Fluids and Electrolytes ( Pearson ) Exam Questions and Answers with 100%
Correct Answers
An emergency room nurse is assessing a client who overhydrated during a marathon. Which
assessment is essential for the nurse to perform during the physical examination? (Select all that apply.)
-LOC
-Blood pressure
-Eye accommodation
-Teeth
-Lung sounds - (ANSWER)-LOC
-BP
-Lung sounds
The nurse is administering a blood transfusion to a client who is hemorrhaging. The nurse
identifies that the client is experiencing a deficit in which body fluid compartment?
-Intravascular fluid
-Intracellular fluid
-Transcellular fluid
-Interstitial fluid - (ANSWER)-Intravascular
Rationale: Blood loss causes a deficit in the intravascular fluid compartment, which is a
subcompartment of extracellular fluid (ECF). Transcellular and interstitial fluids, along with lymph, make
up the other compartments of ECF. Intracellular fluid is the other major fluid compartment in the body.
The nurse is performing an assessment on a client who has had nothing by mouth since the
previous evening. Which manifestation related to the client's fluid restriction would be of concern to the
nurse? (Select all that apply.)
,Fluids and Electrolytes ( Pearson ) Exam Questions and Answers with 100%
Correct Answers
-Dry mucous membranes
-Edema
-Increased blood pressure
-Tenting skin
-Increased hematocrit - (ANSWER)-Dry mucous membranes
-Tenting skin
-Increased hematocrit
Rationale: Oral fluid restriction can cause dehydration. The nurse should monitor for
manifestations of dehydration such as dry mucous membranes, increased hematocrit, and tenting skin.
Edema and increased blood pressure are manifestations of fluid volume excess, not deficit.
The community health nurse is performing health screenings at a homeless shelter. When
assessing for fluid and electrolyte imbalances, which question is most important for the nurse to ask?
-"Are you currently being treated for joint problems?"
-"Have you recently had a cold?"
-"Describe what you eat and drink on a typical day."
-"Describe your anxiety level on a typical day." - (ANSWER)-"Describe what you eat and drink on
a typical day?"
Rationale
It is important for the nurse to consider socioeconomic factors affecting food and fluid intake
when assessing a client's risk for fluid and electrolyte imbalances, especially with a vulnerable
population like the homeless. Asking a client to describe a typical day's food and fluid intake will help the
nurse determine if a client's oral intake is adequate. Joint problems and minor respiratory infections are
not primary risk factors for fluid and electrolyte imbalances. It would be more important for the nurse to
ask about kidney or thyroid disease, diabetes, or hypertension and acute conditions that cause fluid loss
such as gastroenteritis. Asking about anxiety is too general when assessing a client's fluid and electrolyte
status, as some anxiety is to be expected in a homeless client.
, Fluids and Electrolytes ( Pearson ) Exam Questions and Answers with 100%
Correct Answers
The nurse is caring for a client with a fluid volume deficit. Which nursing intervention addresses
the client's potential for poor perfusion?
-Assessing client's nail beds
-Administering whole blood
-Checking client's
temperature
-Monitoring for signs of blood loss - (ANSWER)-Assessing client's nail beds
Rationale
Fluid and electrolyte balance is related to several nursing concepts, including perfusion, cellular
regulation, and cognition. Fluid volume loss can lead to decreased perfusion, so the nurse should assess
pulses, nail beds, and color to assure that perfusion is adequate. Monitoring for signs of blood loss and
administering whole blood are interventions targeted toward hemorrhage (cellular regulation) rather
than poor perfusion. Checking the client's
temperature helps to determine the client's
thermoregulation status, not perfusion
A client experiencing hyperkalemia is scheduled for dialysis. The nurse anticipates an order for
what therapy to help drive potassium back into the cells prior to dialysis?
-Potassium supplements
-Insulin
-Antidiuretic hormone
-Blood transfusion - (ANSWER)-Insulin
Rationale
Correct Answers
An emergency room nurse is assessing a client who overhydrated during a marathon. Which
assessment is essential for the nurse to perform during the physical examination? (Select all that apply.)
-LOC
-Blood pressure
-Eye accommodation
-Teeth
-Lung sounds - (ANSWER)-LOC
-BP
-Lung sounds
The nurse is administering a blood transfusion to a client who is hemorrhaging. The nurse
identifies that the client is experiencing a deficit in which body fluid compartment?
-Intravascular fluid
-Intracellular fluid
-Transcellular fluid
-Interstitial fluid - (ANSWER)-Intravascular
Rationale: Blood loss causes a deficit in the intravascular fluid compartment, which is a
subcompartment of extracellular fluid (ECF). Transcellular and interstitial fluids, along with lymph, make
up the other compartments of ECF. Intracellular fluid is the other major fluid compartment in the body.
The nurse is performing an assessment on a client who has had nothing by mouth since the
previous evening. Which manifestation related to the client's fluid restriction would be of concern to the
nurse? (Select all that apply.)
,Fluids and Electrolytes ( Pearson ) Exam Questions and Answers with 100%
Correct Answers
-Dry mucous membranes
-Edema
-Increased blood pressure
-Tenting skin
-Increased hematocrit - (ANSWER)-Dry mucous membranes
-Tenting skin
-Increased hematocrit
Rationale: Oral fluid restriction can cause dehydration. The nurse should monitor for
manifestations of dehydration such as dry mucous membranes, increased hematocrit, and tenting skin.
Edema and increased blood pressure are manifestations of fluid volume excess, not deficit.
The community health nurse is performing health screenings at a homeless shelter. When
assessing for fluid and electrolyte imbalances, which question is most important for the nurse to ask?
-"Are you currently being treated for joint problems?"
-"Have you recently had a cold?"
-"Describe what you eat and drink on a typical day."
-"Describe your anxiety level on a typical day." - (ANSWER)-"Describe what you eat and drink on
a typical day?"
Rationale
It is important for the nurse to consider socioeconomic factors affecting food and fluid intake
when assessing a client's risk for fluid and electrolyte imbalances, especially with a vulnerable
population like the homeless. Asking a client to describe a typical day's food and fluid intake will help the
nurse determine if a client's oral intake is adequate. Joint problems and minor respiratory infections are
not primary risk factors for fluid and electrolyte imbalances. It would be more important for the nurse to
ask about kidney or thyroid disease, diabetes, or hypertension and acute conditions that cause fluid loss
such as gastroenteritis. Asking about anxiety is too general when assessing a client's fluid and electrolyte
status, as some anxiety is to be expected in a homeless client.
, Fluids and Electrolytes ( Pearson ) Exam Questions and Answers with 100%
Correct Answers
The nurse is caring for a client with a fluid volume deficit. Which nursing intervention addresses
the client's potential for poor perfusion?
-Assessing client's nail beds
-Administering whole blood
-Checking client's
temperature
-Monitoring for signs of blood loss - (ANSWER)-Assessing client's nail beds
Rationale
Fluid and electrolyte balance is related to several nursing concepts, including perfusion, cellular
regulation, and cognition. Fluid volume loss can lead to decreased perfusion, so the nurse should assess
pulses, nail beds, and color to assure that perfusion is adequate. Monitoring for signs of blood loss and
administering whole blood are interventions targeted toward hemorrhage (cellular regulation) rather
than poor perfusion. Checking the client's
temperature helps to determine the client's
thermoregulation status, not perfusion
A client experiencing hyperkalemia is scheduled for dialysis. The nurse anticipates an order for
what therapy to help drive potassium back into the cells prior to dialysis?
-Potassium supplements
-Insulin
-Antidiuretic hormone
-Blood transfusion - (ANSWER)-Insulin
Rationale
