Fluid, Electrolytes and Acid-Base Imbalances Quizzes

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Fluid, electrolytes, and acid-base imbalances

Fluid, Electrolytes and Acid-Base Imbalances Quiz I

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1. If a patient has severe hyperkalemia, it is possible to administer calcium gluconate intravenously to___

1. immediately lower the potassium (K+) level by active transport

2. antagonize the action of K+ on the heart

3. prevent transient renal failure (TRF)

4. accomplish all of the above

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2. A normal oxygen saturation value for arterial blood is___

1. 65%

2. 75%

3. 85%

4. 95%

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3. A clinical indication of hyperphosphatemia is___

1. bone pain

2. paresthesia

3. seizures

4. tetany

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4. Cardiac effects of hyperkalemia are usually present when the serum potassium level reaches___

1. 5 mEq/L

2. 6 mEq/L

3. 7 mEq/L

4. 8 mEq/L

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5. The most characteristic manifestation of hypocalcemia and hypomagnesemia is___

1. anorexia and nausea

2. constipation

3. lack of coordination

4. tetany

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6. The most common buffer system in the body is the___

1. plasma protein buffer system

2. hemoglobin buffer system

3. phosphate buffer system

4. bicarbonate–carbonic acid buffer system

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7. The nurse should expect that a patient with mild fluid volume excess would be prescribed a diuretic that blocks sodium reabsorption in the distal tubule, such as___

1. Bumex

2. Demadex

3. HydroDIURIL

4. Lasix

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8. An isotonic solution that contains electrolytes similar to the concentration used in plasma is___

1. 5% dextrose in water

2. lactated Ringer’s solution (Hartmann’s solution)

3. 3% NaCl solution

4. 5% NaCl solution.

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9. A patient is admitted who has had severe vomiting for 24 hours. She states that she is exhausted and weak. The results of an admitting electrocardiogram (ECG) show flat T waves and ST-segment depression. Choose the most likely potassium (K+) value for this patient.

1. 4.0 mEq/L

2. 8.0 mEq/L

3. 2.0 mEq/L

4. 2.6 mEq/L

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10. A nurse is directed to administer a hypotonic intravenous solution. Looking at the following labeled solutions, she should choose___

1. 0.45% sodium chloride

2. 0.90% sodium chloride

3. 5% dextrose in water

4. 5% dextrose in normal saline solution

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11. The ECG change that is specific to hypokalemia is___

1. a depressed ST segment

2. a flat T wave

3. an elevated U wave

4. an inverted T wave

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12. The nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory data for all of the following except___

1. hypocalcemia

2. hypoglycemia

3. hypokalemia

4. hypoxemia

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13. A patient is admitted with a diagnosis of renal failure. He also mentions that he has had stomach distress and has ingested numerous antacid tablets over the past 2 days. His blood pressure is 110/70 mm Hg, his face is flushed, and he is experiencing generalized weakness. Choose the most likely magnesium (Mg+) value for this patient.

1. 11 mEq/L

2. 5 mEq/L

3. 2 mEq/L

4. 1 mEq/L

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14. A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory mechanisms associated with hypovolemia would cause all of the following symptoms except___

1. oliguria

2. hypertension

3. tachycardia

4. tachypnea

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15. Laboratory findings consistent with hypovolemia in a female would include all of the following except___

1. hematocrit level of >47%

2. BUN-serum creatinine ratio of >12:1

3. urine specific gravity of 1.027

4. urine osmolality of >450 mOsm/kg.

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16. A patient complains of tingling in his fingers. He has positive Trousseau’s and Chvostek’s signs. He says that he feels depressed. Choose the most likely serum calcium (Ca+) value for this patient

1. 11 mg/dL

2. 9 mg/dL

3. 7 mg/dL

4. 5 mg/dL

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17. A clinical manifestation not found in hypovolemia is___

1. muscle weakness

2. oliguria

3. postural hypotension

4. bradycardia

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18. Management of hypocalcemia includes all of the following actions except administration of___

1. fluid to dilute the calcium levels

2. the diuretic furosemide (Lasix), without saline, to increase calcium excretion through the kidneys

3. inorganic phosphate salts

4. intravenous phosphate therapy

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19. To supplement a diet with foods high in potassium, the nurse should recommend the addition of___

1. bananas and apricots

2. green leafy vegetables

3. milk and yogurt

4. nuts and legumes

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20. One of the dangers of treating hypernatremia is____

1. red blood cell crenation

2. red blood cell hydrolysis

3. cerebral edema

4. renal shutdown

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21. Choose the condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration.

1. Respiratory acidosis

2. Respiratory alkalosis

3. Metabolic acidosis

4. Metabolic alkalosis

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22. Choose the condition that exhibits blood values with a low pH and a high PCO2.

1. Respiratory acidosis

2. Respiratory alkalosis

3. Metabolic acidosis

4. Metabolic alkalosis

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23. Nursing intervention for a patient with a diagnosis of hyponatremia includes all of the following except___

1. assessing for symptoms of nausea and malaise

2. encouraging the intake of low-sodium liquids, such as coffee or tea

3. monitoring neurologic status

4. restricting tap water intake

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24. Cardiac arrest will probably occur with a serum calcium level of____

1. 9 mg/dL

2. 12 mg/dL

3. 15 mg/dL

4. 18 mg/dL

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25. One of the best indicators of renal function is___

1. blood urea nitrogen

2. serum creatinine

3. specific gravity

4. urine osmolality

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Fluid, electrolytes, and acid-base imbalances

Fluid, Electrolytes and Acid-Base Imbalances Quiz II

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1. While caring for an 84-year-old patient, the nurse monitors the patient’s fluid and electrolyte balance, recognizing what as a normal change of aging?

1. Hyperkalemia

2. Hyponatremia

3. Decreased insensible fluid loss

4. Increased plasma oncotic pressures

B: A decrease in renin and aldosterone and an increase in ADH and atrial natriuretic peptide (ANP) lead to decreased sodium reabsorption and increased water retention by the kidney, both of which lead to hyponatremia. Loss of subcutaneous tissue and thinning dermis of aging lead to increased moisture lost through the skin. Plasma oncotic pressure is often decreased because of lack of protein intake.

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2. A patient’s serum sodium concentration is within the normal range. The nurse estimates that the serum osmolality should be___

1. less than 136 mOsm/kg

2. 275 to 300 mOsm/kg

3. greater than 408 mOsm/kg

4. 350 to 544 mOsm/kg

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3. Which of the following would tend to cause hypokalemia by shifting potassium from the extracellular fluid into the intracellular fluid?

1. Metabolic alkalosis

2. Insulin deficiency

3. Aldosterone deficiency

4. Beta-adrenergic receptor blockade

A: Metabolic alkalosis shifts potassium from the extracellular fluid into the cells and contributes to hypokalemia. Insulin deficiency, aldosterone deficiency, beta-adrenergic blockade, and increased extracellular fluid osmolarity all cause a shift of potassium from the cells to the extracellular fluid.

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4. Juvenile (type 1) diabetes mellitus is often diagnosed because of polyuria (high urine flow) and polydipsia (frequent drinking) that occur because of which of the following?

1. Increased delivery of glucose to the collecting duct interferes with the action of antidiuretic hormone

2. Increased glomerular filtration of glucose increases Na+ reabsorption via the sodium-glucose co-transporter

3. When the filtered load of glucose exceeds the renal threshold, a rising glucose concentration in the proximal tubule decreases the osmotic driving force for water reabsorption

4. High plasma glucose concentration decreases thirst

C: High urine flow occurs in type 1 diabetes because the filtered load of glucose exceeds the renal threshold, resulting in an increase in glucose concentration in the tubule, which decreases the osmotic driving force for water reabsorption. Increased urine flow reduces extracellular fluid_x000D_volume and stimulates the release of ADH.

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5. In a patient with a positive Chvostek’s sign, the nurse would expect the IV administration of which medication?

1. Calcitonin

2. Vitamin D

3. Loop diuretics

4. Calcium gluconate

D: Chvostek’s sign is a contraction of facial muscles in response to a tap over the facial nerve. This indicates the neuromuscular irritability of low calcium levels. IV calcium is the treatment used to prevent laryngeal spasms and respiratory arrest. Calcitonin and loop diuretics are treatments for hypercalcemia. Oral vitamin D supplements are part of the treatment for hypocalcemia but not for impending tetany.

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6. A febrile patient’s fluid output is in excess of normal because of diaphoresis. The nurse should plan fluid replacement based on the knowledge that insensible losses in an afebrile person are normally not greater than___

1. 300 mL/24 h

2. 600 mL/24 h

3. 900 mL/24 h

4. 1200 mL/24 h

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7. What is an example of an appropriate IV solution to treat an extracellular fluid volume deficit?

1. D5W

2. 3% saline

3. Lactated Ringer’s solution

4. D5W in ½ normal saline (0.45%)

C: An isotonic solution does not change the osmolality of the blood and does not cause fluid shifts between the ECF and ICF. In the case of ECF loss, an isotonic solution, such as lactated Ringer’s solution, is ideal because it stays in the extracellular compartment. A hypertonic solution would pull fluid from the cells into the ECF, resulting in cellular fluid loss and possible vascular overload.

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8. With which disorder is hyperkalemia often associated?

1. Hypoglycemia

2. Metabolic acidosis

3. Respiratory alkalosis

4. Decreased urine potassium levels

B: In metabolic acidosis, hydrogen ions in the blood are taken into the cell in exchange for potassium ions as a means of buffering excess acids. This results in an increase in serum potassium until the kidneys have time to excrete the excess potassium.

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9. Which of the following statements is not correct?

1. Carbonic anhydrase inhibitors tend to cause metabolic acidosis.

2. Thiazide diuretics inhibit the Na-Cl co-transporter in the distal tubules.

3. Aldosterone antagonists (e.g., spironolactone) tend to cause hypokalemia.

4. Loop diuretics (e.g., furosemide) tend to cause hypokalemia.

Aldosterone antagonists such as spironolactone tend to cause hyperkalemia rather than hypokalemia by shifting potassium from the intracellular to the extracellular fluid and by inhibiting potassium secretion in the principal cells of collecting tubules. All of the other_x000D_statements are correct.

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10. Which patient is at risk for hypernatremia?

1. Has an aldosterone deficiency

2. Has prolonged vomiting and diarrhea

3. Receives excessive IV 5% dextrose solution

4. Has impaired consciousness and decreased thirst sensitivity

D: A major cause of hypernatremia is water deficit, which can occur in those with decreased sensitivity to thirst, which is the major protection against hyperosmolality. All other conditions lead to hyponatremia.

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11. A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication?

1. Seizures

2. Paralysis

3. Dysrhythmias

4. Acute kidney injury

C: Potassium maintains normal cardiac rhythm, transmission and conduction of nerve impulses, and contraction of muscles. Cardiac cells have the most clinically significant changes with potassium imbalances because of changes in cardiac conduction. Although paralysis may occur with severe potassium imbalances, cardiac changes are seen earlier and much more commonly.

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12.

What stimulates aldosterone secretion from the adrenal cortex?

1. Excessive water intake

2. Increased serum osmolality

3. Decreased serum potassium

4. Decreased sodium and water

D: Aldosterone is secreted by the adrenal cortex in response to a decrease in plasma volume (loss of water) and resulting decreased renal perfusion; decreased serum sodium, increased serum potassium, or adrenocorticotropic hormone (ACTH).

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13. A patient who has a large amount of carbon dioxide in the blood also has what in the blood?

1. Large amount of carbonic acid and low hydrogen ion concentration

2. Small amount of carbonic acid and low hydrogen ion concentration

3. Large amount of carbonic acid and high hydrogen ion concentration

4. Small amount of carbonic acid and high hydrogen ion concentration

The amount of CO2 in the blood directly relates to carbonic acid concentration and subsequently hydrogen ion concentration. The CO2 combines with water in the blood to form carbonic acid and in cases in which CO2 is retained in the blood, acidosis occurs.

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14. Which of the following would be expected to cause a decrease in extracellular fluid potassium concentration (hypokalemia) at least in part by stimulating potassium uptake into the cells?

1. Beta-Adrenergic blockade

2. Insulin deficiency

3. Strenuous exercise

4. Metabolic alkalosis

D: Metabolic alkalosis is associated with hypokalemia due to a shift of potassium from the extracellular fluid into the cells. Beta-adrenergic blockade, insulin deficiency, strenuous exercise, and aldosterone deficiency all cause hyperkalemia due to a shift of potassium out of the cells into the extracellular fluid.

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15. A patient is scheduled to have a tunneled catheter placed for administration of chemotherapy for breast cancer. When preparing the patient for the catheter insertion, what does the nurse explain about this method of chemotherapy administration?

1. Reduces the incidence of systemic side effects of the drug

2. Decreases the risk for extravasation at the infusion site

3. Does not become occluded as peripherally inserted catheters can

4. Allows continuous infusion of the drug directly to the area of the tumor

B: Catheters tunneled to the distal end of the superior vena cava or the right atrium are vascular access devices inserted into central veins, which decrease the incidence of extravasation, provide for rapid dilution of chemotherapy, and reduce the need for venipunctures. Most right atrial catheters, except for a Groshong catheter, must be flushed with heparin to prevent clotting in the tubing. Regional chemotherapy administration delivers the drug directly to the tumor and is the only administration route that can decrease the systemic effects of the drugs.

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16. What is the normal pH range of the blood, and what ratio of base to acid does this reflect?

1. 7.32 to 7.42; 25 to 2

2. 7.32 to 7.42; 28 to 2

3. 7.35 to 7.45; 20 to 1

4. 7.35 to 7.45; 30 to 1

C: 7.35 to 7.45; 20 to 1. The other answers are incorrect.

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17. To provide free water and intracellular fluid hydration for a patient with acute gastroenteritis who is NPO, the nurse would expect administration of which infusion?

1. Dextrose 5% in water

2. Dextrose 10% in water

3. Lactated Ringer’s solution

4. Dextrose 5% in normal saline (0.9%)

A: Fluids such as 5% dextrose in water (D5W) allow water to move from the ECF to the ICF. Although D5W is physiologically isotonic, the dextrose is rapidly metabolized, leaving free water to shift into cells.

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18. The nurse expects that a decrease in serum osmolality would occur with___

1. diabetes insipidus

2. hyperglycemia

3. renal failure

4. uremia

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19. The average daily urinary output in an adult is___

1. 0.5 L

2. 1.0 L

3. 1.5 L

4. 2.5 L

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20.

A patient with cirrhosis experiences a doubling of his serum creatinine over a 6-month period after sustained heavy ingestion of a nonsteroidal anti-inflammatory drug (NSAID) for his arthritis. Which of the following is the best explanation for his increased serum creatinine?

1. Increased efferent arteriolar resistance which reduced glomerular filtration rate (GFR)

2. Decreased Bowman’s capsule pressure which reduced GFR

3. Increased afferent arteriolar resistance which reduced GFR

4. Increased renal prostaglandins due to the NSAID

C: A doubling of serum creatinine implies a reduction in glomerular filtration rate (GFR). Non-steroidal anti-inflammatory drugs (NSAIDS) inhibit prostaglandin synthesis, which would tend increase afferent arteriolar and reduce GFR.

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21. Which of the following statements is incorrect?

1. Beta-adrenergic stimulation would tend to cause hypokalemia by shifting potassium from the extracellular fluid into the cells

2. A powerful diuretic that inhibits proximal tubule or loop of Henle sodium reabsorption would tend to increase potassium secretion by the collecting tubules

3. Injection of excess insulin into a patient would tend to cause hypokalemia

4. Increased extracellular fluid osmolarity would tend to cause hypokalemia

D: Increased extracellular fluid osmolarity would tend to cause hyperkalemia, rather than hypokalemia due to cell dehydration, which raise intracellular potassium concentration and promotes potassium diffusion into the extracellular fluid. All of the other statements are correct.

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22. The nurse notes that a patient’s urine osmolality is 980 mOsm/kg. The nurse knows to assess for the possible cause of___

1. acidosis

2. fluid volume excess

3. diabetes insipidus

4. hyponatrenia

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23. The nurse is reviewing a patient’s morning laboratory results. Which result is of greatest concern?

1. Serum Na + of 150 mEq/L

2. Serum Mg 2 + of 1.1 mEq/L

3. Serum PO4 3 − of 4.5 mg/dL

4. Serum Ca 2 + (total) of 8.6 mg/dL

B: With a low magnesium level there is an increased risk for hypokalemia and hypocalcemia as well as altered sodium-potassium pump and altered carbohydrate and protein metabolism. Hypokalemia could lead to dysrhythmias and severe muscle weakness. The sodium and phosphate levels are also not within normal limits. However, the implications are not as life-threatening. The calcium level is normal.

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24. A patient with chronic kidney disease has hyperphosphatemia. What is a commonly associated electrolyte imbalance?

1. Hypokalemia

2. Hyponatremia

3. Hypocalcemia

4. Hypomagnesemia

C: Kidneys are the major route of phosphate excretion, a function that is impaired in renal failure. A reciprocal relationship exists between phosphorus and calcium, and high serum phosphate levels of kidney failure cause low calcium concentration in the serum.

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25. In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system?

1. Kidneys

2. Cardiovascular system

3. Musculoskeletal system

4. Central nervous system

D: As water shifts into and out of cells in response to the osmolality of the blood, the cells that are most sensitive to shrinking or swelling are those of the brain, resulting in neurologic symptoms.

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26.

Which of the following statements is incorrect?

1. Beta-adrenergic stimulation would tend to cause hypokalemia by shifting potassium from the extracellular fluid into the cells

2. Injection of excess insulin into a patient would tend to cause hypokalemia

3. Strenuous, sustained exercise may tend to cause significant hyperkalemia

4. Increased extracellular fluid osmolarity would tend to cause hypokalemia

D: Increased extracellular fluid osmolarity would tend to cause hyperkalemia, rather than hypokalemia due to cell dehydration, which raise intracellular potassium concentration and promotes potassium diffusion into the extracellular fluid. All of the other statements are correct.

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27. Which change would you expect to find in a dehydrated person deprived of water for 24 hours?

1. Decreased plasma renin activity

2. Decreased plasma antidiuretic hormone concentration

3. Increased plasma atrial natriuretic peptide concentration

4. Increased water permeability of the collecting duct

D: Dehydration due to water deprivation decreases extracellular fluid volume, which in turn increases renin secretion and decreases plasma atrial natriuretic peptide. Dehydration also increases the plasma sodium concentration, which stimulates the secretion of ADH. The increased ADH increases water permeability in the collecting ducts. The ascending limb of the loop of Henle is relatively impermeable to water, and this low permeability is not altered by water deprivation or increased levels of ADH.

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28.

All of the following changes would tend to cause interstitial fluid edema in a tissue EXCEPT one. Which one is the EXCEPTION?

1. Increased venous resistance

2. Increased venous pressure

3. Increased capillary filtration coefficient

4. Increased plasma protein concentration

D: Increased plasma protein concentration would reduce the net force favoring capillary filtration and would oppose edema formation. All of the other changes would increase capillary filtration rate and tend to cause edema.

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