Question 1

During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?

Accepted Answer

When cells are placed in a hypotonic solution, which has a lower effective osmolality than the ICF, they swell as water moves into the cell, and when they are placed in a hypertonic solution, which has a greater effective osmolality than the ICF, they shrink as water is pulled out of the cell.

Question 2

A 34-year-old male client has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The client's family is questioning the care team as to why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide the family?

Accepted Answer

Ascites is characterized by an accumulation of fluid in the transcellular component of the ECF, not ICF. The fluid is not categorized as belonging to the plasma component of the ECF.

Question 3

Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply.

Accepted Answer

Right-sided heart failure, burns, and low levels of plasma proteins are all associated with the development of edema. Diabetes and GI bleeds are not identified as contributors to edema.

Question 4

Recognizing the prevalence and incidence of dehydration among older adults, a care aide at a long-term care facility is in the habit of encouraging residents to drink even though they may not feel thirsty at the time. Which of the following facts underlies the care aide's advice?

Accepted Answer

The elderly are prone to hypodipsia even when osmolality and serum sodium levels are elevated, a fact that is compounded by sensory and/or neurological deficits. Hypodipsia in the elderly is not related to differing metabolic needs, ineffective kidney function, or compromise of the RAAS.

Question 5

The nurse is providing teaching to a student nurse about how antidiuretic hormone (ADH) plays a central role in the reabsorption of water by the kidneys. The nursing student is correct to place the following components of the homeostatic action of ADH in the correct sequence. Use all the options.

Accepted Answer

ADH is produced in the hypothalamus, sequestered in the pituitary, and is released in response to increased serum osmolality. Its influence on tubular cells is exerted by way of the insertion of aquaporins in the tubular membrane.

Question 6

A patient arrives in the ED very hypovolemic related to excretion of "at least 3 gallon jugs of urine in the past 24 hours." He describes the urine as being clear-like water. The physician suspects diabetes insipidus. The nurse should be prepared to administer which of the following medications?

Accepted Answer

Diabetes insipidus is caused by a deficiency of or a decreased response to ADH. The preferred drug for treating chronic DI is desmopressin acetate (DDAVP).

Question 7

A patient has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit, the nurse will be assessing the patient for syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessments would alert the clinic nurse that the patient may be developing this complication?

Accepted Answer

SIADH manifests as a dilutional hyponatremia. Decrease urine output, absence of edema, and headaches are signs of this. Answer choice B relates to s/s of diabetes insipidus; answer choice C is indicative of common flu s/s; answer choice D is relates to s/s of hypocalcemia.

Question 8

A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?

Accepted Answer

This woman is at risk of isotonic fluid volume deficit and sodium imbalances as a result of her diarrhea. She is not likely to develop fluid volume excess or third spacing as consequences of diarrhea.

Question 9

You are volunteering in the medical tent of a road race on a hot, humid day. A runner who has collapsed on the road is brought in with the following symptoms: sunken eyes, a body temperature of 100°F, and a complaint of dizziness while sitting to have his blood pressure taken (which subsides upon his lying down). These are signs of a fluid volume deficit. Which of the following treatments should be carried out first?

Accepted Answer

Fluid volume deficit results in postural hypotension (dizziness while upright) due to decreased blood volume. Sunken eyes and elevated temperature also point to a fluid volume deficit. The most important action to take is to replace fluid; however, pure water would be a mistake, since without accompanying electrolytes such as sodium, hyponatremia (water retention and a decrease in serum osmolality) could result. Thus, an oral electrolyte solution is recommended; in more severe cases, an IV would be appropriate.

Question 10

A client is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. What is the client's most likely diagnosis?

Accepted Answer

Peripheral and pulmonary edema as well as a bounding pulse and dyspnea are indicators of fluid volume overload.

Question 11

A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Given this diagnosis, what clinical manifestations and lab results should the nurse anticipate the patient will exhibit?

Accepted Answer

Weakness, lethargy, and nausea are noted manifestations of hyponatremia. High urine specific gravity, tachycardia, and a weak, thread pulse are associated with hypernatremia, while low blood pressure, fever, and increased urine osmolality are manifestations of fluid volume deficit. Increased hematocrit and blood urea nitrogen and seizures are also associated with hypernatremia.

Question 12

An ECG technician is performing an ECG on a hospital patient who has developed hypokalemia secondary to diuretic use. Which of the following manifestations of the client's health problem will the technician anticipate on the ECG?

Accepted Answer

ECG changes associated with hypokalemia include a prominent U wave and a flattening of the T wave. Atrial fibrillation, a low P wave, and the absence of a U wave are not associated with hypokalemia.

Question 13

A nurse in a medical unit has noted that a client's potassium level is elevated at 6.1 mEq/L. The nurse has notified the physician, removed the banana from the client's lunch tray, and is performing a focused assessment. When questioned by the client for the rationale for these actions, which of the following explanations is most appropriate?

Accepted Answer

Paresthesia and muscle weakness are manifestations of hyperkalemia. Tachycardia and dysrhythmias are more commonly associated with hypokalemia, and the greatest risks associated with potassium imbalances are cardiac rather than neurological.Hyperkalemia is not normally resolved by correction using IV fluid.

Question 14

A renal failure patient with severe hyperkalemia (K⁺level 7.2 mEq/L) has just been admitted to the nursing unit. Given the severity of this situation, the nurse should be prepared to administer which intravenous infusion stat?

Accepted Answer

The administration of sodium bicarbonate, F1F1F1S1?F1F1F10-adrenergic agonists, or insulin distributes potassium into the ICF compartment and rapidly decreases the ECF concentration.Lactated Ringer solution, steroids, or narcotics will not help to lower potassium levels.

Question 15

Vitamin D is integral to the regulation of calcium and phosphate levels. Put the following steps in the action of vitamin D into the correct sequence. Use all the options.

Accepted Answer

Vitamin D is either synthesized in the skin by ultraviolet exposure or obtained from the intestines following ingestion. It is then concentrated in the liver and transported to the kidneys

Question 16

A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well. What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy?

Accepted Answer

Hyperparathyroidism, in which parathyroid hormone is secreted in excess, may be caused by a parathyroid adenoma. Since parathyroid hormone mobilizes calcium from bone and promotes its transfer to the extracellular fluid, excess calcium is excreted in the urine (promoting the development of kidney stones) and is evident in the plasma. In primary hyperparathyroidism, antibody binding assays of intact PTH would reveal either normal or elevated parathyroid hormone in the face of hypercalcemia, whereas in hypercalcemia of malignancy, levels of intact PTH are suppressed.

Question 17

An 81-year-old female has a long-standing diagnosis of hypocalcemia secondary to kidney disease. She will be moving into an assisted living facility shortly. Which of the following clinical manifestations would the nursing staff at the facility likely observe in this patient?

Accepted Answer

Muscular spasms and cramping are common manifestations of low serum calcium. Polydipsia, polyuria, anorexia, lethargy, and stupor are associated with hypercalcemia.

Question 18

A terminally ill cancer patient with metastasis to the bone has been admitted with elevated calcium levels (hypercalcemic crisis). The patient is very lethargic and exhibiting muscle flaccidity. The nurse should be prepared to administer (Select all that apply.)

Accepted Answer

The bisphosphonates (e.g.,pamidronate, zoledronate), which act mainly by inhibiting osteoclastic activity, provide a significant reduction in calcium levels with relatively few side effects. Calcitonin also inhibits osteoclastic activity. Gallium nitrate is highly effective in the treatment of severe hypercalcemia associated with malignancy.Prednisone, a corticosteroid, inhibits bone resorption.

Question 19

A 56-year-old female hospital patient with a history of alcohol abuse is receiving intravenous (IV) phosphate replacement. Which of the following health problems will this IV therapy most likely resolve?

Accepted Answer

Phosphate is necessary for the normal function of platelets and the excretion of hydrogen ions that contribute to acidosis. Phosphate replacement would be unlikely to resolve ascites and cardiac anomalies, while abdominal spasms and hyperactive reflexes are more likely consequences of low calcium levels.

Question 20

A patient who has had a prolonged period of nasogastric (NG) suctioning following colon surgery is experiencing electrolyte imbalances. The magnesium level is low (1.2 mg/dL). Knowing that magnesium deficiency occurs in conjunction with low calcium levels, the nurse should assess the patient for which of the following clinical manifestations of hypocalcaemia? Select all that apply.

Accepted Answer

Hypocalcaemia may be evidenced by personality changes and neuromuscular irritability along with tremors, choreiform movements, and positive Chvostek or Trousseau signs. Cardiovascular manifestations include tachycardia, hypertension, and ventricular dysrhythmias.

Quiz 8: Disorders of Fluid and Electrolyte, and Acid Base Balance

During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?

Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply.

Recognizing the prevalence and incidence of dehydration among older adults, a care aide at a long-term care facility is in the habit of encouraging residents to drink even though they may not feel thirsty at the time. Which of the following facts underlies the care aide's advice?

The nurse is providing teaching to a student nurse about how antidiuretic hormone (ADH) plays a central role in the reabsorption of water by the kidneys. The nursing student is correct to place the following components of the homeostatic action of ADH in the correct sequence. Use all the options.

A patient arrives in the ED very hypovolemic related to excretion of "at least 3 gallon jugs of urine in the past 24 hours." He describes the urine as being clear-like water. The physician suspects diabetes insipidus. The nurse should be prepared to administer which of the following medications?

A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?

A client is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. What is the client's most likely diagnosis?

A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Given this diagnosis, what clinical manifestations and lab results should the nurse anticipate the patient will exhibit?

An ECG technician is performing an ECG on a hospital patient who has developed hypokalemia secondary to diuretic use. Which of the following manifestations of the client's health problem will the technician anticipate on the ECG?

A renal failure patient with severe hyperkalemia (K⁺level 7.2 mEq/L) has just been admitted to the nursing unit. Given the severity of this situation, the nurse should be prepared to administer which intravenous infusion stat?

Vitamin D is integral to the regulation of calcium and phosphate levels. Put the following steps in the action of vitamin D into the correct sequence. Use all the options.

A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well. What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy?

An 81-year-old female has a long-standing diagnosis of hypocalcemia secondary to kidney disease. She will be moving into an assisted living facility shortly. Which of the following clinical manifestations would the nursing staff at the facility likely observe in this patient?

A terminally ill cancer patient with metastasis to the bone has been admitted with elevated calcium levels (hypercalcemic crisis) . The patient is very lethargic and exhibiting muscle flaccidity. The nurse should be prepared to administer (Select all that apply.)

A 56-year-old female hospital patient with a history of alcohol abuse is receiving intravenous (IV) phosphate replacement. Which of the following health problems will this IV therapy most likely resolve?

Quiz 8: Disorders of Fluid and Electrolyte, and Acid Base Balance

During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?

Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply.

Recognizing the prevalence and incidence of dehydration among older adults, a care aide at a long-term care facility is in the habit of encouraging residents to drink even though they may not feel thirsty at the time. Which of the following facts underlies the care aide's advice?

The nurse is providing teaching to a student nurse about how antidiuretic hormone (ADH) plays a central role in the reabsorption of water by the kidneys. The nursing student is correct to place the following components of the homeostatic action of ADH in the correct sequence. Use all the options.

A patient arrives in the ED very hypovolemic related to excretion of "at least 3 gallon jugs of urine in the past 24 hours." He describes the urine as being clear-like water. The physician suspects diabetes insipidus. The nurse should be prepared to administer which of the following medications?

A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?

A client is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. What is the client's most likely diagnosis?

A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Given this diagnosis, what clinical manifestations and lab results should the nurse anticipate the patient will exhibit?

An ECG technician is performing an ECG on a hospital patient who has developed hypokalemia secondary to diuretic use. Which of the following manifestations of the client's health problem will the technician anticipate on the ECG?

A renal failure patient with severe hyperkalemia (K+ level 7.2 mEq/L) has just been admitted to the nursing unit. Given the severity of this situation, the nurse should be prepared to administer which intravenous infusion stat?

Vitamin D is integral to the regulation of calcium and phosphate levels. Put the following steps in the action of vitamin D into the correct sequence. Use all the options.

A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well. What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy?

An 81-year-old female has a long-standing diagnosis of hypocalcemia secondary to kidney disease. She will be moving into an assisted living facility shortly. Which of the following clinical manifestations would the nursing staff at the facility likely observe in this patient?

A terminally ill cancer patient with metastasis to the bone has been admitted with elevated calcium levels (hypercalcemic crisis) . The patient is very lethargic and exhibiting muscle flaccidity. The nurse should be prepared to administer (Select all that apply.)

A 56-year-old female hospital patient with a history of alcohol abuse is receiving intravenous (IV) phosphate replacement. Which of the following health problems will this IV therapy most likely resolve?

A renal failure patient with severe hyperkalemia (K⁺level 7.2 mEq/L) has just been admitted to the nursing unit. Given the severity of this situation, the nurse should be prepared to administer which intravenous infusion stat?