NCLEX Practice Exam for Fluids, Electrolytes & Homeostasis 2

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1.The net diffusion of water from one solution of water from one solution through a semipermeable membrane to another solution containing a lower concentration of water is termed:

  1. filtration
  2. diffusion
  3. osmosis
  4. brownian motion

2. When assessing a patient’s total body water percentage, the nurse is aware that all of the following factors influence this except:

  1. age
  2. fat tissue
  3. muscle mass
  4. gender

3. Orly Khan is suffering from fluid volume deficit (FVD), which of the following symptoms would the nurse expect to assess in the patient?

  1. rales
  2. bounding pulse
  3. tachycardia
  4. bulging neck veins

4. John Reid is admitted in the hospital and is currently receiving hypertonic fluids. Nursing management for the client includes monitoring for all of the following potential complications except:

  1. water intoxication
  2. fluid volume excess (FVE)
  3. cellular dehydration
  4. cell shrinkage

5. Mr. Alberto is scheduled to receive an isotonic solution; which one of the following is an example of such solution?

  1. D10% W
  2. 0.45% saline
  3. 0.9% saline
  4. 3% normal saline W

6. Which of the following arterial blood gas (ABG) values indicates uncompensated metabolic alkalosis?

  1. pH 7.48, PaCO2 42, HCO3 30
  2. pH 7.48, PaCO2 46, HCO3 30
  3. pH 7.48, PaCO2 34, HCO3 20
  4. pH 7.48, PaCO2 34, HCO3 26

7. The body’s compensation of metabolic alkalosis involves:

  1. increasing the respiratory rate
  2. decreasing the respiratory rate
  3. increasing urine output
  4. decreasing urine output

8. When assessing a patient for metabolic alkalosis, the nurse would expect to find:

  1. low serum potassium
  2. changes in urine output
  3. hypotension
  4. increased CVP

9. Which of the following blood products should be infused rapidly?

  1. packed red blood cells (PRBC)
  2. fresh frozen plasma (FFP)
  3. platelets
  4. dextran

10. Which of the following statements provides the rationale for using a hypotonic solution for a patient with FVD?

  1. A hypotonic solution provides free water to help the kidneys eliminate the solute.
  2. A hypotonic solution supplies an excess of sodium and chloride ions.
  3. Excessive volumes are recommended in the early postoperative period.
  4. A hypotonic solution is used to treat hyponatremia.

11. Brad is receiving a blood transfusion. When monitoring the patient, the nurse would analyze an elevated body temperature as indicating:

  1. a normal physiologic process
  2. evidence of sepsis
  3. a possible transfusion reaction
  4. an expected response to the transfusion

12. The process of endocrine regulation of electrolytes involves:

  1. sodium reabsorption and chloride excretion
  2. chloride reabsorption and sodium excretion
  3. potassium reabsorption and sodium excretion
  4. sodium reabsorption and potassium excretion

13. The chief anion in the intracellular fluid (ICF) is:

  1. phosphorus
  2. potassium
  3. sodium
  4. chloride

14. The major cation in the ICF is:

  1. potassium
  2. sodium
  3. phosphorus
  4. magnesium

15. Hypophosphatemia may result from which of the following diseases?

  1. liver cirrhosis
  2. renal failure
  3. Paget’s disease
  4. alcoholism

16. A patient with which of the following disorders is at high risk for developing hyperphosphatemia?

  1. hyperkalemia
  2. hyponatremia
  3. hypocalcemia
  4. hyperglycemia

17. Normal calcium levels must be analyzed in relation to:

  1. sodium
  2. glucose
  3. protein
  4. fats

18. Calcium is absorbed in the GI tract under the influence of:

  1. vitamin D
  2. glucose
  3. HCl
  4. vitamin C

19. Which of the following diagnoses is most appropriate for a patient with hypo calcemia?

  1. constipation, bowel
  2. high risk for injury: bleeding
  3. airway clearance, ineffective
  4. high risk for injury: confusion

20. When serum calcium levels rise, which of the following hormones is secreted?

  1. aldosterone
  2. renin
  3. parathyroid hormone
  4. calcitonin

21. The presence of which of the following electrolytes contributes to acidosis?

  1. sodium
  2. potassium
  3. hydrogen
  4. chloride

22. The lungs participate in acid-base balance by:

  1. reabsorbing bicarbonate
  2. splitting carbonic acid in two
  3. using CO2 to regulate hydrogen ions
  4. sending hydrogen ions to the renal tubules

23. The respiratory system regulates acid-base balance by:

  1. increasing mucus production
  2. changing the rate and depth of respirations
  3. forming bicarbonate
  4. reabsorbing bicarbonate

24. Which of the following is a gas component of the ABG measurement?

  1. carbon dioxide
  2. bicarbonate
  3. hydrogen
  4. pH

25. Chloride helps maintain acid-base balance by performing which of the following roles?

  1. participating in the chloride shift
  2. following sodium to maintain serum osmolarity
  3. maintaining the balance of cations in the ICF and ECF
  4. separating carbonic acid

26. Which of the following hormones helps regulate chloride reabsorption?

  1. antidiuretic hormone
  2. renin
  3. estrogen
  4. aldosterone

27. Chloride is absorbed in the:

  1. stomach
  2. bowel
  3. liver
  4. kidney

28. When chloride concentration drops below 95 mEq/L, reabsorption of which of the following electrolytes increases proportionally?

  1. hydrogen
  2. potassium
  3. sodium
  4. bicarbonate

29. Jonas is admitted with 1,000 ml of diarrhea per day for the last 3 days. An IV of 0.45% NaCl mixed with 5% dextrose is infusing. Which of the following nursing interventions is the most appropriate?

  1. Get an infusion controller from central supply.
  2. Mix all antibiotics in 0.45% NaCl with 5% dextrose.
  3. Check the patient’s potassium level and contact the doctor for IV additive orders.
  4. Assess the patient for signs of hyperkalemia.

30. Mrs. Waltraud is receiving digoxin and Lasix daily. Today, she complains of nausea, and her apical pulse is 130 and irregular. Which of the following nursing interventions is the most appropriate?

  1. Hold the digoxin and check the patient’s potassium level.
  2. Remove the orange juice from the patient’s tray.
  3. Identify the patient as high risk for hyperkalemia.
  4. Assess the patient for other signs of hypernatremia.

31. The type of fluid used to manipulate fluid shifts among compartments states is:

  1. whole blood
  2. TPN
  3. albumin
  4. Ensure

32. Mr. Miyazaki who is diagnosed of bipolar disorder has been drinking copious amounts of water and voiding frequently. The patient is experiencing muscle cramps, twitching, and is reporting dizziness. the nurse checks lab work for:

  1. complete blood count results, particularly the platelets.
  2. electrolytes, particularly the serum sodium
  3. urine analysis, particularly for the presence of white blood cells
  4. EEG results

33. When teaching a patient about foods high in magnesium, the nurse would include:

  1. green vegetables
  2. butter
  3. cheese
  4. tomatoes

34. The balance of anions and cations as it occurs across cell membranes is known as:

  1. osmotic activity
  2. electrical neutrality
  3. electrical stability
  4. sodium-potassium pump

35. Maria, an 85-year-old patient with a feeding tube, has been experiencing severe watery stool. The patient is lethargic and has poor skin turgor, a pulse of 120, and hyperactive reflexes. Nursing interventions would include:

  1. measuring and recording intake and output and daily weights
  2. administering salt tablets and monitoring hypertonic parenteral solutions
  3. administering sedatives
  4. applying wrist restraints to avoid displacement of the feeding tube

36. Disease of which of the following structures is most likely to affect electrolyte reabsorption?

  1. glomerulus
  2. renal tubules
  3. bladder
  4. renal pelvis

37. Analiza is diagnosed with hypermagnesemia. Symptoms of her condition may include:

  1. hypertension
  2. tachycardia
  3. hyperactive deep-tendon reflex
  4. cardiac arrhythmias

38. Daniel who is a marathon runner is at high risk for fluid volume deficit. Which one of the following is a related factor?

  1. decreased diuresis
  2. disease-related process
  3. decreased breathing and perspiration
  4. increased breathing and perspiration

39. Jordan is diagnosed with FVD; which of the following nursing diagnoses might apply to his condition?

  1. altered urinary elimination
  2. decreased cardiac output
  3. increased cardiac output
  4. vomiting

40. Body fluids perform which of the following functions?

  1. transport nutrients
  2. transport electrical charges
  3. cushion the organs
  4. facilitate fat metabolism

41. Sodium levels are affected by the secretion of which of the following hormones?

  1. progesterone and aldosterone
  2. ADH and ACTH
  3. antidiuretic hormone and FSH
  4. ECF and aldosterone

42. Bicarbonate is lost during which of the following clinical conditions?

  1. diarrhea
  2. diuresis
  3. diaphoresis
  4. vomiting

43. Magnesium reabsorption is controlled by:

  1. Loop of Henle
  2. glomerulus
  3. pituitary
  4. parathyroid hormone

44. Heidi has a nursing diagnosis of fluid volume deficit. Which one of the following medications could potentially exacerbate the problem?

  1. Synthroid
  2. Digoxin
  3. Lasix
  4. insulin

45. Alexander has hypotonic FVE; which of the following findings would the nurse expect to assess in the patient?

  1. poor skin turgor and increased thirst
  2. weight gain and thirst
  3. interstitial edema and hypertension
  4. hypotension and pitting edema

46. The interstitial space holds approximately how many liters?

  1. 3 L
  2. 6 L
  3. 9 L
  4. 12 L

47. Sodium balance is important for which of the following functions?

  1. transmitting impulses in nerve and muscle fibers via the calcium-potassium pump
  2. exchanging for magnesium and attracting chloride
  3. combining with hydrogen and chloride for acid-base balance
  4. exchanging for potassium and attracting chloride

48. In renal regulation of water balance, the functions of angiotensin II include:

  1. blood clotting within the nephron
  2. increasing progesterone secretion into the renal tubules
  3. catalyzing calcium-rich nutrients
  4. selectively constricting portions of the arteriole in the nephron

49. Which of the following nursing diagnoses might apply to a patient with hypertonic FVE?

  1. ineffective airway clearance
  2. potential for decreased cardiac output
  3. ineffective breathing pattern
  4. potential for increased cardiac output

50. The intracellular compartment holds water and:

  1. proteins
  2. glucose
  3. sodium
  4. uric acid

51. The majority gastrointestinal reabsorption of water occurs in:

  1. small intestines
  2. the esophagus
  3. the colon
  4. the stomach

52. Isotonic FVD can result from:

  1. GI fluid loss through diarrhea
  2. insensible water loss during prolonged fever
  3.  inadequate ingestion of fluids and electrolytes
  4. impaired thirst regulation

53. The majority of the body’s water is contained in which of the following fluid compartments?

  1. intracellular
  2. interstitial
  3. intravascular
  4. extracellular

54. Etiologies associated with hypomagnesemia include:

  1. decreased vitamin D intake
  2. constipation
  3. malabsorption syndrome
  4. renal failure

55. The danger of fluid sequestered in the third space is that the fluid:

  1. is hypertonic and can cause hypervolemia
  2. is hypotonic and can cause water intoxication
  3. is not available for circulation
  4. contains large amounts of acids

56. The extracellular fluid space holds water, electrolytes, proteins and:

  1. red blood cells
  2. potassium
  3. lipids
  4. nucleic acids

57. Magnesium performs all of the following functions except:

  1. contributing to vasoconstriction
  2.  assisting in cardiac muscle contraction
  3. facilitating sodium transport
  4. assisting in protein metabolism

58. Which of the following clinical conditions exacerbates electrolyte excretion?

  1. nasogastric feedings
  2. use of surgical drains
  3. immobility from fractures
  4. chronic water drinking

59. A diet containing the minimum daily sodium requirement for an adult would be:

  1. a no-salt diet
  2. a diet including 2 gm sodium
  3. a diet including 4 gm sodium
  4. a 1500 calorie weight-loss diet

60. Which of the following electrolytes are lost as a result of vomiting?

  1. bicarbonate and calcium
  2. sodium and hydrogen
  3. sodium and potassium
  4. hydrogen and potassium
Answers and Rationales
  1. Answer: C. osmosis. Osmosis is defined as the diffusion of water through a semipermeable membrane to a solution with a lower concentration of water. Filtration is the process in which fluids are pushed through biologic membranes by unequal processes. Diffusion (Brownian motion) is the random kinetic motion causing atoms and molecules to spread out evenly.
  2. Answer: D. gender. A patient’s gender does not influence the percentage of total body water.
  3. Answer: C. tachycardia. Tachycardia, poor tissue turgor, and hypotension are symptoms of FVD. Other choices are symptoms of FVE.
  4. Answer: A. water intoxication. Water intoxication is a potential complication associated with hypotonic fluid administration. Other choice are potential complication of hypertonic fluid administration.
  5. Answer: C. A solution of 0.9% saline is isotonic. A solution of 0.9% saline is isotonic. Solutions of 0.33% and 0.45% saline and D5W are hypotonic.
  6. Answer: A. pH 7.48, PaCO2 42, HCO3 30. Uncompensated metabolic alkalosis is indicated by ABG values of pH 7.48, PaCO2 42, and HCO3 30. B indicates metabolic alkalosis, partially compensated. C indicates respiratory alkalosis, partially compensated. D indicates respiratory alkalosis, uncompensated.
  7. Answer: B. decreasing the respiratory rate. The body attempts to compensate for metabolic alkalosis by decreasing the respiratory rate and conserving carbon dioxide (an acid). Urine volume does not influence acid-base balance.
  8. Answer: A. low serum potassium. Decreased serum potassium is a common symptom of metabolic alkalosis.
  9. Answer: C. platelets. Platelets and cryoprecipitate can be infused quickly. PRBC and FFP should be administered over 1 ½ to 4 hours. Dextran is not a blood product.
  10. Answer: A. A hypotonic solution provides free water to help the kidneys eliminate the solute. Hypotonic solutions provide free water, which helps the kidneys eliminate solute.
  11. Answer: C. a possible transfusion reaction. An increase in the body temperature indicates a possible transfusion reaction and requires immediate discontinuation of the infusion.
  12. Answer: D. sodium reabsorption and potassium excretion. ACTH stimulates release of aldosterone, which in turn acts on the tubules to reabsorb sodium. When this occurs, the cation potassium is excreted.
  13. Answer: A. phosphorus. Phosphorus is the major ICF cation. Potassium and sodium are cations. Chloride is the chief anion found in the ECF.
  14. Answer: A. potassium. Potassium is the major ICF cation. Sodium is the major ECF cation. Phosphorus is the major ICF anion. Magnesium is the second-most abundant cation in the ICF.
  15. Answer: D. alcoholism. Hypophosphatemia may occur secondary to alcoholism. Renal failure is usually associated with hyperphosphatemia
  16. Answer: C. hypocalcemia. Because calcium and phosphorus ratios are inversely proportional, when phosphorus levels are high, calcium levels are low.
  17. Answer: C. protein. Some calcium is bound to protein, so abnormal calcium levels are analyzed in relation to proteins.
  18. Answer: A. vitamin D. Calcium is absorbed in the GI tract under the influence of vitamin D in its biologically active form.
  19. Answer: B. high risk for injury: bleeding. A patient with hypocalcemia may bleed, since calcium is required for normal blood clotting. A and D are diagnoses appropriate for a patient with hypercalcemia. C is not associated with fluctuating calcium levels.
  20. Answer: D. calcitonin. When calcium levels rise, calcitonin is secreted from the thyroid; this hormone moves calcium from plasma into bone. Parathyroid hormone is secreted in response to lowered calcium levels; this hormone moves calcium from bone into plasma.
  21. Answer: C. hydrogen. The presence of hydrogen ions determines a solution’s acidity.
  22. Answer: C. using CO2 to regulate hydrogen ions. The lungs use carbon dioxide to regulate hydrogen ion concentration.
  23. Answer: B. changing the rate and depth of respirations. Through changes in the rate and depth of respirations, acid-base balance is achieved via CO2 elimination and retention. Mucus production is not part of the pulmonary regulatory system. C and D are responses that refer to ways in which kidneys balance acids and bases.
  24. Answer: A. carbon dioxide. The gases measured by ABGs are oxygen and carbon dioxide. Bicarbonate and hydrogen are ions; their ratio is measured in the pH.
  25. Answer: A. participating in the chloride shift. To maintain acid-base balance, chloride shifts into and out of red blood cells in exchange for bicarbonate.
  26. Answer: D. aldosterone. Chloride reabsorption depends on sodium reabsorption, which is regulated by aldosterone in the distal tubule and collecting ducts.
  27. Answer: B. bowel. Chloride is absorbed in the bowel, mainly the duodenum and jejunum.
  28. Answer: D. bicarbonate. When chloride concentrations drop below 95 mEq/L, bicarbonate reabsorption increases proportionally, causing metabolic alkalosis. Other choices are cations, chloride is an anion; a cation must always exchange for a cation in order to maintain electrical neutrality.
  29. Answer: C. Check the patient’s potassium level and contact the doctor for IV additive orders. Potassium is lost via the GI and renal systems. Prolonged or excessive diarrhea can lead to hypokalemia. In the event of hypokalemia, a potassium additive would likely be prescribed.
  30. Answer: A. Hold the digoxin and check the patient’s potassium level. Patient experiencing hypokalemia are at risk for digitalis toxicity. Nausea and irregular pulse are signs digitalis toxicity.
  31. Answer: C. albumin. Albumin is a colloid that is used to manipulate fluid shifts among compartments. Whole blood is used to replace blood volume. TPN is used for patients who are unable to take in food or fluid. Ensure is high caloric nutritional supplement; it is not used to manipulate fluid shifts.
  32. Answer: B. electrolytes, particularly the serum sodium. The patient is exhibiting behavior that could lead to a sodium and water imbalance and is exhibiting signs of hyponatremia. The nurse would check the electrolytes with attention to the sodium level.
  33. Answer: A. green vegetables. Green vegetables are high in magnesium.
  34. Answer: B. electrical neutrality. Electrical neutrality refers to a state in which the same number of positively charged ions and negatively charged ions are present on either side of the membrane. Osmotic activity refers to the attraction of a solute to a solvent. Sodium-potassium pump refers to the exchange of electrolytes.
  35. Answer: A. measuring and recording intake and output and daily weights. The patient is exhibiting signs of hypernatremia and dehydration. The most appropriate nursing intervention is to measure and record intake and output and daily weight.
  36. Answer: B. renal tubules. The renal tubules are the site of electrolyte reabsorption. The glomerulus is the site of electrolyte filtration. The bladder is where the urine is stored. The renal pelvis is where urine travels as it moves from the collecting ducts to the ureter.
  37. Answer: D. cardiac arrhythmias. Cardiac arrhythmias are associated with hypermagnesemia. Hypertension, tachycardia, and hyperactive reflexes are signs of hypomagnesemia.
  38. Answer: D. increased breathing and perspiration. Excessive fluid can be lost if breathing and perspiration are at an increased rate for a prolonged period.
  39. Answer: B. decreased cardiac output. Decreased cardiac output is a nursing diagnosis associated with isotonic FVD. Other appropriate nursing diagnoses include altered tissue perfusion, potential for injury, and ineffective breathing pattern.
  40. Answer: A. transport nutrients. Body fluids facilitate the transport of nutrients, hormones, proteins, and other molecules.
  41. Answer: B. ADH and ACTH. The endocrine system secretes aldosterone and ADH to help regulate sodium levels. The pituitary secretes adrenocorticotropin hormone to help regulate sodium. A and C are reproductive hormones. ECF is not a hormone.
  42. Answer: A. diarrhea. Bicarbonate is lost in diarrhea because the lower intestinal tract contains fluids rich in bicarbonate.
  43. Answer: A. Loop of Henle. The Loop of Henle is responsible for magnesium reabsorption.
  44. Answer: C. Lasix. Lasix will contribute to fluid loss through its action as a diuretic.
  45. Answer: B. weight gain and thirst. Weight gain and thirst are symptoms of hypotonic FVE; other symptoms include excretion of dilute urine, non-pitting edema, dysrhythmias, and hyponatremia.
  46. Answer: C. 9 L. The interstitial space hold 9 L.
  47. Answer: D. exchanging for potassium and attracting chloride. Sodium influences the levels of potassium and chloride by exchanging for potassium and attracting chloride.
  48. Answer: D. selectively constricting portions of the arteriole in the nephron. As part of the renal regulation of water balance, angiotensin II selectively constricts portions of the arteriole in the nephron.
  49. Answer: B. potential for decreased cardiac output. Potential for decreased cardiac output is a nursing diagnosis associated with hypertonic FVE.
  50. Answer: A. proteins. The intracellular compartment holds large amounts of water and proteins. Potassium, lipids, and nucleic acids are also components of the intracellular compartment.
  51. Answer: A. small intestines. Approximately 85% to 95% of water absorption takes place in the small intestine. The colon absorbs only 500 to 100 cc.
  52. Answer: C. inadequate ingestion of fluids and electrolytes. Isotonic FVD may result from inadequate intake of fluids and electrolytes that can occur secondary to an inability to ingest orally. GI fluid loss through diarrhea is an etiology of hypotonic FVD. Insensible water loss during prolonged fever is a cause of hypertonic FVD. Impaired thirst regulation is a cause of hypertonic FVD.
  53. Answer: A. intracellular. The intracellular compartment holds two-thirds of total body water. The extracellular compartment is the interstitial space plus the intravascular space. The extracellular compartment accounts for one-third of total body water.
  54. Answer: C. malabsorption syndrome. Malabsorption syndrome is associated with hypomagnesemia. Increased vitamin D intake and diarrhea are also associated with hypomagnesemia.
  55. Answer: C. is not available for circulation. In third-spacing, fluid is sequestered and is unavailable to the general circulation.
  56. Answer: A. red blood cells. The extracellular space contains red blood cells, white blood cells, and platelets in addition to water, electrolytes, and proteins. Potassium, lipids, and nucleic acids are intracellular components.
  57. Answer: A. contributing to vasoconstriction. Magnesium contributes to vasodilation, not vasoconstriction.
  58. Answer: B. use of surgical drains. Surgical drains will cause a fluid loss, and electrolytes are eliminated along with the fluid.
  59. Answer: B. a diet including 2 gm sodium. The minimum sodium requirement for adults is 2 gm daily. Most adults consume more than this because sodium is abundant in almost all foods.
  60. Answer: D. hydrogen and potassium. In upper gastrointestinal fluid loss, hydrogen and potassium are lost because these electrolytes are present in abundance in the stomach.
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