Chapter 16: Fluid and Electrolyte Replacement Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 16: Fluid and Electrolyte Replacement

Test Bank

MULTIPLE CHOICE

1. A clients serum osmolality is 270 mOsm/kg. What is the clients body fluid osmolality?

a.

Iso-osmolar

b.

Hypo-osmolar

c.

Hyperosmolar

d.

Normosmolar

ANS: B

Normal osmolality is 275 to 295 mOsm/kg. This client is therefore hypo-osmolar.

DIF: Cognitive Level: Analysis REF: p. 230

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

2. A clients serum chemistry values are serum sodium level 142 mEq/L, blood urea nitrogen (BUN) 15 mg/dl, and glucose level 90 mg/dl. What is the clients body fluid osmolality?

a.

Iso-osmolar

b.

Hypo-osmolar

c.

Hyperosmolar

d.

Hypotonic

ANS: A

To calculate osmolality, use the equation:

2(serum Na concentration) + BUN/3 + glucose level/18.

2(142) + 15/3 + 90/18 = 294 mOsm/kg, or iso-osmolality.

DIF: Cognitive Level: Analysis REF: p. 230

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

3. A clients serum chemistry measurements are serum sodium level 146 mEq/L, BUN 24 mg/dl, and glucose level 90 mg/dl. What is the clients serum osmolality?

a.

275 mOsm/kg

b.

285 mOsm/kg

c.

295 mOsm/kg

d.

305 mOsm/kg

ANS: D

To calculate osmolality, use the equation:

2(serum Na concentration) + BUN/3 + glucose level/18.

2(146) + 24/3 + 90/18 = 305 mOsm/kg.

DIF: Cognitive Level: Analysis REF: p. 230

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

4. A client received 3 L of D5W. With continuous use of 5% dextrose in water, the intravenous (IV) fluids become:

a.

isotonic.

b.

hypotonic.

c.

hypertonic.

d.

megatonic.

ANS: B

D5W is isotonic, but when the dextrose is metabolized in the human body, it becomes hypotonic.

DIF: Cognitive Level: Comprehension REF: p. 231

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

5. A client is ordered to receive lactated Ringers solution. What type of intravenous (IV) solution is this?

a.

Lipid

b.

Crystalloid

c.

Colloid

d.

Blood product

ANS: B

Lactated Ringers solution is a crystalloid solution.

DIF: Cognitive Level: Comprehension REF: p. 231

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

6. A client in severe shock is ordered to receive dextran as a volume expander. This type of fluid known as a:

a.

lipid.

b.

crystalloid.

c.

colloid.

d.

blood product.

ANS: C

Dextran is a colloid.

DIF: Cognitive Level: Comprehension REF: p. 231

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

7. A nurse is calculating a clients daily fluid needs. The client weighs 85 kg. The approximate daily fluid requirement is _____ mL.

a.

1700

b.

2000

c.

2550

d.

3000

ANS: C

Fluids for adults may be calculated as 30 mL/kg/day: 30 85 = 2550 mL.

DIF: Cognitive Level: Application REF: p. 231

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

8. A client is admitted to the emergency department with tachycardia, hypotension, and a serum sodium level of 115 mEq/L. What does the clients serum sodium level indicate?

a.

Normal serum sodium value

b.

Hyponatremia

c.

Hypernatremia

d.

Hypocalcemia

ANS: B

Hyponatremia occurs when serum sodium levels fall below 135 mEq/L.

DIF: Cognitive Level: Analysis REF: p. 236

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

9. Which physician order would the nurse question when administering IV fluids with potassium chloride (KCl)?

a.

Inject IV KCl directly into the IV tubing.

b.

Check for infiltration because potassium is irritating to subcutaneous tissues.

c.

Check for phlebitis because potassium is irritating to the veins.

d.

Check for adequate urinary output (kidney dysfunction can cause potassium retention that may lead to hyperkalemia).

ANS: A

KCl should never be directly injected, but must be diluted so that it will not cause venous or tissue damage, or more serious effects of a large bolus, such as cardiac standstill.

DIF: Cognitive Level: Application REF: p. 233

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

10. A client is ordered to receive potassium. The nurse should instruct the client to take KCl at what time of day?

a.

Throughout the day with sips of water

b.

Before breakfast

c.

At bedtime with 1 ounce of fluid

d.

At mealtime

ANS: D

Potassium should be given at mealtimes or be well diluted (in at least 6 to 8 ounces of fluid) to avoid gastric upset and improve absorption.

DIF: Cognitive Level: Application REF: p. 233

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

11. A client is instructed to use potassium supplements because a medication that has been prescribed may cause hypokalemia. The nurse is aware that which group of drugs may cause hypokalemia?

a.

Potassium-sparing diuretics

b.

Potassium-wasting diuretics

c.

Beta-blockers

d.

Narcotics

ANS: B

These drugs cause the body to lose potassium.

DIF: Cognitive Level: Application REF: p. 235

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

12. A clients serum potassium level is 5.4 mEq/L. What intervention may correct this type of potassium imbalance?

a.

Restriction of foods containing potassium

b.

Administration of sodium bicarbonate (NaHCO3)

c.

Administration of insulin and glucose

d.

Administration of sodium polystyrene sulfonate (Kayexalate) and sorbitol

ANS: A

Mild hyperkalemia may be treated with dietary restriction of potassium-rich foods.

DIF: Cognitive Level: Application REF: p. 235

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

13. A clients serum potassium level is 6.9 mEq/L. The nurse anticipates that the healthcare provider will order:

a.

atropine.

b.

sodium bicarbonate (NaHCO3).

c.

insulin and glucose.

d.

sodium polystyrene sulfonate (Kayexalate) and sorbitol.

ANS: D

The client has severe hyperkalemia and requires aggressive treatment with Kayexalate and sorbitol. These increase the bodys excretion of potassium.

DIF: Cognitive Level: Application REF: p. 236

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

14. In monitoring a client taking potassium supplements, the nurse observes for which signs and symptoms of hyperkalemia?

a.

Oliguria, tachycardia, and later bradycardia

b.

Soft, flabby muscles

c.

Abdominal distention

d.

Blurred vision and loss of hearing

ANS: A

Oliguria, tachycardia, and later bradycardia are the signs of hyperkalemia.

DIF: Cognitive Level: Application REF: p. 233

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

15. A nurse is teaching a client about ways to avoid hypocalcemia. Dietary recommendations indicate that vitamin _____ is necessary for calcium absorption.

a.

A

b.

B

c.

D

d.

E

ANS: C

Vitamin D enhances the absorption of calcium in the body.

DIF: Cognitive Level: Application REF: p. 237

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

16. A clients serum calcium level is 3.7 mEq/L. Concerning this level, the nurse knows that it is:

a.

low.

b.

normal.

c.

high.

d.

dangerously high.

ANS: A

The appropriate range for serum calcium is 4.5 to 5.6 mEq/L.

DIF: Cognitive Level: Analysis REF: p. 236

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

17. A client is receiving D5NSS via a peripheral IV. The client is prescribed to receive calcium gluconate (Kalcinate). The nurse knows that calcium should not be mixed with saline solution. What is the appropriate response from the nurse?

a.

Ask the healthcare provider about changing the IV solution to 5% dextrose in water (D5W), because saline encourages calcium loss.

b.

Do not give the medication because it is the wrong solution.

c.

Report the healthcare provider immediately to the supervisor because it is the wrong solution.

d.

Change the IV solution to D5W and report it later to the healthcare provider.

ANS: A

Asking the healthcare provider about changing the IV solution to 5% dextrose in water (D5W) is the correct action to take when administering IV calcium. Saline encourages calcium loss.

DIF: Cognitive Level: Application REF: p. 236

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

18. The nurse is aware that which groups of drugs contains magnesium and can cause hypermagnesemia if taken in excess?

a.

Laxatives and steroids

b.

Laxatives and antacids

c.

Antacids and antibiotics

d.

Antacids and steroids

ANS: B

Laxatives and antacids may contain magnesium and have the potential for misuse in clients.

DIF: Cognitive Level: Comprehension REF: p. 234

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

19. A client with congestive heart failure is noted to have gained 17 pounds in the 2 weeks since the last appointment. The nurse is aware that this represents an approximate fluid retention volume of which amount?

a.

5 L

b.

8 L

c.

10 L

d.

15 L

ANS: B

1 L of fluid weighs 1 kg: therefore 17 lb = 7.7 kg. Thus 8 L is the closest answer.

DIF: Cognitive Level: Application REF: p. 232

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

20. Which sign or symptom may be noted in a client with overhydration?

a.

Bradycardia

b.

Hypotension

c.

Pulmonary congestion

d.

Weight loss

ANS: C

Pulmonary congestion is a sign of fluid overload. Hypotension and weight loss are associated with dehydration and shock. Bradycardia may be due to longtime hypoxia and hypoxemia, but this is a very late sign.

DIF: Cognitive Level: Application REF: p. 232

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

21. A postoperative client enters the postanesthesia care unit and blood studies are done. The clients serum potassium level is 2.9 mEq/L. What will the nurse do next?

a.

Institute seizure precautions.

b.

Monitor ECG readings.

c.

Draw liver enzyme levels.

d.

Elevate the head of the bed.

ANS: B

This level of potassium puts the client at risk for cardiac dysrhythmias. The nurse must monitor for cardiac irregularities.

DIF: Cognitive Level: Analysis REF: p. 235

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

22. Which symptom would alert the nurse to the diagnosis of deficient fluid volume?

a.

Weight gain

b.

Tachycardia

c.

Moist mucous membranes

d.

Urine output greater than 600 mL/day

ANS: B

Tachycardia is a compensatory mechanism for hypovolemia; the other symptoms are consistent with appropriate hydration or overhydration.

DIF: Cognitive Level: Analysis REF: p. 232

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

23. The client is experiencing potassium excess and is being treated with 10% calcium gluconate. The client has been diagnosed with cardiac disease. The highest priority action on the part of the nurse is to check the clients:

a.

medications since this drug can lead to digitalis toxicity.

b.

pulse frequently since bradycardia is likely to result.

c.

pedal pulses frequently and lower extremities for swelling.

d.

mental status since alteration in consciousness may occur.

ANS: A

Combining 10% calcium gluconate with digitalis can result in digitalis toxicity.

DIF: Cognitive Level: Analysis REF: p. 236

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

24. The client has been ordered Kayexalate as a treatment for potassium excess. The nurse is gathering equipment to administer the medication and recognizes that the drug will be given as a(n):

a.

intramuscular injection.

b.

intravenous medication.

c.

rectal medication.

d.

subcutaneous injection.

ANS: C

Kayexalate is a medication that can be given rectally as an enema or orally.

DIF: Cognitive Level: Application REF: p. 236

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

25. A client who is taking calcium supplements is concerned about her ability to determine that the supplements are absorbable. The nurse should instruct the client to check the tablets absorbability by performing which action?

a.

Put 1 tablet into 1 ounce of white vinegar; the tablet should dissolve within 30 minutes.

b.

Put 1 tablet into 1 ounce of hydrogen peroxide; the tablet should not dissolve.

c.

Put 1 tablet into 1 ounce of alcohol; the tablet should dissolve within 1 hour.

d.

Put 1 tablet into 1 ounce of water; the tablet should dissolve within 15 minutes.

ANS: A

Encourage the client taking calcium supplements to check that the calcium tablet is absorbable. To do this, put 1 tablet into 1 ounce of white vinegar. Stir every 3 minutes. The tablet should break up or dissolve within 30 minutes.

DIF: Cognitive Level: Application REF: p. 242

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

MULTIPLE RESPONSE

1. Tetany symptoms result from severe calcium deficit. The nurse checks for symptoms of tetany. Which symptoms are associated with tetany? (Select all that apply.)

a.

twitching of the mouth and numbness of the fingers

b.

muscle weakness

c.

carpopedal spasms

d.

laryngeal spasm

ANS: A, C, D

Muscle weakness is not characteristic of tetany; the other symptoms are.

DIF: Cognitive Level: Application REF: p. 237

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

ESSAY

1. A client with cirrhosis is noted to have low serum albumin levels. The client 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?

ANS:

100 gtt/min

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

DIF: Cognitive Level: Analysis REF: p. 231

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Basic Care and Comfort: Nutrition

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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