1
MEDICAL-SURGICAL NURSING NURSING CARE OF
PATIENTS WITH ALTERED FLUID, ELECTROLYTE,
AND ACID-BASE BALANCE 2026-27 LATEST VERSION
QS, AS AND EXPLANATIONS
1) The nurse is caring for an older patient who is occasionally confused. What should be the
nurse's primary concern regarding fluid and electrolytes when caring for this patient?
1. Risk of dehydration
2. Risk of kidney damage
3. Risk of stroke
4. Risk of bleeding
Answer: 1
Explanation: 1. As an adult ages, the thirst mechanism declines. In a patient with an altered
level of consciousness, this presents an increased risk of dehydration and high serum
osmolality.
2. The risks for kidney damage are not specifically related to aging or fluid and electrolyte
issues.
3. The risk of stroke is not specifically related to aging or fluid and electrolyte issues.
4. The risk of bleeding is not specifically related to aging or fluid and electrolyte issues.
Page Ref: 232
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-
centered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management, and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated
Concepts: Nursing Process: Planning
Learning Outcome: 10.1 Describe the functions and regulatory mechanisms that maintain
water and electrolyte balance in the body.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical
manifestations for patients with altered fluid, electrolyte, and acid-base balance.
,2
2) The nurse is planning care for a patient with severe burns. What health problem should the
nurse realize that this patient could develop?
1. Intracellular fluid deficit
2. Intracellular fluid overload
3. Extracellular fluid deficit
4. Interstitial fluid deficit
Answer: 1
Explanation: 1. Because this patient was severely burned, the fluid within the cells is
diminished, leading to an intracellular fluid deficit.
2. The intracellular fluid is composed of all fluids that exist within the cell cytoplasm and
nucleus. Because this patient was severely burned, the fluid within the cells is diminished,
leading to an intracellular fluid deficit.
3. The extracellular fluid is composed of all fluids that exist outside the cell, including the
interstitial fluid between the cells. Because this patient was severely burned, the fluid within
the cells is diminished, leading to an intracellular fluid deficit.
4. The extracellular fluid is composed of all fluids that exist outside the cell, including the
interstitial fluid between the cells. Because this patient was severely burned, the fluid within
the cells is diminished, leading to an intracellular fluid deficit.
Page Ref: 235
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-
centered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated
Concepts: Nursing Process: Planning
Learning Outcome: 10.2 Describe the pathophysiology and manifestations of fluid volume
deficit and fluid volume excess, and outline the interprofessional care, nursing care, and
transitions of care for patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical
manifestations for patients with altered fluid, electrolyte, and acid-base balance.
2
Copyright © 2020 Pearson Education, Inc.
,3
3) A patient experiencing multisystem fluid volume deficit has tachycardia; pale, cool skin; and
decreased urine output. Which process should the nurse consider is causing these findings?
1. The body's natural compensatory mechanisms
2. Pharmacological effects of a diuretic
3. Effects of rapidly infused intravenous fluids
4. Cardiac failure
Answer: 1
Explanation: 1. The internal vasoconstrictive compensatory reactions within the body are
responsible for the symptoms exhibited. The body naturally attempts to conserve fluid
internally specifically for the brain and heart.
2. No evidence is provided that the patient received a diuretic.
3. Rapidly infused intravenous fluids would not cause a decrease in urine output.
4. The manifestations are not associated with cardiac failure.
Page Ref: 235
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-
centered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management, and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated
Concepts: Nursing Process: Assessment
Learning Outcome: 10.2 Describe the pathophysiology and manifestations of fluid volume
deficit and fluid volume excess, and outline the interprofessional care, nursing care, and
transitions of care for patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical
manifestations for patients with altered fluid, electrolyte, and acid-base balance.
3
Copyright © 2020 Pearson Education, Inc.
, 4
4) A pregnant patient is admitted with excessive thirst and increased urination. For which
problem should the nurse focus the care of this patient?
1. Imbalanced fluid
2. Fluid overload
3. Nutritional deficiency
4. Insufficient blood flow
Answer: 1
Explanation: 1. The patient with excessive thirst and increased urination is losing fluid. This is
the problem on which the nurse should focus with this patient.
2. There is no evidence that the patient has an overabundance of fluid.
3. There is no evidence that the patient has a nutritional deficiency.
4. There is no evidence that this patient has insufficient blood flow.
Page Ref: 232
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-
centered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management, and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated
Concepts: Nursing Process: Planning
Learning Outcome: 10.1 Describe the functions and regulatory mechanisms that maintain
water and electrolyte balance in the body.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical
manifestations for patients with altered fluid, electrolyte, and acid-base balance.
4
Copyright © 2020 Pearson Education, Inc.
MEDICAL-SURGICAL NURSING NURSING CARE OF
PATIENTS WITH ALTERED FLUID, ELECTROLYTE,
AND ACID-BASE BALANCE 2026-27 LATEST VERSION
QS, AS AND EXPLANATIONS
1) The nurse is caring for an older patient who is occasionally confused. What should be the
nurse's primary concern regarding fluid and electrolytes when caring for this patient?
1. Risk of dehydration
2. Risk of kidney damage
3. Risk of stroke
4. Risk of bleeding
Answer: 1
Explanation: 1. As an adult ages, the thirst mechanism declines. In a patient with an altered
level of consciousness, this presents an increased risk of dehydration and high serum
osmolality.
2. The risks for kidney damage are not specifically related to aging or fluid and electrolyte
issues.
3. The risk of stroke is not specifically related to aging or fluid and electrolyte issues.
4. The risk of bleeding is not specifically related to aging or fluid and electrolyte issues.
Page Ref: 232
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-
centered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management, and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated
Concepts: Nursing Process: Planning
Learning Outcome: 10.1 Describe the functions and regulatory mechanisms that maintain
water and electrolyte balance in the body.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical
manifestations for patients with altered fluid, electrolyte, and acid-base balance.
,2
2) The nurse is planning care for a patient with severe burns. What health problem should the
nurse realize that this patient could develop?
1. Intracellular fluid deficit
2. Intracellular fluid overload
3. Extracellular fluid deficit
4. Interstitial fluid deficit
Answer: 1
Explanation: 1. Because this patient was severely burned, the fluid within the cells is
diminished, leading to an intracellular fluid deficit.
2. The intracellular fluid is composed of all fluids that exist within the cell cytoplasm and
nucleus. Because this patient was severely burned, the fluid within the cells is diminished,
leading to an intracellular fluid deficit.
3. The extracellular fluid is composed of all fluids that exist outside the cell, including the
interstitial fluid between the cells. Because this patient was severely burned, the fluid within
the cells is diminished, leading to an intracellular fluid deficit.
4. The extracellular fluid is composed of all fluids that exist outside the cell, including the
interstitial fluid between the cells. Because this patient was severely burned, the fluid within
the cells is diminished, leading to an intracellular fluid deficit.
Page Ref: 235
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-
centered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated
Concepts: Nursing Process: Planning
Learning Outcome: 10.2 Describe the pathophysiology and manifestations of fluid volume
deficit and fluid volume excess, and outline the interprofessional care, nursing care, and
transitions of care for patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical
manifestations for patients with altered fluid, electrolyte, and acid-base balance.
2
Copyright © 2020 Pearson Education, Inc.
,3
3) A patient experiencing multisystem fluid volume deficit has tachycardia; pale, cool skin; and
decreased urine output. Which process should the nurse consider is causing these findings?
1. The body's natural compensatory mechanisms
2. Pharmacological effects of a diuretic
3. Effects of rapidly infused intravenous fluids
4. Cardiac failure
Answer: 1
Explanation: 1. The internal vasoconstrictive compensatory reactions within the body are
responsible for the symptoms exhibited. The body naturally attempts to conserve fluid
internally specifically for the brain and heart.
2. No evidence is provided that the patient received a diuretic.
3. Rapidly infused intravenous fluids would not cause a decrease in urine output.
4. The manifestations are not associated with cardiac failure.
Page Ref: 235
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-
centered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management, and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated
Concepts: Nursing Process: Assessment
Learning Outcome: 10.2 Describe the pathophysiology and manifestations of fluid volume
deficit and fluid volume excess, and outline the interprofessional care, nursing care, and
transitions of care for patients with these disorders.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical
manifestations for patients with altered fluid, electrolyte, and acid-base balance.
3
Copyright © 2020 Pearson Education, Inc.
, 4
4) A pregnant patient is admitted with excessive thirst and increased urination. For which
problem should the nurse focus the care of this patient?
1. Imbalanced fluid
2. Fluid overload
3. Nutritional deficiency
4. Insufficient blood flow
Answer: 1
Explanation: 1. The patient with excessive thirst and increased urination is losing fluid. This is
the problem on which the nurse should focus with this patient.
2. There is no evidence that the patient has an overabundance of fluid.
3. There is no evidence that the patient has a nutritional deficiency.
4. There is no evidence that this patient has insufficient blood flow.
Page Ref: 232
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-
centered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management, and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated
Concepts: Nursing Process: Planning
Learning Outcome: 10.1 Describe the functions and regulatory mechanisms that maintain
water and electrolyte balance in the body.
MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical
manifestations for patients with altered fluid, electrolyte, and acid-base balance.
4
Copyright © 2020 Pearson Education, Inc.
