Chapter 40: Fluid, Electrolyte, & Acid-Base Balances Potter et al: Canadian Fundamentals, Exams of Health sciences

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Chapter 40: Fluid, Electrolyte, & Acid-

Base Balances Potter et al: Canadian

Fundamentals of Nursing, 6th Edition

2024-2025. Questions & Correct

Answers. Rated A+.

6. What is the most abundant cation in the blood? a. Sodium. b. Potassium. c. Chloride. d. Magnesium. - ANSa. Sodium.
7. The nurse receives the patient's most recent blood work results. Which laboratory value is of greatest concern? a. Sodium level of 145 mmol/L (145 mEq/L). b. Calcium level of 4.5 mmol/L (17.5 mg/dL). c. Potassium level of 3.5 mmol/L (3.5 mEq/L). d. Chloride level of 100 mmol/L (100 mEq/L). - ANSb. Calcium level of 4. mmol/L (17.5 mg/dL).
8. A 2-year-old child was brought into the emergency department after ingesting several morphine tablets from a bottle in his mother's purse. The nurse knows that the child is at greatest risk for which acid-base imbalance? - ANSRespiratory acidosis.

A nurse begins infusing a 250-mL bag of IV fluid at 1845 hours on Monday and programs the pump to infuse at 20 mL/hr. At what time should the infusion be completed? a. 0645 Tuesday. b. 0675 Tuesday. c. 0715 Tuesday. d. 0735 Tuesday. - ANSc. 0715 Tuesday. A nurse is assessing a patient who is receiving a blood transfusion and finds that the patient is anxiously fidgeting in bed. The patient is afebrile and dyspneic. The nurse auscultates crackles in both lung bases and sees jugular vein distension. The nurse recognizes that the patient is experiencing which transfusion complication? - ANSFluid volume overload. A nurse is caring for a patient who is in hypertensive crisis. When the nurse is flushing the patient's peripheral IV line, the patient complains of pain. Upon assessment, the nurse notices a red streak near the IV site that is warm to the touch. What is the nurse's initial action? - ANSStart a new IV line. A nurse is caring for a patient whose electrocardiogram displays changes characteristic of hypokalemia. Which assessment finding would the nurse expect? - ANSAbdominal distension. A nurse is caring for a patient with cancer who presents with anorexia, blood pressure of 100/60, elevated white blood cell count, and oral

candidiasis. The nurse knows that the purpose of starting total parenteral nutrition (TPN) is what? - ANSReplace fluid, electrolytes, and nutrients in the patient. A nurse is caring for a patient with diabetes who has a bowel obstruction and has orders to ensure that the volume of intake matches the output. In the past 4 hours, the patient received dextrose 5% with 0.9% sodium chloride through a 22-gauge catheter infusing at 150 mL/hr and has eaten 200 mL of ice chips. The patient also has a nasogastric suction tube set to low continuous suction, which yielded an output of 300 mL. The patient has voided 400 mL of urine. After reporting these values to the physician, what orders does the nurse anticipate? - ANSa. Add a potassium supplement to replace loss from output. A patient had an acute intravascular hemolytic reaction during a blood transfusion. After discontinuing the blood transfusion, what is the nurse's next action? - ANSStart normal saline at to-keep-open (TKO) rate with new tubing. A patient has the following laboratory values: sodium level, 145 mmol/L (145 mEq/L); potassium level, 4.5 mmol/L (4.5 mEq/L); calcium level, 1. mmol/L (4.5 mg/dL). What would the nurse expect to find in the assessment? - ANSTingling of the extremities and tetany. A patient informs the nurse that he has the type of diabetes that does not have to do with "blood sugar." The nurse advises the patient to make which

dietary change? - ANSDrink plenty of fluids throughout the day to stay hydrated. A patient is admitted to the hospital with a history of vomiting for 2 days and diminished oral intake. Arterial blood gas measurements on admission are as follows: pH, 7.30; arterial partial pressure of carbon dioxide (PaCO2), 36 mm Hg; arterial partial pressure of oxygen (PaO2), 92 mm Hg; bicarbonate level (HCO3-),18 mmol/L. The nurse understands that the patient's acid- base imbalance is which of the following? Metabolic acidosis. Metabolic alkalosis. Respiratory acidosis. Respiratory alkalosis. - ANSMetabolic acidosis. A pH of less than 7.35 and a normal PaCO2, along with a HCO3- level of less than 22 mmol/L and a normal PaO2, are indicative of metabolic acidosis. Metabolic acidosis can result from dehydration, including that caused by vomiting. A patient is to receive 1500 mL of 0.9% sodium chloride intravenously at a rate of 125 mL/hr. The nurse is using microdrip gravity drip tubing. What is the minute flow rate (drops per minute)? - ANS125 gtt/min. A patient presents to the emergency department with the complaint of vomiting and diarrhea for the past 48 hours. The nurse anticipates which fluid therapy initially? - ANS0.9% sodium chloride.

A patient receiving chemotherapy has gained 2 kg (5 pounds) in 2 days. Which assessment question by the nurse is most appropriate? a. "Are you having difficulty sleeping at night?" b. "How many calories a day do you consume?" c. "Do you have dry mouth or feel thirsty?" d. "How many times a day do you urinate?" - ANSd. "How many times a day do you urinate?" A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low intermittent suction for the past 3 days. The patient's respiratory rate has decreased to 12 breaths per minute. The nurse would expect the patient to have which of the following arterial blood gas values? a. pH of 7.78, PaCO2 of 40 mm Hg, HCO3- level of 30 mmol/L (30 mEq/L). b. pH of 7.52, PaCO2 of 48 mm Hg, HCO3- level of 28 mmol/L (28 mEq/L). c. pH of 7.35, PaCO2 of 35 mm Hg, HCO3- level of 26 mmol/L (26 mEq/L). d. pH of 7.25, PaCO2 of 47 mm Hg, HCO3- level of 29 mmol/L (29 mEq/L).

• ANSb. pH of 7.52, PaCO2 of 48 mm Hg, HCO3- level of 28 mmol/L ( mEq/L). Rationale In compensated metabolic alkalosis, the pH and HCO3- (metabolic) values are alkaline, and CO2 level is slightly acidic (compensatory respiratory acidosis). In this case, the pH of 7.52 is alkaline (normal, 7.35 to 7.45), partial pressure of arterial carbon dioxide (PaCO2) is acidic (normal, 35 to 45 mm Hg), and HCO3- level is elevated (normal, 22 to 26 mmol/L [22 to 26 mEq/L]). When the pH is 7.78, PaCO2 is 40 mm Hg, and HCO3- is 30 mmol/L (30 mEq/L), the condition is uncompensated metabolic alkalosis. A

pH of 7.35, a PaCO2 of 35 mm Hg, and a HCO3- level of 26 mmol/L ( mEq/L) are within normal limits. When the pH is 7.25, PaCO2 is 47 mm Hg, and HCO3- is 29 mmol/L (29 mEq/L), the condition is compensated respiratory acidosis. A patient was admitted for hypovolemia and has IV fluid running at 250 mL/hr. The patient complains of burning at the IV insertion site. Upon assessment, the nurse does not find redness, swelling, heat, or coolness. The nurse suspects which of the following? a. IV infiltration has occurred. b. The IV catheter has caused phlebitis. c. Fluid is infusing too quickly. d. Patient is allergic to the fluid. - ANSc. Fluid is infusing too quickly. A patient who has AB-positive blood is to receive a blood transfusion. The nurse understands that blood of which of the following types could be administered to this patient? - ANSO positive. A positive. B positive. AB positive. A patient who has AB-positive blood is to receive a blood transfusion. The nurse understands that blood of which of the following types could be administered to this patient? (Select all that apply.) - ANSO positive. A positive. B positive. AB positive.

A patient with a history of cardiac disease is taking a potassium-wasting diuretic (furosemide) and is seen in the emergency department for complaints of weakness. The nurse expects to evaluate which laboratory values? Albumin and protein levels. Sodium and chloride levels. Potassium and blood glucose levels. Hemoglobin level and hematocrit. - ANSPotassium and blood glucose levels. Individuals taking potassium-wasting diuretics are at risk for hypokalemia. Evaluating blood glucose level when the patient reports weakness is important to ensure that low blood glucose level is not an issue. Levels of the other substances would not be affected by a potassium-wasting diuretic. A patient with a lower respiratory infection has a pH of 7.25, a PaCO2 of 55 mm Hg, and a HCO3- level of 20 mmol/L (20 mEq/L). The physician has been notified. Which is the priority nursing intervention for this patient? - ANSEncourage the patient to increase respirations. An hour ago, the nurse obtained a blood specimen from a patient and sent it to the chemistry laboratory for electrolyte measurements. The laboratory calls to say that the specimen was lysed. The nurse interprets this to mean

which of the following? - ANSThe potassium reading will be abnormally elevated. The specimen must be redrawn. An hour ago, the nurse obtained a blood specimen from a patient and sent it to the chemistry laboratory for electrolyte measurements. The laboratory calls to say that the specimen was lysed. The nurse interprets this to mean which of the following? (Select all that apply.) The specimen must be redrawn. The results signal a life-threatening situation. The potassium reading will be abnormally elevated. A laboratory error occurred with regard to the results. - ANSThe specimen must be redrawn. The potassium reading will be abnormally elevated. anaerobic metabolism - ANSThe metabolism that takes place in the absence of oxygen; the principle product is lactic acid. Approximately two thirds of the body's total water volume exists in which fluid? - ANSIntracellular Assessment data indicating IV fluid infiltration include which of the following? - ANSEdema and pain. Pallor and coolness. Assessment data indicating IV fluid infiltration include which of the following? (Select all that apply.)

Edema and pain. Pain and erythema. Pallor and coolness. Numbness and pain. Phlebitis and coolness. - ANSEdema and pain Pallor and coolness. Base Excess (BE) - ANS-2 to +2 mEq/L Clinical assessment of dehydration would be confirmed if the nurse identified which of the following? Increased blood pressure. Engorged neck vessels. Dry mucous membranes. Full bounding radial pulse. - ANSDry mucous membranes. Dry mucous membranes are a clinical sign of dehydration. Blood pressure usually decreases with dehydration. Engorged neck vessels and a bounding pulse are signs of fluid overload. Clinical assessment of dehydration would be confirmed if the nurse identified which of the following? - ANSDry mucous membranes. How does the nurse discontinue peripheral IV access? (Select all that apply.) a. Use scissors to remove the IV site dressing and tape. b. Keep the catheter parallel to the skin while removing it.

c. Apply firm pressure with sterile gauze during removal. d. Stop the infusion before removing the IV catheter. e. Wear sterile gloves and a mask. f. Apply pressure to the site for 2 to 3 minutes after removal. - ANSb. Keep the catheter parallel to the skin while removing it. d. Stop the infusion before removing the IV catheter. f. Apply pressure to the site for 2 to 3 minutes after removal. hypoventilation - ANSventilation of the lungs that does not fulfill the body's gas exchange needs In which patient would the nurse expect to see a positive Chvostek sign? a. A 7-year-old child admitted for severe burns. b. A 24-year-old adult admitted for chronic alcohol abuse. c. A 50-year-old patient admitted for an acute exacerbation of hyperparathyroidism. d. A 75-year-old patient admitted for a broken hip related to osteoporosis. - ANSb. A 24-year-old adult admitted for chronic alcohol abuse. Normal calcium levels range from - ANS2.25 to 2.75 mmol/L (8.5 mg/dL to 10.5 mg/dL); normal chloride levels range from - ANS97 to 107 mmol/L (98 to 106 mEq/L) normal potassium levels range from - ANS3.5 to 5.0 mmol/L (3.5 to 5. mEq/L)

normal sodium levels range from - ANS135 to 145 mmol/L (135 to 145 mEq/L) Pa02 range - ANS80- PaCO2 normal range - ANS35-45 mm Hg Sp02 Normal range - ANS95 - The following blood gas results return for a patient recently admitted to the respiratory care unit: pH, 7.30; PaCO2, 52 mm Hg; PaO2, 75 mm Hg; HCO3- level, 27 mmol/L. The nurse interprets these results to indicate which of the following? Metabolic acidosis. Metabolic alkalosis. Respiratory acidosis. Respiratory alkalosis. - ANSRespiratory acidosis. PaCO2 is elevated and, as CO2 is an acid when mixed with water, this contributes to the lowering of the pH (to a more acidic state). Metabolic acidosis would be indicated if the HCO3- level was low. In this example, it is slightly elevated, which suggests that the body is retaining bicarbonate in an attempt to return the pH to within normal limits (7.35 to 7.45). Metabolic alkalosis could be a consideration because the HCO3- level is slightly elevated. However, because the pH is in the low range, a condition of acidosis exists. Thus an elevated HCO3- level (alkalosis) is not consistent

with the pH (acidosis). In respiratory alkalosis, the PaCO2 would be low. In this case, it is high. The following blood gas results return for a patient recently admitted to the respiratory care unit: pH, 7.30; PaCO2, 52 mm Hg; PaO2, 75 mm Hg; HCO3- level, 27 mmol/L. The nurse interprets these results to indicate which of the following? - ANSRespiratory acidosis. Correct The following four patients are all at risk for fluid volume excess. Which of the patients should the nurse see first? An 88-year-old patient with a fractured femur who is scheduled for surgery. A 20-year-old patient with a five-year history of type 1 diabetes mellitus. A 65-year-old patient with a recent diagnosis of heart failure. A 40-year-old patient with second-degree burns on the hands and forearms. - ANSA 65-year-old patient with a recent diagnosis of heart failure. The 65-year-old patient with heart failure is at the greatest risk for problems from fluid volume excess. Fluid overload in this patient could quickly cause life-threatening problems. The 40-year-old patient with second-degree burns is at risk for fluid volume deficit. The following four patients are all at risk for fluid volume excess. Which of the patients should the nurse see first? - ANSA 65-year-old patient with a recent diagnosis of heart failure.

The nurse anticipates that the physician will order which intravenous (IV) fluid for a patient who is dehydrated? - ANS0.45% Sodium chloride. Because a 0.45% sodium chloride solution is hypotonic, water will move from the vein into the cells to help hydrate them. A 3% sodium chloride solution is hypertonic and thus would cause water to move out of the cells into the cardiovascular space, which would dehydrate the cells even more. Both a 0.9% sodium chloride solution and lactated Ringer's solution are isotonic. They increase body fluid volume without causing a shift of water from one compartment to another. The nurse assesses the four following patients. Which patient is at greatest risk for the development of hypocalcemia? A 56-year-old patient with acute renal failure. A 40-year-old patient with systemic lupus erythematosus. A 28-year-old patient who has just undergone a total thyroidectomy. A 65-year-old patient with hypertension taking beta-adrenergic blockers. - ANSA 56-year-old patient with acute renal failure. The patient with acute renal failure is at the highest risk for hypocalcemia. The patient who underwent a thyroidectomy is also at risk for hypocalcemia, but the risk is lower. The nurse assesses the four following patients. Which patient is at greatest risk for the development of hypocalcemia? - ANSA 56-year-old patient with acute renal failure.

The nurse is assessing a patient and finds crackles in the lung bases and neck vein distension. The nurse gives the patient a diuretic. What electrolyte imbalance is the nurse most concerned about? a. Potassium imbalance. b. Sodium imbalance. c. Calcium imbalance. d. Phosphate imbalance. - ANSa. Potassium imbalance. The nurse is assisting a physician in obtaining a sample for blood gas analysis from a patient's left wrist. After drawing the sample into the syringe, what should the nurse do? - ANSSeal the end of the syringe, and place it in a cup of crushed ice water. The nurse is assisting a physician in obtaining a sample for blood gas analysis from a patient's left wrist. After drawing the sample into the syringe, what should the nurse do? - ANSSeal the end of the syringe, and place it in a cup of crushed ice water. Sealing the end of the syringe prevents atmospheric air from diffusing into the specimen. Placing the specimen in a cup of crushed ice water slows the metabolism of cells, which continues outside the body and could affect the results. The syringe already contains heparin (liquid or dehydrated). Blood gases are not affected by light. Samples for blood gas analysis must be transported immediately to the laboratory, or the results will not be accurate.

The nurse is caring for a patient who has diabetes and is in renal failure. Which laboratory findings would the nurse expect? a. pH of 7.3, PaCO2 of 36 mm Hg, HCO3- level of 19 mEq/L (19 mmol/L). b. pH of 7.5, PaCO2 of 35 mm Hg, HCO3- level of 35 mEq/L (35 mmol/L). c. pH of 7.3, PaCO2 of 47 mm Hg, HCO3- level of 23 mEq/L (23 mmol/L). d. pH of 7.35, PaCO2 of 40 mm Hg, HCO3- level of 25 mEq/L (25 mmol/L).

• ANSpH of 7.3, PaCO2 of 36 mm Hg, HCO3- level of 19 mEq/L ( mmol/L). The nurse is caring for a patient with hyperkalemia. Which body system would be most important for the nurse plan to monitor closely? - ANSCardiac. The nurse is caring for a patient with sepsis. The plan of care for the patient is to administer antibiotics three times a day for 4 weeks. What device will be used to administer these antibiotics? - ANSA peripherally inserted central catheter (PICC) line. The nurse is conducting an assessment of a patient receiving IV fluids via a central line. Today is March 9. The tubing is dated March 5. The nurse determines which of the following about the tubing? - ANSIt requires changing because it is beyond the 3-day recommended limit. The U.S. Centers for Disease Control and Prevention recommend that IV tubing be replaced no more frequently than every 72 hours. The Intravenous Nurses Society recommends changing the tubing every 72 hours or more frequently if catheter infections and phlebitis rates exceed

5%. A period of 7 days is too long for IV tubing to be used. Transparent IV dressings may be left in place for 7 days but not the tubing. The IV line does not require changing, only the tubing. Peripheral IV sites are rotated every 3 days, but this is not necessary for central lines. Leaving the IV tubing attached for an unspecified length of time increases the risk of catheter-related infections and phlebitis. The nurse is conducting an assessment of a peripheral IV site on the hand. The infusion rate is running at 150 mL per hour as ordered. Which of the following is considered a normal finding? - ANSThe temperature of the hand above the insertion site is slightly cool to touch. The IV rate of 150 mL per hour could cause the hand to become slightly cool. Swelling of the site indicates that the IV has become interstitial. Redness at the insertion site may indicate phlebitis. Blood backing up into the tubing indicates that the IV is not running properly. The nurse knows that an imbalance of which ion causes acid-base impairment? - ANSHydrogen. The nurse knows that edema in a patient who has venous congestion from right-sided heart failure is facilitated by an imbalance with regard to which pressure? - ANSHydrostatic. The nurse knows that IV fluid therapy has been effective for a patient with hypernatremia when what happens? - ANSSerum sodium concentration returns to normal.

The nurse selects appropriate tubing for a blood transfusion by ensuring that the tubing has which of the following? a. Two-way valves to allow the patient's blood to mix and warm the incoming transfused blood. b. An injection port to mix additional electrolytes into the blood. c. An air vent to let bubbles in the blood escape. d. A filter to ensure that clots do not enter the patient. - ANSd. A filter to ensure that clots do not enter the patient. The nurse understands that administering a hypertonic solution to a patient will shift water from which space to which space? - ANSIntracellular to extracellular The nurse would expect a patient with increased levels of serum calcium to also have which abnormal values? - ANSDecreased phosphate levels. The nurse would expect a patient with respiratory acidosis to have an excessive amount of which of the following? - ANSCarbon dioxide The nurse would select the dorsal venous plexus of the foot as an IV site for which patient? a. A 2-year-old child. b. A 22-year-old adult. c. A 50-year-old patient. d. An 80-year-old patient. - ANSA 2-year-old child.

The physician asks the nurse to monitor the fluid volume statuses of a patient with heart failure and a patient at risk for clinical dehydration. What is the most effective nursing intervention for monitoring both of these patients? - ANSWeigh the patients every morning before breakfast. The physician has ordered that a patient with hypertension begin receiving a thiazide diuretic. The nurse will now closely monitor the patient for which of the following? - ANSHypokalemia. Thiazide diuretics cause the loss of water and potassium through the kidneys. Thus if the patient is not consuming sufficient potassium in the diet, a hypokalemic state could occur. Hypokalemia can cause muscle weakness and dysrhythmias. Hyponatremia is not usually a problem because of the abundance of sodium in the body, and the additional regulation of sodium by aldosterone would compensate for sodium loss due to diuretics. The calcium level would be unaffected by thiazide diuretics. If magnesium were to be affected by thiazide diuretics, it would be excreted along with potassium, but the imbalance would be hypomagnesemia, not hypermagnesemia. The unit secretary has just returned from the blood bank, where she obtained a unit of packed red blood cells that was ordered for a patient. The nurse enters the room with a colleague to check the blood at the bedside. When evaluating the IV site, the nurse notes that the size of the needle in the IV line is 22 gauge. What actions should the nurse take at this time? (Select all that apply.)

Return the blood to the blood bank. Hang the blood on the IV apparatus as soon as possible. Continue with the blood check at the bedside. Place the blood in the medication refrigerator. Start another IV line with a 20-gauge needle or larger. - ANSReturn the blood to the blood bank. Start another IV line with a 20-gauge needle or larger. Correct The unit secretary has just returned from the blood bank, where she obtained a unit of packed red blood cells that was ordered for a patient. The nurse enters the room with a colleague to check the blood at the bedside. When evaluating the IV site, the nurse notes that the size of the needle in the IV line is 22 gauge. What actions should the nurse take at this time? (Select all that apply.) Return the blood to the blood bank. Hang the blood on the IV apparatus as soon as possible. Continue with the blood check at the bedside. Place the blood in the medication refrigerator. Start another IV line with a 20-gauge needle or larger. - ANSReturn the blood to the blood bank. Start another IV line with a 20-gauge needle or larger. What is the process of passively moving water from an area of lower particle concentration to an area of higher particle concentration? - ANSOsmosis

When selecting a site to insert an IV catheter on an adult, the nurse should follow which procedure? (Select all that apply.) a. Start proximally and move distally on the arm. b. Choose a vein with minimal curvature. c. Choose the patient's dominant arm. d. Check for contraindications to using the extremity. e. Select a vein that is rigid. f. Avoid areas of flexion. - ANSb. Choose a vein with minimal curvature. d. Check for contraindications to using the extremity. f. Avoid areas of flexion. Which assessment finding should cause a nurse to question administering a sodium-containing isotonic IV fluid? a. Blood pressure of 102/58. b. Dry mucous membranes. c. Poor skin turgor. d. Pitting edema. - ANSd. Pitting edema. Which fluid order should the nurse question for a patient with a traumatic brain injury? - ANS0.45% sodium chloride. Which laboratory value should the nurse examine when evaluating a patient with uncompensated respiratory alkalosis? a. Partial pressure of arterial oxygen (PaO2). b. Anion gap. c. PaCO2. d. HCO3-. - ANSPaCO2.

Which of the following activities can be properly delegated to unregulated care providers? (Select all that apply.) Measuring intake and output. Preparing IV tubing for systematic change. Reporting that an IV bag is low in fluid. Discontinuing an IV infusion per the health care provider's orders. - ANSMeasuring intake and output Reporting that an IV bag is low in fluid Which of the following activities can be properly delegated to unregulated care providers? (Select all that apply.) - ANSMeasuring intake and output. Reporting that an IV bag is low in fluid. Which of the following assessments would indicate infiltration of a patient's IV line? (Select all that apply.) a. Edema of the extremity near the insertion site. b. Skin discoloured or bruised in appearance. c. Pain and warmth at the insertion site. d. Skin cool to the touch. e. Reddish streak proximal to the insertion site. f. Numbness or loss of sensation. g. Palpable venous cord. - ANSa. Edema of the extremity near the insertion site. b. Skin discoloured or bruised in appearance. d. Skin cool to the touch.

f. Numbness or loss of sensation. Which organ system is responsible for compensation of respiratory acidosis? - ANSRenal Which patient is most at risk for sensible water loss? a. A 7-year-old child with asthma. b. A 24-year-old adult with constipation. c. A 56-year-old patient with gastroenteritis. d. An 80-year-old patient with pneumonia. - ANSd. An 80-year-old patient with pneumonia.