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.
