Brunner Chapter 10: Fluid and Electrolytes
QUESTION 1: LAB VALUE ANALYSIS IN PATIENTS WITH SEVERE
LIVER DYSFUNCTION
The nurse is performing an admission assessment on a 79-
year-old client newly admitted for end-stage liver disease.
Which principle should the nurse apply when assessing the
client's skin turgor?
A. For healthy elderly individuals, overhydration is a
common clinical finding.
B. Fluid volume deficit results in a spongy skin texture
upon inspection..
C. Inelastic skin turgor is a normal part of aging.
D. In clients over the age of 70, skin turgor cannot be
assessed.
CORRECT ANSWER: C
BRUNNER-ALIGNED COMPETENCY MAPPING: Fluid &
Electrolyte Dynamics
Unit Reference: 15th Edition Textbook Framework, Chapter 12
Outcomes
CLINICAL RATIONALE:
A normal, expected physiological change associated with aging
is a loss of subcutaneous fat and skin elasticity. Because
inelastic skin turgor is a normal part of aging, the nurse must
assess skin turgor over the sternum or forehead rather than
the hand for an accurate reading in older adults.
, Brunner Chapter 10: Fluid and Electrolytes
DISTRACTOR RATIONALE:
A & B: Dehydration—not overhydration—causes inelastic
skin with tenting. Overhydration typically leads to
edematous, puffy, or spongy skin.
D: Skin turgor can absolutely still be assessed in clients
over 70, provided the nurse uses appropriate anatomical
sites (like the forehead or chest) instead of the
extremities.
QUESTION 2: INTRAVENOUS POTASSIUM CRITICAL SAFETY
Intravenous (IV) potassium replacement is indicated for a
client who has developed hypokalemia. Which action should
the nurse take when administering potassium intravenously?
(Select all that apply.)
A. Administer potassium by IV push.
B. Assess the client's renal function markers (BUN and
serum creatinine) before giving potassium.
C. During a potassium infusion, monitor the client's
complete blood count.
D. Review and follow specific hospital guidelines prior to
initiating a potassium infusion.
E. Report a reduced urinary output to the health care
provider.
CORRECT ANSWER: B, D, E
, Brunner Chapter 10: Fluid and Electrolytes
BRUNNER-ALIGNED COMPETENCY MAPPING: Fluid &
Electrolyte Dynamics
Unit Reference: 15th Edition Textbook Framework, Chapter 12
Outcomes
CLINICAL RATIONALE:
The kidneys are responsible for almost the entire excretion of
potassium. If a patient has renal impairment or oliguria,
infusing potassium can cause a dangerous buildup leading to
lethal cardiac arrhythmias. Therefore, the nurse must assess
kidney labs (BUN, creatinine) and urine output before and
during administration, stopping the infusion and notifying the
provider if urine output drops. Facility policy must always be
followed strictly to ensure accurate dilution and rate limits.
DISTRACTOR RATIONALE:
A: NEVER give potassium via IV push. Direct, rapid IV
administration of potassium stops the heart and is fatal.
Always dilute the medication and administer it using an
infusion pump.
C: Potassium levels do not impact or alter blood
components, so monitoring a complete blood count
(CBC) is unnecessary for this therapy.
QUESTION 3: MEMBRANE TRANSPORT MECHANISMS
A nurse in the neurologic ICU has received a prescription to
infuse a hypertonic solution into a client with increased
, Brunner Chapter 10: Fluid and Electrolytes
intracranial pressure. This solution will increase the number of
dissolved particles in the client's blood, creating pressure for
fluids in the tissues to shift into the capillaries and increase
the blood volume. Which of the following terms best
describes this process?
A. Hydrostatic pressure
B. Osmosis and osmolality
C. Diffusion
D. Active transport
CORRECT ANSWER: B
BRUNNER-ALIGNED COMPETENCY MAPPING: Fluid &
Electrolyte Dynamics
Unit Reference: 15th Edition Textbook Framework, Chapter 12
Outcomes
CLINICAL RATIONALE:
Osmosis is the natural movement of fluid across a
semipermeable membrane from an area of low solute
concentration to an area of high solute concentration.
Hypertonic fluids increase blood osmolality (particle
concentration), drawing excess fluid out of the swollen brain
tissues and into the blood vessels to decrease brain swelling.
DISTRACTOR RATIONALE:
QUESTION 1: LAB VALUE ANALYSIS IN PATIENTS WITH SEVERE
LIVER DYSFUNCTION
The nurse is performing an admission assessment on a 79-
year-old client newly admitted for end-stage liver disease.
Which principle should the nurse apply when assessing the
client's skin turgor?
A. For healthy elderly individuals, overhydration is a
common clinical finding.
B. Fluid volume deficit results in a spongy skin texture
upon inspection..
C. Inelastic skin turgor is a normal part of aging.
D. In clients over the age of 70, skin turgor cannot be
assessed.
CORRECT ANSWER: C
BRUNNER-ALIGNED COMPETENCY MAPPING: Fluid &
Electrolyte Dynamics
Unit Reference: 15th Edition Textbook Framework, Chapter 12
Outcomes
CLINICAL RATIONALE:
A normal, expected physiological change associated with aging
is a loss of subcutaneous fat and skin elasticity. Because
inelastic skin turgor is a normal part of aging, the nurse must
assess skin turgor over the sternum or forehead rather than
the hand for an accurate reading in older adults.
, Brunner Chapter 10: Fluid and Electrolytes
DISTRACTOR RATIONALE:
A & B: Dehydration—not overhydration—causes inelastic
skin with tenting. Overhydration typically leads to
edematous, puffy, or spongy skin.
D: Skin turgor can absolutely still be assessed in clients
over 70, provided the nurse uses appropriate anatomical
sites (like the forehead or chest) instead of the
extremities.
QUESTION 2: INTRAVENOUS POTASSIUM CRITICAL SAFETY
Intravenous (IV) potassium replacement is indicated for a
client who has developed hypokalemia. Which action should
the nurse take when administering potassium intravenously?
(Select all that apply.)
A. Administer potassium by IV push.
B. Assess the client's renal function markers (BUN and
serum creatinine) before giving potassium.
C. During a potassium infusion, monitor the client's
complete blood count.
D. Review and follow specific hospital guidelines prior to
initiating a potassium infusion.
E. Report a reduced urinary output to the health care
provider.
CORRECT ANSWER: B, D, E
, Brunner Chapter 10: Fluid and Electrolytes
BRUNNER-ALIGNED COMPETENCY MAPPING: Fluid &
Electrolyte Dynamics
Unit Reference: 15th Edition Textbook Framework, Chapter 12
Outcomes
CLINICAL RATIONALE:
The kidneys are responsible for almost the entire excretion of
potassium. If a patient has renal impairment or oliguria,
infusing potassium can cause a dangerous buildup leading to
lethal cardiac arrhythmias. Therefore, the nurse must assess
kidney labs (BUN, creatinine) and urine output before and
during administration, stopping the infusion and notifying the
provider if urine output drops. Facility policy must always be
followed strictly to ensure accurate dilution and rate limits.
DISTRACTOR RATIONALE:
A: NEVER give potassium via IV push. Direct, rapid IV
administration of potassium stops the heart and is fatal.
Always dilute the medication and administer it using an
infusion pump.
C: Potassium levels do not impact or alter blood
components, so monitoring a complete blood count
(CBC) is unnecessary for this therapy.
QUESTION 3: MEMBRANE TRANSPORT MECHANISMS
A nurse in the neurologic ICU has received a prescription to
infuse a hypertonic solution into a client with increased
, Brunner Chapter 10: Fluid and Electrolytes
intracranial pressure. This solution will increase the number of
dissolved particles in the client's blood, creating pressure for
fluids in the tissues to shift into the capillaries and increase
the blood volume. Which of the following terms best
describes this process?
A. Hydrostatic pressure
B. Osmosis and osmolality
C. Diffusion
D. Active transport
CORRECT ANSWER: B
BRUNNER-ALIGNED COMPETENCY MAPPING: Fluid &
Electrolyte Dynamics
Unit Reference: 15th Edition Textbook Framework, Chapter 12
Outcomes
CLINICAL RATIONALE:
Osmosis is the natural movement of fluid across a
semipermeable membrane from an area of low solute
concentration to an area of high solute concentration.
Hypertonic fluids increase blood osmolality (particle
concentration), drawing excess fluid out of the swollen brain
tissues and into the blood vessels to decrease brain swelling.
DISTRACTOR RATIONALE:
