Question 1

The nurse is assessing a patient and finds crackles in the lung bases and neck vein distention.The nurse gives the patient a diuretic.What electrolyte imbalance is the nurse most concerned about?

Accepted Answer

Using a diuretic can cause excess excretion of potassium,unless it is a potassium-sparing diuretic.The other electrolytes are not excreted in the same way with diuretics.

Question 2

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

Accepted Answer

A rapid gain in weight usually indicates ECV excess if the person began with normal ECV.Asking the patient about urination habits will illuminate whether the body is trying to excrete the excess fluid,or if renal dysfunction is contributing to ECV excess.Difficulty sleeping at night can occur if the body builds up excessive fluid in the lungs; however,it could also mean that the patient is getting up frequently to urinate,so the question is not specific enough.Caloric intake does not account for rapid weight changes.Dry mouth and thirst accompany ECV deficit,which would be associated with rapid weight loss.

Question 3

The nurse knows that the most abundant cation in the blood is

Accepted Answer

Sodium is the most abundant cation in the blood.Potassium is the predominant intracellular cation.Chloride is an anion (negatively charged)rather then a cation (positively charged).Magnesium is found predominantly inside cells and in bone.

Question 4

The nurse knows that an imbalance of which ion causes acid-base impairment?

Accepted Answer

The concentration of hydrogen ions determines pH.Low pH designates an acidic environment.High pH designates an alkaline environment.Calcium,magnesium,and sodium are ions,but their imbalances are not direct acid-base impairments.

Question 5

Which patient is most at risk for sensible water loss?

Accepted Answer

Sensible water loss consists of fluids lost from the skin through visible perspiration,such as with a resolving fever related to pneumonia.Asthma would be insensible water loss through respiration.Gastroenteritis causes diarrhea with its large volume loss.Constipation does not affect fluid loss.

Question 6

The nurse knows that edema in a patient who has venous congestion from right heart failure is facilitated by an imbalance with regard to _____ pressure.

Accepted Answer

Venous congestion increases capillary hydrostatic pressure.Increased hydrostatic pressure causes edema by causing increased movement of fluid into the interstitial area.Osmotic and oncotic pressures involve the concentrations of solutes and can contribute to edema in other situations.Concentration pressure is not a nursing term.

Question 7

In which patient would the nurse expect to see a positive Chvostek sign?

Accepted Answer

A positive Chvostek sign is representative of hypocalcemia or hypomagnesemia.Hypomagnesemia is common with alcohol abuse.Hypocalcemia can be brought on by alcohol abuse and pancreatitis (which also can be affected by alcohol consumption).Burn patients frequently experience ECV deficit.Hyperparathyroidism causes hypercalcemia.Immobility is associated with hypercalcemia.

Question 8

A 2-year-old child was brought into the emergency department after ingesting several morphine tablets from a bottle in his mother's purse.The nurse knows that the child is at greatest risk for which acid-base imbalance?

Accepted Answer

Morphine overdose can cause respiratory depression and hypoventilation.Hypoventilation results in retention of CO₂ and respiratory acidosis.Respiratory alkalosis would result from hyperventilation,causing a decrease in CO₂ levels.Metabolic acid-base imbalance would be a result of kidney dysfunction,vomiting,diarrhea,or other conditions that affect metabolic acids.

Question 9

Which organ system is responsible for compensation of respiratory acidosis?

Accepted Answer

The kidneys are responsible for respiratory acidosis compensation.A problem with the respiratory system causes respiratory acidosis,so another organ system (renal)needs to compensate.Problems with the gastrointestinal and endocrine systems can cause acid-base imbalances,but these systems cannot compensate for an existing imbalance.

Question 10

The nurse is caring for a diabetic patient in renal failure.Which laboratory findings would the nurse expect?

Accepted Answer

Patients in renal failure develop metabolic acidosis.The laboratory values that reflect this are pH 7.3,PaCO₂ 36 mm Hg,HCO₃^-19 mEq/L.A laboratory finding of pH 7.5,PaCO₂ 35 mm Hg,HCO₃^-35 mEq/L is metabolic alkalosis.pH 7.3,PaCO₂ 47 mm Hg,HCO₃^-23 mEq/L is respiratory acidosis.pH 7.35,PaCO₂ 40 mm Hg,HCO₃^-25 mEq/L values are within normal range.

Question 11

The nurse would not expect full compensation to occur for which acid-base imbalance?

Accepted Answer

Usually the cause of respiratory alkalosis is a temporary event (e.g.,an asthma or anxiety attack).The kidneys take about 24 hours to compensate for an event,so it is unlikely to see much if any compensation for respiratory alkalosis.Respiratory acidosis usually results from longer-term conditions such as chronic lung disease,narcotic overdose,or another event that causes respiratory depression.The kidneys still do not respond for about 24 hours,but usually the event is still occurring.For both metabolic imbalances,the respiratory system is quick to attempt to compensate: however,it may have difficulty sustaining that compensation.

Question 12

The nurse understands that administering a hypertonic solution to a patient will shift water from the _____ to the _____ space.

Accepted Answer

A hypertonic solution has a concentration greater than normal body fluids,so water will shift out of cells because of the osmotic pull of the extra particles.Movement of water into cells occurs when hypotonic fluids are administered.Distribution of fluid between intravascular and interstitial spaces occurs by filtration,the net sum of hydrostatic and osmotic pressures.

Question 13

Which laboratory value should the nurse examine when evaluating uncompensated respiratory alkalosis?

Accepted Answer

Uncompensated respiratory imbalances are seen in the PaCO₂ levels.PaO₂ indicates oxygen status.Anion gap is used for metabolic acidosis.HCO₃^-is used to evaluate compensation for respiratory imbalances or uncompensated metabolic imbalances.

Question 14

Approximately two thirds of the body's total water volume exists in the _____ fluid.

Accepted Answer

Intracellular fluid accounts for approximately two thirds of the fluids in the body-about 42% of total body weight.Interstitial fluid,intravascular fluid,and transcellular fluid constitute extracellular fluid,which is the fluid outside a cell.

Question 15

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

Accepted Answer

Signs and symptoms of hypokalemia are muscle weakness and fatigue,abdominal distention,decreased bowel sounds,and cardiac dysrhythmias.Thready peripheral pulses indicate hypovolemia.Dry mucous membranes and flushed skin are indicative of dehydration and hypernatremia.

Question 16

The process of passively moving water from an area of lower particle concentration to an area of higher particle concentration is known as

Accepted Answer

The process of moving water from an area of low particle concentration to an area of higher particle concentration is known as osmosis.Hydrolysis is not a term related to fluid and electrolyte balance.Filtration is mediated by fluid pressure from an area of higher pressure to an area of lower pressure.Active transport requires metabolic activity and is not passive.

Question 17

A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low intermittent suction for the past 3 days.The patient's respiratory rate has decreased to 12 breaths per minute.The nurse would expect the patient to have which of the following arterial blood gas values?

Accepted Answer

Compensated metabolic alkalosis should show alkalosis pH and HCO₃^-(metabolic)values,with a slightly acidic CO₂ (compensatory respiratory acidosis).In this case,pH 7.52 is alkaline (normal = 7.35 to 7.45),PaCO₂ is acidic (normal 35 to 45 mm Hg),and HCO₃^-is elevated (normal = 22 to 26 mEq/L).A result of pH 7.78,PaCO₂ 40 mm Hg,HCO₃^-30 mEq/L is uncompensated metabolic alkalosis.pH 7.35,PaCO₂ 35 mm Hg,HCO₃^-26 mEq/L is within normal limits.pH 7.25,PaCO₂ 47 mm Hg,HCO₃^-29 mEq/L is compensated respiratory acidosis.

Question 18

The nurse would expect a patient with respiratory acidosis to have an excessive amount of

Accepted Answer

Respiratory acidosis occurs when the lungs are not able to excrete enough carbon dioxide.Carbon dioxide and water create carbonic acid.A buildup of carbonic acid causes the ECF to become more acidic,decreasing the pH.Bicarbonate is normal with uncompensated respiratory acidosis or elevated with compensated respiratory acidosis.Excessive oxygen and phosphate are not characteristic of respiratory acidosis.

Question 19

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

Accepted Answer

Normal calcium range is 8.5 mg/dL to 10.5 mg/dL; therefore,a value of 17.5 mg/dL is abnormally high and of concern.The rest of the laboratory values are within their normal ranges: sodium 135 to 145 mEq/L; potassium 3.5 to 5.0 mEq/L; chloride 98 to 106 mEq/L.

Question 20

The nurse would expect a patient with increased levels of serum calcium to also have _____ levels.

Accepted Answer

Serum calcium and phosphate have an inverse relationship.When one is elevated,the other decreases,except in some patients with end-stage renal disease.Increased serum calcium would not necessarily cause changes in levels of potassium,sodium,or magnesium.

Quiz 41: Fluid, electrolyte, and Acid-Base Balance