Chapter 14: Fluids and Electrolytes Nursing School Test Banks

Chapter 14: Fluids and Electrolytes
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A nurse assesses that a patients urine has become much more concentrated. What is the most likely cause for the change?
a. Adrenaline
b. Aldosterone
c. Antidiuretic hormone (ADH)
d. Insulin
ANS: B
Aldosterone acts on the kidney tubules, affecting water retention and its attendant urine concentration.

DIF: Cognitive Level: Comprehension REF: p. 195 OBJ: 6
TOP: Urine Concentration KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. When the water absorption in the renal tubules becomes greater than normal, what assessment finding should a nurse anticipate?
a. More concentrated urine
b. Less concentrated urine
c. More alkaline urine
d. Less alkaline urine
ANS: A
When more water is kept back in the body, the water left to form urine is less; therefore, the urine is more concentrated.

DIF: Cognitive Level: Analysis REF: p. 195 OBJ: 6
TOP: Water Reabsorption by Kidney KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. What process occurs when oxygen is directed out of the arteries and into the capillaries?
a. Active transport
b. Diffusion
c. Filtration
d. Osmosis
ANS: B
Diffusion is the movement from areas of higher concentration to areas of lower concentration.

DIF: Cognitive Level: Knowledge REF: p. 194 OBJ: 2
TOP: Fluid Movements between Portions of the Circulatory System
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. A patients intravenous (IV) injection has been infusing at a very high rate. What assessment indicates fluid volume overload in this patient?
a. Hypotension
b. Tachycardia
c. Pulmonary edema
d. Kidney failure
ANS: C
An IV infusing at a high rate is used to increase intravascular fluid volume, but there is an equalization level, after which the patient goes into fluid overload; this results in pulmonary edema.

DIF: Cognitive Level: Application REF: p. 197-198 OBJ: 4
TOP: Fluid Overload KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. A small child is hospitalized with severe metabolic acidosis after ingesting a whole bottle of baby aspirin approximately 8 hours earlier. In addition to providing reassurance to the patient, which nursing action is the most appropriate?
a. Providing IV treatments as ordered but without sodium bicarbonate
b. Frequently assessing the mental and neurologic status
c. Taking daily weights and vital signs
d. Inducing vomiting
ANS: B
The baby aspirin was ingested too long ago to have vomiting or stomach aspiration be of any use. The child requires frequent assessment of neurologic function because the child may need mechanical ventilation.

DIF: Cognitive Level: Application REF: p. 208-209 OBJ: 8
TOP: Metabolic Acidosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. What is primarily responsible for carrying fluids with nutrients and wastes on a random basis throughout the body?
a. Filtrates
b. Extracellular fluid
c. Intracellular fluid
d. Osmolytes
ANS: B
The blood and lymph are the main media for transporting nutrients and wastes in the body.

DIF: Cognitive Level: Knowledge REF: p. 194-195 OBJ: 3
TOP: Fluid Transportation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. A nurse clarifies that electrolytes, such as sodium and potassium (K+), break down into smaller particles when dissolved. What are these smaller particles?
a. Cells
b. Elements
c. Ions
d. Molecules
ANS: C
Electrolytes dissolved in water are called ions.

DIF: Cognitive Level: Knowledge REF: p. 193 OBJ: 3
TOP: Ions KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. A nurse assists a patient with dyspnea to sit in a high Fowler position. What process allows gravity to help move oxygen from the pulmonary capillaries into the blood when the patient is in this position?
a. Active transport
b. Diffusion
c. Filtration
d. Osmosis
ANS: B
The Fowler position increases blood flow through the lungs and therefore facilitates better oxygen diffusion.

DIF: Cognitive Level: Comprehension REF: p. 194 OBJ: 3
TOP: Movement of Oxygen in the Body KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. A nurse evaluates the laboratory reports on electrolyte values carefully to assess the balance between positive and negative ions. What is responsible for the regulation of this process?
a. Adaptation
b. Diffusion
c. Homeostasis
d. Osmosis
ANS: B
Diffusion allows the ions to support homeostatic balance.

DIF: Cognitive Level: Knowledge REF: p. 194 OBJ: 5
TOP: Electrolyte Values KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. What is being administered when a nurse hangs an IV bag with Na+, K+, and Cl-?
a. Nutrients
b. Electrolytes
c. Enzymes
d. Vitamins
ANS: B
Sodium, K+, and chlorides are electrolytes.

DIF: Cognitive Level: Knowledge REF: p. 193 OBJ: 7
TOP: Electrolyte Administration KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. Each compartment of the body has a water-fluid distribution movement of its own. What is the process allowing these fluids to move and distribute themselves among compartments?
a. Active transport
b. Diffusion
c. Filtration
d. Osmosis
ANS: D
The intracellular and extracellular compartments contain water and dissolved substances. The water filters back and forth as needed to maintain homeostasis via osmolarity.

DIF: Cognitive Level: Knowledge REF: p. 194 OBJ: 1 | 2
TOP: Water Distribution and Movement KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

12. A licensed practical/vocational nurse (LPN/LVN) is preparing to add a new IV of 5% dextrose in water (D5W) with potassium (K+) to an existing line. The LPN/LVN notices that only 25 mL of urine has been collected over the past hour. What is the most appropriate nursing intervention?
a. Avoid hanging the IV with K+ and inform the registered nurse (RN) of the urine output.
b. Run the IV rapidly for 30 minutes to stimulate urine production.
c. Call the physician who ordered the K+.
d. Hang the IV as ordered and chart the output.
ANS: A
The low urine output will allow K+ to build up to a hazardous level. K+ administration is dependent on adequate urine output. LVN/LPNs are required to report problematic findings to an RN.

DIF: Cognitive Level: Analysis REF: p. 205 OBJ: 8
TOP: K+ Administration KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. Both the intracellular and extracellular fluids are made up of many different electrolytes. What is the most abundant intracellular positively charged electrolyte?
a. Calcium
b. Chloride
c. Potassium
d. Sodium
ANS: C
K+ is the most abundant electrolyte in the cell.

DIF: Cognitive Level: Knowledge REF: p. 193 OBJ: 5
TOP: Electrolytes KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

14. For what compensatory condition should the nurse carefully assess when the patient with metabolic acidosis is hyperventilating?
a. Metabolic alkalosis
b. Respiratory acidosis
c. Respiratory alkalosis
d. Thyroid imbalances
ANS: C
When in metabolic acidosis, the body attempts to compensate by increasing respirations and creating respiratory alkalosis.

DIF: Cognitive Level: Application REF: p. 208 OBJ: 10
TOP: Acidosis and Compensatory Alkalosis
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. The K+ laboratory report shows a level of 5.2 mEq/L. What is the most important assessment for the nurse to make?
a. Excessive thirst
b. Irregular heartbeat
c. Swelling of ankles
d. Frightening hallucinations
ANS: B
Arrhythmias can be triggered by hyperkalemia.

DIF: Cognitive Level: Comprehension REF: p. 205 OBJ: 8
TOP: Hyperkalemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. A patient has renal damage because of diabetes. What is the highest risk for this patient?
a. Hypercalcemia
b. Hypocalcemia
c. Hyperkalemia
d. Hypokalemia
ANS: C
When the renal system cannot rid the body of enough K+, this electrolyte builds up and a condition called hyperkalemia develops.

DIF: Cognitive Level: Analysis REF: p. 205 OBJ: 6
TOP: Kidney Damage Limiting Excretion of Potassium
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. What is usually associated with hyperchloremia?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
ANS: A
Chlorides bind with positively charged ions such as K+ in the patient with metabolic acidosis.

DIF: Cognitive Level: Comprehension REF: p. 205 | p. 209
OBJ: 10 TOP: Hyperchloremia
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. Older adults are at risk for dehydration because of reduced thirst and aging kidneys. What should the nurse assess as an early indicator of dehydration?
a. Reduced skin turgor
b. Constipation
c. Concentrated urine
d. Disorientation
ANS: B
Because older adults have poor skin turgor and urine concentration is difficult to assess, constipation is the earliest indicator of a fluid deficit.

DIF: Cognitive Level: Application REF: p. 196 OBJ: 9
TOP: Fluid Loss in Older Adults KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. A nurse has two newly admitted patients with dehydration. One patient is dehydrated from heat exhaustion, and the other is dehydrated from an overdose of Lasix. What finding should be present in both patients?
a. Increased skin turgor
b. Decreased pulse and respirations
c. Copious saliva and nasal secretions
d. Increased laboratory values of hemoglobin and hematocrit
ANS: D
Water has been lost; therefore, the red blood cells will concentrate and show artificially high values of hemoglobin and hematocrit.

DIF: Cognitive Level: Analysis REF: p. 201 OBJ: 4
TOP: Dehydration Assessment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. A nurse understands that fluid balance is mainly monitored in the body by which two systems?
a. Circulatory and renal
b. Respiratory and circulatory
c. Renal and gastrointestinal
d. Hepatic and lymphatic
ANS: A
The monitoring of basic fluid balance in the body is performed by the renal and circulatory systems.

DIF: Cognitive Level: Knowledge REF: p. 195 OBJ: 4
TOP: Fluid Balance KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. What primarily maintains extracellular fluid osmolarity?
a. Chloride
b. Magnesium
c. Potassium
d. Sodium
ANS: D
Sodium, as the primary extracellular electrolyte, controls the osmolarity (either too much or too little) of the extracellular fluid.

DIF: Cognitive Level: Comprehension REF: p. 193 OBJ: 5
TOP: Extracellular Fluid Osmolarity KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. How does the healthy kidney adjust the volume and composition of filtrate that prevents excessive fluid loss?
a. Active transport
b. Filtration in the lymphatic system
c. Secretion of adrenalin
d. Tubular reabsorption
ANS: D
The kidney reabsorbs water and other electrolytes in response to chemical receptors.

DIF: Cognitive Level: Comprehension REF: p. 195 OBJ: 1
TOP: Renal Physiology KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. What process involves blood being brought by the incoming capillaries into the kidney, which contains nitrogenous substances to be excreted as waste?
a. Active transport
b. Diffusion
c. Filtration
d. Osmosis
ANS: C
Capillary blood from the renal arteries filters into the kidney for processing as the first step.

DIF: Cognitive Level: Knowledge REF: p. 195 OBJ: 3
TOP: Kidney Filtration KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. What should treatment focus on when a patient is hypovolemic?
a. Extracellular fluid deficit and limiting drinking water
b. Hypertonic intracellular deficit and limiting water intake
c. Extracellular fluid deficit and encouraging fluid intake
d. Circulatory system hormone deficit and limiting water intake
ANS: C
A fluid volume deficit occurs when the fluid volume in the body is inadequate; the nurse may encourage drinking fluids as a nursing action.

DIF: Cognitive Level: Application REF: p. 201 OBJ: 8
TOP: Fluid Deficit KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. A patient is frequently thirsty. To what should the nurse attribute this symptom?
a. Too much sodium and too much water in the body
b. Too little sodium and too much water in the body
c. Too much sodium and too little water in the body
d. Too little sodium and too little water in the body
ANS: C
Normal thirst is the bodys way of calling for an increase in fluid volume, which could mean that the body is retaining too much sodium and too little water.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 6
TOP: Thirst Assessment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

26. What should a nurse instruct a patient with a K+ level of 6.2 to avoid? (Select all that apply.)
a. Lima beans
b. Bananas
c. Carrots
d. Tomatoes
e. Celery
ANS: B, C, D, E
Banana, carrots, tomatoes, and celery are all high in K+ and should be avoided. Lima beans are low in K+.

DIF: Cognitive Level: Application REF: p. 205 OBJ: 8
TOP: Foods High in K+ KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

COMPLETION

27. A nurse assesses that a patient with congestive heart failure who is being treated with a diuretic has lost 4.4 lb in 1 day. This weight loss is equivalent to the loss of _____ of fluid.

ANS:
2 L
1 L of fluid is equal to 2.2 lb. A weight loss of 4.4 lb is equal to 2 L.

DIF: Cognitive Level: Analysis REF: p. 196 OBJ: 4
TOP: Fluid Loss KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. A nurse assesses deep-rapid respirations in a patient with metabolic acidosis to be an indicator of the homeostatic system at work to reduce the _____ level.

ANS:
carbon dioxide
CO2
The lungs are primarily responsible for the regulation of CO2 by changing the rate and depth of respirations.

DIF: Cognitive Level: Comprehension REF: p. 208-209 OBJ: 10
TOP: Metabolic Acidosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. A nurse should anticipate in a patient with respiratory acidosis that the blood pH reading would be lower than _____.

ANS:
7.3
The lowest normal value for blood pH is 7.35. Any value lower than 7.3 indicates acidosis.

DIF: Cognitive Level: Application REF: p. 207 OBJ: 10
TOP: Respiratory Acidosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

30. A nurse cautions a group of high school athletes about fluid loss in hot, dry weather, because the normal loss from respiration, which is _____ to _____ mL/day, is doubled.

ANS:
300; 400
The normal fluid loss through evaporation is 300 to 400 mL a day. The fluid loss increases in hot, dry weather.

DIF: Cognitive Level: Application REF: p. 196 OBJ: 6
TOP: Insensible Fluid Loss KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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