Chapter 42: Fluid, Electrolyte, AcidBase Balance
ra ra ra ra ra
MULTIPLE CHOICE ra
1. A hospital client is experiencing dehydration. While planning care, the nursing atten
ra ra ra ra ra ra ra ra ra ra ra
dant considers that the majority of the hospital client ’s total water volume exists in
ra ra ra ra ra ra ra ra ra ra ra ra ra ar ra
w ith compartment? a. Intracellular
ra
b. Extracellular
c. Intravascular
d. Transcellular
ACCURATE ra
ANSWER:-A
Intracellular (inside the cells) fluid accounts for approximately two thirds of total body water
ra ra ra ra ra ra ra ra ra ra ra ra ar
. Extracellular (outside the cells) is approximately one third of the total body water.
ar ra ra ra ra ra ra ra ra ra ra ra ra
Intravascular fluid (liquid portion of the blood) and transcellular fluid are two major divisions
ra ra ra ra ra ra ra ra ra ra ra ra ra ar
of the extracellular compartment.
ra ra ra
DIF:Understand (comprehension) ra
OBJ:Determine what processes regulate fluid distribution, extracellular fluid volume, and body fluid
ra ra ra ra ra ra ra ra ra ra ra ar
osmolality. TOP:Planning MSC: Physiological Adaptation ra ra
2. The nursing attendant is teaching about the process of passively moving water from
ra ra ra ra ra ra ra ra ra ra ra ra ra
an area ra ar
of lower particle concentration to an area of higher particle concentration. Which pr
ra ra ra ra ra ra ra ra ra ra ra ra
ocess is the nursing attendant describing? a. Osmosis
ra ra ra ra ra
b. Filtration
c. Diffusion
d. Active transport ra
ACCURATE ANSWER:-A ra
The process of moving water from an area of low particle concentration to an area of higher p
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
article concentration is known as osmosis. Filtration is mediated by fluid pressure from an ar
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
ea of higher pressure to an area of lower pressure. Diffusion is passive movement of electrolyt
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
es or other particles down the concentration gradient (from areas of higher concentration to a
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
reas of lower concentration). Active transport requires energy in the form of adenosine triphos
ra ra ra ra ra ra ra ra ra ra ra ar ra
phate (ATP) to move electrolytes across cell membranes against the concentration gradient (
ra ra ra ra ra ra ra ra ra ra ra ra
from areas of lower concentration to areas of higher concentration).
ra ra ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Determine what processes regulate fluid distribution, extracellular fluid volume, and body fluid
ra ra ra ra ra ra ra ra ra ra ra ra
osmolality. TOP:Teaching/Learning MSC: Physiological Adaptation ra ra
3. The nursing attendant observes edema in a hospital client
ra who is experiencing venou
ra ra ra ra ra ra ra r a ra ra ra
s congestion as a result of right heart failure. Which type of pressure facilitated the for
ar ra ra ra ra ra ra ra ra ra ra ra ra ra ra
mation of the hospital client ’s edema? ra ra ra ra ra ra
a. Osmotic
b. Oncotic
, c. Hydrostatic
d. Concentration
ACCURATE ANSWER:-C ra
Venous congestion increases capillary hydrostatic pressure. Increased hydrostatic pressure c
ra ra ra ra ra ra ra ra ra
auses edema by causing increased movement of fluid into the interstitial area. Osmotic and o
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
ncotic pressures involve the concentrations of solutes and can contribute to edema in other si
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
tuations, such as inflammation or malnutrition. Concentration pressure is not a nursing term.
ra ra ra ra ra ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Recall common fluid, electrolyte, and acidbase imbalances. TOP:Assessme
ra ra ra ra ra ra ar
nt
MSC: Physiological Adaptation ra ra
4. The nursing attendant administers an intravenous (IV) hypertonic solution to a hospit
ra ra ra ra ra ra ra ra ra ra ra
al client expects the fluid shift to occur in what direction?
ar ra ra ra ra ra ra ra ra ra a.
From intracellular to extracellular
ra ra ra
b. From extracellular to intracellular ra ra ra
c. From intravascular to intracellular ra ra ra
d. From intravascular to interstitial ra ra ra
ACCURATE ANSWER:-A ra
Hypertonic solutions will move fluid from the intracellular to the extracellular (intravascular).
ra ra ra ra ra ra ra ra ra ra ra ar
A hypertonic solution has a concentration greater than normal body fluids, so water will shift
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ar
out of cells because of the osmotic pull of the extra particles. Movement of water from the ext
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
racellular (intravascular) into cells (intracellular) occurs when hypotonic fluids are administ
ra ra ra ra ra ra ra ra ra ra
ered. Distribution of fluid between intravascular and interstitial spaces occurs by filtration, t
ra ra ra ra ra ra ra ra ra ra ra ra
he net sum of hydrostatic and osmotic pressures.
ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Determine what processes regulate fluid distribution, extracellular fluid volume, and body fluidra ra ra ra ra ra ra ra ra ra ra ar
osmolality. TOP:Planning MSC: Pharmacological and Parenteral Therapies ra ra ra ra
5. A nursing attendant is preparing to start peripheral intravenous (IV) therapy. In which orde
ra ra ra ra ra ra ra ra ra ra ra ra ra
r will the nursing attendant perform the steps starting with the first one?
ar ra ra ra ra ra ra ra ra ra ra ra
1. Clean site. ra
2. Select vein. ra
3. Apply tourniquet. ra
4. Release tourniquet. ra
5. Reapply tourniquet. ra
6. Advance and secure. ra ra
7. Insert vascular access device. ra ra ra
a. 1, 3, 2, 7, 5, 4, 6 ra ra ra ra ra ra
b. 1, 3, 2, 5, 7, 6, 4
rarara
ra ra ra ra ra ra
c. 3, 2, 1, 5, 7, 6, 4 ra ra ra ra ra ra
d. 3, 2, 4, 1, 5, 7, 6
rarar a
ra ra ra ra ra ra
ACCURATE ANSWER:-D ra
The steps for inserting an intravenous catheter are as follows: Apply tourniquet, select vein
ra ra ra ra ra ra ra ra ra ra ra ra ra
, release tourniquet, clean site, reapply tourniquet, insert vascular access device, and advanc
ar ra ra ra ra ra ra ra ra ra ra ra
eand secure. ra ra
, DIF:Understand (comprehension) ra
OBJ:Explain rationale and procedures for initiating an intravenous line; maintaining the system; ch
ra ra ra ra ra ra ra ra ra ra ra ra
anging intravenous solution containers, tubing, and dressings; and discontinuing peripheral venous
ra ra ra ra ra ra ra ra ra ra ar
a ccess.TOP:Implementation MSC: Pharmacological and Parenteral Therapies ra ra ra ra
6. The nursing attendant is laboratory blood results will expect to observe which cation in the
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
most abundance? a. Sodium
b. Chloride
c. Potassium
d. Magnesium
ACCURATE ANSWER:-A ra
Sodium is the most abundant cation in the blood. Potassium is the predominant intracellular ca
ra ra ra ra ra ra ra ra ra ra ra ra ra ar
tion. Chloride is an anion (negatively charged) rather than a cation (positively charged). Mag
ra ra ra ra ra ra ra ra ra ra ra ra ra
nesium is found predominantly inside cells and in bone.
ra ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Explain processes that regulate electrolyte balance. TOP:Assessment ra ra ra ra ra ar
MSC: Physiological Adaptation ra ra
7. The nursing attendant receives the hospital client ’s most recent blood work results. Whic
ra ra ra ra ra ra ra ra ra ra ra ra ra
h laboratory value is of greatest concern? a. Sodium of 145 mEq/L
ar ra ra ra ra ra ra ra ra
b. Calcium of 15.5 mg/dL ra ra ra
c. Potassium of 3.5 mEq/L ra ra ra
d. Chloride of 100 mEq/L ra ra ra
ACCURATE ANSWER:-B ra
Normal calcium range is 9 to 10.5 mg/dL; therefore, a value of 15.5 mg/dL is abnormally high and
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ar r
of concern. The rest of the laboratory values are within their normal ranges: sodium 136 to 145
a ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
mEq/L, potassium 3.5 to 5.0 mEq/L, and chloride 98 to 106 mEq/L.
ra ra ra ra ra ra ra ra ra ra ra ra
DIF:Apply (application) ra
OBJ:Apply the nursing process and use clinical judgment when caring for hospital client s with fluid,
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
electrolyte, and acid-base imbalances. TOP:Assessment
ar ra ra ra
MSC: Reduction of Risk Potential ra ra ra ra
8. The nursing attendant observes that the hospital client ’s calcium is elevated. When checkin
ra ra ra ra ra ra ra ra ra ra ra ra ra
g the phosphate level, what does the nursing attendant expect to see? a. An increase
ar ra ra ra ra ra ra ra ra ra ra ra
b. A decrease ra
c. Equal to calcium ra ra
d. No change in phosphate ra ra ra
ACCURATE ANSWER:-B ra
Phosphate will decrease. Serum calcium and phosphate have an inverse relationship. When o
ra ra ra ra ra ra ra ra ra ra ra ar
ne is elevated, the other decreases, except in some hospital client s with endstage renal disease.
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Choose appropriate clinical assessments using clinical judgment for specific fluid, electrolyte, a
ra ra ra ra ra ra ra ra ra ra ar
nd acid-base imbalances.
ra TOP:Assessment ra MSC: Physiological Adaptation ra ra
9. Four hospital client s arrive at the emergency department at the same time. Whic
ra ra ra ra ra ra ra ra ra ra ra ra ra
h hospital client will the nursing attendant see first?
ar ra ra ra ra ra ra ra
ra ra ra ra ra
MULTIPLE CHOICE ra
1. A hospital client is experiencing dehydration. While planning care, the nursing atten
ra ra ra ra ra ra ra ra ra ra ra
dant considers that the majority of the hospital client ’s total water volume exists in
ra ra ra ra ra ra ra ra ra ra ra ra ra ar ra
w ith compartment? a. Intracellular
ra
b. Extracellular
c. Intravascular
d. Transcellular
ACCURATE ra
ANSWER:-A
Intracellular (inside the cells) fluid accounts for approximately two thirds of total body water
ra ra ra ra ra ra ra ra ra ra ra ra ar
. Extracellular (outside the cells) is approximately one third of the total body water.
ar ra ra ra ra ra ra ra ra ra ra ra ra
Intravascular fluid (liquid portion of the blood) and transcellular fluid are two major divisions
ra ra ra ra ra ra ra ra ra ra ra ra ra ar
of the extracellular compartment.
ra ra ra
DIF:Understand (comprehension) ra
OBJ:Determine what processes regulate fluid distribution, extracellular fluid volume, and body fluid
ra ra ra ra ra ra ra ra ra ra ra ar
osmolality. TOP:Planning MSC: Physiological Adaptation ra ra
2. The nursing attendant is teaching about the process of passively moving water from
ra ra ra ra ra ra ra ra ra ra ra ra ra
an area ra ar
of lower particle concentration to an area of higher particle concentration. Which pr
ra ra ra ra ra ra ra ra ra ra ra ra
ocess is the nursing attendant describing? a. Osmosis
ra ra ra ra ra
b. Filtration
c. Diffusion
d. Active transport ra
ACCURATE ANSWER:-A ra
The process of moving water from an area of low particle concentration to an area of higher p
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
article concentration is known as osmosis. Filtration is mediated by fluid pressure from an ar
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
ea of higher pressure to an area of lower pressure. Diffusion is passive movement of electrolyt
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
es or other particles down the concentration gradient (from areas of higher concentration to a
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
reas of lower concentration). Active transport requires energy in the form of adenosine triphos
ra ra ra ra ra ra ra ra ra ra ra ar ra
phate (ATP) to move electrolytes across cell membranes against the concentration gradient (
ra ra ra ra ra ra ra ra ra ra ra ra
from areas of lower concentration to areas of higher concentration).
ra ra ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Determine what processes regulate fluid distribution, extracellular fluid volume, and body fluid
ra ra ra ra ra ra ra ra ra ra ra ra
osmolality. TOP:Teaching/Learning MSC: Physiological Adaptation ra ra
3. The nursing attendant observes edema in a hospital client
ra who is experiencing venou
ra ra ra ra ra ra ra r a ra ra ra
s congestion as a result of right heart failure. Which type of pressure facilitated the for
ar ra ra ra ra ra ra ra ra ra ra ra ra ra ra
mation of the hospital client ’s edema? ra ra ra ra ra ra
a. Osmotic
b. Oncotic
, c. Hydrostatic
d. Concentration
ACCURATE ANSWER:-C ra
Venous congestion increases capillary hydrostatic pressure. Increased hydrostatic pressure c
ra ra ra ra ra ra ra ra ra
auses edema by causing increased movement of fluid into the interstitial area. Osmotic and o
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
ncotic pressures involve the concentrations of solutes and can contribute to edema in other si
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
tuations, such as inflammation or malnutrition. Concentration pressure is not a nursing term.
ra ra ra ra ra ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Recall common fluid, electrolyte, and acidbase imbalances. TOP:Assessme
ra ra ra ra ra ra ar
nt
MSC: Physiological Adaptation ra ra
4. The nursing attendant administers an intravenous (IV) hypertonic solution to a hospit
ra ra ra ra ra ra ra ra ra ra ra
al client expects the fluid shift to occur in what direction?
ar ra ra ra ra ra ra ra ra ra a.
From intracellular to extracellular
ra ra ra
b. From extracellular to intracellular ra ra ra
c. From intravascular to intracellular ra ra ra
d. From intravascular to interstitial ra ra ra
ACCURATE ANSWER:-A ra
Hypertonic solutions will move fluid from the intracellular to the extracellular (intravascular).
ra ra ra ra ra ra ra ra ra ra ra ar
A hypertonic solution has a concentration greater than normal body fluids, so water will shift
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ar
out of cells because of the osmotic pull of the extra particles. Movement of water from the ext
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
racellular (intravascular) into cells (intracellular) occurs when hypotonic fluids are administ
ra ra ra ra ra ra ra ra ra ra
ered. Distribution of fluid between intravascular and interstitial spaces occurs by filtration, t
ra ra ra ra ra ra ra ra ra ra ra ra
he net sum of hydrostatic and osmotic pressures.
ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Determine what processes regulate fluid distribution, extracellular fluid volume, and body fluidra ra ra ra ra ra ra ra ra ra ra ar
osmolality. TOP:Planning MSC: Pharmacological and Parenteral Therapies ra ra ra ra
5. A nursing attendant is preparing to start peripheral intravenous (IV) therapy. In which orde
ra ra ra ra ra ra ra ra ra ra ra ra ra
r will the nursing attendant perform the steps starting with the first one?
ar ra ra ra ra ra ra ra ra ra ra ra
1. Clean site. ra
2. Select vein. ra
3. Apply tourniquet. ra
4. Release tourniquet. ra
5. Reapply tourniquet. ra
6. Advance and secure. ra ra
7. Insert vascular access device. ra ra ra
a. 1, 3, 2, 7, 5, 4, 6 ra ra ra ra ra ra
b. 1, 3, 2, 5, 7, 6, 4
rarara
ra ra ra ra ra ra
c. 3, 2, 1, 5, 7, 6, 4 ra ra ra ra ra ra
d. 3, 2, 4, 1, 5, 7, 6
rarar a
ra ra ra ra ra ra
ACCURATE ANSWER:-D ra
The steps for inserting an intravenous catheter are as follows: Apply tourniquet, select vein
ra ra ra ra ra ra ra ra ra ra ra ra ra
, release tourniquet, clean site, reapply tourniquet, insert vascular access device, and advanc
ar ra ra ra ra ra ra ra ra ra ra ra
eand secure. ra ra
, DIF:Understand (comprehension) ra
OBJ:Explain rationale and procedures for initiating an intravenous line; maintaining the system; ch
ra ra ra ra ra ra ra ra ra ra ra ra
anging intravenous solution containers, tubing, and dressings; and discontinuing peripheral venous
ra ra ra ra ra ra ra ra ra ra ar
a ccess.TOP:Implementation MSC: Pharmacological and Parenteral Therapies ra ra ra ra
6. The nursing attendant is laboratory blood results will expect to observe which cation in the
ra ra ra ra ra ra ra ra ra ra ra ra ra ra
most abundance? a. Sodium
b. Chloride
c. Potassium
d. Magnesium
ACCURATE ANSWER:-A ra
Sodium is the most abundant cation in the blood. Potassium is the predominant intracellular ca
ra ra ra ra ra ra ra ra ra ra ra ra ra ar
tion. Chloride is an anion (negatively charged) rather than a cation (positively charged). Mag
ra ra ra ra ra ra ra ra ra ra ra ra ra
nesium is found predominantly inside cells and in bone.
ra ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Explain processes that regulate electrolyte balance. TOP:Assessment ra ra ra ra ra ar
MSC: Physiological Adaptation ra ra
7. The nursing attendant receives the hospital client ’s most recent blood work results. Whic
ra ra ra ra ra ra ra ra ra ra ra ra ra
h laboratory value is of greatest concern? a. Sodium of 145 mEq/L
ar ra ra ra ra ra ra ra ra
b. Calcium of 15.5 mg/dL ra ra ra
c. Potassium of 3.5 mEq/L ra ra ra
d. Chloride of 100 mEq/L ra ra ra
ACCURATE ANSWER:-B ra
Normal calcium range is 9 to 10.5 mg/dL; therefore, a value of 15.5 mg/dL is abnormally high and
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ar r
of concern. The rest of the laboratory values are within their normal ranges: sodium 136 to 145
a ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
mEq/L, potassium 3.5 to 5.0 mEq/L, and chloride 98 to 106 mEq/L.
ra ra ra ra ra ra ra ra ra ra ra ra
DIF:Apply (application) ra
OBJ:Apply the nursing process and use clinical judgment when caring for hospital client s with fluid,
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
electrolyte, and acid-base imbalances. TOP:Assessment
ar ra ra ra
MSC: Reduction of Risk Potential ra ra ra ra
8. The nursing attendant observes that the hospital client ’s calcium is elevated. When checkin
ra ra ra ra ra ra ra ra ra ra ra ra ra
g the phosphate level, what does the nursing attendant expect to see? a. An increase
ar ra ra ra ra ra ra ra ra ra ra ra
b. A decrease ra
c. Equal to calcium ra ra
d. No change in phosphate ra ra ra
ACCURATE ANSWER:-B ra
Phosphate will decrease. Serum calcium and phosphate have an inverse relationship. When o
ra ra ra ra ra ra ra ra ra ra ra ar
ne is elevated, the other decreases, except in some hospital client s with endstage renal disease.
ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra
DIF:Understand (comprehension) ra
OBJ:Choose appropriate clinical assessments using clinical judgment for specific fluid, electrolyte, a
ra ra ra ra ra ra ra ra ra ra ar
nd acid-base imbalances.
ra TOP:Assessment ra MSC: Physiological Adaptation ra ra
9. Four hospital client s arrive at the emergency department at the same time. Whic
ra ra ra ra ra ra ra ra ra ra ra ra ra
h hospital client will the nursing attendant see first?
ar ra ra ra ra ra ra ra
