Chapter 14 Fluid and Electrolytes: Balance and Disturbance

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Chapter 14  Fluid and Electrolytes: Balance and Disturbance

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

Multiple Choice

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) Nutritional deficit
B) Hyperkalemia
C) Hypercalcemia
D) Fluid volume status

Ans: D
Chapter: 14
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process Objective: 2
Page and Header: 266, Fundamental Concepts

Feedback: A specific gravity will detect if the patient has a fluid volume deficit or fluid volume excess. This will not detect hyperkalemia, hypercalcemia, or nutritional deficits.

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) Diminished deep tendon reflexes

B) Tachycardia
C) Cool, clammy skin
D) Increased serum magnesium

Ans: A
Chapter: 14
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process Objective: 5
Page and Header: 290, Magnesium Imbalances

Feedback: To gauge a patient’s magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia and cool, clammy skin are not assessments for hypermagnesemia. Option D is incorrect because you do not assess increased serum magnesium to assess high magnesium levels.

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) Hypertension B) Bradycardia C) Hypervolemia D) Hypovolemia

Ans: D
Chapter: 14
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process Objective: 4
Page and Header: 264, Fundamental Concepts

Feedback: Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Hypertension, bradycardia, and hypervolemia are not indicators of third-spacing fluid shift.

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) Respiratory acidosis
B) Respiratory alkalosis
C) Increased PaCO2
D) CNS disturbances

Ans: B
Chapter: 14
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 8
Page and Header: 297, Acute and Chronic Respiratory Alkalosis (Carbonic Acid Deficit)

Feedback: The most common cause of acute respiratory alkalosis is hyperventilation. Extreme anxiety can lead to hyperventilation. Acute respiratory acidosis occurs in emergency situations such as pulmonary edema and is exhibited by hypoventilation and decreased PaCO2. CNS disturbances are found in extreme hyponatremia and fluid overload.

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
Chapter: 14
Client Needs: D-4
Cognitive Level: Analysis Difficulty: Difficult
Integrated Process: Nursing Process

Objective: 9
Page and Header: 294, Acute and Chronic Metabolic Acidosis (Base Bicarbonate Deficit)

Feedback: A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO3 is also low, which causes alkalosis. The bicarb is low, which causes acidosis. The pH bicarb more closely corresponds with a decrease in pH, making the metabolic component the primary problem. These facts make options A, B, and C incorrect.

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