Republic of the Philippines

Batangas State University

COLLEGE OF NURSING
Gov. Pablo Borbon Campus 1, Rizal Ave., Batangas City
Tel. No.: (043) 300-2202 loc. 120
e-mail at: bsu_collegeofnursing@yahoo.com

CARE OF CLIENTS WITH PROBLEMS IN FLUIDS & ELECTROLYTES

DIRECTION: Shade the letter of the correct answer on the answer sheet provided.
STRICTLY NO ERASURES.

1. As hydrostatic pressure builds to force fluids and solutes through the capillary walls,
which force acts to prevent excessive loss of intravascular fluid volume?
a. Osmosis c. Active transport
b. Colloid osmotic pressure mechanisms
d. Diffusion

2. The nurse is infusing a hypotonic solution into her client. The nurse knows that this
type of solution will affect her client’s fluid status by:
a. Decreasing water content in the blood vessels.
b. Not changing water content in the blood vessels.
c. Increasing water content in the blood vessels.
d. Drawing water into the blood vessels.

3. If the osmolality of ICF increases, it can be expected that:

a. Colloid osmotic pressure will force water from ICF into ECF.
b. There will be no water movement between compartments.
c. Water will shift from ICF into ECF.
d. Water will shift from ECF into ICF.

4. The rate at which nephrons filter blood is referred to as:

a. Osmotic pressure. c. Glomerular filtration rate.
b. Capillary filtration rate. d. Urinary clearance time.

5. How does ANP work to decrease blood pressure and reduce intravascular blood
volume? Select all that apply.
1. Decreasing aldosterone release 4. Increasing ADH release
2. Increasing aldosterone release 5. Causing vasodilatation
3. Decreasing ADH release 6. Causing vasoconstriction
a. 2, 3, 5 c. 1, 3, 5
b. 1, 4, 6 d. 2, 4, 5

6. The nurse is caring for a client with GI hemorrhage. She can expect his kidneys to
respond to this condition by
a. Causing vasodilation c. Secreting angiotensin II
b. Secreting more renin d. Secreting less renin

7. Although electrolytes exist inside and outside of cells, measurement of electrolyte

level occurs:
a. Only inside the cells
b. Outside the cells in the blood stream
c. Outside the cells in the interstitial fluid
d. In the transcellular spaces

8. Which structure plays a major role in balancing calcium and phosphorus levels?
a. Lungs c. Hypothalamus
b. Adrenal cortex d. Parathyroid glands
9. What effect does breathing faster have on arterial pH level?
a. No effect
b. Decreases arterial pH
c. Provides long term pH regulation
d. Increases arterial pH

10. A client was just placed on mechanical ventilation for a worsening respiratory status.
Which ABG parameter indicates the effectiveness of the ventilator breaths?
a. PaCO2 c. PaO2
b. HCO3- d. SaO2

11. A priority nursing intervention for a client with hypervolemia involves

a. Establishing IV access with a large bore catheter
b. Monitoring respiratory status for signs and symptoms of pulmonary edema
c. Encouraging the client to consume sodium-free fluids
d. Drawing a blood sample for typing and cross-matching

12. Third-space fluid shifting involves the movement of fluid into the:
a. Arteries c. Abdominal cavity
b. Veins d. Intracellular space

13. Because diabetes insipidus involves the loss of large amounts of highly dilute urine,
a client with this disorder is at risk for which type of fluid imbalance?
a. Hypovolemia c. Hypervolemia
b. Water intoxication d. Dehydration

14. What’s the major risk of dehydration?

a. Excessive circulating blood volume
b. Low HCT
c. Cellular shrinkage
d. Pulmonary edema

15. Which physiologic difference places infants at greater risk for fluid imbalances than
adults?
a. Infants have diminished thirst mechanism
b. Infants have a lower percentage of total body water
c. Infants typically retain sodium
d. Infants have a greater ratio of BSA to weight

16. Positive Chvostek’s and Trousseau’s signs indicate which electrolyte imbalance?
a. Hypernatremia c. Hypercalcemia
b. Hyperkalemia d. Hypocalcemia

17. A tracheostomy tray should readily available for a client with hypocalcemia because
of the potential for:
a. Bronchodilation c. Laryngospasm
b. Vasoconstriction d. Cardiac arrhythmias

18. Signs and symptoms of acute hyperphosphatemia are usually caused by the effects
of which electrolyte imbalance?
a. Hypokalemia
b. Hypocalcemia
c. Hypomagnesemia
d. Hypochloremia

19. Which nursing intervention is most appropriate for a client with hypercalcemia?
a. Ambulate the client as soon as possible
b. Encourage compliance with fluid restrictions
c. Maintain the client on strict bed rest
 d. Encourage the consumption of green, leafy vegetables

20. The most appropriate method to administer IV potassium chloride involves:

a. Infusing it at a rate no faster than 10 mEq/hour
b. Pushing the dose over 3-5 minutes
c. Preparing the final concentration to be 100 mEq/L or less
d. Calculating the appropriate drip rate

21. When taken by a client with an electrolyte imbalance, levels of which drug should be
monitored closely?
a. Acetazolamide (Diamox) c. Digoxin (Lanoxin)
b. Morphine d. Furosemide (Lasix)

22. Kussmaul’s respirations are associated with which acid-base imbalance?

a. Respiratory acidosis c. Metabolic acidosis
b. Respiratory alkalosis d. Metabolic alkalosis

23. A client has been diagnosed with an intestinal obstruction and has an NG tube set to
low continuous suction. For which acid-base imbalance is this client at risk?
a. Respiratory acidosis c. Metabolic acidosis
b. Respiratory alkalosis d. Metabolic alkalosis

24. ABG results for the client above indicate that he has, indeed, developed the condition
in number 20. Which ABG results are consistent with this finding?
a. pH 7.35 : PaCO2 38 mmHg : HCO3 20 mEq/L
b. pH 7.49 : PaCO2 43 mmHg : HCO3 28 mEq/L
c. pH 7.30 : PaCO2 49 mmHg : HCO3 25 mEq/L
d. pH 7.48 : PaCO2 32 mmHg : HCO3 23 mEq/L

25. A nurse has just received a client’s ABG results: pH 7.31, PaCO2 52 mmHg, HCO3
28 mEq/L. which acid-base imbalance would the nurse suspect based on these
results?
a. Uncompensated respiratory acidosis
b. Compensated respiratory acidosis
c. Uncompensated metabolic acidosis
d. Compensated metabolic acidosis

26. In conditions of acidosis, which electrolyte imbalance should be expected?

a. Hypokalemia c. Hypercalcemia
b. Hyperkalemia d. Hypermagnesemia

27. Elise, age 5 years, has been vomiting for the past 4 days. She has been able to drink
small sips of water but has vomited three times the volume she has taken in. She is
admitted to the hospital with fluid and electrolyte imbalance. Which of the following
is the nurse likely to observe?
a. Urine output of 100 mL/hour
b. Skin elastic and moist
c. Complaints of thirst
d. Dilute yellow urine output

28. If a patient is low on fluid volume, what reaction by the body would be the likely
response?
a. High levels of ADH c. Low levels of renin
b. Low levels of d. High levels of ANP
aldosterone

29. A high level of extracellular Na+ will result in which of the following?
a. Low osmotic pressure
b. Low water level in extracellular fluid
c. High water retention in extracellular fluid
 d. High movement of fluid from extracellular to intracellular spaces

30. Potassium is regulated through what mechanisms?

a. ADH causes retention of potassium.
b. Renin–angiotensin causes an increased retention of potassium.
c. ANP causes an increase in potassium reabsorption.
d. Aldosterone causes potassium loss in the kidneys.

31. Mr. Ellis, age 85 years, has been experiencing diarrhea for the past 4 days. He has
been able to drink small sips of water but has had no other intake. The nurse suspects
that an acid–base imbalance may occur and monitors for signs of the most likely
imbalance. What symptom is the nurse likely to observe?
a. High blood pH c. Alkalosis
b. Low H+ levels d. Acidosis

32. If a patient has breathing problems resulting in low blood oxygen levels and
anaerobic metabolism, what state should the nurse monitor the patient for?
a. Low blood pH level c. Acidosis
b. Alkalosis d. Low hydrogen level

33. If there is a high H+ level in the blood, the body would attempt to balance it through
what mechanisms?
a. Diuresis c. Hyperventilation
b. Hypoventilation d. Urinary retention

34. Hosea, age 15 years, has had diarrhea for the past 5 days. He has been able to drink
small sips of water, but any volume taken in stimulates more diarrhea. He is admitted
to the hospital with suspected electrolyte imbalance. Which of the following is the
nurse likely to observe?
a. Magnesium levels of 2.2 mEq/L or higher
b. Elastic and moist skin
c. Potassium levels of 2.5 mEq/L or lower
d. Dilute yellow urine output

35. Which of the following statements is accurate about the patient at risk for a
potassium imbalance?
a. The patient taking diuretics is at risk for hypokalemia.
b. The patient with high magnesium levels is at risk for hypokalemia.
c. Addison’s disease places a patient at risk for hyperkalemia.
d. Aldosterone excess places a patient at risk for hyperkalemia.

36. Pete, a 5-year-old patient, is admitted to the emergency room with a history of
vomiting and diarrhea over the past 3 days. His mother is concerned because she
noticed that Pete is less awake and less active than usual and will not even watch his
favorite television program. Vital signs reveal a blood pressure of 70/20 mm Hg, a
pulse rate of 140 beats/minute, and a respiratory rate of 45 breaths/minute. The nurse
is concerned that a fluid imbalance is present. Which of the following findings would
the nurse likely observe that would support the concerns regarding fluid imbalance?
a. Urine output is 40 mL/h.
b. The patient is awake and alert.
c. The skin is loose and nonelastic.
d. The skin is cool to the touch.

37. Which of the following questions would provide the most important data to further
support the nurse’s concerns?
a. What has Pete eaten today?
b. Which television program does Pete like the most?
c. What type of activities does Pete usually participate in?
d. What has Pete had to drink over the last 3 days?
38. The nurse would anticipate what treatment initially for Pete?
a. A high-protein diet
b. Infuse 50–100 mL of fluids hourly
c. Sodium infusions over 3 days
d. Antibiotics in intravenous fluids

39. Which would be the most accurate explanation for Pete’s vital signs readings?
a. Pete is lethargic owing to the dilutional hyponatremia.
b. The elevated blood pressure is due to increased hydrostatic pressure.
c. Pete’s decreased pulse rate is due to decreased circulating blood.
d. The respiratory rate is increased to compensate for poor circulation.

40. The nurse would monitor for what signs to prevent the treatment provided to Pete
from being excessive?
a. Pete begins to watch the television in his room.
b. The nurse hears rales in Pete’s lung fields.
c. Pete’s urine output remains at 50 mL/h for 3 hours.
d. Skin turgor testing reveals a slow return to normal position.

41. A 25-year-old patient admitted after a car accident with head injury begins to have
massive urine output (500 mL/h). The nurse is concerned that the patient will soon
demonstrate a sodium imbalance. The nurse would anticipate which of the following
treatment to address the sodium imbalance the patient is at highest risk for?
a. Increase intake of foods such as bananas.
b. Infuse 30–40 mL intravenous fluids hourly.
c. Administer aldactone (spironolactone).
d. Administer sodium supplements.

42. The nurse should watch which of the following patient most closely for
hyponatremia?
a. Andy Peters, who eats canned vegetables three times each day
b. Aziz Akbar, who is a marathon runner and drinks water for hydration
c. Lola Ameriz, who has been constipated and is eating raw fruit for
fiber
d. Bob Green, who exercises daily by swimming in an indoor pool

43. Bailey McIntosh, age 34, was in a motorcycle accident. His arterial blood gases
show a pH of 7.30, and the nurse infuses four times the standard amount of sodium
bicarbonate as ordered. The nurse also infuses a normal saline drip at a rate of 200
mL/h. The nurse would watch closely for which of the following signs of a likely
sodium imbalance?
a. Slow cardiac rhythm with a narrow QRS complex on
electrocardiogram (ECG)
b. Increased respiratory rate with deep, regular breathing
c. Fluid build-up in extremities and pulmonary edema
d. Complaint of thirst and requests for large volumes of water

44. The nurse suspects that Mrs. Hong has a low sodium concentration. Which of the
following pieces of information collected in the history would place Mrs. Hong at
risk for hyponatremia?
a. A report of loose stools six to eight times per day for 4 days
b. A recent history of taking milk of magnesia for constipation
c. A past pregnancy resulting in aldosterone deficit
d. A recent episode of acute renal failure

45. Which of the following symptoms would indicate that the treatment for a patient
with hypernatremia had been effective?
a. Patient’s heart rate is 170 beats/minute, and the rhythm is regular.
b. Patient’s muscle tone and reflexes are hyporeactive.
c. Patient’s lips and mucous membranes are moist.
 d. Patient’s urinary output is 20 mL or less per hour.

46. The nurse should watch which of the following patients most closely for
hypokalemia?
a. Andy Peters, who eats three to four bananas daily
b. Aziz Akbar, who has acute renal failure
c. Lola Ameriz, who had diarrhea for 3 days
d. Bob Brown, who exercises strenuously daily

47. Which of the following symptoms indicate a complication that is likely to occur with
hypokalemia?
a. Increased bowel activity with diarrhea
b. Decreased cardiac contractility
c. Increased irritability—disorientation and confusion
d. Decreased renal output and edema formation

48. Which of the following symptoms would indicate that the treatment for a patient
with hypokalemia had been effective?
a. Patient’s heart rate is 70 beats/minute, and rhythm is regular.
b. Patient’s muscle tone and reflexes are hyporeactive.
c. Patient’s respiratory rate is 36 breaths/minute and shallow.
d. Patient’s urinary output is 100 mL/h or greater.

49. Which of the following questions would provide the most important data to support
the nurse’s concern that a patient was hyperkalemic?
a. Has the patient eaten large portions of red meat or fruit recently?
b. Does the patient have a sedentary lifestyle?
c. Has the patient experienced muscle cramps recently?
d. Does the patient smoke more than two packs of cigarettes daily?

50. Which of the following symptoms indicates a complication that is likely to occur
with prolonged acidosis?
a. Cardiac dysrhythmia owing to hypokalemia
b. Respiratory failure owing to workload on the lungs
c. Fluid overload owing to chloride reabsorption and intoxication
d. Renal calculi owing to hypercalcemia from protein release of Ca+

PREPARED BY:
_____________________________
ARCON S. ALVAR, RN
Instructor I