Chapter 41 Fluid, Electrolyte, and AcidBase Balance
Correct Review Test 2023 (A+)
Your patient has severe hypercalcemia. What are your priority nursing
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(Select all that apply.)
A. Fall prevention interventions
B. Teaching regarding sodium restriction
C. Encouraging increased fluid intake
D. Monitoring for constipation
E. Explaining how to take daily weights - Correct Answer-C. Encouraging increased fluid
intake
D. Monitoring for constipation
Severe hypercalcemia causes lethargy, which creates a risk for falling and constipation.
Increased fluid intake is important to prevent renal calculi during hypercalcemia
A patient who is comatose is admitted to the hospital with an unknown history.
Respirations are deep and rapid. Arterial blood gas levels on admission are pH, 7.20;
PaCO2, 21 mm Hg; PaO2, 92 mm Hg; and HCO3-, 8. You interpret these laboratory
values to indicate:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis - Correct Answer-A. Metabolic acidosis
The low pH indicates acidosis. The low PaCO2 is caused by the hyperventilation, either
from primary respiratory alkalosis (not compatible with the measured pH) or as a
compensation for metabolic acidosis. The low HCO3- indicates metabolic acidosis or
compensation for respiratory alkalosis (again, not compatible with the measured pH).
Thus metabolic acidosis is the correct interpretation.
A patient with a cardiac history is taking the diuretic furosemide (Lasix) and is seen in
the emergency department for muscle weakness. Which laboratory value do you assess
first?
A. Serum albumin
B. Serum sodium
C. Hematocrit
D. Serum potassium - Correct Answer-D. Serum potassium
Potassium-wasting diuretics such as furosemide increase potassium urinary output and
can cause hypokalemia unless potassium intake also increases. Hypokalemia causes
muscle weakness
Which of these patients do you expect will need teaching regarding dietary sodium
restriction?
A. An 88-year-old with a fractured femur scheduled for surgery
B. A 65-year-old recently diagnosed with heart failure
C. A 50-year-old recently diagnosed with asthma and diabetes
D. A 20-year-old with vomiting and diarrhea from gastroenteritis - Correct Answer-B. A
65-year-old recently diagnosed with heart failure
Heart failure commonly causes extracellular fluid volume (ECV) excess because
diminished cardiac output reduces kidney perfusion and activates the renin-angiotensinaldosterone system, causing the kidneys to retain Na+ and water. Dietary sodium
restriction is important with heart failure because Na+holds water in the extracellular
fluid, making the ECV excess worse.
You teach patients to replace sweat, vomiting, or diarrhea fluid losses with which type of
fluid?
A. Tap water or bottled water
B. Fluid that has sodium (salt) in it
C. Fluid that has K+ and HCO3- in it
D. Coffee or tea, whichever they prefer - Correct Answer-B. Fluid that has sodium (salt)
in it
Body fluid losses remove sodium-containing fluid from the body and can cause
extracellular fluid volume deficit unless both the sodium and the water are replaced.
You assess four patients. Which patient is at greatest risk for the development of
hypocalcemia?
A. 56-year-old with acute kidney renal failure
B. 40-year-old with appendicitis
C. 28-year-old who has acute pancreatitis
D. 65-year-old with hypertension and asthma - Correct Answer-C. 28-year-old who has
acute pancreatitis
People who have acute pancreatitis frequently develop hypocalcemia because calcium
binds to undigested fat in their feces and is excreted. This is called steatorrhea. This
process decreases absorption of dietary calcium and also increases calcium output by
preventing resorption of calcium contained in gastrointestinal fluids
Which of the following activities can you delegate to nursing assistive personnel (NAP)?
(Select all that apply.)
A. Measuring oral intake and urine output Correct
B. Preparing intravenous (IV) tubing for routine change
C. Reporting an IV container that is low in fluid Correct
D. Changing an IV fluid container - Correct Answer-A. Measuring oral intake and urine
output
C. Reporting an IV container that is low in fluid
The registered nurse cannot delegate working with IV tubing or changing an IV infusion
to NAP
Assessment findings consistent with intravenous (IV) fluid infiltration include: (Select all
that apply.)
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