CHAPTER 16- CARING FOR CLIENTS
WITH FLUID, ELECTROLYTE, AND
ACID-BASE IMBALANCES
QUESTIONS & VERIFIED ANSWERS
PASSED 100%
Below which serum sodium concentration might convulsions or coma occur?
a. 135 mEq/L (135 mmol/L)
b. 145 mEq/L (145 mmol/L)
c. 140 mEq/L (140 mmol/L)
d. 142 mEq/L (142 mmol/L) - Correct Answer ✔✔ a
Normal serum concentration level ranges from 135 to 145 mEq/L (135-145 mmol/L).
When the level dips below 135 mEq/L (135 mmol/L), hyponatremia occurs.
Manifestations of hyponatremia include mental confusion, muscular weakness,
anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and
personality changes. Convulsions or coma can occur if the deficit is severe. Values of
140, 142, and 145 mEq/L (mmol/L) are within the normal range.
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic
alkalosis?
a. HCO 21 mEq/L
b. pH 7.48
c. PaCO 36
d. O saturation 95% - Correct Answer ✔✔ b
Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma
bicarbonate concentration. The HCO value is below normal. The PaCO value and the
oxygen saturation level are within a normal range.
Fluid and electrolyte balance is maintained through the process of translocation. What
specific process allows water to pass through a membrane from a dilute to a more
concentrated area?
a. osmosis
b. filtration
c. evaporation
d. active transport - Correct Answer ✔✔ a
,Osmosis is the movement of water through a semipermeable membrane; one that
allows some but not all substances in a solution to pass through from a diluted area to a
more concentrated area. Filtration promotes the movement of fluid and some dissolved
substances through a semipermeable membrane according to pressure differences.
Evaporation is the process of converting water into a vapor. Active transport requires
the energy source ATP to drive dissolved chemicals from an area of low concentration
to an area of higher concentration; the opposite of passive diffusion.
A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The
client's spouse became alarmed when the client demonstrated confusion and elevated
temperature, and reported "dry mouth." The nurse suspects the client is experiencing
which condition?
a. dehydration
b. hypervolemia
c. hypercalcemia
d. hyperkalemia - Correct Answer ✔✔ a
Dehydration results when the volume of body fluid is significantly reduced in both
extracellular and intracellular compartments. In dehydration, all fluid compartments have
decreased volumes; in hypovolemia, only blood volume is low. The most common fluid
imbalance in older adults is dehydration. Hypervolemia is caused by fluid intake that
exceeds fluid loss, such as from excessive oral intake or rapid IV infusion of fluid. Early
signs of hypervolemia are weight gain, elevated BP, and increased breathing effort.
Hypercalcemia occurs when the serum calcium level is higher than normal. Some of its
signs include tingling in the extremities and the area around the mouth (circumoral
paresthesia) and muscle and abdominal cramps. Hyperkalemia is an excess of
potassium in the blood. Symptoms include diarrhea, nausea, muscle weakness,
paresthesias, and cardiac dysrhythmias.
The physician has prescribed a peripheral IV to be inserted before the client goes for
computed tomography. What should the nurse do when selecting a site on the hand or
arm for insertion of an IV catheter?
a. Choose a hairless site if available.
b. Consider potential effects on the client's mobility when selecting a site.
c. Have the client briefly hold his arm over his head before insertion.
d. Leave the tourniquet on for at least 3 minutes. - Correct Answer ✔✔ b
Ideally, both arms and hands are carefully inspected before choosing a specific
venipuncture site that does not interfere with mobility. Instruct the client to hold his arm
in a dependent position to increase blood flow. Never leave a tourniquet in place longer
than 2 minutes. The site does not necessarily need to be devoid of hair.
Which electrolyte is a major cation in body fluid?
,a. Chloride
b. Bicarbonate
c. Potassium
d. Phosphate - Correct Answer ✔✔ c
Potassium is a major cation that affects cardiac muscle functioning. Chloride,
bicarbonate, and phosphate are anions.
Clients diagnosed with hypervolemia should avoid sweet or dry food because it
a. obstructs water elimination.
b. increases the client's desire to consume fluid.
c. can cause dehydration.
d. can lead to weight gain. - Correct Answer ✔✔ b
The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is
rationed and the client is advised to take a limited amount of fluid when thirsty. Sweet or
dry food can increase the client's desire to consume fluid. Sweet or dry food does not
obstruct water elimination or cause dehydration. Weight regulation is not part of
hypervolemia management except to the extent it is achieved on account of fluid
reduction.
Which is the most common cause of symptomatic hypomagnesemia?
a. Intravenous drug use
b. Alcoholism
c. Sedentary lifestyle
d. Burns - Correct Answer ✔✔ b
Alcoholism is currently the most common cause of symptomatic hypomagnesemia.
Intravenous drug use, sedentary lifestyle, and burns are not the most common causes
of hypomagnesemia.
A client is to receive hypotonic IV solution in order to provide free water replacement.
Which solution does the nurse anticipate administering?
a. Lactated Ringer solution
b. 0.45% NaCl
c. 0.9% NaCl
d. 5% NaCl - Correct Answer ✔✔ b
Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to replace
cellular fluid because it is hypotonic compared with plasma. Another is to provide free
water to excrete body wastes. At times, hypotonic sodium solutions are used to treat
hypernatremia and other hyperosmolar conditions. Lactated Ringer solution and normal
saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic.
, A client is being treated in the ICU 24 hours after having a radical neck dissection
completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which
physical examination finding is consistent with this electrolyte imbalance?
a. Presence of Trousseau sign
b. Slurred speech
c. Negative Chvostek sign
d. Muscle weakness - Correct Answer ✔✔ a
After radical neck resection, a client is prone to developing hypocalcemia.
Hypocalcemia is defined as a serum value <8.6 mg/dL (<2.15 mmol/L). Signs and
symptoms of hypocalcemia include Chvostek sign, which consists of muscle twitching
enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe,
just below the zygomatic arch, is tapped; and a positive Trousseau sign can be elicited
by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic
pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and
metacarpophalangeal joints, and extended interphalangeal joints with fingers together)
will occur as ischemia of the ulnar nerve develops. Slurred speech and muscle
weakness are signs of hypercalcemia.
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of
solution?
a. Neutral
b. Alkaline
c. Acidic
d. Basic - Correct Answer ✔✔ c
Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is
considered an alkaline or basic solution. A pH of 7.0 is considered neutral.
Which is an insensible mechanism of fluid loss?
a. Urination
b. Bowel elimination
c. Breathing
d. Nausea - Correct Answer ✔✔ c
Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is
unnoticeable and immeasurable. Losses from urination and bowel elimination are
measurable. Nausea does not result in fluid loss, however if the client would develop
emesis ( vomiting) this would be considered loss of body fluids and would need
measured.
Which is a correct route of administration for potassium?
WITH FLUID, ELECTROLYTE, AND
ACID-BASE IMBALANCES
QUESTIONS & VERIFIED ANSWERS
PASSED 100%
Below which serum sodium concentration might convulsions or coma occur?
a. 135 mEq/L (135 mmol/L)
b. 145 mEq/L (145 mmol/L)
c. 140 mEq/L (140 mmol/L)
d. 142 mEq/L (142 mmol/L) - Correct Answer ✔✔ a
Normal serum concentration level ranges from 135 to 145 mEq/L (135-145 mmol/L).
When the level dips below 135 mEq/L (135 mmol/L), hyponatremia occurs.
Manifestations of hyponatremia include mental confusion, muscular weakness,
anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and
personality changes. Convulsions or coma can occur if the deficit is severe. Values of
140, 142, and 145 mEq/L (mmol/L) are within the normal range.
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic
alkalosis?
a. HCO 21 mEq/L
b. pH 7.48
c. PaCO 36
d. O saturation 95% - Correct Answer ✔✔ b
Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma
bicarbonate concentration. The HCO value is below normal. The PaCO value and the
oxygen saturation level are within a normal range.
Fluid and electrolyte balance is maintained through the process of translocation. What
specific process allows water to pass through a membrane from a dilute to a more
concentrated area?
a. osmosis
b. filtration
c. evaporation
d. active transport - Correct Answer ✔✔ a
,Osmosis is the movement of water through a semipermeable membrane; one that
allows some but not all substances in a solution to pass through from a diluted area to a
more concentrated area. Filtration promotes the movement of fluid and some dissolved
substances through a semipermeable membrane according to pressure differences.
Evaporation is the process of converting water into a vapor. Active transport requires
the energy source ATP to drive dissolved chemicals from an area of low concentration
to an area of higher concentration; the opposite of passive diffusion.
A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The
client's spouse became alarmed when the client demonstrated confusion and elevated
temperature, and reported "dry mouth." The nurse suspects the client is experiencing
which condition?
a. dehydration
b. hypervolemia
c. hypercalcemia
d. hyperkalemia - Correct Answer ✔✔ a
Dehydration results when the volume of body fluid is significantly reduced in both
extracellular and intracellular compartments. In dehydration, all fluid compartments have
decreased volumes; in hypovolemia, only blood volume is low. The most common fluid
imbalance in older adults is dehydration. Hypervolemia is caused by fluid intake that
exceeds fluid loss, such as from excessive oral intake or rapid IV infusion of fluid. Early
signs of hypervolemia are weight gain, elevated BP, and increased breathing effort.
Hypercalcemia occurs when the serum calcium level is higher than normal. Some of its
signs include tingling in the extremities and the area around the mouth (circumoral
paresthesia) and muscle and abdominal cramps. Hyperkalemia is an excess of
potassium in the blood. Symptoms include diarrhea, nausea, muscle weakness,
paresthesias, and cardiac dysrhythmias.
The physician has prescribed a peripheral IV to be inserted before the client goes for
computed tomography. What should the nurse do when selecting a site on the hand or
arm for insertion of an IV catheter?
a. Choose a hairless site if available.
b. Consider potential effects on the client's mobility when selecting a site.
c. Have the client briefly hold his arm over his head before insertion.
d. Leave the tourniquet on for at least 3 minutes. - Correct Answer ✔✔ b
Ideally, both arms and hands are carefully inspected before choosing a specific
venipuncture site that does not interfere with mobility. Instruct the client to hold his arm
in a dependent position to increase blood flow. Never leave a tourniquet in place longer
than 2 minutes. The site does not necessarily need to be devoid of hair.
Which electrolyte is a major cation in body fluid?
,a. Chloride
b. Bicarbonate
c. Potassium
d. Phosphate - Correct Answer ✔✔ c
Potassium is a major cation that affects cardiac muscle functioning. Chloride,
bicarbonate, and phosphate are anions.
Clients diagnosed with hypervolemia should avoid sweet or dry food because it
a. obstructs water elimination.
b. increases the client's desire to consume fluid.
c. can cause dehydration.
d. can lead to weight gain. - Correct Answer ✔✔ b
The management goal in hypervolemia is to reduce fluid volume. For this reason, fluid is
rationed and the client is advised to take a limited amount of fluid when thirsty. Sweet or
dry food can increase the client's desire to consume fluid. Sweet or dry food does not
obstruct water elimination or cause dehydration. Weight regulation is not part of
hypervolemia management except to the extent it is achieved on account of fluid
reduction.
Which is the most common cause of symptomatic hypomagnesemia?
a. Intravenous drug use
b. Alcoholism
c. Sedentary lifestyle
d. Burns - Correct Answer ✔✔ b
Alcoholism is currently the most common cause of symptomatic hypomagnesemia.
Intravenous drug use, sedentary lifestyle, and burns are not the most common causes
of hypomagnesemia.
A client is to receive hypotonic IV solution in order to provide free water replacement.
Which solution does the nurse anticipate administering?
a. Lactated Ringer solution
b. 0.45% NaCl
c. 0.9% NaCl
d. 5% NaCl - Correct Answer ✔✔ b
Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to replace
cellular fluid because it is hypotonic compared with plasma. Another is to provide free
water to excrete body wastes. At times, hypotonic sodium solutions are used to treat
hypernatremia and other hyperosmolar conditions. Lactated Ringer solution and normal
saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic.
, A client is being treated in the ICU 24 hours after having a radical neck dissection
completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which
physical examination finding is consistent with this electrolyte imbalance?
a. Presence of Trousseau sign
b. Slurred speech
c. Negative Chvostek sign
d. Muscle weakness - Correct Answer ✔✔ a
After radical neck resection, a client is prone to developing hypocalcemia.
Hypocalcemia is defined as a serum value <8.6 mg/dL (<2.15 mmol/L). Signs and
symptoms of hypocalcemia include Chvostek sign, which consists of muscle twitching
enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe,
just below the zygomatic arch, is tapped; and a positive Trousseau sign can be elicited
by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic
pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and
metacarpophalangeal joints, and extended interphalangeal joints with fingers together)
will occur as ischemia of the ulnar nerve develops. Slurred speech and muscle
weakness are signs of hypercalcemia.
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of
solution?
a. Neutral
b. Alkaline
c. Acidic
d. Basic - Correct Answer ✔✔ c
Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is
considered an alkaline or basic solution. A pH of 7.0 is considered neutral.
Which is an insensible mechanism of fluid loss?
a. Urination
b. Bowel elimination
c. Breathing
d. Nausea - Correct Answer ✔✔ c
Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is
unnoticeable and immeasurable. Losses from urination and bowel elimination are
measurable. Nausea does not result in fluid loss, however if the client would develop
emesis ( vomiting) this would be considered loss of body fluids and would need
measured.
Which is a correct route of administration for potassium?
