Chapter 29. Fluids, Electrolytes, and Acid-Base Balance
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. A nursing instructor teaches that the movement of fluid from extracellular to intracellular compartments
is most dependent on which of the following?
1. Age
2. Water intake
3. Potassium balance
4. Percentage of body fat
2. A nursing instructor teaches that which of the following body processes is an example of diffusion?
1. The movement of oxygen into the blood
2. The movement of water into the bloodstream after the injection of radiopaque dye
3. The movement of blood into a tube during a blood draw
4. The movement of fluid out of the bloodstream due to the force of the heart’s contractions
3. While preparing for a rotation in the intensive care unit, a student nurse is told in report that a patient is “third
spacing.” Which of the following symptoms does the student expect to see?
1. Elevated body temperature
2. Large amounts of dilute urine
3. High blood pressure
4. Swelling in the extremities
4. While caring for a patient with dehydration, a nurse is most likely to include which of the following in the
patient’s plan of care?
1. Chronic pain
2. Alteration in body temperature
3. Ineffective airway clearance
4. Readiness for enhanced coping
5. A nurse working in the sports medicine complex is counseling a female college athlete about
dietary concerns. Which of the following recommendations should be included in the teaching?
1. “It is important for you to drink about a liter of fluid each day.”
2. “You should be drinking four to five glasses of water every day.”
3. “A woman your age needs to drink nearly 3 liters of fluid a day.”
4. “Now that you’ve finished growing, you don’t need as much fluid as you did before.”
6. Which of the following individuals will be at the lowest risk for an electrolyte imbalance?
1. A 42-year-old with an estimated blood loss of 1/2 pint because of traumatic injury
2. A 28-year-old with third-degree burns to an estimated 30% of his body
3. A 31-year-old who has had vomiting and diarrhea for the past 3 days
4. A 55-year-old suffering from heat stroke after running a marathon
7. While caring for a newly admitted patient with fluid and electrolyte imbalances, a nurse would be
most concerned by which of the following?
1. Urinary output of 300 mL in 8 hours
2. Blood pressure of 128/60 mm Hg
3. Lung fields with crackles noted bilaterally
4. Nausea
, 8. A nurse is providing care for a patient admitted with nausea, vomiting, and diarrhea who has orders to remain
NPO. Family members ask, “Why can’t she have anything to drink?” Which of the following responses by
the nurse is best?
1. “I think the doctor must have forgotten to order a diet. I’ll call and get one ordered.”
2. “She can have as many ice chips as she wants, but it might make her sick if she drinks
anything.”
3. “I don’t know. Did the doctor mention any tests to be done that would need her stomach
to be empty?”
4. “It is best to let her bowels rest, but you can use these mouth swabs to help her feel
more comfortable.”
9. A nurse is caring for multiple patients on a medical floor. Which of the following patients should the nurse
see first?
1. A 94-year-old with a history of congestive heart failure receiving IV D51/2NS with
20 mEq potassium chloride (KCl) at 120 mL/hr
2. A 52-year-old admitted with sickle cell anemia who has a patient-controlled analgesia
(PCA)
3. A 27-year-old with Crohn disease with IV 1/2NS at 100 mL/hr
4. A 39-year-old recovering from gastric bypass surgery with a saline lock
10. While reviewing laboratory results, a nurse notes that one of the patients has a low blood urea nitrogen (BUN)
level. Which of the following is the most likely cause of that result?
1. Dehydration
2. Fluid volume excess
3. Hypernatremia
4. Hypokalemia
11. A nurse caring for a patient taking the diuretic furosemide (Lasix) would be most concerned by which of the
following findings?
1. Muscle spasms
2. Hypercalcemia
3. Low urine specific gravity
4. Constricted pupils
12. While caring for a patient taking furosemide (Lasix), a nurse recognizes that teaching is successful if the
patient chooses which of the following foods?
1. Green beans
2. Grapes
3. Oranges
4. Zucchini
13. Which of the following statements indicates to a nurse that a patient taking an osmotic diuretic needs further
teaching?
1. “I’ll need to have blood work drawn periodically.”
2. “A couple of the foods I should eat are yogurt and potatoes.”
3. “Taking this medicine will make my body hold on to salt and water.”
4. “Yellow fruits are high in potassium, so I should eat more of them.”
14. When reviewing laboratory values of multiple patients with fluid and electrolyte imbalance, a nurse
recognizes that which of the following values represents a therapeutic response to treatment?
1. Sodium = 132 mEq
2. Sodium = 136 mEq
, 3. Sodium = 147 mEq
4. Sodium = 149 mEq
15. Which of the following individuals should follow the American Heart Association recommendation to limit
salt intake to 1500 mg/d?
1. A 41-year-old with hypertension
2. A 37-year-old with appendicitis
3. A 27-year-old with an ovarian cyst
4. An 18-year-old with pneumonia
16. After receiving a report from the emergency department of a new admission with hyponatremia, a nurse
anticipates that which of the following intravenous (IV) fluids may be included in the treatment plan?
1. Dextrose 5% in water (D5W)
2. Normal saline (NS)
3. 0.45% normal saline
4. Sodium bicarbonate
17. During change of shift report, a nurse is informed that a patient has new orders for sodium polystyrene
(Kayexalate). After providing the treatment later in the shift, which of the following statements would
most likely document the patient’s care?
1. “Telemetry shows normal sinus rhythm; Kayexalate provided; patient had two stools
this shift.”
2. “Kayexalate provided, monitoring patient’s level of consciousness q2h.”
3. “Kayexalate given per order for hypokalemia; patient resting comfortably.”
4. “IV D51/2NS with 20 mEq potassium chloride (KCl) infusing without
difficulty; Kayexalate provided; adequate urine output noted.”
18. A nurse is providing care for a patient recently admitted with hypercalcemia related to breast cancer. The
nurse would be most concerned if the patient reported taking which of the following medications?
1. Lasix (furosemide)
2. Digitalis (digoxin)
3. Multivitamins
4. Tylenol (acetaminophen)
19. A patient with hypercalcemia is at increased risk for which of the following additional electrolyte imbalances?
1. Hypomagnesemia
2. Hypophosphatemia
3. Hypokalemia
4. Hyponatremia
20. For a patient with alkalosis, a nurse would expect which of the following assessments?
1. Slow respiratory rate
2. Urine that is more acidic
3. Urine that has a low level of NaHCO3
4. Rapid respiratory rate
21. A nurse is providing care for a patient whose arterial blood gas results are pH = 7.48; CO 2 = 44; NaHCO3 =
29. The nurse recognizes that the patient’s results indicate
1. Respiratory acidosis.
2. Metabolic acidosis.
3. Respiratory alkalosis.
4. Metabolic alkalosis.
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. A nursing instructor teaches that the movement of fluid from extracellular to intracellular compartments
is most dependent on which of the following?
1. Age
2. Water intake
3. Potassium balance
4. Percentage of body fat
2. A nursing instructor teaches that which of the following body processes is an example of diffusion?
1. The movement of oxygen into the blood
2. The movement of water into the bloodstream after the injection of radiopaque dye
3. The movement of blood into a tube during a blood draw
4. The movement of fluid out of the bloodstream due to the force of the heart’s contractions
3. While preparing for a rotation in the intensive care unit, a student nurse is told in report that a patient is “third
spacing.” Which of the following symptoms does the student expect to see?
1. Elevated body temperature
2. Large amounts of dilute urine
3. High blood pressure
4. Swelling in the extremities
4. While caring for a patient with dehydration, a nurse is most likely to include which of the following in the
patient’s plan of care?
1. Chronic pain
2. Alteration in body temperature
3. Ineffective airway clearance
4. Readiness for enhanced coping
5. A nurse working in the sports medicine complex is counseling a female college athlete about
dietary concerns. Which of the following recommendations should be included in the teaching?
1. “It is important for you to drink about a liter of fluid each day.”
2. “You should be drinking four to five glasses of water every day.”
3. “A woman your age needs to drink nearly 3 liters of fluid a day.”
4. “Now that you’ve finished growing, you don’t need as much fluid as you did before.”
6. Which of the following individuals will be at the lowest risk for an electrolyte imbalance?
1. A 42-year-old with an estimated blood loss of 1/2 pint because of traumatic injury
2. A 28-year-old with third-degree burns to an estimated 30% of his body
3. A 31-year-old who has had vomiting and diarrhea for the past 3 days
4. A 55-year-old suffering from heat stroke after running a marathon
7. While caring for a newly admitted patient with fluid and electrolyte imbalances, a nurse would be
most concerned by which of the following?
1. Urinary output of 300 mL in 8 hours
2. Blood pressure of 128/60 mm Hg
3. Lung fields with crackles noted bilaterally
4. Nausea
, 8. A nurse is providing care for a patient admitted with nausea, vomiting, and diarrhea who has orders to remain
NPO. Family members ask, “Why can’t she have anything to drink?” Which of the following responses by
the nurse is best?
1. “I think the doctor must have forgotten to order a diet. I’ll call and get one ordered.”
2. “She can have as many ice chips as she wants, but it might make her sick if she drinks
anything.”
3. “I don’t know. Did the doctor mention any tests to be done that would need her stomach
to be empty?”
4. “It is best to let her bowels rest, but you can use these mouth swabs to help her feel
more comfortable.”
9. A nurse is caring for multiple patients on a medical floor. Which of the following patients should the nurse
see first?
1. A 94-year-old with a history of congestive heart failure receiving IV D51/2NS with
20 mEq potassium chloride (KCl) at 120 mL/hr
2. A 52-year-old admitted with sickle cell anemia who has a patient-controlled analgesia
(PCA)
3. A 27-year-old with Crohn disease with IV 1/2NS at 100 mL/hr
4. A 39-year-old recovering from gastric bypass surgery with a saline lock
10. While reviewing laboratory results, a nurse notes that one of the patients has a low blood urea nitrogen (BUN)
level. Which of the following is the most likely cause of that result?
1. Dehydration
2. Fluid volume excess
3. Hypernatremia
4. Hypokalemia
11. A nurse caring for a patient taking the diuretic furosemide (Lasix) would be most concerned by which of the
following findings?
1. Muscle spasms
2. Hypercalcemia
3. Low urine specific gravity
4. Constricted pupils
12. While caring for a patient taking furosemide (Lasix), a nurse recognizes that teaching is successful if the
patient chooses which of the following foods?
1. Green beans
2. Grapes
3. Oranges
4. Zucchini
13. Which of the following statements indicates to a nurse that a patient taking an osmotic diuretic needs further
teaching?
1. “I’ll need to have blood work drawn periodically.”
2. “A couple of the foods I should eat are yogurt and potatoes.”
3. “Taking this medicine will make my body hold on to salt and water.”
4. “Yellow fruits are high in potassium, so I should eat more of them.”
14. When reviewing laboratory values of multiple patients with fluid and electrolyte imbalance, a nurse
recognizes that which of the following values represents a therapeutic response to treatment?
1. Sodium = 132 mEq
2. Sodium = 136 mEq
, 3. Sodium = 147 mEq
4. Sodium = 149 mEq
15. Which of the following individuals should follow the American Heart Association recommendation to limit
salt intake to 1500 mg/d?
1. A 41-year-old with hypertension
2. A 37-year-old with appendicitis
3. A 27-year-old with an ovarian cyst
4. An 18-year-old with pneumonia
16. After receiving a report from the emergency department of a new admission with hyponatremia, a nurse
anticipates that which of the following intravenous (IV) fluids may be included in the treatment plan?
1. Dextrose 5% in water (D5W)
2. Normal saline (NS)
3. 0.45% normal saline
4. Sodium bicarbonate
17. During change of shift report, a nurse is informed that a patient has new orders for sodium polystyrene
(Kayexalate). After providing the treatment later in the shift, which of the following statements would
most likely document the patient’s care?
1. “Telemetry shows normal sinus rhythm; Kayexalate provided; patient had two stools
this shift.”
2. “Kayexalate provided, monitoring patient’s level of consciousness q2h.”
3. “Kayexalate given per order for hypokalemia; patient resting comfortably.”
4. “IV D51/2NS with 20 mEq potassium chloride (KCl) infusing without
difficulty; Kayexalate provided; adequate urine output noted.”
18. A nurse is providing care for a patient recently admitted with hypercalcemia related to breast cancer. The
nurse would be most concerned if the patient reported taking which of the following medications?
1. Lasix (furosemide)
2. Digitalis (digoxin)
3. Multivitamins
4. Tylenol (acetaminophen)
19. A patient with hypercalcemia is at increased risk for which of the following additional electrolyte imbalances?
1. Hypomagnesemia
2. Hypophosphatemia
3. Hypokalemia
4. Hyponatremia
20. For a patient with alkalosis, a nurse would expect which of the following assessments?
1. Slow respiratory rate
2. Urine that is more acidic
3. Urine that has a low level of NaHCO3
4. Rapid respiratory rate
21. A nurse is providing care for a patient whose arterial blood gas results are pH = 7.48; CO 2 = 44; NaHCO3 =
29. The nurse recognizes that the patient’s results indicate
1. Respiratory acidosis.
2. Metabolic acidosis.
3. Respiratory alkalosis.
4. Metabolic alkalosis.
