Fluid and electrolyte balance plays an important role in homeostasis, and critical care nurses assume a vital role in identifying and treating the physiologic stressors experienced by critically ill patients that disrupt homeostasis.
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Included topics in this practice quiz are:
- Fluids and Electrolytes
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Fluids and Electrolytes 2 (30 Items)
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Fluids and Electrolytes 2 (30 Items)
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1. Lee Angela’s lab test just revealed that her chloride level is 96 mEq/L. As a nurse, you would interpret this serum chloride level as:
C. within normal range
D. high normal
2. Which of the following conditions is associated with elevated serum chloride levels?
3. In the extracellular fluid, chloride is a major:
4. Nursing intervention for the patient with hyperphosphatemia include encouraging intake of:
B. Fleets phospho-soda
D. vitamin D
5. Etiologies associated with hypocalcemia may include all of the following except:
A. renal failure
B. inadequate intake calcium
C. metastatic bone lesions
D. vitamin D deficiency
6. Which of the following findings would the nurse expect to asses in hypercalcemia?
A. prolonged QRS complex
D. urinary calculi
7. Which of the following is not an appropriate nursing intervention for a patient with hypercalcemia?
A. administering calcitonin
B. administering calcium gluconate
C. administering loop diuretics
D. encouraging ambulation
8. A patient in which of the following disorders is at high risk to develop hypermagnesemia?
9. Nursing interventions for a patient with hypermagnesemia include administering calcium gluconate to:
A. increase calcium levels
B. antagonize the cardiac effects of magnesium
C. lower calcium levels
D. lower magnesium levels
10. For a patient with hypomagnesemia, which of the following medications may become toxic?
C. calcium gluconate
11. Which of the following is the most important physical assessment parameter the nurse would consider when assessing fluid and electrolyte imbalance?
A. skin turgor
B. intake and output
C. osmotic pressure
D. cardiac rate and rhythm
12. Insensible fluid losses include:
13. Which of the following intravenous solutions would be appropriate for a patient with severe hyponatremia secondary to syndrome of inappropriate antidiuretic hormone (SIADH)?
A. hypotonic solution
B. hypertonic solution
C. isotonic solution
D. normotonic solution
14. Aldosterone secretion in response to fluid loss will result in which one of the following electrolyte imbalances?
15. When assessing a patient for signs of fluid overload, the nurse would expect to observe:
A. bounding pulse
B. flat neck veins
C. poor skin turgor
16. The physician has ordered IV replacement of potassium for a patient with severe hypokalemia. The nurse would administer this:
A. by rapid bolus
B. diluted in 100 cc over 1 hour
C. diluted in 10 cc over 10 minutes
D. IV push
17. Which of the following findings would the nurse exp[ect to assess in a patient with hypokalemia?
18. Vien is receiving oral potassium supplements for his condition. How should the supplements be administered?
C. on an empty stomach
D. at bedtime
19. Normal venous blood pH ranges from:
A. 6.8 to 7.2
B. 7.31 to 7.41
C. 7.35 to 7.45
D. 7.0 to 8.0
20. Respiratory regulation of acids and bases involves:
D. carbon dioxide
21. To determine if a patient’s respiratory system is functioning, the nurse would assess which of the following parameters:
A. respiratory rate
C. arterial blood gas
D. pulse oximetry
22. Which of the following conditions is an equal decrease of extracellular fluid (ECF) solute and water volume?
A. hypotonic FVD
B. isotonic FVD
C. hypertonic FVD
D. isotonic FVE
23. When monitoring the daily weight of a patient with fluid volume deficit (FVD), the nurse is aware that fluid loss may be considered when weight loss begins to exceed:
A. 0.25 lb
B. 0.50 lb
C. 1 lb
D. 1 kg
24. Dietary recommendations for a patient with a hypotonic fluid excess should include:
A. decreased sodium intake
B. increased sodium intake
C. increased fluid intake
D. intake of potassium-rich foods
25. Osmotic pressure is created through the process of:
D. capillary dynamics
26. A rise in arterial pressure causes the baroreceptors and stretch receptors to signal an inhibition of the sympathetic nervous system, resulting in:
A. decreased sodium reabsorption
B. increased sodium reabsorption
C. decreased urine output
D. increased urine output
27. Normal serum sodium concentration ranges from:
A. 120 to 125 mEq/L
B. 125 to 130 mEq/L
C. 136 to 145 mEq/L
D. 140 to 148 mEq/L
28. When assessing a patient for electrolyte balance, the nurse is aware that etiologies for hyponatremia include:
A. water gain
B. diuretic therapy
D. all of the following
29. Nursing interventions for a patient with hyponatremia include:
A. administering hypotonic IV fluids
B. encouraging water intake
C. restricting fluid intake
D. restricting sodium intake
30. The nurse would analyze an arterial pH of 7.46 as indicating:
Answers and Rationale
Here are the answers for this exam. Gauge your performance by counter checking your answers to those below. If you have any disputes or clarifications, please direct them to the comments section.
1. Answer: C. within normal range
Normal serum concentrations of chloride range from 95 to 108 mEq/L.
2. Answer: C. eclampsia
Eclampsia is associated with increased levels of serum chloride.
3. Answer: C. anion
Chloride is a major anion found in the extracellular fluid. A compound occurs when two ions are bound together. Chloride is an ion, but this choice is too general. HCO3 is a cation.
4. Answer: A. amphogel
Administration of phosphate binders (amphogel and basagel) will reduce the serum phosphate levels.
5. Answer: C. metastatic bone lesions
Metastatic bone lesions are associated with hypercalcemia due to accelerated bone metabolism and release of calcium into the serum. Renal failure, inadequate calcium intake, and vitamin D deficiency may cause hypocalcemia.
6. Answer: D. urinary calculi
Urinary calculi may occur with hypercalcemia. Shortened, not prolonged QRS complex would be seen in hypercalcemia. Tetany and petechiae are signs of hypocalcemia.
7. Answer: B. administering calcium gluconate
Calcium gluconate is used for replacement in deficiency states. Calcitonin and loop diuretics are used to lower serum calcium.
8. Answer: D. renal failure
Renal failure can reduce magnesium excretion, leading to hypermagnesemia. Diabetic ketoacidosis, not insulin shock is a cause of hypermagnesemia. Hypoadrenalism, not hyperadrenalism is a cause of hypermagnesemia. Nausea and vomiting lead to hypomagnesemia.
9. Answer: B. antagonize the cardiac effects of magnesium
In a patient with hypermagnesemia, administration of calcium gluconate will antagonize the cardiac effects of magnesium. Although calcium gluconate will raise serum calcium levels, that is not the purpose of administration. Calcium gluconate does not lower calcium or magnesium levels.
10. Answer: B. Digoxin
11. Answer: D. cardiac rate and rhythm
Cardiac rate and rhythm are the most important physical assessment parameter to measure. Skin turgor, intake and output are physical assessment parameters a nurse would consider when assessing fluid and electrolyte imbalance, but choice d is the most important.
12. Answer: D. perspiration
Perspiration and the fluid lost via the lungs are termed insensible losses; normally, insensible losses equal about 1000 cc/day.
13. Answer: B. hypertonic solution
When hyponatremia is severe, hypertonic solutions may be used but should be infused with caution due to the potential for development of CHF. In SIADH, isotonic and hypotonic solutions are not indicated, because urine output is minimal, so water is retained. this water retention dilutes serum sodium levels, making the patient hyponatremic and necessitating administration of hypertonic solutions to balance sodium and water. Normotonic solutions do not exist.
14. Answer: A. hypokalemia
Aldosterone is secreted in response to fluid loss. Aldosterone causes sodium reabsorption and potassium elimination, further exacerbating hypokalemia.
15. Answer: A. bounding pulse
Bounding pulse is a sign of fluid overload as more volume in the vessels causes a stronger sensation against the blood vessel walls. Flat neck veins and vesicular breath sounds are normal findings. Poor skin turgor is consistent with dehydration.
16. Answer: B. diluted in 100 cc over 1 hour
Potassium must be well diluted and given slowly because rapid administration will cause cardiac arrest.
17. Answer: D. hyporeflexia
Hyporeflexia is a symptom of hypokalemia
18. Answer: B. diluted
Oral potassium supplements are known to irritate gastrointestinal (GI) mucosa and should be diluted.
19. Answer: B. 7.31 to 7.41
Normal venous blood pH ranges from 7.31 to 7.41. Normal arterial blood pH ranges from 7.35 to 7.45.
20. Answer: D. carbon dioxide
Respiratory regulation of acid-base balance involves the elimination or retention of carbon dioxide.
21. Answer: C. arterial blood gas
Arterial blood gases will indicate CO2 and O2 levels. This is an indication that the respiratory system is functioning. Respiratory rate can reveal data about other systems, such as the brain, making letter c a better choice. Pulse rate is not measure of respiratory status. Pulse oximetry yields oxygen saturation levels, which is not a measure of acid-base balance.
22. Answer: B. isotonic FVD
Isotonic FVD involves an equal decrease in solute concentration and water volume.
23. Answer: B. 0.50 lb
Weight loss of more than 0.50 lb. is considered to be fluid loss.
24. Answer: B. increased sodium intake
Hypotonic fluid volume excess (FVE) involves an increase in water volume without an increase in sodium concentration. Increased sodium intake is part of the management of this condition.
25. Answer: B. diffusion
In diffusion, the solute moves from an area of higher concentration to one of lower concentration, creating osmotic pressure. Osmotic pressure is related to the process of osmosis. Filtration is created by hydrostatic pressure. Capillary dynamics are related to fluid exchange at the intravascular and interstitial levels.
26. Answer: D. increased urine output
Arterial baroreceptors and stretch receptors help maintain fluid balance by increasing urine output in response to a rise in arterial pressure.
27. Answer: C. 136 to 145 mEq/L
Normal serum sodium level ranges from 136 to 145 mEq/L.
28. Answer: D. all of the following
Water gain, diuretic therapy, and diaphoresis are etiologies of hyponatremia.
29. Answer: C. restricting fluid intake
Hyponatremia involves a decreased concentration of sodium in relation to fluid volume, so restricting fluid intake is indicated.
30. Answer: B. alkalosis
Alkalosis is indicated by a pH above 7.45.
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