Fluids & Electrolytes Exam

St. Michael’s College NCM 102 Name:______________________ Name:___________________________________ __________________________ _________________________  ____________   Test I: Select the best answer from the choices given.

1. In a client with with a urine specif specific ic gravity gravity of 1.040, 1.040, a subnormal subnormal serum osmolality, and a serum sodium level of 128 mEq/L, the least beneficial beneficial type of I.V. fluid would be: a. Dextrose Dextrose 5% 5% in half-norma half-normall saline saline solution solution b. Normal Normal saline saline soluti solution on c. Dext Dextro rose se 5% 5% in in wate waterr (D5W) d. Lactat Lactated ed Ring Ringer’ er’s s solut solution ion

2. Before Before administerin administering g packed red blood blood cells, cells, the nurse must flush flush the client’s client’s I.V. line. Which solution should the nurse use to flush the line? a. Norm Normal al sali saline ne solut solutio ion n b. Lactat Lactated ed Ring Ringer’ er’s s solut solution ion c. Dext Dextro rose se 5% in wate waterr d. Dextro Dextrose se 5% in normal normal salin saline e solutio solution n

3. A child with with type 1 diabetes diabetes develops develops diabetic diabetic ketoaci ketoacidosis dosis and receives receives a continuous insulin infusion. Which condition represents the greatest risk to this child? a. Hype Hyperc rcal alce cemi mia a b. Hype Hyperp rpho hosp spha hate temi mia a c. Hyp Hypok oka alem lemia d. Hype Hypern rnat atre remi mia a

4. A client with with fluid volume volume deficit deficit is receiving receiving an I.V. infusion infusion of dextrose dextrose 5% in water and lactated Ringer’s solution at 125 mL/hour. Which assessment finding indicates the need for additional I.V. fluids?

a. Serum sodium level of 135 mEq/L b. Temperature of 99.6° F (37.6° C) c. Neck vein distention d. Dark amber urine

5. When assessing a client’s I.V. insertion site, the nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven’t infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first? a. Discontinue the I.V. infusion at that site and restart it in the other arm. b. Irrigate the I.V. tubing with 1 mL of normal saline solution. c. Check the tubing for kinks and reposition the client’s wrist and elbow. d. Elevate the I.V. fluid bag.

6. A client is receiving furosemide (Lasix) 40 mg by mouth twice a day. In the plan of care, the nurse should emphasize teaching the client about the importance of consuming: a. Fresh, green vegetables b. Bananas and oranges c. Low-fat milk d. Creamed corn

7. The physician prescribes a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance? a. Hypervolemia b. Hypokalemia c. Hyperkalemia d. Hypernatremia

8. Which of the following type of solutions, when administered I.V., would cause a shift of fluid from body tissues to the bloodstream? a. Hypotonic b. Isotonic c. Sodium chloride d. Hypertonic

9. Which type of solution raises serum osmolarity and pulls fluid from the intracellular and interstitial compartments into the intravascular compartment? a. Isotonic b. Hypertonic c. Electrotonic d. Hypotonic

10.While preparing to start a stat I.V. infusion, the nurse notices that the ground on the infusion pump’s plug is broken. What should the nurse do first? a. Use the pump as is because the physician has ordered the medication stat. b. Obtain another pump from central supply to use for the infusion. c. Tape the broken ground to the plug and use the pump. d. Report the problem to the supervisor.

11.While performing rounds, a nurse finds that a client is receiving the wrong I.V. solution. The nurse’s initial response should be to: a. Remove the I.V. catheter and call the physician. b. Write up an incident report describing the mistake. c. Slow the I.V. rate and hang the appropriate solution. d. Wait until the next bottle is due and then change to the proper solution.

12.The nurse is caring for a client with Congestive Heart Failure. On assessment, the nurse finds the client complaining of dyspnea and that rales are heard on auscultation. The nurse suspects fluid volume excess. Which additional would the nurse expect if fluid volume excess is present? a. Flat neck and hand veins b. Weight loss c. Increased central venous pressure d. Hypotension

13.A client with Congestive Heart Failure is assessed by the nurse. Upon reviewing the chart, it is determined that his weight increased by 4.5 pounds.  The nurse estimates that the client has gained how many liters of fluid? a. 3 b. 1 c. 2 d. 0.5

14.A nurse reads a doctor’s progress notes in the client’s chart which states “insensible fluid loss approximately 800 mL.” The nurse understands that this fluid loss may  occur through: a. The gastrointestinal tract b. Urinary output c. Wound drainage d. The skin

15.A nurse is administering IVF as ordered to a patient who sustained seconddegree burns. In evaluating the adequacy of fluid resuscitation, the nurse understands that the most reliable indicator for fluid adequacy is the: a. Blood pressure b. Mental status c. Urine output d. Peripheral pulses

16.The nurse receives the following endorsements. She is certain that which patient is at most risk for the development of fluid volume deficit? a. The client who came from the OR after a hemorroidectomy. b. The client who has Renal Failure undergoing dialysis. c. The client with AIDS taking corticosteroids. d. The client with Rheumatic Fever taking diuretics.

17.The nurse is caring for a psychiatric patient who ingested high-sodium containing foods. She suspects hypernatremia in this patient and expect to note: a. Hyperactive deep tendon reflex b. Chovstek’s Sign c. Dry skin and sticky mucous membrane d. Decreased muscle tone

18.The nurse reviews the laboratory report of a patient with fluid volume deficit. Which of the following laboratory findings will support this condition? a. WBC count of 9,000 b. Creatinine of 1 mg/dl

c. Sodium of 140 mEq/L d. Hematocrit of 58%

19.The client is taking a high dose of Furosemide. To determine the progress of  the therapy, the nurse performs which of the following important action? a. Monitor urinary pH b. Check the temperature periodically c. Weigh the patient daily d. Obtain a serial serum Sodium level

20.The nurse notes that the client’s I.V. insertion site is red, swollen, and warm to the touch. Which action should the nurse take first? a. Discontinue the I.V. solution. b. Apply a warm, moist compress to the I.V. site. c. Check the I.V. infusion for patency. d. Apply and ice pack to the I.V. site.

Basic knowledge on Intravenous solutions in necessary for care of clients with problems with fluid and electrolytes.

21.A client involved in a motor vehicle crash presents to the emergency department with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates which of the following intravenous solutions will most likely be prescribed to increase intravascular volume, replace immediate blood loss and increase blood pressure?

a. 0.45% sodium chloride b. Normal saline solution c. 0.33% sodium chloride d. Lactated ringer’s solution

22.The physician orders the nurse to prepare an isotonic solution. Which of the following IV solution would the nurse expect the intern to prescribe? a. 5% dextrose in water b. 10% dextrose in water c. 0.45% sodium chloride d. 5% dextrose in 0.9% sodium chloride

23.The nurse is making initial rounds on the nursing unit to assess if the condition of assigned clients. The nurse notes that the client’s IV site is cool, pale, and swollen and the solution is not infusing. The nurse concludes that which of the following complications has been experienced by the client? a. Infection b. Phlebitis c. Infiltration d. Thrombophlebitis

24.A nurse reviews the client’s electrolyte laboratory report and notes that the potassium level is 3.2 mEq/L. Which of the following would the nurse note on the electrocardiogram as a result of the laboratory value? a. U waves

b. Absent P waves c. Elevated T waves d. Elevated ST segment

25.One patient had a runaway IV of 50% dextrose. To prevent temporary excess of insulin or transient hyperinsulin reaction, what solution you prepare in anticipation of the doctor’s order? a. Any I.V. solution available to KVO b. Isotonic solution c. Hypertonic solution d. Hypotonic solution

26.An informed consent is required for a. Closed reduction of a fracture b. Insertion of intravenous catheter c. Irrigation of the external ear canal d. Urethral catheterization

27.Which of the following is not true with regards to the informed consent? a. It should describe different treatment alternatives b. It should contain a thorough and detailed explanation of the procedure to be done c. It should describe the client’s diagnosis d. It should give an explanation of the client’s prognosis

28.You know that the hallmark of nursing accountability is the a. Accurate documentation and reporting b. Admitting your mistakes c. Filling an incidence report d. Reporting a medication error

29.A nurse is assigned to care for a group of clients. On review of the client’s medical records, the nurse determined that which client is at risk for excess fluid volume? a. The client taking diuretics b. The client with renal failure c. The client with an ileostomy d. The client who requires gastrointestinal suctioning

30.A nurse is assigned to care for a group of clients. On review of the client’s medical records, the nurse determines that which client is at risk for deficient fluid volume? a. A client with colostomy b. A client with congestive heart failure c. A client with decreased kidney function d. A client receiving frequent wound irrigation

31.Which of the following nursing interventions is correct for clients receiving I.V. therapy? a. Change the tubing every 8 hours. b. Monitor the flow rate at least every hour. c. Change the I.V. catheter and entry site daily.

d. Increase the rate to catch up if the correct amount hasn't been infused at the end of the shift.

Carina, 17 years old, is admitted to the hospital with a diagnosis of acute renal failure

32.Kayexalate was prescribed by the doctor for the patient. The nurse understands that in Carina’s condition, this medication is given to treat: a. Cardiac complication b. Uremia c. Edema d. Hyperkalemia

33.The doctor ordered for a 24 hour urine specimen. Which action of the nurse is correct? a. Monitor and record the patient’s intake and output for the next 24 hours b. In the next 24 hours, bring the fresh voided urine of the patient after every urination to the laboratory for examination. c. Provide the patient with water only to drink in the next 24 hours. d. Begin 24 hour collection period after the patient’s latest voiding.

34.When the doctor orders for sterile urine specimen, which would be an appropriate action of the nurse: a. The nurse should catheterize the patient. b. The nurse should collect the midstream urine. c.

The nurse performs perineal hygiene then collects the midstream urine.

d. The nurse should remind the doctor that a sterile specimen cannot be collected because normal flora is always present in the genital tract.

35.Which of the following is the most important action in assessing fluid status of Carina? a. Monitor urine specific gravity b. Measure fluid intake and output c. Weigh daily d. Record frequency of bowel movements

Marina, age 20, is admitted to the hospital with hyperglycemia, anxiety, hypokalemia, and muscle wasting. The physician’s diagnosis is Cushing’s syndrome.

36.The excessive production of adrenal hormones will result in: a. Hyperkalemia b. Falling hair c. Elevated blood sugar d. Increased urine output

37.Laboratory blood test results revealed that the patient developed acute hyperclacemia. The nurse should: a. Institute bedrest b. Administer calcium supplements c. Encourage fluid intake to >2000 mL/day d. Assess for signs of arthritis

Ms. Carla Ponte is admitted to the hospital with a diagnosis of Syndrome of  Inappropriate secretion of Antiduiretic Hormone (SIADH).

38.What finding in the patient’s history could have probably contributed to the development of SIADH? a. Overmedication with iron and folic acid supplements b. Patient just sustained a head injury c. Patient has diabetes mellitus d. History of TB

39.Compared to diabetes insipidus, a patient with SIADH will manifest? a. Hyponatremia b. Polyuria c. Polydipsia d. Specific gravity of urine is 1.001-1.005

40. After the lungs, the kidneys work to maintain body pH. The best explanation of how kidneys accomplish regulation of pH is that they a. Secrete hydrogen ions and sodium b. Secrete ammonia c. Exchange hydrogen and sodium in the kidney tubules d. Decrease sodium ions, hold on to hydrogen ions, and then secrete sodium bicarbonate

41.Of the following blood gas values, the one the nurse would expect to see in the client with acute renal failure is a. pH 7.49, HCO 3 24, PaCO2 46 b. pH 7.49, HCO 3 14, PaCO2 30 c. pH 7.26, HCO 3 24, PaCO2 46 d. pH 7.26, HCO 3 14, PaCO2 30

 Test II: Complete the following table

Acid-Base Imbalances 42.

pH Level

HCO3/PaCO2 Levels

Commonly Seen

>26 mEq/L

Nasogastric Suction/Vomiting

43. Respiratory Acidosis

44.

45.

Respiratory Alkalosis

46.

47.

49.