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Fluid 2

54 Questions
Physics Quizzes & Trivia

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Questions and Answers
  • 1. 
    • A. 

      Rales

    • B. 

      A bounding pulse

    • C. 

      Engorged peripheral veins

    • D. 

      An elevated hematocrit level

  • 2. 
            2.   A homeless client is brought into the emergency department with indications of extremely poor nutrition. Arterial blood gas levels are assessed, and the nurse anticipates that this client will demonstrate which of the following results?
    • A. 

      PH 7.3, PaCO2 38 mm Hg, HCO3 19 mEq/L

    • B. 

      PH 7.5, PaCO2 34 mm Hg, HCO3 20 mEq/L

    • C. 

      PH 7.35, PaCO2 35 mm Hg, HCO3 24 mEq/L

    • D. 

      PH 7.52, PaCO2 48 mm Hg, HCO3 28 mEq/L

  • 3. 
            3.   When a client’s serum sodium level is 120 mEq/L, the priority nursing assessment is to monitor the status of which body system?
    • A. 

      Neurological

    • B. 

      Gastrointestinal

    • C. 

      Pulmonary

    • D. 

      Hepatic

  • 4. 
            4.   An 8-year-old is admitted to the pediatric unit with pneumonia. On assessment the nurse notes that the child is warm and flushed, is lethargic, has difficulty breathing, and has moist rales. The nurse determines that the child is suffering from:
    • A. 

      Metabolic acidosis

    • B. 

      Respiratory acidosis

    • C. 

      Respiratory alkalosis

    • D. 

      Metabolic alkalosis

  • 5. 
            5.   Arterial blood gas levels are obtained for the client. If the client’s results are pH 7.48, CO2 42 mm Hg, and HCO3 32 mEq/L, the client is exhibiting which one of the following acid-base imbalances?
    • A. 

      Metabolic acidosis

    • B. 

      Respiratory acidosis

    • C. 

      Respiratory alkalosis

    • D. 

      Metabolic alkalosis

  • 6. 
            6.   The nurse is aware that the compensating mechanism that is most likely to occur in the presence of respiratory acidosis is:
    • A. 

      Hyperventilation to decrease the CO2 levels

    • B. 

      Hypoventilation to increase the CO2 levels

    • C. 

      Retention of HCO3 by the kidneys to increase the pH level

    • D. 

      Excretion of HCO3 by the kidneys to decrease the pH level

  • 7. 
            7.   Of all of the following clients, the nurse recognizes that the individual who is most at risk for a fluid volume deficit is:
    • A. 

      A 6-month-old learning to drink from a cup

    • B. 

      A 12-year-old who is moderately active in 80° F weather

    • C. 

      A 42-year-old with severe diarrhea

    • D. 

      A 90-year-old with frequent headaches

  • 8. 
            8.   A client experiences a loss of intracellular fluid. The nurse anticipates that the intravenous (IV) therapy that will be used to replace this type of loss is:
    • A. 

      0.45% normal saline (NS)

    • B. 

      10% dextrose

    • C. 

      5% dextrose in lactated Ringer’s

    • D. 

      Dextrose 5% in NS

  • 9. 
            9.   The client has been experiencing right flank and lower back pain. Which of the following laboratory values would be most desirable for the nurse to obtain based on the client’s assessment?
    • A. 

      Serum potassium

    • B. 

      Serum sodium

    • C. 

      Serum magnesium

    • D. 

      Serum calcium

  • 10. 
          10.   The health care provider orders 1000 mL of D5LR with 20 mEq KCl to run for 8 hours. Using an infusion set with a drop factor of 15 gtt/mL, the nurse calculates the flow rate to be:
    • A. 

      12 gtt/min

    • B. 

      22 gtt/min

    • C. 

      32 gtt/min

    • D. 

      42 gtt/min

  • 11. 
          11.   The nurse will be starting a new intravenous infusion and needs to select the site for the insertion. In selection of a site, the nurse should:
    • A. 

      Start with the most proximal site

    • B. 

      Look for hard, cordlike veins

    • C. 

      Use the dominant arm

    • D. 

      Avoid sites on the extremity away from a dialysis graft

  • 12. 
          12.   A client has intravenous therapy for the administration of antibiotics and is stating that the “IV site hurts and is swollen.” Which of the following information assessed on the client indicates the presence of phlebitis, as opposed to infiltration?
    • A. 

      Intensity of the pain

    • B. 

      Warmth of integument surrounding the IV site

    • C. 

      Amount of subcutaneous edema

    • D. 

      Skin discoloration of a bruised nature

  • 13. 
          13.   A client complains of a headache, nausea, and vomiting during a blood transfusion. Which one of the following actions should the nurse take immediately?
    • A. 

      Check the vital signs.

    • B. 

      Stop the blood transfusion.

    • C. 

      Slow down the rate of blood flow.

    • D. 

      Notify the health care provider and blood bank personnel.

  • 14. 
          14.   For a client with a nursing diagnosis of excess fluid volume, the nurse is alert to which one of the following signs and symptoms?
    • A. 

      Weak, thready pulse

    • B. 

      Hypertension

    • C. 

      Dry mucous membranes

    • D. 

      Flushed skin

  • 15. 
          15.   A client is currently taking Lasix and digoxin. As a result of the medication regimen, the nurse is alert to the presence of:
    • A. 

      Cardiac dysrhythmias

    • B. 

      Severe diarrhea

    • C. 

      Hyperactive reflexes

    • D. 

      Peripheral cyanosis

  • 16. 
          16.   A rapid infusion of citrated blood has been given to the client. The nurse observes for:
    • A. 

      Diaphoresis

    • B. 

      Anxiety

    • C. 

      Chvostek’s sign

    • D. 

      Nausea and vomiting

  • 17. 
          17.   For a child who has ingested the remaining contents of an aspirin bottle, the nurse suspects signs and symptoms consistent with:
    • A. 

      Metabolic acidosis

    • B. 

      Metabolic alkalosis

    • C. 

      Respiratory acidosis

    • D. 

      Respiratory alkalosis

  • 18. 
    • A. 

      Skin turgor

    • B. 

      Intake and output

    • C. 

      Serum electrolyte levels

    • D. 

      Daily weight

  • 19. 
          19.   An IV solution of 125 mL is to be infused over a 1-hour period. A microdrip infusion set will be used. The nurse calculates the infusion rate as:
    • A. 

      32 gtt/min

    • B. 

      60 gtt/min

    • C. 

      125 gtt/min

    • D. 

      250 gtt/min

  • 20. 
          20.   A client is admitted to the hospital with a diagnosis of adrenal insufficiency. In preparing to complete the admission history, the nurse anticipates that the client will have experienced:
    • A. 

      Decreased muscle tone

    • B. 

      Hypertension

    • C. 

      Diarrhea

    • D. 

      Fever

  • 21. 
          21.   In reviewing the results of the client’s blood work, the nurse recognizes that the unexpected value that should be reported to the health care provider is:
    • A. 

      Calcium 3.9 mEq/L

    • B. 

      Sodium 140 mEq/L

    • C. 

      Potassium 3.5 mEq/L

    • D. 

      Magnesium 2.1 mEq/L

  • 22. 
          22.   The nurse anticipates that the client with a fluid volume excess will manifest a(n):
    • A. 

      Increased urine specific gravity

    • B. 

      Decreased body weight

    • C. 

      Increased blood pressure

    • D. 

      Decreased pulse strength

  • 23. 
          23.   The nurse recognizes that the client, based on the imbalance that is present, will require fluid replacement with isotonic solution. One of the isotonic solutions that may be ordered by the health care provider is:
    • A. 

      0.45% saline

    • B. 

      Lactated Ringer’s

    • C. 

      5% dextrose in normal saline

    • D. 

      5% dextrose in lactated Ringer’s

  • 24. 
    • A. 

      Administer an antipyretic

    • B. 

      Begin an infusion of epinephrine

    • C. 

      Run normal saline through the blood tubing

    • D. 

      Obtain and send a urine specimen to the laboratory

  • 25. 
          25.   A client is prescribed 0.9% sodium chloride (normal saline), which is an isotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
    • A. 

      Expand the volume of fluid in the vascular system

    • B. 

      Pull fluid from the cells

    • C. 

      Keep protein levels normal

    • D. 

      Move fluid into the cells

  • 26. 
          26.   A client is prescribed 3% sodium chloride, which is a hypertonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
    • A. 

      Expand the volume of fluid in the vascular system

    • B. 

      Pull fluid from the cells

    • C. 

      Keep protein levels normal

    • D. 

      Move fluid into the cells

  • 27. 
          27.   A client is prescribed 0.45% sodium chloride, which is a hypotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
    • A. 

      Expand the volume of fluid in the vascular system

    • B. 

      Pull fluid from the cells

    • C. 

      Keep protein levels normal

    • D. 

      Move fluid into the cells

  • 28. 
          28.   The nurse recognizes which of the following clients is at the greatest risk for dehydration?
    • A. 

      A 35-year-old client diagnosed with Crohn’s disease

    • B. 

      A 15-year-old client who is following a low-carbohydrate diet

    • C. 

      A 2-year-old client diagnosed with an allergy to milk proteins

    • D. 

      A 79-year-old client who has been diagnosed with advanced Alzheimer’s disease

  • 29. 
          29.   Which of the following clients is at greatest risk for insensible water loss?
    • A. 

      A 37-year-old with a superficial burn to the left hand

    • B. 

      A 15-year-old experiencing an asthmatic attack

    • C. 

      A 50-year-old with type 2 diabetes

    • D. 

      A 73-year-old with a history of pneumonia

  • 30. 
          30.   Which of the following foods will have the greatest impact on the water balance of the person consuming it?
    • A. 

      A pickle

    • B. 

      A banana

    • C. 

      A milkshake

    • D. 

      A spinach salad

  • 31. 
          31.   Which of the following foods will have the greatest impact on the heart’s conductivity of the person consuming it?
    • A. 

      A pickle

    • B. 

      A banana

    • C. 

      A milkshake

    • D. 

      A spinach salad

  • 32. 
          32.   Which of the following foods will have the greatest impact on the blood-clotting mechanism of the person consuming it?
    • A. 

      A pickle

    • B. 

      A banana

    • C. 

      A milkshake

    • D. 

      A spinach salad

  • 33. 
          33.   Which of the following foods will have the greatest impact on the neurochemical activity of the person consuming it?
    • A. 

      A pickle

    • B. 

      A banana

    • C. 

      A milkshake

    • D. 

      A spinach salad

  • 34. 
          34.   Which of the following clinical assessment findings is most likely seen in a client experiencing partial-thickness burns over 35% of the body as a result of hyponatremia?
    • A. 

      Dry, sticky tongue

    • B. 

      Increased anxiety

    • C. 

      Nausea and vomiting

    • D. 

      Decreased bowel sounds

  • 35. 
          35.   Which of the following clinical assessment findings is most likely seen in a client experiencing hypernatremia as a result of diabetes insipidus?
    • A. 

      Dry, sticky tongue

    • B. 

      Increased anxiety

    • C. 

      Nausea and vomiting

    • D. 

      Decreased bowel sounds

  • 36. 
          36.   Which of the following clinical assessment findings is most likely seen in a client experiencing hypokalemia as a result of the misuse of potassium-wasting diuretics?
    • A. 

      Dry, sticky tongue

    • B. 

      Increased anxiety

    • C. 

      Nausea and vomiting

    • D. 

      Decreased bowel sounds

  • 37. 
          37.   Which of the following clinical assessment findings is most likely seen in a client experiencing hyperkalemia as a result of adrenal insufficiency?
    • A. 

      Dry, sticky tongue

    • B. 

      Increased anxiety

    • C. 

      Nausea and vomiting

    • D. 

      Decreased bowel sounds

  • 38. 
          38.   A client who takes furosemide presents at the emergency department with weakness and fatigue and complains of nausea and vomiting for 3 days. Upon assessment, the nurse finds that the client has decreased bowel sounds and ECG abnormalities including a flattened T wave and flattened ST segment. The nurse knows that these are signs of:
    • A. 

      Hypokalemia

    • B. 

      Hyperkalemia

    • C. 

      Hyponatremia

    • D. 

      Hypocalcemia

  • 39. 
          39.   A mother brings her 2-year-old daughter to the clinic with a 2-day history of a fever of unknown origin. The mother explains to the nurse that the air conditioning in her apartment is not working and it has been very hot; her daughter has been vomiting for 2 days and has had a fever, and the child is lethargic. The child’s rectal temperature is 101.1° F. The nurse knows the child is probably dehydrated and should do which of the following first?
    • A. 

      Give the child some juice to drink.

    • B. 

      Prepare to start an IV.

    • C. 

      Get an order for an antipyretic.

    • D. 

      Sponge the child to bring down the fever.

  • 40. 
          40.   The nurse is caring for a 73-year-old female client who is 3 days postoperative for a bowel obstruction. The nurse knows that the stress response of surgery causes fluid-balance changes in the second to fifth postoperative day, when aldosterone, glucocorticoids, and antidiuretic hormone (ADH) are increasingly secreted, causing sodium and chloride retention and potassium excretion. Because of this, it is important for the nurse to closely monitor:
    • A. 

      Urine output

    • B. 

      Intake of sodium

    • C. 

      Activity level

    • D. 

      Oxygen level

  • 41. 
          41.   Which of the following clients is most at risk for fluid volume deficit?
    • A. 

      25-year-old male near-drowning victim

    • B. 

      56-year-old woman with salicylate poisoning

    • C. 

      45-year-old woman with second-degree burns over 20% of her body

    • D. 

      13-year-old boy with an oral temperature of 103.4° F

  • 42. 
          42.   A 66-year-old female client is admitted to the hospital with diabetic ketoacidosis. The client has a running IV line through which she receives her medications and fluid maintenance. Which of the following would not be counted on the daily intake and output (I&O)?
    • A. 

      IV fluids

    • B. 

      Cream of mushroom soup

    • C. 

      Gelatin

    • D. 

      Mashed potatoes

  • 43. 
          43.   A client with transient atrial fibrillation has been taking 83 mg of aspirin daily for the past 3 years. When preparing the client for discharge from the hospital, the nurse discontinues his IV line. In order to prevent a hematoma, the nurse needs to hold pressure on the IV site for:
    • A. 

      1 to 2 minutes

    • B. 

      2 to 3 minutes

    • C. 

      3 to 5 minutes

    • D. 

      5 to 10 minutes

  • 44. 
          44.   The nurse is preparing to replace a bag of IV fluids for a client receiving fluid therapy. When assessing the client, the nurse notes that the IV solution is not dripping. Which of the following should the nurse do to assess the patency of the site?
    • A. 

      Lower IV container below level of IV site for presence of blood return.

    • B. 

      Use a large-volume syringe to apply negative pressure to achieve a blood return.

    • C. 

      Carefully adjust the roller clamp to see an increase in flow rate.

    • D. 

      Massage the client’s arm proximal to where the catheter is inserted.

  • 45. 
          45.   A client has been hospitalized following a myocardial infarction. The client has an IV line running with multiple drips. The nurse assesses the client’s medical record to determine the last time the IV tubing was changed, because the nurse knows that the Centers for Disease Control and Prevention (CDC) recommends that IV tubing be changed:
    • A. 

      Every shift

    • B. 

      Daily

    • C. 

      Every 48 hours

    • D. 

      Every 72 hours

  • 46. 
          46.   The nurse is assessing the client with an IV line. The nurse notes that the IV insertion site is red, edematous, and painful. The nurse’s first action should be to:
    • A. 

      Immediately discontinue the IV line and remove the cannula

    • B. 

      Put cool compresses on the IV site to decrease the edema

    • C. 

      Notify the health care provider of the situation

    • D. 

      Put warm compresses on the IV site to decrease the pain

  • 47. 
          47.   Blood replacement or transfusion is the IV administration of whole blood or a component such as plasma, packed red blood cells (RBCs), or platelets. The minimum gauge IV cannula necessary for administering a blood transfusion is:
    • A. 

      24 gauge

    • B. 

      22 gauge

    • C. 

      20 gauge

    • D. 

      18 gauge

  • 48. 
          48.   The nurse is discontinuing a client’s IV line in preparation for the client’s discharge home. Upon withdrawing the cannula from the peripheral site, the nurse notes that the tip of the cannula is missing. The first thing that the nurse should do is:
    • A. 

      Notify the health care provider immediately

    • B. 

      Apply pressure to the IV site

    • C. 

      Apply a tourniquet high on the extremity

    • D. 

      Ask another nurse to double-check the cannula

  • 49. 
            1.   A client with partial-thickness burns over 40% of the body is likely to lose body fluid via: (Select all that apply.)
    • A. 

      Water vapor that is lost through the skin that is burned

    • B. 

      Plasma and interstitial fluids that are lost as burn exudate

    • C. 

      Blood leakage via damaged capillaries in the dermis

    • D. 

      Respiratory acidosis resulting from altered respiratory function

    • E. 

      Plasma that leaves the intravascular space and becomes trapped in blisters

    • F. 

      Sodium and water shift that out of the vessels because of increased permeability

  • 50. 
            2.   A client experiencing respiratory alkalosis as a result of asthma is likely to present with which of the following clinical signs? (Select all that apply.)
    • A. 

      A respiratory rate of 36 breaths per minute

    • B. 

      Complaints of numbness in fingers and toes

    • C. 

      Dizziness when attempting to sit upright

    • D. 

      Difficulty holding a cup because of tremors

    • E. 

      An irregular heartbeat on an electrocardiogram (ECG)

    • F. 

      Warm, flushed skin

  • 51. 
            3.   A client experiencing respiratory acidosis as a result of pneumonitis is likely to present with which of the following clinical signs? (Select all that apply.)
    • A. 

      Tingling fingers

    • B. 

      Difficult to arouse

    • C. 

      Warm, flushed skin

    • D. 

      Tremors in the hands

    • E. 

      Reporting a “terrible headache”

    • F. 

      Repeatedly asking “Where am I?”

  • 52. 
            4.   A client experiencing diabetic ketoacidosis is likely to present with which of the following clinical signs? (Select all that apply.)
    • A. 

      Red, flushed skin

    • B. 

      Verbally aggressive

    • C. 

      Complaints of dry mouth

    • D. 

      Crackles in both lung fields

    • E. 

      Oral temperature of 102.8° F

    • F. 

      Requiring frequent linen changes

  • 53. 
            5.   A client experiencing acute congestive heart failure (CHF) is likely to present with which of the following clinical signs? (Select all that apply.)
    • A. 

      Flat neck veins

    • B. 

      Bilateral crackles

    • C. 

      +2 ankle edema bilaterally

    • D. 

      Urine output of 790 mL in 24 hours

    • E. 

      History of a 5-pound weight gain in 3 days

    • F. 

      Systemic blood pressure 15 mm Hg above usual baseline

  • 54. 
            6.   Which of the following clients is at risk for fluid, electrolyte, and acid-base imbalances? (Select all that apply.)
    • A. 

      50-year-old with hypertension

    • B. 

      36-year-old with schizophrenia

    • C. 

      40-year-old with a fractured femur

    • D. 

      15-month-old with diarrhea for 2 days

    • E. 

      76-year-old with advanced Alzheimer’s disease

    • F. 

      25-year-old with partial-thickness burns over 40% of the body

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