Fluid, Electrolyte, And Acid Base Problems (Practice Mode)

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1. A client is admitted to the unit for chemotherapy. To prevent an acid-base problem, which of the following would you instruct the nursing assistant to report? 

Explanation

Prolonged nausea and vomiting can result in acid deficit that can lead to metabolic alkalosis. The other findings are important and need to be assessed but are not related to acid-base imbalances.

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Fluid, Electrolyte, And Acid Base Problems (Practice Mode) - Quiz

Mark the letter of the letter of choice then click on the next button. Answer will be revealed after each question. No time limit  to finish the exam. Good luck!

2. A nursing assistant asks why the client with a chronically low phosphorus level needs so much assistance with activities of daily living. What is your best response? 

Explanation

A musculoskeletal manifestation of low phosphorous is generalized muscle weakness that may lead to acute muscle breakdown (rhabdomyolysis). Even though the other statements are true, they do not answer the nursing assistant’s question.

Submit
3. A client with lung cancer has received oxycodone 10 mg orally for pain. When the student nurse assesses the client, which finding should you instruct the student to report immediately? 

Explanation

A decreased respiratory rate indicates respiratory depression which also puts the client at risk for respiratory acidosis, All of the other findings are important and should be reported to the RN, but the respiratory rate is urgent.

Submit
4. A client’s nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to the fluid management should be delegated to a nursing assistant? 

Explanation

The nursing assistant can reinforce additional fluild intake once it is part of the care plan. Administering IV fluids, developing plans, and teaching families require additional education and skills that are within the scope of practice for the RN.

Submit
5. You are preparing to discharge a client whose calcium level was low but is now just slightly within the normal range (9-10.5 mg/dL). Which statement by the client indicates the need for additional teaching? 

Explanation

Clients with low calcium levels should be encouraged to consume dairy products, seafood, nuts, broccoli, and spinach. Which are all good sources of dietary calcium.

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6. The physician has written the following orders for the client with Excess Fluid volume. The client’s morning assessment includes bounding peripheral pulses, weight gain of 2 pounds, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time? 

Explanation

Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other orders are important but not urgent.

Submit
7. You have been pulled to the telemetry unit for the day. The monitor informs you that the client has developed prominent U waves. Which laboratory value should you check immediately? 

Explanation

Suspect hypokalemia and check the client’s potassium level. Common ECG changes with hypokalemia include ST depression, inverted T waves, and prominent U waves. Client with hypokalemia may also develop heart block.

Submit
8. The experienced LPN/LVN reports that a client’s blood pressure and heart rate have decreased and that when the face is assessed, one side twitches. What action should you take at this time? 

Explanation

A positive Chvostek’s sign (facial twitching of one side of the mouth, nose, and cheek in response to tapping the face just below and in front of the ear) is a neurologic manifestation of hypocalcemia. The LPN/LVN is experienced and possesses the skills to take accurate vital signs.

Submit
9. The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant? 

Explanation

Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.

Submit
10. A client has a nasogastric tube connected to intermittent wall suction. The student nurse asks why the client’s respiratory rate has increased. What your best response? 


 

Explanation

Nasogastric suctioning can result in a decrease in acid components and metabolic alkalosis. The client’s increase in rate and depth of ventilation is an attempt to compensate by blowing off CO2. the first response maybe true but does not address all the components of the question. The third and fourth answers are inaccurate.

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11. You are admitting an elderly client to the medical unit. Which factor indicates that this client has a risk for acid-base imbalances? 


Explanation

Risk factors for acid-base imbalances in the older adult include chronic renal disease and pulmonary disease. Occasional antacid use will not cause imbalances, although antacid abuse is a risk factor for metabolic alkalosis.

Submit
12. The client’s potassium level is 6.7 mEq/L. Which intervention should you delegate to the student nurse under your supervision? 

.

Explanation

The client’s potassium level is high (normal range 3.5-5.0). Kayexalate removes potassium from the body through the gastrointestinal system. Spironolactone is a potassium-sparing diuretic that may cause the client’s potassium level to go even higher. The nursing student may not have the skill to assess ECG strips and this should be done by the RN.

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13. The client also has the nursing diagnosis Decreased Cardiac Output related to decrease plasma volume. Which finding on assessment supports this nursing diagnosis? 

Explanation

Normally, neck veins are distended when the client is in the supine position. The veins flatten as the client moves to a sitting position. The other three responses are characteristic of Excess Fluid Volume.

Submit
14. The nursing assistant reports to you that a client seems very anxious and that vital signs included a respiratory rate of 38 per minute. Which acid-base imbalance should you suspect? 

Explanation

The client is most likely hyperventilating and blowing off CO2. This decrease in CO2 will lead to an increase in pH, causing respiratory alkalosis. Respiratory acidosis results from respiratory depression and retained CO2. Metabolic acidosis and alkalosis result from problems related to renal acid-base control.

Submit
15. You are the charge nurse. Which client is most appropriate to assign to the step-down unit nurse pulled to the intensive care unit for the day? 

Explanation

The client with COPD, although ventilator dependent, is the most stable of this group. Clients with acid-base imbalances often require frequent laboratory assessment and changes in therapy to correct their disorders. In addition, the client with DKA is a new admission and will require an in-depth admission assessment. All three of these clients need care from an experienced critical care nurse.

Submit
16. You are reviewing a client’s morning laboratory results. Which of these results is of most concern? 

Explanation

While all of these laboratory values are outside of the normal range, the magnesium is most outside of normal. With a magnesium level this low, the client is at risk for
ECG changes and life-threatening ventricular dysrhythmias.

Submit
17. A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). For which electrolyte abnormality will you be sure to monitor? 

Explanation

SIADH causes a relative sodium deficit due to excessive retention of water.

Submit
18. A client with respiratory failure is receiving mechanical ventilation and continues to produce ABG results indicating respiratory acidosis. Which action should you expect to correct this problem? 

Explanation

the blood gas component responsible for respiratory acidosis is CO2 (Carbon dioxide). Increasing the ventilator rate will blow off more CO2 and decrease the acidosis. Changes in the oxygen setting may improve oxygenation but will not affect respiratory acidosis.

Submit
19. Which action should you delegate to the nursing assistant for the client with diabetic ketoacidosis? (Choose all that apply.) 

Explanation

The nursing assistant’s training and education include how to take vital signs and record intake and output. The need to take vital signs this frequently indicates that the client maybe unstable. The nurse should give the nursing assistant reporting parameters when delegating this action, should also check the vital signs for indications in instability. Performing fingerstick glucose checks and assessing clients require additional education and skill that are appropriate to licensed nurses. Some facilities may train experienced nursing assistants to perform fingerstick glucose checks and change their role descriptions to designate their new skills, but this is beyond the normal scope of practice for a nursing assistant.

Submit
20. The nursing care plan for the client with dehydration includes interventions for oral health. Which interventions are within the scope of practice for the LPN/LVN being supervised by the nurse? (Choose all that apply.) 

Explanation

The LPN/LVN’s scope of practice and educational preparation includes oral care and routine observation. State practice acts vary as to whether LPN/LVNs are permitted to perform assessment. The client should be reminded to avoid most commercial mouthwashes that contain alcohol, a drying agent. Initiating a dietary consult is within the purview of the RN or physician.

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A client is admitted to the unit for chemotherapy. To prevent an ...
A nursing assistant asks why the client with a chronically low ...
A client with lung cancer has received oxycodone 10 mg orally for ...
A client’s nursing diagnosis is Deficient Fluid Volume related to ...
You are preparing to discharge a client whose calcium level was low ...
The physician has written the following orders for the client with ...
You have been pulled to the telemetry unit for the day. The monitor ...
The experienced LPN/LVN reports that a client’s blood pressure and ...
The charge nurse assigned in the care for a client with acute renal ...
A client has a nasogastric tube connected to intermittent wall ...
You are admitting an elderly client to the medical unit. Which factor ...
The client’s potassium level is 6.7 mEq/L. Which intervention should...
The client also has the nursing diagnosis Decreased Cardiac Output ...
The nursing assistant reports to you that a client seems very anxious ...
You are the charge nurse. Which client is most appropriate to assign ...
You are reviewing a client’s morning laboratory results. Which of...
A client is admitted to the unit with a diagnosis of syndrome of ...
A client with respiratory failure is receiving mechanical ventilation ...
Which action should you delegate to the nursing assistant for ...
The nursing care plan for the client with dehydration includes ...
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