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WorksheetsFluids and Electrolytes Worksheet
Total questions: 100
Worksheet time: 50hrs 0mins
A nurse in the medical-surgical unit is giving a client with low blood pressure a hypertonic solution. What is the expected effect of its administration?
It initially increases the osmotic pressure within the blood.
It initially increases the osmotic pressure within cells.
It initially increases the hydrostatic pressure within the cells.
It initially increases the hydrostatic pressure within the blood.
Third-space fluid shifting may cause the client to demonstrate
Hypertension
Increased urine output
Hypervolemia
Hypovolemia
The client is manifesting severe proteinuria. What clinical manifestation will this client exhibit?
Hypervolemia
Hyponatremia
Hyperkalemia
Edema
A client is manifesting edema formation on both upper and lower extremities. The following mechanisms may explain its occurrence, EXCEPT
Increased hydrostatic pressure in the IVC
Decreased oncotic pressure within the IVC
Increased ADH secretion
Increased oncotic pressure within IVC
A client experiences a loss of intracellular fluid. The nurse anticipates that the intravenous therapy that will be used to replace this type of loss is
0.45% normal saline (NS)
10% dextrose
5% dextrose in lactated Ringer's
Dextrose 5% in 1/2% NS
For a client with a nursing diagnosis of excess fluid volume, the nurse is alert to which of the following signs and symptoms?
Weak, thready pulse
Hypertension
Dry mucous membranes
Flushed skin
Signs and symptoms of ECF fluid volume deficit do not include which of the following?
Weight loss, poor skin turgor
Thirst, dry mouth and mucous membrane
Oliguria, dark concentrated urine
Decreased hematocrit, decreased specific gravity
Based on laboratory findings, what result will cause the release of ADH?
Increased serum sodium
Decreased serum sodium
Decrease in serum osmolarity
Decrease in thirst
Aldosterone secretion in response to fluid loss will result in which one of the following electrolyte imbalances?
Increased serum sodium level and increased potassium level
Decreased serum sodium level and increased potassium level
Increased serum sodium level and decreased potassium level
Decreased serum sodium level and increased potassium level
Prolonged administration of D5W without conscientious monitoring may predispose the client to develop what complication?
Dehydration
Water intoxication
Isotonic fluid volume excess
Hypertonic fluid volume excess
A client with cerebral edema is given Mannitol. You will anticipate that its therapeutic effect is based on the fact that Mannitol's tonicity is
Hypertonic
Hypotonic
Isotonic
A client is receiving furosemide (Lasix) 40 mg/dl IV. What electrolyte value should be monitored when a client is receiving a loop diuretic?
Calcium level
Sodium level
K level
Mg Level
The client is receiving albumin supplementation. Expected priority nursing responsibilities with this type of medical management include the following, except
Monitoring of urine output
Auscultation of the lungs for adventitious sounds
Monitoring for constipation
Auscultation for abnormal heart sounds
An 18-year-old client is admitted for signs and symptoms of hypervolemia, isotonic in nature. The client informed the nurse that she is asthmatic and has been taking a corticosteroid inhaler ever since she was a child. Basing on your knowledge, what sodium imbalance is this client prone to manifest?
Hyponatremia
Hypernatremia
A diuretic is administered to the client for fluid volume excess management. Upon the client's serum sodium level is 115 mEq/L. This serum sodium level tells us that the client is
Hyponatremic
Hypernatremic
Having a normal level of sodium
The nurse is caring for a client with a diagnosis of dehydration. The client is receiving intravenous (IV) fluids. Which assessment data would indicate to the nurse that the dehydration remains unresolved?
An oral temperature of 36.8 C
A urine specific gravity of 1.043
A urine output that is pale yellow
A blood pressure of 120/80 mmHg
You noticed that in a client who has severe burns, the fluid is starting to accumulate in the client's abdominal tissues. There is no change in his weight. What do you suspect?
It is a normal effect after a burn injury
Hypervolemia
Third space shifting
Sepsis
A client has developed hyponatremia as a result of SIADH. Which type of IV fluid would the nurse be most likely to administer initially?
D5W
0.45% NaCl
D10W
0.9% NaCl
Hypertonic IV fluids may cause cerebral and pulmonary fluid overload due to what specific fluid shifting?
Movement of fluids from the interstitial compartment and intracellular compartment to the intravascular compartment.
Movement of fluids from the intravascular compartment to the interstitial and intracellular compartments.
Movement of fluids from the transcellular fluid compartments to the interstitial compartments.
Movement of fluids from interstitial compartment to transcellular compartments.
A client, with a sodium level of 178 mEq/L, is ordered to be started on 0.45% NaCl. What is the most IMPORTANT nursing intervention for this client?
Maintain patent IV
Give rapidly to ensure fluids levels are shifted properly
Clarify the doctor's order because 0.45% saline is contraindicated in hypernatremia
Give slowly and watch for signs and symptoms of cerebral edema
The pumping action of the heart generates
Hydrostatic pressure
Hypertonic pressure
Osmotic pressure
Oncotic pressure
When ECF sodium is decreased, the adrenal gland secretes aldosterone to cause the kidneys to
Reabsorb water alone
Reabsorb potassium and sodium
Reabsorb sodium and then water
Reabsorb sodium and then potassium
When ECF sodium is elevated, what is released to decrease serum osmolality?
Aldosterone
ADH
ANF
Glucocorticoid
Which of the following findings would the nurse expect to assess in a client with hypotonic fluid volume excess?
Poor skin turgor and increased thirst
Interstitial edema and cellular swelling
Hypotension and pitting edema
Interstitial edema and cellular shrinking
The danger of fluid sequestered in the third space and interstitial compartment is that the fluid
Is hypertonic and can cause hypervolemia
Is hypertonic and can cause water intoxication
Is not available for circulation
Contains large amounts of acids
Fluids would be likely to leave out of the capillary or blood vessel if
Hydrostatic pressure is less than the osmotic pressure within the capillaries and blood vessels
Hydrostatic pressure is greater than the osmotic pressure within the capillary and blood vessels
Osmotic pressure is high in the capillary and blood vessels
Osmotic pressure is less than the hydrostatic pressure in the interstitial compartment
The plasma oncotic pressure does which of the following?
Pulls fluid back into the vascular compartment
Pulls fluid out of the 'vascular compartment
Pushes fluid out of the intracellular compartment into the transcellular compartment.
Pushes fluid back into the transcellular compartment.
Clients suffering from Fluid Volume Deficit will generally have
Low specific gravity
Low-temperature
Increased hematocrit count
Increased albumin level
The R-A-A-S mechanism in hypovolemia elicits the following effects, except
Renal arterial vasodilation
Peripheral vasoconstriction
Retention of sodium and water
Release of aldosterone
Aldosterone secretion in response to fluid loss may result in which one of the following potassium imbalances?
Hypokalemia
Hyperkalemia
The state of hyperkalemia is associated with
Catabolism
Alkalosis
Acidosis
Hypothyroidism
The nursing care plan states to observe for hyperkalemia. The nurse should recognize that the greatest risk of hyperkalemia is
Tetany
Cardiac arrest
Fluid overload
Prevent Tetany
The physician orders regular insulin, 10 "u" added to 50 ml. of 50% dextrose to be given intravenously to a client with renal failure. The expected outcome is to
Lower serum potassium level
Increase the serum potassium level
Reduce cerebral edema
Decrease blood glucose
The 50% dextrose administered with insulin in clients with hyperkalemia would help counter what probable complication?
Hyperosmolar blood
Hypoosmolar blood
Hypoglycemia
Hyperglycemia
The client manifested signs and symptoms of dysrhythmia secondary to hyperkalemia. Which medication would you anticipate that the physician will order which is specific for this manifestation?
Kayexalate
Calcium gluconate
Insulin and dextrose
Potassium chloride
The following are ECG changes in hyperkalemia, except
Presence of U wave
Elevated ST segment
Prolonged QRS complex
Peaked T wave
The nurse reviews a client's electrolyte results and notes a potassium level of 5.5 mEq/L. The nurse understands that a potassium value at this level would be noted with which condition?
Traumatic burn injuries
Cushing's disease
Overuse of laxatives
Diarrhea
The nurse reviews a client's electrolyte results and notes a potassium level of 2.7 mEq/L. Which of the following would the nurse note on the cardiac monitor as a result of this laboratory value?
ST elevation
Peaked P wave
Prominent U wave
Peaked T wave
A client is diagnosed with hypoparathyroidism. The nurse would assess for what electrolyte imbalance as a result?
Hypocalcemia
Hypercalcemia
Hyperkalemia
Hypernatremia
The nurse is caring for a bedridden client admitted with a serum calcium level of 11 mg/dl. Which of the following is the most appropriate nursing action?
Provide passive ROM exercises and encourage fluid intake
Teach the client to increase intake of antacids
Measure intake and output
Provide meticulous skin care
A 26-year-old client has been complaining of profuse vomiting for 4 days. ABG analysis points out that the client suffers from metabolic alkalosis. As a prudent nurse, you will also anticipate what particular potassium imbalance the client might suffer from.
Hypokalemia
Hyperkalemia
Hypocalcemia
Hypercalcemia
A client's serum glucose level increased. This hyperglycemic state predisposes the client to manifest.
Hypokalemia
Hyperkalemia
Hypocalcemia
Hypercalcemia
Potassium chloride intravenously is prescribed for a client with hypokalemia. The following are the actions the nurse should take to plan for the preparation and administration of the potassium, EXCEPT
Assessment and monitoring of urine output prior and during administration, respectively
Preparing the medication for bolus administration
Monitoring the IV site for signs of infiltration or phlebitis
Ensuring that the medication is diluted in the appropriate volume of fluid
An elderly client is ordered to receive 4 bags of PRBC because of anemia. As a nurse, you would anticipate that the physician may order what particular medication after the last blood bag?
Potassium supplements
Sodium bicarbonate
Calcium gluconate
Keto-analogues
For the 1st 72 hours after thyroidectomy, the nurse should assess the client for possible risk of
Hypocalcemia
Hypercalcemia
Hypokalemia
Hyperkalemia
In clients whose serum calcium level is 12 mg/dL, the following may be administered to the client, EXCEPT
Corticosteroids
Furosemide
Vitamin D3
Plain NSS
A known hypertensive client is taking an ACE inhibitor. What Potassium imbalance would the client be at risk for developing
Hyperkalemia
Hypokalemia
Hypocalcemia
Hypercalcemia
A decrease in the aldosterone level, as in Addison's disease, would lead to what potassium imbalance?
Hyperkalemia
Hypokalemia
Hypocalcemia
Hypercalcemia
The client's serum potassium level is elevated in acute kidney disease, and the nurse administers sodium polystyrene sulfonate (Kayexalate). This drug acts to:
Exchange sodium for potassium ions in the colon, increasing potassium excretion from the colon.
Release hydrogen ions for sodium ions
Increase calcium absorption in the colon
Enhance entry of potassium back into cells
A client manifests a serum calcium level of 13 mEq/L. What hormone is stimulated to act on this abnormality to maintain balance?
Parathyroid Hormone
Aldosterone
Calcitonin
The doctor ordered calcium gluconate to be given slowly through intravenous infusion. This medication has to be diluted with
D5W solution
0.9% NaCl
LR solutions
3% NaCl
A client's lab test revealed that her serum calcium is 2.5 mEq/L. Which assessment data does the nurse document when a client diagnosed with hypocalcemia develops a carpopedal spasm after the blood-pressure cuffs inflated?
Positive Chvostek's sign
Positive Trousseau's sign
Tetany
Paresthesia
The client is manifesting circumoral numbness, paresthesia in extremities, and weakness of muscles. The following may be administered to the client, EXCEPT
IV fluid of Plain NSS
Calcium gluconate
D5W
You are taking care of a client who is in albumin supplementation. As the nurse, you would anticipate what particular calcium imbalance is if this supplementation goes unmonitored.
Hypercalcemia
Hypocalcemia
Hyperkalemia
Hypokalemia
The client had undergone multiple blood transfusions on the 5th day the client manifested signs and symptoms of tetany. This pathophysiologic change could be caused by
Release of too much calcium from red blood cells, increasing serum calcium level
The binding of calcium to hemoglobin decreases oxygen saturation and calcium level
Binding of calcium to citrate contained in the blood bag, decreasing serum calcium level
Release of potassium from red blood cells because of the breakdown of red blood cells
The body of a client whose serum calcium level is decreased will undergo compensation by the increase in the parathyroid hormone release. Based on your knowledge about the mechanism behind such compensatory reaction, you will then anticipate that the client might eventually be suffering from
Tetany
Hyperphosphatemia
Pathologic fractures
Carpopedal spasms
In a hypercalcemic state, the gland that will be stimulated to normalize serum calcium level will be
Parathyroid gland
Posterior pituitary gland
Hypothalamus
Thyroid gland
A client with renal insufficiency is to undergo electrolyte blood work. As a nurse, you understand that his condition will have an impact on his serum calcium level. What specific calcium imbalance will this client manifest?
Hypercalcemia
Hypocalcemia
Hyperkalemia
Hypokalemia
Hypoactive bowel sounds and subsequent manifestation of constipation are commonly seen in clients with
Hypocalcemia and hyperkalemia
Hypercalcemia and hypokalemia
Hypercalcemia and hyperkalemia
Hypocalcemia and hypokalemia
Among the etiologies stated, which is not an etiologic factor for hypokalemia?
Prolonged GI suctioning
Treatment for metabolic acidosis
Hyperinsulinism
Administration of stored blood
A patient has the following arterial blood gasses: HCO3 38, pH 7.50, PaCO2 50. Which of the following signs may this patient exhibit as a compensatory mechanism?
Hyperventilation (tachypnea)
Hypoventilation (bradypnea)
Increased potassium level (hyperkalemia)
Constipation
Which of the following is NOT a cause of metabolic acidosis?
Aspirin toxicity
Ileostomy
Hyperaldosteronism
Carbonic anhydrase inhibitors
Respiratory alkalosis can affect other electrolyte levels in the body. Which of the following electrolyte levels can also be affected in this condition?
Calcium level
Potassium level
Calcium and potassium levels
Which of the following is not a cause of respiratory acidosis?
Hypoventilation
Neuromuscular Disorder
Chronic Obstructive
Hyperventilation
The nurse is performing assessment in a client with acute kidney injury who is in the oliguric phase. Which among the assessment findings the nurse will not expect to note?
Increased serum creatinine level
A low and fixed specific gravity
Increased blood urea nitrogen (BUN) level
A urine output of 600 to 800 mL in a 24-hour period
You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
Which of the following would be a potential cause for respiratory acidosis?
Diarrhea
Vomiting
Hyperventilation
Hypoventilation
Which of the following may occur with respiratory acidosis?
CNS depression, cerebral arterial dilation, and peripheral vasoconstriction
Tetany and carpopedal spasm
Increased neuromuscular excitability with paresthesias
Alkaline urine and decreased PaCO2
A patient is experiencing respiratory acidosis due to brain trauma. Which of the following lab values correlates with this acid imbalance?
Potassium level of 6.0
Potassium level of 6.05
Potassium level of 6.10
Potassium level of 6.08
You are caring for a patient with respiratory acidosis. Which of the following results confirms this diagnosis?
pH 7.50, PCO2 52 mmHg
pH 7.35, PCO2 40 mmHg
pH 7.25, PCO2 50 mmHg
pH 5.50, PCO2 30 mmHg
Which acid-base imbalance could potentially occur for a patient with an ileostomy?
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
A client manifesting alkalosis may exhibit signs of an
Paresthesia and carpopedal spasms
Peaked T wave
Kidney Stones
Widened QRS complex
An individual ingests high amounts of fatty food. This predispose this person to manifests signs and symptoms of
Metabolic alkalosis
Metabolic acidosis
Respiratory alkalosis
Respiratory acidosis
An individual has figured in an accident and has lost massive amounts of blood. The physician ordered 4 bags of fresh whole blood to be administered to this client in series. What possible imbalance will this client be at risk for?
Metabolic alkalosis
Metabolic acidosis
Respiratory alkalosis
Respiratory acidosis
When analyzing an arterial blood gas report of a client with COPD and respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms?
The kidneys retain bicarbonate
The lungs increase alveolar ventilation
The kidneys excrete bicarbonate
The lungs decrease alveolar ventilation
A patient has metabolic acidosis due to diabetic ketoacidosis. Which of the following signs and symptoms would you expect to see in this patient?
Neuron excitability
Hypokalemia
Deep, rapid breathing
Hyperkalemia
In a client 4 minutes post cardiac arrest, the nurse correlates the largest source of excess hydrogen ions with which cause?
Renal retention of hydrogen ions
Excess bicarbonate loss in stool
Anaerobic metabolism leading to lactic acid buildup
Excess carbonic acid from hyperventilation
The nurse identifies a nursing diagnosis of risk for injury fracture related to alterations in calcium and phosphorus metabolism for a patient with chronic renal disease. The pathologic process directly related to the risk for fractures is
Impaired vitamin D activation resulting in increased GI absorption of calcium
Impaired vitamin E activation resulting in increase GI absorption of calcium
Impaired vitamin D activation resulting in decreased GI absorption of calcium
Impaired vitamin E activation resulting in decreased GI absorption of calcium
Hemorrhage, myocardial infarction and antihypertensive medications are examples of what specific causes of AKI?
Prerenal causes
Intrarenal causes
Postrenal causes
Hypercalcemia has caused the formation of calculi within ureters blocking urine flow to the bladder. This is one of the causes of AKI under one cluster. Among these clusters, where does this condition belong to?
Prerenal causes
Intrarenal causes
Postrenal causes
The physician orders regular insulin, 10 “u” added to 50 mL of 50% dextrose to be given intravenously to a client with renal failure. The expected outcome is to
Lower serum potassium level
Increase serum potassium level
Raise blood glucose level
Decrease serum sodium level
An elderly client is ordered to receive 4 bags of PRBC because of anemia. As a nurse, you would anticipate that the physician may order for what particular medication after the last blood bag?
Potassium supplements
Sodium bicarbonate
Calcium gluconate
Adequate amount of carbohydrates should be taken in by a uremic client to
Prevent hyperkalemia
Prevent hypoglycemia
Prevent accumulation of metabolic wastes
Prevent accumulation of amino acids
Hyperphosphatemia is one of the clinical manifestations of CKD. What medical intervention would be most appropriate to manage such?
Regular insulin and dextrose
Sodium bicarbonate
Epoetin alfa (Epogen)
Calcium acetate
Intrarenal causes include the following, EXCEPT:
Indiscriminate and prolonged use of NSAIDs
Use of ACE inhibitors
Myoglobinuria
Use of mannitol
In clients with CKI, their kidneys lose the ability to concentrate urine. What lab result should we look into?
Platelet count
Serum creatinine level
Urine specific gravity
Serum albumin level
Polystyrene sulfonate (Kayexalate) is used in renal failure to
Correct acidosis
Reduce serum phosphate levels
Exchange potassium for sodium for excretion of potassium
Prevent constipation
In the assessment of a client diagnosed with CKD, manifestations like circumoral numbness, paresthesia, positive Chvostek’s and Trousseau's signs are prominent. Bearing in mind the pathophysiologic cause of these manifestations, the client may be given?
Kayexalate
Regular insulin with 50% glucose
Calcium gluconate
Sodium bicarbonate
Ulceration of the gastric mucosa may be manifested by the client with renal injury. How could this be explained?
Ammonia, which is formed by the breakdown of urea by intestinal bacteria, irritates the gastric mucosa
Serum creatinine from protein metabolism
Increased phosphates in the gastric mucosa
Increased hydrochloric acid
Bleeding tendencies and anemia may be experienced by clients with AKI or CKD. The pathophysiologic causes of these two, except:
Increased serum calcium level
Gastric mucosal damage
Decreased erythropoietin production
Impaired platelet function
SITUATION: Arnolfo Dimautakan, 48 yrs old, was admitted in the hospital. After the laboratory tests were made he was diagnosed with Syndrome of Inappropriate Anti-diuretic Hormone (SIADH). The nurse recognizes that these signs and symptoms indicate the usual manifestation of SIADH.
Flat neck veins, tachypnea and tachycardia
Tachycardia, tachypnea, and hypertension
Narrowed pulse pressure and hypotension
Confusion, tremors and bradycardia
SITUATION: Arnolfo Dimautakan, 48 yrs old, was admitted in the hospital. After the laboratory tests were made he was diagnosed with Syndrome of Inappropriate Anti-diuretic Hormone (SIADH). Which assessment finding best supports a nursing diagnosis of Arnolfo Dimautakan as having fluid volume excess?
Bradypnea
tachycardia
pulmonary edema
Weight loss
SITUATION: Arnolfo Dimautakan, 48 yrs old, was admitted in the hospital. After the laboratory tests were made he was diagnosed with Syndrome of Inappropriate Anti-diuretic Hormone (SIADH). What nursing intervention would be the most accurate in evaluating Arnolfo Dimautakan fluid balance?
Measure the Intake and output
Check for tissue turgor
Evaluate changes in daily weight
Evaluate vital signs every 3 hours
SITUATION: Arnolfo Dimakulangan becomes restless. Vital signs reveal an elevated blood pressure with tachycardia. The nurse recognizes that these signs and symptoms indicate which of the following complications related to SIADH?
Increase ICP
Encephalopathy
Brain tumor
Meningitis
Basing on the knowledge about Arnolfo Dimautakan’s condition, which of the following electrolyte should the nurse watchful for?
Decreased sodium
Increased sodium
Increased potassium
Decreased potassium
What is an allergic reaction that can quickly deteriorate into shock and death?
Anaphylaxis
Graft-versus-host reaction
Serum sickness
Delayed-type hypersensitivity
In the treatment of the progressive stage of shock, the nurse would anticipate the use of:
Dobutamine
Dopamine
Amrinone
Norepinephrine
The nurse is administering heparin, subcutaneous twice daily, for a patient in cardiogenic shock. The expected action of this drug is as:
an inotropic to improve cardiac contractibility
an anticoagulant to prevent blood clots
an antidysrhythmic to restore normal cardiac contractibility
a vasopressor to increase blood pressure
While caring for an elderly client, notes that the patient has a low serum protein level. She will plan to assess for:
Confusion
restlessness
edema
pallor
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
Peripheral pulses
Lung sounds
Peripheral edema
Urinary output
