Fluids and Electrolytes Formative Assessment 1 PDF
Fluids and Electrolytes Formative Assessment 1 PDF
Fluids and Electrolytes Formative Assessment 1 PDF
1. You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic
hormone secretion (SIADH). Your patient's plan of care includes assessment of specific
gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of
the patient's health?
A) Nutritional status
B) Potassium balance
C) Calcium balance
D) Fluid volume status
ANS: D
2. You are caring for a patient admitted with a diagnosis of acute kidney injury. When you
review your patient's most recent laboratory reports, you note that the patient's magnesium
levels are high. You should prioritize assessment for which of the following health
problems?
A) Diminished deep tendon reflexes
B) Tachycardia
C) Cool, clammy skin
D) Acute flank pain
ANS: A
3. You are working on a burns unit and one of your acutely ill patients is exhibiting signs and
symptoms of third spacing. Based on this change in status, you should expect the patient to
exhibit signs and symptoms of what imbalance?
A) Metabolic alkalosis
B) Hypermagnesemia
C) Hypercalcemia
D) Hypovolemia
ANS: D
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) Respiratory acidosis with no compensation
B) Metabolic alkalosis with a compensatory alkalosis
C) Metabolic acidosis with no compensation
D) Metabolic acidosis with a compensatory respiratory alkalosis
ANS: D
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 should you document this
complication related to IV therapy?
A) Air emboli
B) Phlebitis
C) Infiltration
D) Fluid overload
ANS: C
7. You are performing an admission assessment on an older adult patient newly admitted for
end-stage liver disease. What principle should guide your assessment of the patient's skin
turgor?
A) Overhydration is common among healthy older adults.
B) Dehydration causes the skin to appear spongy.
C) Inelastic skin turgor is a normal part of aging.
D) Skin turgor cannot be assessed in patients over 70.
ANS: C
8. The physician has ordered a peripheral IV to be inserted before the patient goes for
computed tomography. What should the nurse do when selecting a site on the hand or arm
for insertion of an IV catheter?
A) Choose a hairless site if available.
B) Consider potential effects on the patient's mobility when selecting a site.
C) Have the patient briefly hold his arm over his head before insertion.
D) Leave the tourniquet on for at least 3 minutes.
ANS: B
9. A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with
increased intracranial 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. This process is best described as which of the following?
A) Hydrostatic pressure
B) Osmosis and osmolality
C) Diffusion
D) Active transport
ANS: B
10. You are the surgical nurse caring for a 65-year-old female patient who is postoperative day
1 following a thyroidectomy. During your shift assessment, the patient complains of tingling
in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand
and she exhibits increased muscle tone. What electrolyte imbalance should you first
suspect?
A) Hypophosphatemia
B) Hypocalcemia
C) Hypermagnesemia
D) Hyperkalemia
ANS: B
11. A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse
states, “A patient in renal failure partially loses the ability to regulate changes in pH.” What
is the cause of this partial inability?
A) The kidneys regulate and reabsorb carbonic acid to change and maintain pH.
B) The kidneys buffer acids through electrolyte changes.
C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.
D) The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
ANS: C
12. You are caring for a 65-year-old male patient admitted to your medical unit 72 hours ago
with pyloric stenosis. A nasogastric tube placed upon admission has been on low
intermittent suction ever since. Upon review of the morning's blood work, you notice that
the patient's potassium is below reference range. You should recognize that the patient may
be at risk for what imbalance?
A) Hypercalcemia
B) Metabolic acidosis
C) Metabolic alkalosis
D) Respiratory acidosis
ANS: C
13. The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids
and IV antibiotics. How should the nurse always start the process of insertion?
A) Leave one hand ungloved to assess the site.
B) Cleanse the skin with normal saline.
C) Ask the patient about allergies to latex or iodine.
D) Remove excessive hair from the selected site.
ANS: C
14. A patient who is being treated for pneumonia starts complaining of sudden shortness 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) Respiratory acidosis
B) Metabolic alkalosis
C) Respiratory alkalosis
D) Metabolic acidosis
ANS: A
15. One day after a patient is admitted to the medical unit, you note that the patient is oliguric.
You notify the acute-care nurse practitioner who orders a fluid challenge of 200 mL of
normal saline solution over 15 minutes. This intervention will achieve which of the
following?
A) Help distinguish hyponatremia from hypernatremia
B) Help evaluate pituitary gland function
C) Help distinguish reduced renal blood flow from decreased renal function
D) Help provide an effective treatment for hypertension-induced oliguria
ANS: C
16. The community health nurse is performing a home visit to an 84-year-old woman
recovering from hip surgery. The nurse notes that the woman seems uncharacteristically
confused and has dry mucous membranes. 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) “I will need to have your medications adjusted so you will need to be readmitted to
the hospital for a complete workup.”
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.”
C) “It is normal to be a little confused following surgery, and it is safe not to urinate
at night.”
D) “If you build up too much urine in your bladder, it can cause you to get confused,
especially when your body is under stress. ”
ANS: B
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; his pupils are equal and reactive to light and accommodation. 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 low urine output?
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) The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH),
and needs vasopressin.
C) The man is experiencing symptoms of heart failure and is releasing atrial
natriuretic peptide that results in decreased urine output.
D) The man is having a sympathetic reaction, which has stimulated the
renin–angiotensin–aldosterone system that results in diminished urine output.
ANS: D
18. A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How
should these nurses be encouraged to deal with excess hair at the intended site?
A) Leave the hair intact.
B) Shave the area.
C) Clip the hair in the area.
D) Remove the hair with a depilatory.
ANS: C
19. You are the nurse evaluating a newly admitted patient's laboratory results, which include
several values that are outside of reference ranges. Which of the following would cause the
release of antidiuretic hormone (ADH)?
A) Increased serum sodium
B) Decreased serum potassium
C) Decreased hemoglobin
D) Increased platelets
ANS: A
20. A newly graduated nurse is admitting a patient with a long 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 64 mm 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) The patient's calcium will rise dramatically due to pituitary stimulation.
B) Oxygen will increase the patient's intracranial pressure and create confusion.
C) Oxygen may cause the patient to hyperventilate and become acidotic.
D) Using oxygen may result in the patient developing carbon dioxide narcosis and
hypoxemia.
ANS: D
21. The nurse is providing care for a patient with chronic obstructive pulmonary disease. When
describing the process of respiration the nurse explains how oxygen and carbon dioxide are
exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what
process?
A) Diffusion
B) Osmosis
C) Active transport
D) Filtration
ANS: A
22. When planning the care of a patient with a fluid imbalance, the nurse understands that in the
human body, water and electrolytes move from the arterial capillary bed to the interstitial
fluid. What causes this to occur?
A) Active transport of hydrogen ions across the capillary walls
B) Pressure of the blood in the renal capillaries
C) Action of the dissolved particles contained in a unit of blood
D) Hydrostatic pressure resulting from the pumping action of the heart
ANS: D
23. The baroreceptors, located in the left atrium and in 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 effect?
A) Decrease in the release of aldosterone
B) Increase of filtration in the Loop of Henle
C) Decrease in the reabsorption of sodium
D) Decrease in glomerular filtration
ANS: D
24. You are the nurse caring for a 77-year-old male patient who has been involved in a motor
vehicle accident. You and your colleague note that the patient's labs indicate minimally
elevated serum creatinine levels, which your colleague dismisses. What can this increase in
creatinine indicate in older adults?
A) Substantially reduced renal function
B) Acute kidney injury
C) Decreased cardiac output
D) Alterations in ratio of body fluids to muscle mass
ANS: A
25. You are the nurse caring for a patient who is to receive IV daunorubicin, a chemotherapeutic
agent. You start the infusion and check the insertion site as per protocol. During your most
recent check, you note that the IV has infiltrated so you stop the infusion. What is your main
concern with this infiltration?
A) Extravasation of the medication
B) Discomfort to the patient
C) Blanching at the site
D) Hypersensitivity reaction to the medication
ANS: A
26. The nurse caring for a patient post colon resection is assessing the patient on the second
postoperative day. The nasogastric tube (NG) remains patent and continues at low
intermittent wall suction. The IV is patent and infusing at 125 mL/hr. The patient reports
pain at the incision site rated at a 3 on a 0-to-10 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) and you suspect the
patient has hypokalemia. What other sign or symptom would you expect this patient to
exhibit?
A) Diarrhea
B) Dilute urine
C) Increased muscle tone
D) Joint pain
ANS: B
27. You are caring for a patient who is being treated on the oncology unit with a diagnosis of
lung cancer with bone metastases. During your assessment, you note the patient complains
of a new onset of weakness with abdominal pain. Further assessment suggests that the
patient likely has a fluid volume deficit. You should recognize that this patient may be
experiencing what electrolyte imbalance?
A) Hypernatremia
B) Hypomagnesemia
C) Hypophosphatemia
D) Hypercalcemia
ANS: D
28. A medical nurse educator is reviewing a patient's recent episode of metabolic acidosis with
members of the nursing staff. What should the educator describe about the role of the
kidneys in metabolic acidosis?
A) The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore
balance.
B) The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore
balance.
C) The kidneys react rapidly to compensate for imbalances in the body.
D) The kidneys regulate the bicarbonate level in the intracellular fluid.
ANS: B
29. 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) Endocarditis
B) Multiple myeloma
C) Guillain-Barré syndrome
D) Overdose of amphetamines
ANS: C
30. The ICU nurse is caring for a patient who experienced trauma in a workplace accident. 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. The nurse should
recognize the likelihood of what acid–base disorder?
A) Respiratory acidosis
B) Metabolic alkalosis
C) Respiratory alkalosis
D) Mixed acid–base disorder
ANS: D
31. A patient has questioned the nurse's administration of IV normal saline, asking whether
sterile water would be a more appropriate choice than “saltwater.” Under what
circumstances would the nurse administer electrolyte-free water intravenously?
A) Never, because it rapidly enters red blood cells, causing them to rupture.
B) When the patient is severely dehydrated resulting in neurologic signs and
symptoms
C) When the patient is in excess of calcium and/or magnesium ions
D) When a patient's fluid volume deficit is due to acute or chronic renal failure
ANS: A
32. A gerontologic nurse is teaching students about the high incidence and prevalence of
dehydration in older adults. What factors contribute to this phenomenon? Select all that
apply.
A) Decreased kidney mass
B) Increased conservation of sodium
C) Increased total body water
D) Decreased renal blood flow
E) Decreased excretion of potassium
ANS: A, D, E
33. 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 is the most plausible cause of this patient's signs and symptoms?
A) Hypocalcemia
B) Hyponatremia
C) Hyperchloremia
D) Hypophosphatemia
ANS: C
34. Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and
high anion gap acidosis in an acutely ill patient. What health problem typically precedes
normal anion gap acidosis?
A) Metastases
B) Excessive potassium intake
C) Water intoxication
D) Excessive administration of chloride
ANS: D
35. The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low
intermittent suction for a diagnosis of bowel obstruction. What drug would the nurse expect
to find on the medication orders?
A) Cimetidine
B) Maalox
C) Potassium chloride elixir
D) Furosemide
ANS: A
36. You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from
a homeless shelter and is a vague historian. The patient appears malnourished and on day 3
of the patient's admission total parenteral nutrition (TPN) has been started. Why would you
know to start the infusion of TPN slowly?
A) Patients receiving TPN are at risk for hypercalcemia if calories are started too
rapidly.
B) Malnourished patients receiving parenteral nutrition are at risk for
hypophosphatemia if calories are started too aggressively.
C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
D) Patients receiving TPN need a slow initiation of treatment in order to allow
digestive enzymes to accumulate
ANS: B
37. You are doing discharge teaching with a patient who has hypophosphatemia during his time
in hospital. The patient has a diet ordered that is high in phosphate. What foods would you
teach this patient to include in his diet? Select all that apply.
A) Milk
B) Beef
C) Poultry
D) Green vegetables
E) Liver
ANS: A, C, E
38. You are caring for a patient with a secondary diagnosis of hypermagnesemia. What
assessment finding would be most consistent with this diagnosis?
A) Hypertension
B) Kussmaul respirations
C) Increased DTRs
D) Shallow respirations
ANS: D
39. A patient's most recent laboratory results show a slight decrease in potassium. The physician
has opted to forego drug therapy but has suggested increasing the patient's dietary intake of
potassium. Which of the following would be a good source of potassium?
A) Apples
B) Asparagus
C) Carrots
D) Bananas
ANS: D
40. The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte
imbalance would a positive Chvostek's sign indicate?
A) Hypermagnesemia
B) Hyponatremia
C) Hypocalcemia
D) Hyperkalemia
ANS: C