Chapter 16: Fluid and Electrolyte Replacement Nursing School Test Banks

Chapter 16: Fluid and Electrolyte Replacement
Test Bank

MULTIPLE CHOICE

1. A patients serum osmolality is 305 mOsm/kg. Which term describes this patients body fluid osmolality?
a. Iso-osmolar
b. Hypo-osmolar
c. Hyperosmolar
d. Isotonic
ANS: C
Normal osmolality is 280 to 300 mOsm/kg. This patient is therefore hyperosmolar.

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2. A patient is admitted after experiencing vomiting and diarrhea for several days. The provider orders intravenous lactated Ringers solution. The nurse understands that this fluid is given for which purpose?
a. To increase interstitial and intracellular hydration
b. To maintain plasma volume over time
c. To pull water from the interstitial space into the extracellular fluid
d. To replace water and electrolytes
ANS: D
Lactated Ringers solution is an isotonic solution and is used to replace water and electrolytes and is often used to replace gastrointestinal losses. Hypotonic fluids increase interstitial and intracellular hydration. Colloidal solutions are used to maintain plasma volume over time. Hypertonic solutions pull water from the interstitial space into the extracellular fluid.

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3. A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion?
a. Decreased urine output
b. Improved blood oxygenation
c. Increased interstitial fluid
d. Stabilization of heart rate and blood pressure
ANS: D
6% Dextran 75 is a high molecular-weight colloidal solution and is used to treat shock from burns or trauma. Colloids are plasma expanders, and the end result is an improvement in heart rate (decreased) and blood pressure (increased). Plasma expanders will result in an increase in urine output. Blood oxygenation is not affected, and colloids do not increase the amount of interstitial fluid.

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4. The nurse is caring for a patient who weighs 75 kg. The patient has intravenous (IV) fluids infusing at a rate of 50 mL/hour and has consumed 100 mL of fluids orally in the past 24 hours. Which action will the nurse take?
a. Contact the provider to ask about increasing the IV rate to 90 mL/hour.
b. Discuss with the provider the need to increase the IV rate to 150 mL/hour.
c. Encourage the patient to drink more water so the IV can be discontinued.
d. Instruct the patient to drink 250 mL of water every 8 hours.
ANS: A
The recommended daily fluid intake for adults is 30 to 40 mL/kg/day. This patient should have a minimum of 2250 mL/day and is currently receiving 1200 mL IV plus 100 mL orally for a total of 1300 mL. Increasing the IV rate to 90 mL/hour would give the patient 2160 mL. If the patient continues to take oral fluids, the amount of 2250 mL can be met. A rate of 150 mL per hour would give the patient 3600 mL per day, which exceeds the recommended amount. Since this patient is not taking fluids well and is not receiving adequate IV fluids, encouraging an increased fluid intake is not indicated. Even if the patient drank 250 mL of water every 8 hours, the amount would not be sufficient.

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5. The nurse is caring for a patient who has a heart rate of 98 beats per minute and a blood pressure of 82/58 mm Hg. The patient is lethargic, is complaining of muscle weakness, and has had gastroenteritis for several days. Based on this patients vital signs, which sodium value would the nurse expect?
a. 126 mEq/L
b. 140 mEq/L
c. 145 mEq/L
d. 158 mEq/L
ANS: A
Patients who are hyponatremic will have tachycardia and hypotension along with lethargy and muscle weakness. The normal range for serum sodium is 135 mEq/L to 145 mEq/L; a serum sodium level of 126 mEq/L would be considered hyponatremic.

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6. The nurse is caring for a patient who has had severe vomiting. The patients serum sodium level is 130 mEq/L. The nurse will expect the patients provider to order which treatment?
a. Diuretic therapy
b. Intravenous hypertonic 5% saline
c. Intravenous normal saline 0.9%
d. Oral sodium supplements
ANS: C
Patients with hyponatremia may be treated with oral sodium supplements if the patient is able or if the deficit is mild. This patient is vomiting and would not be able to take supplements easily. For a serum level between 125 and 135 mEq/L, normal saline may increase sodium content in vascular fluid. Hypertonic saline is used for severe hyponatremia with a serum sodium <120 mEq/L. Diuretics would further deplete sodium and fluid volume in a patient already likely to be dehydrated from severe vomiting.

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7. The nurse is caring for a newly admitted patient who has severe gastroenteritis. The patients electrolytes reveal a serum sodium level of 140 mEq/L and a serum potassium level of 3.5 mEq/L. The nurse receives an order for intravenous 5% dextrose and normal saline with 20 mEq/L potassium chloride to infuse at 125 mL per hour. Which action is necessary prior to administering this fluid?
a. Evaluate the patients urine output.
b. Contact the provider to order arterial blood gases.
c. Request an order for an initial potassium bolus.
d. Suggest a diet low in sodium and potassium.
ANS: A
If the patient is receiving potassium and the urine output is <25 mL/hr or <600 mL/d, potassium accumulation may occur. Patients with a low urine output should not receive IV potassium. Arterial blood gases are not necessary prior to IV potassium administration. Potassium should never be given as a bolus. Patients should be put on a potassium-enriched diet when foods are tolerated.

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8. A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/hour. The nurse assuming care for the patient reviews the patients serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?
a. Contact the patients provider to discuss increasing the potassium chloride to 40 mEq/L.
b. Continue the intravenous fluids as ordered and reassess the patient frequently.
c. Notify the provider and discuss increasing the rate of fluids to 200 mL/hour.
d. Stop the intravenous fluids and notify the provider of the assessment findings.
ANS: D
The patients potassium level is within normal limits, but the urine output is decreased, so the patient should not be receiving IV potassium. The nurse should stop the IV and report the findings to the provider. The patient does not need an increase in potassium. The patient needs more fluids but not with potassium.

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9. A patient has a serum potassium level of 2.7 mEq/L. The patients provider has determined that the patient will need 200 mEq of potassium to replace serum losses. How will the nurse caring for this patient expect to administer the potassium?
a. As a single-dose 200 mEq oral tablet
b. As an intravenous bolus over 15 to 20 minutes
c. In an intravenous solution at a rate of 10 mEq/hour
d. In an intravenous solution at a rate of 45 mEq/hour
ANS: C
Potassium chloride should be given intravenously when hypokalemia is severe, so this patient should receive IV potassium chloride. Potassium should never be given as a bolus and should be administered slowly. The maximum infusion rate for adults with a serum potassium level greater than 2.5 mEq/L is 10 mEq/hour or 200 mEq/24 hours.

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10. A patient is taking a thiazide diuretic and reports anorexia and fatigue. The nurse suspects which electrolyte imbalance in this patient?
a. Hypercalcemia
b. Hypocalcemia
c. Hyperkalemia
d. Hypokalemia
ANS: D
Thiazide diuretics cause the body to lose potassium. Patients who take thiazide diuretics should be monitored for hypokalemia.

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11. The nurse is caring for a patient whose serum sodium level is 140 mEq/L and serum potassium level is 5.4 mEq/L. The nurse will contact the patients provider to discuss an order for
a. a low-potassium diet.
b. intravenous sodium bicarbonate.
c. Kayexalate and sorbitol.
d. salt substitutes.
ANS: A
Mild hyperkalemia may be treated with dietary restriction of potassium-rich foods. The patients sodium level is normal, so sodium bicarbonate is not indicated. Kayexalate is used for severe hyperkalemia. Salt substitutes contain potassium and would only compound the hyperkalemia.

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12. The provider has ordered Kayexalate and sorbitol to be administered to a patient. The nurse caring for this patient would expect which serum electrolyte values prior to administration of this therapy?
a. Sodium 125 mEq/L and potassium 2.5 mEq/L
b. Sodium 150 mEq/L and potassium 3.6 mEq/L
c. Sodium 135 mEq/L and potassium 6.9 mEq/L
d. Sodium 148 mEq/L and potassium 5.5 mEq/L
ANS: C
Severe hyperkalemia, with a potassium level of 6.9 mEq/L, requires aggressive treatment with Kayexalate and sorbitol to increase the bodys excretion of potassium. The normal range for serum potassium is 3.5 to 5.5 mEq/L, so patients with the other potassium levels would not be treated aggressively or would need potassium supplementation.

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13. The nurse is caring for a patient who is receiving oral potassium chloride supplements. The nurse notes that the patient has a heart rate of 120 beats per minute and has had a urine output of 200 mL in the past 12 hours. The patient reports abdominal cramping. Which action will the nurse take?
a. Contact the provider to request an order for serum electrolytes.
b. Encourage the patient to consume less fluids.
c. Report symptoms of hyperchloremia to the provider.
d. Request an order to increase the patients potassium dose.
ANS: A
Oliguria, tachycardia, and abdominal cramping are signs of hyperkalemia, so the nurse should request an order for serum electrolytes. This patient should increase fluid intake. The patient is not exhibiting signs of hyperchloremia; the patient is showing signs of hyperkalemia, and an increased potassium dose is not indicated.

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14. A patient asks the nurse about taking calcium supplements to avoid hypocalcemia. The nurse will suggest that the patient follow which instruction?
a. Take a calcium and vitamin D combination supplement.
b. Take calcium along with phosphorus to improve absorption.
c. Take calcium with antacids to reduce stomach upset.
d. Use aspirin instead of acetaminophen when taking calcium.
ANS: A
Vitamin D enhances the absorption of calcium in the body. Calcium and phosphorus have an inverse relationshipan increased level of one mineral decreases the level of the other. Antacids can contain magnesium, which can promote calcium loss. Aspirin can alter vitamin D levels and interfere with calcium absorption.

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15. The nurse is caring for a newly admitted patient who will receive digoxin to treat a cardiac dysrhythmia. The patient takes hydrochlorothiazide (HydroDIURIL) and reports regular use of over-the-counter laxatives. Before administering the first dose of digoxin, the nurse will review the patients electrolytes with careful attention to the levels of which electrolytes?
a. Calcium and magnesium
b. Sodium and calcium
c. Potassium and chloride
d. Potassium and magnesium
ANS: D
Hypomagnesemia, like hypokalemia, enhances the action of digitalis and causes digitalis toxicity. Laxatives and diuretics can deplete both of these electrolytes.

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16. The nurse is administering intravenous fluids to a patient who is dehydrated. On the second day of care, the patients weight is increased by 2.25 pounds. The nurse would expect that the patients fluid intake has
a. equaled urine output.
b. exceeded urine output by 1 L.
c. exceeded urine output by 2.5 L.
d. exceeded urine output by 3 L.
ANS: B
A weight gain of 1 kg, or 2.2 to 2.5 lb, is equivalent to 1 L of fluid.

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17. The nurse is caring for a patient who is receiving isotonic intravenous (IV) fluids at an infusion rate of 125 mL/hour. The nurse performs an assessment and notes a heart rate of 102 beats per minute, a blood pressure of 160/85 mm Hg, and crackles auscultated in both lungs. Which action will the nurse take?
a. Decrease the IV fluid rate and notify the provider.
b. Increase the IV fluid rate and notify the provider.
c. Request an order for a colloidal IV solution.
d. Request an order for a hypertonic IV solution.
ANS: A
The patient shows signs of fluid volume excess, so the nurse should slow the IV fluid rate and notify the provider. Increasing the rate would compound the problem. Colloidal and hypertonic fluids would pull more fluids into the intravascular space and compound the problem.

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18. The nurse is preparing to administer digoxin to a patient who is newly admitted to the intensive care unit. The nurse reviews the patients admission electrolytes and notes a serum potassium level of 2.9 mEq/L. Which action by the nurse is correct?
a. Administer the digoxin and monitor the patients electrocardiogram closely.
b. Hold the digoxin dose and notify the provider of the patients lab values.
c. Request an order for an intravenous bolus of potassium.
d. Request an order for oral potassium supplements.
ANS: B
Hypokalemia can cause digoxin toxicity, so the nurse should hold the dose and notify the provider. Potassium should never be given as an IV bolus. Oral supplements are not used when hypokalemia is severe.

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19. The nurse is performing an assessment on a patient brought to the emergency department for treatment for dehydration. The nurse assesses a respiratory rate of 26 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 86/50 mm Hg, and a temperature of 39.5 C. The patient becomes dizzy when transferred from the wheelchair to a bed. The nurse notes cool, clammy skin. Which diagnosis does the nurse suspect?
a. Fluid volume deficit (FVD)
b. Fluid volume excess (FVE)
c. Mild extracellular fluid (ECF) deficit
d. Renal failure
ANS: A
Patients with FVD will exhibit elevated temperature, tachycardia, tachypnea, hypotension, orthostatic hypotension, and cool, clammy skin. Patients with FVE will have bounding pulses, elevated blood pressure, dyspnea, and crackles. Mild ECF deficit causes thirst. Renal failure generally leads to FVE.

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20. The nurse is caring for a patient who will receive 10% calcium gluconate to treat a serum potassium level of 5.9 mEq/L. The nurse performs a drug history prior to beginning the infusion. Which drug taken by the patient would cause concern?
a. Digitalis
b. Hydrochlorothiazide
c. Hydrocortisone
d. Vitamin D
ANS: A
Calcium gluconate is given to treat hyperkalemia in order to decrease irritability of the myocardium. When administered to a patient taking digitalis, it can cause digitalis toxicity. The other drugs may affect potassium levels but are not a cause for concern with calcium gluconate.

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21. The nurse is caring for a patient who is ordered to take nothing by mouth. The patient weighs 65 kg. What volume of intravenous fluid should this patient receive in 24 hours?
a. 2225 mL
b. 2400 mL
c. 2520 mL
d. 2640 mL
ANS: C
Fluid maintenance needs for the NPO patient are calculated as 4 mL/kg/h for the first 10 kg of weight, 2 mL/kg/h for the second 10 kg of weight, and 1 mL/kg/h for every kg of weight thereafter. This patients fluid needs are (10 kg 4 mL) + (10 kg 2 mL) + (45 kg 1 mL) = 105 mL/h. The 24-hour total is 105 mL/h 24 h = 2,520 mL.

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22. A patient is admitted with orthopnea, cough, pulmonary crackles, and peripheral edema. The patients urine specific gravity is 1.002. The nurse will expect this patients provider to order which treatment?
a. Diuretics
b. Colloidal IV fluids
c. Hypertonic IV fluids
d. Hypotonic IV fluids
ANS: A
This patient has signs of fluid volume excess. Diuretics are prescribed to reduce fluid overload.

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MULTIPLE RESPONSE

1. The nurse is caring for a patient who will receive intravenous calcium gluconate. Which nursing actions are appropriate when giving this solution? (Select all that apply.)
a. Administering through a central line
b. Assessing for Trousseaus and Chvosteks signs
c. Giving as a rapid intravenous bolus
d. Mixing in a solution containing sodium bicarbonate
e. Monitoring the patients electrocardiogram (ECG)
f. Reporting a serum calcium level >2.5mEq/L
ANS: B, E, F
Trousseaus and Chvosteks signs indicate hypocalcemia, and patients receiving calcium should be monitored closely for signs of calcium imbalance. Hypercalcemia can cause ECG changes. A serum calcium level greater than 2.5mEq/L indicates hypercalcemia and therefore should be reported. Calcium does not require infusion through a central line and should not be given as a rapid IV bolus. Calcium should not be added to a solution containing bicarbonate, because rapid precipitation occurs.

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2. A patient is suspected of having severe hypocalcemia. While waiting for the patients serum electrolyte results, the nurse will assess for which symptoms? (Select all that apply.)
a. Laryngeal spasms
b. Fatigue
c. Muscle weakness
d. Nausea and vomiting
e. Numbness of fingers
f. Twitching of the mouth
ANS: A, E, F
Patients who have hypocalcemia will exhibit laryngeal spasms, numbness of fingers, and twitching of the mouth. The other symptoms are not characteristic of hypocalcemia.

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OTHER

1. A patient with cirrhosis is noted to have low serum albumin levels. The patient is to receive 200 mL of albumin in 30 minutes. The drop factor for the IV set is 15 gtt/mL. The nurse correctly adjusts the IV rate to what rate?

ANS:
100 gtt/min
(200 mL 15 gtt/mL) 30 min = 100 gtt/min.

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