Fluids 1
Exam
- 1.
1. You are caring for a patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion. Your patient has specific gravities ordered every 4 hours. What does this test detect?
- A.
A) Nutritional deficit
- B.
B) Hyperkalemia
- C.
C) Hypercalcemia
- D.
D) Fluid volume status
Correct Answer
D. D) Fluid volume statusExplanation
The specific gravity test measures the concentration of solutes in urine and is used to assess the patient's fluid volume status. It helps to determine if the patient is adequately hydrated or experiencing dehydration. This test is not used to detect nutritional deficits, hyperkalemia, or hypercalcemia.Rate this question:
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- 2.
2. You are caring for a patient admitted with a diagnosis of renal failure. When you review your patient's laboratory reports, you note that the patient's magnesium levels are high. What would be important for you to assess?
- A.
A) Diminished deep tendon reflexes
- B.
B) Tachycardia
- C.
C) Cool, clammy skin
- D.
D) Increased serum magnesium
Correct Answer
A. A) Diminished deep tendon reflexesExplanation
High levels of magnesium can cause a decrease in deep tendon reflexes. This is because magnesium acts as a calcium channel blocker, inhibiting the release of acetylcholine and reducing the excitability of the motor neurons. Diminished deep tendon reflexes can indicate magnesium toxicity, and it is important to assess this in a patient with high magnesium levels. Tachycardia and cool, clammy skin are not specifically associated with high magnesium levels. Increased serum magnesium is already mentioned in the question and does not provide any new information.Rate this question:
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- 3.
3. You are working on a burn unit. One of your patients is exhibiting signs and symptoms of third spacing, which occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, what would you expect the patient to demonstrate?
- A.
A) Hypertension
- B.
B) Bradycardia
- C.
C) Hypervolemia
- D.
D) Hypovolemia
Correct Answer
D. D) HypovolemiaExplanation
Third spacing refers to the abnormal accumulation of fluid in the interstitial spaces, which leads to a decrease in the circulating blood volume. This results in hypovolemia, or decreased blood volume. Hypovolemia can cause symptoms such as low blood pressure, rapid heart rate, and decreased urine output. Therefore, based on the fluid shift described, it would be expected that the patient would demonstrate hypovolemia.Rate this question:
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- 4.
4. A patient with anxiety presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance?
- A.
A) Respiratory acidosis
- B.
B) Respiratory alkalosis
- C.
C) Increased PaCO2
- D.
D) CNS disturbances
Correct Answer
B. B) Respiratory alkalosisExplanation
Hyperventilation is the most common cause of respiratory alkalosis. When a person hyperventilates, they breathe rapidly and shallowly, leading to a decrease in carbon dioxide (CO2) levels in the blood. This results in a decrease in the concentration of carbonic acid (H2CO3) in the blood, leading to an increase in blood pH. This shift towards alkalinity is known as respiratory alkalosis.Rate this question:
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- 5.
5. You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results?
- A.
A) Respiratory acidosis with no compensation
- B.
B) Metabolic alkalosis with a compensatory alkalosis
- C.
C) Metabolic acidosis with no compensation
- D.
D) Metabolic acidosis with a compensatory respiratory alkalosis
Correct Answer
D. D) Metabolic acidosis with a compensatory respiratory alkalosisExplanation
The given arterial blood gas results indicate a low pH (7.26), low PaCO2 (28), and low HCO3 (11 mEq/L). These values suggest a primary metabolic acidosis, as the pH is below the normal range and the HCO3 is significantly decreased. Additionally, there is evidence of compensatory respiratory alkalosis, as the PaCO2 is lower than the normal range. This compensatory response occurs in an attempt to increase the pH by decreasing the PaCO2 through hyperventilation. Therefore, the correct interpretation of these results is metabolic acidosis with a compensatory respiratory alkalosis.Rate this question:
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- 6.
6. You are making initial shift assessments on your patients. While assessing one patient's peripheral IV site, you note edema around the insertion site. How will you document this complication related to IV therapy?
- A.
A) Air emboli
- B.
B) Phlebitis
- C.
C) Infiltration
- D.
D) Fluid overload
Correct Answer
C. C) InfiltrationExplanation
Infiltration refers to the leakage of IV fluid into the surrounding tissue, resulting in edema around the insertion site. This complication is documented as infiltration, as it indicates that the IV catheter has come out of the vein and the fluid is accumulating in the tissue instead. Air emboli, phlebitis, and fluid overload are different complications that are not relevant to the given scenario.Rate this question:
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- 7.
7. You are doing an admission assessment on an elderly patient newly admitted for end-stage liver disease. You must assess the patient's skin turgor. What should you remember when evaluating skin turgor?
- A.
A) Overhydration causes the skin to tent.
- B.
B) Dehydration causes the skin to appear edematous and spongy.
- C.
C) Inelastic skin turgor is a normal part of aging.
- D.
D) Normal skin turgor is moist and boggy.
Correct Answer
C. C) Inelastic skin turgor is a normal part of aging.Explanation
As people age, the elasticity of their skin decreases, leading to inelastic skin turgor. This means that the skin does not bounce back as quickly when it is pinched or pulled. It is important to remember this when evaluating skin turgor in elderly patients, as it is a normal part of the aging process and not necessarily indicative of dehydration or overhydration.Rate this question:
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- 8.
8. The physician has ordered a peripheral IV to be inserted before the patient goes to the operating room. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter?
- A.
A) Choose a proximal site
- B.
B) Choose a distal site
- C.
C) Have the patient hold his arm over his head
- D.
D) Leave the tourniquet on for at least 5 minutes
Correct Answer
B. B) Choose a distal siteExplanation
When selecting a site on the hand or arm for insertion of an IV catheter, the nurse should choose a distal site. This means selecting a site that is further away from the heart. Choosing a distal site allows for better blood flow and reduces the risk of complications such as infiltration or thrombosis. Proximal sites are closer to the heart and are typically reserved for more critical situations. Having the patient hold his arm over his head or leaving the tourniquet on for at least 5 minutes are not necessary steps for selecting a site for IV insertion.Rate this question:
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- 9.
9. A nurse in the medical ICU has orders to infuse a hypertonic solution into her patient with low blood pressure. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. Which term or terms is/are associated with this process?
- A.
A) Hydrostatic pressure
- B.
B) Osmosis and osmolality
- C.
C) Diffusion
- D.
D) Active transport
Correct Answer
B. B) Osmosis and osmolalityExplanation
The correct answer is B) Osmosis and osmolality. Osmosis is the process by which water molecules move from an area of lower solute concentration to an area of higher solute concentration, through a semipermeable membrane. In this case, the hypertonic solution, which has a higher concentration of solutes, will cause water to move from the tissues into the capillaries, increasing the blood volume. Osmolality refers to the concentration of solutes in a solution, and in this case, the hypertonic solution will increase the osmolality of the patient's blood, causing osmosis to occur.Rate this question:
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- 10.
10. You are the nurse caring for a 65-year-old female patient who is in renal failure. During your shift assessment, the patient complains of tingling in her lips and fingers whenever anyone takes her blood pressure. She tells you that she gets a spasm in her wrist and hand and that it is very painful. What would you suspect?
- A.
A) Hypophosphatemia
- B.
B) Hypocalcemia
- C.
C) Hypermagnesemia
- D.
D) Hyperkalemia
Correct Answer
B. B) HypocalcemiaExplanation
Based on the patient's symptoms of tingling in her lips and fingers, along with the wrist and hand spasms, it is likely that she is experiencing hypocalcemia. Hypocalcemia is a condition characterized by low levels of calcium in the blood, which can lead to neuromuscular irritability and muscle spasms. The tingling sensation and painful spasms in her lips, fingers, wrist, and hand are consistent with the symptoms of hypocalcemia.Rate this question:
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- 11.
11. The nursing instructor is discussing renal failure with her senior nursing class. The instructor states, “A patient in renal failure partially loses the ability to regulate changes in pH.” What is the cause of this partial inability?
- A.
A) The kidneys regulate and reabsorb carbonic acid to change and maintain pH.
- B.
B) The kidneys buffer acids through electrolyte changes.
- C.
C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.
- D.
D) The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
Correct Answer
C. C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.Explanation
The correct answer is C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH. In renal failure, the kidneys are not able to effectively perform their function of reabsorbing bicarbonate, leading to a decrease in the body's ability to regulate pH. Bicarbonate is an important buffer in the body that helps maintain a stable pH by neutralizing excess acids. Without the kidneys' ability to regenerate and reabsorb bicarbonate, there is an imbalance in the body's acid-base regulation, resulting in a partial loss of ability to regulate changes in pH.Rate this question:
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- 12.
12. You are caring for a 65-year-old male patient admitted to your unit 72 hours ago with pyloric stenosis. A nasogastric tube was placed upon admission has been on low intermittent suction ever since. You notice that the patient's potassium is very low. What would you be concerned that the patient may be at risk for?
- A.
A) Hypercalcemia
- B.
B) Metabolic acidosis
- C.
C) Metabolic alkalosis
- D.
D) Respiratory acidosis
Correct Answer
C. C) Metabolic alkalosisExplanation
The correct answer is C) Metabolic alkalosis. The patient's low potassium level is indicative of hypokalemia, which can be caused by excessive loss of gastric acid through continuous suctioning. This loss of gastric acid can lead to an imbalance in the body's acid-base status, resulting in metabolic alkalosis.Rate this question:
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- 13.
13. Nursing students are learning the skill of starting a peripheral IV in the skills lab setting. After gathering all the supplies, the nurse would begin to prepare the site. How should the nurse always start?
- A.
A) Leave one hand ungloved to assess the site
- B.
B) Prepare the skin with an iodine solution
- C.
C) Ask the patient if he is allergic to latex or iodine
- D.
D) Remove excessive hair at the selected site
Correct Answer
C. C) Ask the patient if he is allergic to latex or iodineExplanation
The nurse should always start by asking the patient if they are allergic to latex or iodine before preparing the site for starting a peripheral IV. This is important because if the patient has an allergy to either latex or iodine, alternative supplies and solutions need to be used to prevent an allergic reaction. By asking the patient about their allergies, the nurse can ensure the safety and well-being of the patient during the procedure.Rate this question:
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- 14.
14. A patient in the ICU starts complaining of being “short of breath.” An arterial blood gas (ABG) is drawn. The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?
- A.
A) Respiratory acidosis
- B.
B) Metabolic alkalosis
- C.
C) Respiratory alkalosis
- D.
D) Metabolic acidosis
Correct Answer
A. A) Respiratory acidosisExplanation
The ABG values indicate respiratory acidosis. The low pH (7.21) suggests acidosis, and the high PaCO2 (64 mm Hg) indicates that there is an excess of carbon dioxide in the blood, which is a characteristic of respiratory acidosis. The normal range for PaCO2 is 35-45 mm Hg, so a value of 64 mm Hg is significantly elevated. The HCO3 value (24 mm Hg) is within the normal range, which suggests that there is no compensatory metabolic component to the acidosis. Therefore, the ABG reflects respiratory acidosis.Rate this question:
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- 15.
15. While admitting a new patient to your medical-surgical unit, you note that the patient is oliguric. You notify the the acute-care nurse practitioner who orders a fluid challenge of 100 to 200 mL of normal saline solution over 15 minutes. What do you know this intervention will do?
- A.
A) Help distinguish hyponatremia from hypernatremia
- B.
B) Help evaluate pituitary gland function
- C.
C) Help distinguish reduced renal blood flow from decreased renal function
- D.
D) Help provide an effective treatment for hypertension-induced oliguria
Correct Answer
C. C) Help distinguish reduced renal blood flow from decreased renal functionExplanation
This intervention will help distinguish reduced renal blood flow from decreased renal function. Oliguria is a condition characterized by reduced urine output, and it can be caused by either reduced renal blood flow or decreased renal function. The fluid challenge with normal saline solution helps to determine the underlying cause by assessing the response of the kidneys to the increased fluid volume. If the oliguria improves after the fluid challenge, it suggests that reduced renal blood flow was the cause. If there is no improvement, it indicates decreased renal function as the cause. Therefore, this intervention helps to differentiate between the two possibilities.Rate this question:
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- 16.
16. The home health nurse is visiting an 84-year-old woman living at home and recovering from hip surgery. The nurse notes that the woman seems confused and has poor skin turgor. When asked about her fluid intake, the patient states, “I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom.” What would be the nurse's best response?
- A.
A) “I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup.”
- B.
B) “Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of you fluids.”
- C.
C) “It is normal to be a little confused following surgery, and it's safe not to urinate a night.”
- D.
D) “Confusion following surgery is common in the elderly due to a loss of sleep. “
Correct Answer
B. B) “Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of you fluids.”Explanation
The nurse's best response would be B) "Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids." This response acknowledges the patient's concern about getting up at night to go to the bathroom, but also addresses the potential consequences of limiting fluid intake. It suggests adjusting the timing of fluids to ensure adequate hydration without disrupting the patient's sleep. This response shows that the nurse is considering the patient's needs and concerns while also providing necessary education about the importance of fluid intake.Rate this question:
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- 17.
17. A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; PERLA is intact. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurse's most likely explanation for the urine output?
- A.
A) The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.
- B.
B) The man has a brain injury, lacks ADH, and needs vasopressin.
- C.
C) The man is in heart failure and is releasing atrial natriuretic peptide that results in decreased urine output.
- D.
D) He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.
Correct Answer
D. D) He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.Explanation
The patient's elevated heart rate, anxiety, and thirst suggest a sympathetic reaction, which can stimulate the renin-angiotensin-aldosterone system. This system causes vasoconstriction and sodium and water retention, leading to decreased urine output. The presence of 40 mL of urine in the Foley catheter indicates that the patient is not experiencing urinary retention or lack of ADH. There is no information suggesting brain injury or heart failure, so options B and C can be ruled out. Therefore, option D is the most likely explanation for the urine output.Rate this question:
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- 18.
18. The student nurses are in the skills lab learning the technique for the insertion of an IV catheter. How should these students be taught to treat excess hair at the intended site?
- A.
A) Leave the hair intact
- B.
B) Shave the area
- C.
C) Clip the hair in the area
- D.
D) Remove the hair with a depilatory
Correct Answer
C. C) Clip the hair in the areaExplanation
The correct answer is C) Clip the hair in the area. When inserting an IV catheter, it is important to remove excess hair at the intended site to ensure proper adhesion of the dressing and to prevent contamination. Shaving the area may cause micro-abrasions and increase the risk of infection. Leaving the hair intact may also interfere with proper adhesion of the dressing. Removing the hair with a depilatory may cause skin irritation and allergic reactions. Therefore, clipping the hair in the area is the most appropriate method to treat excess hair.Rate this question:
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- 19.
19. You are the nurse evaluating a new patient's laboratory results. Based upon the laboratory findings, what will cause the release of antidiuretic hormone (ADH)?
- A.
A) Increased serum sodium
- B.
B) Decreased serum sodium
- C.
C) Decrease in serum osmolality
- D.
D) Decrease in thirst
Correct Answer
A. A) Increased serum sodiumExplanation
Increased serum sodium levels can cause the release of antidiuretic hormone (ADH). ADH is released by the pituitary gland in response to high levels of sodium in the blood. ADH helps to regulate water balance in the body by increasing water reabsorption in the kidneys. When serum sodium levels are high, ADH is released to conserve water and prevent further increase in sodium concentration. This helps to maintain proper fluid balance in the body.Rate this question:
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- 20.
20. A new nurse is admitting a patient with a history of emphysema. The new nurse's preceptor is going over the patient's past lab reports with the new nurse. The nurse takes note that the patient's PaCO2 has been between 56 and 64mm Hg for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurse's best response?
- A.
A) The patient's calcium will rise dramatically due to pituitary stimulation.
- B.
B) The oxygen will increase the patient's intracranial pressure and create confusion.
- C.
C) The oxygen may cause the patient to hyperventilate and become acidotic.
- D.
D) Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.
Correct Answer
D. D) Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.Explanation
The patient's PaCO2 levels have been consistently high, indicating that they have developed a tolerance to high levels of carbon dioxide. Administering oxygen may decrease the patient's respiratory drive and cause them to retain even more carbon dioxide, leading to carbon dioxide narcosis and hypoxemia.Rate this question:
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- 21.
21. When oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli, which process is used?
- A.
A) Diffusion
- B.
B) Osmosis
- C.
C) Active transport
- D.
D) Filtration
Correct Answer
A. A) DiffusionExplanation
During the exchange of oxygen and carbon dioxide between the pulmonary capillaries and the alveoli, the process used is diffusion. Diffusion is the movement of molecules from an area of high concentration to an area of low concentration. In this case, oxygen moves from the alveoli, where its concentration is high, to the pulmonary capillaries, where its concentration is lower. Similarly, carbon dioxide moves from the capillaries, where its concentration is high, to the alveoli, where its concentration is lower. This exchange occurs passively, without the need for energy or a transport mechanism.Rate this question:
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- 22.
22. In the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur?
- A.
A) The active transport of hydrogen ions across the capillary walls
- B.
B) The pressure of the blood in the renal capillaries
- C.
C) The number of dissolved particles contained in a unit of blood
- D.
D) The hydrostatic pressure resulting from the pumping action of the heart
Correct Answer
D. D) The hydrostatic pressure resulting from the pumping action of the heartExplanation
The correct answer is D) The hydrostatic pressure resulting from the pumping action of the heart. This is because the heart's pumping action creates a force that pushes the blood through the arteries and capillaries, generating hydrostatic pressure. This pressure helps to push water and electrolytes out of the arterial capillary bed and into the interstitial fluid.Rate this question:
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- 23.
23. The baroreceptors, located in the left atrium, and the carotid and aortic arches respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what?
- A.
A) Decrease in the release of aldosterone
- B.
B) Increase of filtration in the Loop of Henle
- C.
C) Decrease in the reabsorption of sodium
- D.
D) Decrease in glomerular filtration
Correct Answer
D. D) Decrease in glomerular filtrationExplanation
The baroreceptors, located in the left atrium, and the carotid and aortic arches, respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, which leads to a decrease in glomerular filtration. This is because the constriction of the arterioles reduces the blood flow to the glomerulus, resulting in a decrease in the filtration rate.Rate this question:
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- 24.
24. You are the nurse caring for a 77-year-old male who fell off his roof. You note that the patient's labs indicate minimally elevated serum creatinine levels. What can this indicate in older adults?
- A.
A) Substantially reduced renal function
- B.
B) Reduced respiratory function
- C.
C) Increased cardiac function
- D.
D) Alterations in ratio of body fluids to muscle mass
Correct Answer
A. A) Substantially reduced renal functionExplanation
Elevated serum creatinine levels can indicate reduced renal function in older adults. The kidneys play a vital role in filtering waste products from the blood, and a decrease in renal function can lead to a buildup of creatinine in the blood. This can be a sign of impaired kidney function, which is common in older adults due to age-related changes and other health conditions. Therefore, the minimally elevated serum creatinine levels in this patient suggest that their renal function may be substantially reduced.Rate this question:
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- 25.
You are the nurse caring for a patient who is to receive IV daunorubicin. You start the infusion and check the insertion site as per protocol. This time when you look at the IV site, you note that the IV has infiltrated. You stop the infusion. What is your main concern with this infiltration?
- A.
A) Extravasation of the medication
- B.
B) Discomfort to the patient
- C.
C) Blanching at the site
- D.
D) Reaction to the medication
Correct Answer
A. A) Extravasation of the medicationExplanation
The main concern with infiltration of the IV daunorubicin is the possibility of extravasation of the medication. Extravasation occurs when the medication leaks into the surrounding tissues instead of entering the bloodstream. Daunorubicin is a chemotherapy drug that can cause severe tissue damage if it infiltrates. It can lead to pain, swelling, tissue necrosis, and long-term complications. Therefore, it is crucial to stop the infusion immediately to prevent further damage and initiate appropriate interventions to manage the extravasation.Rate this question:
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- 26.
27. The nurse caring for a patient post colon resection is assessing the patient on the first postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL per hour. The patient reports pain at the incision site rated at a three on a zero-to-ten rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs). You suspect the patient has hypokalemia. What other signs or symptoms would you expect this patient to exhibit?
- A.
A) Increased bowel motility
- B.
B) Dilute urine
- C.
C) Increased muscle strength
- D.
D) Excessive thirst
Correct Answer
B. B) Dilute urineExplanation
Hypokalemia is a condition characterized by low levels of potassium in the blood. One of the main functions of potassium is to help regulate fluid balance in the body. In hypokalemia, the kidneys are unable to properly concentrate urine, leading to the production of dilute urine. Therefore, it is expected that a patient with hypokalemia would exhibit dilute urine as a symptom. Increased bowel motility, increased muscle strength, and excessive thirst are not directly associated with hypokalemia.Rate this question:
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- 27.
28. You are caring for a patient on the oncology floor with a diagnosis of metastatic brain cancer. During your assessment, you note the patient complains of abdominal pain. Skin turgor indicates dehydration is present. What would you further assess for in this patient?
- A.
A) Hypernatremia
- B.
B) Hypomagnesemia
- C.
C) Hypophosphatemia
- D.
D) Hypercalcemia
Correct Answer
D. D) HypercalcemiaExplanation
In a patient with metastatic brain cancer, the presence of abdominal pain and dehydration indicated by skin turgor suggests the possibility of hypercalcemia. Hypercalcemia is a common complication of advanced cancer, including brain cancer. It can cause abdominal pain as well as other symptoms such as constipation, nausea, vomiting, and confusion. Therefore, further assessment for hypercalcemia would be appropriate in this patient.Rate this question:
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- 28.
29. As the ICU nurse caring for a patient with multiple traumas from an ATV accident, you draw arterial blood gasses (ABGs) every 4 hours. What are you assessing in this patient with the ABGs?
- A.
A) The bicarbonate-carbonic acid buffer system
- B.
B) The patient's oxygen status
- C.
C) The patient's intracellular buffer systems
- D.
D) Metabolic acidosis status
Correct Answer
A. A) The bicarbonate-carbonic acid buffer system -
- 29.
30. The nursing instructor is discussing metabolic acidosis with her senior nursing students. What would she tell her students about the role of the kidneys in metabolic acidosis?
- A.
A) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.
- B.
B) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.
- C.
C) The kidneys react rapidly to compensate for imbalances in the body.
- D.
D) The kidneys regulate the bicarbonate level in the ICF.
Correct Answer
B. B) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.Explanation
The nursing instructor would tell her students that in metabolic acidosis, the role of the kidneys is to excrete hydrogen ions and conserve bicarbonate ions in order to restore balance. This helps to decrease the acidity in the body and maintain a proper pH level. The kidneys play a crucial role in regulating the acid-base balance in the body by adjusting the excretion and conservation of ions.Rate this question:
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- 30.
31. The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequate ventilation. What diagnosis could the patient have that could cause inadequate ventilation?
- A.
A) Insomnia
- B.
B) Multiple myloma
- C.
C) Guillain-Barré syndrome
- D.
D) Overdose of amphetamines
Correct Answer
C. C) Guillain-Barré syndromeExplanation
Guillain-Barré syndrome is a neurological disorder that can cause muscle weakness and paralysis. In severe cases, it can affect the muscles involved in breathing, leading to inadequate ventilation and respiratory acidosis. Insomnia, multiple myeloma, and overdose of amphetamines do not directly affect ventilation and are unlikely to cause respiratory acidosis.Rate this question:
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- 31.
32. You are an ICU nurse caring for a trauma patient. The patient is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3- 23 mEq/L. What would you know is happening with this patient?
- A.
A) Respiratory acidosis
- B.
B) Metabolic alkalosis
- C.
C) Respiratory alkalosis
- D.
D) Mixed acid-base disorder
Correct Answer
D. D) Mixed acid-base disorderExplanation
Based on the ABG results, the patient has a low pH (acidosis) and an elevated PaCO2 (respiratory acidosis). However, the HCO3- level is within the normal range, indicating that there is no compensation occurring. This combination of respiratory acidosis without metabolic compensation suggests a mixed acid-base disorder.Rate this question:
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- 32.
33. Isotonic IV fluids are fluids with a total osmolality close to that of the ECF. Most IV fluids contain either dextrose or electrolytes in water. When would you infuse electrolyte-free water intravenously?
- A.
A) Never, it rapidly enters red blood cells, causing them to rupture.
- B.
B) When the patient is severely dehydrated
- C.
C) When the patient is in an excess of an electrolyte, i.e. hypercalcemia
- D.
D) When the patient is in a deficit of an electrolyte, i.e. hypocalcemia
Correct Answer
A. A) Never, it rapidly enters red blood cells, causing them to rupture.Explanation
Electrolyte-free water should never be infused intravenously because it rapidly enters red blood cells and causes them to rupture. This can lead to severe complications and is therefore not recommended. It is important to infuse fluids that have a total osmolality close to that of the extracellular fluid (ECF) to maintain the balance of electrolytes and prevent any harm to the red blood cells.Rate this question:
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- 33.
34. Dehydration in the elderly is a problem that is all too common. What causes dehydration in the elderly? (Mark all that apply.)
- A.
A) Decreased kidney mass
- B.
B) Increased conservation of sodium
- C.
C) Increased total body water
- D.
D) Decreased renal blood flow
- E.
E) Decreased excretion of potassium
Correct Answer(s)
A. A) Decreased kidney mass
D. D) Decreased renal blood flow
E. E) Decreased excretion of potassiumExplanation
Dehydration in the elderly can be caused by several factors. One of the causes is decreased kidney mass, which can affect the ability of the kidneys to filter and regulate water levels in the body. Another cause is decreased renal blood flow, which can reduce the amount of blood reaching the kidneys and impair their function. Additionally, decreased excretion of potassium can lead to imbalances in electrolyte levels and contribute to dehydration. Increased conservation of sodium and increased total body water are not causes of dehydration in the elderly.Rate this question:
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- 34.
35. You are called to your patient's room by a family member who voices concern about the patient's status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance would you suspect?
- A.
A) Hypercalcemia
- B.
B) Hyponatremia
- C.
C) Hyperchloremia
- D.
D) Hypophosphatemia
Correct Answer
C. C) HyperchloremiaExplanation
Based on the symptoms described, including tachypnea, lethargy, weakness, diminished cognitive ability, and pitting edema, the most likely electrolyte imbalance is hyperchloremia. Hyperchloremia refers to an excess of chloride ions in the blood, which can be caused by conditions such as dehydration, kidney dysfunction, or certain medications. It can lead to symptoms such as respiratory distress, altered mental status, and fluid retention, which are consistent with the patient's presentation. Hypercalcemia, hyponatremia, and hypophosphatemia do not typically cause these specific symptoms.Rate this question:
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- 35.
36. Metabolic acidosis can be divided clinically into two forms: normal anion gap acidosis and high anion gap acidosis. What causes normal anion gap acidosis?
- A.
A) Constipation
- B.
B) Small bowel fistulas
- C.
C) Late renal insufficiency
- D.
D) Excessive administration of chloride
Correct Answer
D. D) Excessive administration of chlorideExplanation
Excessive administration of chloride can cause normal anion gap acidosis. Normal anion gap acidosis occurs when there is an increase in the concentration of chloride ions in the blood, leading to a decrease in the concentration of bicarbonate ions. This can happen due to excessive administration of chloride-containing fluids or medications, such as saline solutions. The increased chloride ions can disrupt the acid-base balance in the body, resulting in metabolic acidosis. This is different from high anion gap acidosis, which is caused by an increase in other acid-forming substances in the blood.Rate this question:
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- 36.
37. The nurse is caring for a patient in metabolic alkalosis. The patient has a nasogastric tube to low intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the medication orders?
- A.
A) Cimetidine
- B.
B) Maalox
- C.
C) KCl
- D.
D) Fursosemide
Correct Answer
A. A) CimetidineExplanation
In metabolic alkalosis, there is an excess of bicarbonate in the body, leading to an increase in pH. Cimetidine is a histamine-2 receptor antagonist that can help decrease gastric acid secretion. This can be beneficial in this case because it can help reduce the alkalosis by decreasing the production of bicarbonate. Therefore, the nurse would expect to find cimetidine on the medication orders for this patient.Rate this question:
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- 37.
38. You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a poor historian. The patient appears malnourished and TPN has been started. Why would you know to start the TPN slowly?
- A.
A) Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
- B.
B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.
- C.
C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
- D.
D) Patients receiving TPN are at risk for hypochloremia if fluids are introduced too rapidly.
Correct Answer
B. B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.Explanation
Malnourished patients who receive parenteral nutrition (TPN) are at risk for hypophosphatemia if calories are started too aggressively. TPN provides essential nutrients, including phosphorus, to patients who are unable to consume food orally. Rapid introduction of calories can lead to a shift of phosphorus into the cells, causing a decrease in serum phosphorus levels. This can result in symptoms such as weakness, muscle pain, and respiratory distress. Therefore, it is important to start TPN slowly to prevent this electrolyte imbalance.Rate this question:
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- 38.
39. You are doing discharge teaching with a patient who is going home with a diagnosis of hypophosphatemia. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? (Mark all that apply.)
- A.
A) Milk
- B.
B) Beef
- C.
C) Poultry
- D.
D) Green vegetables
- E.
E) Liver
Correct Answer(s)
A. A) Milk
C. C) Poultry
E. E) LiverExplanation
Hypophosphatemia is a condition characterized by low levels of phosphate in the blood. To increase phosphate levels, the patient should include foods that are high in phosphate in their diet. Milk is a good source of phosphate and should be included. Poultry and liver are also high in phosphate and should be included in the diet. Beef and green vegetables are not as high in phosphate and therefore would not be as beneficial in increasing phosphate levels.Rate this question:
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- 39.
40. You are caring for a patient with a secondary diagnosis of hypermagnesemia. What would you assess this patient for?
- A.
A) Hypertension
- B.
B) Kussmaul respirations
- C.
C) Increased DTRs
- D.
D) Shallow respirations
Correct Answer
D. D) Shallow respirationsExplanation
Patients with hypermagnesemia, an excessive amount of magnesium in the blood, may experience shallow respirations. Magnesium is a muscle relaxant and can depress the central nervous system, leading to respiratory depression. This can result in shallow breathing or even respiratory arrest. Therefore, it is important to assess patients with hypermagnesemia for shallow respirations to ensure their respiratory status is stable.Rate this question:
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- 40.
41. A patient's lab results show a slight decrease in potassium. The physician has declined to treat with drug therapy but has suggested increasing potassium through diet. Which of the following would be a good source of potassium?
- A.
A) Apples
- B.
B) Asparagus
- C.
C) Carrots
- D.
D) Bananas
Correct Answer
D. D) BananasExplanation
Bananas would be a good source of potassium because they are known to be high in this mineral. Potassium is an essential nutrient that plays a crucial role in maintaining proper heart and muscle function, as well as regulating blood pressure. Increasing potassium intake through diet is a common recommendation for individuals with a slight decrease in potassium levels, as it can help restore the balance. Apples, asparagus, and carrots are not particularly high in potassium compared to bananas.Rate this question:
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- 41.
42. The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance does a positive Chvostek's sign indicate?
- A.
A) Hypermagnesemia
- B.
B) Hypercalcemia
- C.
C) Hypocalcemia
- D.
D) Hyperkalemia
Correct Answer
C. C) HypocalcemiaExplanation
A positive Chvostek's sign indicates hypocalcemia. Chvostek's sign is a clinical sign characterized by the twitching of the facial muscles in response to tapping over the facial nerve. It is a result of increased neuromuscular excitability due to low levels of calcium in the blood. Hypocalcemia can lead to muscle spasms, tetany, and other neuromuscular symptoms.Rate this question:
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Mar 08, 2012Quiz Created by
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