Chapter 39- Fluid and Electrolytes
Question 1 of 25
The nurse will be caring for a patient who is severely malnourished. Laboratory test results show that the patient’s albumin level is
critically low. What assessment finding will the nurse expect to note when assessing the patient?
• The patient is confused and disoriented.
• The patient has generalized 3+ pitting edema.
• The patient’s lung sounds are much diminished.
• The patient’s urine is dark and very concentrated.
Question 2 of 25
The nurse is reviewing the patient’s laboratory results. Which result must be communicated to the physician immediately?
• Serum potassium level 6.8 mEq/L
• Serum magnesium level 2.3 mEq/L
• Serum sodium level 134 mEq/L
• Serum chloride level 85 mEq/L
Normal serum potassium level is 3.5 to 5.0 mEq/L. A serum potassium level of 6.8 mEq/L is very high and puts the patient at risk for
cardiac arrhythmias. The potassium level should be reported to the physician immediately. The chlorine and sodium levels are slightly
low and the magnesium level is slightly elevated.
Question 3 of 25
The nurse is caring for a patient who is at risk for fluid overload due to a history of congestive heart failure. Which intervention will
the nurse teach the patient to perform at home to monitor fluid balance?
• “Drink plain water rather than soda, coffee, or fruit juice.”
• “Weigh yourself every morning before breakfast.”
• “Check to make sure that your urine is a bright yellow color.”
• “Count your heart rate every evening before you go to bed.”
Fluid volume excess leads to an increase in circulating fluid, thereby increasing the workload of the heart. Daily weights are a more
precise method of monitoring changes in fluid balance. A change of 1 kg (2.2 lb) is equivalent to 1 L (1000 mL) of fluid. Fluid
retention should be reported to the physician.
Question 4 of 25
The nurse is caring for a patient who is admitted to the hospital with diabetic ketoacidosis. Which assessment finding indicates an
attempt made by the patient’s body to correct the pH?
• The patient’s skin is pale, cool, and diaphoretic.
• The patient’s urine is dark and concentrated.
• The patient’s respirations are very deep and rapid.
• The patient is sleepy and difficult to arouse.
The patient with diabetic ketoacidosis is in a state of metabolic acidosis. The body will attempt to compensate for the acidosis by
blowing off extra amounts of carbon dioxide through deep, rapid respirations. Since carbon dioxide is converted to carbonic acid,
removal of carbon dioxide will help shift the body’s pH to a less acidotic state.
, Question 5 of 25
The nurse is caring for a patient who takes furosemide (Lasix) daily to treat congestive heart failure. The nurse will watch for which
electrolyte imbalance that may occur due to this therapy?
• Hypocalcemia
• Hyperphosphatemia
• Hypokalemia
• Hypernatremia
Furosemide is a loop diuretic that causes loss of potassium through the urine. Patients taking this medication are at risk for
hypokalemia, so the nurse should check the patient’s electrolyte values closely, particularly the serum potassium level.
Question 6 of 25
The nurse is caring for a patient who was brought to the ED after overdosing on narcotic pain medication. The patient was found
unresponsive with no respirations. Arterial blood gases were drawn shortly after the patient’s arrival to the hospital. Which results
will the nurse expect to see?
• pH 7.35, PaCO2 45 mm Hg, HCO3 26 mEq/L, PaO2 70 mm Hg
• pH 7.45, PaCO2 38 mm Hg, HCO3 28 mEq/L, PaO2 80 mm Hg
• pH 7.56, PaCO2 32 mm Hg, HCO3 32 mEq/L, PaO2 90 mm Hg
• pH 7.27, PaCO2 58 mm Hg, HCO3 24 mEq/L, PaO2 60 mm Hg
The patient who overdosed on narcotic pain medication will be in respiratory acidosis due to respiratory suppression. Low pH of 7.27
and elevated PaCO2 are consistent with respiratory acidosis as insufficient carbon dioxide is removed from the blood. The low 60 mm
Hg PaO2 is due to insufficient oxygen intake.
Question 7 of 25
The nurse is caring for a patient who is admitted to the hospital with dehydration and gastroenteritis. The patient attempted to walk
to the bathroom and fainted right after getting out of bed. The nurse knows which condition to be the most likely cause of the
patient’s collapse?
• Circulatory overload
• Catheter embolism
• Hemolytic reaction
• Orthostatic hypotension
With fluid volume deficit, the blood pressure decreases. It is important to assess for orthostatic hypotension when moving from lying
or seated to standing. When the blood pressure falls sufficiently, fainting may occur. The patient should be assisted to rise slowly from
a supine to a sitting position first before slowly getting to his feet. Circulatory overload, hemolytic anemia, and catheter embolism are
unlikely to be causative factors.
Question 8 of 25
The nurse is caring for a patient whose ABG results reveal the following: pH 7.56, PaCO2 32 mm Hg, HCO3 42 mEq/L, PaO2 90 mm
Hg. Which condition will the nurse expect to see in the patient’s chart as the underlying cause of these results?
• Gastroenteritis with severe nausea, vomiting, and diarrhea
• Respiratory failure caused by pneumonia with pleural effusions
• Hyperventilation after a panic attack
• Widespread tissue ischemia caused by cardiogenic shock
Gastroenteritis with nausea, vomiting, and diarrhea will lead to a metabolic alkalosis resulting from loss of electrolytes and acids
through emesis and loose stools. Metabolic alkalosis features the elevated pH of 7.56, elevated HCO 3 42 mEq/L, and normal PaCO2 of
32 mm Hg. Widespread tissue ischemia would lead to metabolic acidosis with low pH resulting from release of lactic acid from the
tissues. Respiratory failure leads to a respiratory acidosis with a low pH and elevated PaCO 2 level. Hyperventilation leads to
respiratory alkalosis with an elevated pH and elevated HCO3 level.
Question 1 of 25
The nurse will be caring for a patient who is severely malnourished. Laboratory test results show that the patient’s albumin level is
critically low. What assessment finding will the nurse expect to note when assessing the patient?
• The patient is confused and disoriented.
• The patient has generalized 3+ pitting edema.
• The patient’s lung sounds are much diminished.
• The patient’s urine is dark and very concentrated.
Question 2 of 25
The nurse is reviewing the patient’s laboratory results. Which result must be communicated to the physician immediately?
• Serum potassium level 6.8 mEq/L
• Serum magnesium level 2.3 mEq/L
• Serum sodium level 134 mEq/L
• Serum chloride level 85 mEq/L
Normal serum potassium level is 3.5 to 5.0 mEq/L. A serum potassium level of 6.8 mEq/L is very high and puts the patient at risk for
cardiac arrhythmias. The potassium level should be reported to the physician immediately. The chlorine and sodium levels are slightly
low and the magnesium level is slightly elevated.
Question 3 of 25
The nurse is caring for a patient who is at risk for fluid overload due to a history of congestive heart failure. Which intervention will
the nurse teach the patient to perform at home to monitor fluid balance?
• “Drink plain water rather than soda, coffee, or fruit juice.”
• “Weigh yourself every morning before breakfast.”
• “Check to make sure that your urine is a bright yellow color.”
• “Count your heart rate every evening before you go to bed.”
Fluid volume excess leads to an increase in circulating fluid, thereby increasing the workload of the heart. Daily weights are a more
precise method of monitoring changes in fluid balance. A change of 1 kg (2.2 lb) is equivalent to 1 L (1000 mL) of fluid. Fluid
retention should be reported to the physician.
Question 4 of 25
The nurse is caring for a patient who is admitted to the hospital with diabetic ketoacidosis. Which assessment finding indicates an
attempt made by the patient’s body to correct the pH?
• The patient’s skin is pale, cool, and diaphoretic.
• The patient’s urine is dark and concentrated.
• The patient’s respirations are very deep and rapid.
• The patient is sleepy and difficult to arouse.
The patient with diabetic ketoacidosis is in a state of metabolic acidosis. The body will attempt to compensate for the acidosis by
blowing off extra amounts of carbon dioxide through deep, rapid respirations. Since carbon dioxide is converted to carbonic acid,
removal of carbon dioxide will help shift the body’s pH to a less acidotic state.
, Question 5 of 25
The nurse is caring for a patient who takes furosemide (Lasix) daily to treat congestive heart failure. The nurse will watch for which
electrolyte imbalance that may occur due to this therapy?
• Hypocalcemia
• Hyperphosphatemia
• Hypokalemia
• Hypernatremia
Furosemide is a loop diuretic that causes loss of potassium through the urine. Patients taking this medication are at risk for
hypokalemia, so the nurse should check the patient’s electrolyte values closely, particularly the serum potassium level.
Question 6 of 25
The nurse is caring for a patient who was brought to the ED after overdosing on narcotic pain medication. The patient was found
unresponsive with no respirations. Arterial blood gases were drawn shortly after the patient’s arrival to the hospital. Which results
will the nurse expect to see?
• pH 7.35, PaCO2 45 mm Hg, HCO3 26 mEq/L, PaO2 70 mm Hg
• pH 7.45, PaCO2 38 mm Hg, HCO3 28 mEq/L, PaO2 80 mm Hg
• pH 7.56, PaCO2 32 mm Hg, HCO3 32 mEq/L, PaO2 90 mm Hg
• pH 7.27, PaCO2 58 mm Hg, HCO3 24 mEq/L, PaO2 60 mm Hg
The patient who overdosed on narcotic pain medication will be in respiratory acidosis due to respiratory suppression. Low pH of 7.27
and elevated PaCO2 are consistent with respiratory acidosis as insufficient carbon dioxide is removed from the blood. The low 60 mm
Hg PaO2 is due to insufficient oxygen intake.
Question 7 of 25
The nurse is caring for a patient who is admitted to the hospital with dehydration and gastroenteritis. The patient attempted to walk
to the bathroom and fainted right after getting out of bed. The nurse knows which condition to be the most likely cause of the
patient’s collapse?
• Circulatory overload
• Catheter embolism
• Hemolytic reaction
• Orthostatic hypotension
With fluid volume deficit, the blood pressure decreases. It is important to assess for orthostatic hypotension when moving from lying
or seated to standing. When the blood pressure falls sufficiently, fainting may occur. The patient should be assisted to rise slowly from
a supine to a sitting position first before slowly getting to his feet. Circulatory overload, hemolytic anemia, and catheter embolism are
unlikely to be causative factors.
Question 8 of 25
The nurse is caring for a patient whose ABG results reveal the following: pH 7.56, PaCO2 32 mm Hg, HCO3 42 mEq/L, PaO2 90 mm
Hg. Which condition will the nurse expect to see in the patient’s chart as the underlying cause of these results?
• Gastroenteritis with severe nausea, vomiting, and diarrhea
• Respiratory failure caused by pneumonia with pleural effusions
• Hyperventilation after a panic attack
• Widespread tissue ischemia caused by cardiogenic shock
Gastroenteritis with nausea, vomiting, and diarrhea will lead to a metabolic alkalosis resulting from loss of electrolytes and acids
through emesis and loose stools. Metabolic alkalosis features the elevated pH of 7.56, elevated HCO 3 42 mEq/L, and normal PaCO2 of
32 mm Hg. Widespread tissue ischemia would lead to metabolic acidosis with low pH resulting from release of lactic acid from the
tissues. Respiratory failure leads to a respiratory acidosis with a low pH and elevated PaCO 2 level. Hyperventilation leads to
respiratory alkalosis with an elevated pH and elevated HCO3 level.
