and abdomen after a trauma or burn. It is normal not to see a change in weight or abnormal intake or output values.
  5. A patient is admitted to the ER with the following findings: heart rate of 110 (thready upon palpation), 80/ blood pressure, 25 ml/hr urinary output, and Sodium level of 160. What interventions do you expect the medical doctor to order for this patient? A. Restrict fluid intake and monitor daily weights B. Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output C. Administer hypotonic IV fluid and administer sodium tablets. D. No interventions are expected Ans: B. The patient must be re-hyrdated and the sodium levels should be decreased at the same time. So a hypertonic solution of 5% dextrose and 0.45% NA will help do this. The solution is hypertonic because of the 5% Dextrose which will rapidly metabolize to the cells. When the dextrose metabolizes to the cells it leaves behind 0.9% NA which acts as a isotonic solution. This allows the 0.45% NA to act as a hypotonic solution to repair the vascular compartment. After these fluids are infused the patient’s NA level should decrease, BP increase, HR return to normal etc. It is a complicated physiological process because the Dextrose has unique capabilities when it is metabolized….although the solution is labeled as hypertonic it becomes a hypotonic solution when the Dextrose is metabolized by the cells.
    1. After obtaining an EKG on a patient you notice that ST depression is present along with an inverted T wave and prominent U wave. What lab value would be the cause of this finding? A. Magnesium level of 2. B. Potassium level of 5.6 C. Potassium level of

D. Phosphorus level of 2.

Ans: C. Hypokalemia (normal potassium levels are 3.5 to 5.1) will present with these type of EKG findings.

  1. You are taking a patient’s blood pressure manually. As you pump up the cuff above the systolic pressure for a few minutes you notice that the patient develop a carpal spasm. Which of the following is true? A. The patient is having a normal nervous response to an inflating blood pressure cuff that is inflated above the systolic pressure B. This is known as Trousseau’s Sign and is present in patients with hypercalcemia C. This is known as Chvostek’s Sign D. This is known as Trousseau’s Sign and is present in patients with hypocalcemia Ans: D. The correct answer is “this is known as Trousseau’s Sign and is present in patients with hypocalcemia”. Patient’s with hypokalemia may present with a positive Trousseau’s and Chvostek sign.
  2. The nurse is caring for a patient with suspected fluid volume excess. On assessment, the nurse notes that the patient has pedal edema, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note: A. Weight loss and dry skin B. Flat neck veins and decreased urine output C. An increased BP and increased respirations D. Weakness and decreased CVP
  3. When reviewing morning lab results, the nurse notes that the patient’s potassium level is 6.2 mEq/L. Which EKG changes would the nurse look for on the cardiac monitor? Select all that apply. A. Wide, flat P wave B. Prominent U wave C. Tall peaked T waves D. Prolonged ST segment E. Widened QRS
  4. The nurse is assessing a patient with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note? A. Hypoactive bowel sounds B. Twitching C. Negative Trousseau’s sign D. Hypoactive deep tendon reflexes
  5. The nurse is caring for a post-op patient with suspected fluid volume deficit. The patient’s BP is 86/48. The nurse anticipates that the physician will order which of the following IV solutions for fluid volume replacement? Select all that apply. A. 0.9% NaCl (NS) B. 3% NaCl C. D 5 W D. Lactated Ringer solution (LR) Acid-Base Balance
  6. A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Increased PaCO D. CNS disturbances

3 occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations.

  1. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? A. A decreased pH and an increased PaCO 2 B. An increased pH and a decreased PaCO 2 C. A decreased pH and a decreased HCO 3 D. An increased pH and an increased HCO 3 Ans: D. Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO –^ to increase. Symptoms experienced by the client would include hypoventilation and tachycardia. Option 1 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition, and option 3 reflects a metabolic acidotic condition.
  2. The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. A. Respirations that are shallow B. Respirations that are increased in rate C. Respirations that are abnormally slow D. Respirations that are abnormally deep E. Respirations that cease for several seconds Ans: B, D. Kussmaul's respirations are abnormally deep and increased in rate. These occur as a result of the compensatory action by the lungs. In bradypnea, respirations are regular but abnormally slow. Apnea is described as respirations that cease for several seconds.
  3. The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco 2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply. A. Nausea B. Confusion C. Bradypnea D. Tachycardia E. Hyperkalemia F. Lightheadedness Ans: A, B, D, F. Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation 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 respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs. Bradypnea describes respirations that are regular but abnormally slow. Hyperkalemia is associated with acidosis.
  4. The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco 2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? A. Sodium level of 145 mEq/L (145 mmol/L) B. Potassium level of 3.0 mEq/L (3.0 mmol/L) C. Magnesium level of 1.3 mEq/L (0.65 mmol/L)

D. Phosphorus level of 3.0 mg/dL (0.97 mmol/L) Ans: B. Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation 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 respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. All three incorrect options identify normal laboratory values. The correct option identifies the presence of hypokalemia.

  1. The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid- base imbalance? A. Respiratory acidosis from inadequate ventilation B. Respiratory alkalosis from anxiety and hyperventilation C. Metabolic acidosis from calcium loss due to broken bones D. Metabolic alkalosis from taking analgesics containing base products Ans: A. Respiratory acidosis is most often caused by hypoventilation. The client with broken ribs will have difficulty with breathing adequately and is at risk for hypoventilation and resultant respiratory acidosis. The remaining options are incorrect. Respiratory alkalosis is associated with hyperventilation. There are no data in the question that indicate calcium loss or that the client is taking analgesics containing base products.
  2. A client with a history of lung disease is at risk for developing respiratory acidosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder? A. Bradycardia and hyperactivity B. Decreased respiratory rate and depth C. Headache, restlessness, and confusion D. Bradypnea, dizziness, and paresthesias Ans: C. When a client is experiencing respiratory acidosis, the respiratory rate and depth increase in an attempt to compensate. The client also experiences headache; restlessness; mental status changes, such as drowsiness and confusion; visual disturbances; diaphoresis; cyanosis as the hypoxia becomes more acute; hyperkalemia; rapid, irregular pulse; and dysrhythmias.
  3. A client's blood gas results reveal acidosis. What are some signs and symptoms the nurse would expect to see? Select all that apply. A. Seizures B. Lethargy C. Headache D. Weakness E. Confusion F. Hyperactivity Ans: B,C,D, E. In both respiratory and metabolic acidosis, the central nervous system (CNS) is depressed. Headache, lethargy, weakness, and confusion develop, leading eventually to coma and death. Therefore, seizures and hyperactivity would not be noted.
  4. The nurse is caring for a client whose arterial blood gas results reveal alkalosis. What client reactions would the nurse expect to see? Select all that apply. A. Tetany B. Lethargy C. Tingling D. Confusion E. Numbness F. Restlessness