Chapter 39 Fluid, Electrolytes, and Acid-Base Balance

Chapter 39  Fluid, Electrolytes, and Acid-Base Balance

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse will be caring for a patient who is severely malnourished. Laboratory test results show that the patient’s albumin level is critically low. What assessment finding will the nurse expect to note when meeting with the patient?
a.
The patient has generalized 3+ pitting edema.
b.
The patient is confused and disoriented.
c.
The patient’s urine is dark and very concentrated.
d.
The patient lung sounds are very diminished.

ANS: A
The patient’s low albumin level will lead to generalized pitting edema because there isn’t enough protein in the blood to keep water within the bloodstream. Lack of oncotic pressure from low serum albumin leads to edema.

DIF: Understanding REF: p. 996 | p. 1007
TOP: Assessment
MSC: NCLEX Client Needs Category: Reduction of Risk Potential: Laboratory Values
NOT: Concepts: Fluid and Electrolyte Balance

2. The nurse is reviewing the patient’s laboratory results. Which result must be communicated to the physician immediately?
a.
Serum chloride level 85 mEq/L
b.
Serum sodium level 134 mEq/L
c.
Serum potassium level 6.8 mEq/L
d.
Serum magnesium level 2.3 mEq/L

ANS: C
Normal serum potassium level is 3.5 to 5.0 mEq/L. A serum potassium level of 6.8 mEq/L is very high and puts the patient at risk for cardiac arrhythmias. The potassium level should be reported to the physician immediately.

DIF: Understanding REF: p. 1001 TOP: Implementation
MSC: NCLEX Client Needs Category: Reduction of Risk Potential: Laboratory Values
NOT: Concepts: Fluid and Electrolyte Balance

3. The nurse is caring for a patient who is at risk for fluid overload as a result of a history of congestive heart failure. Which intervention will the nurse teach the patient to perform at home to monitor fluid balance?
a.
“Check to make sure that your urine is a bright yellow color.”
b.
“Weigh yourself every morning before breakfast.”
c.
“Count your heart rate every evening before you go to bed.”
d.
“Drink plain water rather than soda, coffee, or fruit juice.”

ANS: B
Checking the weight every morning before breakfast is a sensitive indicator of the patient’s fluid volume status. Weight gain of 2 to 3 lb over 1 to 2 days generally indicates fluid retention and should be reported to the physician.

DIF: Understanding REF: p. 997 TOP: Teaching/Learning
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance: Self-Care
NOT: Concepts: Patient Education

4. The nurse is caring for a patient who is admitted to the hospital with diabetic ketoacidosis. Which assessment finding indicates an attempt made by the patient’s body to correct the pH?
a.
The patient’s respirations are very deep and rapid.
b.
The patient’s urine is dark and concentrated.
c.
The patient’s skin is pale, cool, and diaphoretic.
d.
The patient is sleepy and difficult to arouse.

ANS: A
The patient with diabetic ketoacidosis is in a state of metabolic acidosis. The body will attempt to compensate for the acidosis by blowing off extra amounts of carbon dioxide through deep, rapid respirations. Since carbon dioxide is converted to carbonic acid, removal of carbon dioxide will help shift the body’s pH to a less acidotic state.

DIF: Applying REF: p. 1004 TOP: Assessment
MSC: NCLEX Client Needs Category: Physiological Adaptation: Alterations in Body Systems
NOT: Concepts: Acid-Base Balance

5. The nurse is caring for a patient who takes furosemide (Lasix) daily to treat congestive heart failure. The nurse will watch for which electrolyte imbalance that may occur as a result of this therapy?
a.
Hypocalcemia
b.
Hypernatremia
c.
Hypokalemia
d.
Hyperphosphatemia

ANS: C
Furosemide (Lasix) is a loop diuretic that causes loss of potassium through the urine. Patients taking Lasix are at risk for hypokalemia, so the nurse should check the patient’s electrolyte values closely, particularly the serum potassium level.

DIF: Understanding REF: p. 1001 TOP: Assessment
MSC: NCLEX Client Needs Category: Pharmacological and Parenteral Therapies: Adverse Effects
NOT: Concepts: Fluid and Electrolyte Balance