Question 1

A patient who has required prolonged mechanical ventilation has the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO3 32 mm Hg, and HCO3 25 mEq/L. The nurse interprets these results as

Accepted Answer

A)   metabolic acidosis.
B)   metabolic alkalosis.
C)   respiratory acidosis.
D)   respiratory alkalosis. D

Question 2

The nurse has administered 3% saline to a patient with hyponatremia. Which one of these assessment data will require the most rapid response by the nurse?

Accepted Answer

A)   The patient's radial pulse is 105 beats/minute.
B)   There is sediment and blood in the patient's urine.
C)   The blood pressure increases from 120/80 to 142/94.
D)   There are crackles audible throughout both lung fields. D

Question 3

The nurse in the outpatient clinic who notes that a patient has a decreased magnesium level should ask the patient about

Accepted Answer

A)   daily alcohol intake.
B)   intake of dietary protein.
C)   multivitamin/mineral use.
D)   use of over-the-counter ( OTC )  laxatives. A

Question 4

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

Accepted Answer

A)   The bibasilar breath sounds are decreased.
B)   The patellar and triceps reflexes are absent.
C)   The patient has been sleeping most of the day.
D)   The patient reports feeling "sick to my stomach."

Question 5

A patient with advanced lung cancer is admitted to the emergency department with urinary retention caused by renal calculi. Which of these laboratory values will require the most immediate action by the nurse?

Accepted Answer

A)   Arterial blood pH is 7.32.
B)   Serum calcium is 18 mEq/L.
C)   Serum potassium is 5.1 mEq/L.
D)   Arterial oxygen saturation is 91%.

Question 6

When the nurse is evaluating the fluid balance for a patient admitted for hypovolemia associated with multiple draining wounds, the most accurate assessment to include is

Accepted Answer

A)   skin turgor.
B)   daily weight.
C)   presence of edema.
D)   hourly urine output.

Question 7

A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.1 mEq/L. Of the following medications that the patient has been taking at home, the nurse will be most concerned about

Accepted Answer

A)   oral digoxin (Lanoxin)  0.25 mg daily.
B)   ibuprofen (Motrin)  400 mg every 6 hours.
C)   metoprolol (Lopressor)  12.5 mg orally daily.
D)   lantus insulin 24 U subcutaneously every evening.

Question 8

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

Accepted Answer

A)   ingestion of dairy products.
B)   the amount of high-fat foods.
C)   the quantity of fruits and juices.
D)   intake of green, leafy vegetables.

Question 9

The nurse obtains all of the following assessment data about a patient with deficient fluid volume caused by a massive burn injury. Which of the following assessment data will be of greatest concern?

Accepted Answer

A)   The blood pressure is 90/40 mm Hg.
B)   Urine output is 30 ml over the last hour.
C)   Oral fluid intake is 100 ml for the last 8 hours.
D)   There is prolonged skin tenting over the sternum.

Question 10

When caring for an alert and oriented elderly patient with a history of dehydration, the home health nurse will teach the patient to increase fluid intake

Accepted Answer

A)   in the late evening hours.
B)   if the oral mucosa feels dry.
C)   when the patient feels thirsty.
D)   as soon as changes in level of consciousness ( LOC )  occur.

Question 11

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

Accepted Answer

A)   K+ 3.4 mEq/L (3.4 mmol/L) 
B)   Ca+2 7.8 mg/dl (1.95 mmol/L) 
C)   Na+ 154 mEq/L (154 mmol/L) 
D)   PO4-3 4.8 mg/dl (1.55 mmol/L)

Question 12

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

Accepted Answer

A)   Restrict patient's oral free water intake.
B)   Avoid use of electrolyte-containing drinks.
C)   Infuse a solution of 5% dextrose in 0.45% saline.
D)   Administer vasopressin (antidiuretic hormone, [ADH]) .

Question 13

The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take?

Accepted Answer

A)   Notify the patient's health care provider.
B)   Give the prescribed PRN lorazepam (Ativan) .
C)   Start the prescribed PRN oxygen at 2 to 4 L/min.
D)   Encourage the patient to take deep, slow breaths.

Question 14

The long-term care nurse is evaluating the effectiveness of protein supplements on a patient who has low serum total protein level. Which of these data indicate that the patient's condition has improved?

Accepted Answer

A)   Hematocrit 28%
B)   Good skin turgor
C)   Absence of peripheral edema
D)   Blood pressure 110/72 mm Hg

Question 15

Intravenous potassium chloride (KCl) 60 mEq is prescribed for treatment of a patient with severe hypokalemia. Which action should the nurse take?

Accepted Answer

A)   Administer the KCl as a rapid IV bolus.
B)   Infuse the KCl at a rate of 20 mEq/hour.
C)   Give the KCl only through a central venous line.
D)   Add no more than 40 mEq/L to a liter of IV fluid.

Question 16

A recently admitted patient has a small cell carcinoma of the lung, which is causing the syndrome of inappropriate antidiuretic hormone (SIADH). The nurse will monitor carefully for

Accepted Answer

A)   increased total urinary output.
B)   elevation of serum hematocrit.
C)   decreased serum sodium level.
D)   rapid and unexpected weight loss.

Question 17

A patient with hypercalcemia is being cared for on the medical unit. Nursing actions included on the care plan will include

Accepted Answer

A)   maintaining the patient on bed rest.
B)   auscultating lung sounds every 4 hours.
C)   monitoring for Trousseau's and Chvostek's signs.
D)   encouraging fluid intake up to 4000 ml every day.

Question 18

A patient is taking a potassium-wasting diuretic for treatment of hypertension. The nurse will teach the patient to report symptoms of adverse effects such as

Accepted Answer

A)   personality changes.
B)   frequent loose stools.
C)   facial muscle spasms.
D)   generalized weakness.

Question 19

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

Accepted Answer

A)   Discontinue the nasogastric suctions for a few hours.
B)   Notify the health care provider about the ABG results.
C)   Teach the patient about the need to take slow, deep breaths.
D)   Give the patient the PRN morphine sulfate 4 mg intravenously.

Question 20

Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." The nurse will immediately check for

Accepted Answer

A)   an elevated serum potassium level.
B)   the presence of Chvostek's sign.
C)   a decreased thyroid hormone level.
D)   bleeding on the patient's dressing.

Exam 17: Fluid, Electrolyte, and Acid-Base Imbalances

A patient who has required prolonged mechanical ventilation has the following arterial blood gas results: pH 7.48, PaO₂ 85 mm Hg, PaCO₃ 32 mm Hg, and HCO₃25 mEq/L. The nurse interprets these results as