Fluid and Electrolytes- Saunders
Comprehensive Review Exam
Questions & Answers (Grade A+)
The nurse is caring for a client with heart failure. On assessment,
the nurse notes that the client is dys- pneic, and crackles are
audible on auscultation. What additional manifestations would the
nurse expect to note in this client if excess fluid volume is present?
1. Weight loss and dry skin
2. Flat neck and hand veins and decreased urinary output
3. An increase in blood pressure and increased respirations
4. Weakness and decreased central venous pressure (CVP) -
correct answer ✅Answer: 3.
Rationale: Afluid volume excess is also known as overhydration or
fluid overload and occurs when fluid intake or fluid retention
exceeds the fluid needs of the body. Assessment findings associated
with fluid volume excess include cough, dyspnea, crackles,
tachypnea, tachycardia, elevated blood pressure, bounding pulse,
elevated CVP, weight gain, edema, neck and hand vein distention,
altered level of consciousness, and decreased hematocrit. Dry skin,
flat neck and hand veins, decreased urinary output, and decreased
CVP are noted in fluid volume deficit. Weakness can be present in
either fluid volume excess or deficit.
,Fluid and Electrolytes- Saunders
Comprehensive Review Exam
Questions & Answers (Grade A+)
Test-Taking Strategy: Focus on the subject, fluid volume excess.
Remember that when there is more than one part to an option, all
parts need to be correct in order for the option to be correct. Think
about the pathophysiology associated with a fluid volume excess to
assist in directing you to the correct option. Also, note that the
incorrect options are comparable or alike in that each includes
manifestations that reflect a decrease.
The nurse is preparing to care for a client with a potassium deficit.
The nurse reviews the client's record and determines that the client
is at risk for developing the potassium deficit because of which
situation?
1. Sustained tissue damage
2. Requires nasogastric suction
3. Has a history of Addison's disease
4. Uric acid level of 9.4 mg/dL (559 μmol/L) -
correct answer ✅Answer: 2.
Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L
(3.5 to 5.0 mmol/L). A potassium deficit is known as hypokalemia.
Potassium-rich gastrointestinal fluids are lost through
gastrointestinal suction, placing the client at risk for hypokalemia.
, Fluid and Electrolytes- Saunders
Comprehensive Review Exam
Questions & Answers (Grade A+)
The client with tissue damage or Addison's disease and the client
with hyperuricemia are at risk for hyperkalemia. The normal uric
acid level for a female is 2.7 to 7.3 mg/dL (0.16 to 0.43 mmol/L) and
for a male is 4.0 to 8.5 mg/dL(0.24 to 0.51 mmol/L). Hyperuricemia
is a cause of hyperkalemia.
Test-Taking Strategy: Note that the subject of the question is
potassium deficit. First recall the normal uric acid levels and the
causes of hypokalemia to assist in eliminating option 4. For the
remaining options, note that the correct option is the only one that
identifies a loss of body fluid.
The nurse reviews a client's electrolyte laboratory report and notes
that the potassium level is 2.5 mEq/L (2.5 mmol/L). Which patterns
should the nurse watch for on the electrocardiogram (ECG) as a
result of the laboratory value? Select all that apply.
1. U waves
2. Absent P waves
3. Inverted T waves
4. Depressed ST segment 5. Widened QRS complex -
correct answer ✅Answer: 1, 3, 4
Comprehensive Review Exam
Questions & Answers (Grade A+)
The nurse is caring for a client with heart failure. On assessment,
the nurse notes that the client is dys- pneic, and crackles are
audible on auscultation. What additional manifestations would the
nurse expect to note in this client if excess fluid volume is present?
1. Weight loss and dry skin
2. Flat neck and hand veins and decreased urinary output
3. An increase in blood pressure and increased respirations
4. Weakness and decreased central venous pressure (CVP) -
correct answer ✅Answer: 3.
Rationale: Afluid volume excess is also known as overhydration or
fluid overload and occurs when fluid intake or fluid retention
exceeds the fluid needs of the body. Assessment findings associated
with fluid volume excess include cough, dyspnea, crackles,
tachypnea, tachycardia, elevated blood pressure, bounding pulse,
elevated CVP, weight gain, edema, neck and hand vein distention,
altered level of consciousness, and decreased hematocrit. Dry skin,
flat neck and hand veins, decreased urinary output, and decreased
CVP are noted in fluid volume deficit. Weakness can be present in
either fluid volume excess or deficit.
,Fluid and Electrolytes- Saunders
Comprehensive Review Exam
Questions & Answers (Grade A+)
Test-Taking Strategy: Focus on the subject, fluid volume excess.
Remember that when there is more than one part to an option, all
parts need to be correct in order for the option to be correct. Think
about the pathophysiology associated with a fluid volume excess to
assist in directing you to the correct option. Also, note that the
incorrect options are comparable or alike in that each includes
manifestations that reflect a decrease.
The nurse is preparing to care for a client with a potassium deficit.
The nurse reviews the client's record and determines that the client
is at risk for developing the potassium deficit because of which
situation?
1. Sustained tissue damage
2. Requires nasogastric suction
3. Has a history of Addison's disease
4. Uric acid level of 9.4 mg/dL (559 μmol/L) -
correct answer ✅Answer: 2.
Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L
(3.5 to 5.0 mmol/L). A potassium deficit is known as hypokalemia.
Potassium-rich gastrointestinal fluids are lost through
gastrointestinal suction, placing the client at risk for hypokalemia.
, Fluid and Electrolytes- Saunders
Comprehensive Review Exam
Questions & Answers (Grade A+)
The client with tissue damage or Addison's disease and the client
with hyperuricemia are at risk for hyperkalemia. The normal uric
acid level for a female is 2.7 to 7.3 mg/dL (0.16 to 0.43 mmol/L) and
for a male is 4.0 to 8.5 mg/dL(0.24 to 0.51 mmol/L). Hyperuricemia
is a cause of hyperkalemia.
Test-Taking Strategy: Note that the subject of the question is
potassium deficit. First recall the normal uric acid levels and the
causes of hypokalemia to assist in eliminating option 4. For the
remaining options, note that the correct option is the only one that
identifies a loss of body fluid.
The nurse reviews a client's electrolyte laboratory report and notes
that the potassium level is 2.5 mEq/L (2.5 mmol/L). Which patterns
should the nurse watch for on the electrocardiogram (ECG) as a
result of the laboratory value? Select all that apply.
1. U waves
2. Absent P waves
3. Inverted T waves
4. Depressed ST segment 5. Widened QRS complex -
correct answer ✅Answer: 1, 3, 4
