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NCLEX Practice Exam for Fluids, Electrolytes & Homeostasis 2 (PM)*
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Question 1
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:
A
complete blood count results, particularly the platelets.
B
electrolytes, particularly the serum sodium
C
urine analysis, particularly for the presence of white blood cells
D
EEG results
Question 1 Explanation:
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.
Question 2
The type of fluid used to manipulate fluid shifts among compartments states is:
A
whole blood
B
TPN
C
albumin
D
Ensure
Question 2 Explanation:
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.
Question 3
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?
A
Hold the digoxin and check the patient’s potassium level.
B
Remove the orange juice from the patient’s tray.
C
Identify the patient as high risk for hyperkalemia.
D
Assess the patient for other signs of hypernatremia.
Question 3 Explanation:
Patient experiencing hypokalemia are at risk for digitalis toxicity. Nausea and irregular pulse are signs digitalis toxicity.
Question 4
Sodium balance is important for which of the following functions?
A
transmitting impulses in nerve and muscle fibers via the calcium-potassium pump
B
exchanging for magnesium and attracting chloride
C
combining with hydrogen and chloride for acid-base balance
D
exchanging for potassium and attracting chloride
Question 4 Explanation:
exchanging for potassium and attracting chloride. Sodium influences the levels of potassium and chloride by exchanging for potassium and attracting chloride.
Question 5
When teaching a patient about foods high in magnesium, the nurse would include:
A
green vegetables
B
butter
C
cheese
D
tomatoes
Question 5 Explanation:
Green vegetables are high in magnesium.
Question 6
Normal calcium levels must be analyzed in relation to:
A
sodium
B
glucose
C
protein
D
fats
Question 6 Explanation:
Some calcium is bound to protein, so abnormal calcium levels are analyzed in relation to proteins.
Question 7
Etiologies associated with hypomagnesemia include:
A
decreased vitamin D intake
B
constipation
C
malabsorption syndrome
D
renal failure
Question 7 Explanation:
Malabsorption syndrome is associated with hypomagnesemia. Increased vitamin D intake and diarrhea are also associated with hypomagnesemia.
Question 8
A patient with which of the following disorders is at high risk for developing hyperphosphatemia?
A
hyperkalemia
B
hyponatremia
C
hypocalcemia
D
hyperglycemia
Question 8 Explanation:
Because calcium and phosphorus ratios are inversely proportional, when phosphorus levels are high, calcium levels are low.
Question 9
Which of the following statements provides the rationale for using a hypotonic solution for a patient with FVD?
A
A hypotonic solution provides free water to help the kidneys eliminate the solute.
B
A hypotonic solution supplies an excess of sodium and chloride ions.
C
Excessive volumes are recommended in the early postoperative period.
D
A hypotonic solution is used to treat hyponatremia.
Question 9 Explanation:
Hypotonic solutions provide free water, which helps the kidneys eliminate solute.
Question 10
A diet containing the minimum daily sodium requirement for an adult would be:
A
a no-salt diet
B
a diet including 2 gm sodium
C
a diet including 4 gm sodium
D
a 1500 calorie weight-loss diet
Question 10 Explanation:
The minimum sodium requirement for adults is 2 gm daily. Most adults consume more than this because sodium is abundant in almost all foods.
Question 11
The balance of anions and cations as it occurs across cell membranes is known as:
A
osmotic activity
B
electrical neutrality
C
electrical stability
D
sodium-potassium pump
Question 11 Explanation:
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.
Question 12
Hypophosphatemia may result from which of the following diseases?
A
liver cirrhosis
B
renal failure
C
Paget’s disease
D
alcoholism
Question 12 Explanation:
Hypophosphatemia may occur secondary to alcoholism. Renal failure is usually associated with hyperphosphatemia
Question 13
Which of the following electrolytes are lost as a result of vomiting?
A
bicarbonate and calcium
B
sodium and hydrogen
C
sodium and potassium
D
hydrogen and potassium
Question 13 Explanation:
In upper gastrointestinal fluid loss, hydrogen and potassium are lost because these electrolytes are present in abundance in the stomach.
Question 14
Calcium is absorbed in the GI tract under the influence of:
A
vitamin D
B
glucose
C
HCl
D
vitamin C
Question 14 Explanation:
Calcium is absorbed in the GI tract under the influence of vitamin D in its biologically active form.
Question 15
Which of the following clinical conditions exacerbates electrolyte excretion?
A
nasogastric feedings
B
use of surgical drains
C
immobility from fractures
D
chronic water drinking
Question 15 Explanation:
Surgical drains will cause a fluid loss, and electrolytes are eliminated along with the fluid.
Question 16
When chloride concentration drops below 95 mEq/L, reabsorption of which of the following electrolytes increases proportionally?
A
hydrogen
B
potassium
C
sodium
D
bicarbonate
Question 16 Explanation:
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.
Question 17
The respiratory system regulates acid-base balance by:
A
increasing mucus production
B
changing the rate and depth of respirations
C
forming bicarbonate
D
reabsorbing bicarbonate
Question 17 Explanation:
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.
Question 18
The chief anion in the intracellular fluid (ICF) is:
A
phosphorus
B
potassium
C
sodium
D
chloride
Question 18 Explanation:
Phosphorus is the major ICF cation. Potassium and sodium are cations. Chloride is the chief anion found in the ECF.
Question 19
Alexander has hypotonic FVE; which of the following findings would the nurse expect to assess in the patient?
A
poor skin turgor and increased thirst
B
weight gain and thirst
C
interstitial edema and hypertension
D
hypotension and pitting edema
Question 19 Explanation:
Weight gain and thirst are symptoms of hypotonic FVE; other symptoms include excretion of dilute urine, non-pitting edema, dysrhythmias, and hyponatremia.
Question 20
Orly Khan is suffering from fluid volume deficit (FVD), which of the following symptoms would the nurse expect to assess in the patient?
A
rales
B
bounding pulse
C
tachycardia
D
bulging neck veins
Question 20 Explanation:
Tachycardia, poor tissue turgor, and hypotension are symptoms of FVD. Other choices are symptoms of FVE.
Question 21
When serum calcium levels rise, which of the following hormones is secreted?
A
aldosterone
B
renin
C
parathyroid hormone
D
calcitonin
Question 21 Explanation:
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.
Question 22
Magnesium performs all of the following functions except:
A
contributing to vasoconstriction
B
assisting in cardiac muscle contraction
C
facilitating sodium transport
D
assisting in protein metabolism
Question 22 Explanation:
Magnesium contributes to vasodilation, not vasoconstriction.
Question 23
Which of the following hormones helps regulate chloride reabsorption?
A
antidiuretic hormone
B
renin
C
estrogen
D
aldosterone
Question 23 Explanation:
Chloride reabsorption depends on sodium reabsorption, which is regulated by aldosterone in the distal tubule and collecting ducts.
Question 24
Which of the following blood products should be infused rapidly?
A
packed red blood cells (PRBC)
B
fresh frozen plasma (FFP)
C
platelets
D
dextran
Question 24 Explanation:
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.
Question 25
The intracellular compartment holds water and:
A
proteins
B
glucose
C
sodium
D
uric acid
Question 25 Explanation:
The intracellular compartment holds large amounts of water and proteins. Potassium, lipids, and nucleic acids are also components of the intracellular compartment.
Question 26
Mr. Alberto is scheduled to receive an isotonic solution; which one of the following is an example of such solution?
A
D10% W
B
0.45% saline
C
0.9% saline
D
3% normal saline W
Question 26 Explanation:
A solution of 0.9% saline is isotonic. Solutions of 0.33% and 0.45% saline and D5W are hypotonic.
Question 27
Chloride helps maintain acid-base balance by performing which of the following roles?
A
participating in the chloride shift
B
following sodium to maintain serum osmolarity
C
maintaining the balance of cations in the ICF and ECF
D
separating carbonic acid
Question 27 Explanation:
To maintain acid-base balance, chloride shifts into and out of red blood cells in exchange for bicarbonate.
Question 28
In renal regulation of water balance, the functions of angiotensin II include:
A
blood clotting within the nephron
B
increasing progesterone secretion into the renal tubules
C
catalyzing calcium-rich nutrients
D
selectively constricting portions of the arteriole in the nephron
Question 28 Explanation:
As part of the renal regulation of water balance, angiotensin II selectively constricts portions of the arteriole in the nephron.
Question 29
The extracellular fluid space holds water, electrolytes, proteins and:
A
red blood cells
B
potassium
C
lipids
D
nucleic acids
Question 29 Explanation:
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.
Question 30
Heidi has a nursing diagnosis of fluid volume deficit. Which one of the following medications could potentially exacerbate the problem?
A
Synthroid
B
Digoxin
C
Lasix
D
insulin
Question 30 Explanation:
Lasix will contribute to fluid loss through its action as a diuretic.
Question 31
Chloride is absorbed in the:
A
stomach
B
bowel
C
liver
D
kidney
Question 31 Explanation:
Chloride is absorbed in the bowel, mainly the duodenum and jejunum.
Question 32
Isotonic FVD can result from:
A
GI fluid loss through diarrhea
B
insensible water loss during prolonged fever
C
inadequate ingestion of fluids and electrolytes
D
impaired thirst regulation
Question 32 Explanation:
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.
Question 33
The lungs participate in acid-base balance by:
A
reabsorbing bicarbonate
B
splitting carbonic acid in two
C
using CO2 to regulate hydrogen ions
D
sending hydrogen ions to the renal tubules
Question 33 Explanation:
The lungs use carbon dioxide to regulate hydrogen ion concentration.
Question 34
When assessing a patient for metabolic alkalosis, the nurse would expect to find:
A
low serum potassium
B
changes in urine output
C
hypotension
D
increased CVP
Question 34 Explanation:
Decreased serum potassium is a common symptom of metabolic alkalosis.
Question 35
The majority gastrointestinal reabsorption of water occurs in:
A
small intestines
B
the esophagus
C
the colon
D
the stomach
Question 35 Explanation:
Approximately 85% to 95% of water absorption takes place in the small intestine. The colon absorbs only 500 to 100 cc.
Question 36
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:
A
filtration
B
diffusion
C
osmosis
D
brownian motion
Question 36 Explanation:
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.
Question 37
The process of endocrine regulation of electrolytes involves:
A
sodium reabsorption and chloride excretion
B
chloride reabsorption and sodium excretion
C
potassium reabsorption and sodium excretion
D
sodium reabsorption and potassium excretion
Question 37 Explanation:
ACTH stimulates release of aldosterone, which in turn acts on the tubules to reabsorb sodium. When this occurs, the cation potassium is excreted.
Question 38
When assessing a patient’s total body water percentage, the nurse is aware that all of the following factors influence this except:
A
age
B
fat tissue
C
muscle mass
D
gender
Question 38 Explanation:
A patient’s gender does not influence the percentage of total body water.
Question 39
The danger of fluid sequestered in the third space is that the fluid:
A
is hypertonic and can cause hypervolemia
B
is hypotonic and can cause water intoxication
C
is not available for circulation
D
contains large amounts of acids
Question 39 Explanation:
In third-spacing, fluid is sequestered and is unavailable to the general circulation.
Question 40
Which of the following diagnoses is most appropriate for a patient with hypo calcemia?
A
constipation, bowel
B
high risk for injury: bleeding
C
airway clearance, ineffective
D
high risk for injury: confusion
Question 40 Explanation:
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.
Question 41
The major cation in the ICF is:
A
potassium
B
sodium
C
phosphorus
D
magnesium
Question 41 Explanation:
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.
Question 42
Sodium levels are affected by the secretion of which of the following hormones?
A
progesterone and aldosterone
B
ADH and ACTH
C
antidiuretic hormone and FSH
D
ECF and aldosterone
Question 42 Explanation:
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.
Question 43
Daniel who is a marathon runner is at high risk for fluid volume deficit. Which one of the following is a related factor?
A
decreased diuresis
B
disease-related process
C
decreased breathing and perspiration
D
increased breathing and perspiration
Question 43 Explanation:
Excessive fluid can be lost if breathing and perspiration are at an increased rate for a prolonged period.
Question 44
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:
A
water intoxication
B
fluid volume excess (FVE)
C
cellular dehydration
D
cell shrinkage
Question 44 Explanation:
Water intoxication is a potential complication associated with hypotonic fluid administration. Other choice are potential complication of hypertonic fluid administration.
Question 45
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:
A
measuring and recording intake and output and daily weights
B
administering salt tablets and monitoring hypertonic parenteral solutions
C
administering sedatives
D
applying wrist restraints to avoid displacement of the feeding tube
Question 45 Explanation:
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.
Question 46
The presence of which of the following electrolytes contributes to acidosis?
A
sodium
B
potassium
C
hydrogen
D
chloride
Question 46 Explanation:
The presence of hydrogen ions determines a solution’s acidity.
Question 47
The majority of the body’s water is contained in which of the following fluid compartments?
A
intracellular
B
interstitial
C
intravascular
D
extracellular
Question 47 Explanation:
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.
Question 48
Which of the following nursing diagnoses might apply to a patient with hypertonic FVE?
A
ineffective airway clearance
B
potential for decreased cardiac output
C
ineffective breathing pattern
D
potential for increased cardiac output
Question 48 Explanation:
Potential for decreased cardiac output is a nursing diagnosis associated with hypertonic FVE.
Question 49
Jordan is diagnosed with FVD; which of the following nursing diagnoses might apply to his condition?
A
altered urinary elimination
B
decreased cardiac output
C
increased cardiac output
D
vomiting
Question 49 Explanation:
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.
Question 50
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?
A
Get an infusion controller from central supply.
B
Mix all antibiotics in 0.45% NaCl with 5% dextrose.
C
Check the patient’s potassium level and contact the doctor for IV additive orders.
D
Assess the patient for signs of hyperkalemia.
Question 50 Explanation:
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.
Question 51
Disease of which of the following structures is most likely to affect electrolyte reabsorption?
A
glomerulus
B
renal tubules
C
bladder
D
renal pelvis
Question 51 Explanation:
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.
Question 52
Bicarbonate is lost during which of the following clinical conditions?
A
diarrhea
B
diuresis
C
diaphoresis
D
vomiting
Question 52 Explanation:
Bicarbonate is lost in diarrhea because the lower intestinal tract contains fluids rich in bicarbonate.
Question 53
Body fluids perform which of the following functions?
A
transport nutrients
B
transport electrical charges
C
cushion the organs
D
facilitate fat metabolism
Question 53 Explanation:
Body fluids facilitate the transport of nutrients, hormones, proteins, and other molecules.
Question 54
Analiza is diagnosed with hypermagnesemia. Symptoms of her condition may include:
A
hypertension
B
tachycardia
C
hyperactive deep-tendon reflex
D
cardiac arrhythmias
Question 54 Explanation:
Cardiac arrhythmias are associated with hypermagnesemia. Hypertension, tachycardia, and hyperactive reflexes are signs of hypomagnesemia.
Question 55
Brad is receiving a blood transfusion. When monitoring the patient, the nurse would analyze an elevated body temperature as indicating:
A
a normal physiologic process
B
evidence of sepsis
C
a possible transfusion reaction
D
an expected response to the transfusion
Question 55 Explanation:
An increase in the body temperature indicates a possible transfusion reaction and requires immediate discontinuation of the infusion.
Question 56
Which of the following arterial blood gas (ABG) values indicates uncompensated metabolic alkalosis?
A
pH 7.48, PaCO2 42, HCO3 30
B
pH 7.48, PaCO2 46, HCO3 30
C
pH 7.48, PaCO2 34, HCO3 20
D
pH 7.48, PaCO2 34, HCO3 26
Question 56 Explanation:
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.
Question 57
Which of the following is a gas component of the ABG measurement?
A
carbon dioxide
B
bicarbonate
C
hydrogen
D
pH
Question 57 Explanation:
The gases measured by ABGs are oxygen and carbon dioxide. Bicarbonate and hydrogen are ions; their ratio is measured in the pH.
Question 58
Magnesium reabsorption is controlled by:
A
Loop of Henle
B
glomerulus
C
pituitary
D
parathyroid hormone
Question 58 Explanation:
The Loop of Henle is responsible for magnesium reabsorption.
Question 59
The interstitial space holds approximately how many liters?
A
3 L
B
6 L
C
9 L
D
12 L
Question 59 Explanation:
The interstitial space hold 9 L.
Question 60
The body’s compensation of metabolic alkalosis involves:
A
increasing the respiratory rate
B
decreasing the respiratory rate
C
increasing urine output
D
decreasing urine output
Question 60 Explanation:
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.
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NCLEX Practice Exam for Fluids, Electrolytes & Homeostasis 2 (EM)*
Choose the letter of the correct answer. You have 60 mins to finish this exam.
Start
Congratulations - you have completed NCLEX Practice Exam for Fluids, Electrolytes & Homeostasis 2 (EM)*.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
The lungs participate in acid-base balance by:
A
reabsorbing bicarbonate
B
splitting carbonic acid in two
C
using CO2 to regulate hydrogen ions
D
sending hydrogen ions to the renal tubules
Question 1 Explanation:
The lungs use carbon dioxide to regulate hydrogen ion concentration.
Question 2
Bicarbonate is lost during which of the following clinical conditions?
A
diarrhea
B
diuresis
C
diaphoresis
D
vomiting
Question 2 Explanation:
Bicarbonate is lost in diarrhea because the lower intestinal tract contains fluids rich in bicarbonate.
Question 3
A diet containing the minimum daily sodium requirement for an adult would be:
A
a no-salt diet
B
a diet including 2 gm sodium
C
a diet including 4 gm sodium
D
a 1500 calorie weight-loss diet
Question 3 Explanation:
The minimum sodium requirement for adults is 2 gm daily. Most adults consume more than this because sodium is abundant in almost all foods.
Question 4
When chloride concentration drops below 95 mEq/L, reabsorption of which of the following electrolytes increases proportionally?
A
hydrogen
B
potassium
C
sodium
D
bicarbonate
Question 4 Explanation:
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.
Question 5
The danger of fluid sequestered in the third space is that the fluid:
A
is hypertonic and can cause hypervolemia
B
is hypotonic and can cause water intoxication
C
is not available for circulation
D
contains large amounts of acids
Question 5 Explanation:
In third-spacing, fluid is sequestered and is unavailable to the general circulation.
Question 6
Jordan is diagnosed with FVD; which of the following nursing diagnoses might apply to his condition?
A
altered urinary elimination
B
decreased cardiac output
C
increased cardiac output
D
vomiting
Question 6 Explanation:
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.
Question 7
Which of the following electrolytes are lost as a result of vomiting?
A
bicarbonate and calcium
B
sodium and hydrogen
C
sodium and potassium
D
hydrogen and potassium
Question 7 Explanation:
In upper gastrointestinal fluid loss, hydrogen and potassium are lost because these electrolytes are present in abundance in the stomach.
Question 8
The extracellular fluid space holds water, electrolytes, proteins and:
A
red blood cells
B
potassium
C
lipids
D
nucleic acids
Question 8 Explanation:
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.
Question 9
Analiza is diagnosed with hypermagnesemia. Symptoms of her condition may include:
A
hypertension
B
tachycardia
C
hyperactive deep-tendon reflex
D
cardiac arrhythmias
Question 9 Explanation:
Cardiac arrhythmias are associated with hypermagnesemia. Hypertension, tachycardia, and hyperactive reflexes are signs of hypomagnesemia.
Question 10
Which of the following nursing diagnoses might apply to a patient with hypertonic FVE?
A
ineffective airway clearance
B
potential for decreased cardiac output
C
ineffective breathing pattern
D
potential for increased cardiac output
Question 10 Explanation:
Potential for decreased cardiac output is a nursing diagnosis associated with hypertonic FVE.
Question 11
Normal calcium levels must be analyzed in relation to:
A
sodium
B
glucose
C
protein
D
fats
Question 11 Explanation:
Some calcium is bound to protein, so abnormal calcium levels are analyzed in relation to proteins.
Question 12
In renal regulation of water balance, the functions of angiotensin II include:
A
blood clotting within the nephron
B
increasing progesterone secretion into the renal tubules
C
catalyzing calcium-rich nutrients
D
selectively constricting portions of the arteriole in the nephron
Question 12 Explanation:
As part of the renal regulation of water balance, angiotensin II selectively constricts portions of the arteriole in the nephron.
Question 13
Which of the following is a gas component of the ABG measurement?
A
carbon dioxide
B
bicarbonate
C
hydrogen
D
pH
Question 13 Explanation:
The gases measured by ABGs are oxygen and carbon dioxide. Bicarbonate and hydrogen are ions; their ratio is measured in the pH.
Question 14
Hypophosphatemia may result from which of the following diseases?
A
liver cirrhosis
B
renal failure
C
Paget’s disease
D
alcoholism
Question 14 Explanation:
Hypophosphatemia may occur secondary to alcoholism. Renal failure is usually associated with hyperphosphatemia
Question 15
Calcium is absorbed in the GI tract under the influence of:
A
vitamin D
B
glucose
C
HCl
D
vitamin C
Question 15 Explanation:
Calcium is absorbed in the GI tract under the influence of vitamin D in its biologically active form.
Question 16
The intracellular compartment holds water and:
A
proteins
B
glucose
C
sodium
D
uric acid
Question 16 Explanation:
The intracellular compartment holds large amounts of water and proteins. Potassium, lipids, and nucleic acids are also components of the intracellular compartment.
Question 17
Daniel who is a marathon runner is at high risk for fluid volume deficit. Which one of the following is a related factor?
A
decreased diuresis
B
disease-related process
C
decreased breathing and perspiration
D
increased breathing and perspiration
Question 17 Explanation:
Excessive fluid can be lost if breathing and perspiration are at an increased rate for a prolonged period.
Question 18
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:
A
measuring and recording intake and output and daily weights
B
administering salt tablets and monitoring hypertonic parenteral solutions
C
administering sedatives
D
applying wrist restraints to avoid displacement of the feeding tube
Question 18 Explanation:
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.
Question 19
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?
A
Hold the digoxin and check the patient’s potassium level.
B
Remove the orange juice from the patient’s tray.
C
Identify the patient as high risk for hyperkalemia.
D
Assess the patient for other signs of hypernatremia.
Question 19 Explanation:
Patient experiencing hypokalemia are at risk for digitalis toxicity. Nausea and irregular pulse are signs digitalis toxicity.
Question 20
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:
A
water intoxication
B
fluid volume excess (FVE)
C
cellular dehydration
D
cell shrinkage
Question 20 Explanation:
Water intoxication is a potential complication associated with hypotonic fluid administration. Other choice are potential complication of hypertonic fluid administration.
Question 21
Which of the following clinical conditions exacerbates electrolyte excretion?
A
nasogastric feedings
B
use of surgical drains
C
immobility from fractures
D
chronic water drinking
Question 21 Explanation:
Surgical drains will cause a fluid loss, and electrolytes are eliminated along with the fluid.
Question 22
The interstitial space holds approximately how many liters?
A
3 L
B
6 L
C
9 L
D
12 L
Question 22 Explanation:
The interstitial space hold 9 L.
Question 23
When assessing a patient for metabolic alkalosis, the nurse would expect to find:
A
low serum potassium
B
changes in urine output
C
hypotension
D
increased CVP
Question 23 Explanation:
Decreased serum potassium is a common symptom of metabolic alkalosis.
Question 24
Alexander has hypotonic FVE; which of the following findings would the nurse expect to assess in the patient?
A
poor skin turgor and increased thirst
B
weight gain and thirst
C
interstitial edema and hypertension
D
hypotension and pitting edema
Question 24 Explanation:
Weight gain and thirst are symptoms of hypotonic FVE; other symptoms include excretion of dilute urine, non-pitting edema, dysrhythmias, and hyponatremia.
Question 25
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:
A
filtration
B
diffusion
C
osmosis
D
brownian motion
Question 25 Explanation:
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.
Question 26
Body fluids perform which of the following functions?
A
transport nutrients
B
transport electrical charges
C
cushion the organs
D
facilitate fat metabolism
Question 26 Explanation:
Body fluids facilitate the transport of nutrients, hormones, proteins, and other molecules.
Question 27
When assessing a patient’s total body water percentage, the nurse is aware that all of the following factors influence this except:
A
age
B
fat tissue
C
muscle mass
D
gender
Question 27 Explanation:
A patient’s gender does not influence the percentage of total body water.
Question 28
Chloride is absorbed in the:
A
stomach
B
bowel
C
liver
D
kidney
Question 28 Explanation:
Chloride is absorbed in the bowel, mainly the duodenum and jejunum.
Question 29
Brad is receiving a blood transfusion. When monitoring the patient, the nurse would analyze an elevated body temperature as indicating:
A
a normal physiologic process
B
evidence of sepsis
C
a possible transfusion reaction
D
an expected response to the transfusion
Question 29 Explanation:
An increase in the body temperature indicates a possible transfusion reaction and requires immediate discontinuation of the infusion.
Question 30
Isotonic FVD can result from:
A
GI fluid loss through diarrhea
B
insensible water loss during prolonged fever
C
inadequate ingestion of fluids and electrolytes
D
impaired thirst regulation
Question 30 Explanation:
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.
Question 31
Which of the following statements provides the rationale for using a hypotonic solution for a patient with FVD?
A
A hypotonic solution provides free water to help the kidneys eliminate the solute.
B
A hypotonic solution supplies an excess of sodium and chloride ions.
C
Excessive volumes are recommended in the early postoperative period.
D
A hypotonic solution is used to treat hyponatremia.
Question 31 Explanation:
Hypotonic solutions provide free water, which helps the kidneys eliminate solute.
Question 32
When serum calcium levels rise, which of the following hormones is secreted?
A
aldosterone
B
renin
C
parathyroid hormone
D
calcitonin
Question 32 Explanation:
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.
Question 33
Magnesium performs all of the following functions except:
A
contributing to vasoconstriction
B
assisting in cardiac muscle contraction
C
facilitating sodium transport
D
assisting in protein metabolism
Question 33 Explanation:
Magnesium contributes to vasodilation, not vasoconstriction.
Question 34
Magnesium reabsorption is controlled by:
A
Loop of Henle
B
glomerulus
C
pituitary
D
parathyroid hormone
Question 34 Explanation:
The Loop of Henle is responsible for magnesium reabsorption.
Question 35
A patient with which of the following disorders is at high risk for developing hyperphosphatemia?
A
hyperkalemia
B
hyponatremia
C
hypocalcemia
D
hyperglycemia
Question 35 Explanation:
Because calcium and phosphorus ratios are inversely proportional, when phosphorus levels are high, calcium levels are low.
Question 36
The process of endocrine regulation of electrolytes involves:
A
sodium reabsorption and chloride excretion
B
chloride reabsorption and sodium excretion
C
potassium reabsorption and sodium excretion
D
sodium reabsorption and potassium excretion
Question 36 Explanation:
ACTH stimulates release of aldosterone, which in turn acts on the tubules to reabsorb sodium. When this occurs, the cation potassium is excreted.
Question 37
Sodium balance is important for which of the following functions?
A
transmitting impulses in nerve and muscle fibers via the calcium-potassium pump
B
exchanging for magnesium and attracting chloride
C
combining with hydrogen and chloride for acid-base balance
D
exchanging for potassium and attracting chloride
Question 37 Explanation:
exchanging for potassium and attracting chloride. Sodium influences the levels of potassium and chloride by exchanging for potassium and attracting chloride.
Question 38
Which of the following diagnoses is most appropriate for a patient with hypo calcemia?
A
constipation, bowel
B
high risk for injury: bleeding
C
airway clearance, ineffective
D
high risk for injury: confusion
Question 38 Explanation:
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.
Question 39
Chloride helps maintain acid-base balance by performing which of the following roles?
A
participating in the chloride shift
B
following sodium to maintain serum osmolarity
C
maintaining the balance of cations in the ICF and ECF
D
separating carbonic acid
Question 39 Explanation:
To maintain acid-base balance, chloride shifts into and out of red blood cells in exchange for bicarbonate.
Question 40
The body’s compensation of metabolic alkalosis involves:
A
increasing the respiratory rate
B
decreasing the respiratory rate
C
increasing urine output
D
decreasing urine output
Question 40 Explanation:
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.
Question 41
Which of the following hormones helps regulate chloride reabsorption?
A
antidiuretic hormone
B
renin
C
estrogen
D
aldosterone
Question 41 Explanation:
Chloride reabsorption depends on sodium reabsorption, which is regulated by aldosterone in the distal tubule and collecting ducts.
Question 42
Which of the following arterial blood gas (ABG) values indicates uncompensated metabolic alkalosis?
A
pH 7.48, PaCO2 42, HCO3 30
B
pH 7.48, PaCO2 46, HCO3 30
C
pH 7.48, PaCO2 34, HCO3 20
D
pH 7.48, PaCO2 34, HCO3 26
Question 42 Explanation:
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.
Question 43
Etiologies associated with hypomagnesemia include:
A
decreased vitamin D intake
B
constipation
C
malabsorption syndrome
D
renal failure
Question 43 Explanation:
Malabsorption syndrome is associated with hypomagnesemia. Increased vitamin D intake and diarrhea are also associated with hypomagnesemia.
Question 44
Which of the following blood products should be infused rapidly?
A
packed red blood cells (PRBC)
B
fresh frozen plasma (FFP)
C
platelets
D
dextran
Question 44 Explanation:
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.
Question 45
The presence of which of the following electrolytes contributes to acidosis?
A
sodium
B
potassium
C
hydrogen
D
chloride
Question 45 Explanation:
The presence of hydrogen ions determines a solution’s acidity.
Question 46
The chief anion in the intracellular fluid (ICF) is:
A
phosphorus
B
potassium
C
sodium
D
chloride
Question 46 Explanation:
Phosphorus is the major ICF cation. Potassium and sodium are cations. Chloride is the chief anion found in the ECF.
Question 47
When teaching a patient about foods high in magnesium, the nurse would include:
A
green vegetables
B
butter
C
cheese
D
tomatoes
Question 47 Explanation:
Green vegetables are high in magnesium.
Question 48
Disease of which of the following structures is most likely to affect electrolyte reabsorption?
A
glomerulus
B
renal tubules
C
bladder
D
renal pelvis
Question 48 Explanation:
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.
Question 49
Heidi has a nursing diagnosis of fluid volume deficit. Which one of the following medications could potentially exacerbate the problem?
A
Synthroid
B
Digoxin
C
Lasix
D
insulin
Question 49 Explanation:
Lasix will contribute to fluid loss through its action as a diuretic.
Question 50
The majority of the body’s water is contained in which of the following fluid compartments?
A
intracellular
B
interstitial
C
intravascular
D
extracellular
Question 50 Explanation:
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.
Question 51
Sodium levels are affected by the secretion of which of the following hormones?
A
progesterone and aldosterone
B
ADH and ACTH
C
antidiuretic hormone and FSH
D
ECF and aldosterone
Question 51 Explanation:
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.
Question 52
The respiratory system regulates acid-base balance by:
A
increasing mucus production
B
changing the rate and depth of respirations
C
forming bicarbonate
D
reabsorbing bicarbonate
Question 52 Explanation:
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.
Question 53
The majority gastrointestinal reabsorption of water occurs in:
A
small intestines
B
the esophagus
C
the colon
D
the stomach
Question 53 Explanation:
Approximately 85% to 95% of water absorption takes place in the small intestine. The colon absorbs only 500 to 100 cc.
Question 54
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?
A
Get an infusion controller from central supply.
B
Mix all antibiotics in 0.45% NaCl with 5% dextrose.
C
Check the patient’s potassium level and contact the doctor for IV additive orders.
D
Assess the patient for signs of hyperkalemia.
Question 54 Explanation:
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.
Question 55
The major cation in the ICF is:
A
potassium
B
sodium
C
phosphorus
D
magnesium
Question 55 Explanation:
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.
Question 56
The balance of anions and cations as it occurs across cell membranes is known as:
A
osmotic activity
B
electrical neutrality
C
electrical stability
D
sodium-potassium pump
Question 56 Explanation:
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.
Question 57
Orly Khan is suffering from fluid volume deficit (FVD), which of the following symptoms would the nurse expect to assess in the patient?
A
rales
B
bounding pulse
C
tachycardia
D
bulging neck veins
Question 57 Explanation:
Tachycardia, poor tissue turgor, and hypotension are symptoms of FVD. Other choices are symptoms of FVE.
Question 58
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:
A
complete blood count results, particularly the platelets.
B
electrolytes, particularly the serum sodium
C
urine analysis, particularly for the presence of white blood cells
D
EEG results
Question 58 Explanation:
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.
Question 59
Mr. Alberto is scheduled to receive an isotonic solution; which one of the following is an example of such solution?
A
D10% W
B
0.45% saline
C
0.9% saline
D
3% normal saline W
Question 59 Explanation:
A solution of 0.9% saline is isotonic. Solutions of 0.33% and 0.45% saline and D5W are hypotonic.
Question 60
The type of fluid used to manipulate fluid shifts among compartments states is:
A
whole blood
B
TPN
C
albumin
D
Ensure
Question 60 Explanation:
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.
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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:
filtration
diffusion
osmosis
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:
age
fat tissue
muscle mass
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?
rales
bounding pulse
tachycardia
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:
water intoxication
fluid volume excess (FVE)
cellular dehydration
cell shrinkage
5. Mr. Alberto is scheduled to receive an isotonic solution; which one of the following is an example of such solution?
D10% W
0.45% saline
0.9% saline
3% normal saline W
6. Which of the following arterial blood gas (ABG) values indicates uncompensated metabolic alkalosis?
pH 7.48, PaCO2 42, HCO3 30
pH 7.48, PaCO2 46, HCO3 30
pH 7.48, PaCO2 34, HCO3 20
pH 7.48, PaCO2 34, HCO3 26
7. The body’s compensation of metabolic alkalosis involves:
increasing the respiratory rate
decreasing the respiratory rate
increasing urine output
decreasing urine output
8. When assessing a patient for metabolic alkalosis, the nurse would expect to find:
low serum potassium
changes in urine output
hypotension
increased CVP
9. Which of the following blood products should be infused rapidly?
packed red blood cells (PRBC)
fresh frozen plasma (FFP)
platelets
dextran
10. Which of the following statements provides the rationale for using a hypotonic solution for a patient with FVD?
A hypotonic solution provides free water to help the kidneys eliminate the solute.
A hypotonic solution supplies an excess of sodium and chloride ions.
Excessive volumes are recommended in the early postoperative period.
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:
a normal physiologic process
evidence of sepsis
a possible transfusion reaction
an expected response to the transfusion
12. The process of endocrine regulation of electrolytes involves:
sodium reabsorption and chloride excretion
chloride reabsorption and sodium excretion
potassium reabsorption and sodium excretion
sodium reabsorption and potassium excretion
13. The chief anion in the intracellular fluid (ICF) is:
phosphorus
potassium
sodium
chloride
14. The major cation in the ICF is:
potassium
sodium
phosphorus
magnesium
15. Hypophosphatemia may result from which of the following diseases?
liver cirrhosis
renal failure
Paget’s disease
alcoholism
16. A patient with which of the following disorders is at high risk for developing hyperphosphatemia?
hyperkalemia
hyponatremia
hypocalcemia
hyperglycemia
17. Normal calcium levels must be analyzed in relation to:
sodium
glucose
protein
fats
18. Calcium is absorbed in the GI tract under the influence of:
vitamin D
glucose
HCl
vitamin C
19. Which of the following diagnoses is most appropriate for a patient with hypo calcemia?
constipation, bowel
high risk for injury: bleeding
airway clearance, ineffective
high risk for injury: confusion
20. When serum calcium levels rise, which of the following hormones is secreted?
aldosterone
renin
parathyroid hormone
calcitonin
21. The presence of which of the following electrolytes contributes to acidosis?
sodium
potassium
hydrogen
chloride
22. The lungs participate in acid-base balance by:
reabsorbing bicarbonate
splitting carbonic acid in two
using CO2 to regulate hydrogen ions
sending hydrogen ions to the renal tubules
23. The respiratory system regulates acid-base balance by:
increasing mucus production
changing the rate and depth of respirations
forming bicarbonate
reabsorbing bicarbonate
24. Which of the following is a gas component of the ABG measurement?
carbon dioxide
bicarbonate
hydrogen
pH
25. Chloride helps maintain acid-base balance by performing which of the following roles?
participating in the chloride shift
following sodium to maintain serum osmolarity
maintaining the balance of cations in the ICF and ECF
separating carbonic acid
26. Which of the following hormones helps regulate chloride reabsorption?
antidiuretic hormone
renin
estrogen
aldosterone
27. Chloride is absorbed in the:
stomach
bowel
liver
kidney
28. When chloride concentration drops below 95 mEq/L, reabsorption of which of the following electrolytes increases proportionally?
hydrogen
potassium
sodium
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?
Get an infusion controller from central supply.
Mix all antibiotics in 0.45% NaCl with 5% dextrose.
Check the patient’s potassium level and contact the doctor for IV additive orders.
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?
Hold the digoxin and check the patient’s potassium level.
Remove the orange juice from the patient’s tray.
Identify the patient as high risk for hyperkalemia.
Assess the patient for other signs of hypernatremia.
31. The type of fluid used to manipulate fluid shifts among compartments states is:
whole blood
TPN
albumin
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:
complete blood count results, particularly the platelets.
electrolytes, particularly the serum sodium
urine analysis, particularly for the presence of white blood cells
EEG results
33. When teaching a patient about foods high in magnesium, the nurse would include:
green vegetables
butter
cheese
tomatoes
34. The balance of anions and cations as it occurs across cell membranes is known as:
osmotic activity
electrical neutrality
electrical stability
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:
measuring and recording intake and output and daily weights
administering salt tablets and monitoring hypertonic parenteral solutions
administering sedatives
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?
glomerulus
renal tubules
bladder
renal pelvis
37. Analiza is diagnosed with hypermagnesemia. Symptoms of her condition may include:
hypertension
tachycardia
hyperactive deep-tendon reflex
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?
decreased diuresis
disease-related process
decreased breathing and perspiration
increased breathing and perspiration
39. Jordan is diagnosed with FVD; which of the following nursing diagnoses might apply to his condition?
altered urinary elimination
decreased cardiac output
increased cardiac output
vomiting
40. Body fluids perform which of the following functions?
transport nutrients
transport electrical charges
cushion the organs
facilitate fat metabolism
41. Sodium levels are affected by the secretion of which of the following hormones?
progesterone and aldosterone
ADH and ACTH
antidiuretic hormone and FSH
ECF and aldosterone
42. Bicarbonate is lost during which of the following clinical conditions?
diarrhea
diuresis
diaphoresis
vomiting
43. Magnesium reabsorption is controlled by:
Loop of Henle
glomerulus
pituitary
parathyroid hormone
44. Heidi has a nursing diagnosis of fluid volume deficit. Which one of the following medications could potentially exacerbate the problem?
Synthroid
Digoxin
Lasix
insulin
45. Alexander has hypotonic FVE; which of the following findings would the nurse expect to assess in the patient?
poor skin turgor and increased thirst
weight gain and thirst
interstitial edema and hypertension
hypotension and pitting edema
46. The interstitial space holds approximately how many liters?
3 L
6 L
9 L
12 L
47. Sodium balance is important for which of the following functions?
transmitting impulses in nerve and muscle fibers via the calcium-potassium pump
exchanging for magnesium and attracting chloride
combining with hydrogen and chloride for acid-base balance
exchanging for potassium and attracting chloride
48. In renal regulation of water balance, the functions of angiotensin II include:
blood clotting within the nephron
increasing progesterone secretion into the renal tubules
catalyzing calcium-rich nutrients
selectively constricting portions of the arteriole in the nephron
49. Which of the following nursing diagnoses might apply to a patient with hypertonic FVE?
ineffective airway clearance
potential for decreased cardiac output
ineffective breathing pattern
potential for increased cardiac output
50. The intracellular compartment holds water and:
proteins
glucose
sodium
uric acid
51. The majority gastrointestinal reabsorption of water occurs in:
small intestines
the esophagus
the colon
the stomach
52. Isotonic FVD can result from:
GI fluid loss through diarrhea
insensible water loss during prolonged fever
inadequate ingestion of fluids and electrolytes
impaired thirst regulation
53. The majority of the body’s water is contained in which of the following fluid compartments?
intracellular
interstitial
intravascular
extracellular
54. Etiologies associated with hypomagnesemia include:
decreased vitamin D intake
constipation
malabsorption syndrome
renal failure
55. The danger of fluid sequestered in the third space is that the fluid:
is hypertonic and can cause hypervolemia
is hypotonic and can cause water intoxication
is not available for circulation
contains large amounts of acids
56. The extracellular fluid space holds water, electrolytes, proteins and:
red blood cells
potassium
lipids
nucleic acids
57. Magnesium performs all of the following functions except:
contributing to vasoconstriction
assisting in cardiac muscle contraction
facilitating sodium transport
assisting in protein metabolism
58. Which of the following clinical conditions exacerbates electrolyte excretion?
nasogastric feedings
use of surgical drains
immobility from fractures
chronic water drinking
59. A diet containing the minimum daily sodium requirement for an adult would be:
a no-salt diet
a diet including 2 gm sodium
a diet including 4 gm sodium
a 1500 calorie weight-loss diet
60. Which of the following electrolytes are lost as a result of vomiting?
bicarbonate and calcium
sodium and hydrogen
sodium and potassium
hydrogen and potassium
Answers and Rationales
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.
Answer: D. gender. A patient’s gender does not influence the percentage of total body water.
Answer: C. tachycardia. Tachycardia, poor tissue turgor, and hypotension are symptoms of FVD. Other choices are symptoms of FVE.
Answer: A. water intoxication. Water intoxication is a potential complication associated with hypotonic fluid administration. Other choice are potential complication of hypertonic fluid administration.
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.
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.
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.
Answer: A. low serum potassium. Decreased serum potassium is a common symptom of metabolic alkalosis.
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.
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.
Answer: C. a possible transfusion reaction. An increase in the body temperature indicates a possible transfusion reaction and requires immediate discontinuation of the infusion.
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.
Answer: A. phosphorus. Phosphorus is the major ICF cation. Potassium and sodium are cations. Chloride is the chief anion found in the ECF.
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.
Answer: D. alcoholism. Hypophosphatemia may occur secondary to alcoholism. Renal failure is usually associated with hyperphosphatemia
Answer: C. hypocalcemia. Because calcium and phosphorus ratios are inversely proportional, when phosphorus levels are high, calcium levels are low.
Answer: C. protein. Some calcium is bound to protein, so abnormal calcium levels are analyzed in relation to proteins.
Answer: A. vitamin D. Calcium is absorbed in the GI tract under the influence of vitamin D in its biologically active form.
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.
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.
Answer: C. hydrogen. The presence of hydrogen ions determines a solution’s acidity.
Answer: C. using CO2 to regulate hydrogen ions. The lungs use carbon dioxide to regulate hydrogen ion concentration.
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.
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.
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.
Answer: D. aldosterone. Chloride reabsorption depends on sodium reabsorption, which is regulated by aldosterone in the distal tubule and collecting ducts.
Answer: B. bowel. Chloride is absorbed in the bowel, mainly the duodenum and jejunum.
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.
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.
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.
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.
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.
Answer: A. green vegetables. Green vegetables are high in magnesium.
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.
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.
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.
Answer: D. cardiac arrhythmias. Cardiac arrhythmias are associated with hypermagnesemia. Hypertension, tachycardia, and hyperactive reflexes are signs of hypomagnesemia.
Answer: D. increased breathing and perspiration. Excessive fluid can be lost if breathing and perspiration are at an increased rate for a prolonged period.
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.
Answer: A. transport nutrients. Body fluids facilitate the transport of nutrients, hormones, proteins, and other molecules.
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.
Answer: A. diarrhea. Bicarbonate is lost in diarrhea because the lower intestinal tract contains fluids rich in bicarbonate.
Answer: A. Loop of Henle. The Loop of Henle is responsible for magnesium reabsorption.
Answer: C. Lasix. Lasix will contribute to fluid loss through its action as a diuretic.
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.
Answer: C. 9 L. The interstitial space hold 9 L.
Answer: D. exchanging for potassium and attracting chloride. Sodium influences the levels of potassium and chloride by exchanging for potassium and attracting chloride.
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.
Answer: B. potential for decreased cardiac output. Potential for decreased cardiac output is a nursing diagnosis associated with hypertonic FVE.
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.
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.
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.
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.
Answer: C. malabsorption syndrome. Malabsorption syndrome is associated with hypomagnesemia. Increased vitamin D intake and diarrhea are also associated with hypomagnesemia.
Answer: C. is not available for circulation. In third-spacing, fluid is sequestered and is unavailable to the general circulation.
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.
Answer: A. contributing to vasoconstriction. Magnesium contributes to vasodilation, not vasoconstriction.
Answer: B. use of surgical drains. Surgical drains will cause a fluid loss, and electrolytes are eliminated along with the fluid.
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.
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.