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Fluid and Electrolytes NCLEX Style Questions

Total questions: 83

Worksheet time: 3hrs 48mins

Name
Class
Date
1.

A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments?

a)

Intracellular fluid (ICF)

b)

Extracellular fluid (ECF)

c)

Interstitial fluid

d)

Intravascular fluid

2.

Water movement between the ICF and ECF compartments is determined by:

a)

Osmotic forces

b)

Plasma oncotic pressure

c)

Antidiuretic hormone

d)

Buffer systems

3.

A nurse is teaching the staff about antidiuretic hormone (ADH). Which information should the nurse include? Secretion of ADH is stimulated by:

a)

Increased serum potassium

b)

Increased plasma osmolality

c)

Decreased renal blood flow

d)

Generalized edema

4.

Which statement by the staff indicates teaching was successful concerning aldosterone? Secretion of aldosterone results in:

a)

Decreased plasma osmolality

b)

Increased serum potassium levels

c)

Increased blood volume

d)

Localized edema

5.

Which of the following patients is the most at risk for developing hypernatremia? A patient with:

a)

Vomiting

b)

Diuretic use

c)

Dehydration

d)

Hypoaldosteronism

6.

A 5-year-old male presents to the ER with delirium and sunken eyes. After diagnosing him with severe dehydration, the primary care provider orders fluid replacement. The nurse administers a hypertonic intravenous solution. Which of the following would be expected?

a)

Symptoms subside quickly

b)

Increased ICF volume

c)

Decreased ECF volume

d)

Intracellular dehydration

7.

A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the nurse expect to observe?

a)

Weak pulse

b)

Excessive thirst

c)

Oliguria

d)

Constipation

8.

Which of the following buffer pairs is considered the major plasma buffering system?

a)

Which of the following buffer pairs is considered the major plasma buffering system?

b)

Carbonic acid/bicarbonate

c)

Sodium/potassium

d)

Amylase/albumin

9.
Choose the incorrect facts about Potassium
a)
Major cation of extracellular fluid
b)
Major anion of intracellular fluid
c)
Maintain by NA- K pump
d)
Can easily consumed by eating banana
10.
Hypernatremia due to all the list below, except
a)
Excess water intake
b)
Sweating
c)
Diabetes insipidus
d)
Burns
11.

A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments?

a)

Intracellular fluid (ICF)

b)

Extracellular fluid (ECF)

c)

Interstitial fluid

d)

Intravascular fluid

12.

While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have a(n):

a)

Higher total body water volume

b)

Decreased muscle mass

c)

Increase in thirst

d)

Increased tendency towards developing edema

13.

Water movement between the ICF and ECF compartments is determined by:

a)

Osmotic forces

b)

Plasma oncotic pressure

c)

Antidiuretic hormone

d)

Buffer systems

14.

When planning care for a dehydrated patient, the nurse remembers the principle of water balance is closely related to _____ balance.

a)

Potassium

b)

Chloride

c)

Bicarbonate

d)

Sodium

15.

A nurse is teaching the staff about antidiuretic hormone (ADH). Which information should the nurse include? Secretion of ADH is stimulated by:

a)

Increased serum potassium

b)

Increased plasma osmolality

c)

Decreased renal blood flow

d)

Generalized edema

16.

Which statement by the staff indicates teaching was successful concerning aldosterone? Secretion of aldosterone results in:

a)

Decreased plasma osmolality

b)

Increased serum potassium levels

c)

Increased blood volume

d)

Localized edema

17.

A 5-year-old male presents to the ER with delirium and sunken eyes. After diagnosing him with severe dehydration, the primary care provider orders fluid replacement. The nurse administers a hypertonic intravenous solution. Which of the following would be expected?

a)

Symptoms subside quickly

b)

Increased ICF volume

c)

Decreased ECF volume

d)

Intracellular dehydration

18.

Which of the following patients is the most at risk for developing hypernatremia? A patient with:

a)

Vomiting

b)

Diuretic use

c)

Dehydration

d)

Hypoaldosteronism

19.

Which of the following conditions would cause the nurse to monitor for hyperkalemia?

a)

Excess aldosterone

b)

Acute acidosis

c)

Insulin usage

d)

Metabolic alkalosis

20.

A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the nurse expect to observe?

a)

Weak pulse

b)

Excessive thirst

c)

Oliguria

d)

Constipation

21.

Which of the following buffer pairs is considered the major plasma buffering system?

a)

Which of the following buffer pairs is considered the major plasma buffering system?

b)

Carbonic acid/bicarbonate

c)

Sodium/potassium

d)

Amylase/albumin

22.

Which patient is most prone to metabolic alkalosis? A patient with:

a)

Retention of metabolic acids

b)

Hypoaldosteronism

c)

Excessive loss of chloride (Cl)

d)

Hyperventilation

23.

For a patient experiencing metabolic acidosis, the body will compensate by:

a)

Excreting H+ through the kidneys

b)

Hyperventilating

c)

Retaining CO2 in the lungs

d)

Secreting aldosterone

24.

A client is brought to the Emergency Department after passing out in a local department store. The client has been fasting and has ketones in the urine. Which acid-base imbalance would the nurse expect to assess in this client?

a)

Metabolic acidosis

b)

Respiratory alkalosis

c)

Metabolic alkalosis

d)

Respiratory acidosis

25.

The nurse uses a diagram to show that fluids in the interstitial and intravascular compartments are combined. What do they combine to form?

a)

Intercellular compartment

b)

Circulating compartment

c)

Vertical compartment

d)

Extracellular compartment

26.

The nurse must keep an accurate intake and output record to assess kidney efficiency. In order for the kidneys to remove waste, what is the least amount of hourly urine output the kidneys must produce to remove waste?

a)

10 mL

b)

20 mL

c)

30 mL

d)

40 mL

27.

The nurse explains to a patient that the drug Lasix reduces edema by drawing water from the interstitial space into the intravascular space. What is this process called?

a)

Diffusion

b)

Filtration

c)

Osmosis

d)

Homeostasis

28.

What does actively transporting electrolytes from an area of higher concentration to an area of lower concentration require?

a)

Hydrostatic pressure

b)

Osmotic pressure

c)

Blood pressure

d)

Pulse pressure

29.

Sodium is the most abundant electrolyte in the body. The location of electrolytes is important for maintaining homeostasis. Sodium is the major electrolyte in which fluid compartment?

a)

Intracellular

b)

Intravascular

c)

Extracellular

d)

Interstitial

30.

The lactating mother is counseled by the nurse to eat adequate amounts of meat and legumes. What level will this help to increase?

a)

Potassium

b)

Chloride

c)

Magnesium

d)

Phosphorus

31.

A nurse assesses an edematous cardiac patient. The nurse is aware that this condition is a result of retained fluid. What is the patient considered to be?

a)

Hyponatremic

b)

Hypokalemic

c)

Hypernatremic

d)

Hypercalcemic

32.

What is the nurse closely assessing for in a patient with hypokalemia?

a)

Systemic edema

b)

Cardiac complications

c)

Muscle cramping

d)

Impaired kidney function

33.

The nurse modifies the care plan for the immobilized patient after assessing a calcium level of 6.2 mEq/L. What nursing assessment should the nurse include when modifying this care plan?

a)

Osteoporosis

b)

Tooth loss

c)

Renal calculi

d)

Contractures

34.

The nurse is educating a patient regarding the need to avoid foods high in potassium. What food choices led the nurse to conclude that teaching was not effective?

a)

Apples and green beans

b)

Kiwis and onions

c)

Apricots and asparagus

d)

Grapes and lima beans

35.

A 10-month-old infant has had watery green stool for 2 days and refuses the bottle. The nurse is aware that the primary concern for this baby is:

a)

metabolic acidosis.

b)

metabolic alkalosis.

c)

weight loss.

d)

diaper rash.

36.

An isotonic state exists within a patient’s body fluids when the solute concentration of:

a)

interstitial fluid is less than the transcellular.

b)

intracellular and extracellular fluid is equal.

c)

intracellular fluid is greater than extracellular fluid.

d)

extracellular fluid is lesser than intracellular fluid.

37.

The nurse is aware that an infant is more at risk for dehydration because the infant:

a)

has kidneys that reabsorb water from the intravascular space.

b)

has a larger body surface compared with body weight.

c)

urinates more frequently.

d)

has fat that absorbs water.

38.

A nurse gets a positive Chvostek’s sign on a young woman with bulimia who has been giving herself frequent enemas containing phosphate. The nurse anticipates a laboratory finding of _____ mEq/L.

a)

sodium 140

b)

potassium 4.5

c)

magnesium 1.6

d)

calcium 6.5

39.

A patient has been identified as having a dietary deficiency of vitamin D. The nurse understands that this patient is also at risk for having a deficiency of:

a)

calcium.

b)

magnesium.

c)

sodium.

d)

potassium.

40.

The nurse explains that the dehydrated patient’s urine is concentrated because:

a)

renal tubules reabsorb more water and reduce urine output.

b)

kidneys cease to function.

c)

blood pressure drops.

d)

the colon retains more fluid from the fecal waste.

41.

The nurse is aware that small ions such as glucose, oxygen, and carbon dioxide redistribute themselves through semi-permeable membranes by a process called:

a)

diffusion.

b)

osmosis.

c)

blood pressure.

d)

rehydration.

42.

A patient with congestive heart failure has gained 1.1 pounds over the last 24 hours. The nurse is aware that this weight gain represents a fluid retention of _____ L.

a)

0.25

b)

0.5

c)

1.0

d)

2.0

43.

A patient drank a cup of coffee, a half glass of orange juice, and half a carton of milk with breakfast. Using common equivalents of food containers as a guide, the nurse notes on the intake column of the intake and output sheet that the patient consumed _____ mL. You have 15 minutes to calculate this question.

a)

360

b)

400

c)

420

d)

600

44.

The nurse is aware that the patient who suffered a brain injury with cerebral edema will most likely receive a fluid that is:

a)

isotonic.

b)

hypertonic.

c)

hypotonic.

d)

enhanced with vitamin B.

45.

The patient who is prescribed furosemide for fluid-volume excess is discharged home. The patient verbalizes understanding of his disease process when he says:

a)

“I can put catsup on my scrambled eggs.”

b)

“I can snack on salted popcorn.”

c)

“I will snack on raisins.”

d)

“I will avoid apricots.”

46.

The nurse assessing a newly admitted patient with marked edema from severe congestive failure would anticipate that the patient would exhibit: (Select all that apply.)

a)

a thready pulse.

b)

concentrated urine.

c)

hypertension.

d)

weight gain.

e)

crackles heard on auscultation.

47.

The nurse assessing a patient with vomiting and diarrhea observes that the urine is scant and concentrated. The nurse explains that the compensatory reabsorption of water is controlled by:

a)

osmoreceptors in the hypothalamus.

b)

antidiuretic hormone in the posterior pituitary.

c)

baroreceptors in the carotid sinus.

d)

insulin from the pancreas.

48.

Prior to hanging an IV containing potassium, the nurse will confirm that there is a:

a)

blood pressure of at least 60 mm Hg diastolic.

b)

urine output of at least 30 mL/hr.

c)

filter on the IV line.

d)

pulse of at least 50 beats/min.

49.

Because the 80-year-old patient is prone to dehydration related to the age-related change of decreased thirst and kidney function, the nurse monitors for the earliest sign of dehydration, which is:

a)

reduced skin turgor.

b)

constipation.

c)

increased temperature.

d)

thirst.

50.

The nurse can record that the compensatory mechanism for the correction of metabolic acidosis is in effect when the nurse observes:

a)

increased urinary output.

b)

reduced abdominal distention.

c)

Kussmaul’s respirations.

d)

decreased blood pressure.

51.

The nurse is assessing the hydration status of the patient. The nurse demonstrates knowledge of proper assessment techniques by: (Select all that apply.)

a)

monitoring the patient’s daily weight.

b)

assessing the patient’s skin turgor on the back of the hand.

c)

checking the patient’s blood glucose level 4 times a day.

d)

assessing for skin tenting on the patient’s forehead.

e)

asking the patient if he is experiencing thirst.

52.

When caring for a patient admitted with hyponatremia, which actions will the nurse anticipate taking?

a)

Restrict patient’s oral free water intake.

b)

Avoid use of electrolyte-containing drinks.

c)

Infuse a solution of 5% dextrose in 0.45% saline.

d)

Administer vasopressin (antidiuretic hormone, [ADH]).

53.

The home health nurse notes that an elderly patient has a low serum protein level. The nurse will plan to assess for

a)

pallor.

b)

edema.

c)

confusion.

d)

restlessness.

54.

A patient is receiving 3% NaCl solution for correction of hyponatremia. During administration of the solution, the most important assessment for the nurse to monitor is

a)

lung sounds.

b)

urinary output.

c)

peripheral pulses.

d)

peripheral edema.

55.

When teaching a patient with renal failure about a low phosphate diet, the nurse will include information to restrict

a)

ingestion of dairy products.

b)

the amount of high-fat foods.

c)

the quantity of fruits and juices.

d)

intake of green, leafy vegetables.

56.

A patient receiving isoosmolar continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory result is most important to report to the health care provider?

a)

K+ 3.4 mEq/L (3.4 mmol/L)

b)

Ca+2 7.8 mg/dl (1.95 mmol/L)

c)

Na+ 154 mEq/L (154 mmol/L)

d)

PO4-3 4.8 mg/dl (1.55 mmol/L)

57.

A patient with renal failure who has been taking aluminum hydroxide/magnesium hydroxide suspension (Maalox) at home for indigestion is somnolent and has decreased deep tendon reflexes. Which action should the nurse take first?

a)

Notify the patient’s health care provider.

b)

Withhold the next scheduled dose of Maalox.

c)

Review the magnesium level on the patient’s chart.

d)

Check the chart for the most recent potassium level.

58.

A postoperative patient who is receiving nasogastric suction is complaining of anxiety and incisional pain. The patient’s respiratory rate is 32 breaths/minute and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first?

a)

Discontinue the nasogastric suctions for a few hours.

b)

Notify the health care provider about the ABG results.

c)

Teach the patient about the need to take slow, deep breaths.

d)

Give the patient the PRN morphine sulfate 4 mg intravenously.

59.

The following data are obtained by the nurse when assessing a pregnant patient with eclampsia who is receiving IV magnesium sulfate. Which finding is most important to report to the health care provider immediately?

a)

The bibasilar breath sounds are decreased.

b)

The patellar and triceps reflexes are absent.

c)

The patient has been sleeping most of the day.

d)

The patient reports feeling “sick to my stomach.”

60.

A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments?

a)

Intracellular fluid (ICF)

b)

Extracellular fluid (ECF)

c)

Interstitial fluid

d)

Intravascular fluid

61.

A client who has acute pancreatitis reports muscle spasms. Which of the following laboratory values is the highest priority for the nurse to report to the provider?

a)

Calcium 6.8 mg/dL

b)

Glucose 180 mg/dL

c)

WBC count 11,800/mm3

d)

Sodium 130 mg/dL

62.

A nurse is caring for a client who has a central venous access device. Which of the following should the nurse know before performing a complete assessment of the device? (Select all that apply)

a)

Health care professional who inserted the device

b)

Length of the catheter

c)

Insertion site

d)

Form of anesthesia used for insertion

e)

Location of the tip

63.

A client presents to the emergency department with a history of vomiting and diarrhea for 3 days. The nurse should recognize that which of the following indicates fluid volume deficit?

a)

Pulse rate 110

b)

Blood pressure 160/90 mm Hg

c)

Urine specific gravity < 1.001

d)

BUN 5 mg/dL

64.

A nurse is educating a client who has hypernatremia about nutrition. Which of the following food choices made by the client indicates an understanding of the teaching? Select all that apply.

a)

Cheddar cheese

b)

Orange wedges

c)

Tomato slices

d)

Canned beans

e)

Brown rice

65.

A nurse is assisting a client to choose foods high in magnesium. Which of the following foods is a good source of magnesium?

a)

Peanuts

b)

Cottage cheese

c)

Almonds

d)

Hot dogs

66.

A nurse is administering an oral rehydration solution to a child who was admitted due to severe hypotonic dehydration. Which of the following laboratory results indicates that the child is responding to the treatment?

a)

Urine pH 6.0

b)

Urine specific gravity 1.035

c)

Serum sodium 136 mEq/L

d)

Serum potassium 3.5 mEq/L

67.

A nurse is evaluating a client’s ABG results. Which of the following findings requires an action by the nurse?

a)

SaO2 95%

b)

PCO2 33 mm Hg

c)

HCO3 22 mEq/L

d)

pH 7.45

68.

A client has chronic kidney disease and a low phosphate level. Which of the following foods should the nurse encourage the client to consume more frequently?

a)

Whole wheat bread

b)

Long-grain rice

c)

Orange juice

d)

Chocolate milk

69.

What is primarily responsible for carrying fluids with nutrients and wastes on a random basis throughout the body?

a)

Filtrates

b)

Extracellular fluid

c)

Intracellular fluid

d)

Osmolytes

70.

A patient has renal damage because of diabetes. What is the highest risk for this patient?

a)

Hypercalcemia

b)

Hypocalcemia

c)

Hyperkalemia

d)

Hypokalemia

71.

A nurse has two newly admitted patients with dehydration. One patient is dehydrated from heat exhaustion, and the other is dehydrated from an overdose of Lasix. What finding should be present in both patients?

a)

Increased skin turgor

b)

Decreased pulse and respirations

c)

Copious saliva and nasal secretions

d)

Increased laboratory values of hemoglobin and hematocrit

72.

A nurse understands that fluid balance is mainly monitored in the body by which two systems?

a)

Circulatory and renal

b)

Respiratory and circulatory

c)

Renal and gastrointestinal

d)

Hepatic and lymphatic

73.

How does the healthy kidney adjust the volume and composition of filtrate that prevents excessive fluid loss?

a)

Active transport

b)

Filtration in the lymphatic system

c)

Secretion of adrenalin

d)

Tubular reabsorption

74.

What percentage of blood volume is plasma?

a)

20%

b)

40%

c)

60%

d)

80%

75.

True or False: Interstitial Colloid Osmotic Pressure tends to hold fluid inside a vessel

a)

True

b)

False

76.

An isotonic fluid has an osmolality of:

a)

28O mOsm/L

b)

320 mOsm/L

c)

360 mOsm/L

d)

400 mOsm/L

77.

Jugular venous distension is a sign of:

a)

Hypovolemic hypernatremia

b)

Hypervolemic hypernatremia

78.

A CRNA decides to hyperventilate a patient. A decrease of 10 mmHg in paCO2 will cause a(n):

a)

decrease in potassium of 0.5 mEq/L

b)

increase in potassium of 1.0 mEq/L

c)

decrease in potassium of 1.0 mEq/L

d)

increase in potassium of 0.5 mEq/L

79.

What does an increase in aldosterone level cause? (Select 2.)

a)

Increase in serum sodium

b)

Increase in serum potassium

c)

Decrease in serum sodium

d)

Decrease in serum potassium

80.

Calcitonin causes:

a)

Calcium to rise as it is removed from bone storage

b)

Membrane exchange with hydrogen atoms

c)

Decreases calcium excretion in bone

d)

Calcium suppresses osteoclast activity in bone

81.

Hyypermagnesemia is defined as:

a)

> 0.5 mEq/L

b)

>1 mEq/L

c)

>2 mEq/L

d)

>2.5 mEq/L

82.

Which receptor causes the establishment of aquaporin 2 channels?

a)

V1

b)

V2

c)

V3

d)

V4

83.

All the following can occur with hyperkalemia EXCEPT:

a)

Peaked T waves

b)

Narrowed PR interval

c)

Widened QRS

d)

Loss of P wave