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Med/Surg Exam 2 - Fluids, Electrolytes, ABG
1.pH 7.53, PaCO2 23, HCO3 23: Respiratory alkalosis
2.pH 7.20, PaCO2 38, HCO3 17: Metabolic acidosis
3.pH 7.48, PaCO2 42, HCO3 35: Metabolic alkalosis
4.pH 7.21, PaCO2 50, HCO3 29: Partially compensated respiratory acidosis
5.pH 7.50, PaCO2 47, HCO3 29: Partially Compensated Metabolic Alkalosis
6.pH 7.23, PaCO2 50, HCO3 30: Partially Compensated Respiratory acidosis
7.pH 7.45, paCo2 20, HCO3 20: Compensated Respiratory alkalosis
8.pH 7.23, paCo2 37, HCO3 18: Uncompensated Metabolic acidosis
9.pH 7.35, paCo2 34, HCO3 21: Compensated Metabolic acidosis
10.A patient has had diarrhea since Easter, which ABG do you expect?: pH 7.31,
PaCO2 35, HCO3 18
11.A patient has a COPD exacerbation due to Salt Lake City's lovely winter air, which
ABG is likely?: pH 7.28, PaCO2 52, HCO3 29
12.A patient presents to the ED with fatigue, diaphoresis and fruity breath, which
ABG is likely?: pH 7.31, PaCO2 42, HCO3 20
13.A patient with Cannabinoid Hyperemesis Syndrome has had nausea with vomiting
for 48 hours, which ABG is likely?: pH 7.48, PaCO2 45, HCO3 29
14.A patient is in renal failure and has not attended dialysis, which ABG is most
likely?: pH 7.31, PaCO2 35, HCO3 18
15.0.9% Normal Saline: Isotonic
16.Lactated Ringer's (LR): Isotonic
17.D5W (5% dextrose in water): isotonic
18.0.45% sodium chloride (1/2 NS): Hypotonic
19.0.225% sodium chloride (1/4 NS): Hypotonic
20.0.33% sodium chloride (1/3 NS): Hypotonic
21.3% sodium chloride (3% NS): Hypertonic
22.5% sodium chloride (5% NS): Hypertonic
23.Potassium normal value: 3.5-5.0 mEq/L
24.Sodium normal value: 135-145 mEq/L
25.Chloride normal value: 97-107 mEq/L
26.Calcium normal value: 8.6-10.2 mEq/L
27.Magnesium normal value: 1.5-2.5 mEq/L
28.A client with hypoparathyroidism complains of numbness and tingling in his
fingers and around the mouth. The nurse would assess for what electrolyte imbalance?: Hypocalcemia
29.The nurse evaluates which of the following clients to be at risk for devel- oping
hypernatremia?: 50-year-old with pneumonia, diaphoresis, and high fevers
30. A client is admitted with diabetic ketoacidosis who, with treatment, has a normal
blood glucose, pH, and serum osmolality. During assessment, the client complains of weakness in the legs. Which of the following is a priority nursing intervention?: Ensure the client is safe from falls and check the most recent potassium level
31.A client with a potassium level of 5.5 mEq/L is to receive sodium poly- styrene
sulfonate (Kayexalate) orally. After administering the drug, the priority nursing action is to monitor: bowel movements
32. The nurse is caring for a client who has been in good health up to the present
and is admitted with cellulitis of the hand. The client's serum potas- sium level was 4. mEq/L yesterday. Today the level is 7 mEq/L. Which of the following is the next appropriate nursing action?: Question the results and redraw the specimen
maintenance fluids. The urine output has been 120 ml every 8 hours for the past 16 hours and the next dose is due. Before administering the next potassium dose, which of the following is the priority nursing action?: Notify the physician of the urine output and hold the dose
41.The nurse should monitor for clinical manifestations of hypophosphatemia in which
of the following clients?: A client who is alcoholic receiving total par- enteral nutrition
42.A client admitted with squamous cell carcinoma of the lung has a serum calcium
level of 14 mg/dl. The nurse should instruct the client to avoid which of the following foods upon discharge?: Broccoli, Nuts, Canned Salmon
43.A client with pancreatitis has been receiving potassium supplementation for four
days since being admitted with a serum potassium of 3.0 mEq/L. Today the potassium level is 3.1 mEq/L. Which of the following laboratory values should the nurse check before notifying the physician of the client's failure to respond to treatment?: Magnesium
44.The nurse should include which of the following instructions to as- sist in
controlling phosphorus levels for a client in renal failure?: Take alu- minum-based antacids such as aluminum hydroxide (Amphojel) with or after meals
45.A client with pneumonia presents with the following arterial blood gases: pH of
7.28, PaCO2 of 74, HCO3 of 28 mEq/L, and PO2 of 45, which of the follow- ing is the most appropriate nursing intervention?: Place client in high-Fowler's position
46.A client with COPD feels short of breath after walking to the bathroom on 2 liters of
oxygen nasal cannula. The morning's ABGs were pH of 7.36, PaCO2 of 62, HCO3 of 35 mEq/L, O2 at 88% on 2 liters. Which of the following should be the nurse's first intervention?: Encourage the client to rest and to use pursed-lip breathing technique
47.A client who had a recent surgery has been vomiting and becomes dizzy while
standing up to go to the bathroom. After assisting the client back to bed, the nurse
notes that the blood pressure is 55/30 and the pulse is 140. The nurse hangs which of the following IV fluids to correct this condition?: 0.9 NS at an open rate
48.A client with renal failure enters the emergency room after skipping three dialysis
treatments to visit family out of town. Which set of ABGs would indicate to the nurse that the client is in a state of metabolic acidosis?: pH of 7.33, PCO2 of 35, HCO3 of 17
49.A client with a small bowel obstruction has had an NG tube connected to low
intermittent suction for two days. The nurse should monitor for clinical manifestations of which acid-base disorder?: Metabolic alkalosis
50.A client who suffers from an anxiety disorder is very upset, has a respi- ratory rate
of 32, and is complaining of lightheadedness and tingling in the fingers. ABG values are pH of 7.48, PaCO2 of 29, HCO3 of 24, and O2 is at 93% on room air. The nurse performs which of the following as a priority nursing intervention?: Provide reassurance to the client and administer sedatives
51.Which of the following assessment findings would indicate to the nurse that a
client's diabetic ketoacidosis is deteriorating?: Deep tendon reflexes decreasing from +2 to +
52.A client who is admitted with malnutrition and anorexia secondary to chemotherapy
is also exhibiting generalized edema. The client asks the nurse for an explanation for the edema. Which of the following is the most appropri- ate response by the nurse?: Poor nutrition has caused decreased blood protein levels, and fluid has moved from the blood vessels into the tissues.
53.A client with a recent thyroidectomy complains of numbness and tingling around
the mouth. Which of the following findings indicates the serum calcium is low?: Positive Chvostek's sign
54.A client who is post-gallbladder surgery has a nasogastric tube, decreased reflexes,
pulse of 110 weak and irregular, and blood pressure of 80/50 and is weak, mildly confused, and has a serum of potassium of 3.0 mEq/L. Based on the assessment data,
64.The client who has undergone an exploratory laparotomy and subsequent removal
of a large intestinal tumor has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the health care provider?: On auscultation, crackles and rales in all lung fields are noted.
65.The nurse writes the nursing problem of "fluid volume excess" (FVE). Which
intervention should be included in the plan of care?: Restrict the client's sodium in the diet.
66.The client is admitted with a serum sodium level of 110 mEq/L. Which nursing
intervention should be implemented?: Place on seizure precautions.
67.The telemetry monitor technician notifies the nurse of the morning teleme- try
readings. Which client should the nurse assess first?: The client in normal sinus rhythm with a peaked T wave.
68.The client post-thyroidectomy complains of numbness and tingling around the
mouth and the tips of the fingers. Which intervention should be implement- ed first?: Tap the cheek about two (2) centimeters anterior to the ear lobe.
69.Which statement best explains the scientific rationale for Kussmaul's
respirations in the client diagnosed with diabetic ketoacidosis (DKA)?: The lungs speed up to release carbon dioxide and increase the pH.
70.The client has been vomiting and has had numerous episodes of diarrhea. Which
laboratory test should the nurse monitor?: Serum potassium
71.A nurse is reading a physician's progress notes in the client's record and reads
that the physician has documented "insensible fluid loss of approxi- mately 800 mL daily." The nurse understands that this type of fluid loss can occur through:: The skin
72.A nurse is assigned to care for a group of clients. On review of the clients' medical
records, the nurse determines that which client is at risk for deficient fluid volume?: A client with a colostomy
73.A nurse caring for a client who has been receiving intravenous diuretics suspects
that the client is experiencing a deficient fluid volume. Which assess- ment finding would the nurse note in a client with this condition?: Decreased central venous pressure (CVP)
74.A nurse is assigned to care for a group of clients. On review of the clients' medical
records, the nurse determines that which client is at risk for excess fluid volume?: The client with renal failure
75.The nurse is caring for a client with congestive heart failure. On assess- ment, the
nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present?: An increase in blood pressure
76.A nurse is preparing to care for a client with a potassium deficit. The nurse reviews
the client's record and determines that the client was at risk for developing the potassium deficit because the client:: Requires nasogastric suction.
77.A nurse reviews a client's electrolyte laboratory report and notes that the
potassium level is 3.2 mEq/L. Which of the following would the nurse note on the electrocardiogram as a result of the laboratory value?: U waves
78.A nursing student needs to administer potassium chloride intravenously as
prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium?: Preparing the medication for bolus administration
79.A nurse instructs a client at risk for hypokalemia about the foods high in potassium
that should be included in the daily diet. The nurse determines that the client understands the food sources of potassium if the client states that the food item lowest in potassium is:: Apples
80.A nurse caring for a group of clients reviews the electrolyte laboratory results and
notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a potassium
91.SAIDH can cause: hyponatremia due to increased water reabsorption
92.Treatment of DKA can cause: hypokalemia because K+ moves into cells
93.Dietary sources of calcium: dairy and green leafy vegetables
94.How is Kayexalate excreted?: bowel movements
95.Manifestions of hyperkalemia: peaked T waves and widened QRS
96.Hypercalcemia interventions: fluid intake (encourages excretion of excess)
ROM exercise (reabsorbs back into bones)
97.hyponatremia S/S: Anorexia, N/V, Weakness, Lethargy, Confusion, Muscle
cramps, Twitching, Seizures
98.Sodium important for: nerve/muscle function, maintaining fluid balance, affects
brain and nervous system
99.Causes of hyponatremia: GI loss (suction, vomit, diarrhea), diuretics, skin
losses, SAIDH, edema, hyperglycemia
100. Causes of hypernatremia: Water deprivation, excess sodium intake,
kidney failure, Cushing's syndrome
101. Symptoms of hyponatremia: tachycardia, hypotension, confusion,
fatigue, n/v, headache
102. Symptoms of hypernatremia: tachycardia, muscle twitching/weakness,
GI upset, edema
103. Calcium important for: muscle/nerve function
104. Causes of hypocalcemia: diarrhea, vitamin D deficiency,
hypoparathyroidism
105. Causes of hypercalcemia: hyperparathyroidism, long-term steroid use,
bone cancer
106. Symptoms of hypocalcemia: positive Chvostek's and Trousseau's
signs, muscle spasms, numbness/tingling in lips/fingers, GI upset
107. Symptoms of hypercalcemia: constipation, decreased DTR's, kidney
stones, lethargy
108. Potassium important for: regulating heart/muscle contractions,
maintaining ICF
109. Causes of hypokalemia: GI losses, diuretics, skin losses, metabolic
alkalosis
110. Causes of hyperkalemia: Uncontrolled diabetes (DKA), metabolic
acidosis, salt substitutes, kidney failure
111. Symptoms of hypokalemia: Dysrhythmias/EKG changes, muscle weak-
ness/cramps, constipation/ileus, hypotension
112. Symptoms of hyperkalemia: Dysrhythmias, muscle weakness,
numb- ness/tingling, diarrhea, confusion
113. Magnesium is important for: nerve/muscle function
114. Causes of hypomagnesemia: GI losses, diuretics, malnutrition, alcohol
abuse
115. Causes of hypermagnesemia: Kidney disease, laxatives containing Mg
116. Symptoms of hypomagnesemia: Dysrhythmias, tachycardia,
hypertension, tremors, seizures, increased DTR's
117. Symptoms of hypermagnesemia: Hypotension, muscle weakness,
lethargy, respiratory and cardiac arrest
118. Chloride is important for: maintaining fluid balance, component of
digestive juices
119. Chloride normal range: 95-105 mEq/L
120. Causes of hypochloremia: Metabolic alkalosis, GI losses (vomit, NG
suction), CHF
121. Causes of hyperchloremia: Metabolic acidosis, dehydration, excess salt
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